Bringing the individual back to small-area variation studies: A multilevel analysis of all-cause mortality in Andalusia, Spain
AbstractWe performed a multilevel analysis (including individuals, households, census tracts, municipalities and provinces) on a 10% sample (N=230,978) from the Longitudinal Database of the Andalusian Population (LDAP). We aimed to investigate place effects on 8-year individual mortality risk. Moreover, besides calculating association (yielding odds ratios, ORs) between area socio-economic circumstances and individual risk, we wanted to estimate variance and clustering using the variance partition coefficient (VPC). We explicitly proclaim the relevance of considering general contextual effects (i.e. the degree to which the context, as a whole, affects individual variance in mortality risk) under at least two circumstances. The first of these concerns the interpretation of specific contextual effects (i.e. the association between a particular area characteristic and individual risk) obtained from multilevel regression analyses. The second involves the interpretation of geographical variance obtained from classic ecological spatial analyses. The so-called “ecological fallacy” apart, the lack of individual-level information renders geographical variance unrelated to the total individual variation and, therefore, difficult to interpret. Finally, we stress the importance of considering the familial household in multilevel analyses. We observed an association between percentage of people with a low educational level in the census tract and individual mortality risk (OR, highest v. lowest quintile=1.14; 95% confidence interval, CI 1.08–1.20). However, only a minor proportion of the total individual variance in the probability of dying was at the municipality (M) and census tract (CT) levels (VPCM=0.2% and VPCCT=0.3%). Conversely, the household (H) level appeared much more relevant (VPCH=18.6%) than the administrative geographical areas. Without considering general contextual effects, both multilevel analyses of specific contextual effects and ecological studies of small-area variation may provide a misleading picture that overstates the role of administrative areas as contextual determinants of individual differences in mortality.
Download InfoIf you experience problems downloading a file, check if you have the proper application to view it first. In case of further problems read the IDEAS help page. Note that these files are not on the IDEAS site. Please be patient as the files may be large.
As the access to this document is restricted, you may want to look for a different version under "Related research" (further below) or search for a different version of it.
Bibliographic InfoArticle provided by Elsevier in its journal Social Science & Medicine.
Volume (Year): 75 (2012)
Issue (Month): 8 ()
Contact details of provider:
Web page: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description
Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.:
- Mineau, Geraldine P. & Smith, Ken R. & Bean, Lee L., 2002. "Historical trends of survival among widows and widowers," Social Science & Medicine, Elsevier, vol. 54(2), pages 245-254, January.
- Duncan, Craig & Jones, Kelvyn & Moon, Graham, 1998. "Context, composition and heterogeneity: Using multilevel models in health research," Social Science & Medicine, Elsevier, vol. 46(1), pages 97-117, January.
- Jones, Kelvyn & Moon, Graham & Clegg, Andrew, 1991. "Ecological and individual effects in childhood immunisation uptake: A multi-level approach," Social Science & Medicine, Elsevier, vol. 33(4), pages 501-508, January.
- Ohlsson, Henrik & Merlo, Juan, 2011. "Place effects for areas defined by administrative boundaries: A life course analysis of mortality and cause specific morbidity in Scania, Sweden," Social Science & Medicine, Elsevier, vol. 73(8), pages 1145-1151.
- Duncan, Craig & Jones, Kelvyn & Moon, Graham, 1996. "Health-related behaviour in context: A multilevel modelling approach," Social Science & Medicine, Elsevier, vol. 42(6), pages 817-830, March.
- Turrell, Gavin & Mengersen, Kerrie, 2000. "Socioeconomic status and infant mortality in Australia: a national study of small urban areas, 1985-89," Social Science & Medicine, Elsevier, vol. 50(9), pages 1209-1225, May.
- Bullen, Nina & Moon, Graham & Jones, Kelvyn, 1996. "Defining localities for health planning: A GIS approach," Social Science & Medicine, Elsevier, vol. 42(6), pages 801-816, March.
- W. J. Browne & S. V. Subramanian & K. Jones & H. Goldstein, 2005. "Variance partitioning in multilevel logistic models that exhibit overdispersion," Journal of the Royal Statistical Society Series A, Royal Statistical Society, vol. 168(3), pages 599-613.
- Duncan, Craig & Jones, Kelvyn & Moon, Graham, 1993. "Do places matter? A multi-level analysis of regional variations in health-related behaviour in Britain," Social Science & Medicine, Elsevier, vol. 37(6), pages 725-733, September.
- David J. Spiegelhalter & Nicola G. Best & Bradley P. Carlin & Angelika van der Linde, 2002. "Bayesian measures of model complexity and fit," Journal of the Royal Statistical Society Series B, Royal Statistical Society, vol. 64(4), pages 583-639.
- Duncan, Craig & Jones, Kelvyn & Moon, Graham, 1999. "Smoking and deprivation: are there neighbourhood effects?," Social Science & Medicine, Elsevier, vol. 48(4), pages 497-505, February.
- Macintyre, Sally & Ellaway, Anne & Cummins, Steven, 2002. "Place effects on health: how can we conceptualise, operationalise and measure them?," Social Science & Medicine, Elsevier, vol. 55(1), pages 125-139, July.
- Twigg, Liz & Moon, Graham & Jones, Kelvyn, 2000. "Predicting small-area health-related behaviour: a comparison of smoking and drinking indicators," Social Science & Medicine, Elsevier, vol. 50(7-8), pages 1109-1120, April.
- Cummins, Steven & Curtis, Sarah & Diez-Roux, Ana V. & Macintyre, Sally, 2007. "Understanding and representing 'place' in health research: A relational approach," Social Science & Medicine, Elsevier, vol. 65(9), pages 1825-1838, November.
- Castelli, Adriana & Jacobs, Rowena & Goddard, Maria & Smith, Peter C., 2013. "Health, policy and geography: Insights from a multi-level modelling approach," Social Science & Medicine, Elsevier, vol. 92(C), pages 61-73.
For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Zhang, Lei).
If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.
If references are entirely missing, you can add them using this form.
If the full references list an item that is present in RePEc, but the system did not link to it, you can help with this form.
If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your profile, as there may be some citations waiting for confirmation.
Please note that corrections may take a couple of weeks to filter through the various RePEc services.