uu.seUppsala University Publications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
An Original Stepwise Multilevel Logistic Regression Analysis of Discriminatory Accuracy: The Case of Neighbourhoods and Health
Lund Univ, Fac Med, Unit Social Epidemiol, Malmo, Sweden..
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Lund Univ, Fac Med, Unit Social Epidemiol, Malmo, Sweden..
Lund Univ, Fac Med, Unit Social Epidemiol, Malmo, Sweden.;Bispebjerg Hosp, Res Unit Chron Condit, Copenhagen, Denmark..
Univ Bristol, Ctr Multilevel Modelling, Bristol, Avon, England..
2016 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 4, e0153778Article in journal (Refereed) Published
Resource type
Text
Abstract [en]

Background and Aim Many multilevel logistic regression analyses of "neighbourhood and health" focus on interpreting measures of associations (e.g., odds ratio, OR). In contrast, multilevel analysis of variance is rarely considered. We propose an original stepwise analytical approach that distinguishes between "specific" (measures of association) and "general" (measures of variance) contextual effects. Performing two empirical examples we illustrate the methodology, interpret the results and discuss the implications of this kind of analysis in public health. Methods We analyse 43,291 individuals residing in 218 neighbourhoods in the city of Malm, Sweden in 2006. We study two individual outcomes (psychotropic drug use and choice of private vs. public general practitioner, GP) for which the relative importance of neighbourhood as a source of individual variation differs substantially. In Step 1 of the analysis, we evaluate the OR and the area under the receiver operating characteristic (AUC) curve for individual-level covariates (i.e., age, sex and individual low income). In Step 2, we assess general contextual effects using the AUC. Finally, in Step 3 the OR for a specific neighbourhood characteristic (i.e., neighbourhood income) is interpreted jointly with the proportional change in variance (i.e., PCV) and the proportion of ORs in the opposite direction (POOR) statistics. Results For both outcomes, information on individual characteristics (Step 1) provide a low discriminatory accuracy (AUC = 0.616 for psychotropic drugs; = 0.600 for choosing a private GP). Accounting for neighbourhood of residence (Step 2) only improved the AUC for choosing a private GP (+0.295 units). High neighbourhood income (Step 3) was strongly associated to choosing a private GP (OR = 3.50) but the PCV was only 11% and the POOR 33%. Conclusion Applying an innovative stepwise multilevel analysis, we observed that, in Malmo, the neighbourhood context per se had a negligible influence on individual use of psychotropic drugs, but appears to strongly condition individual choice of a private GP. However, the latter was only modestly explained by the socioeconomic circumstances of the neighbourhoods. Our analyses are based on real data and provide useful information for understanding neighbourhood level influences in general and on individual use of psychotropic drugs and choice of GP in particular. However, our primary aim is to illustrate how to perform and interpret a multilevel analysis of individual heterogeneity in social epidemiology and public health. Our study shows that neighbourhood "effects" are not properly quantified by reporting differences between neighbourhood averages but rather by measuring the share of the individual heterogeneity that exists at the neighbourhood level.

Place, publisher, year, edition, pages
2016. Vol. 11, no 4, e0153778
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:uu:diva-297349DOI: 10.1371/journal.pone.0153778ISI: 000374976200036PubMedID: 27120054OAI: oai:DiVA.org:uu-297349DiVA: diva2:942002
Funder
Swedish Research Council, 2013-2484
Available from: 2016-06-23 Created: 2016-06-22 Last updated: 2017-11-28Bibliographically approved

Open Access in DiVA

fulltext(1859 kB)62 downloads
File information
File name FULLTEXT01.pdfFile size 1859 kBChecksum SHA-512
002468711af077c924a9db3bc85926c138dde0e102f16dd1f2537c5fc513a6c7f72bd553542caf98207d1e1cc700c6ccfd21bd3a2be9f328fd5019c593500662
Type fulltextMimetype application/pdf

Other links

Publisher's full textPubMed

Authority records BETA

Wagner, Philippe

Search in DiVA

By author/editor
Wagner, Philippe
By organisation
Centre for Clinical Research, County of Västmanland
In the same journal
PLoS ONE
Public Health, Global Health, Social Medicine and Epidemiology

Search outside of DiVA

GoogleGoogle Scholar
Total: 62 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

doi
pubmed
urn-nbn

Altmetric score

doi
pubmed
urn-nbn
Total: 192 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf