IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v75y2012i8p1477-1487.html
   My bibliography  Save this article

Bringing the individual back to small-area variation studies: A multilevel analysis of all-cause mortality in Andalusia, Spain

Author

Listed:
  • Merlo, Juan
  • Viciana-Fernández, Francisco J.
  • Ramiro-Fariñas, Diego

Abstract

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.

Suggested Citation

  • Merlo, Juan & Viciana-Fernández, Francisco J. & Ramiro-Fariñas, Diego, 2012. "Bringing the individual back to small-area variation studies: A multilevel analysis of all-cause mortality in Andalusia, Spain," Social Science & Medicine, Elsevier, vol. 75(8), pages 1477-1487.
    • Handle: RePEc:eee:socmed:v:75:y:2012:i:8:p:1477-1487
    DOI: 10.1016/j.socscimed.2012.06.004
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277953612004819
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.socscimed.2012.06.004?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    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. 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, September.
    2. 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.
    3. 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.
    4. 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.
    5. 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.
    6. 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.
    7. 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.
    8. 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.
    9. 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.
    10. 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, October.
    11. 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.
    12. 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.
    13. 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.
    14. 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.
    15. 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.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Shai Mulinari & Sol Pia Juárez & Philippe Wagner & Juan Merlo, 2015. "Does Maternal Country of Birth Matter for Understanding Offspring’s Birthweight? A Multilevel Analysis of Individual Heterogeneity in Sweden," PLOS ONE, Public Library of Science, vol. 10(5), pages 1-19, May.
    2. 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.
    3. Anna-Karin Ivert & Marie Torstensson Levander & Juan Merlo, 2013. "Adolescents' Utilisation of Psychiatric Care, Neighbourhoods and Neighbourhood Socioeconomic Deprivation: A Multilevel Analysis," PLOS ONE, Public Library of Science, vol. 8(11), pages 1-1, November.
    4. Juan Merlo & Philippe Wagner & Nermin Ghith & George Leckie, 2016. "An Original Stepwise Multilevel Logistic Regression Analysis of Discriminatory Accuracy: The Case of Neighbourhoods and Health," PLOS ONE, Public Library of Science, vol. 11(4), pages 1-31, April.
    5. Evans, Clare R. & Onnela, Jukka-Pekka & Williams, David R. & Subramanian, S.V., 2016. "Multiple contexts and adolescent body mass index: Schools, neighborhoods, and social networks," Social Science & Medicine, Elsevier, vol. 162(C), pages 21-31.
    6. Per E Gustafsson & Miguel San Sebastian, 2014. "When Does Hardship Matter for Health? Neighborhood and Individual Disadvantages and Functional Somatic Symptoms from Adolescence to Mid-Life in the Northern Swedish Cohort," PLOS ONE, Public Library of Science, vol. 9(6), pages 1-9, June.
    7. 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.
    8. Per E Gustafsson & Miguel San Sebastian & Urban Janlert & Töres Theorell & Hugo Westerlund & Anne Hammarström, 2013. "Residential Selection across the Life Course: Adolescent Contextual and Individual Determinants of Neighborhood Disadvantage in Mid-Adulthood," PLOS ONE, Public Library of Science, vol. 8(11), pages 1-11, November.
    9. Wemrell, Maria & Mulinari, Shai & Merlo, Juan, 2017. "Intersectionality and risk for ischemic heart disease in Sweden: Categorical and anti-categorical approaches," Social Science & Medicine, Elsevier, vol. 177(C), pages 213-222.
    10. 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.
    11. Low, Chien Tat & Lai, Poh Chin & Li, Han Dong & Ho, Wai Kit & Wong, Paulina & Chen, Si & Wong, Wing Cheung, 2016. "Neighbourhood effects on body constitution–A case study of Hong Kong," Social Science & Medicine, Elsevier, vol. 158(C), pages 61-74.

    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. Juan Merlo & Philippe Wagner & Nermin Ghith & George Leckie, 2016. "An Original Stepwise Multilevel Logistic Regression Analysis of Discriminatory Accuracy: The Case of Neighbourhoods and Health," PLOS ONE, Public Library of Science, vol. 11(4), pages 1-31, April.
    2. 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.
    3. Andrews, Gavin J. & Hall, Edward & Evans, Bethan & Colls, Rachel, 2012. "Moving beyond walkability: On the potential of health geography," Social Science & Medicine, Elsevier, vol. 75(11), pages 1925-1932.
    4. Mitchell, Richard & Dujardin, Claire & Popham, Frank & Farfan Portet, Maria-Isabel & Thomas, Isabelle & Lorant, Vincent, 2011. "Using matched areas to explore international differences in population health," Social Science & Medicine, Elsevier, vol. 73(8), pages 1113-1122.
    5. Frohlich, Katherine L. & Ross, Nancy & Richmond, Chantelle, 2006. "Health disparities in Canada today: Some evidence and a theoretical framework," Health Policy, Elsevier, vol. 79(2-3), pages 132-143, December.
    6. De Clercq, Bart & Pfoertner, Timo-Kolja & Elgar, Frank J. & Hublet, Anne & Maes, Lea, 2014. "Social capital and adolescent smoking in schools and communities: A cross-classified multilevel analysis," Social Science & Medicine, Elsevier, vol. 119(C), pages 81-87.
    7. Bécares, Laia & Nazroo, James & Albor, Christo & Chandola, Tarani & Stafford, Mai, 2012. "Examining the differential association between self-rated health and area deprivation among white British and ethnic minority people in England," Social Science & Medicine, Elsevier, vol. 74(4), pages 616-624.
    8. Petrović, Ana & Manley, David & van Ham, Maarten, 2018. "Freedom from the Tyranny of Neighbourhood: Rethinking Socio-Spatial Context Effects," IZA Discussion Papers 11416, Institute of Labor Economics (IZA).
    9. Santana, Paula & Santos, Rita & Nogueira, Helena, 2009. "The link between local environment and obesity: A multilevel analysis in the Lisbon Metropolitan Area, Portugal," Social Science & Medicine, Elsevier, vol. 68(4), pages 601-609, February.
    10. Etsuji Suzuki & Eiji Yamamoto & Soshi Takao & Ichiro Kawachi & S V Subramanian, 2012. "Clarifying the Use of Aggregated Exposures in Multilevel Models: Self-Included vs. Self-Excluded Measures," PLOS ONE, Public Library of Science, vol. 7(12), pages 1-9, December.
    11. Greves Grow, H. Mollie & Cook, Andrea J. & Arterburn, David E. & Saelens, Brian E. & Drewnowski, Adam & Lozano, Paula, 2010. "Child obesity associated with social disadvantage of children's neighborhoods," Social Science & Medicine, Elsevier, vol. 71(3), pages 584-591, August.
    12. Kelvyn Jones & Ron Johnston & David Manley & Dewi Owen & Chris Charlton, 2015. "Ethnic Residential Segregation: A Multilevel, Multigroup, Multiscale Approach Exemplified by London in 2011," Demography, Springer;Population Association of America (PAA), vol. 52(6), pages 1995-2019, December.
    13. Bernard, Paul & Charafeddine, Rana & Frohlich, Katherine L. & Daniel, Mark & Kestens, Yan & Potvin, Louise, 2007. "Health inequalities and place: A theoretical conception of neighbourhood," Social Science & Medicine, Elsevier, vol. 65(9), pages 1839-1852, November.
    14. Corsi, Daniel J. & Finlay, Jocelyn E. & Subramanian, S.V., 2012. "Weight of communities: A multilevel analysis of body mass index in 32,814 neighborhoods in 57 low- to middle-income countries (LMICs)," Social Science & Medicine, Elsevier, vol. 75(2), pages 311-322.
    15. Southwell, Brian G. & Slater, Jonathan S. & Rothman, Alexander J. & Friedenberg, Laura M. & Allison, Tiffany R. & Nelson, Christina L., 2010. "The availability of community ties predicts likelihood of peer referral for mammography: Geographic constraints on viral marketing," Social Science & Medicine, Elsevier, vol. 71(9), pages 1627-1635, November.
    16. Spielman, Seth E. & Yoo, Eun-hye, 2009. "The spatial dimensions of neighborhood effects," Social Science & Medicine, Elsevier, vol. 68(6), pages 1098-1105, March.
    17. Garthwaite, Kayleigh & Bambra, Clare, 2017. "“How the other half live”: Lay perspectives on health inequalities in an age of austerity," Social Science & Medicine, Elsevier, vol. 187(C), pages 268-275.
    18. Anna-Karin Ivert & Marie Torstensson Levander & Juan Merlo, 2013. "Adolescents' Utilisation of Psychiatric Care, Neighbourhoods and Neighbourhood Socioeconomic Deprivation: A Multilevel Analysis," PLOS ONE, Public Library of Science, vol. 8(11), pages 1-1, November.
    19. Kelvyn Jones & David Manley & Ron Johnston & Dewi Owen, 2018. "Modelling residential segregation as unevenness and clustering: A multilevel modelling approach incorporating spatial dependence and tackling the MAUP," Environment and Planning B, , vol. 45(6), pages 1122-1141, November.
    20. De Clercq, B. & Vyncke, V. & Hublet, A. & Elgar, F.J. & Ravens-Sieberer, U. & Currie, C. & Hooghe, M. & Ieven, A. & Maes, L., 2012. "Social capital and social inequality in adolescents’ health in 601 Flemish communities: A multilevel analysis," Social Science & Medicine, Elsevier, vol. 74(2), pages 202-210.

    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:75:y:2012:i:8:p:1477-1487. 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.