SOEPpapers on Multidisciplinary Panel Data Research Examining the Structure of Spatial Health Effects in Germany Using Hierarchical Bayes Models

This paper uses Hierarchical Bayes Models to model and estimate spatial health effects in Germany. We combine rich individual-level household panel data from the German SOEP with administrative county-level data to estimate spatial county-level health dependencies. As dependent variable we use the generic, continuous, and quasi-objective SF12 health measure. We find strong and highly significant spatial dependencies and clusters. The strong and systematic county-level impact is equivalent to 0.35 standard deviations in health. Even 20 years after German reunification, we detect a clear spatial East-West health pattern that equals an age impact on health of up to 5 life years for a 40-year old.

[1]  M. Wimberly,et al.  Spatial patterns of obesity and associated risk factors in the conterminous U.S. , 2010, American journal of preventive medicine.

[2]  H. Boshuizen,et al.  Avoidable mortality in Europe (1980–1997): a comparison of trends , 2004, Journal of Epidemiology and Community Health.

[3]  A. Bhattacharjee,et al.  Spatial structures of health outcomes and health behaviours in Scotland: Evidence from the Scottish Health Survey , 2014 .

[4]  Konrad B. Burchardi,et al.  The Economic Impact of Social Ties: Evidence from German Reunification , 2011 .

[5]  Oliver Razum,et al.  The impact of regional and neighbourhood deprivation on physical health in Germany: a multilevel study , 2010, BMC public health.

[6]  Till von Wachter,et al.  Job Displacement and Mortality: An Analysis Using Administrative Data , 2009 .

[7]  S. Moebus,et al.  Neighbourhood socioeconomic status and cardiovascular risk factors: a multilevel analysis of nine cities in the Czech Republic and Germany , 2007, BMC public health.

[8]  L. di Matteo,et al.  Evidence on the determinants of Canadian provincial government health expenditures: 1965-1991. , 1998, Journal of health economics.

[9]  G. Knies,et al.  Regional Data in the German Socio-Economic Panel Study (SOEP) , 2007 .

[10]  Katja Coneus,et al.  Pollution exposure and child health: evidence for infants and toddlers in Germany. , 2012, Journal of health economics.

[11]  Mike Rees,et al.  5. Statistics for Spatial Data , 1993 .

[12]  S. Moebus,et al.  Subclinical coronary atherosclerosis and neighbourhood deprivation in an urban region , 2008, European Journal of Epidemiology.

[13]  John P. Haisken-DeNew,et al.  You're Fired! The Causal Negative Effect of Entry Unemployment on Life Satisfaction , 2009 .

[14]  Hendrik Jürges,et al.  True health vs response styles: exploring cross-country differences in self-reported health. , 2007, Health economics.

[15]  A. Gittelsohn,et al.  Small Area Variations in Health Care Delivery , 1973, Science.

[16]  M. Mckee,et al.  Trends in mortality attributable to current alcohol consumption in east and west Germany. , 2003, Social science & medicine.

[17]  L. Bonneux,et al.  Mortality in 272 European regions, 2002–2004. An update , 2010, European Journal of Epidemiology.

[18]  C. Propper,et al.  Keeping Up with the Schmidts - An Empirical Test of Relative Deprivation Theory in the Neighbourhood Context , 2007 .

[19]  R. Holle,et al.  Regional differences in the prevalence of known Type 2 diabetes mellitus in 45–74 years old individuals: Results from six population‐based studies in Germany (DIAB‐CORE Consortium) , 2012, Diabetic medicine : a journal of the British Diabetic Association.

[20]  Sw. Banerjee,et al.  Hierarchical Modeling and Analysis for Spatial Data , 2003 .

[21]  J. Lauridsen,et al.  Geographic and Temporal Heterogeneity in Public Prescription Pharmaceutical Expenditures in Spain , 2008 .

[22]  K. Zimmermann,et al.  The Mortality Crisis in East Germany , 1998, SSRN Electronic Journal.

[23]  Christian P. Robert,et al.  Statistics for Spatio-Temporal Data , 2014 .

[24]  Anthony S. Bryk,et al.  Hierarchical Linear Models: Applications and Data Analysis Methods , 1992 .

[25]  N. Fuchs-Schündeln.  The Response of Household Saving to the Large Shock of German Reunification , 2008 .

[26]  Joan Costa-Font,et al.  Public health expenditure and spatial interactions in a decentralized national health system. , 2007, Health economics.

[27]  Nicolas R. Ziebarth.  Measurement of health, health inequality, and reporting heterogeneity. , 2010, Social science & medicine.

[28]  Dennis M Gorman,et al.  Hierarchical Bayesian spatial models for alcohol availability, drug "hot spots" and violent crime , 2006, International journal of health geographics.

[29]  U. John,et al.  [Regional differences in the prevalence of high-risk alcohol drinking: secondary analysis of the East-West health survey]. , 1998, Gesundheitswesen (Bundesverband der Arzte des Offentlichen Gesundheitsdienstes (Germany)).

[30]  Gert G. Wagner,et al.  The German Socio-Economic Panel Study (SOEP) - Evolution, Scope and Enhancements , 2007 .

[31]  Christian P. Robert,et al.  “Not Only Defended But Also Applied”: The Perceived Absurdity of Bayesian Inference , 2010, 1006.5366.

[32]  S. Ayllón,et al.  State Dependence in Self-Assessed Health in Spain. , 2012 .

[33]  S. Felder,et al.  Federal state differentials in the efficiency of health production in Germany: an artifact of spatial dependence? , 2013, The European Journal of Health Economics.

[34]  Jeffrey P. Cohen,et al.  Semi-Parametric Regression Models and Connecticut's Hospital Costs , 2013 .

[35]  L. di Matteo.  The macro determinants of health expenditure in the United States and Canada: assessing the impact of income, age distribution and time. , 2005, Health policy.

[36]  B. Baltagi,et al.  Health Care Expenditure and Income in the OECD Reconsidered: Evidence from Panel Data , 2010, SSRN Electronic Journal.

[37]  C. Pollack,et al.  Housing and health in Germany , 2004, Journal of Epidemiology and Community Health.

[38]  R. Ocaña-Riola,et al.  Spatio-temporal trends of mortality in small areas of Southern Spain , 2010, BMC public health.

[39]  J. Besag.  Spatial Interaction and the Statistical Analysis of Lattice Systems , 1974 .

[40]  A. Molli'e.  Bayesian mapping of disease , 1996 .

[41]  J. Besag,et al.  On conditional and intrinsic autoregressions , 1995 .

[42]  F. Moscone,et al.  Health Expenditure and Income in the United States , 2010, Health economics.

[43]  J. Hunt.  STAUNCHING EMIGRATION FROM EAST GERMANY: AGE AND THE DETERMINANTS OF MIGRATION , 2006 .

[44]  H. Schmitz,et al.  What accounts for the regional differences in the utilisation of hospitals in Germany? , 2013, The European Journal of Health Economics.

[45]  John P. Haisken-DeNew,et al.  The causal effect of income on health: evidence from German reunification. , 2005, Journal of health economics.

[46]  Mickael Bech,et al.  Public pharmaceutical expenditure: identification of spatial effects , 2010, J. Geogr. Syst..

[47]  J. Lauridsen,et al.  Exploring the spatial pattern in hospital admissions. , 2008, Health policy.

[48]  Elliott S Fisher,et al.  Geography and the debate over Medicare reform. , 2002, Health affairs.

[49]  Mickael Bech,et al.  A spatiotemporal analysis of public pharmaceutical expenditure , 2010 .

[50]  G. A. Marcoulides.  Multilevel Analysis Techniques and Applications , 2002 .

[51]  Jürgen Schupp,et al.  Computation of Standard Values for Physical and Mental Health Scale Scores Using the SOEP Version of SF-12v2 , 2007, Journal of Contextual Economics – Schmollers Jahrbuch.

[52]  G. Masiero,et al.  Disentangling spillover effects of antibiotic consumption: a spatial panel approach , 2013 .

[53]  B. Baltagi,et al.  Center for Policy Research Working Paper No . 130 MEDICAL TECHNOLOGY AND THE PRODUCTION OF HEALTH CARE , 2011 .

[54]  M. Pesaran.  Estimation and Inference in Large Heterogeneous Panels with a Multifactor Error Structure , 2004, SSRN Electronic Journal.

[55]  P. Moran.  Notes on continuous stochastic phenomena. , 1950, Biometrika.

[56]  Sven Schneider,et al.  How relevant are district characteristics in explaining subjective health in Germany? A multilevel analysis. , 2011, Social science & medicine.

[57]  Michael D. Frakes.  The Impact of Medical Liability Standards on Regional Variations in Physician Behavior: Evidence from the Adoption of National-Standard Rules , 2013 .

[58]  J. Lauridsen,et al.  Political or dental power in private and public service provision: a study of municipal expenditures for child dental care , 2011, Health Economics, Policy and Law.

[59]  Robert Haining,et al.  Statistics for spatial data: by Noel Cressie, 1991, John Wiley & Sons, New York, 900 p., ISBN 0-471-84336-9, US $89.95 , 1993 .

[60]  G. Heineck,et al.  A different look at Lenin's legacy: Social capital and risk taking in the two Germanies , 2013 .

[61]  Martin Knapp,et al.  Mental health expenditure in England: a spatial panel approach. , 2007, Journal of health economics.

[62]  Bradley P. Carlin,et al.  Bayesian measures of model complexity and fit , 2002 .

[63]  N. Powe,et al.  Small area variations in health care delivery in Maryland. , 1995, Health services research.

[64]  M. Mckee,et al.  Temporal and spatial pattern of infant mortality in Germany after unification , 2005, Sozial- und Präventivmedizin.

[65]  M. Filippini,et al.  Assessing the impact of national antibiotic campaigns in Europe , 2013, The European Journal of Health Economics.

[66]  Gert G. Wagner,et al.  The German Socio-Economic Panel Study (SOEP) - Scope, Evolution and Enhancements , 2007, Journal of Contextual Economics – Schmollers Jahrbuch.

[67]  Jeannette E. Brosig-Koch,et al.  Still different after all these years: Solidarity behavior in East and West Germany , 2011 .

[68]  L. Kazembe,et al.  A Bayesian multinomial model to analyse spatial patterns of childhood co-morbidity in Malawi , 2007, European Journal of Epidemiology.

[69]  Peter Congdon.  Applied Bayesian Hierarchical Methods , 2010 .

[70]  Helmut Rainer,et al.  Does Democracy Foster Trust? , 2006, SSRN Electronic Journal.

[71]  Adam Drewnowski,et al.  Disparities in obesity rates: analysis by ZIP code area. , 2007, Social science & medicine.

[72]  G. Arbia.  Spatial Econometrics , 2006, Encyclopedia of Big Data.

[73]  S. Moebus,et al.  Traffic exposure and subclinical cardiovascular disease: is the association modified by socioeconomic characteristics of individuals and neighbourhoods? Results from a multilevel study in an urban region , 2009, Occupational and Environmental Medicine.

[74]  L. Gauvin,et al.  Toward the next generation of research into small area effects on health: a synthesis of multilevel investigations published since July 1998 , 2007, Journal of Epidemiology & Community Health.

[75]  Nicolas R. Ziebarth,et al.  Analyzing Regional Variation in Health Care Utilization Using (Rich) Household Microdata , 2013, Health policy.

[76]  Paul Frijters,et al.  Money Does Matter! Evidence from Increasing Real Income and Life Satisfaction in East Germany Following Reunification , 2004 .

[77]  R. Busse,et al.  Spatial distribution of avoidable cancer deaths in Germany , 2012, Journal of Public Health.

[78]  Nicolas R. Ziebarth,et al.  In Vino Pecunia? The Association Between Beverage-Specific Drinking Behavior and Wages , 2008 .

[79]  Timothy J. Robinson,et al.  Multilevel Analysis: Techniques and Applications , 2002 .

[80]  L. Anselin.  Local Indicators of Spatial Association—LISA , 2010 .

[81]  S. Elliott,et al.  An exploratory spatial analysis of overweight and obesity in Canada. , 2009, Preventive medicine.

[82]  Paul Knekt,et al.  Mapping geographical variation in obesity in Finland. , 2008, European journal of public health.

[83]  E. van Doorslaer,et al.  Differential health reporting by education level and its impact on the measurement of health inequalities among older Europeans. , 2008, International journal of epidemiology.

[84]  Gary M Owens,et al.  Gender Differences in Health Care Expenditures, Resource Utilization, and Quality of Care , 2008, Journal of managed care pharmacy : JMCP.

[85]  D. Rubin,et al.  Inference from Iterative Simulation Using Multiple Sequences , 1992 .

[86]  J. Lauridsen,et al.  Exploring spatial patterns in general practice expenditure , 2009, The European Journal of Health Economics.

[87]  L. Sundmacher,et al.  Regionale Unterschiede der Lebenserwartung in Deutschland auf Ebene der Kreise und kreisfreien Städte und deren möglichen Determinanten , 2011 .

[88]  Sylvia Richardson,et al.  Bayesian mapping of disease , 1995 .

[89]  Oliver Razum,et al.  Health inequalities in Germany: do regional-level variables explain differentials in cardiovascular risk? , 2007, BMC public health.

[90]  R. Burkhauser,et al.  Beyond BMI: The Value of More Accurate Measures of Fatness and Obesity in Social Science Research , 2006, Journal of health economics.

[91]  Andrew Gelman,et al.  General methods for monitoring convergence of iterative simulations , 1998 .

[92]  R. Busse,et al.  The impact of physician supply on avoidable cancer deaths in Germany. A spatial analysis. , 2011, Health policy.

[93]  A. Páez,et al.  Infant mortality in Brazil, 1980-2000: A spatial panel data analysis , 2012, BMC Public Health.

[94]  N. G. Best,et al.  Spatial Poisson Regression for Health and Exposure Data Measured at Disparate Resolutions , 2000 .

[95]  P. Vounatsou,et al.  Spatial patterns of child growth in Papua New Guinea and their relation to environment, diet, socio-economic status and subsistence activities , 2001, Annals of human biology.

[96]  N. Fuchs-Schündeln,et al.  Precautionary Savings and Self-Selection - Evidence from the German Reunification 'Experiment' , 2005 .

[97]  J. M. Hammersley,et al.  Markov fields on finite graphs and lattices , 1971 .

[98]  S. Willich,et al.  Regional variation and time trends in mortality from ischaemic heart disease: East and West Germany 10 years after reunification , 2004, Journal of Epidemiology and Community Health.

[99]  H. Schmitz,et al.  Regional variation in the utilisation of ambulatory services in Germany. , 2014, Health economics.

[100]  J. Besag,et al.  Bayesian image restoration, with two applications in spatial statistics , 1991 .

[101]  M. Filippini,et al.  Regional consumption of antibiotics: A demand system approach☆ , 2009 .

[102]  Ron D. Hays,et al.  User's Manual for the Medical Outcomes Study (MOS) Core Measures of Health-Related Quality of Life , 1995 .

[103]  M. Wen,et al.  Explaining variation in health status across space and time: implications for racial and ethnic disparities in self-rated health. , 2003, Social science & medicine.