Context, composition and heterogeneity: using multilevel models in health research
Abstract
This paper considers the use of multilevel models in health research. Attention focuses on the structure and potential of such models and particular consideration is given to their use in elucidating the importance of contextual effects in relation to individual level social and demographic factors in understanding health outcomes, health-related behaviour and health service performance. Four graphical typologies are used to outline the questions that multilevel models can address and the paper illustrates their potential by drawing on published examples in a number of different research areas.
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Empirical studies of syndemics are natural candidates for multilevel models, which bridge ecological and individual-level data and permit simultaneous estimation of associations at different levels.
“One would expect empirical studies of syndemics to be natural candidates for the application of multilevel models, which bridge analyses of ecological and individual-level data and permit simultaneous estimation of associations at different levels (Diez-Roux, 1998; Duncan, Jones, & Moon, 1998).”
From Syndemics: a theory in search of data or data in search of a theory? (2018) · cites this paper as Duncan, Jones, & Moon, 1998
Cites
Parametric empirical Bayes inference: theory and applications
Morris, C. N. (1983) · Journal of the American Statistical Association · doi:10.1080/01621459.1983.10477920 · Cited by 1,448 · cited 1× · see citing works
“…contexts identified are treated as coming from a population distribution the estimation procedure can "pool" all the information in the data thus allowing the predictions of place-specific relationships to be based on precision-weighted estimators (Morris, 1983) which take account of sample sizes.”
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Behavioral science at the crossroads in public health: Extending horizons, envisioning the future
Glass, T. A., & McAtee, M. J. (2006) · Social Science & Medicine · doi:10.1016/j.socscimed.2005.08.044 · Cited by 821 · see citing works
Is there a “school effect” on pupil outcomes? A review of multilevel studies
Sellström, E., & Bremberg, S. (2006) · Journal of Epidemiology and Community Health · doi:10.1136/jech.2005.036707 · Cited by 306 · see citing works
Campbell, M. K., Fayers, P. M., & Grimshaw, J. M. (2005) · Clinical Trials · doi:10.1191/1740774505cn071oa · Cited by 275 · see citing works
Weight Status and Restaurant Availability
Mehta, N. K., & Chang, V. W. (2008) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2007.09.031 · Cited by 236 · see citing works
Syndemics: a theory in search of data or data in search of a theory?
Tsai, A. C. (2018) · Social Science & Medicine · doi:10.1016/j.socscimed.2018.03.040 · Cited by 185 · see citing works
Long-term survival after acute myocardial infarction is lower in more deprived neighborhoods
Tonne, C., Schwartz, J., Mittleman, M., Melly, S., Suh, H., & Goldberg, R. (2005) · Circulation · doi:10.1161/circulationaha.104.496174 · Cited by 122 · see citing works
An approach to studying social disparities in health and health care
Braveman, P. A., Egerter, S. A., Cubbin, C., & Marchi, K. S. (2004) · American Journal of Public Health · doi:10.2105/ajph.94.12.2139 · Cited by 100 · see citing works
- Authors
- Duncan, C., Jones, K., & Moon, G.
- Affiliations
- University of Portsmouth (GB)
- Corresponding author
- Duncan, Craig
- Venue
- Social Science & Medicine
- Publisher
- Elsevier BV
- Published
- 1998-01
- Volume
- 46
- Issue
- 1
- Pages
- 97-117
- ISSN
- 0277-9536 (ISSN-L)
- OpenAlex
- W2049406759
- Cited by
- 689
- References
- 1
- Citations by year
- 2026: 9 · 2025: 12 · 2024: 17 · 2023: 19 · 2022: 29 · 2021: 19 · 2020: 21 · 2019: 35 · 2018: 18 · 2017: 32 · 2016: 39 · 2015: 37 · 2014: 36 · 2013: 23 · 2012: 28
- FWCI
- 14.67
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Social Science & Medicine (publishedVersion)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- Topics
- Social Sciences › Health › Health disparities and outcomes
- Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods and Bayesian Inference
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Spatial and Panel Data Analysis
- Keywords
- multilevel models, contextual effects, health outcomes, health behavior, health service performance, sociodemographic factors, health disparities, heterogeneity
- MeSH terms
- Analysis of Variance, Health Services Research, Humans, Regression Analysis, Research Design, Models, Statistical, Health Behavior
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