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International Journal for Equity in Health
Published in: International Journal for Equity in Health 1/2009

Open Access 01-12-2009 | Research

Mortality effects of average education: a multilevel study of small neighbourhoods in rural and urban areas in Norway

Author: Øystein Kravdal

Published in: International Journal for Equity in Health | Issue 1/2009

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Abstract

Background

The intention was to find out whether there was an association between the socio-economic resources in a small neighbourhood ("basic statistical unit"; BSU) and individual mortality, net of individual resources, and whether this association differed between municipalities including a quite large city and others. The possibility of a rural-urban difference in the health effect of community resources has not been checked earlier.

Methods

Discrete-time hazard models for mortality at age 60-89 were estimated for 1990-1992 and 2000-2002, using register data that cover the entire Norwegian population. For each person, the educational level and the municipality and BSU of residence in 1990 and 2000 were known. Average education was computed by aggregating over the individual data. In total, there were about 200000 deaths in more than 13000 BSUs during 5 million person-years of observation.

Results

There was a significant relationship between average education in the BSU and individual mortality, but only in the medium-sized and largest municipalities. The sharpest relationship was seen in the latter, where for example OR per year of education was 0.908 (95% CI 0.887-0.929) in the 1990-92 period. The findings were robust to various alternative specifications.

Conclusion

These results from a large data set are consistent with the idea that neighbourhood socio-economic resources may affect individual mortality, but suggest that distinctions according to population size or density be made in future research and that one should be careful, if focusing on cities, to generalize beyond that setting. With these data, one can only speculate about the reasons for the rural-urban difference. A stronger higher-level spatial segregation in urban areas may be one explanation.
Literature
1.
Kunst AE, Mackenbach JP: The size of mortality differences associated with educational level in nine industrialized countries. Am J Publ Health. 1996, 84: 932-937. 10.2105/AJPH.84.6.932.CrossRef
2.
Pickett KE, Pearl M: Multilevel analyses of neighborhood socioeconomic context and health outcomes. J Epidemiol Community Health. 2001, 55: 111-122. 10.1136/jech.55.2.111.PubMedCentralCrossRefPubMed
3.
Robert SA: Socioeconomic position and health: The independent contribution of community socioeconomic context. Ann Rev Sociol. 1999, 25: 489-516. 10.1146/annurev.soc.25.1.489.CrossRef
4.
Martikainen P, Kauppinen TM, Valkonen T: Effects of the characteristics of neighborhoods and the characteristics of people on cause specific mortality: A register based follow-up study of 252000 men. J Epidemiol Comm Health. 2003, 57: 210-217. 10.1136/jech.57.3.210.CrossRef
5.
Sundquist K, Winkleby M, Ahlen H, Johansson SE: Neigborhood socioeconomic environment and incidence of coronary heart disease: a follow-up study of 25319 women and men in Sweden. Am J Epidemiol. 2004, 159: 655-662. 10.1093/aje/kwh096.CrossRefPubMed
6.
Osler M, Christensen U, Lund R, Gamborg N, Godtfredsen N, Prescott E: High local unemployment and increased mortality in Danish adults. Results from a prospective multilevel study. Occup Environm Med. 2003, 60: e16-10.1136/oem.60.11.e16.CrossRef
7.
Kravdal Ø: Mortality effects of average education in current and earlier municipality of residence among migrants, net of own education. Soc Sci Med. 2009, 69: 1484-1492. 10.1016/j.socscimed.2009.08.035.CrossRefPubMed
8.
Reijneveld SA, Schene AH: Higher prevalence of mental disorders in socioeconomic deprived urban areas in the Netherlands: community or personal disadvantage. J Epidemiol Comm Health. 1998, 52: 2-7. 10.1136/jech.52.1.2.CrossRef
9.
Propper C, Jones K, Bolster A, Burgess S, Johnston R, Sarker R: Local neighborhood and mental health: Evidence from the UK. Soc Sci Med. 2005, 61: 2065-2083. 10.1016/j.socscimed.2005.04.013.CrossRefPubMed
10.
Ecob R: A multilevel modelling approach to examining the effects of area of residence on health and functioning. J Royal Stat Society: Series A. 1996, 159: 61-75.CrossRef
11.
12.
Kawachi I, Subramanian SV: Neighbourhood influences on health. J Epidemiol Comm Health. 2007, 61: 3-4. 10.1136/jech.2005.045203.CrossRef
13.
Kennedy BP, Kawachi I, Glass R, Prothrow-Stith D: Income distribution, socio-economic status, and self-rated health in the United States: multilevel analysis. BMJ. 1998, 317: 917-921.PubMedCentralCrossRefPubMed
14.
Blomgren JP, Martikainen P, Mäkelä P, Valkonen T: The effects of regional characteristics on alcohol-related mortality - a register-based multilevel analysis of 1.1. million men. Soc Sci Med. 2004, 58: 2523-2535. 10.1016/j.socscimed.2003.09.027.CrossRefPubMed
15.
Elstad JI, Dahl E, Hofoss D: Associations between relative income and mortality in Norway: a register-based study. Eur J Publ Health. 2006, 16: 640-644. 10.1093/eurpub/ckl018.CrossRef
16.
Martikainen P, Maki N, Blomgren J: The effects of area and individual social characteristics on suicide risk: A multilevel study of relative contribution and effect modification. Eur J Popul. 2004, 20: 323-350. 10.1007/s10680-004-3807-1.CrossRef
17.
Stafford M, Martikainen P, Lahelma E, Marmot M: Neighborhoods and self rated health: a comparison of public sector employees in London and Helsinki. J Epidemiol Comm Health. 2004, 58: 772-778. 10.1136/jech.2003.015941.CrossRef
18.
Stafford M, Cummins S, Macintyre S, Ellaway A, Marmot M: Gender differences in the association between health and neighborhood environment. Soc Sci Med. 2005, 60: 1681-1692. 10.1016/j.socscimed.2004.08.028.CrossRefPubMed
19.
Cozier YC, Palmer JR, Horton NJ, Fredman L, Wise LA, Rosenberg L: Relation between neighborhood median housing value and hypertension risk among black women in the United States. Am J Publ Health. 2007, 97: 718-724. 10.2105/AJPH.2005.074740.CrossRef
20.
Chaix B, Rosvall M, Lynch J, Merlo J: Disentangling contextual effects on cause-specific mortality in a longitudinal 23-year follow-up study: impact of population density or socioeconomic environment. Int J Epidemiol. 2006, 35: 633-643. 10.1093/ije/dyl009.CrossRefPubMed
21.
Chaix B, Rosvall M, Merlo J: Recent increase of neighborhood socioeconomic effects on ischemic heart disease mortality: A multilevel survival analysis of two large Swedish cohorts. Am J Epidemiol. 2007, 165: 22-26. 10.1093/aje/kwj322.CrossRefPubMed
22.
Sundquist K, Malmström M, Johansson SE: Neighborhood deprivation and incidence of coronary heart disease: A multilevel study of 2.6 million women and men in Sweden. J Epidemiol Comm Health. 2004, 58: 71-77. 10.1136/jech.58.1.71.CrossRef
23.
Fone D, Dunstan F, Llloyd K, Williams G, Watkins J, Palmer S: Does social cohesion modify the association between area income deprivation and mental health? A multilevel analysis. Int J Epidemiol. 2005, 36: 338-345. 10.1093/ije/dym004.CrossRef
24.
Veugelers PJ, Yip AM, Kephart G: Proximate and contextual socioeconomic determinants of mortality: multilevel approaches in a setting with universal health care coverage. Am J Epidemiol. 2001, 154: 725-732. 10.1093/aje/154.8.725.CrossRefPubMed
25.
Datta BD, Subramanian SV, Colditz GA, Kawachi I, Palmer JR, Rosenberg L: Individual, neighborhood, and state-level predictors of smoking among US Black women: A multilevel analysis. Soc Sci Med. 2006, 63: 1034-1044. 10.1016/j.socscimed.2006.03.010.CrossRefPubMed
26.
Turrell G, Kavanagh A, Draper D, Subramanian SV: Do places affect the probability of death in Australia? A multilevel study of area-level disadvantage, individual-level socioeconomic position and all-cause mortality. J Epidemiol Comm Health. 2007, 61: 13-19. 10.1136/jech.2006.046094.CrossRef
27.
Reijneveld SA, Verheij RA, de Bakker DH: The impact of area deprivation on differences in health: does the choice of the geographical classification matter?. J Epidemiol Comm Health. 2000, 54: 306-313. 10.1136/jech.54.4.306.CrossRef
28.
Kavanagh M, Bentley R, Turrell G, Bromm DH, Subramanian SV: Does gender modify associations between self rated health and the social and economic characteristics of local environments. J Epidemiol Comm Health. 2006, 60: 490-495. 10.1136/jech.2005.043562.CrossRef
29.
Wight RG, Aneshensel CS, Miller-Martinez D, Botticello AL, Cummings JR, Karlamangla AS, Seeman TE: Urban neighborhood context, educational attainment, and cognitive function among older adults. Am J Epidemiol. 2006, 163: 1071-1078. 10.1093/aje/kwj176.CrossRefPubMed
30.
Winkleby M, Cubbin C, Ahn D: Effect of cross-level interaction between individual and neighborhood socioeconomic status on adult mortality rates. Am J Publ Health. 2006, 96: 2145-2153. 10.2105/AJPH.2004.060970.CrossRef
31.
Kravdal Ø: A broader perspective on education and mortality: Are Norwegian men and women influenced by other people's education?. Soc Sci Med. 2008, 66: 620-636. 10.1016/j.socscimed.2007.10.009.CrossRefPubMed
32.
Reijneveld SA: Neighborhood socioeconomic context and self reported health and smoking: a secondary analysis of data on seven cities. J Epidemiol Comm Health. 2002, 56: 935-942. 10.1136/jech.56.12.935.CrossRef
33.
Van Lenthe FJ, Borrell LN, Costa G, Diez Roux AV, Kauppinen TM, Marinacci C, Martkainen P, Regidor E, Stafford M, Valkonen T: Neigbourhood unemployment and all cause mortality: a comparison of six countries. J Epidemiol Comm Health. 2005, 59: 231-237. 10.1136/jech.2004.022574.CrossRef
34.
Sundquist K, Theobald H, Yang M, Li X, Johansson S-E, Sundquist J: Neighborhood violent crime and unemployment increase the risk of coronary heart disease: A multilevel study in an urban setting. Soc Sci Med. 2006, 62: 2061-2071. 10.1016/j.socscimed.2005.08.051.CrossRefPubMed
35.
Browning CR, Cagney KA: Neighborhood structural disadvantage, collective efficacy, and self-rated physical health in an urban setting. J Health Social Behav. 2003, 43: 383-399. 10.2307/3090233.CrossRef
36.
Sampson RJ: Neighborhood-level context and health: lessons from sociology. Neighborhoods and Health. Edited by: Kawachi I, Berkman LF. 2003, New York, NY: Oxford University Press, 132-146. full_text.CrossRef
37.
38.
Wen M, Browning CR, Cagney KA: Poverty, affluence, and income inequality: Neighborhood economic structure and its implications for health. Soc Sci Med. 2003, 57: 843-860. 10.1016/S0277-9536(02)00457-4.CrossRefPubMed
39.
Lee RE, Cubbin C, Winkelby M: Contribution of neighborhood socioeconomic status and physical activity resources to physical activity among women. J Epidemiol Comm Health. 2007, 61: 882-890. 10.1136/jech.2006.054700.CrossRef
40.
Geronimus AT, Bound J: Use of census-based aggregate variables to proxy for socioeconomic group: Evidence from national samples. Am J Epidemiol. 1998, 148: 475-486.CrossRefPubMed
41.
Goldstein H: Multilevel Statistical Models. 2003, London: Arnold, 3
42.
Statistics Norway: Norwegian standard classification of education. Revised 2000. Official Statistics of Norway C 617. Oslo-Kongsvinger. 2001
43.
Ross CE, Mirowsky J: Refining the association between education and health: The effects of quantity, credential, and selectivity. Demography. 1999, 36: 445-460. 10.2307/2648083.CrossRefPubMed
44.
Montgomery MR, Casterline JB: Social learning, social influence and new models of fertility. Pop Dev Rev. 1996, 22 (suppl): 151-175. 10.2307/2808010.CrossRef
45.
46.
Sørensen R, Rongen G, Grytten J: Local government decision-making and access to primary physician services in Norway. International Journal of Health Services. 1997, 27: 697-720.CrossRefPubMed
47.
Rognerud MA, Zahl PH: Social inequalities in mortality: changes in the relative importance of income, education and household size over a 27-year period. Eur J Publ Health. 2006, 16: 62-68. 10.1093/eurpub/cki070.CrossRef
48.
Kawachi I, Subramanian SV, Almeida-Filho N: A glossary for health inequalities. J Epidemiol Comm Health. 2002, 56: 647-652. 10.1136/jech.56.9.647.CrossRef
49.
Lynch J, Davey Smith G, Harper S, Hillemeier M, Ross N, Kaplan GA, Wolfson M: Is income inequality a determinant of population health? Part 1. A systematic review. The Milbank Quarterly. 2004, 82: 5-99. 10.1111/j.0887-378X.2004.00302.x.PubMedCentralCrossRefPubMed
50.
51.
Wagstaff A, van Doorslaer E: Income inequality and health: What does the literature tell us?. Ann Rev Publ Health. 2000, 21: 543-567. 10.1146/annurev.publhealth.21.1.543.CrossRef
52.
Putnam RD: Bowling alone: the collapse and revival of American community. 2000, New York: Simon and SchusterCrossRef
53.
Brueckner JK, Largey AG: Social interaction and urban sprawl. Journal of Urban Economics. 2008, 64: 18-34. 10.1016/j.jue.2007.08.002.CrossRef
54.
Coughy MO, Hayslett-McCall , O'Campo : No neighborhood is an island: Incorporating distal neighborhood effects into multilevel studies of child development competence. Health & Place. 2007, 13: 788-798.CrossRef
55.
Cummins S, Curtis S, Diez-Roux AV, Macintyre S: Understanding and representing 'place' in health research: A relational approach. Soc Sci Med. 2007, 65: 1825-1838. 10.1016/j.socscimed.2007.05.036.CrossRefPubMed
56.
Sridharan S, Tunstall H, Lawder R, Mitchell R: An exploratory spatial data analysis approach to understanding the relationship between deprivation and mortality in Scotland. Soc Sci Med. 2007, 65: 1942-1952. 10.1016/j.socscimed.2007.05.052.CrossRefPubMed
57.
Inagami S, Cohen DA, Finch BK: Non-residential neighborhood exposures suppress neighborhood effect on self-rated health. Soc Sci Med. 2007, 65: 1779-1791. 10.1016/j.socscimed.2007.05.051.CrossRefPubMed
58.
Bosettingsmønster og segregasjon i storbyregionene. Ikke-vestlige innvandrere og grupper med høy og lav utdanning. Notater 2003/33. Statistics Norway. Oslo-Kongsvinger. 2003
59.
Jargowski PA, Kim J: A measure of spatial segregation: The generalized neighborhood sorting index. 2005, National Poverty Center Working Paper 05-3, University of Michigan
60.
Reardon SF, Matthews SA, O'Sullivan D, Lee BA, Firebaugh G, Farrell CR, Bischoff K: The geographic scale of metropolitan racial segregation. Demography. 2008, 45: 489-514. 10.1353/dem.0.0019.PubMedCentralCrossRefPubMed
Metadata
Title
Mortality effects of average education: a multilevel study of small neighbourhoods in rural and urban areas in Norway
Author
Øystein Kravdal
Publication date
01-12-2009
Publisher
BioMed Central
Published in
International Journal for Equity in Health / Issue 1/2009
Electronic ISSN: 1475-9276
DOI
https://doi.org/10.1186/1475-9276-8-41

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