IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v69y2009i11p1584-1591.html
   My bibliography  Save this article

Misspecification of the effect of race in fixed effects models of health inequalities

Author

Listed:
  • Scribner, Richard Allen
  • Theall, Katherine P.
  • Simonsen, Neal R.
  • Mason, Karen E.
  • Yu, Qingzhao

Abstract

The purpose of this study is to characterize the different results obtained when analyzing health inequalities data in which individuals are nested within their neighborhoods and a single level model is used to characterize risk rather than a multilevel model. The inability of single level models to characterize between neighborhood variance in risk may affect the level of risk attributed to black race if blacks are differentially distributed in high risk neighborhoods. The research replicates in Los Angeles an approach applied by a different group of researchers in Massachusetts (Subramanian, Chen, Rehkopf, Waterman, & Krieger, 2005). Single level and multilevel models were used to analyze Los Angeles County, California, US all-cause mortality data for the years 1989-1991, modeled as 29,936 cells (deaths and population denominators cross-tabulated by age, gender, and race/ethnicity) nested within 1552 census tracts. Overall blacks had 1.27 times the risk of mortality compared to whites. However, multilevel models demonstrated considerable between census tract variance in mortality for both blacks and whites which was partially explained by neighborhood poverty. Comparing the results of equivalent single level and multilevel models, the mortality odds ratio for blacks compared to the white reference group reversed itself, indicating greater risk for blacks in the single level model and lower risk in the multilevel model. Adding an area based socioeconomic measure (ABSM) to the single level model reduced but did not remove the discrepancy. Predictions of mortality risk for the interaction of race and age group demonstrate that all single level models exaggerated the mortality risk associated with black race. We conclude that characterizing health inequalities in mortality for blacks using single level models, which do not account for the cross level interaction created by the greater likelihood of black residence in neighborhoods where the risk of mortality is greater regardless of race, can exaggerate the risk of mortality attributable to the individual level effects of black race.

Suggested Citation

  • Scribner, Richard Allen & Theall, Katherine P. & Simonsen, Neal R. & Mason, Karen E. & Yu, Qingzhao, 2009. "Misspecification of the effect of race in fixed effects models of health inequalities," Social Science & Medicine, Elsevier, vol. 69(11), pages 1584-1591, December.
    • Handle: RePEc:eee:socmed:v:69:y:2009:i:11:p:1584-1591
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277-9536(09)00538-3
    Download Restriction: Full text for ScienceDirect subscribers only
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Mansfield, C.J. & Wilson, J.L. & Kobrinski, E.J. & Mitchell, J., 1999. "Premature mortality in the United States: The roles of geographic area, socioeconomic status, household type, and availability of medical care," American Journal of Public Health, American Public Health Association, vol. 89(6), pages 893-898.
    2. Subramanian, S.V. & Chen, J.T. & Rehkopf, D.H. & Waterman, P.D. & Krieger, N., 2005. "Erratum: Racial disparities in context: A multilevel analysis of neighborhood variations in poverty and excess mortality among Black populations in Massachusetts (American Journal of Public Health (20," American Journal of Public Health, American Public Health Association, vol. 95(3), pages 375-375.
    3. Corti, M.-C. & Guralnik, J.M. & Ferrucci, L. & Izmirlian, G. & Leveille, S.G. & Pahor, M. & Cohen, H.J. & Pieper, C. & Havlik, R.J., 1999. "Evidence for a Black-White crossover in all-cause and coronary heart disease mortality in an older population: The North Carolina EPESE," American Journal of Public Health, American Public Health Association, vol. 89(3), pages 308-314.
    4. Oakes, J. Michael, 2004. "The (mis)estimation of neighborhood effects: causal inference for a practicable social epidemiology," Social Science & Medicine, Elsevier, vol. 58(10), pages 1929-1952, May.
    5. Waitzman, N.J. & Smith, K.R., 1998. "Erratum: Phantom of the area: Poverty-area residence and mortality in the United States (American Journal of Public Health (1998) 88 (973-976))," American Journal of Public Health, American Public Health Association, vol. 88(7), pages 1122-1122.
    6. 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, July.
    7. Subramanian, S.V. & Chen, J.T. & Rehkopf, D.H. & Waterman, P.D. & Krieger, N., 2005. "Racial disparities in context: A multilevel analysis of neighborhood variations in poverty and excess mortality among black populations in Massachusetts," American Journal of Public Health, American Public Health Association, vol. 95(2), pages 260-265.
    8. Braveman, P.A. & Egerter, S.A. & Cubbin, C. & Marchi, K.S., 2004. "An approach to studying social disparities in health and health care," American Journal of Public Health, American Public Health Association, vol. 94(12), pages 2139-2148.
    9. Waitzman, N.J. & Smith, K.R., 1998. "Phantom of the area: Poverty-area residence and mortality in the United States," American Journal of Public Health, American Public Health Association, vol. 88(6), pages 973-976.
    10. S V Subramanian & Craig Duncan & Kelvyn Jones, 2001. "Multilevel Perspectives on Modeling Census Data," Environment and Planning A, , vol. 33(3), pages 399-417, March.
    11. Krieger, N. & Chen, J.T. & Waterman, P.D. & Rehkopf, D.H. & Subramanian, S.V., 2005. "Painting a truer picture of US socioeconomic and racial/ethnic health inequalities: The public health disparities geocoding project," American Journal of Public Health, American Public Health Association, vol. 95(2), pages 312-323.
    12. Krieger, N. & Chen, J.T. & Waterman, P.D. & Rehkopf, D.H. & Subramanian, S.V., 2003. "Race/Ethnicity, Gender, and Monitoring Socioeconomic Gradients in Health: Comparison of Area-Based Socioeconomic Measures - The Public Health Disparities Geocoding Project," American Journal of Public Health, American Public Health Association, vol. 93(10), pages 1655-1671.
    13. Lisa Berkman & Burton Singer & Kenneth Manton, 1989. "Black/White Differences in Health Status and Mortality Among the Elderly," Demography, Springer;Population Association of America (PAA), vol. 26(4), pages 661-678, November.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Dustin T. Duncan & Jared Aldstadt & John Whalen & Kellee White & Márcia C. Castro & David R. Williams, 2012. "Space, race, and poverty: Spatial inequalities in walkable neighborhood amenities?," Demographic Research, Max Planck Institute for Demographic Research, Rostock, Germany, vol. 26(17), pages 409-448.
    2. Votruba, Mark Edward & Kling, Jeffrey R., 2009. "Effects of neighborhood characteristics on the mortality of black male youth: Evidence from Gautreaux, Chicago," Social Science & Medicine, Elsevier, vol. 68(5), pages 814-823, March.
    3. van Hooijdonk, Carolien & Droomers, Mariël & van Loon, Jeanne A.M. & van der Lucht, Fons & Kunst, Anton E., 2007. "Exceptions to the rule: Healthy deprived areas and unhealthy wealthy areas," Social Science & Medicine, Elsevier, vol. 64(6), pages 1326-1342, March.
    4. Subramanian, S.V. & Elwert, Felix & Christakis, Nicholas, 2008. "Widowhood and mortality among the elderly: The modifying role of neighborhood concentration of widowed individuals," Social Science & Medicine, Elsevier, vol. 66(4), pages 873-884, February.
    5. Zick, Cathleen D. & Smith, Ken R. & Fan, Jessie X. & Brown, Barbara B. & Yamada, Ikuho & Kowaleski-Jones, Lori, 2009. "Running to the Store? The relationship between neighborhood environments and the risk of obesity," Social Science & Medicine, Elsevier, vol. 69(10), pages 1493-1500, November.
    6. Islam, M. Kamrul & Gerdtham, Ulf-G. & Gullberg, Bo & Lindström, Martin & Merlo, Juan, 2008. "Social capital externalities and mortality in Sweden," Economics & Human Biology, Elsevier, vol. 6(1), pages 19-42, March.
    7. Regidor, Enrique & Vallejo, Fernando & Reques, Laura & Cea, Lucía & Miqueleiz, Estrella & Barrio, Gregorio, 2015. "Area-level socioeconomic context, total mortality and cause-specific mortality in Spain: Heterogeneous findings depending on the level of geographic aggregation," Social Science & Medicine, Elsevier, vol. 141(C), pages 142-150.
    8. Andrew Fenelon, 2013. "An examination of black/white differences in the rate of age-related mortality increase," Demographic Research, Max Planck Institute for Demographic Research, Rostock, Germany, vol. 29(17), pages 441-472.
    9. Jacob, Brian A. & Ludwig, Jens & Miller, Douglas L., 2013. "The effects of housing and neighborhood conditions on child mortality," Journal of Health Economics, Elsevier, vol. 32(1), pages 195-206.
    10. Merlo, Juan & Ohlsson, Henrik & Chaix, Basile & Lichtenstein, Paul & Kawachi, Ichiro & Subramanian, S.V., 2013. "Revisiting causal neighborhood effects on individual ischemic heart disease risk: A quasi-experimental multilevel analysis among Swedish siblings," Social Science & Medicine, Elsevier, vol. 76(C), pages 39-46.
    11. Mamelund, Svenn-Erik, 2006. "A socially neutral disease? Individual social class, household wealth and mortality from Spanish influenza in two socially contrasting parishes in Kristiania 1918-19," Social Science & Medicine, Elsevier, vol. 62(4), pages 923-940, February.
    12. Do, D. Phuong & Finch, Brian Karl & Basurto-Davila, Ricardo & Bird, Chloe & Escarce, Jose & Lurie, Nicole, 2008. "Does place explain racial health disparities? Quantifying the contribution of residential context to the Black/white health gap in the United States," Social Science & Medicine, Elsevier, vol. 67(8), pages 1258-1268, October.
    13. Bjornstrom, Eileen E.S., 2011. "The neighborhood context of relative position, trust, and self-rated health," Social Science & Medicine, Elsevier, vol. 73(1), pages 42-49, July.
    14. Wen, Ming & Cagney, Kathleen A. & Christakis, Nicholas A., 2005. "Effect of specific aspects of community social environment on the mortality of Individuals diagnosed with serious illness," Social Science & Medicine, Elsevier, vol. 61(6), pages 1119-1134, September.
    15. Francois Beland & Steve Birch & Greg Stoddart, 1999. "Health and Individual and Community Characteristics: A Research Protocol," Social and Economic Dimensions of an Aging Population Research Papers 7, McMaster University.
    16. Justin T. Denney & Jarron M. Saint Onge & Jeff A. Dennis, 2018. "Neighborhood Concentrated Disadvantage and Adult Mortality: Insights for Racial and Ethnic Differences," Population Research and Policy Review, Springer;Southern Demographic Association (SDA), vol. 37(2), pages 301-321, April.
    17. Arcaya, Mariana C. & Tucker-Seeley, Reginald D. & Kim, Rockli & Schnake-Mahl, Alina & So, Marvin & Subramanian, S.V., 2016. "Research on neighborhood effects on health in the United States: A systematic review of study characteristics," Social Science & Medicine, Elsevier, vol. 168(C), pages 16-29.
    18. Seth Feinberg, 2009. "Preventable Mortality as a Predictor of Community Social Organisation: Examining Reverse Causality," Urban Studies, Urban Studies Journal Limited, vol. 46(9), pages 1829-1858, August.
    19. Michael Reibel, 2007. "Geographic Information Systems and Spatial Data Processing in Demography: a Review," Population Research and Policy Review, Springer;Southern Demographic Association (SDA), vol. 26(5), pages 601-618, December.
    20. Chiara Acquati & Tzuan A. Chen & Isabel Martinez Leal & Shahnjayla K. Connors & Arooba A. Haq & Anastasia Rogova & Stephanie Ramirez & Lorraine R. Reitzel & Lorna H. McNeill, 2021. "The Impact of the COVID-19 Pandemic on Cancer Care and Health-Related Quality of Life of Non-Hispanic Black/African American, Hispanic/Latina and Non-Hispanic White Women Diagnosed with Breast Cancer ," IJERPH, MDPI, vol. 18(24), pages 1-16, December.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:69:y:2009:i:11:p:1584-1591. See general information about how to correct material in RePEc.

    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 CitEc recognized a bibliographic reference but did not link an item in RePEc 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 RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.