Adding interactions to models of intersectional health inequalities: Comparing multilevel and conventional methods


Evans, Clare R. (2019). Adding interactions to models of intersectional health inequalities: Comparing multilevel and conventional methods. Social Science & Medicine. vol. 221 pp. 95-105


Examining health inequalities intersectionally is gaining in popularity and recent quantitative innovations, such as the development of intersectional multilevel methods, have enabled researchers to expand the number of dimensions of inequality evaluated while avoiding many of the theoretical and methodological limitations of the conventional fixed effects approach. Yet there remains substantial uncertainty about the effects of integrating numerous additional interactions into models: will doing so reveal statistically significant interactions that were previously hidden or explain away interactions seen when fewer dimensions were considered? Furthermore, how does the multilevel approach compare empirically to the conventional approach across a range of conditions? These questions are essential to informing our understanding of population-level health inequalities. I address these gaps using data from the National Longitudinal Study of Adolescent to Adult Health by evaluating conventional and multilevel intersectional models across a range of interaction conditions (ranging from six points of interaction to more than ninety, interacting gender, race/ethnicity/immigration status, parent education, family income, and sexual identification), different model types (linear and logistic), and seven diverse dependent variables commonly examined by health researchers: body mass index, depression, general self-rated health, binge drinking, cigarette use, marijuana use, and other illegal drug use. Findings suggest that adding categories to intersectional analyses will tend to reveal new points of interaction. Stratum-level results from the multilevel approach are robust to cross-classification by school context. Conventional and multilevel approaches differ substantially when tested empirically. I conclude with a detailed consideration of the origin of these differences and provide recommendations for future scholarship of intersectional health inequalities.



Intersectionality Multilevel models Health inequalities Social determinants Adolescent health

Reference Type

Journal Article

Journal Title

Social Science & Medicine


Evans, Clare R.

Year Published


Volume Number





November 29, 2018



Reference ID