Socioeconomic and geographical disparities in health and health care utilisation - a longitudinal and contextual (multilevel and spatial) analysis
Principal investigator; Merlo, Juan, Professor, MD/PhD
Clinical speciality: Social medicine
Many studies have shown differences in the social distribution of health (e.g., cardiovascular diseases) and health care utilization (e.g., medication) according to geographical and economic factors. In a life-course developmental framework, environmental factors are literally embodied over time, an aspect that is especially relevant for chronic disorder like arteriosclerosis related diseases that have a long natural history.
Today, research within Social epidemiology and Public Health is aimed at improving our understanding of the mechanisms leading to inequalities in health and health care utilization, and the way geographical and socio-economic contexts influence individuals. Longitudinal (i.e., life course) and multi-level (i.e., contextual / spatial) methodological approaches have become the most important "lenses" through which we can gain better understanding of those processes.
Combining longitudinal and contextual (multilevel and spatial) approaches this project aims to understand the life-course and contextual mechanisms underlying socioeconomic inequalities in cardiovascular diseases (CVDs). We investigate the interrelation between the physical and the social environment and the proximal mechanisms that mediate contextual effects on CVDs. We consider two possibly complementary hypotheses: the psychosocial and the materialist and conceptualize the social environment within different theories, particularly that of social capital and social cohesion. We measure context by state of the art ecometric techniques and apply multilevel and also spatial analytical techniques that go beyond administrative criteria and consider the natural places where the individuals interact.
Our project joins together life-course and macro-level influences in different socioeconomic groups and develops innovative epidemiological methods (longitudinal, multilevel and spatial analysis). Our research contributes to the scientific explanation of health inequalities and proportionates a basis for planning evidence-based health policy. Since equity in health is a cornerstone of the Swedish public health system, understanding longitudinal, multilevel and spatial differences in health is very relevant in the context of ideas about the efficacy of focusing intervention on places instead of people and on specific life periods.
The data available to us in Skåne are relatively unique in the world and offer and important opportunity for investigating social disparities in health and health care utilisation.
Link to project homepage: http://www.med.lu.se/social_epidemiology
5 recent original publications
Merlo Juan, Ohlsson Henrik, Chaix Basile, Lichtenstein Paul, Kawachi Ichiro, Subramanian S V
Revisiting causal neighborhood effects on individual ischemic heart disease risk: A quasi-experimental multilevel analysis among Swedish siblings.
Social science & medicine (1982). 2012; Oct.,24: -
Pía Juárez S, Merlo J
The effect of maternal smoking during pregnancy on offspring birthweight: a quasi-experimental sibling analysis in Sweden
PLoS ONE. 2013; :
• Merlo J, Viciana-Fernández FJ, Ramiro-Fariñas D
Research Group of Longitudinal Database of Andalusian Population (LDAP).Bringing the individual back to small-area variation studies: a multilevel analysis of all-cause mortality in Andalusia, Spain.
Soc Sci Med. . 2012 Oct; 75(8):: 1477-87
Gray Linsay, Merlo Juan, Mindell Jennifer, Hallqvist Johan, Tafforeau Jean, O‘Reilly Dermot, Regidor Enrique, Naess Oyvind, Kelleher Cecily, Helakorpi Satu, Lange Cornelia, Leyland Alastair H.
International differences in self-reported health measures in 33 major metropolitan areas in Europe
European Journal of Public Health. 2012; 22: 40 - 47
Ohlsson Henrik, Merlo Juan
Place effects for areas defined by administrative boundaries: A life course analysis of mortality and cause specific morbidity in Scania, Sweden.
Social science & medicine (1982). 2011; 73: 1145 - 1151
Further publications here (new window)