A brief conceptual tutorial of multilevel analysis in social epidemiology: linking the statistical concept of clustering to the idea of contextual phenomenon

• Published in: Journal of epidemiology and community health (1979) Vol. 59; no. 6; pp. 443 - 449
• Main Authors: Merlo, Juan, Chaix, Basile, Yang, Min, Lynch, John, Råstam, Lennart
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd 01.06.2005; BMJ Publishing Group; BMJ; BMJ Publishing Group LTD; BMJ Group
• Subjects: Adult; Automatic classification; Biological and medical sciences; Blood pressure; Cluster Analysis; Community health; Confidence intervals; Correlations; Epidemiologic Methods; Epidemiology; Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi; Health Sciences; Health Status; Human relations; Humans; Hälsovetenskap; ICC; intraclass correlation; Life Sciences; Medical and Health Sciences; Medical sciences; Medicin och hälsovetenskap; Middle Aged; Miscellaneous; MLRA; Modeling; Models, Statistical; multilevel analysis; Multilevel models; multilevel regression analysis; Neighborhoods; neighbourhood health; Population; Public health; Public Health, Global Health, Social Medicine and Epidemiology; Public health. Hygiene; Public health. Hygiene-occupational medicine; Regression Analysis; Research Support, Non-U.S. Gov't; Residence Characteristics; Santé publique et épidémiologie; SBP; Sociology, Medical; Sociology, Medical - methods; Statistical variance; Suicides & suicide attempts; systolic blood pressure; Theory and Methods; variance partition coefficient; VPC; Concept; Context; Social environment; Medicine; Multilevel analysis; Neighbourhood; Social analysis; Regression analysis; Epidemiology; Social aspect; Public health
• ISSN: 0143-005X; 1470-2738; 1470-2738
• DOI: 10.1136/jech.2004.023473

Study objective: This didactical essay is directed to readers disposed to approach multilevel regression analysis (MLRA) in a more conceptual than mathematical way. However, it specifically develops an epidemiological vision on multilevel analysis with particular emphasis on measures of health variation (for example, intraclass correlation). Such measures have been underused in the literature as compared with more traditional measures of association (for example, regression coefficients) in the investigation of contextual determinants of health. A link is provided, which will be comprehensible to epidemiologists, between MLRA and social epidemiological concepts, particularly between the statistical idea of clustering and the concept of contextual phenomenon. Design and participants: The study uses an example based on hypothetical data on systolic blood pressure (SBP) from 25 000 people living in 39 neighbourhoods. As the focus is on the empty MLRA model, the study does not use any independent variable but focuses mainly on SBP variance between people and between neighbourhoods. Results: The intraclass correlation (ICC = 0.08) informed of an appreciable clustering of individual SBP within the neighbourhoods, showing that 8% of the total individual differences in SBP occurred at the neighbourhood level and might be attributable to contextual neighbourhood factors or to the different composition of neighbourhoods. Conclusions: The statistical idea of clustering emerges as appropriate for quantifying “contextual phenomena” that is of central relevance in social epidemiology. Both concepts convey that people from the same neighbourhood are more similar to each other than to people from different neighbourhoods with respect to the health outcome variable.