The geography of overweight in Quebec: analyzing and visualizing spatial inequalities using second-level residuals.
OBJECTIVE
To discuss critically the contribution of using second-level residuals from multilevel analyses to further the understanding of how place relates to health and to visualize areas, in the province of Quebec (Canada), with above- and below-average levels of overweight.


METHODS
Data on 20,449 individuals are from the Canadian Community Health Survey (CCHS Cycle 2.1) and were linked to 51 spatial units. Area-level residuals were computed from a multilevel analysis examining individual and area characteristics associated with the risk of overweight. Mapping the area-level residuals indicates geographic areas where the risk of overweight is higher or lower compared to the provincial adjusted prevalence.


RESULTS
Controlling for socio-economic conditions and lifestyle, distinct spatial patterns of overweight were observed, indicating that the processes linking place to health may differ between men and women and between regional contexts. In some regions, the probability of overweight differed by 23% for men and 38% for women living in privileged conditions in comparison to the province's adjusted prevalence of overweight.


CONCLUSIONS
Analyzing and visualizing area-level residuals provides multi-scaled information that could enhance the understanding of the geographic distribution of overweight and has the potential to support more integrated and locally relevant interventions.
Lebel
Alexandre
A
Centre de recherche en aménagement et développement, Pavilion Félix-Antoine-Savard, 2325 rue des Bibliothêques, local 1612, Université Laval, Québec, QC G1V 0A6. alexandre.lebel.1@ulaval.ca
Riva
Mylène
M
Pampalon
Robert
R
Thériault
Marius
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D016000:Cluster Analysis; D005260:Female; D005843:Geography; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D050177:Overweight / Q000453:epidemiology*; D011792:Quebec / Q000453:epidemiology; D012737:Sex Factors; D012959:Socioeconomic Factors; D055815:Young Adult