Int. J. Environ. Res. Public Health 2010, 7(2), 333-352; doi:10.3390/ijerph7020333
Article

A Multilevel Model for Comorbid Outcomes: Obesity and Diabetes in the US

email
Received: 16 November 2009; Accepted: 21 January 2010 / Published: 27 January 2010
(This article belongs to the Special Issue Advances in Epidemiology)
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract: Multilevel models are overwhelmingly applied to single health outcomes, but when two or more health conditions are closely related, it is important that contextual variation in their joint prevalence (e.g., variations over different geographic settings) is considered. A multinomial multilevel logit regression approach for analysing joint prevalence is proposed here that includes subject level risk factors (e.g., age, race, education) while also taking account of geographic context. Data from a US population health survey (the 2007 Behavioral Risk Factor Surveillance System or BRFSS) are used to illustrate the method, with a six category multinomial outcome defined by diabetic status and weight category (obese, overweight, normal). The influence of geographic context is partly represented by known geographic variables (e.g., county poverty), and partly by a model for latent area influences. In particular, a shared latent variable (common factor) approach is proposed to measure the impact of unobserved area influences on joint weight and diabetes status, with the latent variable being spatially structured to reflect geographic clustering in risk.
Keywords: diabetes; obesity; multilevel; multinomial; latent variable; spatial; poverty
PDF Full-text Download PDF Full-Text [593 KB, uploaded 19 June 2014 02:28 CEST]

Export to BibTeX |
EndNote


MDPI and ACS Style

Congdon, P. A Multilevel Model for Comorbid Outcomes: Obesity and Diabetes in the US. Int. J. Environ. Res. Public Health 2010, 7, 333-352.

AMA Style

Congdon P. A Multilevel Model for Comorbid Outcomes: Obesity and Diabetes in the US. International Journal of Environmental Research and Public Health. 2010; 7(2):333-352.

Chicago/Turabian Style

Congdon, Peter. 2010. "A Multilevel Model for Comorbid Outcomes: Obesity and Diabetes in the US." Int. J. Environ. Res. Public Health 7, no. 2: 333-352.


Int. J. Environ. Res. Public Health EISSN 1660-4601 Published by MDPI AG, Basel, Switzerland RSS E-Mail Table of Contents Alert