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Division of General Medicine, College of Physicians and Surgeons, School of Public Health, Columbia University, New York, USA.
A large portion of current epidemiologic research is based on methodologic individualism: the notion that the distribution of health and disease in populations can be explained exclusively in terms of the characteristics of individuals. The present paper discusses the need to include group- or macro-level variables in epidemiologic studies, thus incorporating multiple levels of determination in the study of health outcomes. These types of analyses, which have been called contextual or multi-level analyses, challenge epidemiologists to develop theoretical models of disease causation that extend across levels and explain how group-level and individual-level variables interact in shaping health and disease. They also raise a series of methodological issues, including the need to select the appropriate contextual unit and contextual variables, to correctly specify the individual-level model, and, in some cases, to account for residual correlation between individuals within contexts. Despite its complexities, multilevel analysis holds potential for reemphasizing the role of macro-level variables in shaping health and disease in populations.
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A. H. Auchincloss, J. F. van Nostrand, and D. Ronsaville Access to Health Care for Older Persons in the United States: Personal, Structural, and Neighborhood Characteristics J Aging Health, August 1, 2001; 13(3): 329 - 354. [Abstract] [PDF]
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N. Krieger Historical roots of social epidemiology: socioeconomic gradients in health and contextual analysis Int. J. Epidemiol., August 1, 2001; 30(4): 899 - 900. [Full Text] [PDF]
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S Schwartz and R Diez-Roux Commentary: Causes of incidence and causes of cases--a Durkheimian perspective on Rose Int. J. Epidemiol., June 1, 2001; 30(3): 435 - 439. [Full Text] [PDF]
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H. Bosma, H. Dike van de Mheen, G. J. J. M. Borsboom, and J. P. Mackenbach Neighborhood Socioeconomic Status and All-Cause Mortality Am. J. Epidemiol., February 15, 2001; 153(4): 363 - 371. [Abstract] [Full Text] [PDF]
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K E Pickett and M Pearl Multilevel analyses of neighbourhood socioeconomic context and health outcomes: a critical review J Epidemiol Community Health, February 1, 2001; 55(2): 111 - 122. [Abstract] [Full Text]
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G. Davey Smith, S. Ebrahim, and S. Frankel How policy informs the evidence BMJ, January 27, 2001; 322(7280): 184 - 185. [Full Text]
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L Laflamme and F Diderichsen Social differences in traffic injury risks in childhood and youth--a literature review and a research agenda Inj. Prev., December 1, 2000; 6(4): 293 - 298. [Abstract] [Full Text] [PDF]
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