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Comparing social determinants of self-rated health across the United States and Canada

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  • Prus, Steven G.
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    A large body of research shows that social determinants of health have significant impact on the health of Canadians and Americans. Yet, very few studies have directly compared the extent to which social factors are associated with health in the two countries, in large part due to the historical lack of comparable cross-national data. This study examines differences in the effect of a wide-range of social determinants on self-rated health across the two populations using data explicitly designed to facilitate comparative health research--Joint Canada/United States Survey of Health. The results show that: 1) sociodemographic and socioeconomic factors have substantial effects on health in each country, though the size of the effects tends to differ--gender, nativity, and race are stronger predictors of health among Americans while the effects of age and marital status on health are much larger in Canada; the income gradient in health is steeper in Canada whereas the education gradient is steeper in the U.S.; 2) Socioeconomic status (SES) mediates or links sociodemographic variables with health in both countries--the observed associations between gender, race, age, and marital status and health are considerably weakened after adjusting for SES; 3) psychosocial, behavioural risk and health care access factors are very strong determinants of health in each country, however being severely/morbidly obese, a smoker, or having low life satisfaction has a stronger negative effect on the health of Americans, while being physically inactive or having unmet health care needs has a stronger effect among Canadians; and 4) risk and health care access factors together play a relatively minor role in linking social structural factors to health. Overall, the findings demonstrate the importance of social determinants of health in both countries, and that some determinants matter more in one country relative to the other.

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    File URL: http://www.sciencedirect.com/science/article/pii/S0277953611002474
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    Article provided by Elsevier in its journal Social Science & Medicine.

    Volume (Year): 73 (2011)
    Issue (Month): 1 (July)
    Pages: 50-59

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    Handle: RePEc:eee:socmed:v:73:y:2011:i:1:p:50-59
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    1. Karen M. Kobayashi & Steven Prus & Zhiqiu Lin, 2008. "Ethnic Differences in Health: Does Immigration Status Matter?," Social and Economic Dimensions of an Aging Population Research Papers 230, McMaster University.
    2. Siddiqi, Arjumand & Hertzman, Clyde, 2007. "Towards an epidemiological understanding of the effects of long-term institutional changes on population health: A case study of Canada versus the USA," Social Science & Medicine, Elsevier, vol. 64(3), pages 589-603, February.
    3. van Doorslaer, Eddy & Gerdtham, Ulf-G., 2003. "Does inequality in self-assessed health predict inequality in survival by income? Evidence from Swedish data," Social Science & Medicine, Elsevier, vol. 57(9), pages 1621-1629, November.
    4. Steven G. Prus & Rania Tfaily & Zhiqiu Lin, 2010. "Comparing Racial and Immigrant Health Status and Health Care Access in Later Life in Canada and the United States," Social and Economic Dimensions of an Aging Population Research Papers 280, McMaster University.
    5. Franks, Peter & Gold, Marthe R. & Fiscella, Kevin, 2003. "Sociodemographics, self-rated health, and mortality in the US," Social Science & Medicine, Elsevier, vol. 56(12), pages 2505-2514, June.
    6. Denton, Margaret & Walters, Vivienne, 1999. "Gender differences in structural and behavioral determinants of health: an analysis of the social production of health," Social Science & Medicine, Elsevier, vol. 48(9), pages 1221-1235, May.
    7. Kosteniuk, Julie G. & Dickinson, Harley D., 2003. "Tracing the social gradient in the health of Canadians: primary and secondary determinants," Social Science & Medicine, Elsevier, vol. 57(2), pages 263-276, July.
    8. Denton, Margaret & Prus, Steven & Walters, Vivienne, 2004. "Gender differences in health: a Canadian study of the psychosocial, structural and behavioural determinants of health," Social Science & Medicine, Elsevier, vol. 58(12), pages 2585-2600, June.
    9. Kaplan, Mark S. & Huguet, Nathalie & Feeny, David H. & McFarland, Bentson H., 2010. "Self-reported hypertension prevalence and income among older adults in Canada and the United States," Social Science & Medicine, Elsevier, vol. 70(6), pages 844-849, March.
    10. Siddiqi, Arjumand & Zuberi, Daniyal & Nguyen, Quynh C., 2009. "The role of health insurance in explaining immigrant versus non-immigrant disparities in access to health care: Comparing the United States to Canada," Social Science & Medicine, Elsevier, vol. 69(10), pages 1452-1459, November.
    11. Huguet, Nathalie & Kaplan, Mark S. & Feeny, David, 2008. "Socioeconomic status and health-related quality of life among elderly people: Results from the Joint Canada/United States Survey of Health," Social Science & Medicine, Elsevier, vol. 66(4), pages 803-810, February.
    12. Birch, Stephen & Jerrett, Mike & Eyles, John, 2000. "Heterogeneity in the determinants of health and illness: the example of socioeconomic status and smoking," Social Science & Medicine, Elsevier, vol. 51(2), pages 307-317, July.
    13. Lantz, Paula M. & Lynch, John W. & House, James S. & Lepkowski, James M. & Mero, Richard P. & Musick, Marc A. & Williams, David R., 2001. "Socioeconomic disparities in health change in a longitudinal study of US adults: the role of health-risk behaviors," Social Science & Medicine, Elsevier, vol. 53(1), pages 29-40, July.
    14. Sonja Lyubomirsky & Heidi Lepper, 1999. "A Measure of Subjective Happiness: Preliminary Reliability and Construct Validation," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 46(2), pages 137-155, February.
    15. Alberto Palloni & Elizabeth Arias, 2004. "Paradox lost: Explaining the hispanic adult mortality advantage," Demography, Springer;Population Association of America (PAA), vol. 41(3), pages 385-415, August.
    16. Dunlop, Sheryl & Coyte, Peter C. & McIsaac, Warren, 2000. "Socio-economic status and the utilisation of physicians' services: results from the Canadian National Population Health Survey," Social Science & Medicine, Elsevier, vol. 51(1), pages 123-133, July.
    17. Smith, Anthony M. A. & Shelley, Julia M. & Dennerstein, Lorraine, 1994. "Self-rated health: Biological continuum or social discontinuity?," Social Science & Medicine, Elsevier, vol. 39(1), pages 77-83, July.
    18. Baker, Michael & Fortin, Nicole, 2000. "The Gender Composition and Wages: Why is Canada Different from the United States?," Analytical Studies Branch Research Paper Series 2000140e, Statistics Canada, Analytical Studies Branch.
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