Proximate and contextual socioeconomic determinants of mortality: Multilevel approaches in a setting with universal health care coverage

P. J. Veugelers, A. M. Yip, G. Kephart

Research output: Contribution to journalArticlepeer-review

110 Citations (Scopus)

Abstract

Investigations of contextual factors (income inequality, cultural disruption, access to health and social services, safety and crime rate, and others) have received little emphasis by epidemiologists, although a few have demonstrated the importance of such factors for mortality, particularly in the United States. To expand current understanding of the importance of contextual factors, the authors evaluated mortality in a longitudinal study in Nova Scotia, Canada, where all residents have greater access to health and social services and where income inequalities are smaller than in the United States. A total of 2,116 participants were followed from 1990 through December 1999, linked to the 1991 Canada Census as a source of neighborhood characteristics, and analyzed using individual-level and multilevel logistic regression. Well-educated and high-earning persons fared better. Neighborhood socioeconomic characteristics (neighborhood income, educational level, unemployment rate), in contrast, were not significantly associated with mortality. However, within advantaged neighborhoods, the importance of individual income and education for mortality was increased relative to disadvantaged neighborhoods. The latter findings may direct health policy aimed at reducing health inequalities.

Original languageEnglish
Pages (from-to)725-732
Number of pages8
JournalAmerican Journal of Epidemiology
Volume154
Issue number8
DOIs
Publication statusPublished - Oct 15 2001

Bibliographical note

Funding Information:
This study was supported in part by grants R01-CA45614 and R03-CA89745 from the National Cancer Institute, National Institutes of Health.

ASJC Scopus Subject Areas

  • Epidemiology

PubMed: MeSH publication types

  • Journal Article
  • Research Support, Non-U.S. Gov't

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Veugelers, P. J., Yip, A. M., & Kephart, G. (2001). Proximate and contextual socioeconomic determinants of mortality: Multilevel approaches in a setting with universal health care coverage. American Journal of Epidemiology, 154(8), 725-732. https://doi.org/10.1093/aje/154.8.725