Appropriate assessment of neighborhood effects on individual health: Integrating random and fixed effects in multilevel logistic regression
Appropriate assessment of neighborhood effects on individual health: Integrating random and fixed effects in multilevel logistic regression
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DOI：
10.1093/aje/kwi017
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发表时间：
2005-01-01
影响因子：
5
通讯作者：
Merlo, J
中科院分区：
文献类型：
--
作者：
Larsen, K;Merlo, J
逻辑回归模型常用于流行病学研究，产生比值比或相对风险解释。受线性正态模型理论的启发，逻辑回归模型已被扩展为通过引入随机效应来允许相关响应。然而，该模型没有继承正常模型的解释特征。在本文中，作者认为，现有的措施是不令人满意的（其中一些甚至是不适当的）时，从多层次逻辑回归分析的量化结果。作者提出了一种异质性指标，即中位比值比，它量化了聚类异质性，并有助于直接比较协变量效应和众所周知的比值比异质性程度。以有意义的方式量化聚类水平的协变量是多水平logistic回归中的一个挑战。为此，作者提出了一个比值比指标，区间比值比，考虑到这些困难。作者证明了这两个措施，通过调查社区之间的异质性和社区水平的协变量的影响，在两个例子-公共医生的访问和缺血性心脏病住院-使用1999年的数据，11,312名男子年龄在45-85岁的马尔莫，瑞典。
The logistic regression model is frequently used in epidemiologic studies, yielding odds ratio or relative risk interpretations. Inspired by the theory of linear normal models, the logistic regression model has been extended to allow for correlated responses by introducing random effects. However, the model does not inherit the interpretational features of the normal model. In this paper, the authors argue that the existing measures are unsatisfactory (and some of them are even improper) when quantifying results from multilevel logistic regression analyses. The authors suggest a measure of heterogeneity, the median odds ratio, that quantifies cluster heterogeneity and facilitates a direct comparison between covariate effects and the magnitude of heterogeneity in terms of well-known odds ratios. Quantifying cluster-level covariates in a meaningful way is a challenge in multilevel logistic regression. For this purpose, the authors propose an odds ratio measure, the interval odds ratio, that takes these difficulties into account. The authors demonstrate the two measures by investigating heterogeneity between neighborhoods and effects of neighborhood-level covariates in two examples-public physician visits and ischemic heart disease hospitalizations-using 1999 data on 11,312 men aged 45-85 years in Malmo, Sweden.