ReviewJournal of epidemiology and community health2005
A brief conceptual tutorial of multilevel analysis in social epidemiology: linking the statistical concept of clustering to the idea of contextual phenomenon.
Review in Journal of epidemiology and community health, 2005. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 353 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
353 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Frequency of nurse-provided spiritual care: An international comparison.Journal of clinical nursing · 2023Pooled it
- Effectiveness of checklist-based box system intervention (CBBSI) versus routine care on improving utilization of antenatal care visits in Northwest Ethiopia: a cluster randomized controlled trial.BMC health services research · 2022Trial
- A Nutrition-Sensitive Agroecology Intervention in Rural Tanzania Increases Children's Dietary Diversity and Household Food Security But Does Not Change Child Anthropometry: Results from a Cluster-Randomized Trial.The Journal of nutrition · 2021Trial
- Individual-, household- and community-level determinants of infant mortality in Ethiopia.PloS one · 2021Trial
- Testing a physical education-delivered autonomy supportive intervention to promote leisure-time physical activity in lower secondary school students: the PETALS trial.BMC public health · 2020Trial
- Inequalities in maternal health service utilisation in Somalia: analysis of the 2020 Somali health and demographic survey.Global health action · 2026Article
- Understanding Differences in Resident Loneliness/Isolation Across US Nursing Homes: A Multilevel Analysis of MDS 3.0 Data.Journal of the American Medical Directors Association · 2026Article
- Multilevel analysis of noncommunicable diseases and associated factors among Ethiopian adults: evidence from the 2024 STEPS survey.Tropical medicine and health · 2026Article
- Caregiver-reported experience of integrated care for children with special health care needs and its sociodemographic, health- and network-related correlates in Germany: Cross-sectional results from the PART-CHILD cohort.BMC health services research · 2026Article
- Prevalence, spatial distribution, and determinants of anemia among under-five children in the Democratic Republic of Congo: evidence from the 2023-24 DHS.International journal of health geographics · 2026Article
- Article
- From Averages to Heterogeneity: A Plain-Language Guide to MAIHDA in Epidemiology.International journal of social determinants of health and health services · 2026Review
- Multilevel modified Poisson regression analysis of barriers to healthcare access among pregnant women in high and very high maternal mortality sub-Saharan African countries: insights from demographic and health surveys data.Archives of public health = Archives belges de sante publique · 2026Article
- Article
- Overweight/obesity clustering and wealth differentials among indigenous households in Eastern India.Scientific reports · 2026Article
- Determinants of food safety practices among Ethiopian households: a multilevel mixed effects linear regression analysis.Scientific reports · 2026Article
- Comparison of Laparoscopic and Hand-assisted Live Donor Nephrectomy: An Analysis of NSQIP Transplant.Transplantation direct · 2026Article
- The usual and preferred sources of healthcare for Aboriginal and Torres Strait Islander Australians: a multilevel analysis.BMC health services research · 2026Article
- Prevalence of Delayed Breastfeeding Initiation and Its Risk Factors Among Reproductive Aged Women in Somalia: A Cross-Sectional Study Using Somalia Health and Demographic Survey.Health science reports · 2026Article
- Healthcare access difficulty due to fear of COVID-19 infection among women of reproductive age: multilevel mixed-effects logistic regression analysis.African health sciences · 2026Article
293 more citing papers are in PubMed but not listed here.
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
STUDY
objectiveThis 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
participantsThe 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.
resultsThe 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.
conclusionsThe 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.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.