Does rapid urbanization aggravate health disparities? Reflections on the epidemiological transition in Pune, India.
Does rapid urbanization aggravate health disparities? Reflections on the epidemiological transition in Pune, India.
复制标题
快速城市化是否会加剧健康差距？对印度浦那流行病学转变的思考。
DOI：
10.3402/gha.v7.23447
复制
发表时间：
2014
影响因子：
2.6
通讯作者：
Kraas F
中科院分区：
文献类型：
--
作者：
Kroll M;Bharucha E;Kraas F
低收入和中等收入国家的快速城市化加剧了城市社会的风险和流行病转变，而城市社会的特点是社会经济梯度很高。在这些情况下，分类的发病率数据有限，妨碍了对不同人口亚群的流行病学概况的研究。该研究旨在分析新兴大城市浦那在发病率和死亡率模式变化方面的流行病学转变，同时考虑到不同社会经济群体之间的健康差异。采用了混合方法，包括死亡率数据的二次分析，在6个社区的900个家庭中进行了调查，这些家庭具有不同的社会经济概况，46个与外行的深入访谈，以及与37名卫生保健提供者和22名其他卫生保健工作者的专家访谈。死亡率数据说明了流行病的转变，浦那非传染性疾病造成的死亡人数不断增加。传染病和寄生虫病造成的死亡比例几乎保持不变，但这一群体的死亡原因变化很大。调查数据和专家访谈表明，社会经济地位较高的群体中糖尿病和高血压的患病率略高，但社会经济地位较低的群体中糖尿病和高血压的发病率较高，并发症和合并症更频繁。虽然疟疾、胃肠炎和结核病的自我报告发病率没有显示出社会经济模式，但专家估计，社会经济地位较低的群体发病率较高，尽管浦那的所有群体都会受到影响。所有社会经济群体的非传染性疾病负担日益加重，同时传染性疾病持续存在，对公共卫生构成重大挑战。改善城市健康需要更加注重所有社会经济群体的健康促进和疾病预防，并对城市健康有全面的了解。为了得出基于证据的解决方案和干预措施，例行监测数据变得不可或缺。
Rapid urbanization in low- and middle-income countries reinforces risk and epidemiological transition in urban societies, which are characterized by high socioeconomic gradients. Limited availability of disaggregated morbidity data in these settings impedes research on epidemiological profiles of different population subgroups. The study aimed to analyze the epidemiological transition in the emerging megacity of Pune with respect to changing morbidity and mortality patterns, also taking into consideration health disparities among different socioeconomic groups. A mixed-methods approach was used, comprising secondary analysis of mortality data, a survey among 900 households in six neighborhoods with different socioeconomic profiles, 46 in-depth interviews with laypeople, and expert interviews with 37 health care providers and 22 other health care workers. The mortality data account for an epidemiological transition with an increasing number of deaths due to non-communicable diseases (NCDs) in Pune. The share of deaths due to infectious and parasitic diseases remained nearly constant, though the cause of deaths changed considerably within this group. The survey data and expert interviews indicated a slightly higher prevalence of diabetes and hypertension among higher socioeconomic groups, but a higher incidence and more frequent complications and comorbidities in lower socioeconomic groups. Although the self-reported morbidity for malaria, gastroenteritis, and tuberculosis did not show a socioeconomic pattern, experts estimated the prevalence in lower socioeconomic groups to be higher, though all groups in Pune would be affected. The rising burden of NCDs among all socioeconomic groups and the concurrent persistence of communicable diseases pose a major challenge for public health. Improvement of urban health requires a stronger focus on health promotion and disease prevention for all socioeconomic groups with a holistic understanding of urban health. In order to derive evidence-based solutions and interventions, routine surveillance data become indispensable.