title: Multilevel analysis of the physical health perception of employees: community and individual factors.
abstract: OBJECTIVE
  To investigate whether the communities where employees reside are associated with employee perception of overall physical health after adjusting for individual factors.
  
  
  METHODS
  Retrospective cross-sectional.
  
  
  METHODS
  Active employees from a large manufacturing company representing 157 zip code tabulation areas (ZCTAs) in Michigan.
  
  
  METHODS
  22,012 active employees who completed at least one voluntary health risk appraisal (HRA) during 1999-2001.
  
  
  METHODS
  Community deprivation and racial segregation at the ZCTA level were obtained using indices created from 2000 U.S. Census data. Demographics and HRA-related data (health-related behaviors, medical history, and quality of life indicators) at the individual level were used as independent variables. A two-level logistic regression model (employees nested in ZCTA) was used to model the probability of better self-rated health perception (SRH) (better health: 89.1% versus poor health: 10.9%).
  
  
  RESULTS
  Relative to those living in highly deprived communities, employees residing in less-deprived communities showed 2.06 (95% confidence interval [CI], 1.57-2.72) and those living in moderately deprived communities showed 1.83 (95% CI, 1.42-2.35) increased odds of better SRH. After adjusting for individual-level variables, employees living in less-deprived communities had increased odds (1.31 [95% CI, 1.07-1.60]) and those living in moderately deprived communities had increased odds (1.33 [95% CI, 1.11-1.59]) of better SRH compared with individuals from highly deprived communities. The association of racial segregation with employees' SRH was mediated after adjusting for other variables. Individual-level variables showed significant statistical associations with SRH.
  
  
  CONCLUSIONS
  Communities do have a modest association with SRH of the employees living there. After adjusting for individual-level and demographic variables, employees living in less/moderately deprived communities are more likely to perceive better physical health relative to those who live in highly deprived communities.
authors.affiliation: University of Michigan Health Management Research Center, Ann Arbor, Michigan 48104-1688, USA. sudhas@umich.edu
authors.forename: Sudhakar
authors.initials: S
authors.lastname: Sathyanarayanan
authors.forename: Ambyr J
authors.initials: AJ
authors.lastname: Brooks
authors.forename: Susan E
authors.initials: SE
authors.lastname: Hagen
authors.forename: Dee W
authors.initials: DW
authors.lastname: Edington
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D004651:Employment; D005260:Female; D006304:Health Status; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008824:Michigan; D008875:Middle Aged; D011788:Quality of Life; D012044:Regression Analysis; D012111:Residence Characteristics; D012189:Retrospective Studies; D057566:Self Report; D012923:Social Class