Epidemiol Rev 2004;26:104-111
© 2004 by the Oxford University Press
The Study of Group-Level Factors in Epidemiology: Rethinking Variables, Study Designs, and Analytical Approaches
From the Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI.
Correspondence to Dr. Ana V. Diez Roux, 1214 S. University, 2nd Floor, Ann Arbor, MI 48104-2548 (adiezrou@umich.edu).
Received for publication December 16, 2003; accepted for publication March 11, 2004.
| The first 150 words of the full text of this article appear below. |
A key notion that has received much attention in epidemiology over the past few years has been that not all disease determinants can be conceptualized as individual-level attributes, hence the need to consider features of the groups to which individuals belong when studying the causes of ill health. This has led epidemiologists and public health researchers to rethink the ideas on ecologic studies and ecologic variables traditionally espoused in epidemiology (1–6). This reconceptualization of ecologic or group-level variables has been manifested, for example, in recent interest and debate on the possible health effects of group-level constructs, such as income inequality (7, 8), social capital (9, 10), and neighborhood characteristics (11–14). In this context, the advent of the statistical technique of multilevel models has been viewed as especially promising because of its ability to incorporate both group-level
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RECONSIDERING GROUP-LEVEL VARIABLES |
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RETHINKING THE ECOLOGIC FALLACY |
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CONTRASTING STUDY DESIGNS |
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DESIGN AND SAMPLE SIZE |
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GROUPS AND GROUP-LEVEL VARIABLES |
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SELECTING THE RELEVANT GROUPS OR "LEVELS" |
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DISTAL AND PROXIMAL FACTORS |
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OBSERVATIONAL STUDIES AND CAUSAL INFERENCE |
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CONCLUSION |
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