Context, composition and heterogeneity: Using multilevel models in health research

https://doi.org/10.1016/S0277-9536(97)00148-2Get rights and content

Abstract

This paper considers the use of multilevel models in health research. Attention focuses on the structure and potential of such models and particular consideration is given to their use in elucidating the importance of contextual effects in relation to individual level social and demographic factors in understanding health outcomes, health-related behaviour and health service performance. Four graphical typologies are used to outline the questions that multilevel models can address and the paper illustrates their potential by drawing on published examples in a number of different research areas.

References (75)

  • N.G. Best et al.

    Bayesian analysis of realistically complex models

    Journal of the Royal Statistical Society

    (1996)
  • M. Blaxter

    Health and Lifestyles

    (1990)
  • F.E.M. Braddon et al.

    Social and regional differences in food and alcohol consumption and their measurement in a national birth cohort

    Journal of Epidemiology and Community Health

    (1988)
  • M. Britton

    Geographical variation in mortality since 1920 for selected causes

  • A.S. Bryk et al.

    An Introduction to HLM: Computer Program and User's Guide

    (1988)
  • A.S. Bryk et al.

    Hierarchical Linear Models: Applications and Data Analysis Methods

    (1992)
  • N. Bullen et al.

    Modelling complexity: analyzing between-individual and between-place variation

    Environment and Planning

    (1997)
  • R. Carr-Hill et al.

    Allocating resources to health authorities: development of methods for small area analysis of use of inpatient services

    British Medical Journal

    (1994)
  • R. Carr-Hill et al.

    Socio-economic determinants of rates of consultations in general practice based on fourth national morbidity survey of general practices

    British Medical Journal

    (1996)
  • P. Congdon

    The impact of area context on long term illness and premature mortality: An illustration of multi-level analysis

    Regional Studies

    (1995)
  • B.D. Cox

    Health and Lifestyle Survey, 1984–1985

    (1988)
  • B.D. Cox et al.
  • R.O. Cummins et al.

    Smoking and drinking by middle-aged British men: effects of social class and town of residence

    British Medical Journal

    (1981)
  • J.A. Davies et al.

    A technique for analyzing the effects of group composition

    American Sociological Review

    (1961)
  • P. Davies et al.

    Rational prescribing and interpractitioner variation: a multilevel approach

    International Journal of Technology Assessment in Health Care

    (1995)
  • J. de Leeuw et al.

    Questioning multilevel models

    Journal of Educational and Behavioral Statistics

    (1995)
  • T. DiPrete et al.

    Multilevel models: methods and substance

    Annual Review of Sociology

    (1994)
  • D. Draper

    Inference and hierarchical modelling in the social sciences

    Journal of Educational and Behavioral Statistics

    (1995)
  • G.C. Dunbar et al.

    The changing pattern of alcohol consumption in England and Wales 1978–1985

    British Medical Journal

    (1987)
  • C. Duncan

    Health-related behaviour in context: a multilevel approach

    (1995)
  • C. Duncan et al.

    Psychiatric morbidity: A multilevel approach to regional variations in the UK

    Journal of Epidemiology and Community Health

    (1995)
  • C. Duncan et al.

    Blood pressure, age and gender

  • R. Ecob

    A multilevel modelling approach to examining the effects of area of residence on health and functioning

    Journal of the Royal Statistical Society

    (1996)
  • C. Gatsonis et al.

    Geographical variation of procedure utilisation: a hierarchical model approach

    Medical Care

    (1993)
  • W.R. Gilks et al.

    A language and program for complex Bayesian modelling

    The Statistician

    (1994)
  • H. Goldstein

    Multilevel modelling of survey data

    The Statistician

    (1991)
  • H. Goldstein

    Multilevel cross-classified models

    Sociological Methods and Research

    (1994)
  • Cited by (526)

    • Family, community, and the rural social mobility advantage

      2023, Research in Social Stratification and Mobility
    View all citing articles on Scopus
    View full text