A multilevel approach to modeling health inequalities at the intersection of multiple social identities
A multilevel approach to modeling health inequalities at the intersection of multiple social identities
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DOI：
10.1016/j.socscimed.2017.11.011
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发表时间：
2018-04-01
影响因子：
5.4
通讯作者：
Subramanian, S. V.
中科院分区：
文献类型：
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作者：
Evans, Clare R.;Williams, David R.;Subramanian, S. V.
基本原理：研究众多环环相扣的社会身份之间的相互作用和压迫和特权制度，塑造他们是健康不平等研究的核心。多层次模型是一种替代和新颖的方法来检查在多重社会身份的交叉点的健康不平等。这种方法提请注意内部和跨两个level.Method的总方差分割的异质性之间的交叉社会阶层：利用一个熟悉的经验的例子，从社会流行病学的身体质量指数在美国成年人（N = 32,788），我们比较应用多层次模型的传统的固定效应的方法来研究高维的相互作用。研究人员经常面临着需要探索身份和社会过程的许多相互作用。我们探讨了社会身份和地位性别，种族/民族，收入，教育和年龄共384个独特的交叉社会阶层的五个维度的相互作用。结果：我们发现，多层次的方法提供了传统模型的优势，包括更高的维度的可扩展性，调整社会阶层的样本量，模型简约，易于解释。结论：相当大的变化可归因于层内水平，表明这些交叉身份的低判别准确性和层内风险的高异质性，仍然无法解释。多层次模型是一个创新的和有价值的工具，用于评估健康不平等的交叉性。
Rationale: Examining interactions between numerous interlocking social identities and the systems of oppression and privilege that shape them is central to health inequalities research. Multilevel models are an alternative and novel approach to examining health inequalities at the intersection of multiple social identities. This approach draws attention to the heterogeneity within and between intersectional social strata by partitioning the total variance across two levels.Method: Utilizing a familiar empirical example from social epidemiology body mass index among U.S. adults (N = 32,788) we compare the application of multilevel models to the conventional fixed effects approach to studying high-dimension interactions. Researchers are often confronted with the need to explore numerous interactions of identities and social processes. We explore the interactions of five dimensions of social identity and position gender, race/ethnicity, income, education, and age for a total of 384 unique intersectional social strata.Results: We find that the multilevel approach provides advantages over conventional models, including scalability for higher dimensions, adjustment for sample size of social strata, model parsimony, and ease of interpretation.Conclusion: Considerable variation is attributable to the within-strata level, indicating the low discriminatory accuracy of these intersectional identities and the high within-strata heterogeneity of risk that remains unexplained. Multilevel modeling is an innovative and valuable tool for evaluating the intersectionality of health inequalities.