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Modeling the Cumulative Effects of Social Exposures on Health: Moving beyond Disease-Specific Models
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
Institute for Clinical Evaluative Sciences, Toronto, ON M4N 3M5, Canada
Centre for Research on Inner City Health, The Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON M5C 1N8, Canada
Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
Department of Population, Reproductive and Family Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
Department of Family and Community Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada
* Author to whom correspondence should be addressed.
Received: 6 February 2013; in revised form: 13 March 2013 / Accepted: 19 March 2013 / Published: 25 March 2013
Abstract: The traditional explanatory models used in epidemiology are “disease specific”, identifying risk factors for specific health conditions. Yet social exposures lead to a generalized, cumulative health impact which may not be specific to one illness. Disease-specific models may therefore misestimate social factors’ effects on health. Using data from the Canadian Community Health Survey and Canada 2001 Census we construct and compare “disease-specific” and “generalized health impact” (GHI) models to gauge the negative health effects of one social exposure: socioeconomic position (SEP). We use logistic and multinomial multilevel modeling with neighbourhood-level material deprivation, individual-level education and household income to compare and contrast the two approaches. In disease-specific models, the social determinants under study were each associated with the health conditions of interest. However, larger effect sizes were apparent when outcomes were modeled as compound health problems (0, 1, 2, or 3+ conditions) using the GHI approach. To more accurately estimate social exposures’ impacts on population health, researchers should consider a GHI framework.
Keywords: social determinants; socioeconomic position; multinomial regression; multilevel modeling; health inequities
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MDPI and ACS Style
White, H.L.; O'Campo, P.; Moineddin, R.; Matheson, F.I. Modeling the Cumulative Effects of Social Exposures on Health: Moving beyond Disease-Specific Models. Int. J. Environ. Res. Public Health 2013, 10, 1186-1201.
White HL, O'Campo P, Moineddin R, Matheson FI. Modeling the Cumulative Effects of Social Exposures on Health: Moving beyond Disease-Specific Models. International Journal of Environmental Research and Public Health. 2013; 10(4):1186-1201.
White, Heather L.; O'Campo, Patricia; Moineddin, Rahim; Matheson, Flora I. 2013. "Modeling the Cumulative Effects of Social Exposures on Health: Moving beyond Disease-Specific Models." Int. J. Environ. Res. Public Health 10, no. 4: 1186-1201.