The impact of regional and neighbourhood deprivation on physical health in Germany: a multilevel study
The impact of regional and neighbourhood deprivation on physical health in Germany: a multilevel study
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DOI：
10.1186/1471-2458-10-403
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发表时间：
2010-07-08
影响因子：
4.5
通讯作者：
Razum, Oliver
中科院分区：
文献类型：
--
作者：
Voigtlaender, Sven;Berger, Ursula;Razum, Oliver
背景：越来越多的证据表明，个人健康至少部分取决于邻里和区域因素。然而，人们对机制仍然知之甚少，来自德国的证据也很少。本研究探讨了区域和邻里剥夺是否与身体健康相关，以及这种关联在多大程度上可以通过特定的邻里暴露来解释。方法：使用 2004 年德国社会经济小组研究 (SOEP) 的数据，结合区域和邻里特征，我们拟合了以 SF-12 测量的主观身体健康为因变量的多级线性回归模型。这些模型包括区域和社区的剥夺代理（即区域失业配额、街道部分的平均购买力）以及特定的社区暴露（即感知的空气污染）。包括社会经济地位和健康行为在内的个人特征已得到控制。结果：本研究发现区域剥夺与身体健康之间存在显着关联，这种关联独立于构成因素，并且在不同空间尺度上保持一致。此外，邻里剥夺与身体健康之间的关联可以部分地用邻里环境的具体特征来解释。在这些感知到的空气污染中，与身体健康的关联性最强（-2.4 分表示空气污染非常强，-1.5 分表示空气污染严重干扰，标准误差 (SE) 分别为 0.8 和 0.4）。当模型中包含个人健康行为时，感知空气污染、感知噪音和感知到娱乐资源的距离的 Beta 系数不会减少。结论：这项研究强调了区域（特别是邻里）剥夺对德国个人身体健康的影响。结果支持这样的论点：特定的社区暴露是贫困和健康之间的中间步骤。由于社会经济地位较低的人更有可能接触到不利的社区特征，这些条件可能会导致健康不平等。
Background: There is increasing evidence that individual health is at least partly determined by neighbourhood and regional factors. Mechanisms, however, remain poorly understood, and evidence from Germany is scant. This study explores whether regional as well as neighbourhood deprivation are associated with physical health and to what extent this association can be explained by specific neighbourhood exposures.Methods: Using 2004 data from the German Socio-Economic Panel Study (SOEP) merged with regional and neighbourhood characteristics, we fitted multilevel linear regression models with subjective physical health, as measured by the SF-12, as the dependent variable. The models include regional and neighbourhood proxies of deprivation (i.e. regional unemployment quota, average purchasing power of the street section) as well as specific neighbourhood exposures (i.e. perceived air pollution). Individual characteristics including socioeconomic status and health behaviour have been controlled for.Results: This study finds a significant association between area deprivation and physical health which is independent of compositional factors and consistent across different spatial scales. Furthermore the association between neighbourhood deprivation and physical health can be partly explained by specific features of the neighbourhood environment. Among these perceived air pollution shows the strongest association with physical health (-2.4 points for very strong and -1.5 points for strong disturbance by air pollution, standard error (SE) = 0.8 and 0.4, respectively). Beta coefficients for perceived air pollution, perceived noise and the perceived distance to recreational resources do not diminish when including individual health behaviour in the models.Conclusions: This study highlights the difference regional and in particular neighbourhood deprivation make to the physical health of individuals in Germany. The results support the argument that specific neighbourhood exposures serve as an intermediary step between deprivation and health. As people with a low socioeconomic status were more likely to be exposed to unfavourable neighbourhood characteristics these conditions plausibly contribute towards generating health inequalities.