29 research outputs found
Défis conceptuels et méthodologiques posés par la définition opérationnelle du milieu : l'exemple des milieux résidentiels favorables à la marche
Thèse numérisée par la Division de la gestion de documents et des archives de l'Université de Montréal
Neighbourhood built environments as correlates of hospital burden and premature mortality in Canada
Introduction
The built environment can shape modifiable risk factors such as obesity, poor diet, and physical inactivity, and could be a policy lever for the reduction of chronic disease. In Canada, the health care costs related to chronic disease continue to rise and there have been few policy options offered.
Objectives and Approach
We examine the role of the built environment in hospital burden and premature mortality, with an emphasis on one of the highest burden diseases, Type 2 Diabetes (T2D). Neighbourhood built environment measures for active living were derived using geographic information systems for respondents of the Canadian Community Health Survey, for whom we have linked hospitalization and mortality records. A combination of ICD codes, self-reported diabetes status, as well as a population-based algorithm identifying those at higher risk of developing diabetes were used to identify cases. Differences in hospitalization frequency, cumulative length of stay, and mortality are investigated.
Results
Over half a million hospitalization records were identified in our cohort of roughly 450,000 survey respondents. Key factors such as age, gender, race, and socioeconomic status are accounted for in modelling the association between neighborhood environment and hospitalization. Hospital burden and mortality in T2D patients are much higher than that of patients who do not report having the condition, and those at elevated risk of T2D display intermediate levels of hospitalization. Two-part hurdle models show evidence of an association between more walkable neighborhoods and lower hospitalization risk in non-T2D patients as well as those at elevated risk of developing T2D. The relationship between neighborhoods and the volume of chronic-disease related episodes as well as mortality is unclear, and under further investigation.
Conclusion/Implications
Elucidating the role of neighbourhood built environments on hospital burden and premature mortality for individuals with diabetes will provide insight as to the full range of clinical and non-clinical interventions that could feasibly address the needs of some the highest health care system users
Editorial
Ce numéro, organisé autour de trois mots-clefs familiers, n’a pas pour vocation de répondre aux lancinantes questions évoquées dans la presse ; le téléphone portable présente t-il un danger pour la santé des personnes utilisatrices ? Les populations voisines des centrales nucléaires doivent-elles craindre pour leur bien-être ?… Ces interrogations et bien d’autres, tout aussi compliquées à résoudre, nous rappellent que tout n’est pas sous contrôle et qu’il reste dans les sciences les plus dure..
Contribution de la géographie quantitative à l’étude des inégalités sociales de santé : Analyse des effets de milieu
Champ de recherche Ă l’interface de la gĂ©ographie et de l’épidĂ©miologie, l’analyse des effets du milieu sur la santĂ© a Ă©tĂ© l’objet, au cours des dernières annĂ©es, d’un intĂ©rĂŞt croissant. Les travaux dans ce domaine ont pour objectif l’étude des caractĂ©ristiques sociales et matĂ©rielles des milieux locaux comme facteurs de risque pour la santĂ©. Dans un premier temps, nous proposons un survol des principales explications quant aux mĂ©canismes par lesquels s’exercent les influences du milieu sur la santĂ©. Nous prĂ©sentons ensuite les aspects empiriques de la mesure des effets de milieu sur la santĂ©. En conclusion, nous identifions des enjeux pour la recherche.As a field of research integrating geography and epidemiology, the analysis of neighbourhood effects on health has received increasing attention in recent years. Our research focuses on the social and material characteristics of local milieux as risk factors for health. This paper first proposes an overview of the main factors explaining the mechanisms through which conditions in a given area might influence health. We then present the empirical indicators used for measuring area effects on health and, in conclusion, identify challenges and avenues for future research.Terreno de investigaciĂłn en la conjunciĂłn de la GeografĂa y la EpidemiologĂa, el análisis de los efectos del medio sobre la salud ha sido objeto de creciente interĂ©s en los Ăşltimos años. El objetivo de estos trabajos es el estudio de las caracterĂsticas sociales y materiales de los medios locales, en tanto que sean factores de riesgo para la salud. Primeramente, los autores del presente artĂculo proponen un panorama de los mecanismos principales del medio que influencian la salud. Luego, presentan los resultados empĂricos de la medida de los efectos del medio sobre la salud. Finalmente y en conclusiĂłn, identifican las contingencias para la investigaciĂłn