American Journal of Epidemiology Advance Access published online on June 22, 2005
American Journal of Epidemiology, doi:10.1093/aje/kwi175
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1 Research Unit in Epidemiology, Information Systems, and Modelisation (INSERM U707), National Institute of Health and Medical Research, Paris, France; Department of Community Medicine, Malmö University Hospital, Lund University, Malmö, Sweden
* To whom correspondence should be addressed. Most studies of neighborhood effects on health have used the multilevel approach. However, since this methodology does not incorporate any notion of space, it may not provide optimal epidemiologic information when modeling variations or when investigating associations between contextual factors and health. Investigating mental disorders due to psychoactive substance use among all 65,830 individuals aged 40-59 years in 2001 in Malmö, Sweden, geolocated at their place of residence, the authors compared a spatial analytical perspective, which builds notions of space into hypotheses and methods, with the multilevel approach. Geoadditive models provided precise cartographic information on spatial variations in prevalence independent of administrative boundaries. The multilevel model showed significant neighborhood variations in the prevalence of substance-related disorders. However, hierarchical geostatistical models provided information on not only the magnitude but also the scale of neighborhood variations, indicating a significant correlation between neighborhoods in close proximity to each other. The prevalence of disorders increased with neighborhood deprivation. Far stronger associations were observed when using indicators measured in spatially adaptive areas, centered on residences of individuals, smaller in size than administrative neighborhoods. In neighborhood studies, building notions of space into analytical procedures may yield more comprehensive information than heretofore has been gathered on the spatial distribution of outcomes.
Received October 29, 2004
Accepted March 7, 2005
ORIGINAL CONTRIBUTIONS
Comparison of a Spatial Perspective with the Multilevel Analytical Approach in Neighborhood Studies: The Case of Mental and Behavioral Disorders due to Psychoactive Substance Use in Malmö, Sweden, 2001
2 Department of Community Medicine, Malmö University Hospital, Lund University, Malmö, Sweden
3 Department of Society, Human Development and Health, Harvard School of Public Health, Boston, MA
4 Department of Epidemiology, Center for Social Epidemiology and Population Health (CSEPH), University of Michigan, Ann Arbor, MI
5 Research Unit in Epidemiology, Information Systems, and Modelisation (INSERM U707), National Institute of Health and Medical Research, Paris, France
Basile Chaix, E-mail: chaix{at}u707.jussieu.fr
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