Place effects for areas defined by administrative boundaries: a life course analysis of mortality and cause specific morbidity in Scania, Sweden

To understand the origin of disease risk in adulthood, factors in all stages of life and on different contextual levels should be considered. Therefore, the aim of this study was to investigate the relevance of a person's area of residence over their life course with regard to four outcomes: all-cause mortality; ischemic heart disease mortality and morbidity; cancer mortality and morbidity; and respiratory diseases and related mortality. We applied a cross-classified multilevel model for three age groups on a longitudinal data set spanning a 35 year period in Scania, Sweden. According to our analyses, the proportion of the total variance at the district level for all the outcomes studied was below 2% for the 65 to 84 age group, below 4.5% for those ages 50-64 years, and below 6.5% for those 30-49 years old. Our results suggest that the parish of residence, at four different time points during the individual life course, had little influence on individual all-cause mortality, or on mortality or morbidity from IHD, cancer, and respiratory diseases; i.e., knowing when and where an individual resided during their life course gives little indication of future mortality and morbidity. Such knowledge is essential in assisting decision makers determine the relevant geographical level of intervention (in our case whether to direct interventions toward the entire region of Scania or to specific parishes) needed. Valuable information for planning public health interventions might be obtained by considering measures of variance and clustering from specific contexts before implementing strategic programs.