Community effects on public health in India: A hierarchical model

Sada Nand Dwivedi, Shahina Begum, Alok Kumar Dwived, Arvind Pandey

Department of Biostatistics, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
National Institute of Medical Statistics, Indian Council of Medical Research, New Delhi, India.

DOI: 10.4236/health.2012.48084                

Abstract

The data on any aspect of public health, including that on infant mortality, has inbuilt hierarchical structure. Using traditional regression approach in data analysis, i.e., ignoring hierarchical structure, either at micro (individual) or at macro (community) level will be avoiding desired assumption related to independence of records. Accordingly, this may result into distortion in the results due to probable underestimation of standard error of the regression coefficients. To be more specific, an irrelevant co-variate may emerge as an important covariate leading to inappropriate public health implications. To overcome this problem, the objective of the present work was to deal with multilevel analysis of the data on infant mortality available under second round of National family Health Survey and notify changes in results under traditional regression analysis that ignores hierarchical structure of data. This method provides more accurate results leading to meaningful public health implications. In addition, estimation of variability at different levels and their covariance are also obtained. The results indicate that the community (e.g., state) level characteristics still have major role regarding infant mortality in India. Further, if computational facilities are available, multilevel analysis may be preferred in dealing with data involving hierarchical structure leading to accurate results having meaningful public health implications.

Keywords

Community Effects; Public Health; Multilevel Analysis; Hierarchical Model; Traditional Regression Model

Conflicts of Interest

The authors declare no conflicts of interest.

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