Covariation in the socioeconomic determinants of self rated health and happiness: a multivariate multilevel analysis of individuals and communities in the USA

Objective: To investigate individual level determinants of self rated health and happiness, as well as the extent of community level covariation in health and happiness. Design: Multivariate multilevel regression analysis of self rated poor health and unhappiness at level 1, nested within 24118 people at level 2, nested within 36 communities at level 3. Data were obtained from the 2000 social capital benchmark survey. Setting: USA communities. Participants: 24118 adults. Main outcome measures: Self reported fair/poor health; and a single item measure of subjective wellbeing. Results: Controlling for demographic markers, a strong income and education gradient was seen for self rated poor health and unhappiness, with the gradient being stronger for poor health. Community level correlations between self rated poor health and happiness were stronger (0.65) than the individual level correlations (0.16) between the two outcomes. Conclusion: Poor health and unhappiness are highly positively correlated within individuals, and communities that are healthier tend to be happier and vice versa.