It's not 'just deprivation': Why do equally deprived UK cities experience different health outcomes?
It's not 'just deprivation': Why do equally deprived UK cities experience different health outcomes?
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DOI：
10.1016/j.puhe.2010.02.006
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发表时间：
2010-09-01
期刊：
影响因子：
5.2
通讯作者：
Hanlon, P.
中科院分区：
文献类型：
--
作者：
Walsh, D.;Bendel, N.;Hanlon, P.
背景：贫困与健康之间的联系已得到公认。然而，最近的研究强调了“苏格兰效应”的存在，这一术语用于描述苏格兰经历的健康状况不佳的程度高于社会经济环境的解释。这种“过剩”集中在苏格兰中西部的证据导致了对更具体的“格拉斯哥效应”的讨论。然而，在英国，格拉斯哥并不是唯一一个经历相对较高水平的健康状况不佳和贫困的城市;利物浦和曼彻斯特是另外两个在这方面也很突出的城市。以前对这种“效应”的分析也受到数据和地理的限制。目的：确定是否有所谓的“格拉斯哥效应”的证据：（1）即使与英国两个最相似和可比较的城市相比;（2）基于比以前研究人员可用的更强大和空间敏感的剥夺措施。研究设计和方法：在格拉斯哥、利物浦和曼彻斯特的小区域（平均人口规模：1600人）计算了“收入剥夺”率（一种与英国多重剥夺的主要指数高度相关的衡量标准）。计算了格拉斯哥相对于利物浦和曼彻斯特的全因和特异性标准化死亡率，标准化年龄，性别和收入剥夺十分位数。此外，一系列的历史人口普查和死亡率数据进行了analysed.Results：剥夺配置文件的格拉斯哥，利物浦和曼彻斯特几乎是相同的。尽管如此，格拉斯哥的过早死亡率高出30%以上，所有死亡率高出约15%。这种“超额”死亡率几乎遍及整个人口：所有年龄段（除了非常年轻的人），包括男性和女性，居住在贫困和非贫困的社区。至于过早死亡，较贫困地区的标准化死亡率往往较高（特别是男性），65岁以下的“超额”死亡中约有一半与酒精和毒品直接有关。对历史数据的分析表明，近几十年来，相对于利物浦和曼彻斯特，格拉斯哥的贫困状况不太可能发生显著变化;然而，自20世纪70年代初以来，死亡率差距似乎有所扩大，这表明“影响”可能是一个相对较新的现象。虽然贫困是健康的一个基本决定因素，因此也是死亡率的一个重要驱动因素，但它只是复杂情况的一部分。根据目前的测量，贫困并不能解释格拉斯哥与两个非常相似的英国城市相比死亡率较高的原因。因此，需要额外的解释。(C)2010年由Elsevier Ltd代表皇家公共卫生学会出版。
Background: The link between deprivation and health is well established. However, recent research has highlighted the existence of a 'Scottish effect', a term used to describe the higher levels of poor health experienced in Scotland over and above that explained by socio-economic circumstances. Evidence of this 'excess' being concentrated in West Central Scotland has led to discussion of a more specific 'Glasgow effect'. However, within the UK, Glasgow is not alone in experiencing relatively high levels of poor health and deprivation; Liverpool and Manchester are two other cities which also stand out in this regard. Previous analyses of this 'effect' were also constrained by limitations of data and geography.Objectives: To establish whether there is evidence of a so-called 'Glasgow effect': (1) even when compared with its two most similar and comparable UK cities; and (2) when based on a more robust and spatially sensitive measure of deprivation than was previously available to researchers.Study design and methods: Rates of 'income deprivation' (a measure very highly correlated with the main UK indices of multiple deprivation) were calculated for small areas (average population size: 1600) in Glasgow, Liverpool and Manchester. All-cause and cause-specific standardized mortality ratios were calculated for Glasgow relative to Liverpool and Manchester, standardizing for age, gender and income deprivation decile. In addition, a range of historical census and mortality data were analysed.Results: The deprivation profiles of Glasgow, Liverpool and Manchester are almost identical. Despite this, premature deaths in Glasgow are more than 30% higher, with all deaths approximately 15% higher. This 'excess' mortality is seen across virtually the entire population: all ages (except the very young), both males and females, in deprived and non-deprived neighbourhoods. For premature mortality, standardized mortality ratios tended to be higher for the more deprived areas (particularly among males), and approximately half of 'excess' deaths under 65 years of age were directly related to alcohol and drugs. Analyses of historical data suggest that it is unlikely that the deprivation profile of Glasgow has changed significantly relative to Liverpool and Manchester in recent decades; however, the mortality gap appears to have widened since the early 1970s, indicating that the 'effect' may be a relatively recent phenomenon.Conclusion: While deprivation is a fundamental determinant of health and, therefore, an important driver of mortality, it is only one part of a complex picture. As currently measured, deprivation does not explain the higher levels of mortality experienced by Glasgow in relation to two very similar UK cities. Thus, additional explanations are required. (C) 2010 Published by Elsevier Ltd on behalf of The Royal Society for Public Health.