a multilevel model for comorbid outcomes obesity and diabetes in the us共病的多级模型结果在美国肥胖和糖尿病.pdfVIP

Int. J. Environ. Res. Public Health 2010, 7, 333-352; doi:10.3390/ijerph7020333 OPEN ACCESS International Journal of Environmental Research and Public Health ISSN 1660-4601 /journal/ijerph Article A Multilevel Model for Comorbid Outcomes: Obesity and Diabetes in the US Peter Congdon Department of Geography and Centre for Statistics, Queen Mary University of London, Mile End Rd, London E1 4NS, UK; E-Mail: p.congdon@qmul.ac.uk Received: 16 November 2009 / Accepted: 21 January 2010 / Published: 27 January 2010 Abstract: Multilevel models are overwhelmingly applied to single health outcomes, but when two or more health conditions are closely related, it is important that contextual variation in their joint prevalence (e.g., variations over different geographic settings) is considered. A multinomial multilevel logit regression approach for analysing joint prevalence is proposed here that includes subject level risk factors (e.g., age, race, education) while also taking account of geographic context. Data from a US population health survey (the 2007 Behavioral Risk Factor Surveillance System or BRFSS) are used to illustrate the method, with a six category multinomial outcome defined by diabetic status and weight category (obese, overweight, normal). The influence of geographic context is partly represented by