A hierarchical analysis of long-term illness and mortality in socially deprived areas

This article is a multilevel analysis of the effects on self-reported long-term illness and mortality of the socio-economic position of the neighbourhood. Using data from the Swedish Level of Living Survey, neighbourhood social position is measured by a composite Care Need Index, (CNI) together with such indicators of individual socio-economic position as occupation and housing tenure, with adjustment for age, sex, marital status and social network. Data came from 22,236 people aged 25–74, and were collected from 1988 to 1992. The cross-sectional data were analysed using a hierarchical logistic regression model. In a second analysis, each participant was followed from the initial interview until his or her death, or until the termination of data collection (31 December 1996). A neighbourhoodʹs low social position and an individual residentʹs low socio-economic position (i.e., a manual worker, or person renting a flat) were found to be associated with increased risk of long-term illness. We conclude that a neighbourhoodʹs low socio-economic position, that is, a high score on the CNI, is a risk factor for long-standing illness above and beyond an individualʹs socio-economic position. The differences in mortality could be explained by the included independent individual variables.