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

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  • 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.

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  • 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
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    2. 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.
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    4. 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.
    5. 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.
    6. 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.
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    8. 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.
    9. 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.
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