A hierarchical analysis of long-term illness and mortality in socially deprived areas.
This article is a multilevel analysis of the effects on self-reported long-term illness and mortality of the socio-economic position of the neighbourhood. Using data from the Swedish Level of Living Survey, neighbourhood social position is measured by a composite Care Need Index, (CNI) together with such indicators of individual socio-economic position as occupation and housing tenure, with adjustment for age, sex, marital status and social network. Data came from 22,236 people aged 25-74, and were collected from 1988 to 1992. The cross-sectional data were analysed using a hierarchical logistic regression model. In a second analysis, each participant was followed from the initial interview until his or her death, or until the termination of data collection (31 December 1996). A neighbourhood's low social position and an individual resident's low socio-economic position (i.e., a manual worker, or person renting a flat) were found to be associated with increased risk of long-term illness. We conclude that a neighbourhood's low socio-economic position, that is, a high score on the CNI, is a risk factor for long-standing illness above and beyond an individual's socio-economic position. The differences in mortality could be explained by the included independent individual variables.
Malmström
M
M
marianne.malmstrom@klinvet-ki.se
Johansson
S E
SE
Sundquist
J
J
D000328:Adult; D000368:Aged; D002908:Chronic Disease / Q000191:economics / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D003467:Cultural Deprivation; D006301:Health Services Needs and Demand; D006305:Health Status Indicators; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D009026:Mortality; D011204:Poverty Areas; D015995:Prevalence; D012307:Risk Factors; D012647:Self-Assessment; D017062:Small-Area Analysis; D012959:Socioeconomic Factors; D013548:Sweden / Q000453:epidemiology