Adding interactions to models of intersectional health inequalities: Comparing multilevel and conventional methods

Evans, Clare R.

doi:10.1016/j.socscimed.2018.11.036

Cited by 51 publications

(68 citation statements)

References 22 publications

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“…Nowadays, there has been a growing interest in the application of the intersectionality scholarship to the investigation of health inequalities. Whereas intersectionality as a framework has gained prominence in qualitative research, suitable methodological strategies in quantitative research have only recently begun to emerge keeping pace with the theoretical advance 54–60. Two methodological approaches can be distinguished in the intersectional quantitative literature: the fixed effects approach and the Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA) approach 61.…”

Section: Modern Theoretical Approaches To Immigrant Healthmentioning

confidence: 99%

“…Two methodological approaches can be distinguished in the intersectional quantitative literature: the fixed effects approach and the Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA) approach 61. The conventional fixed effects model examines intersections either by accommodating the additive main effects of the social strata as well as all possible interaction terms59 or by using cross-classified categories representing intersections between social groups (eg, unemployed foreign-born women) 6263. This analytical strategy is particularly useful when the dimensions of identity are relatively few.…”

Section: Modern Theoretical Approaches To Immigrant Healthmentioning

confidence: 99%

“…However, as more categories of identity, position and social process are added to the analysis, the number of parameters grows geometrically since the model has to allow all possible combinations of first, second and higher order interaction terms. This inevitably gives rise to a number of methodological concerns regarding model fit and parsimony, reliability of estimates due to low statistical power in some intersectional strata, and the issue of interpretability of the parameters 59 60…”

Section: Modern Theoretical Approaches To Immigrant Healthmentioning

confidence: 99%

“…Most of the limitations associated with the fixed effects approach are effectively handled by a multilevel intersectional approach, termed as MAIHDA, which is a recent methodological innovation59 60 64 and is hailed as the ‘gold standard’ for investigating health inequalities at the intersection of multiple social dimensions 61. Multilevel modelling is typically used to account for clustering or similarity between individuals, a phenomenon induced by a shared context.…”

Section: Modern Theoretical Approaches To Immigrant Healthmentioning

confidence: 99%

“…While the characteristics such as gender, race, class and migration status are modelled as individual-level variables in the fixed effects or the classical multilevel approach, the same variables are explicitly modelled as the properties of the social context in the MAIHDA approach. The practical advantages of the MAIHDA model over the conventional model are that the former adjusts for sample sizes by default and assesses interaction effects, without having to fit any interaction terms, through an estimation of strata-level residuals 59 60…”

Section: Modern Theoretical Approaches To Immigrant Healthmentioning

confidence: 99%

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International migration and health: it is time to go beyond conventional theoretical frameworks

Hossin

2020

BMJ Glob Health

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The large-scale international migration in the 21st century has emerged as a major threat to the global health equity movement. Not only has the volume of migration substantially increased but also the patterns of migration have become more complex. This paper began by focusing on the drivers of international migration and how health inequalities are linked to migration. Situating migration within the broader structural contexts, the paper calls for using the unharnessed potential of the intersectionality framework to advance immigrant health research. Despite coming from poorer socioeconomic backgrounds and facing disparities in the host society, the immigrants are often paradoxically shown to be healthier than the native population, although this health advantage diminishes over time. Studies on immigrant health, however, are traditionally informed by the acculturation framework which holds the assimilation of unhealthy lifestyles primarily responsible for immigrant health deterioration, diverting the attention away from the structural factors. Although the alternative structural framework came up with the promise to explore the structural factors, it is criticised for an overwhelming focus on access to healthcare and inadequate attention to institutional and societal contexts. However, the heterogeneity of the immigrant population across multiple dimensions of vulnerability demands a novel approach that can bring to the fore both premigratory and postmigratory contextual factors and adequately capture the picture of immigrant health. The paper concludes by questioning the acculturation perspective and pushing the structural paradigm to embrace the intersectionality framework which has the potential to address a wide range of vulnerabilities that intersect to produce health inequalities among the immigrants.

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Section: Modern Theoretical Approaches To Immigrant Healthmentioning

confidence: 99%

Section: Modern Theoretical Approaches To Immigrant Healthmentioning

confidence: 99%

Section: Modern Theoretical Approaches To Immigrant Healthmentioning

confidence: 99%

Section: Modern Theoretical Approaches To Immigrant Healthmentioning

confidence: 99%

Section: Modern Theoretical Approaches To Immigrant Healthmentioning

confidence: 99%

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International migration and health: it is time to go beyond conventional theoretical frameworks

Hossin

2020

BMJ Glob Health

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Intersectional Prevalence of Suicide Ideation, Plan, and Attempt Based on Gender, Sexual Orientation, Race and Ethnicity, and Rurality

et al. 2023

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ImportanceSuicidal thoughts and behaviors (STBs) are major public health problems, and some social groups experience disproportionate STB burden. Studies assessing STB inequities for single identities (eg, gender or sexual orientation) cannot evaluate intersectional differences and do not reflect that the causes of inequities are due to structural-level (vs individual-level) processes.ObjectiveTo examine differences in STB prevalence at the intersection of gender, sexual orientation, race and ethnicity, and rurality.Design, Setting, and ParticipantsThis cross-sectional study used adult data from the 2015-2019 National Survey on Drug Use and Health (NSDUH), a population-based sample of noninstitutionalized US civilians. Data were analyzed from July 2022 to March 2023.Main Outcomes and MeasuresOutcomes included past-year suicide ideation, plan, and attempt, each assessed with a single question developed for the NSDUH. Intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) models were estimated, in which participants were nested within social strata defined by all combinations of gender, sexual orientation, race and ethnicity, and rurality; outcome prevalence estimates were obtained for each social stratum. Social strata were conceptualized as proxies for exposure to structural forms of discrimination that contribute to health advantages or disadvantages (eg, sexism, racism).ResultsThe analytic sample included 189 800 adults, of whom 46.5% were men; 53.5%, women; 4.8%, bisexual; 93.0%, heterosexual; 2.2%, lesbian or gay; 18.8%, Hispanic; 13.9%, non-Hispanic Black; and 67.2%, non-Hispanic White. A total of 44.6% were from large metropolitan counties; 35.5%, small metropolitan counties; and 19.9%, nonmetropolitan counties. There was a complex social patterning of STB prevalence that varied across social strata and was indicative of a disproportionate STB burden among multiply marginalized participants. Specifically, the highest estimated STB prevalence was observed among Hispanic (suicide ideation: 18.1%; 95% credible interval [CrI], 13.5%-24.3%) and non-Hispanic Black (suicide plan: 7.9% [95% CrI, 4.5%-12.1%]; suicide attempt: 3.3% [95% CrI, 1.4%-6.2%]) bisexual women in nonmetropolitan counties.Conclusions and RelevanceIn this cross-sectional study, intersectional exploratory analyses revealed that STB prevalence was highest among social strata including multiply marginalized individuals (eg, Hispanic and non-Hispanic Black bisexual women) residing in more rural counties. The findings suggest that considering and intervening in both individual-level (eg, psychiatric disorders) and structural-level (eg, structural discrimination) processes may enhance suicide prevention and equity efforts.

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Intersectional Inequalities and Individual Heterogeneity in Chronic Rheumatic Diseases: An Intersectional Multilevel Analysis

Kiadaliri

Englund

2021

Arthritis Care & Research

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Objective To examine how intersections of multiple sociodemographic variables explain the individual heterogeneity in risk of being diagnosed with any of following chronic rheumatic diseases (CRDs): osteoarthritis (OA), gout, rheumatoid arthritis (RA), or spondyloarthritis (SpA). Methods We identified individuals ages 40–65 years residing in Skåne, Sweden by December 31, 2013 and having done so from January 1, 2000 (n = 342,542). We used a Skåne health care register to identify those with a diagnosis of the CRD of interest between January 1, 2014 and December 31, 2015, with no previous such diagnosis during 2000–2013. We created 144 intersectional social strata (ISS) using categories of age, sex, education, income, civil status, and immigration. For individuals nested within ISS, we applied multilevel logistic regression models to estimate the variance partition coefficient (VPC) as a measure of discriminatory accuracy of the ISS and the predicted absolute risks and 95% credible intervals for each stratum. Results Overall, 3.5%, 0.5%, 0.2%, and 0.2% of the study population were diagnosed with OA, gout, RA, and SpA, respectively. The VPC ranged from 16.2% for gout to 0.5% for SpA. Sex explained the largest proportion of between‐strata variation in risk of RA, gout, and SpA, while age was the most important factor for OA. The most between‐strata differences in risk of these CRDs were due to the additive main effects. Conclusion Despite meaningful between‐strata inequalities in the risk of being diagnosed with CRDs (except SpA), there were substantial within‐strata heterogeneities that remain unexplained. There was limited evidence of intersectional interaction effects.

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Adding interactions to models of intersectional health inequalities: Comparing multilevel and conventional methods

Cited by 51 publications

References 22 publications

International migration and health: it is time to go beyond conventional theoretical frameworks

International migration and health: it is time to go beyond conventional theoretical frameworks

Intersectional Prevalence of Suicide Ideation, Plan, and Attempt Based on Gender, Sexual Orientation, Race and Ethnicity, and Rurality

Intersectional Inequalities and Individual Heterogeneity in Chronic Rheumatic Diseases: An Intersectional Multilevel Analysis

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