Juan Merlo
Datos Biográficos
| ID | 180530 |
|---|---|
| NOMBRE | Juan Merlo |
| NOMBRES | Juan |
| APELLIDO | Merlo |
| FIRMA | MERLO J |
| AFILIACIONES | Lund University |
| ORCID | 0000-0001-8379-9708 |
| VERIFICADO | Sí |
| TOTAL DE OBRAS | 79 |
| TOTAL DE CITAS | 657 |
| TOTAL COMO AUTOR | 79 |
| TOTAL COMO EDITOR | 0 |
| PRIMER AÑO DE PUBLICACIÓN | 2001 |
| AÑO MÁS RECIENTE DE PUBLICACIÓN | 2026 |
| ÍNDICE H | 15 |
Ranking group-level outcomes with multilevel models
Social epidemiologists frequently aim to quantify how social, spatial, or organizational contexts shape individual outcomes, an aim commonly addressed through the use of multilevel models. These models readily estimate the magnitude of group-level differences, but it is more difficult to formalize the uncertainty in the relative ordering of predicted group-level outcomes, which is often considered qualitatively in practice. We propose an entropy-…
Trust in healthcare and perceived discrimination in Sweden
Introduction: Trust in healthcare is central to the delivery of care and unequally distributed between groups in society. Experiences of perceived discrimination have been associated with lack of such trust. Although the importance of trust in healthcare has been highlighted in recent years, studies in this area are relatively scarce. Materials and methods: = 83,135). Applying an analysis of individual heterogeneity and discriminatory accuracy (A…
Social and geographical inequalities in prenatal care coverage in Colombia
BACKGROUND: Access to adequate antenatal care (ANC) is crucial for improving maternal and neonatal health outcomes. Despite high national ANC coverage, Colombia still faces regional and socioeconomic disparities. This study aims to estimate geographical and intersectional inequalities in ANC coverage and evaluate the contribution of social determinants to these disparities. METHODS: We conducted a cross-sectional observational study using data fr…
Socio-geographical disparities in cardiometabolic multimorbidity in Sweden
By applying an intersectionality framework, our study provides a more nuanced map of disparities in cardiometabolic multimorbidity to inform preventive strategies aligned with proportionate universalism and precision of public health. The heterogeneity and discriminatory accuracy measures suggest the need for universally tailored intervention strategies to prevent cardiometabolic multimorbidity
The Statistical Advantages of Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy for Estimating Intersectional Inequalities
Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA) is a multilevel regression approach grounded in intersectionality theory. It examines inequalities across intersections of social identities (e.g., gender, ethnicity, class) and is argued to provide more accurate predictions of intersectional means than conventional methods that estimate group means directly or via regressions with all interactions. This study ev…
Sociodemographic Inequalities in Student Achievement
Sociodemographic inequalities in student achievement are a persistent concern for education systems and are increasingly recognized to be intersectional. Intersectionality considers the multidimensional nature of disadvantage, appreciating the interlocking social determinants which shape individual experience. Intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) is a new approach developed in populat…
A tutorial for conducting intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy (Maihda)
Intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy (I-MAIHDA) is an innovative approach for investigating inequalities, including intersectional inequalities in health, disease, psychosocial, socioeconomic, and other outcomes. I-MAIHDA and related MAIHDA approaches have conceptual and methodological advantages over conventional single-level regression analysis. By enabling the study of inequalities produced…
Mapping socio-geographical disparities in the occurrence of teenage maternity in Colombia using multilevel analysis of individual heterogeneity and discriminatory accuracy (Maihda)
Disparities were observed between intersectional socio-geographical strata but not between geo-political departments. Our results indicate that if resources for prevention are limited, using an intersectional socio-geographical approach would be more effective than focusing on geopolitical departments especially when focusing resources on those groups which show the highest prevalence. MAIHDA could potentially be applied to many other health outc…
Perceived discrimination and refraining from seeking physician’s care in Sweden
AIHDA disclosed complex intersectional inequalities in the average risk of refraining from seeking physician's care. This risk was rather high in some strata, which is relevant from an individual perspective. However, from a population perspective, the low DA of the intersectional strata suggests that potential interventions to reduce such inequalities should be universal but tailored to the specific contextual characteristics of the strata. Disc…
Impact of the Economic Crisis on Body Mass Index in Spain
The Great Recession hit Spain deteriorating the living conditions of many Spanish people, increasing the prevalence of several chronic health issues, including obesity, and affecting health inequalities. We analyse the impact of this economic crisis on body mass index (BMI) disparities in Spain, from two perspectives: the socioeconomic and the territorial, through the application of an intersectional multilevel analysis of individual heterogeneit…
Intimate Partner Violence against Women in the EU
Intimate partner violence against women (IPVAW) poses severe threats to women’s health and rights. This study investigates the role of country context and gender equality in shaping individual perceptions of the severity of IPVAW. Multilevel logistic regression analyses of a Eurobarometer survey on attitudes toward IPVAW from 27 EU states showed that male gender, young age, low education, low self-assessed social position and particularly perceiv…
Physical and social environmental factors related to co-occurrence of unhealthy lifestyle behaviors
An intersectional analysis providing more precise information on inequities in self-rated health
Background Intersectionality theory combined with an analysis of individual heterogeneity and discriminatory accuracy (AIHDA) can facilitate our understanding of health disparities. This enables the application of proportionate universalism for resource allocation in public health. Analyzing self-rated health (SRH) in Sweden, we show how an intersectional perspective allows for a detailed mapping of health inequalities while avoiding simplificati…
Small area influences on the individual unhealthy lifestyle behaviors
Multilevel versus single-level regression for the analysis of multilevel information
Intersectional inequalities and the U.S. opioid crisis
Dominant narratives of prescription opioid misuse (POM) in the U.S. have portrayed it as an issue primarily affecting White communities. In this study we explore POM as reported in data from the 2015 National Survey on Drug Use and Health, using an intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA). We map the risk of POM through a series of multilevel models with individuals (N = 43,409) nested wi…
A simple multilevel approach for analysing geographical inequalities in public health reports
The epidemiological analysis of geographical inequalities in individual outcomes is a fundamental theme in public health research. However, many traditional studies focus on analysing area differences in averages outcomes, disregarding individual variation around such averages. In doing so, these studies may produce misleading information and lead researchers to draw incorrect conclusions. Analysing individual and municipality differences in body…
Chronic Obstructive Pulmonary Disease in Sweden
Socioeconomic, ethnic and gender disparities in Chronic Obstructive Pulmonary Disease (COPD) risk are well established but no studies have applied multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) within an intersectional framework to study this outcome. We study individuals at the first level of analysis and combinations of multiple social and demographic categorizations (i.e., intersectional strata) at the sec…
General and specific contextual effects in multilevel regression analyses and their paradoxical relationship
To be relevant for public health, a context (e.g., neighborhood, school, hospital) should influence or affect the health status of the individuals included in it. The greater the influence of the shared context, the higher the correlation of subject outcomes within that context is likely to be. This intra-context or intra-class correlation is of substantive interest and has been used to quantify the magnitude of the general contextual effect (GCE…
Multilevel analysis of individual heterogeneity and discriminatory accuracy (Maihda) within an intersectional framework
Intermediate and advanced topics in multilevel logistic regression analysis
Multilevel data occur frequently in health services, population and public health, and epidemiologic research. In such research, binary outcomes are common. Multilevel logistic regression models allow one to account for the clustering of subjects within clusters of higher-level units when estimating the effect of subject and cluster characteristics on subject outcomes. A search of the PubMed database demonstrated that the use of multilevel or hie…
The tyranny of the averages and the indiscriminate use of risk factors in public health
Modern medicine is overwhelmed by a plethora of both established risk factors and novel biomarkers for diseases. The majority of this information is expressed by probabilistic measures of association such as the odds ratio (OR) obtained by calculating differences in average "risk" between exposed and unexposed groups. However, recent research demonstrates that even ORs of considerable magnitude are insufficient for assessing the ability of risk f…
Absolute rather than relative income is a better socioeconomic predictor of chronic obstructive pulmonary disease in Swedish adults
Our study supports the materialistic theory. Access to material resources seems more relevant to COPD risk than the consequences of low relative income
Categorical and anti-categorical approaches to US racial/ethnic groupings
Intersectionality theory calls for the understanding of race/ethnicity, sex/gender and class as interlinked. Intersectional analysis can contribute to public health both through furthering understanding of power dynamics causing health disparities, and by pointing to heterogeneities within, and overlap between, social groups. The latter places the usefulness of social categories in public health under scrutiny. Drawing on McCall we relate the fir…
An intersectional approach to multilevel analysis of individual heterogeneity (Maih) and discriminatory accuracy
A brief conceptual tutorial of multilevel analysis in social epidemiology
Study objective: In social epidemiology, it is easy to compute and interpret measures of variation in multilevel linear regression, but technical difficulties exist in the case of logistic regression. The aim of this study was to present measures of variation appropriate for the logistic case in a didactic rather than a mathematical way. Design and participants: Data were used from the health survey conducted in 2000 in the county of Scania, Swed…
Multilevel analysis of individual heterogeneity and discriminatory accuracy (Maihda) within an intersectional framework
A brief conceptual tutorial of multilevel analysis in social epidemiology
Study objective: This didactical essay is directed to readers disposed to approach multilevel regression analysis (MLRA) in a more conceptual than mathematical way. However, it specifically develops an epidemiological vision on multilevel analysis with particular emphasis on measures of health variation (for example, intraclass correlation). Such measures have been underused in the literature as compared with more traditional measures of associat…
Multilevel analytical approaches in social epidemiology
Considering both distribution and determinants of health In this issue of the journal Jennifer Ahern et al 1 present the results of a multilevel analysis showing the increased likelihood of preterm birth affecting both African American and white women living in a neighbourhood with deprived socioeconomic characteristics. This increased risk was independent of individual cigarette smoking and modified by socioeconomic characteristics of the women.…
Intimate partner violence against women and the Nordic paradox
Individual and neighbourhood determinants of social participation and social capital
Social capital and sense of insecurity in the neighbourhood
Perceived discrimination, socioeconomic disadvantage and refraining from seeking medical treatment in Sweden
The goal of equitable access to healthcare services cannot be achieved without public health strategies that confront and tackle discrimination in society and specifically in the healthcare setting
Socioeconomic Inequality in Exposure to Bullying During Adolescence
Objectives. We examined the socioeconomic distribution of adolescent exposure to bullying internationally and documented the contribution of the macroeconomic environment. Methods. We used an international survey of 162 305 students aged 11, 13, and 15 years from nationally representative samples of 5998 schools in 35 countries in Europe and North America for the 2001–2002 school year. The survey used standardized measures of exposure to bullying…
A brief conceptual tutorial on multilevel analysis in social epidemiology
Study objective: (1) To provide a didactic and conceptual (rather than mathematical) link between multilevel regression analysis (MLRA) and social epidemiological concepts. (2) To develop an epidemiological vision of MLRA focused on measures of health variation and clustering of individual health status within areas, which is useful to operationalise the notion of “contextual phenomenon”. The paper shows how to investigate (1) whether there is cl…
Multilevel versus single-level regression for the analysis of multilevel information
Intersectionality and risk for ischemic heart disease in Sweden
Intersectionality theory can contribute to epidemiology and public health by furthering understanding of power dynamics driving production of health disparities, and increasing knowledge about heterogeneities within, and overlap between, social categories. Drawing on McCall, we relate the first of these potential contributions to categorical intersectionality and the second to anti-categorical intersectionality. Both approaches are used in study …
Comparison of a spatial approach with the multilevel approach for investigating place effects on health
Study objective: Most studies of place effects on health have followed the multilevel analytical approach that investigates geographical variations of health phenomena by fragmenting space into arbitrary areas. This study examined whether analysing geographical variations across continuous space with spatial modelling techniques and contextual indicators that capture space as a continuous dimension surrounding individual residences provided more …
A brief conceptual tutorial on multilevel analysis in social epidemiology
Study objective: Using a conceptual rather than a mathematical approach, this article proposed a link between multilevel regression analysis (MLRA) and social epidemiological concepts. It has been previously explained that the concept of clustering of individual health status within neighbourhoods is useful for operationalising contextual phenomena in social epidemiology. It has been shown that MLRA permits investigating neighbourhood disparities…
Diastolic blood pressure and area of residence
STUDY OBJECTIVES: To study geographical differences in diastolic blood pressure and the influence of the social environment (census percentage of people with low educational achievement) on individual diastolic blood pressure level, after controlling for individual age and educational achievement. To compare the results of multilevel and ecological analyses. DESIGN: Cross sectional analysis performed by multilevel linear regression modelling, wit…
Children’s exposure to nitrogen dioxide in Sweden
Study objective: Prior studies have shown that children are particularly sensitive to air pollution. This study examined whether children of low socioeconomic status suffered greater exposure to outdoor nitrogen dioxide than more affluent ones, both at their place of residence and at school, in a country with widespread state intervention for social equity. Design: Local scale data on outdoor nitrogen dioxide obtained from a validated air polluti…
Individual and collective bodies
BACKGROUND: Social epidemiology investigates both individuals and their collectives. Although the limits that define the individual bodies are very apparent, the collective body's geographical or cultural limits (eg "neighbourhood") are more difficult to discern. Also, epidemiologists normally investigate causation as changes in group means. However, many variables of interest in epidemiology may cause a change in the variance of the distribution…
Spatial clustering of mental disorders and associated characteristics of the neighbourhood context in Malmö, Sweden, in 2001
Study objective: Previous research provides preliminary evidence of spatial variations of mental disorders and associations between neighbourhood social context and mental health. This study expands past literature by (1) using spatial techniques, rather than multilevel models, to compare the spatial distributions of two groups of mental disorders (that is, disorders due to psychoactive substance use, and neurotic, stress related, and somatoform …
A simple multilevel approach for analysing geographical inequalities in public health reports
The epidemiological analysis of geographical inequalities in individual outcomes is a fundamental theme in public health research. However, many traditional studies focus on analysing area differences in averages outcomes, disregarding individual variation around such averages. In doing so, these studies may produce misleading information and lead researchers to draw incorrect conclusions. Analysing individual and municipality differences in body…
Bringing the individual back to small-area variation studies
Assessment of the magnitude of geographical variations and socioeconomic contextual effects on ischaemic heart disease mortality
Background: In a public health perspective, it is of interest to assess the magnitude of geographical variations in ischaemic heart disease (IHD) mortality and quantify the strength of contextual effects on IHD. Objective: To investigate whether area effects vary according to the individual and contextual characteristics of the population, socioeconomic contextual influences were assessed in different age groups and within territories of differin…
Social capital, the miniaturisation of community, traditionalism and first time acute myocardial infarction
Revisiting causal neighborhood effects on individual ischemic heart disease risk
Neighbourhood social interactions and risk of acute myocardial infarction
STUDY OBJECTIVE: Previous studies of neighbourhood effects on ischaemic heart disease (IHD) have used census or administrative data to characterise the residential context, most commonly its socioeconomic level. Using the ecometric approach to define neighbourhood social interaction variables that may be relevant to IHD, neighbourhood social cohesion and safety were examined to see how they related to acute myocardial infarction (AMI) mortality, …
An intersectional approach to multilevel analysis of individual heterogeneity (Maih) and discriminatory accuracy
Diastolic blood pressure and area of residence
STUDY OBJECTIVES: To study geographical differences in diastolic blood pressure and the influence of the social environment (census percentage of people with low educational achievement) on individual diastolic blood pressure level, after controlling for individual age and educational achievement. To compare the results of multilevel and ecological analyses. DESIGN: Cross sectional analysis performed by multilevel linear regression modelling, wit…
Multilevel modelling of health statistics
This is a collaborative work that reunites many of the best authors in the area of multilevel analysis. The book fulfils the need of explaining multilevel modelling to researchers in the health sciences. It has a practical orientation, focusing on a series of applications of relevance by means of thoroughly explained, pertinent examples, rather than simply presenting algebraic formulations. The book opens with a good introductory chapter that pro…
Individual and neighbourhood determinants of social participation and social capital
Social inequalities in health- do they diminish with age? Revisiting the question in Sweden 1999
BACKGROUND: Individuals with low income have poorer health and should, therefore, have higher health expenditure than people with high income particularly in countries with a universal health care system. However, it has been discussed if social inequities in health diminish with age and we, hence, aimed to analyse this question. METHODS: We performed an age stratified cross-sectional analysis using averages, logistic and linear regression modell…
Multilevel analytical approaches in social epidemiology
Considering both distribution and determinants of health In this issue of the journal Jennifer Ahern et al 1 present the results of a multilevel analysis showing the increased likelihood of preterm birth affecting both African American and white women living in a neighbourhood with deprived socioeconomic characteristics. This increased risk was independent of individual cigarette smoking and modified by socioeconomic characteristics of the women.…
Social capital and sense of insecurity in the neighbourhood
Country of birth, socioeconomic position, and healthcare expenditure
Study objective: The principle of equity aims to guarantee allocation of healthcare resources on the basis of need. Therefore, people with a low income and persons living alone are expected to have higher healthcare expenditures. Besides these individual characteristics healthcare expenditure may be influenced by country of birth. This study therefore aimed to investigate the role of country of birth in explaining individual healthcare expenditur…
Comparison of a Spatial Perspective with the Multilevel Analytical Approach in Neighborhood Studies
Most studies of neighborhood effects on health have used the multilevel approach. However, since this methodology does not incorporate any notion of space, it may not provide optimal epidemiologic information when modeling variations or when investigating associations between contextual factors and health. Investigating mental disorders due to psychoactive substance use among all 65,830 individuals aged 40-59 years in 2001 in Malmö, Sweden, geolo…
Low adherence with antihypertensives in actual practice
Low social participation seems to be associated with low adherence with antihypertensives during the last two weeks, and this association may be modified by the municipality of residence. Future studies aimed at investigating health-related behaviours in general and low adherence with medication in particular might benefit if they consider area of residence
Social capital and neo-materialist contextual determinants of sense of insecurity in the neighbourhood
A brief conceptual tutorial on multilevel analysis in social epidemiology
Study objective: (1) To provide a didactic and conceptual (rather than mathematical) link between multilevel regression analysis (MLRA) and social epidemiological concepts. (2) To develop an epidemiological vision of MLRA focused on measures of health variation and clustering of individual health status within areas, which is useful to operationalise the notion of “contextual phenomenon”. The paper shows how to investigate (1) whether there is cl…
A brief conceptual tutorial on multilevel analysis in social epidemiology
Study objective: Using a conceptual rather than a mathematical approach, this article proposed a link between multilevel regression analysis (MLRA) and social epidemiological concepts. It has been previously explained that the concept of clustering of individual health status within neighbourhoods is useful for operationalising contextual phenomena in social epidemiology. It has been shown that MLRA permits investigating neighbourhood disparities…
A brief conceptual tutorial of multilevel analysis in social epidemiology
Study objective: This didactical essay is directed to readers disposed to approach multilevel regression analysis (MLRA) in a more conceptual than mathematical way. However, it specifically develops an epidemiological vision on multilevel analysis with particular emphasis on measures of health variation (for example, intraclass correlation). Such measures have been underused in the literature as compared with more traditional measures of associat…
Comparison of a spatial approach with the multilevel approach for investigating place effects on health
Study objective: Most studies of place effects on health have followed the multilevel analytical approach that investigates geographical variations of health phenomena by fragmenting space into arbitrary areas. This study examined whether analysing geographical variations across continuous space with spatial modelling techniques and contextual indicators that capture space as a continuous dimension surrounding individual residences provided more …
Hospital Level of Care and Neonatal Mortality in Low- and High-Risk Deliveries
BACKGROUND: In high-risk births, the availability and concentration of neonatal resources in larger regional hospitals increases the chance of survival. The advantages of regionalization for low-risk deliveries are still unclear, but some studies have suggested that regionalization also is beneficial for low risk deliveries. The aim of the present study was to investigate both the relevance of regionalization and the concentration of neonatal res…
Social capital and health
The aim of the paper is to critically review the notion of social capital and review empirical literature on the association between social capital and health across countries. The methodology used for the review includes a systematic search on electronic databases for peer-reviewed published literature. We categorize studies according to level of analysis (single and multilevel) and examine whether studies reveal a significant health impact of i…
Similar support for three different life course socioeconomic models on predicting premature cardiovascular mortality and all-cause mortality
There was a strong relation between SEP and cardiovascular and all-cause mortality, irrespective of the conceptual model used. The critical period, social mobility, and cumulative life course models, showed the same fit to the data. That is, one model could not be pointed out as "the best" model and even in this large unselected sample it was not possible to adjudicate which theories best describe the links between life course SEP and mortality r…
The role country of birth plays in receiving disability pensions in relation to patterns of health care utilisation and socioeconomic differences
The country of one's birth appears to play a significant role in understanding how individual socioeconomic differences bear on the likelihood of receiving a disability pension and on associated patterns of health care utilisation
Individual characteristics, area social participation, and primary non-concordance with medication
Our results indicate that people in central Sweden with younger age, financial difficulties, low self-rated health, and low trust in the health care system may have a higher probability of primary non-concordance with medication. However, the area of residence--as defined by administrative boundaries--seems to play a minor role for primary non-concordance
Contribution of main causes of death to social inequalities in mortality in the whole population of Scania, Sweden
CHD made a major contribution to the socioeconomic differences in overall mortality. However, there were also important contributions from diseases with less well understood mechanistic links with SEP such as stroke and less-common cancers. Thus, an increased understanding of the mechanisms connecting SEP with more rare causes of disease might be important to be able to more successfully intervene on socioeconomic differences in health
Inequity in access to dental care services explains current socioeconomic disparities in oral health
Objective: To analyse the effects of socioeconomic disadvantage on access to dental care services and on oral health. Design, setting and outcomes: Cross-sectional data from the Swedish National Surveys of Public Health 2004 and 2005. Outcomes were poor oral health (self-rated oral health and symptoms of periodontal disease) and lack of access to dental care services. A socioeconomic disadvantage index (SDI) was developed, consisting of social we…
A brief conceptual tutorial of multilevel analysis in social epidemiology
Study objective: In social epidemiology, it is easy to compute and interpret measures of variation in multilevel linear regression, but technical difficulties exist in the case of logistic regression. The aim of this study was to present measures of variation appropriate for the logistic case in a didactic rather than a mathematical way. Design and participants: Data were used from the health survey conducted in 2000 in the county of Scania, Swed…
Children’s exposure to nitrogen dioxide in Sweden
Study objective: Prior studies have shown that children are particularly sensitive to air pollution. This study examined whether children of low socioeconomic status suffered greater exposure to outdoor nitrogen dioxide than more affluent ones, both at their place of residence and at school, in a country with widespread state intervention for social equity. Design: Local scale data on outdoor nitrogen dioxide obtained from a validated air polluti…
Spatial clustering of mental disorders and associated characteristics of the neighbourhood context in Malmö, Sweden, in 2001
Study objective: Previous research provides preliminary evidence of spatial variations of mental disorders and associations between neighbourhood social context and mental health. This study expands past literature by (1) using spatial techniques, rather than multilevel models, to compare the spatial distributions of two groups of mental disorders (that is, disorders due to psychoactive substance use, and neurotic, stress related, and somatoform …
Anxiolytic-hypnotic drug use associated with trust, social participation, and the miniaturization of community
Medicine (62 obras) · Demography (48 obras) · Health disparities and outcomes (45 obras) · Population (40 obras) · Multilevel model (39 obras) · Sociology (39 obras) · Psychology (34 obras) · Demography (32 obras) · Statistics (32 obras) · Environmental health (30 obras)