Country of birth, socioeconomic position, and healthcare expenditure: a multilevel analysis of Malmo, Sweden

Beckman, Anders; Merlo, Juan; Lynch, John; Gerdtham, Ulf G.; Lindström, Martin; Lithman, Thor

doi:10.1136/jech.58.2.145

Cited by 37 publications

(31 citation statements)

References 13 publications

(11 reference statements)

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“…However, multilevel modelling lends itself to a variety of other meanings of community and context including groups defined by cultural rather than by strict geographical administrative areas. 20 In this and two previous articles 12 13 we have presented a number of concepts that have not been commonly discussed in multilevel epidemiology despite their importance. Our essay contributes to an understanding of the connection between MLRA and social epidemiological concepts and of the relevance of these concepts for public health, with a special focus on the notion of contextual phenomenon.…”

Section: Standardised Neighbourhood Incomementioning

confidence: 94%

A brief conceptual tutorial on multilevel analysis in social epidemiology: interpreting neighbourhood differences and the effect of neighbourhood characteristics on individual health

Merlo

Chaix²,

Yang

et al. 2005

Journal of Epidemiology & Community Health

204

170

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Study objective: Using a conceptual rather than a mathematical approach, this article proposed a link between multilevel regression analysis (MLRA) and social epidemiological concepts. It has been previously explained that the concept of clustering of individual health status within neighbourhoods is useful for operationalising contextual phenomena in social epidemiology. It has been shown that MLRA permits investigating neighbourhood disparities in health without considering any particular neighbourhood characteristic but only information on the neighbourhood to which each person belongs. This article illustrates how to analyse cross level (neighbourhood-individual) interactions, how to investigate associations between neighbourhood characteristics and individual health, and how to use the concept of clustering when interpreting those associations and geographical differences in health. Design and participants: A MLRA was performed using hypothetical data pertaining to systolic blood pressure (SBP) from 25 000 subjects living in the 39 neighbourhoods of an imaginary city. Associations between individual characteristics (age, body mass index (BMI), use of antihypertensive drug, income) or neighbourhood characteristic (neighbourhood income) and SBP were analysed. Results: About 8% of the individual differences in SBP were located at the neighbourhood level. SBP disparities and clustering of individual SBP within neighbourhoods increased along individual BMI. Neighbourhood low income was associated with increased SBP over and above the effect of individual characteristics, and explained 22% of the neighbourhood differences in SBP among people of normal BMI. This neighbourhood income effect was more intense in overweight people. Conclusions: Measures of variance are relevant to understanding geographical and individual disparities in health, and complement the information conveyed by measures of association between neighbourhood characteristics and health.A n aspect of central importance in social epidemiology is that the health differences between people can partly be attributed to the areas in which they live.1-3 People with similar characteristics who live in different neighbourhoods may have different health statuses because of differing cultural, economic, political, historical, or geographical influences. In other words, different people may to some extent share similar health statuses because they share a common environment. 4 This contextual phenomenon expresses itself as the clustering of individual health status within neighbourhoods. [5][6][7] The presence of clustering is, in turn, the main reason for applying multilevel regression techniques. If the individual health status is correlated within neighbourhoods, analysis using common regression methods underestimates the standard errors for contextual effects and gives biased results. Multilevel regression analysis (MLRA) is a statistical methodology that provides information on how health disparities are distributed between the individual and the neighb...

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Section: Standardised Neighbourhood Incomementioning

confidence: 94%

A brief conceptual tutorial on multilevel analysis in social epidemiology: interpreting neighbourhood differences and the effect of neighbourhood characteristics on individual health

Merlo

Chaix²,

Yang

et al. 2005

Journal of Epidemiology & Community Health

204

170

View full text Add to dashboard Cite

show abstract

“…Indeed, poverty and not immigration may be the most important explanatory factor for observed differences in health and health care access. For example, in a Swedish study, income explains much of the differential in health care expenditure between immigrants and native born populations [47] • Illegal drugs and alcohol • Communicable diseases such as TB and HIV • Accidents, injuries and violence • Mental health • Perinatal and maternal mortality [3] However, several studies have found a relative 'mortality advantage' in relation to chronic disease among migrants, compared to non-migrants. For example, some immigrant groups experience lower CHD mortality than the general population, controlling for income and socioeconomic group [14][15][16][17].…”

Section: Data Collectionmentioning

confidence: 99%

A framework for analysing migrant health policies in Europe

Mladovsky

2009

Health Policy

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“…Whereas a number of collective bodies (eg neighbourhoods) are assumed to be exclusively delimited by geographical boundaries, other cultural or relational criteria (either alone or combined with geographical information) may be more appropriate for identifying collective bodies 18 30 31. In any case, if such a collective body exists, one might anticipate finding a correlation in the health of the individuals within it 10.…”

Section: A Measuring Variance To Evaluate the Boundaries Defining Comentioning

confidence: 99%

Individual and collective bodies: using measures of variance and association in contextual epidemiology

Merlo

Ohlsson

Lynch

et al. 2009

Journal of Epidemiology & Community Health

125

150

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Country of birth, socioeconomic position, and healthcare expenditure: a multilevel analysis of Malmo, Sweden

Cited by 37 publications

References 13 publications

A brief conceptual tutorial on multilevel analysis in social epidemiology: interpreting neighbourhood differences and the effect of neighbourhood characteristics on individual health

A brief conceptual tutorial on multilevel analysis in social epidemiology: interpreting neighbourhood differences and the effect of neighbourhood characteristics on individual health

A framework for analysing migrant health policies in Europe

Individual and collective bodies: using measures of variance and association in contextual epidemiology

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