ArticleJournal of epidemiology and community health2005
A brief conceptual tutorial on multilevel analysis in social epidemiology: investigating contextual phenomena in different groups of people.
Article 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 187 papers.
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Who cites it
187 citing papers in PubMed.
- Performance of Pit Latrines and Their Herd Protection Against Diarrhea: A Longitudinal Cohort Study in Rural Ethiopia.Global health, science and practice · 2024Trial
- Hospital Variation in Time to Endovascular Treatment for Ischemic Stroke: What Is the Optimal Target for Improvement?Journal of the American Heart Association · 2022Trial
- From Averages to Heterogeneity: A Plain-Language Guide to MAIHDA in Epidemiology.International journal of social determinants of health and health services · 2026Review
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- Effects of social determinants of health on the landscape of kidney disease.Nature reviews. Nephrology · 2026Review
- Multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) to understand how obesity risk varies according to multiple lifestyle behavior recommendations.International journal of obesity (2005) · 2026Article
- Advancing Methods to Study Clinical Variation in Healthcare.Journal of evaluation in clinical practice · 2026Review
- Determinants of stunting among 0-59 months children in Lesotho: A multilevel analysis of 2023/24 Demographic and Health Survey.PloS one · 2026Article
- Do sociodemographic factors modify the association between antenatal care utilisation and acute respiratory infection among infants in Ethiopia?PLOS global public health · 2026Article
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- Effects of environment and globalization on the double and triple burdens of infection symptoms among under-five children across low-middle income countries using machine learning algorithms.Infectious diseases of poverty · 2025Article
- Determinants of empiric combination antibiotic therapy for hospital associated bloodstream infections in the intensive care unit.Scientific reports · 2025Article
- Where you live and where you receive care: Using cross-classified multilevel modeling to examine hospital and neighborhood variation in in-hospital mortality and mortality disparities.Annals of epidemiology · 2025Article
- A multilevel analysis of factors associated with stunting among children under five years in Lesotho: a study of the lesotho multiple cluster indicator survey 2018.Journal of health, population, and nutrition · 2025Article
- Using multi-level regression to determine associations and estimate causes and effects in clinical anesthesia due to patient, practitioner and hospital or health system practice variability.Journal of anesthesia · 2025Review
- Prevalence, patterns, and determinants of multimorbidity in South Africa: Insights from a nationally representative survey.PLOS global public health · 2025Article
- Improving postnatal social support using antenatal group-based psychoeducation: a cluster randomized controlled trial.Frontiers in global women's health · 2025Article
- Onset of Type 2 diabetes in adults aged 50 and older in Europe: an intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy.Diabetology & metabolic syndrome · 2024Article
- Socioeconomic inequalities in the uptake of postpartum care at home across Dutch neighbourhoods.European journal of public health · 2024Observational
127 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
STUDY
objective(1) To provide a didactic and conceptual (rather than mathematical) link between multilevel regression analysis (MLRA) and social epidemiological concepts. (2) To develop an epidemiological vision of MLRA focused on measures of health variation and clustering of individual health status within areas, which is useful to operationalise the notion of "contextual phenomenon". The paper shows how to investigate (1) whether there is clustering within neighbourhoods, (2) to which extent neighbourhood level differences are explained by the individual composition of the neighbourhoods, (3) whether the contextual phenomenon differs in magnitude for different groups of people, and whether neighbourhood context modifies individual level associations, and (4) whether variations in health status are dependent on individual level characteristics. DESIGN AND
participantsSimulated data are used on systolic blood pressure (SBP), age, body mass index (BMI), and antihypertensive medication (AHM) ascribed to 25 000 subjects in 39 neighbourhoods of an imaginary city. Rather than assessing neighbourhood variables, the paper concentrated on SBP variance between individuals and neighbourhoods as a function of individual BMI.
resultsThe variance partition coefficient (VPC) showed that clustering of SBP within neighbourhoods was greater for people with a higher BMI. The composition of the neighbourhoods with respect to age, AHM use, and BMI explained about one fourth of the neighbourhood differences in SBP. Neighbourhood context modified the individual level association between BMI and SBP. Individual level differences in SBP within neighbourhoods were larger for people with a higher BMI.
conclusionsStatistical measures of multilevel variations can effectively quantify contextual effects in different groups of people, which is a relevant issue for understanding health inequalities.
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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.