A brief conceptual tutorial of multilevel analysis in social epidemiology:: using measures of clustering in multilevel logistic regression to investigate contextual phenomena
A brief conceptual tutorial of multilevel analysis in social epidemiology:: using measures of clustering in multilevel logistic regression to investigate contextual phenomena
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DOI：
10.1136/jech.2004.029454
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发表时间：
2006-04-01
影响因子：
6.3
通讯作者：
Larsen, K
中科院分区：
文献类型：
--
作者：
Merlo, J;Chaix, B;Larsen, K
研究目的：在社会流行病学中，计算和解释多水平线性回归中的变异度量是容易的，但在逻辑回归的情况下存在技术困难。本研究的目的是提出措施的变化适合于逻辑的情况下，在教学，而不是一个数学的方式。设计和参与者：数据来自2000年在瑞典斯堪尼亚县进行的健康调查，其中包括10 723人，年龄在18 - 80岁，生活在60个地区。进行多层次逻辑回归不同的技术被应用于调查是否个人倾向于咨询私人医生是统计依赖于居住地区（即组内相关（ICC）、中位比值比（莫尔）、80%区间比值比（IOR-80）和分类指数）。莫尔提供了更多的解释信息比ICC的相关性的住宅区了解个人倾向咨询私人医生。莫尔表明，地区之间的原因不明的异质性是更大的相关性比分析中考虑的个体变量（年龄，性别和教育），了解个人的倾向访问私人医生。居住在高等教育区增加了去看私人医生的可能性。然而，IOR表明，地区之间的无法解释的变化不允许明确区分低，高倾向地区与地区的教育水平。结论：Logistic回归分析的变异系数可作为量化居住环境对了解健康和健康相关行为差异的重要性的有效手段，在社会流行病学和公共卫生研究中值得推广。
Study objective: In social epidemiology, it is easy to compute and interpret measures of variation in multilevel linear regression, but technical difficulties exist in the case of logistic regression. The aim of this study was to present measures of variation appropriate for the logistic case in a didactic rather than a mathematical way.Design and participants: Data were used from the health survey conducted in 2000 in the county of Scania, Sweden, that comprised 10 723 persons aged 18 - 80 years living in 60 areas. Conducting multilevel logistic regression different techniques were applied to investigate whether the individual propensity to consult private physicians was statistically dependent on the area of residence ( that is, intraclass correlation (ICC), median odds ratio (MOR)), the 80% interval odds ratio (IOR-80), and the sorting out index).Results: The MOR provided more interpretable information than the ICC on the relevance of the residential area for understanding the individual propensity of consulting private physicians. The MOR showed that the unexplained heterogeneity between areas was of greater relevance than the individual variables considered in the analysis ( age, sex, and education) for understanding the individual propensity of visiting private physicians. Residing in a high education area increased the probability of visiting a private physician. However, the IOR showed that the unexplained variability between areas did not allow to clearly distinguishing low from high propensity areas with the area educational level. The sorting out index was equal to 82%.Conclusion: Measures of variation in logistic regression should be promoted in social epidemiological and public health research as efficient means of quantifying the importance of the context of residence for understanding disparities in health and health related behaviour.