Geographies of health perception in Quebec: a multilevel perspective

Self perceived health is a widely used measure and, in Quebec, it has been shown to vary significantly between geographical areas. In the present stud y, these geographical variations are examined in a multilevel analysis in o rder to disentangle compositional (individual characteristics) and contextu al (place) effects. The analysis recognizes four levels of variation: indiv idual, household, local and regional. Similar analyses carried out in Brita in, have considered only two levels: individual and local. Data come from t he 1992-1993 Quebec Health and Social Survey, a general household survey us ing a stratified two-stage sampling design. Health perception (the response variable) is considered with a set of individual predictor characteristics reflecting gender, lifestyle, socio-economic conditions, marital status an d social support. Results show the existence of significant local area vari ations in health perception after having allowed for individual characteris tics and variations at the household level. At the regional level, however, no systematic and significant variations remain although some individual r egions are found to have a significant impact on health perception. (C) 199 9 Elsevier Science Ltd. All rights reserved.