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Neighbourhood chronic stress and gender inequalities in hypertension among Canadian adults: a multilevel analysis
  1. Flora I Matheson1,
  2. Heather L White2,*,
  3. Rahim Moineddin2,
  4. James R Dunn2,
  5. Richard H Glazier3
  1. 1 Centre for Research on Inner City Health, Canada;
  2. 2 University of Toronto, Canada;
  3. 3 Institute for Clinical Evaluative Sciences, Canada
  1. Correspondence to: Heather L White, Health Policy, Management and Evaluation, University of Toronto, 169 St. George Street, Apartment 506, Toronto, M5R 2M4, Canada; heatherlynn.white{at}


Background: A growing body of literature regarding the contextual influences of 'place' effects on health increasingly demonstrates that living in neighbourhoods with high levels of deprivation is associated with worse cardiovascular outcomes; however little research has explored whether neighbourhood deprivation has a differential impact on the cardiovascular health of men and women. The purpose of this study was to explore gender differences in the association between neighbourhood deprivation and the prevalence of hypertension among non-institutionalized Canadian adults.

Methods: Individual-level data from the Canadian Community Health Survey (2000-2005) were combined with area-level data from the 2001 Canada Census to assess the relationship among gender, neighbourhood deprivation and hypertension using multilevel regression.

Results: Of the 103 419 respondents, 20 705 reported having hypertension (17.6%). In multilevel models, neighbourhood deprivation was significantly associated with hypertension and this effect remained significant after adjusting for individual-level demographic, socio-economic and lifestyle characteristics (OR = 1.12; 95% CI: 1.10, 1.15). Neighbourhood deprivation appears to be a stronger predictor of hypertension among women such that women living in areas of high deprivation were 10% more likely to report having hypertension in comparison with men living in the same neighbourhoods and with women living in the least impoverished neighbourhoods.

Conclusions: While future research is needed to determine whether interventions at the area-level are effective in reducing inequalities in health outcomes across neighbourhoods, policies aimed at reducing area-level deprivation may have a differential benefit on the cardiovascular health of men and women.

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