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Neighbourhood chronic stress and gender inequalities in hypertension among Canadian adults: a multilevel analysis
  1. Flora I Matheson1,2,
  2. Heather L White1,3,
  3. Rahim Moineddin4,5,
  4. James R Dunn1,6,
  5. Richard H Glazier1,2,3,4,5
  1. 1Centre for Research on Inner City Health, The Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
  2. 2Department of Public Health Sciences, University of Toronto, Ontario, Canada
  3. 3Department of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
  4. 4Department of Family and Community Medicine, University of Toronto, Ontario, Canada
  5. 5The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
  6. 6Department of Geography, University of Toronto, Ontario, Canada
  1. Correspondence to Heather L White, Department of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, 506-169 St. George Street, Toronto, ON 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-institutionalised 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 between 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, socioeconomic and lifestyle characteristics (OR 1.12, 95% CI 1.10 to 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 Although 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.

  • Cardiovascular diseases
  • gender
  • hypertension
  • residence characteristics
  • socioeconomic factors
  • deprivation
  • gender inequalities
  • multilevel modelling
  • social inequalities
  • urban health

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  • Funding This research was supported by the Social Sciences and Humanities Research Council of Canada [Standard Research Grant Number 410-2005-2306].

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the St. Michael's Hospital Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.