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Commentary: the contingencies of income inequality and health: reflections on the Canadian Experience.

https://arctichealth.org/en/permalink/ahliterature180584
Source
Int J Epidemiol. 2004 Apr;33(2):318-9
Publication Type
Article
Date
Apr-2004
Author
Nancy A Ross
John Lynch
Author Affiliation
Department of Geography, McGill University, 805 Sherbrooke St West, Montreal QC, H3A 2K6, Canada. nancy.ross@mcgill.ca
Source
Int J Epidemiol. 2004 Apr;33(2):318-9
Date
Apr-2004
Language
English
Publication Type
Article
Keywords
Canada - epidemiology
Health status
Humans
Income - statistics & numerical data
Life expectancy
Risk factors
Socioeconomic Factors
Notes
Comment On: Int J Epidemiol. 2004 Apr;33(2):311-715082632
PubMed ID
15082633 View in PubMed
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Exploring the material basis for health: characteristics of parks in Montreal neighborhoods with contrasting health outcomes.

https://arctichealth.org/en/permalink/ahliterature168522
Source
Health Place. 2006 Dec;12(4):361-71
Publication Type
Article
Date
Dec-2006
Author
Stephanie E Coen
Nancy A Ross
Author Affiliation
Department of Geography, McGill University, 805 Sherbrooke St. West, Montréal, QC, Canada H3A 2K6.
Source
Health Place. 2006 Dec;12(4):361-71
Date
Dec-2006
Language
English
Publication Type
Article
Keywords
Humans
Public Health
Qualitative Research
Quebec
Recreation
Residence Characteristics
Abstract
The growing evidence of neighborhood influences on health points to the need for investigation of health-relevant features of local environments. This study examines one potentially health-enhancing neighborhood resource, urban parks, to test for systematic differences in material conditions between areas. Twenty-eight parks selected from six urban Montreal neighborhoods along a health status gradient are qualitatively assessed. While neighborhood parks showed a variety of feature quality ratings, those located in poor health areas displayed several pronounced material disadvantages, including concentration of physical incivilities, limited provision of facilities for physical exercise, and adjacency to industrial sites and multi-lane roads. Equalizing park quality between areas may be an important step for public health promotion.
PubMed ID
16814195 View in PubMed
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14-year diabetes incidence: the role of socio-economic status.

https://arctichealth.org/en/permalink/ahliterature139840
Source
Health Rep. 2010 Sep;21(3):19-28
Publication Type
Article
Date
Sep-2010
Author
Nancy A Ross
Heather Gilmour
Kaberi Dasgupta
Author Affiliation
Department of Geography, McGill University, Montreal, Quebec H3A 2K6, Canada. Nancy.Ross@mcgill.ca
Source
Health Rep. 2010 Sep;21(3):19-28
Date
Sep-2010
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Algorithms
Canada - epidemiology
Diabetes Mellitus, Type 2 - epidemiology
Family Characteristics
Female
Health Surveys
Humans
Incidence
Income
Interviews as Topic
Longitudinal Studies
Male
Pregnancy
Pregnancy in Diabetics - epidemiology
Proportional Hazards Models
Questionnaires
Socioeconomic Factors
Abstract
Diabetes prevalence is associated with low socioeconomic status (SES), but less is known about the relationship between SES and diabetes incidence.
Data from eight cycles of the National Population Health Survey (1994/1995 through 2008/2009) are used. A sample of 5,547 women and 6,786 men aged 18 or older who did not have diabetes in 1994/1995 was followed to determine if household income and educational attainment were associated with increased risk of diagnosis of or death from diabetes by 2008/2009. Three proportional hazards models were applied for income and for education--for men, for women and for both sexes combined. Independent variables were measured at baseline (1994/1995). Diabetes diagnosis was assessed by self-report of diagnosis by a health professional. Diabetes death was based on ICD-10 codes E10-E14.
Among people aged 18 or older in 1994/1995 who were free of diabetes, 7.2% of men and 6.3% of women had developed or died from the disease by 2008/2009. Lower-income women were more likely to develop type 2 diabetes than were those in high-income households. This association was attenuated, but not eliminated, by ethno-cultural background and obesity/overweight. Associations with lower educational attainment in unadjusted models were almost completely mediated by demographic and behavioural variables.
Social gradients in diabetes incidence cannot be explained entirely by demographic and behavioural variables.
PubMed ID
20973430 View in PubMed
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Psychological distress among immigrants and visible minorities in Canada: a contextual analysis.

https://arctichealth.org/en/permalink/ahliterature144338
Source
Int J Soc Psychiatry. 2011 Jul;57(4):428-41
Publication Type
Article
Date
Jul-2011
Author
Mai Stafford
Bruce K Newbold
Nancy A Ross
Author Affiliation
Department of Epidemiology and Public Health, UCL, London, UK. m.stafford@ucl.ac.uk
Source
Int J Soc Psychiatry. 2011 Jul;57(4):428-41
Date
Jul-2011
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Canada - epidemiology
Child
Depression - epidemiology
Emigrants and Immigrants - psychology
Female
Health Surveys
Humans
Male
Middle Aged
Odds Ratio
Social Class
Stress, Psychological - epidemiology
Young Adult
Abstract
Immigrants to Canada are less likely to report depression compared with the non-immigrant population. This healthy migrant effect has not so far been explained by demographic and socioeconomic determinants of health.
The present study examined whether the psychological health advantage of immigrants varied across Canadian health regions and investigated the hypothesis of immigrant density as a determinant of immigrant mental health advantage.
Data from the 2000-2001 Canadian Community Health Survey were used to build multi-level models estimating variation in depression within and between health regions by immigrant/visible minority status.
Immigrant and visible minority residents were less likely to experience depression compared with the general population. Depression varied across health regions and the extent of variation was greater for visible minorities. The likelihood of depression decreased with increasing percentage of immigrants in the region among visible minority participants but not among whites.
The protection against depression afforded by immigrant and visible minority status in Canada appears to depend on contextual factors, notably the percentage of immigrants in the region. Future work should seek to better characterize the experiences of visible minorities in different settings.
PubMed ID
20378661 View in PubMed
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Neighbourhood influences on health in Montréal, Canada.

https://arctichealth.org/en/permalink/ahliterature179248
Source
Soc Sci Med. 2004 Oct;59(7):1485-94
Publication Type
Article
Date
Oct-2004
Author
Nancy A Ross
S Stéphane Tremblay
Katie Graham
Author Affiliation
Department of Geography, McGill University, 805 Sherbrooke St. West, Montréal, Que., H3A 2K6, Canada. nancy.ross@mcgill.ca
Source
Soc Sci Med. 2004 Oct;59(7):1485-94
Date
Oct-2004
Language
English
Publication Type
Article
Keywords
Adult
Female
Geographic Information Systems
Health status
Health Surveys
Humans
Male
Middle Aged
Quebec - epidemiology
Residence Characteristics
Socioeconomic Factors
Urban Population
Abstract
This paper examines neighbourhood effects on health within a large Canadian city--Montréal. Our approach is to consider that individual health outcomes are determined both by individual and neighbourhood characteristics and we consciously take on the problem of neighbourhood definition by developing 'natural' neighbourhoods. Our data come from the Montréal health region sample of the 2000/1 Canadian Community Health Survey, a comprehensive national survey that contains information on health outcomes as well as behavioural and socio-demographic information. Respondents were placed into 'naturally' defined neighbourhoods as opposed to arbitrary geostatistical units, responding to calls in the literature to develop more meaningful units of analysis. We also compare the 'natural' neighbourhood approach with the use of standard census tracts as the unit of analysis. Results show significant between-neighbourhood variation in health status with about 3% of the variance in the Health Utilities Index captured at the neighbourhood level, even after controlling for a variety of socio-demographic and behavioural variables at the individual level. Models using census tracts as the unit of analysis had remarkably similar results to the 'natural' neighbourhood models, suggesting that census tracts are good proxies for natural neighbourhood boundaries in studies of neighbourhood effects on health.
PubMed ID
15246176 View in PubMed
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Unpacking income inequality and population health: the peculiar absence of geography.

https://arctichealth.org/en/permalink/ahliterature160082
Source
Can J Public Health. 2007 Jul-Aug;98 Suppl 1:S10-7
Publication Type
Article
Author
James R Dunn
Peter Schaub
Nancy A Ross
Author Affiliation
Centre for Research on Inner City Health, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada. jim.dunn@utoronto.ca
Source
Can J Public Health. 2007 Jul-Aug;98 Suppl 1:S10-7
Language
English
Publication Type
Article
Keywords
Canada
Geography
Health Services Accessibility
Health status
Health Status Disparities
Humans
Mortality - trends
Population Surveillance
Social Class
Social Justice
Socioeconomic Factors
United States
Abstract
A large and growing body of literature investigating the negative relationship between income inequality and population health (at different geographic scales) has developed over the past several years, although the relationship is not universal apparently. We argue that there has been a peculiar absence of geography in studies of the relationship between income inequality and population health and that explanations for the mixed results have been hampered by an inattention to geography.
Using methods of spatial pattern visualization, outlier analysis and comparative case study analysis, we investigate the role of "geography" as a means of "unpacking" the relationship between income inequality and health in Canada and the United States.
The findings demonstrate how analyzing the study of income inequality and population health in the context of place makes otherwise obscure patterns visible and opens up new questions and opportunities for investigating how unequal places may be less healthy than more egalitarian ones. Rather than dismissing the importance of income inequality and health because it does not appear to exist at all times and in all places, we raise questions such as: Under what conditions does the relationship between income inequality and population health hold? and What, if anything, is similar about places where it does (or does not) hold? as crucial questions requiring a different kind of analysis than has been common in this literature.
We recommend that place and health studies seek this balance between universalistic and particularistic explanations of place and health relationships in order to best understand the socio-geographic production of health.
PubMed ID
18047156 View in PubMed
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Mitigating effect of immigration on the relation between income inequality and mortality: a prospective study of 2 million Canadians.

https://arctichealth.org/en/permalink/ahliterature135744
Source
J Epidemiol Community Health. 2012 Jun;66(6):e5
Publication Type
Article
Date
Jun-2012
Author
Nathalie Auger
Denis Hamel
Jérôme Martinez
Nancy A Ross
Author Affiliation
Institut National de Santé Publique du Québec, Montréal, Canada, USA. nathalie.auger@inspq.qc.ca
Source
J Epidemiol Community Health. 2012 Jun;66(6):e5
Date
Jun-2012
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Canada - epidemiology
Emigration and Immigration
Female
Health Status Disparities
Humans
Male
Middle Aged
Mortality, Premature - ethnology - trends
Prospective Studies
Social Class
Abstract
The relation between income inequality and mortality in Canada is unclear, and modifying effects of characteristics such as immigration have not been examined.
Using a cohort of 2 million Canadians followed for mortality from 1991-2001, we calculated HRs and 95% CIs for income inequality of 140 urban areas (Gini coefficient, Atkinson index, coefficient of variation; expressed as continuous variables) and working age (25-64 y) or post-working age (=65 y) mortality in men and women according to immigration status, accounting for individual and neighbourhood income, and sociodemographic characteristics. Major causes of mortality were examined.
Relative to low income inequality, high inequality was associated with greater working age mortality in male (HR(Gini) 1.08, 95% CI 1.04 to 1.13) and female (HR(Gini) 1.12, 95% CI 1.06 to 1.18) non-immigrants for all income inequality indictors. Results were similar for female post-working age mortality. There was no relation between income inequality and mortality in immigrants. Among Canadian-born individuals, associations were greater for alcohol-related mortality (both sexes) and smoking-related causes/transport injuries (women).
Income inequality is associated with mortality in Canadian-born individuals but not immigrants.
PubMed ID
21450759 View in PubMed
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The contribution of neighbourhood material and social deprivation to survival: a 22-year follow-up of more than 500,000 Canadians.

https://arctichealth.org/en/permalink/ahliterature115042
Source
Int J Environ Res Public Health. 2013 Apr;10(4):1378-91
Publication Type
Article
Date
Apr-2013
Author
Nancy A Ross
Lisa N Oliver
Paul J Villeneuve
Author Affiliation
Department of Geography, McGill University, 805 Sherbrooke St. West, Montreal, QC H3A 2K6, Canada. Nancy.Ross@Mcgill.ca
Source
Int J Environ Res Public Health. 2013 Apr;10(4):1378-91
Date
Apr-2013
Language
English
Publication Type
Article
Keywords
Adult
Canada
Cohort Studies
Female
Humans
Income
Longevity - physiology
Male
Marital Status - statistics & numerical data
Poverty - statistics & numerical data
Residence Characteristics - statistics & numerical data
Risk factors
Socioeconomic Factors
Abstract
We examined the incremental influence on survival of neighbourhood material and social deprivation while accounting for individual level socioeconomic status in a large population-based cohort of Canadians.
More than 500,000 adults were followed for 22 years between 1982 and 2004. Tax records provided information on sex, income, marital status and postal code while a linkage was used to determine vital status. Cox models were used to estimate hazard ratios (HR) for quintiles of neighbourhood material and social deprivation.
There were 180,000 deaths over the follow-up period. In unadjusted analyses, those living in the most materially deprived neighbourhoods had elevated risks of mortality (HR(males) 1.37, 95% CI: 1.33-1.41; HR(females) 1.20, 95% CI: 1.16-1.24) when compared with those living in the least deprived neighbourhoods. Mortality risk was also elevated for those living in socially deprived neighbourhoods (HR(males) 1.15, CI: 1.12-1.18; HR(females) 1.15, CI: 1.12-1.19). Mortality risk associated with material deprivation remained elevated in models that adjusted for individual factors (HR(males) 1.20, CI: 1.17-1.24; HR(females) 1.16, CI: 1.13-1.20) and this was also the case for social deprivation (HR(males) 1.12, CI: 1.09-1.15; HR(females) 1.09, CI: 1.05-1.12). Immigrant neighbourhoods were protective of mortality risk for both sexes. Being poor and living in the most socially advantageous neighbourhoods translated into a survival gap of 10% over those in the most socially deprived neighbourhoods. The gap for material neighbourhood deprivation was 7%.
Living in socially and materially deprived Canadian neighbourhoods was associated with elevated mortality risk while we noted a "healthy immigrant neighbourhood effect". For those with low family incomes, living in socially and materially deprived areas negatively affected survival beyond their individual circumstances.
Notes
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PubMed ID
23549228 View in PubMed
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Double burden of deprivation and high concentrations of ambient air pollution at the neighbourhood scale in Montreal, Canada.

https://arctichealth.org/en/permalink/ahliterature149290
Source
Soc Sci Med. 2009 Sep;69(6):971-81
Publication Type
Article
Date
Sep-2009
Author
Dan L Crouse
Nancy A Ross
Mark S Goldberg
Author Affiliation
McGill University, Montreal, Quebec, Canada. daniel.crouse@mail.mcgill.ca
Source
Soc Sci Med. 2009 Sep;69(6):971-81
Date
Sep-2009
Language
English
Publication Type
Article
Keywords
Air Pollutants - analysis
Air Pollution - analysis
Confidence Intervals
Environmental Exposure
Environmental monitoring
Geographic Information Systems
Health Status Disparities
Humans
Multivariate Analysis
Nitrogen Dioxide - analysis
Quebec
Regression Analysis
Residence Characteristics
Socioeconomic Factors
Urban health
Urban Population - statistics & numerical data
Abstract
Some neighbourhoods in urban areas are characterised by concentrations of socially and materially deprived populations. Additionally, levels of ambient air pollution in a city can be variable at the local scale and can create disparities in air quality between neighbourhoods. Socioeconomic and physical characteristics of neighbourhood environments can affect the health and well-being of local residents. In this paper we identify whether neighbourhoods in Montreal, Canada characterised by social and material deprivation have higher levels of ambient air pollution than do others. We collected two-week integrated samples of nitrogen dioxide (NO(2)) at 133 sites in Montreal during three seasons between 2005 and 2006. We used these data in a geographic information system, along with data describing characteristics of land use, roads, and traffic, to create a spatial model of predicted mean annual concentrations of NO(2) across Montreal. Next, we collected neighbourhood socioeconomic information for 501 census tracts and overlaid their boundaries on the pollution surface. We calculated Pearson correlation coefficients and 95% confidence intervals (CI) between neighbourhood-level indicators of deprivation and levels of ambient NO(2). We found associations between concentrations of NO(2) and neighbourhood-level indicators of material deprivation, including median household income, and with indicators of social deprivation, including proportion of people living alone. We identified specific neighbourhoods that were characterised by a double burden of high levels of deprivation and high concentrations of ambient NO(2). Because of the particular social geography in Montreal, we found that not all deprived neighbourhoods had high levels of pollution and that some affluent neighbourhoods in the downtown core had high levels. Our results underscore the importance of considering social contexts in interpreting general associations between social and environmental risks to population health.
PubMed ID
19656603 View in PubMed
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Neighborhood walkability: field validation of geographic information system measures.

https://arctichealth.org/en/permalink/ahliterature113803
Source
Am J Prev Med. 2013 Jun;44(6):e51-5
Publication Type
Article
Date
Jun-2013
Author
Samantha Hajna
Kaberi Dasgupta
Max Halparin
Nancy A Ross
Author Affiliation
Department of Epidemiology, Biostatistics and Occupational Health, McGill University Health Centre, McGill University, Montréal, Quebec, Canada.
Source
Am J Prev Med. 2013 Jun;44(6):e51-5
Date
Jun-2013
Language
English
Publication Type
Article
Keywords
Confidence Intervals
Environment Design
Geographic Information Systems - standards
Humans
Quebec
Questionnaires
Residence Characteristics
Urban Population
Walking
Abstract
Given the health benefits of walking, there is interest in understanding how physical environments favor walking. Although GIS-derived measures of land-use mix, street connectivity, and residential density are commonly combined into indices to assess how conducive neighborhoods are to walking, field validation of these measures is limited.
To assess the relationship between audit- and GIS-derived measures of overall neighborhood walkability and between objective (audit- and GIS-derived) and participant-reported measures of walkability.
Walkability assessments were conducted in 2009. Street-level audits were conducted using a modified version of the Pedestrian Environmental Data Scan. GIS analyses were used to derive land-use mix, street connectivity, and residential density. Participant perceptions were assessed using a self-administered questionnaire. Audit, GIS, and participant-reported indices of walkability were calculated. Spearman correlation coefficients were used to assess the relationships between measures. All analyses were conducted in 2012.
The correlation between audit- and GIS-derived measures of overall walkability was high (R=0.7 [95% CI=0.6, 0.8]); the correlations between objective (audit and GIS-derived) and participant-reported measures were low (R=0.2 [95% CI=0.06, 0.3]; R=0.2 [95% CI=0.04, 0.3], respectively). For comparable audit and participant-reported items, correlations were higher for items that appeared more objective (e.g., sidewalk presence, R=0.4 [95% CI=0.3, 0.5], versus safety, R=0.1 [95% CI=0.003, 0.3]).
The GIS-derived measure of walkability correlated well with the in-field audit, suggesting that it is reasonable to use GIS-derived measures in place of more labor-intensive audits. Interestingly, neither audit- nor GIS-derived measures correlated well with participants' perceptions of walkability.
PubMed ID
23683990 View in PubMed
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23 records – page 1 of 3.