Geographic clustering of cardiometabolic risk factors in metropolitan centres in France and Australia

Catherine Paquet, Basile Chaix, Natasha J. Howard, Neil T. Coffee, Robert John Adams, Anne W. Taylor, Frédérique Thomas, Mark Daniel

Research output: Contribution to journalArticlepeer-review

11 Citations (Scopus)
12 Downloads (Pure)


Understanding how health outcomes are spatially distributed represents a first step in investigating the scale and nature of environmental influences on health and has important implications for statistical power and analytic efficiency. Using Australian and French cohort data, this study aimed to describe and compare the extent of geographic variation, and the implications for analytic efficiency, across geographic units, countries and a range of cardiometabolic parameters (Body Mass Index (BMI) waist circumference, blood pressure, resting heart rate, triglycerides, cholesterol, glucose, HbA 1c ). Geographic clustering was assessed using Intra-Class Correlation (ICC) coefficients in biomedical cohorts from Adelaide (Australia, n = 3893) and Paris (France, n = 6430) for eight geographic administrative units. The median ICC was 0.01 suggesting 1% of risk factor variance attributable to variation between geographic units. Clustering differed by cardiometabolic parameters, administrative units and countries and was greatest for BMI and resting heart rate in the French sample, HbA 1c in the Australian sample, and for smaller geographic units. Analytic inefficiency due to clustering was greatest for geographic units in which participants were nested in fewer, larger geographic units. Differences observed in geographic clustering across risk factors have implications for choice of geographic unit in sampling and analysis, and highlight potential cross-country differences in the distribution, or role, of environmental features related to cardiometabolic health.

Original languageEnglish
Article number519
Pages (from-to)1-17
Number of pages17
JournalInternational Journal of Environmental Research and Public Health
Issue number5
Publication statusPublished - 21 May 2016
Externally publishedYes

Bibliographical note

(CC-BY 4.0) Open Access article licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license (


  • Intra-Class Correlation
  • cross-country comparison
  • geographic clustering
  • geographic variation
  • cardiometabolic risk factors
  • Geographic clustering
  • Geographic variation
  • Cardiometabolic risk factors
  • Cross-country comparison
  • Intra-class correlation


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