Abstract
Objective
To discuss critically the contribution of using second-level residuals from multilevel analyses to further the understanding of how place relates to health and to visualize areas, in the province of Quebec (Canada), with above- and below-average levels of overweight.
Methods
Data on 20,449 individuals are from the Canadian Community Health Survey (CCHS Cycle 2.1) and were linked to 51 spatial units. Area-level residuals were computed from a multilevel analysis examining individual and area characteristics associated with the risk of overweight. Mapping the area-level residuals indicates geographic areas where the risk of overweight is higher or lower compared to the provincial adjusted prevalence.
Results
Controlling for socio-economic conditions and lifestyle, distinct spatial patterns of overweight were observed, indicating that the processes linking place to health may differ between men and women and between regional contexts. In some regions, the probability of overweight differed by 23% for men and 38% for women living in privileged conditions in comparison to the province’s adjusted prevalence of overweight.
Conclusions
Analyzing and visualizing area-level residuals provides multi-scaled information that could enhance the understanding of the geographic distribution of overweight and has the potential to support more integrated and locally relevant interventions.
Key words: Overweight, obesity, Québec, medical geography, multilevel analysis, population health
Résumé
Objectifs
Utiliser les résidus de second niveau issus d’une analyse multiniveau pour comprendre le rôle du milieu de vie sur la santé et pour visualiser les endroits dans la province de Québec (Canada) ayant un niveau d’excès de poids significativement différent de la moyenne provinciale.
Méthodes
Les données individuelles d’un échantillon de 20 449 personnes proviennent de l’Enquête sur la santé des collectivités canadiennes (Cycle 2.1) et sont liées à 51 secteurs géographiques. Suite à une régression logistique multiniveau visant à explorer les caractéristiques individuelles et des milieux associées au surpoids, les résidus de second niveau associés aux secteurs géographiques ont été calculés. La cartographie de ces résidus informe sur les secteurs qui présentent un risque de surpoids supérieur ou inférieur à la prévalence provinciale ajustée.
Résultats
En contrôlant pour les caractéristiques socioéconomiques et les habitudes de vie des individus, de nets patrons de distribution d’excès de poids ont été observés distinctement pour les hommes et les femmes, ainsi que pour les régions. Ceci indique que les processus qui mettent en lien le milieu de vie et l’excès de poids peuvent différer selon le sexe et le contexte géographique. En comparaison à la prévalence ajustée de la province, la probabilité de surpoids varie jusqu’à 23 % pour les hommes et 38 % pour les femmes qui vivent dans des conditions privilégiées.
Conclusion
L’analyse et la cartographie des résidus de second niveau produisent une information multi-échelle qui peut permettre d’améliorer la compréhension de la distribution territoriale de la santé et justifier la réalisation d’interventions pertinentes à l’échelle régionale et locale.
Mots clés: excès de poids, obésité, Québec, géographie médicale, analyse multiniveau, santé publique
Footnotes
Acknowledgements: This research could not have been carried out without the financial support of the Quebec Population Health Research Network (QPHRN), the Quebec Inter-University Centre for Social Statistics (QICSS), and the Fonds de la recherche en santé du Québec (FRSQ). The Institut national de santé publique du Québec (INSPQ) and the Natural Science and Engineering Research Council of Canada (NSERCC) also contributed to this study. Finally, we thank Denis Hamel for his statistical advice and Pierre Masson for his revision of an earlier version of this paper.
Conflict of Interest: None to declare.
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