Wiggins RD, Bartley M, Gleave S, Joshi H, Lynch K, Mitchell R. Limiting long-term illness: a question of where you live or who you are? A multilevel analysis of the 1971-1999 ONS Longitudinal Study. Risk, Decision and Policy 1998; 3 (3): 181-198
The contribution of individual and area characteristics to geographical variations among county districts in limiting long term illness in England and Wales has been investigated using multilevel modelling of linked census data from the Longitudinal Study of the Office of National Statistics Longitudinal Study (LS). The resulting wide variations between districts in the rates of limiting long term illness in 1991 were only partly explained by men's individual experience of unemployment, low social class and other disadvantages in 1971 and 1981. Further explanation was contributed by classifying their areas of residence according to the ONS clustered typology. The relationship between patterns of individual disadvantage and the risk of illness was not the same in all types of area. Some areas remained which had higher or lower rates of illness than expected on the basis of both individual and area characteristics. It is concluded that the experience of disadvantage over time affects the risk of limiting long term illness. Geographical differences are not, however, entirely explained by the distribution of individual characteristics; the same individual history may face a different risk of illness in different kinds of area.