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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)
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author
organization
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type
Contribution to journal
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published
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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
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
2007-07-23 14:46:39
date last changed
2018-06-17 03:58:36
@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          = {http://dx.doi.org/},
  volume       = {55},
  year         = {2001},
}