Health Economics, Policy and Law


Does it really matter where you live? A panel data multilevel analysis of Swedish municipality-level social capital on individual health-related quality of life

M. Kamrul Islam a1c1, Juan Merlo a2, Ichiro Kawachi a3, Martin Lindström a4, Kristina Burström a5 and Ulf-G. Gerdtham a6
a1 Department of Clinical Sciences, Malmö, Lund University, Sweden
a2 Department of Clinical Sciences, Malmö, Lund University, Sweden
a3 Department of Society, Human Development and Health and the Harvard Center for Society and Health, Harvard School of Public Health, Boston, MA, USA
a4 Department of Health Sciences, Malmö, Lund University, Sweden
a5 Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, Stockholm, Sweden
a6 Department of Clinical Sciences, Malmö, Lund University, Sweden

Article author query
islam mk   [Google Scholar] 
merlo j   [Google Scholar] 
kawachi i   [Google Scholar] 
lindström m   [Google Scholar] 
burström k   [Google Scholar] 
gerdtham u-g   [Google Scholar] 


We test whether individual health status is related to area-level social capital measured by rates of voting participation in municipal political elections, controlling for personal characteristics, where health status is measured by mapping responses to interview survey questions into the generic health-related quality of life measure (HRQoL) the EQ-5D in order to derive the health state scores. The analysis is based on unbalanced panel data from Statistic Sweden's Survey of Living Conditions (the ULF survey) and a 3-level multilevel regression analysis, where level 1 consists of a total of 31,585 observations for 24,419 individuals at level 2 nested within 275 Swedish municipalities at level 3. We find that the health state scores increase significantly with municipality election rates. This result is robust to a number of measurement and specification issues explored in a sensitivity analysis. However, almost all variation in health status exists across individuals (more than 98%), which demonstrates that even if social capital (and other contextual variables) may be significant it is of less importance, at least at the municipality level in Sweden.

c1 Corresponding author: M. Kamrul Islam, Health Economics Program (HEP), Department of Clinical Sciences, Lund University, Malmö University Hospital, SE 205 02 Malmö, Email: