Diastolic blood pressure and area of residence: multilevel versus ecological analysis of social inequity
Merlo, Juan LU
; Östergren, Per-Olof
LU
; Hagberg, Oskar
LU
; Lindström, Martin
LU
; Lindgren, Anna
LU
; Melander, Arne
LU
; Råstam, Lennart
LU
and Berglund, Göran
LU
(2001)
In Journal of Epidemiology and Community Health
55(11).
p.791-798
- Abstract
- STUDY OBJECTIVES---To study geographical differences in diastolic blood pressure and the influence of the social environment (census percentage of people with low educational achievement) on individual diastolic blood pressure level, after controlling for individual age and educational achievement. To compare the results of multilevel and ecological analyses.
DESIGN---Cross sectional analysis performed by multilevel linear regression modelling, with women at the first level and urban areas at the second level, and by single level ecological regression using areas as the unit of analysis.
SETTING---Malmö, Sweden (population 250 000).
PARTICIPANTS---15 569 women aged 45 to 73, residing in 17 urban areas, who took... (More) - STUDY OBJECTIVES---To study geographical differences in diastolic blood pressure and the influence of the social environment (census percentage of people with low educational achievement) on individual diastolic blood pressure level, after controlling for individual age and educational achievement. To compare the results of multilevel and ecological analyses.
DESIGN---Cross sectional analysis performed by multilevel linear regression modelling, with women at the first level and urban areas at the second level, and by single level ecological regression using areas as the unit of analysis.
SETTING---Malmö, Sweden (population 250 000).
PARTICIPANTS---15 569 women aged 45 to 73, residing in 17 urban areas, who took part in the Malmö Diet and Cancer Study (1991-1996).
MAIN RESULTS---In the "fixed effects" multilevel analysis, low educational achievement at both individual (beta =1.093, SE=0.167) and area levels (beta =2.966, SE=1.250) were independently associated with blood pressure, although in the "random effects" multilevel analysis almost none of the total variability in blood pressure across persons was attributable to areas (intraclass correlation=0.3%). The ecological analysis also found an association between the area educational variable and mean diastolic blood pressure (beta =4.058, SE=1.345).
CONCLUSIONS---The small intraclass correlation found indicated very marginal geographical differences and almost no influence of the urban area on individual blood pressure. However, these slight differences were enough to detect an effect of the social environment on blood pressure. The ecological study overestimated the associations found in the "fixed" effects multilevel analysis, and neither distinguished individual from area levels nor provided information on the intraclass correlation. Ecological analyses are inadequate to evaluate geographical differences in health. (Less)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/131637
- author
- Merlo, Juan
LU
; Östergren, Per-Olof
LU
; Hagberg, Oskar
LU
; Lindström, Martin
LU
; Lindgren, Anna
LU
; Melander, Arne
LU
; Råstam, Lennart
LU
and Berglund, Göran
LU
- organization
- publishing date
- 2001
- type
- Contribution to journal
- publication status
- published
- subject
- in
- Journal of Epidemiology and Community Health
- volume
- 55
- issue
- 11
- pages
- 791 - 798
- publisher
- BMJ Publishing Group
- external identifiers
-
- wos:000171646700008
- scopus:0034781032
- ISSN
- 1470-2738
- DOI
- 10.1136/jech.55.11.791
- language
- English
- LU publication?
- yes
- id
- 6baa0332-e808-4c5d-a086-6fb35f2e70ad (old id 131637)
- alternative location
- http://jech.bmjjournals.com/cgi/content/abstract/55/11/791
- date added to LUP
- 2016-04-01 12:24:07
- date last changed
- 2022-02-26 06:33:17
@article{6baa0332-e808-4c5d-a086-6fb35f2e70ad,
abstract = {{STUDY OBJECTIVES---To study geographical differences in diastolic blood pressure and the influence of the social environment (census percentage of people with low educational achievement) on individual diastolic blood pressure level, after controlling for individual age and educational achievement. To compare the results of multilevel and ecological analyses.<br/><br>
DESIGN---Cross sectional analysis performed by multilevel linear regression modelling, with women at the first level and urban areas at the second level, and by single level ecological regression using areas as the unit of analysis.<br/><br>
SETTING---Malmö, Sweden (population 250 000).<br/><br>
PARTICIPANTS---15 569 women aged 45 to 73, residing in 17 urban areas, who took part in the Malmö Diet and Cancer Study (1991-1996).<br/><br>
MAIN RESULTS---In the "fixed effects" multilevel analysis, low educational achievement at both individual (beta =1.093, SE=0.167) and area levels (beta =2.966, SE=1.250) were independently associated with blood pressure, although in the "random effects" multilevel analysis almost none of the total variability in blood pressure across persons was attributable to areas (intraclass correlation=0.3%). The ecological analysis also found an association between the area educational variable and mean diastolic blood pressure (beta =4.058, SE=1.345).<br/><br>
CONCLUSIONS---The small intraclass correlation found indicated very marginal geographical differences and almost no influence of the urban area on individual blood pressure. However, these slight differences were enough to detect an effect of the social environment on blood pressure. The ecological study overestimated the associations found in the "fixed" effects multilevel analysis, and neither distinguished individual from area levels nor provided information on the intraclass correlation. Ecological analyses are inadequate to evaluate geographical differences in health.}},
author = {{Merlo, Juan and Östergren, Per-Olof and Hagberg, Oskar and Lindström, Martin and Lindgren, Anna and Melander, Arne and Råstam, Lennart and Berglund, Göran}},
issn = {{1470-2738}},
language = {{eng}},
number = {{11}},
pages = {{791--798}},
publisher = {{BMJ Publishing Group}},
series = {{Journal of Epidemiology and Community Health}},
title = {{Diastolic blood pressure and area of residence: multilevel versus ecological analysis of social inequity}},
url = {{https://lup.lub.lu.se/search/files/2908388/624239.pdf}},
doi = {{10.1136/jech.55.11.791}},
volume = {{55}},
year = {{2001}},
}