Melbourne School of Population and Global Health - Research Publications

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Author: Kavanagh, Anne × End date: 2012 × Subject: multilevel analysis ×

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    Does area-based social capital matter for the health of Australians? A multilevel analysis of self-rated health in Tasmania
    Kavanagh, Anne M. ; TURRELL, GAVIN ; SUBRAMANIAN, S. V. (Oxford University Press, 2006)
    BACKGROUND: Material circumstances and collective psychosocial processes have been invoked as potential explanations for socioeconomic inequalities in health; and, linking social capital has been proposed as a way of reconciling these apparently opposing explanations. METHODS: We conducted multilevel logistic regression of self-rated health (fair or poor vs excellent, very good, or good) on 14,495 individuals living within 41 statistical local areas who were respondents to the 1998 Tasmanian Healthy Communities Study. We modelled the effects of area-level socioeconomic disadvantage and social capital (neighbourhood integration, neighbourhood alienation, neighbourhood safety, social trust, trust in public/private institutions, and political participation), and adjusted for the effects of individual characteristics. RESULTS: Area-level socioeconomic disadvantage was associated with poor self-rated health (OR 1.10, 95% CI 1.07-1.13) an effect that was attenuated, but remained significant, after adjusting for individual characteristics (OR 1.04, 95% CI 1.02-1.07). Social trust was associated with a reduction in poor self-rated health (OR 0.95, 95% CI 0.92-0.99) and remained significant when individual characteristics (OR 0.96, 95% CI 0.93-0.99) were included. Political participation was non-significant in the unadjusted model but became significant when adjusted for individual characteristics (OR 0.77, 95% CI 0.62-0.97). The effects of social trust and political participation were attenuated and became non-significant when area-level socioeconomic disadvantage was included. CONCLUSION: Area-based socioeconomic disadvantage is a determinant of self-rated health in Tasmania, but we did not find an independent effect of area-level social capital. These findings suggest that in Tasmania investments in improving the material circumstances in which people live are likely to lead to greater improvements in population health than attempts to increase area-level social capital.
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    Weight and place: a multilevel cross-sectional survey of area-level social disadvantage and overweight/obesity in Australia
    King, T ; Kavanagh, A. M. ; JOLLEY, D. ; TURRELL, G. ; CRAWFORD, D. ( 2005)
    OBJECTIVE: To estimate variation between small areas in adult body mass index (BMI), and assess the importance of area level socioeconomic disadvantage in predicting BMI. METHODS: We identified all census collector districts (CCDs) in the 20 innermost Local Government Areas in metropolitan Melbourne, Australia, and ranked them by the percentage of low income households (o$400/week). In all, 50 CCDs were randomly selected from the least, middle and most disadvantaged septiles of the ranked list and 4913 residents (61.4% participation rate) completed one of two surveys. Multilevel linear regression was used to estimate area level variance in BMI and the importance of area level socioeconomic disadvantage in predicting BMI. RESULTS: There were significant variations in BMI between CCDs for women, even after adjustment for individual and area SES (P¼0.012); significant area variation was not found for men. Living in the most versus least disadvantaged areas was associated with an average difference in BMI of 1.08 kg/m2 (95% CI: 0.48–1.68 kg/m2) for women, and of 0.93 kg/m2 (95% CI: 0.32–1.55 kg/m2) for men. Living in the mid versus least disadvantaged areas were associated with an average difference in BMI of 0.67 kg/m2 (95% CI: 0.09–1.26 kg/m2) for women, and 0.43 kg/m2 for men (95% CI: 0.16–1.01). CONCLUSION: These findings suggest that area disadvantage is an important predictor of adult BMI, and support the need to focus on improving local environments to reduce socioeconomic inequalities in overweight and obesity.