Bringing the individual back to small-area variation studies: A multilevel analysis of all-cause mortality in Andalusia, Spain
We 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.
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|
|Order Information:|| Postal: http://www.elsevier.com/wps/find/supportfaq.cws_home/regional|
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.:
- Klaus Larsen & Jørgen Holm Petersen & Esben Budtz-Jørgensen & Lars Endahl, 2000. "Interpreting Parameters in the Logistic Regression Model with Random Effects," Biometrics, The International Biometric Society, vol. 56(3), pages 909-914, 09.
- 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, 1998. "Context, composition and heterogeneity: Using multilevel models in health research," Social Science & Medicine, Elsevier, vol. 46(1), pages 97-117, January.
- 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.
- 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, 1996. "Health-related behaviour in context: A multilevel modelling approach," Social Science & Medicine, Elsevier, vol. 42(6), pages 817-830, 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:75:y:2012:i:8:p:1477-1487. See general information about how to correct material in RePEc.
For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Dana Niculescu)
If references are entirely missing, you can add them using this form.