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Biomedical subjects

S V Subramanian

Publications and source records attributed to S V Subramanian.

At least 37 records · Page 2Linked to original sources
PubMed2006

Population contextual associations with heterosexual partner numbers: a multilevel analysis.

OBJECTIVE: The study examines whether an individual's sexual behaviour is associated with the demographic context within which they live. METHODS: Data from a large behavioural survey were matched to the census and the number of opposite sex partners individuals reported having in the year before interview was modelled against a suite of individual characteristics and analogous characteristics for the population in which they lived. RESULTS: The number of partners reported (none, one, two, three, or more) were variously associated with an individual's gender, age, marital status, sexual identity, and same sex activity in the previous year. Additionally, population age structure, sex ratio, and the proportion of the population reporting specific patterns of sexual activity were associated with the behaviour of individuals. CONCLUSIONS: This study demonstrates that population context is associated with individual behaviour even after individual characteristics have been taken into account. This suggests that multilevel modelling of sexual behaviour data can provide new insights into the pattern of sexual behaviour.

Adolescent↗
PubMed2006

Indigenous health and socioeconomic status in India.

BACKGROUND: Systematic evidence on the patterns of health deprivation among indigenous peoples remains scant in developing countries. We investigate the inequalities in mortality and substance use between indigenous and non-indigenous, and within indigenous, groups in India, with an aim to establishing the relative contribution of socioeconomic status in generating health inequalities. METHODS AND FINDINGS: Cross-sectional population-based data were obtained from the 1998-1999 Indian National Family Health Survey. Mortality, smoking, chewing tobacco use, and alcohol use were four separate binary outcomes in our analysis. Indigenous status in the context of India was operationalized through the Indian government category of scheduled tribes, or Adivasis, which refers to people living in tribal communities characterized by distinctive social, cultural, historical, and geographical circumstances.Indigenous groups experience excess mortality compared to non-indigenous groups, even after adjusting for economic standard of living (odds ratio 1.22; 95% confidence interval 1.13-1.30). They are also more likely to smoke and (especially) drink alcohol, but the prevalence of chewing tobacco is not substantially different between indigenous and non-indigenous groups. There are substantial health variations within indigenous groups, such that indigenous peoples in the bottom quintile of the indigenous-peoples-specific standard of living index have an odds ratio for mortality of 1.61 (95% confidence interval 1.33-1.95) compared to indigenous peoples in the top fifth of the wealth distribution. Smoking, drinking alcohol, and chewing tobacco also show graded associations with socioeconomic status within indigenous groups. CONCLUSIONS: Socioeconomic status differentials substantially account for the health inequalities between indigenous and non-indigenous groups in India. However, a strong socioeconomic gradient in health is also evident within indigenous populations, reiterating the overall importance of socioeconomic status for reducing population-level health disparities, regardless of indigeneity.

Alcohol Drinking↗
PubMed2005

Role of socioeconomic markers and state prohibition policy in predicting alcohol consumption among men and women in India: a multilevel statistical analysis.

OBJECTIVE: To investigate the independent contribution of individual socioeconomic markers and state prohibition policy on alcohol consumption among men and women in India. METHODS: The study used a multilevel cross-sectional analysis of alcohol consumption from the 1998-1999 Indian national family health survey of 301 984 adult individuals in 92 447 households in 3215 villages in 440 districts in 26 states, stratified by sex. FINDINGS: Men with no education were more likely to consume alcohol that those with a post graduate education (OR, 2.28; 95% CI, 2.08-2.50). Unlike men, women showed a U-shaped association between education and alcohol consumption. Men and women living in households at the lowest standard-of-living quintile were more likely to consume alcohol (OR, 1.92; 95% CI, 1.81-2.03, and OR, 2.72, 95% CI, 2.18-3.39), respectively, than those classified as living in the top quintile. Members of scheduled tribes and castes and other backward classes were more likely to consume alcohol than members of other caste groups. There was no difference in alcohol consumption between men from states that were not under prohibition (OR, 1.36; 95% CI 0.69-2.03) and those that were. By contrast, states not under prohibition has higher alcohol use by women (OR, 3.04, 95% CI, 1.59-4.48) than those under partial or complete prohibition. CONCLUSION: Caste, education and standard of living independently influence alcohol use in India. Prohibition policies appear to have little effect on alcohol use by men, but may reduce the proportion of women who consume alcohol. The socioeconomic patterning of health behaviours is likely to feed substantially into inequalities in health outcomes. Further investigation is required to understand how social and cultural factors in more localized contexts (e.g. districts) influence alcohol consumption.

Alcohol Drinking↗
PubMed2005

Neighborhood contextual influences on depressive symptoms in the elderly.

To understand whether neighborhood contexts contribute to the onset or maintenance of mental health problems independently of individual characteristics requires the use of multilevel study designs and analytical strategies. This study used a multilevel analytical framework to examine the relation between neighborhood context and risk of depressive symptoms, using data from the New Haven component of the Established Populations for Epidemiologic Studies of the Elderly, a community-based sample of noninstitutionalized men and women aged 65 years or older and living in the city of New Haven, Connecticut, in 1982. Neighborhoods were characterized by census-based characteristics and also by measures of the neighborhood service environment using data abstracted from the New Haven telephone book Yellow Pages. Living in a poor neighborhood was associated with higher levels of depressive symptoms in older adults, above and beyond individual vulnerabilities. In addition, the presence of more elderly people in the neighborhood was associated with better mental health among older adults. The authors found no evidence that access to services hypothesized to promote social engagement, to provide health services, or to affect the reputation of a neighborhood explained (i.e., mediated) neighborhood variations in depressive symptoms.

Aged↗
PubMed2005

Comparison of a spatial perspective with the multilevel analytical approach in neighborhood studies: the case of mental and behavioral disorders due to psychoactive substance use in Malmo, Sweden, 2001.

Most studies of neighborhood effects on health have used the multilevel approach. However, since this methodology does not incorporate any notion of space, it may not provide optimal epidemiologic information when modeling variations or when investigating associations between contextual factors and health. Investigating mental disorders due to psychoactive substance use among all 65,830 individuals aged 40-59 years in 2001 in Malmö, Sweden, geolocated at their place of residence, the authors compared a spatial analytical perspective, which builds notions of space into hypotheses and methods, with the multilevel approach. Geoadditive models provided precise cartographic information on spatial variations in prevalence independent of administrative boundaries. The multilevel model showed significant neighborhood variations in the prevalence of substance-related disorders. However, hierarchical geostatistical models provided information on not only the magnitude but also the scale of neighborhood variations, indicating a significant correlation between neighborhoods in close proximity to each other. The prevalence of disorders increased with neighborhood deprivation. Far stronger associations were observed when using indicators measured in spatially adaptive areas, centered on residences of individuals, smaller in size than administrative neighborhoods. In neighborhood studies, building notions of space into analytical procedures may yield more comprehensive information than heretofore has been gathered on the spatial distribution of outcomes.

Adult↗
PubMed2005

The relative influence of individual and contextual socio-economic status on consumption of fruit and soft drinks among adolescents in Europe.

BACKGROUND: The number of studies among children and adolescents that focus on socio-economic differences in food habits is limited. Moreover, most are done in only one country and often include a non-representative sample. The present study examines whether socio-economic differences in the consumption of fruit and soft drinks can be found among young adolescents in a wide range of European countries. METHODS: Multilevel statistical analysis of 114 558 school-pupils aged 11, 13 and 15 from 28 countries participating in the WHO collaborative cross-national study of Health Behaviours among School-aged Children 2001-2002. The individual outcomes were daily fruit and soft drink consumption and the socio-economic predictors at the individual level were occupation of the head of household and family material wealth. Family material wealth was aggregated at the country level to operationalize country-level socio-economic status. RESULTS: In general, girls and younger pupils consumed fruit more often and soft drinks less often. Significant between-school, between-country and between-region differences were found. Fruit consumption increased with family material wealth and higher parental occupational status. Soft drink consumption was lower among pupils of higher parental occupational status in Northern, Southern and Western European countries, but not in Central and Eastern European countries. Only in Central and Eastern European countries was a significant increase in soft drink consumption with increasing family affluence found. The country level of family affluence did not seem to have an effect on either outcome variable. CONCLUSION: The findings underscore the importance of socio-economic factors in relation to the food habits of young adolescents.

Adolescent↗
PubMed2005

Poverty, child undernutrition and morbidity: new evidence from India.

Undernutrition continues to be a primary cause of ill-health and premature mortality among children in developing countries. This paper examines how the prevalence of undernutrition in children is measured and argues that the standard indices of stunting, wasting and underweight may each be underestimating the scale of the problem. This has important implications for policy-makers, planners and organizations seeking to meet international development targets. Using anthropometric data on 24 396 children in India, we constructed an alternative composite index of anthropometric failure (CIAF) and compared it with conventional indices. The CIAF examines the relationship between distinct subgroups of anthropometric failure, poverty and morbidity, showing that children with multiple anthropometric failures are at a greater risk of morbidity and are more likely to come from poorer households. While recognizing that stunting, wasting and underweight reflect distinct biological processes of clear importance, the CIAF is the only measure that provides a single, aggregated figure of the number of undernourished children in a population.

Anthropometry↗
PubMed2005

Area variation in mortality in Tasmania (Australia): the contributions of socioeconomic disadvantage, social capital and geographic remoteness.

This study investigated the association between socioeconomic disadvantage, social capital, geographic remoteness and mortality in the Australian state of Tasmania. The analysis is based on death rates among persons aged 25-74 years in 41 statistical local areas (SLA) for the period 1998-2000. Multilevel binomial regression indicated that death rates were significantly higher in disadvantaged areas. There was little support for an association between social capital and mortality, thereby contesting the often held notion that social capital is universally important for explaining variations in population health. Similarly, we found little evidence of a link between geographic remoteness and mortality, which contrasts with that found in other Australian states; this probably reflects the small size of Tasmania, and limited variation in the degree of remoteness amongst its SLA.

Adult↗
PubMed2005

Whose health is affected by income inequality? A multilevel interaction analysis of contemporaneous and lagged effects of state income inequality on individual self-rated health in the United States.

The empirical relationship between income inequality and health has been much debated and discussed. Recent reviews suggest that the current evidence is mixed, with the relationship between state income inequality and health in the United States (US) being perhaps the most robust. In this paper, we examine the multilevel interactions between state income inequality, individual poor self-rated health, and a range of individual demographic and socioeconomic markers in the US. We use the pooled data from the 1995 and 1997 Current Population Surveys, and the data on state income inequality (represented using Gini coefficient) from the 1990, 1980, and 1970 US Censuses. Utilizing a cross-sectional multilevel design of 201,221 adults nested within 50 US states we calibrated two-level binomial hierarchical mixed models (with states specified as a random effect). Our analyses suggest that for a 0.05 change in the state income inequality, the odds ratio (OR) of reporting poor health was 1.30 (95% CI: 1.17-1.45) in a conditional model that included individual age, sex, race, marital status, education, income, and health insurance coverage as well as state median income. With few exceptions, we did not find strong statistical support for differential effects of state income inequality across different population groups. For instance, the relationship between state income inequality and poor health was steeper for whites compared to blacks (OR=1.34; 95% CI: 1.20-1.48) and for individuals with incomes greater than $75,000 compared to less affluent individuals (OR=1.65; 95% CI: 1.26-2.15). Our findings, however, primarily suggests an overall (as opposed to differential) contextual effect of state income inequality on individual self-rated poor health. To the extent that contemporaneous state income inequality differentially affects population sub-groups, our analyses suggest that the adverse impact of inequality is somewhat stronger for the relatively advantaged socioeconomic groups. This pattern was found to be consistent regardless of whether we consider contemporaneous or lagged effects of state income inequality on health. At the same time, the contemporaneous main effect of state income inequality remained statistically significant even when conditioned for past levels of income inequality and median income of states.

Adult↗
PubMed2005

Women's status and depressive symptoms: a multilevel analysis.

The effects of state-level women's status and autonomy on individual-level women's depressive symptoms were examined. We conducted a multi-level analysis of the 1991 longitudinal follow up of the 1988 National Maternal Infant Health Survey (NMIHS), with 7789 women nested within the fifty American states. State-level women's status was assessed by four composite indices measuring women's political participation, economic autonomy, employment & earnings, and reproductive rights. The main outcome measure was symptoms of depression (Center for Epidemiologic Studies Depression Scale, CES-D). The participants were a nationally representative stratified random sample of women in the USA aged between 17 and 40 years old who gave birth to live babies in 1988, were successfully contacted again in 1991 and provided complete information on depressive symptoms. Women who were younger, non-white, not currently married, less educated or had lower household income tended to report higher levels of depressive symptoms. Compared with states ranking low on the employment & earnings index, women residing in states that were high on the same index scored 0.85 points lower on the CES-D (p<0.01). Women who lived in states that were high on the economic autonomy index scored 0.83 points lower in depressive symptoms (p<0.01), compared with women who lived in states low on the same index. Finally, women who resided in states with high reproductive rights scored 0.62 points lower on the CES-D (p<0.05) compared with women who lived in states with lower reproductive rights. Gender inequality appears to contribute to depressive symptoms in women.

Adolescent↗
PubMed2005

Racial residential segregation and geographic heterogeneity in black/white disparity in poor self-rated health in the US: a multilevel statistical analysis.

Existing evidence demonstrating a relationship between racial residential segregation and health has been based on aggregate analysis. Using a multilevel analytical framework, we assess the extent of geographic variation in black/white disparities in self-rated health across US metropolitan areas, and whether racial residential segregation accounts for such variation. We estimated multilevel regression models of poor self-rated health among 51,316 non-Hispanic white and non-Hispanic black adults nested within 207 metropolitan areas to assess the multilevel relationship between segregation and racial disparities in health. We found statistically significant variation in the black/white disparity in poor self-rated health across metropolitan areas, after controlling for individual level factors (age, sex, marital status, education and income) and residential segregation. High black isolation was associated with increased odds of reporting poor health among blacks (p<0.05). While a similar pattern was observed for white/black dissimilarity and white isolation, they were not statistically significant. Our multilevel analysis only partially supports the previously reported aggregate findings linking segregation to health. Additional multilevel statistical investigations across different health outcomes are required to draw firmer conclusions regarding the adverse effects of segregation on health.

Black or African American↗
PubMed2005

Can social factors explain sex differences in insomnia? Findings from a national survey in Taiwan.

STUDY OBJECTIVE: To examine sociological explanations for the higher level of insomnia in women, including social roles and socioeconomic status (SES). DESIGN: Cross sectional survey research SETTING: Taiwanese 2001 "social trend survey" PARTICIPANTS: A nationally representative sample of 39,588 citizens aged 15 years or older living in Taiwan. MAIN RESULTS: On average, women scored 1.25 points higher than men on the insomnia inventory (p<0.001) but after controlling for social roles, the sex discrepancy in insomnia decreased slightly. SES did not, however, explain women's higher levels of insomnia. Subscale analysis showed an association between the role of homemaker and increased night time sleep disturbance and decreased daytime sequelae of poor sleep while higher educational attainment was related only to more severe daytime sequelae. CONCLUSION: The sex discrepancy in insomnia narrowed slightly after taking social role factors into consideration but was not explained by SES. The persistent sex gap in insomnia warrants further investigation.

Adolescent↗
PubMed2005

Covariation in the socioeconomic determinants of self rated health and happiness: a multivariate multilevel analysis of individuals and communities in the USA.

OBJECTIVE: To investigate individual level determinants of self rated health and happiness, as well as the extent of community level covariation in health and happiness. DESIGN: Multivariate multilevel regression analysis of self rated poor health and unhappiness at level 1, nested within 24 118 people at level 2, nested within 36 communities at level 3. Data were obtained from the 2000 social capital benchmark survey. SETTING: USA communities. PARTICIPANTS: 24 118 adults. MAIN OUTCOME MEASURES: Self reported fair/poor health; and a single item measure of subjective wellbeing. RESULTS: Controlling for demographic markers, a strong income and education gradient was seen for self rated poor health and unhappiness, with the gradient being stronger for poor health. Community level correlations between self rated poor health and happiness were stronger (0.65) than the individual level correlations (0.16) between the two outcomes. CONCLUSION: Poor health and unhappiness are highly positively correlated within individuals, and communities that are healthier tend to be happier and vice versa.

Adolescent↗
PubMed2005

Youth smoking risk and community patterns of alcohol availability and control: a national multilevel study.

STUDY OBJECTIVE: To test whether college youth smoking risks are independently associated with community patterns of alcohol availability and control. DESIGN: Hierarchical multilevel multivariable modelling of cross sectional survey data. Outcomes included self reported current (past 30 day) cigarette smoking and heavy episodic (binge) drinking. SETTING: 120 nationally representative US colleges. PARTICIPANTS: 10 924 randomly selected students. MAIN RESULTS: Individual risks for smoking and binge drinking are independently associated with community patterns of alcohol availability, policy enforcement and control over and above individual perceptions about these factors, student and college characteristics, and school binge drinking rates. Youth exposed to high levels of alcohol availability are at higher risk of smoking (OR 3.61, 95% CI 1.75, 7.44) and binge drinking (OR 4.22, 95% CI 2.25, 7.93) than youth not so exposed; youth exposed to strongly enforced alcohol policy environments are at lower risk for smoking (OR 0.30, 95% CI 0.16, 0.57) and binge drinking (OR 0.17, 95% CI 0.10, 0.31) than youth not so exposed; youth exposed to communities with strong parental controls are at lower risk for smoking (OR 0.05, 95% CI 0.01, 0.23) and binge drinking (OR 0.06, 95% CI 0.01, 0.21) than youth not so exposed. Individual risks related to environmental exposures differ for youth with varying perceptions about alcohol availability and policy control. CONCLUSIONS: Drinking environments in US college communities comprise strong independent risks for smoking. Smoking prevention models should be tested that include environmental drinking prevention strategies tailored to underlying perceptions and experiences of college youth.

Adolescent↗
PubMed2005

Painting a truer picture of US socioeconomic and racial/ethnic health inequalities: the Public Health Disparities Geocoding Project.

OBJECTIVES: We describe a method to facilitate routine monitoring of socioeconomic health disparities in the United States. METHODS: We analyzed geocoded public health surveillance data including events from birth to death (c. 1990) linked to 1990 census tract (CT) poverty data for Massachusetts and Rhode Island. RESULTS: For virtually all outcomes, risk increased with CT poverty, and when we adjusted for CT poverty racial/ethnic disparities were substantially reduced. For half the outcomes, more than 50% of cases would not have occurred if population rates equaled those of persons in the least impoverished CTs. In the early 1990s, persons in the least impoverished CT were the only group meeting Healthy People 2000 objectives a decade ahead. CONCLUSIONS: Geocoding and use of the CT poverty measure permit routine monitoring of US socioeconomic inequalities in health, using a common and accessible metric.

Censuses↗
PubMed2005

Racial disparities in context: a multilevel analysis of neighborhood variations in poverty and excess mortality among black populations in Massachusetts.

OBJECTIVES: We analyzed neighborhood heterogeneity in associations among mortality, race/ethnicity, and area poverty. METHODS: We performed a multilevel statistical analysis of Massachusetts all-cause mortality data for the period 1989 through 1991 (n=142836 deaths), modeled as 79813 cells (deaths and denominators cross-tabulated by age, gender, and race/ethnicity) at level 1 nested within 5532 block groups at level 2 within 1307 census tracts (CTs) at level 3. We also characterized CTs by percentage of the population living below poverty level. RESULTS: Neighborhood variation in mortality across CTs and block groups was not accounted for by these areas' age, gender, and racial/ethnic composition. Neighborhood variation in mortality was much greater for the Black population than for the White population, largely because of CT-level variation in poverty rates. CONCLUSIONS: Neighborhood heterogeneity in the relationship between mortality and race/ethnicity in Massachusetts is statistically significant and is closely related to CT-level variation in poverty.

Adolescent↗
PubMed2004

Patterns and distribution of tobacco consumption in India: cross sectional multilevel evidence from the 1998-9 national family health survey.

OBJECTIVE: To investigate the demographic, socioeconomic, and geographical distribution of tobacco consumption in India. DESIGN: Multilevel cross sectional analysis of the 1998-9 Indian national family health survey of 301 984 individuals in 92 447 households in 3215 villages in 440 districts in 26 states. SETTING: Indian states. PARTICIPANTS: 301 984 adults (> or = 18 years). MAIN OUTCOME MEASURES: Dichotomous variable for smoking and chewing tobacco for each respondent (1 if yes, 0 if no) as well as a combined measure of whether an individual smokes, chews tobacco, or both. RESULTS: Smoking and chewing tobacco are systematically associated with socioeconomic markers at the individual and household level. Individuals with no education are 2.69 times more likely to smoke and chew tobacco than those with postgraduate education. Households belonging to the lowest fifth of a standard of living index were 2.54 times more likely to consume tobacco than those in the highest fifth. Scheduled tribes (odds ratio 1.23, 95% confidence interval 1.18 to 1.29) and scheduled castes (1.19, 1.16 to 1.23) were more likely to consume tobacco than other caste groups. The socioeconomic differences are more marked for smoking than for chewing tobacco. Socioeconomic markers and demographic characteristics of individuals and households do not account fully for the differences at the level of state, district, and village in smoking and chewing tobacco, with state accounting for the bulk of the variation in tobacco consumption. CONCLUSION: The distribution of tobacco consumption is likely to maintain, and perhaps increase, the current considerable socioeconomic differentials in health in India. Interventions aimed at influencing change in tobacco consumption should consider the socioeconomic and geographical determinants of people's susceptibility to consume tobacco.

Adolescent↗