Counterfactual Models of Neighborhood Effects: The Effect ...
지역과다수준분석 Neighborhood effects and multilevel...
Transcript of 지역과다수준분석 Neighborhood effects and multilevel...
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지역과다수준분석
Neighborhood effects and multilevel analysis
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SHHN KP
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KAP
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Relationship btw the proportion of lower social class and age-standardized mortality
Source: Taeho YoonDeath per 100,000
Proportion of lower social class
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서울시 424개동의지역박탈지수와사망률(2005-2010년도)의관련성
인구
10만명당사망률
지역박탈지수
원크기는동별초과사망자수(최저사망률동대비)를반영함.
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“It is perhaps unsurprising that epidemiologists generally avoid such analyses (ecological analyses)…, though this is in my opinion a great shame. Most epidemiology courses or textbooks spend much time and effort elaborating the technical aspects of cohort or case–control studies but give little time or space to ecological studies and natural experiments and may or may not include statistical methods such as time series analysis.”
“Simple cross-sectional ecological associations are usually dismissed as mere hypothesis-generating exercises, confounded by the ecological fallacy and very weak evidence for causality. However, temporal ecological data or, where one is fortunate, a population-based natural experiment provides far more robust evidence.”
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왜 지역에 관심을 갖는가?
• 정책의진입지점으로서의지역
– 저소득층 밀집지역이 어디인가? 건강 수준이 좋지 않은 사람들은 어디에
모여 사는가?
– 자원배분을 위한 단위로서의 지역
• 지역의효과에대한관심
– 질병의 원인이 개인이 아닌 지역에 위치할 경우
– 지역에 대한 투자개인에 대한 효과
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What is the effect of neighborhood on health?
• Compositional effect– Non-causal association
• Contextual effect– Causal association
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지역은 어떻게 건강에 영향을 미치는가?
• Non-causal explanation
– compositional effect
• Physical environment
– Pollutants, PM10, PM2.5
• Material factors
– Access to healthcare/social
services, housing, healthy food
• Behavioral factors
– Access to parks, commercial
stores (tobacco & alcohol)
• Psychosocial factors
– Social supports
• Cultural factors
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Advertising of Candy, Breakfast Cereals, Fast Food and Drinks During Children’s Television Viewing Hours
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* Comprises about 75% of all advertising in these time periods
Dibbs. UK Consumers Union, 1996
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Advertising of Fresh Fruit and Vegetables During Children’s Television Viewing Hours
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Dibbs. UK Consumers Union, 1996
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Neighborhood matters:도시공원 분포의 형평성-성남시 사례
신지영. 한국환경복원기술학회지 2009
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도시공원 분포의 형평성-성남시 사례
신지영. 한국환경복원기술학회지 2009
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출생아 1,000명당산부인과전문의수의시군구별분포(전국)
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출생아 1,000명당산부인과전문의수의분포(서울과부산)
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지역 박탈 지수에 따른 출생건수당 산부인과 전문의 수 분포
전문의수
/출생아
1000명
(낮은박탈지수) 지역박탈지수 5분위 (높은박탈지수)
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지역 박탈 지수에 따른 출생건수당 소아과 전문의 수 분포
전문의수
/출생아
1000명
(낮은박탈지수) 지역박탈지수 5분위 (높은박탈지수)
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지역 박탈 지수에 따른 자살 사망자수 대비 정신건강의학과전문의 수 (2011년도 기준) 분포 – 하나의 점은 하나의 시군구를 의미
전문의수
/자살사망자수
(낮은박탈지수) 지역박탈지수 5분위 (높은박탈지수)
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NEJM, 2001
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Neighborhood Effect on CHD
Incidence, ARIC (Atherosclerosis
Risk in Communities) Study of Four
Study Site in US
Diez-Roux et al,N Engl J Med(2001)
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Neighborhood Effect on CHD
Incidence, ARIC (Atherosclerosis
Risk in Communities) Study of Four
Study Site in US
Diez-Roux et al,N Engl J Med(2001)
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지역/맥락에 대한 관심이 왜필요한가?
Type III Error: Right Answer to Wrong
Question
Schwartz & Carpenter. The right answer for the wrong question: consequences of type III error for public health research. AJPH (1999)
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Type III Error의 양상: Homeless• Homeless에대한기존의연구
– Homeless인사람과아닌사람들의개인적특성 individual risk factor 을비교(남성,
알코올중독자, 실직자, 정신질환자등)
• 이들연구는 homeless의원인을찾고있는가?
• 이들특성을교정함으로써 homeless를없앨수있는가?
• 아니라면, 이들연구들이밝힌내용은무엇을의미하는가?
– Individual susceptibility
• 이들 susceptibility에초점을둔 intervention은어떤의미를지닐것인가?
– Population incidence of homelessness vs. individual adaptation skill
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Ecologic Fallacy
Atomistic Fallacy
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Fallacy of the Ecological Fallacy
• Individual-level models are more perfectly specified than ecological-level model.
• Ecological models are substitutes for individual-level models.
• Only characteristics of individuals cause disease.
Schwartz, AJPH (1994)
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Rates of homicide in Chicago and England and Wales by age and sex of perpetrator
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왜 multilevel analysis인가?
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Engels (1845), p136Class of the Houses
No Houses
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Class of the Streets
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용어
• Multilevel model
• Hierarchical model
• Random effect model
• Covariance components model
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Income level
Math. Achievement
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Income level
Math. Achievement
Public School
Catholic School
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Multilevel Model: Example
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Multilevel Analysis를 위한 통계 팩키지
• HLM, Scientific Software International Lincolnwood, IL
• MLn, Institute of Education, London, UK
• VARCL, iec ProGAMMA, The Netherlands
• MIXREG, MIXOR & MIXNO, University of Illinois, Chicago, IL
• SAS procedure MIXED & SAS GLIMMIX macro, SAS Institute, Cary, NC
• BMDP5-V, Statistical Solutions Ltd., Ireland, UK
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왜 multilevel analysis를 해야 하는가?
• 집단내상관성 Intraclass correlation (ICC) 이로인한표준오차의추정오류
• 전체분산중에서지역수준의분산이차지하는비율
• 로짓회귀분석– ICC = neighborhood variance / (neighborhood variance + π2/3)– π2/3 : 개인 간 분산
• 특정변수에의해설명되는분산의분율– Vexplained = (Vunadjusted – Vadjusted)/ Vunadjusted * 100
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동일한관련성을보이더라도 ICC의크기에따라지역의영향력은전혀다른양상을보인다.
ICC = 21% ICC = 84%
Same β = 4.9 Merlo et al. JECH 2001
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Merlo. JECH 2003
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연구 사례
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서울의 파워엘리트의 분포
김창석 (2002)
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Age-adjusted smoking prevalence by the LQ levels of Power Elite distribution among male Seoul citizens aged 15+
(N=26,022)
김창석, 윤성철, 김혜련, 강영호. 예방의학회지 2006
%
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김창석, 윤성철, 김혜련, 강영호. 예방의학회지 2006
Age-adjusted smoking prevalence by the LQ levels of Power Elite distribution among female Seoul citizens aged 15+
(N=28,007)
%
![Page 39: 지역과다수준분석 Neighborhood effects and multilevel analysissnu-dhpm.ac.kr/pds/files/지역효과_강영호.pdf · 2015. 10. 2. · Neighborhood effects and multilevel analysis.](https://reader034.fdocuments.net/reader034/viewer/2022051822/5febfe618230846d7875fe97/html5/thumbnails/39.jpg)
0.025 > 2*0.009지역에 따른변이가통계적으로 유의미하다
0.0075=0.025/(0.025+3.142/3)
24.2=(0.033–0.025)/0.033*100개인의 소득은흡연율의 지역간변이를 24.2% 설명한다
Men
교육수준 만으로동단위변이를 상당부분설명한다
![Page 40: 지역과다수준분석 Neighborhood effects and multilevel analysissnu-dhpm.ac.kr/pds/files/지역효과_강영호.pdf · 2015. 10. 2. · Neighborhood effects and multilevel analysis.](https://reader034.fdocuments.net/reader034/viewer/2022051822/5febfe618230846d7875fe97/html5/thumbnails/40.jpg)
Women
How to explain this pattern?
![Page 41: 지역과다수준분석 Neighborhood effects and multilevel analysissnu-dhpm.ac.kr/pds/files/지역효과_강영호.pdf · 2015. 10. 2. · Neighborhood effects and multilevel analysis.](https://reader034.fdocuments.net/reader034/viewer/2022051822/5febfe618230846d7875fe97/html5/thumbnails/41.jpg)
Changes in OR (by multilevel analysis) of smoking by location quotients (LQ) level of power elites for the 19,351 men aged 25-64 and residing in
the 504 dong: the 2001 Seoul Health Indicators Survey
김창석, 윤성철, 김혜련, 강영호. 예방의학회지 2006
OR
![Page 42: 지역과다수준분석 Neighborhood effects and multilevel analysissnu-dhpm.ac.kr/pds/files/지역효과_강영호.pdf · 2015. 10. 2. · Neighborhood effects and multilevel analysis.](https://reader034.fdocuments.net/reader034/viewer/2022051822/5febfe618230846d7875fe97/html5/thumbnails/42.jpg)
OR
Changes in OR (by multilevel analysis) of smoking by location quotients (LQ) level of power elites for the 19,982 women aged 25-64 and residing
in the 504 dong: the 2001 Seoul Health Indicators Survey
김창석, 윤성철, 김혜련, 강영호. 예방의학회지 2006
![Page 43: 지역과다수준분석 Neighborhood effects and multilevel analysissnu-dhpm.ac.kr/pds/files/지역효과_강영호.pdf · 2015. 10. 2. · Neighborhood effects and multilevel analysis.](https://reader034.fdocuments.net/reader034/viewer/2022051822/5febfe618230846d7875fe97/html5/thumbnails/43.jpg)
동일한 자료를 multilevel analysis로 분석하지않았다면?
![Page 44: 지역과다수준분석 Neighborhood effects and multilevel analysissnu-dhpm.ac.kr/pds/files/지역효과_강영호.pdf · 2015. 10. 2. · Neighborhood effects and multilevel analysis.](https://reader034.fdocuments.net/reader034/viewer/2022051822/5febfe618230846d7875fe97/html5/thumbnails/44.jpg)
![Page 45: 지역과다수준분석 Neighborhood effects and multilevel analysissnu-dhpm.ac.kr/pds/files/지역효과_강영호.pdf · 2015. 10. 2. · Neighborhood effects and multilevel analysis.](https://reader034.fdocuments.net/reader034/viewer/2022051822/5febfe618230846d7875fe97/html5/thumbnails/45.jpg)
0.118 > 2*0.020지역에 따른변이가통계적으로 유의미하다
35.6%=(0.118-0.076)/0.118*100
65.3%%=(0.118-0.041)/0.118*10065.3%-35.6%=29.7%
87.3%%=(0.118-0.015)/0.118*10087.3%-65.3%=22%
박탈지역의 낮은교육계층과 육체직에서 더높은 손상사망을 보인다.
![Page 46: 지역과다수준분석 Neighborhood effects and multilevel analysissnu-dhpm.ac.kr/pds/files/지역효과_강영호.pdf · 2015. 10. 2. · Neighborhood effects and multilevel analysis.](https://reader034.fdocuments.net/reader034/viewer/2022051822/5febfe618230846d7875fe97/html5/thumbnails/46.jpg)
방법론적 이슈들(1)
• 지역의단위
– 읍면동, 시군구, 광역시도, 국가/행정적단위, 생활권/주소, 실거주지, 주 활동
장소중에서어디를측정하여야하나?
• 개인지표
– 얼마나정확하게개인지표를측정하여야하나? Residual confounding
– 어떤개인지표가추가되어야하나?
• 지역지표
– 어떤지역지표가활용되어야하나? 파워엘리트집중도, 박탈지표는무엇을
의미하는가? 이의측정치는정확한가?
– 현재의지역지표가의미가있는가? 아니면과거의지역지표가의미가있는가?
![Page 47: 지역과다수준분석 Neighborhood effects and multilevel analysissnu-dhpm.ac.kr/pds/files/지역효과_강영호.pdf · 2015. 10. 2. · Neighborhood effects and multilevel analysis.](https://reader034.fdocuments.net/reader034/viewer/2022051822/5febfe618230846d7875fe97/html5/thumbnails/47.jpg)
방법론적 이슈들(2)
• 관련성의크기
– 지역 지표의 관련성 크기 vs 개인 지표의 관련성의 크기
• 결과지표
– 모든 결과 지표에 동일한 지역지표, 동일한 개인 특성이 사용될 수 있는가?
여전히 중요한 것은 연구자의 문제설정이다.
![Page 48: 지역과다수준분석 Neighborhood effects and multilevel analysissnu-dhpm.ac.kr/pds/files/지역효과_강영호.pdf · 2015. 10. 2. · Neighborhood effects and multilevel analysis.](https://reader034.fdocuments.net/reader034/viewer/2022051822/5febfe618230846d7875fe97/html5/thumbnails/48.jpg)
왜사람들의건강과행태는지역단위지표의영향을
받는가?
지역단위지표는어떻게인간의건강과행태에
영향을미치는가?
흡연 – 지역내의광고, 담배소매점수, 담배회사의지역별홍보접근전략, 지역의금연
프로그램에의접근성등
손상 – 정비되지않은인도/차도, 도시설계문제, 건축현장에의아동의접근성, 손상시
의료기관접근성, 아동들의놀수있는공간에의접근성, 지역별손상방지대책, 아동들의
여가활동에대한지역별태도/문화의차이
![Page 49: 지역과다수준분석 Neighborhood effects and multilevel analysissnu-dhpm.ac.kr/pds/files/지역효과_강영호.pdf · 2015. 10. 2. · Neighborhood effects and multilevel analysis.](https://reader034.fdocuments.net/reader034/viewer/2022051822/5febfe618230846d7875fe97/html5/thumbnails/49.jpg)
다수준 분석 결과의 유의성만이 중요한 것은
아니다.
다수준 분석 결과가 유의하게 나왔다면, 정작
문제는 왜 그러한 contextual effect가 있는가를
규명하는 것이다.
![Page 50: 지역과다수준분석 Neighborhood effects and multilevel analysissnu-dhpm.ac.kr/pds/files/지역효과_강영호.pdf · 2015. 10. 2. · Neighborhood effects and multilevel analysis.](https://reader034.fdocuments.net/reader034/viewer/2022051822/5febfe618230846d7875fe97/html5/thumbnails/50.jpg)
Chaix. Annu Rev Public Health 2009