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Health Place. 2009 Mar;15(1):198-203. doi: 10.1016/j.healthplace.2008.04.005. Epub 2008 Apr 30.

Compositional and contextual approaches to the study of health behaviour and outcomes: using multi-level modelling to evaluate Wilkinson's income inequality hypothesis.

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  • 1Department of Primary Care and Social Medicine, Imperial College London, London W6 8RP, UK. m.h.jen@imperial.ac.uk


Much research into health behaviour and outcomes involves evaluating compositional and contextual hypotheses: the former suggest that behaviour/outcomes are a function of the individual's characteristics alone, whereas the latter argue for the importance of contextual/environmental influences. Wilkinson has presented a contextual argument relating inter-country variations in mortality rates to income inequalities; Gravelle has countered this arguing that Wilkinson's findings are a statistical artefact and that a compositional approach, relating mortality to individual income, is sufficient. Discriminating between these two cases requires a methodology combining the two approaches. Multi-level modelling is proposed and applied to two data sets. The results sustain Gravelle's case, emphasising the role of compositional rather than contextual variables in accounting for inter-country variations in health status.

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