Geographical epidemiology of health and overall deprivation in England, its changes and persistence from 2004 to 2015: a longitudinal spatial population study
Geographical epidemiology of health and overall deprivation in England, its changes and persistence from 2004 to 2015: a longitudinal spatial population study
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DOI：
10.1136/jech-2017-209999
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发表时间：
2018-02-01
影响因子：
6.3
通讯作者：
Doran, Tim
中科院分区：
文献类型：
--
作者：
Kontopantelis, Evangelos;Mamas, Mamas A.;Doran, Tim
社会经济贫困是健康的一个关键决定因素。在英国，多重贫困指数（IMD）是广泛使用的贫困综合衡量标准。然而，很少有人知道它的空间聚类或持久性跨time.Methods数据整体IMD及其健康域进行了分析，2004-2015年在一个低的地理区域（平均1500人）。水平和时间变化的空间可视化为整个英格兰及其10个行政区。使用Moran's I对空间聚类进行量化，使用Pearson's r对随时间推移的相关性进行量化。结果在2004年至2015年期间，我们观察到整体（r=0.94）和健康相关剥夺（r=0.92）具有很强的持久性。在区域一级，随着时间的推移，观察到了微小的变化，但各地区慢慢地向平均值回归。然而，对于与健康相关的剥夺最高的东北部，西北部和约克郡，与健康相关的剥夺的下降趋势发生了逆转，我们注意到2015年有所增加。结果并不支持我们的假设，随着时间的推移增加空间集群。然而，在这两个总的剥夺结果中观察到明显的区域差异。最低的自相关性被认为是在东北部和改变很小，随着时间的推移，而东南部有最高的自相关性在所有的时间points.Conclusions整体和健康相关的剥夺模式持续在英格兰，与大和不变的健康不平等之间的北方和南方。贫困的空间方面可以为保健和社会护理干预措施的目标确定提供信息，特别是在贫困集中程度高的地区。
Background Socioeconomic deprivation is a key determinant for health. In England, the Index of Multiple Deprivation (IMD) is a widely used composite measure of deprivation. However, little is known about its spatial clustering or persistence across time.Methods Data for overall IMD and its health domain were analysed for 2004-2015 at a low geographical area (average of 1500 people). Levels and temporal changes were spatially visualised for the whole of England and its 10 administrative regions. Spatial clustering was quantified using Moran's I, correlations over time were quantified using Pearson's r.Results Between 2004 and 2015 we observed a strong persistence for both overall (r=0.94) and health-related deprivation (r=0.92). At the regional level, small changes were observed over time, but with areas slowly regressing towards the mean. However, for the North East, North West and Yorkshire, where health-related deprivation was the highest, the decreasing trend in health-related deprivation reversed and we noticed increases in 2015. Results did not support our hypothesis of increasing spatial clustering over time. However, marked regional variability was observed in both aggregate deprivation outcomes. The lowest autocorrelation was seen in the North East and changed very little over time, while the South East had the highest autocorrelation at all time points.Conclusions Overall and health-related deprivation patterns persisted in England, with large and unchanging health inequalities between the North and the South. The spatial aspect of deprivation can inform the targeting of health and social care interventions, particularly in areas with high levels of deprivation clustering.