Multilevel analyses of neighbourhood socioeconomic context and health outcomes: a critical review
Multilevel analyses of neighbourhood socioeconomic context and health outcomes: a critical review
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DOI：
10.1136/jech.55.2.111
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发表时间：
2001-02-01
影响因子：
6.3
通讯作者：
Pearl, M
中科院分区：
文献类型：
--
作者：
Pickett, KE;Pearl, M
研究目的：近年来，人们对邻里或当地社会特征对健康的影响越来越感兴趣，但迄今为止，现有的证据还没有得到系统的回顾。社会因素和健康的多层次或背景分析代表了两种不同的流行病学范式-个体风险因素流行病学和生态学方法之间的可能和解。数据来源-医学索引（Medline）的关键词搜索和检索到的文章中的其他参考文献。研究选择-当地社会特征对个体健康结果的影响的所有原始研究，根据个体社会经济地位进行调整，发表在1998年6月1日之前的英语和发达国家的人口为重点。数据合成，局部区域的影响的多层次研究的设计和解释所带来的方法学挑战进行了讨论，结果总结与参考类型的健康结果。在25项回顾性研究中，除两项外，所有研究都报告了在调整个人社会经济地位（成分效应）后，至少一项社会环境指标与健康结果（背景效应）之间存在统计学显著相关性。背景效应一般温和，远小于compositionaleffects. Conclusions的证据温和的邻里效应对健康的影响是相当一致的，尽管异质性的研究设计，替代当地的措施，邻里措施和可能的测量误差。通过引起公众卫生对与社区社会结构和生态相关的健康风险的关注，社区层面干预的创新方法可能会随之而来。
Purpose-Interest in the effects of neighbourhood or local area social characteristics on health has increased in recent years, but to date the existing evidence has not been systematically reviewed. Multilevel or contextual analyses of social factors and health represent a possible reconciliation between two divergent epidemiological paradigms-individual risk factor epidemiology and an ecological approach.Data sources-Keyword searching of Index Medicus (Medline) and additional references from retrieved articles.Study selection-All original studies of the effect of local area social characteristics on individual health outcomes, adjusted for individual socioeconomic status, published in English before 1 June 1998 and focused on populations in developed countries.Data synthesis-The methodological challenges posed by the design and interpretation of multilevel studies of local area effects are discussed and results summarised with reference to type of health outcome. All but two of the 25 reviewed studies reported a statistically significant association between at least one measure of social environment and a health outcome (contextual effect), after adjusting for individual level socioeconomic status (compositional effect). Contextual effects were generally modest and much smaller than compositional effects.Conclusions-The evidence for modest neighbourhood effects on health is fairly consistent despite heterogeneity of study designs, substitution of local area measures for neighbourhood measures and probable measurement error. By drawing public health attention to the health risks associated with the social structure and ecology of neighbourhoods, innovative approaches to community level interventions may ensue.