The role of individual, household, and area of residence factors on self-rated health in Colombian adults: A multilevel study

INTRODUCTION: Self-rated health is strongly associated with morbidity and mortality. It is largely influenced by individual factors but also by individuals’ social surroundings and environment. OBJECTIVE: To investigate individual, household, and locality factors associated with self- rated health in Colombian adults. MATERIALS AND METHODS: We conducted a cross-sectional multilevel study using data from national databases on 19 urban localities and 37,352 individuals nested within 15,788 households using a population-based survey. Given the natural hierarchical structure of the data, the estimates of self-rated health related to individual, household, and locality characteristics were obtained by fitting a three-level logistic regression. RESULTS: The adjusted multilevel logistic models showed that at individual level, higher odds of poor self-rated health were found among older adults, persons from low socio-economic status, those living without a partner, with no regular physical activity, and reporting morbidities. At the household level, poor self-rated health was associated with households of low socioeconomic status located near noise sources and factories and in polluted and insecure areas. At the locality level, only poverty was associated with poor self-rated health after adjusting for individual and household variables. CONCLUSIONS: These results highlight the need for a more integrated framework when designing and implementing strategies and programs that aim to improve health conditions in urban populations in Latin America.