A tutorial for conducting intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA)

Clare R Evans; George Leckie; S V Subramanian; Andrew Bell; Juan Merlo

doi:10.1016/j.ssmph.2024.101664

A tutorial for conducting intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA)

SSM Popul Health. 2024 Mar 26:26:101664. doi: 10.1016/j.ssmph.2024.101664. eCollection 2024 Jun.

Authors

Clare R Evans¹, George Leckie², S V Subramanian^{3

4}, Andrew Bell⁵, Juan Merlo^{6

7}

Affiliations

¹ Department of Sociology, University of Oregon, Eugene, OR, USA.
² Centre for Multilevel Modelling and School of Education, University of Bristol, UK.
³ Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
⁴ Harvard Center for Population and Development Studies, Cambridge, MA, USA.
⁵ Sheffield Methods Institute, University of Sheffield, Sheffield, UK.
⁶ Research Unit of Social Epidemiology, Faculty of Medicine, University of Lund, Sweden.
⁷ Center for Primary Health Care Research, Region Skåne, Malmö, Sweden.

Abstract

Intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy (I-MAIHDA) is an innovative approach for investigating inequalities, including intersectional inequalities in health, disease, psychosocial, socioeconomic, and other outcomes. I-MAIHDA and related MAIHDA approaches have conceptual and methodological advantages over conventional single-level regression analysis. By enabling the study of inequalities produced by numerous interlocking systems of marginalization and oppression, and by addressing many of the limitations of studying interactions in conventional analyses, intersectional MAIHDA provides a valuable analytical tool in social epidemiology, health psychology, precision medicine and public health, environmental justice, and beyond. The approach allows for estimation of average differences between intersectional strata (stratum inequalities), in-depth exploration of interaction effects, as well as decomposition of the total individual variation (heterogeneity) in individual outcomes within and between strata. Specific advice for conducting and interpreting MAIHDA models has been scattered across a burgeoning literature. We consolidate this knowledge into an accessible conceptual and applied tutorial for studying both continuous and binary individual outcomes. We emphasize I-MAIHDA in our illustration, however this tutorial is also informative for understanding related approaches, such as multicategorical MAIHDA, which has been proposed for use in clinical research and beyond. The tutorial will support readers who wish to perform their own analyses and those interested in expanding their understanding of the approach. To demonstrate the methodology, we provide step-by-step analytical advice and present an illustrative health application using simulated data. We provide the data and syntax to replicate all our analyses.

Keywords: Health inequality; Intersectionality; Linear regression; Logistic regression; MAIHDA; Multilevel models; Quantitative methods; Social determinants.