Patrycja Kolpak
Exploring the Social and Spatial Factors for Chronic Diseases in Toronto and Chicago Neighbourhoods© 2014
Health research has demonstrated that living conditions, namely the social determinants of health, are relevant factors that can help explain disparities in chronic disease prevalence. These determinants also include the availability of health care resources. This study combines the social determinants of health framework with potential spatial accessibility models to determine whether potential spatial accessibility to primary care physicians (PCPs) and hospitals and social factors relate to, or predict, poor health outcomes, represented by diabetes, high blood pressure and stroke, among Toronto neighbourhood and Chicago community populations. The conventional health resource-to-population ratios and Two Step Floating Catchment Area (2SFCA) access scores to PCPs and hospitals revealed disparities between the downtown core and suburban fringes of both cities within 5 and 10km travel thresholds. However, the potential accessibility measures were not strongly correlated with the poor health measures. Statistical analyses showed that neighbourhoods and communities with high levels of poverty, unemployment, low education attainment (below bachelor degree) and certain ethnicities (South American and African) tended to be significantly positively correlated with prevalence rates of the poor health measures. The multivariate linear regression models revealed that low education (high school) and ethnicity were significant predictors for the variance in prevalence rates of the poor health measures. The findings were largely consistent with previous literature, reaffirming that social determinants of health explain the prevalence of poor health across neighbourhoods. This study also demonstrates ways to identify and quantify the relative importance of spatial and contextual factors with chronic conditions at the neighbourhood-level.