Using multilevel modeling and geographically weighted regression to identify spatial variations in the relationship between place-level disadvantages and obesity in Taiwan

Abstract

Objectives We examined whether and to what extent the relationship between township disadvantages and obesity varied across geographical areas. Methods A cross-sectional analysis of a population-based sample of Taiwanese adults ( N = 25,985) from the 2005 Social Development Trend Survey on Health and Safety was performed. Multilevel models integrated with geographically weighted regressions were employed to analyze the spatially varying association between area disadvantages and obesity. The dependent variable was body mass index calculated from respondents’ self-reported weight and height. The key explanatory variable was a township disadvantage index made of poverty level, minority composition, and social disorder. Other individual socio-demographic characteristics were included to account for the compositional effect. Results The association between township disadvantages and elevated obesity risk in Taiwan was found to be area-specific. In contrast to results from the commonly used global regression, geographically weighted regression model showed that township disadvantages elevated obesity level only in certain areas. Conclusions We found heterogeneity of place-level determinants of obesity across geographical areas. Adoption of population approach to curb obesity would require area-specific strategies for most needed areas.