Franzini L and Spears W (2003)Contributions of social context to
inequalities in years of life lost to heart disease in Texas, USA Social Science and Medicine 57:10 1847-1861
Abstract
Several recent articles have pointed to the effect of social context on
heart disease mortality after adjusting for individual level indicators.
This study investigates the contributions of individual socioeconomic
factors (sex, race, and education) and social context at the neighborhood
level (wealth, education, social capital, and racial/ethnic composition),
and the county level (social inequality, human and social capital,
economic and demographic characteristics) on premature cardiovascular
mortality. Death certificate information was obtained for all those who
died of heart disease in Texas, USA, in 1991. Deaths were geocoded to
obtain block-group, census tract, and county social context from the
census. Multilevel hierarchical models quantified the contributions of
individual characteristics and block-group, tract, and county social
context on years of potential life lost to heart disease. Cross-level
analyses investigated the interaction between individual and contextual
factors. Being female, having more education, and residing in areas with
higher median house value were associated with less premature mortality.
Although blacks and Hispanics lost more years of life to heart disease
than whites, blacks and Hispanics living in tracts with higher own
racial/ethnic group density lost fewer years of life than their peers
living in less homogenous tracts. At the county level, premature mortality
was negatively associated with social capital. The tract and county level
variances were statistically significant indicating the importance of
social context to premature heart disease mortality. Plausible mechanisms
through which these effects operate are explored. Social context at the
block-group, tract, and county level played an important role, though a
smaller role than individual factors, in explaining years of life lost to
heart disease.
See:
http://www.sciencedirect.com/science/article/B6VBF-485P5RC-1/1/55ed84c872852f632cdbb6052f281f07


Dr Alex Clark

4th Floor Clinical Sciences Building
Faculty of Nursing
University of Alberta
Edmonton, AB.
Canada T6G 2G3
Tel: (780) 492 8347
Fax: (780) 492 2551

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