ArticleInternational journal for equity in health2009
Multilevel survival analysis of health inequalities in life expectancy.
Article in International journal for equity in health, 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
What it found
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Who cites it
5 citing papers in PubMed.
- Marked Variation Exists Among Surgeons and Hospitals in the Use of Secondary Cleft Lip Surgery.The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association · 2020Article
- Five-Fold Variation Among Surgeons and Hospitals in the Use of Secondary Palate Surgery.The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association · 2019Article
- A fuzzy set qualitative comparative analysis of 131 countries: which configuration of the structural conditions can explain health better?International journal for equity in health · 2018Article
- An Original Stepwise Multilevel Logistic Regression Analysis of Discriminatory Accuracy: The Case of Neighbourhoods and Health.PloS one · 2016Article
- Decreasing disparities in infant survival using surveillance data from Burkina Faso.The American journal of tropical medicine and hygiene · 2015Article
Corrections and comments
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Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe health status of individuals is determined by multiple factors operating at both micro and macro levels and the interactive effects of them. Measures of health inequalities should reflect such determinants explicitly through sources of levels and combining mean differences at group levels and the variation of individuals, for the benefits of decision making and intervention planning. Measures derived recently from marginal models such as beta-binomial and frailty survival, address this issue to some extent, but are limited in handling data with complex structures. Beta-binomial models were also limited in relation to measuring inequalities of life expectancy (LE) directly.
methodsWe propose a multilevel survival model analysis that estimates life expectancy based on survival time with censored data. The model explicitly disentangles total health inequalities in terms of variance components of life expectancy compared to the source of variation at the level of individuals in households and parishes and so on, and estimates group differences of inequalities at the same time. Adjusted distributions of life expectancy by gender and by household socioeconomic level are calculated. Relative and absolute health inequality indices are derived based on model estimates. The model based analysis is illustrated on a large Swedish cohort of 22,680 men and 26,474 women aged 6569 in 1970 and followed up for 30 years. Model based inequality measures are compared to the conventional calculations.
resultsMuch variation of life expectancy is observed at individual and household levels. Contextual effects at Parish and Municipality level are negligible. Women have longer life expectancy than men and lower inequality. There is marked inequality by the level of household socioeconomic status measured by the median life expectancy in each socio-economic group and the variation in life expectancy within each group.
conclusionMultilevel survival models are flexible and efficient tools in studying health inequalities of life expectancy or survival time data with a geographic structure of more than 2 levels. They are complementary to conventional methods and override some limitations of marginal models. Future research on determinants of health inequalities in the LE of the specific cohort on the household and individual factors could reveal some important causes over the marked household level inequalities.
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Registered trials
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