Estimating Health Outcomes and Determinants in Rural Ottawa: An Integration of Geographical and Statistical Techniques

Abstract

Many health geography studies, including the Ottawa Neighbourhood Study (ONS), have faced significant challenges uncovering local variation in patterns of community health in rural areas. This is due to the fact that sparsely populated rural areas make it difficult to define neighbourhoods that are representative of the social and resource utilization patterns of the individuals therein. Moreover, rural areas yield small samples from population-based regional health surveys and this leads to insufficient sample sizes for reliable estimation of health determinants and outcomes. In response to this issue this thesis combines geographical and statistical techniques which allow for the simulation of health variables within small areas and populations within rural Ottawa. This methodological approach combines the techniques of dasymetric mapping and statistical micro-simulation in an innovative way, which will allow health geography researchers to explore health determinants and health outcomes at small spatial scales in rural areas. Dasymetric mapping is used to generate a statistical population surface over Ottawa and then estimate socio-economic (SES) variables within small neighbourhood units within rural Ottawa. The estimated SES variables are then used as correlate variables to simulate health determinant and health outcome variables form the Canadian Community Health Survey (CCHS) using statistical micro-simulation. Through this methodology, simulations of specific health determinants and outcome can be investigated at small spatial scales within rural areas. Dasymetric mapping provided neighbourhood-level population estimates that were used to re-weight as set of SES variables that were correlates with those in the Canadian Community Health Survey (CCHS). These neighbourhood-level correlates allowed microsimulation and consequent spatial exploration of prevalence for smoking, binge drinking, obesity, self-rated mental health, and the presence of two or more chronic conditions. The methodology outlined in this paper, provides and innovative way of exploring health determinants and health outcomes in neighbourhoods for which population and health statistics are not traditionally collected at levels that would allow traditional statistical analyses of prevalence.