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Health Place. 2013 Nov;24:73-9. doi: 10.1016/j.healthplace.2013.07.007. Epub 2013 Aug 3.

Contextual determinants of cardiovascular diseases: overcoming the residential trap by accounting for non-residential context and duration of exposure.

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Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, 3rd Floor, Toronto, Ontario, Canada M5C 1N8. Electronic address:


Multilevel neighbourhood analyses rarely account for (1) non-residential exposures and (2) duration of exposure, which have the potential to improve contextual level variance explained, model fit and strength of associations. Using cross-classified logistic regressions, we evaluate the impact of socio-environmental factors at work and home on cardiovascular disease risk for 1626 adults in Toronto-Canada. In the fully-adjusted model, increased CVD risk was associated with poor food environments, lack of parks/recreational facilities, home and work proximity to a major road and noise, and working in a low-SES neighbourhood (p<0.05). Adjusting for exposure duration improved model fit and the strength of associations.


Cardiovascular disease; Health geography; Multilevel modeling; Neighbourhood effects; Social determinants of health

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