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Revisiting causal neighborhood effects on individual ischemic heart disease risk: A quasi-experimental multilevel analysis among Swedish siblings


  • Merlo, Juan
  • Ohlsson, Henrik
  • Chaix, Basile
  • Lichtenstein, Paul
  • Kawachi, Ichiro
  • Subramanian, S.V.


Neighborhood socioeconomic disadvantage is associated to increased individual risk of ischemic heart disease (IHD). However, the value of this association for causal inference is uncertain. Moreover, neighborhoods are often defined by available administrative boundaries without evaluating in which degree these boundaries embrace a relevant socio-geographical context that condition individual differences in IHD risk. Therefore, we performed an analysis of variance, and also compared the associations obtained by conventional multilevel analyses and by quasi-experimental family-based design that provides stronger evidence for causal inference. Linking the Swedish Multi-Generation Register to several other national registers, we analyzed 184,931 families embracing 415,540 full brothers 45–64 years old in 2004, and residing in 8408 small-area market statistics (SAMS) considered as “neighborhoods” in our study. We investigated the association between low neighborhood income (categorized in groups by deciles) and IHD risk in the next four years. We distinguished between family mean and intrafamilial-centered low neighborhood income, which allowed us to investigate both unrelated individuals from different families and full brothers within families. We applied multilevel logistic regression techniques to obtain odds ratios (OR), variance partition coefficients (VPC) and 95% credible intervals (CI). In unrelated individuals a decile unit increase of low neighborhood income increased individual IHD risk (OR = 1.04, 95% CI: 1.03–1.07). In the intrafamilial analysis this association was reduced (OR = 1.02, 95% CI: 1.02–1.04). Low neighborhood income seems associated with IHD risk in middle-aged men. However, despite the family-based design, we cannot exclude residual confounding by genetic and non-shared environmental factors. Besides, the low neighborhood level VPC = 1.5% suggest that the SAMS are a rather inappropriate construct of the socio-geographic context that conditions individual variance in IHD risk. In contrast the high family level VPC = 20.1% confirms the relevance of the family context for understanding IHD risk.

Suggested Citation

  • 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.
  • Handle: RePEc:eee:socmed:v:76:y:2013:i:c:p:39-46
    DOI: 10.1016/j.socscimed.2012.08.034

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    References listed on IDEAS

    1. 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.
    2. 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.
    3. 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.
    4. 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.
    5. 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.
    6. 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.
    7. 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.
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    Cited by:

    1. Madsen, Mia & Andersen, Per K. & Gerster, Mette & Andersen, Anne-Marie N. & Christensen, Kaare & Osler, Merete, 2014. "Are the educational differences in incidence of cardiovascular disease explained by underlying familial factors? A twin study," Social Science & Medicine, Elsevier, vol. 118(C), pages 182-190.
    2. Manley, David & van Ham, Maarten & Hedman, Lina, 2018. "Experienced and Inherited Disadvantage: A Longitudinal Study of Early Adulthood Neighbourhood Careers of Siblings," IZA Discussion Papers 11335, Institute for the Study of Labor (IZA).
    3. Hedman, Lina & Manley, David & van Ham, Maarten, 2017. "Sorting out Neighbourhood Effects Using Sibling Data," IZA Discussion Papers 11178, Institute for the Study of Labor (IZA).


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