Skip to main content
SpringerLink
Log in

Multilevel and Clustering Analysis of Health Outcomes in Small Areas

  • Published:
European Journal of Population / Revue européenne de Démographie Aims and scope Submit manuscript

Abstract

This paper considers models of the variable incidence of health outcomes in geographical areas and of variable regression effects of socio-economic variables on such outcomes. It adopts a Bayesian approach to variation in relative risk and regression effects, and assesses different prior specifications of risk (e.g. a latent class structure versus a spatially correlated structure). Implications are considered for smoothing and mapping rare health outcomes. The analysis is for electoral wards in London, with the health-deprivation link forming the focus for regression effects. Implications for inferences about risk factors and for health-need ratings (before and after smoothing) are also considered.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Aitkin, M. and Francis, B., 1995. 'Fitting overdispersed generalized linear models by nonparametric maximum likelihood', GLIM Newsletter 25: 37-45.

    Google Scholar 

  • Balarajan, R., 1991. 'Ethnic differences in mortality from ischaemic heart disease and cerebrovascular disease in England and Wales', British Medical Journal 302: 560-564.

    Google Scholar 

  • Baxter,M., 1985, 'Quasi-likelihood estimation and diagnostic statistics for spatial interaction models', Environment and Planning 17A: 1627-1635.

    Google Scholar 

  • Bernardinelli, L. and Montomoli, C., 1992. 'Empirical Bayes versus fully Bayesian analysis of geographical variation in disease risk', Statistics in Medicine 11: 983-1007.

    Google Scholar 

  • Besag, J. and Newell, J., 1991. 'The detection of clusters in rare disease', Journal of Royal Statistical Society 154A: 143-155.

    Google Scholar 

  • Besag, J., York, J. and Mollie, A., 1991. 'Bayesian image restoration, with two applications in spatial statistics', Annals of the Institute of Statistical Mathematics 43: 1-59.

    Google Scholar 

  • Campbell, D., Radford, J. and Burton, P., 1991. 'Unemployment rates: An alternative to the Jarman index?', British Medical Journal 303: 750-755.

    Google Scholar 

  • Carr-Hill, R., Hardman, G., Martin, S., Peacock, S., Sheldon, T. and Smith, P., 1994. A Formula for Distributing NHS Revenues Based on the Small Area Use of Hospital Beds. Centre for Health Economics, University of York.

  • Clayton, D. and Bernardinelli, L., 1994. 'Bayesian methods for mapping disease risk', in P. Elliott (ed), Geographical and Environmental Epidemiology, Chapter 18. Oxford University Press, Oxford, 205-220.

    Google Scholar 

  • Clayton, D. and Bernardinelli, L., 1993. 'Bayesian methods for mapping disease risk', in P. Elliott (ed), Geographical and Environmental Epidemiology. Oxford University Press, Oxford.

    Google Scholar 

  • Clayton, D. and Kaldor, N., 1987. 'Empirical Bayes estimates of age-standardised relative risks for use in disease mapping', Biometrics 43: 671-681.

    Google Scholar 

  • Cliff, A. and Ord, J., 1991. Spatial Processes: Models and Applications. Pion, London.

    Google Scholar 

  • Congdon, P., 1995. 'Localities for epidemiological monitoring and health policy', Urban Studies 32: 523-549.

    Google Scholar 

  • Congdon, P., 1996. 'The epidemiology of suicide in London', Journal of the Royal Statistical Society 159: 515-533.

    Google Scholar 

  • Davies, R. and Guy, C., 1987. 'The statistical modelling of flow data when the Poisson assumption is violated', Geographical Analysis 19(4): 300-314.

    Google Scholar 

  • Department of Health, 1992. The Health of the Nation: A Strategy for Health in England. (Cm.1986) Center, HMSO.

  • Department of Health, 1995. Variations in Health: What Can the Department of Health and the NHS Do? (G07/029), HMSO.

  • Eames, M., Ben-Shalom, Y. and Marmot, M., 1993. 'Social deprivation and premature mortality: regional comparisons across England', British Medical Journal 307: 1097-1102.

    Google Scholar 

  • Elliott, P., Martuzzi,M. and Shaddick, G., 1995. 'Spatial statistical methods in environmental epidemiology', Statistical Methods in Medical Research 4: 137-159.

    Google Scholar 

  • Esteve, J., Benhamou, E. and Raymond, L., 1994. Statistical Methods in Cancer Research, Volume IV, Descriptive Epidemiology. IARC Scientific Publications, Lyon.

  • Everitt, B. and Hand, D., 1981. Finite Mixture Distributions. Chapman and Hall, London.

  • Flowerdew, R. and Green, M., 1992. 'Developments in areal interpolation methods and GIS', Annals of Regional Science 26: 67-78.

    Google Scholar 

  • Gelfand, A. and Smith, A., 1990. 'Sampling-based approaches to calculating marginal densities', Journal of the American Statistical Association 85: 398-409.

    Google Scholar 

  • Gelman, A., Carlin, J., Stern, H. and Rubin, D., 1995. Bayesian Data Analysis. Chapman and Hall, London.

    Google Scholar 

  • Geweke, J., 1992. 'Evaluating the accuracy of sampling based approaches to the calculation of posterior moments', in J. Bernardo et al. (eds), Bayesian Statistics 4. Clarendon Press, Oxford.

    Google Scholar 

  • Gilks, W., Wang, C., Yvonnet, B. and Coursaget, P., 1993. 'Random-effects models for longitudinal data using Gibbs sampling', Biometrics 49: 441-453.

    Google Scholar 

  • Goldstein, H. and Spiegelhalter, D., 1996. 'League tables and their limitations: Statistical issues in comparisons of institutional performance', Journal of the Royal Statistical Society 159: 385-443.

    Google Scholar 

  • Haining, R., 1991. 'Estimation with heteroscedastic and correlated errors: A spatial analysis of intra-urban mortality data', Papers in Regional Science 70(3): 223-241.

    Google Scholar 

  • Hills, J., 1995. Inquiry into Income and Wealth. Joseph Rowntree Foundation, York.

  • Humphreys, K. and Carr-Hill, R., 1991. 'Area variations in health outcomes: Artefact or ecology', International Journal of Epidemiology 20: 251-258.

    Google Scholar 

  • Jarman, B., 1983. 'Identification of underprivileged areas', British Medical Journal 286: 1705-1709.

    Google Scholar 

  • Johnson, I. and Milner, P., 1988. 'Is the Jarman score better than social class at assessing the need for prevention and primary care', Family Practice 5: 105-110.

    Google Scholar 

  • Jones, K. and Bullen, N., 1993. 'A multi-level analysis of the variations in domestic property prices: Southern England 1980-87', Urban Studies 30: 1409-1426.

    Google Scholar 

  • Kleinschmidt, I., Hills, M. and Elliott, P., 1995. 'Smoking behaviour can be predicted by neighbourhood deprivation measures', Journal of Epidemiology and Community Health 49S: S72-S77.

    Google Scholar 

  • Langford, I. and Bentham, G., 1996. 'Regional variations in mortality rates in England and Wales: An analysis using multi-level modelling', Social Science and Medicine 42: 897-908.

    Google Scholar 

  • McColl, A. and Gulliford, M. (eds), 1993. Population Health Outcome Indicators for the NHS: A Feasibility Study. Faculty of Public Health Medicine. London, U.K.

  • MacIntyre, S., MacIver, S. and Sooman, A., 1993. 'Area, class and health: Should we be focusing on places or people?', Journal of Social Policy 22(2): 213-234.

    Google Scholar 

  • McLachan, G. and Basford, K., 1988. Mixture Models. Dekker, New York.

    Google Scholar 

  • Manton, K., Stallard, E., Woodbury, M., Riggan, W., Creason, J. and Mason, T., 1987. 'Statistically adjusted estimates of geographic mortality profiles', Journal of National Cancer Institute 78: 805-815.

    Google Scholar 

  • Marshall, R., 1991. 'A review of methods for the statistical analysis of spatial patterns of disease', Journal of the Royal Statistical Society 154: 421-441.

    Google Scholar 

  • Moksony, F., 1990. 'Ecological analysis of suicide: problems and prospects', in D. Lester (ed), Current Concepts in Suicide, chapter 8. The Charles Press, Philadelphia.

    Google Scholar 

  • Molli´e, A., 1996. 'Bayesian mapping of disease', in W. Gilks, S. Richardson and D. Spieglehalter (eds), Markov Chain Monte Carlo in Practice, chapter 20. Chapman and Hall, London.

    Google Scholar 

  • Morris, R. and Carstiars, V., 1991. 'Which deprivation? A comparison of selected deprivation indexes', Journal of Public Health Medicine 13: 318-326.

    Google Scholar 

  • Phillimore, P. and Reading, R., 1992. 'A rural advantage? Urban-rural health differences in Northern England', Journal of Public Health Medicine, 14(3): 290-299.

    Google Scholar 

  • Raftery A. and Lewis S., 1992. 'How many iterations in the Gibbs sampler?', in J. Bernardo et al. (eds), Bayesian Statistics 4. Oxford University Press, 763-773.

  • Rodriguez, G. and Goldman, N., 1995. 'An assessment of estimation procedures for multi-level models with binary responses', Journal of the Royal Statistical Society 158A: 73-89.

    Google Scholar 

  • Schwartz, S., 1994. 'The fallacy of the ecological fallacy: the potential misuse of a concept and the consequences', American Journal of Public Health 84(S): 819-824.

    Google Scholar 

  • Spiegelhalter, D., Thomas, A., Best, N. and Gilks,W., 1994. BUGS: Bayesian Inference Using Gibbs Sampling. MRC Biostatistics Unit, Cambridge CB2 2SR.

  • Spiegelhalter, D., Thomas, A., Best, N. and Gilks, W., 1995. BUGS: Bayesian Inference using Gibbs Sampling, version 0.50. MRC Biostatistics Unit, Cambridge.

  • Stevenson, J. and Olson, D., 1993. 'Methods for analysing county-level mortality rates', Statistics in Medicine 12: 393-401.

    Google Scholar 

  • Van Duijn, M. and Bockenholt, U., 1995. 'Mixture models for the analysis of repeated count data', Applied Statistics 44: 473-485.

    Google Scholar 

  • Von Korff, M., Koepsell, T., Curry, S. and Diehr, P., 1992. Multi-level analysis in epidemiologic research on health behaviours and outcomes', American Journal of Epidemiology 135: 1077-1082.

    Google Scholar 

  • Wedel, M., Desarbo, W., Butt, J. and Ramaswamy, V., 1993. 'A latent class Poisson regression model for heterogeneous count data', Journal of Applied Econometrics 8: 397-411.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Epidemiology, Imperial College School of Medicine, Norfolk Place, London, W2 1PG

    Peter Congdon

  2. Barking and Havering Health Authority, Directorate of Public Health, The Clock House, East St, Barking, IG11 8EY, Essex

    Peter Congdon

Authors
  1. Peter Congdon
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Congdon, P. Multilevel and Clustering Analysis of Health Outcomes in Small Areas. European Journal of Population 13, 305–338 (1997). https://doi.org/10.1023/A:1005937516293

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1005937516293

Keywords

Search

Navigation