Effects of area deprivation on health risks and outcomes: a multilevel, cross-sectional, Australian population study

Adams, Robert; Howard, Natasha; Tucker, Graeme; Appleton, Sarah; Taylor, Anne; Chittleborough, Catherine R.; Gill, Tiffany K.; Ruffin, Richard E.; Wilson, David H.

doi:10.1007/s00038-009-7113-x

Cited by 65 publications

(80 citation statements)

References 41 publications

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“…However, there is evidence to support an association between neighborhood disadvantage and increased cardiovascular health risk. In an Australian study, 15 for example, arealevel deprivation was associated with obesity and smoking, although no statistically significant association was apparent with diabetes mellitus, at-risk alcohol use, physical activity, or CVD itself. At least 1 study of disease outcomes has reported an increased risk of stroke among whites ≥65 years of age in neighborhoods with the lowest compared with those in neighborhoods with the highest socioeconomic status 21 ; 2 independent ecological studies suggest associations between aspects of neighborhood disadvantage and the risk of stroke 20,22 ; and several studies have shown a link between neighborhood disadvantage and an increased risk of CVD, often independently of adult individual-level socioeconomic status.…”

Section: Discussionmentioning

confidence: 94%

“…13 Thus, adult neighborhood disadvantage may drive the link between childhood experiences and adult health, representing a pathway model. An important source of adversity experienced in adulthood is residence in a socioeconomically disadvantaged neighborhood, which has been shown to be associated with CVD risk factors or morbidities such as obesity, 14,15 ischemic heart disease, 16 myocardial infarction,…”

Section: Clinical Perspective On P 379mentioning

confidence: 99%

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Childhood Psychosocial Adversity and Adult Neighborhood Disadvantage as Predictors of Cardiovascular Disease

et al. 2015

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Section: Discussionmentioning

confidence: 94%

Section: Clinical Perspective On P 379mentioning

confidence: 99%

Childhood Psychosocial Adversity and Adult Neighborhood Disadvantage as Predictors of Cardiovascular Disease

et al. 2015

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“…Their prevalence is linked to deprivation 16 which was included as a confounding factor in the logistic regression model. While this would only partially eliminate their effect, differences in the prevalence of these characteristics between…”

Section: A C C E P T E D Accepted Manuscriptmentioning

confidence: 99%

Regional variation in use of immediate breast reconstruction after mastectomy for breast cancer in England

Jeevan

Cromwell

Browne

et al. 2010

European Journal of Surgical Oncology (EJSO)

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This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT Conclusions: There is substantial regional variation in immediate reconstruction use inEngland that is not explained by the characteristics of the local patient population. EnglishCancer Networks should act to reduce this variation. They should also examine why rates of reconstruction differ between particular patient groups.

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“…They used multilevel models. These types of models are also known as hierarchical models because of (1) the structure of the data (e. g. students clustered within schools) and (2) the hierarchy within the model with the parameters of the within-population regressions at the bottom, controlled by hyperparameters, the parameters of the upper-level models. In the first paper 2 , an Index of Relative Socio-Economic Disadvantage score (IRDS) was used as an indicator of local area disadvantage.…”

mentioning

confidence: 99%

Multilevel analysis of survey data

Oyen

2009

Int J Public Health

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EditorialUsing the 1930 census, W.S. Robinson 1 showed that although there was a positive correlation between the literacy rate in each of the 48 states in the US and the proportion of the population born outside the US, the correlation was negative when individuals were considered. The reason for this discrepancy was that immigrants tended to settle in states where the native population was more literate. Because of possible ecological fallacy-bias, epidemiologists and public health researcher have felt hesitant about deducing conclusions about individuals using ecological data or data population-level. However, individuals in a population are more than a simple sum of a set of loners. Individuals in a population are living within an ecosystem and there is a complex interaction between the health of the individual and the contextual factors of the environment as well as personal factors.In this issue of International Journal of Public Health, two papers are published, in which the authors combined in their analysis information of individuals with information available on populations. They used multilevel models. These types of models are also known as hierarchical models because of (1) the structure of the data (e. g. students clustered within schools) and (2) the hierarchy within the model with the parameters of the within-population regressions at the bottom, controlled by hyperparameters, the parameters of the upper-level models. In the first paper 2 , an Index of Relative Socio-Economic Disadvantage score (IRDS) was used as an indicator of local area disadvantage. The effect of this contextual measure on health-related quality of life (physical, mental health indicators) and lifestyle factors was estimated after accounting for individual socio-economic factors. The authors found independent associations between local area IRDS and health-related quality of life, obesity and smoking. After adjusting for individual socio-economic factors, no independent association was seen between local area IRDS and a cardiovascular risk index, chronic lung disease symptoms, leisure time physical activity and high risk alcohol use. In the second paper 3 , the potential influence of school environment, defined as the school level opportunity for physical activity, on the physical activity of nine-year old children was studied. It was examined if the association between school opportunity and leisure time physical activity was different by gender and BMI status. The authors found that the association between the physical activity frequency of the children and the schoollevel physical activity opportunity differs by gender and BMI and that overweight boys profit from a school policy and environment favoring physical activity.Survey data are often collected with an inherent multilevel structure (e. g. students within school, patients within hospital or data from cluster sampling, annual series of a survey). Based on such sampling design, a more traditional approach of data analysis in both studies would have considered the varyi...

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Effects of area deprivation on health risks and outcomes: a multilevel, cross-sectional, Australian population study

Abstract: Aggregated area-level characteristics make modest, but significant independent contributions to smoking, obesity and quality of life, but not for other health outcomes.

Cited by 65 publications

References 41 publications

Childhood Psychosocial Adversity and Adult Neighborhood Disadvantage as Predictors of Cardiovascular Disease

Childhood Psychosocial Adversity and Adult Neighborhood Disadvantage as Predictors of Cardiovascular Disease

Regional variation in use of immediate breast reconstruction after mastectomy for breast cancer in England

Multilevel analysis of survey data

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