Date of Award

6-2003

Degree Type

Thesis

Degree Name

Doctor of Philosophy (PhD)

Department

Geography

Supervisor

Dr. Susan J. Elliott

Abstract

This thesis aims to understand geographic variations in cardiovascular disease (CVD) mortality and morbidity in Ontario between 1986 and 1994. While cardiovascular disease is the leading cause of preventable mortality and morbidity in Canada and Ontario, a large proportion of the regional variations in the outcomes remain unexplained. Using the public health units in the Province as the units of analysis, the research addressed three specific objectives: 1) to describe the spatial and temporal variations in CVD mortality and morbidity in Ontario, 1986-1989 and 1990-1994; 2) to examine the prevalence and distribution of a broad range of potential CVD risk factors in Ontario; and, 3) to model geographic variations in CVD mortality and morbidity in Ontario. The data used come from a variety of sources, including the Canadian Institute of Health Information, the 1990 Ontario Health Survey, the 1991 census of Canada, the Child Care Services Division of the Ontario Ministry of Community and Social Service, Customs and Revenue Canada, and the Municipal Financial Returns of the Ontario Ministry of Municipal Affairs. Informed by the population health perspective, a socio-ecological conceptual model was developed to guide the research. It is composed of seven CVD risk constructs: economic characteristics, social capital, demographic characteristics, risk factor behaviours, psychosocial health and well-being, social support, and physiological characteristics. The research used GIS analytical techniques to examine the spatial patterns of CVD mortality and morbidity, which were largely concentrated in the northern part of the Province. Results also show that the prevalence of CVD risk factors varied markedly across the public health units with respect to age, sex, and level of education, type of public health unit, and the relative location of public health units in the province. The modelling results show that, overall, variables of the socio-economic and psychosocial environments played a far more significant role in explaining geographic variations in CVD outcomes than physiological variables and CVD risk factor behaviours. The implications of these findings are that strategies aimed at reducing the rate of cardiovascular disease mortality and morbidity in the Province need to place more emphasis on northern Ontario as well as focus more on such risk factors as the socioeconomic and psychosocial environments. This thesis has made a theoretical contribution by developing a conceptual model within the context of the population health perspective to guide the investigation of the underlying causes of geographic variations in cardiovascular disease outcomes. It has also made a methodological contribution by illustrating how GIS and spatial analytical techniques can be applied in identifying local clusters of elevated rates (or 'hot spots') of chronic disease outcomes. Substantively, this research has expanded the range of potential determinants of CVD outcomes in Ontario. It has also provided a basis for rethinking the emphasis on individual level, physiological and behavioural characteristics in CVD risk factor research and heart health programming.

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