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How relevant are district characteristics in explaining subjective health in Germany? - A multilevel analysis

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  • Diehl, Katharina
  • Schneider, Sven

Abstract

This study was the first multilevel analysis to investigate the possible impact of macro-level factors on individual self-rated health over and above individual characteristics across Germany. This is especially interesting against the background of German history and the persistent disparity between Eastern and Western Germany. In this paper, the 439 German administrative districts, called Landkreise, provided the macro-level characteristics for this study. Altogether, 5516 individuals in 437 districts were included from data collected between 2005 and 2007. Our results show a significant association between the district unemployment rate and subjective health. The impact remains significant after adjusting for individual variables, including individual employment status. Furthermore, a significant association was found between subjective health and the degree of rurality, the proportion of elderly inhabitants and the proportion of foreigners. However, the variance of these was zero. In conclusion, our findings indicate an independent association between the unemployment rate of districts and individual self-rated health. Area mechanisms identified for other countries seem to exist in Germany, too, beyond the well-known differences between the Federal Republic of Germany and the German Democratic Republic that still influences individual health outcomes.

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  • Diehl, Katharina & Schneider, Sven, 2011. "How relevant are district characteristics in explaining subjective health in Germany? - A multilevel analysis," Social Science & Medicine, Elsevier, vol. 72(7), pages 1205-1210, April.
    • Handle: RePEc:eee:socmed:v:72:y:2011:i:7:p:1205-1210
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    References listed on IDEAS

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    1. Oliver Razum & Thomas Altenhöner & Jürgen Breckenkamp & Sven Voigtländer, 2008. "Social Epidemiology after the German Reunification: East vs. West or Poor vs. Rich?," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 53(1), pages 13-22, January.
    2. Jaffe, Dena H. & Eisenbach, Zvi & Neumark, Yehuda D. & Manor, Orly, 2005. "Individual, household and neighborhood socioeconomic status and mortality: a study of absolute and relative deprivation," Social Science & Medicine, Elsevier, vol. 60(5), pages 989-997, March.
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    5. Stafford, M. & Cummins, S. & Macintyre, S. & Ellaway, A. & Marmot, M., 2005. "Gender differences in the associations between health and neighbourhood environment," Social Science & Medicine, Elsevier, vol. 60(8), pages 1681-1692, April.
    6. Malmström, M. & Sundquist, J. & Johansson, S.-E., 1999. "Neighborhood environment and self-reported health status: A multilevel analysis," American Journal of Public Health, American Public Health Association, vol. 89(8), pages 1181-1186.
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    Cited by:

    1. Johanna Muckenhuber & Nathalie Burkert & Franziska Großschädl & Wolfgang Freidl, 2014. "Income Inequality as a Moderator of the Relationship between Psychological Job Demands and Sickness Absence, in Particular in Men: An International Comparison of 23 Countries," PLOS ONE, Public Library of Science, vol. 9(2), pages 1-6, February.
    2. Eibich, Peter & Ziebarth, Nicolas, 2014. "Examining the Structure of Spatial Health Effects in Germany Using Hierarchical Bayes Models," EconStor Open Access Articles and Book Chapters, ZBW - Leibniz Information Centre for Economics, vol. 49, pages 305-320.
    3. Eva Kibele, 2014. "Individual- and area-level effects on mortality risk in Germany, both East and West, among male Germans aged 65+," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 59(3), pages 439-448, June.
    4. Eva U. B. Kibele & Sebastian Klüsener & Rembrandt D. Scholz, 2014. "Regional mortality disparities in Germany: long-term dynamics and possible determinants," MPIDR Working Papers WP-2014-009, Max Planck Institute for Demographic Research, Rostock, Germany.

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