Lisa N. Oliver

Deprivation Indices, Population Health and Geography: An Evaluation of the Spatial Effectiveness of Indices at Multiple Scales

Area-based deprivation indices (ABDIs) have become a common tool with which to investigate the patterns and magnitude of socioeconomic inequalities in health. ABDIs are also used as a proxy for individual socioeconomic status. Despite their widespread use, comparably less attention has been focused on their geographic variability and practical concerns surrounding the Modifiable Area Unit Problem (MAUP) than on the individual attributes that make up the indices. Although scale is increasingly recognized as an important factor in interpreting mapped results among population health researchers, less attention has been paid specifically to ABDI and scale. In this paper, we highlight the effect of scale on indices by mapping ABDIs at multiple census scales in an urban area. In addition, we compare self-rated health data from the Canadian Community Health Survey with ABDIs at two census scales. The results of our analysis confirm the influence of spatial extent and scale on mapping population health—with potential implications for health policy implementation and resource distribution.

Neighbourhood quality and self-rated health : A survey of eight suburban neighbourhoods in the Vancouver Census Metropolitan Area

We investigated the relationship between perceptions of neighbourhood quality and self-rated health for residents of eight suburban neighbourhoods with modestly contrasting income profiles in the Vancouver Census Metropolitan Area. Survey respondents from lower income neighbourhoods more often rated their health as fair/poor, and perceived their neighbourhood to be of poor quality. The strongest predictors for fair/poor health status were employment status, body mass index, neighbourhood satisfaction, and age, while modest predictors were annual household income, neighbourhood median income profile, and perceptions of neighbourhood safety. The unique contribution of this study is its demonstration that social gradients in self-rated health are observable between neighbourhoods of even modestly contrasting income profiles.

Are Obesity and Physical Activity Clustered? A Spatial Analysis Linked to Residential Density

The aim of this study was to examine spatial clustering of obesity and/or moderate physical activity and their relationship to a neighborhoods built environment. Data on levels of obesity and moderate physical activity were derived from the results of a telephone survey conducted in 2006, with 1,863 survey respondents in the study sample. This sample was spread across eight suburban neighborhoods in Metro Vancouver. These areas were selected to contrast residential density and income and do not constitute a random sample, but within each area, respondents were selected randomly. Obesity and moderate physical activity were mapped to determine levels of global and local spatial autocorrelation within the neighborhoods. Clustering was measured using Morans I at the global level, Anselins Local Morans I at the local level, and geographically weighted regression (GWR). The global‐level spatial analysis reveals no significant clustering for the attributes of obesity or moderate physical activity. Within individual neighborhoods, there is moderate clustering of obesity and/or physical activity but these clusters do not achieve statistical significance. In some neighborhoods, local clustering is restricted to a single pair of respondents with moderate physical activity. In other neighborhoods, any moderate local clustering is offset by negative local spatial autocorrelation. Importantly, there is no evidence of significant clustering for the attribute of obesity at either the global or local level of analysis. The GWR analysis fails to improve significantly upon the global model—thus reinforcing the negative results. Overall, the study indicates that the relationship between the urban environment and obesity is not direct.

Do neighbourhoods influence the readiness to learn of kindergarten children in Vancouver? A multilevel analysis of neighbourhood effects

A growing body of literature has examined the effects of neighbourhood characteristics on child health and well-being and the mechanisms through which such effects may operate. Research investigating neighbourhood effects on children is based on the notion that individuals and families who live in a neighbourhood collectively create a social context that influences the developing child. In this paper we investigate the relationship between individual and neighbourhood socioeconomic characteristics and kindergarten childrens readiness to learn in Vancouver, Canada (n = 3736), using multilevel modeling techniques and 1996 census data for Vancouver neighbourhoods (n = 68). Findings suggest that although family-level characteristics carry the most weight in shaping childrens readiness to learn, neighbourhood-level factors are independently associated with early developmental outcomes, particularly physical health and well-being, language and cognitive development, and communications skills and general knowledge. The strongest neighbourhood characteristics associated with readiness to learn were median income and the percentage of single-parent families. Also important were the percentage of the population who had not moved in the previous five years and the percentage of the population whose mother tongue was non-English. The latter neighbourhood characteristic was an especially strong predictor of communication skills and general knowledge. The findings suggest that neighbourhood-based policies to improve physical health and well-being, language and cognitive development, and communications skills may also meet with some success.

Assessing the influence of the built environment on physical activity for utility and recreation in suburban metro Vancouver

BackgroundPhysical inactivity and associated co-morbidities such as obesity and cardiovascular disease are estimated to have large societal costs. There is increasing interest in examining the role of the built environment in shaping patterns of physical activity. However, few studies have: (1) simultaneously examined physical activity for leisure and utility; (2) selected study areas with a range of built environment characteristics; and (3) assessed the built environment using high-resolution land use data.MethodsData on individuals used for this study are from a survey of 1602 adults in selected sites across suburban Metro Vancouver. Four types of physical activity were assessed: walking to work/school, walking for errands, walking for leisure and moderate physical activity for exercise. The built environment was assessed by constructing one-kilometre road network buffers around each respondents postal code. Measures of the built environment include terciles of recreational and park land, residential land, institutional land, commercial land and land use mix.ResultsLogistic regression analyses showed that walking to work/school and moderate physical activity were not associated with any built environment measure. Living in areas with lower land use mix, lower commercial and lower recreational land increased the odds of low levels of walking for errands. Individuals living in the lower third of land use mix and institutional land were more likely to report low levels of walking for leisure.ConclusionsThese results suggest that walking for errands and leisure have a greater association with the built environment than other dimensions of physical activity.

Examining the effects of schools and neighbourhoods on the outcomes of Kindergarten children in Canada

The primary objective was to examine the influence of child/family, school, and neighbourhood on Kindergarten childrens outcomes. The sample consisted of 2743 children attending 181 Kindergarten classes from 272 neighbourhoods. Standardized measures were used to assess verbal (Peabody Picture Vocabulary Test-Revised), developmental (Who Am I?), and behavioural (Inattention to Task) outcomes. Social and emotional outcomes were assessed by teachers (Early Development Instrument) and hyperactivity, aggression, and anxiety by parent ratings. Analyses used cross-nested hierarchical linear models. Child/family, school and neighbourhood factors were important with child/family factors explaining the most variability. Boys and children from low income families were associated with poorer Who Am I? scores and higher behaviour problem ratings. Over and above these, school level differences explained more variability than did differences in neighbourhoods. Neighbourhoods characterized by low income and education were associated with poorer verbal and behavioural outcomes. The number of immigrants was associated with lower verbal, and higher aggression and anxiety scores, but also with higher developmental scores. The school environment, as compared to the neighbourhood, had a larger impact on Kindergarten childrens standardized, parent, and teacher reported outcomes over and above child/family factors. Neighbourhood features such as levels of income, education, and immigrants were also influential.

The Contribution of Neighbourhood Material and Social Deprivation to Survival: A 22-Year Follow-up of More than 500,000 Canadians

Background: 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. Methods: 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. Results: 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 (HRmales 1.37, 95% CI: 1.33–1.41; HRfemales 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 (HRmales 1.15, CI: 1.12–1.18; HRfemales 1.15, CI: 1.12–1.19). Mortality risk associated with material deprivation remained elevated in models that adjusted for individual factors (HRmales 1.20, CI: 1.17–1.24; HRfemales 1.16, CI: 1.13–1.20) and this was also the case for social deprivation (HRmales 1.12, CI: 1.09–1.15; HRfemales 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%. Conclusions: 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.

Evaluating potential spatial access to trauma center care by severely injured patients

Injuries are a major public health problem around the world. Previous research has suggested that providing prompt access to specialized trauma center care may greatly improve the health outcomes of trauma patients. In this paper, a geographic information system (GIS) method is used to examine potential spatial access to trauma centers by individuals who were either hospitalized or died as a result of a major trauma. Overall, it was determined that 68.5% of individuals who suffered from a major trauma lived within one hour travel time of a Level I or II trauma center. In addition, major traumas resulting in death were found to have poorer potential spatial access to trauma center care than those that were admitted to hospital.

The association between alcohol use and long-term care placement among older Canadians: a 14-year population-based study.

Studies have shown that moderate alcohol use confers protection against some of the dominant predictors of long-term care placement, including diminished cognitive functioning, physical disability, and injury. But little is known about the association between alcohol use and the likelihood of placement in long-term care facilities. A nationally representative sample of 5404 community-dwelling Canadians ages 50 years and older at baseline (1994/95) was obtained from the longitudinal National Population Health Survey. Alcohol use categories were developed based on the quantity and frequency of use in the 12 months before the interview. Cox proportional hazards models were used to estimate the association between alcohol use at baseline and subsequent placement in long-term care facilities after adjusting for covariates measured at baseline. During the 14-year follow-up period, 14% of lifetime abstainers, 10% of former drinkers, 7% of infrequent drinkers, 4% of moderate drinkers, and 3% of heavy drinkers were placed in long-term care facilities. Furthermore, the multivariate analysis revealed that abstainers, former drinkers, and infrequent drinkers were more than twice as likely to be placed in long-term care as moderate drinkers. Moderate drinking was protective against placement in long-term care facilities even after adjusting for an array of well-known confounders. The strong protective effect of moderate alcohol use on long-term care entry is likely due to a complex mix of physical, cognitive and psychosocial health factors.