American Journal of Epidemiology
Volume 157, Issue 9, 2003, Pages 774-783

Effect of neighborhood social participation on individual use of hormone replacement therapy and antihypertensive medication: A multilevel analysis (Article) (Open Access)

Merlo J.* , Lynch J.W. , Yang M. , Lindström M. , Östergren P.O. , Rasmusens N.K. , Råstam L.
  • a Department of Community Medicine, Malmö University Hospital, Lund University, Malmö, Sweden, NEPI Foundation, Malmö University Hospital, Lund University, Malmö, Sweden, Department of Community Medicine, Malmö University Hospital, S-205 02 Malmö, Sweden
  • b Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, United States, Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, United States
  • c Multilevel Models Project, Institute of Education, University of London, London, United Kingdom
  • d Department of Community Medicine, Malmö University Hospital, Lund University, Malmö, Sweden
  • e Department of Community Medicine, Malmö University Hospital, Lund University, Malmö, Sweden
  • f Danish Natl. Inst. of Public Health, Copenhagen, Denmark
  • g Department of Community Medicine, Malmö University Hospital, Lund University, Malmö, Sweden

Abstract

The authors investigated a possible contextual effect of neighborhood on individual use of hormone replacement therapy (HRT) and antihypertensive medication (AHM) and the impact of neighborhood social participation on individual use of these medications. They attempted to disentangle contextual from individual influences. Multilevel logistic regression modeling was used to analyze data on 15,456 women aged 45-73 years (first level) residing in 95 neighborhoods (second level) of the city of Malmö, Sweden (250,000 inhabitants) who participated in the Malmö Diet and Cancer Study (1991-1996). AHM use was studied among 7,558 participants with defined hypertension. Of the total variability in medication use in this population, only 1.7% (HRT) and 0.5% (AHM) was between neighborhoods, After adjustment for age, individual socioeconomic factors, individual low levels of social participation, and health and behavioral variables, no neighborhood effect on AHM use was found. However, women living in neighborhoods with low social participation were much less likely to use HRT (odds ratio = 0.36, 95% confidence interval: 0,21, 0.63), especially if they themselves experienced low social participation (synergy index, 1.53) or were immigrants (synergy index, 1.68). The Malmö neighborhoods were homogeneous with regard to HRT and especially AHM use. However, differences in neighborhood social participation affected HRT use independently of individual characteristics.

Author Keywords

social medicine Pharmacoepidemiology Antihypertensive agents Hormone replacement therapy Analysis of variance Social environment

Index Keywords

immigrant regression analysis gestagen beta adrenergic receptor blocking agent multivariate logistic regression analysis Prospective Studies drug user human middle aged Cohort Studies antihypertensive therapy pharmacoepidemiology social aspect hypertension Aged neighborhood Residence Characteristics sex hormone Sweden Humans diuretic agent calcium channel blocking agent female hormone substitution Article women's health dipeptidyl carboxypeptidase inhibitor major clinical study adult Social Environment drug use antihypertensive agent age distribution Emigration and Immigration social medicine Patient Acceptance of Health Care Antihypertensive Agents Estrogen Replacement Therapy local participation estrogen
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-0038078094&doi=10.1093%2faje%2fkwg053&partnerID=40&md5=0d6a011b94102dc8943cadd808ae2717
DOI: 10.1093/aje/kwg053
ISSN: 00029262
Cited by: 43
Original Language: English