Individual self-reported health, social participation and neighbourhood:: a multilevel analysis in Malmo, Sweden

Background. The influence of neighbourhood and individual factors on self-reported health was investigated. Methods. The public health survey in Malmo 1994 is a cross-sectional study. A total of 3,602 individuals aged 20-80 living in 75 neighbourhoods answered a postal questionnaire. The participation rate was 71%. A multilevel logistic regression model, with individuals at the first level and neighbourhoods at the second, was performed. We analysed the effect (intra-area correlation, cross-level modification and odds ratios) of neighbourhood on self-reported health after adjustment for individual factors. Results. The neighbourhoods accounted for 2.8% of the crude total variance in self-reported health status. This effect was significantly reduced when individual factors such as country of origin, education and social participation were included in the model. In fact, no significant variance in self-reported health remained after the introduction of the individual factors in the model. Conclusions. In Malmo, the neighbourhood variance in self-reported health is mainly affected by individual factors, especially country of origin, socioeconomic status measured as level of education and individual social participation. (C) 2004 The Institute For Cancer Prevention and Elsevier Inc. All rights reserved.