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Does the state you live in make a difference? Multilevel analysis of self-rated health in the US


  • Subramanian, S. V.
  • Kawachi, Ichiro
  • Kennedy, Bruce P.


This paper investigates the different sources of variation between US states in self-rated health using multilevel statistical procedures. The different sources that are considered are based on individual- and state-level factors. Data for the analysis comes from the 1993-94 Behavioral Risk Factor Surveillance System and the 1986-90 General Social Surveys. Results show that individual-level factors (such as low income, being black, smoking) are strongly associated with self-rated poor health. Significant variation, however, remain between states after allowing for individual characteristics. Crucially, between-state variation in self-rated health is different for different income groups. State-level contextual effects are found for per-capita median-income and 'social capital'. While not strong, there seems to be a differential impact of state income-inequality on high-income groups, such that the affluent report better health from living in high inequality states. The paper substantiates the need to connect individual health to their macro socio-economic context. Importantly, it is argued that without adopting an explicitly multilevel approach, the debate on linkages between individual health and income-inequality/social capital cannot be adequately addressed.

Suggested Citation

  • Subramanian, S. V. & Kawachi, Ichiro & Kennedy, Bruce P., 2001. "Does the state you live in make a difference? Multilevel analysis of self-rated health in the US," Social Science & Medicine, Elsevier, vol. 53(1), pages 9-19, July.
  • Handle: RePEc:eee:socmed:v:53:y:2001:i:1:p:9-19

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