Send to:

Choose Destination
See comment in PubMed Commons below
Am J Epidemiol. 2001 Oct 15;154(8):725-32.

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

Author information

  • 1Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, 5849 University Avenue, Halifax, Nova Scotia, B3H 4H7 Canada.


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.

[PubMed - indexed for MEDLINE]
Free full text
PubMed Commons home

PubMed Commons

How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for HighWire
    Loading ...
    Write to the Help Desk