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Der Einfluß kontextueller Merkmale auf die Entstehung gesundheitlicher Ungleichheit: Theoriebildung und Methodenentwicklung

背景特征对健康不平等出现的影响：理论构建和方法开发

基本信息

批准号：
161104643
负责人：
Professor Dr. Oliver Razum
金额：
--
依托单位：
Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie
依托单位国家：
德国
项目类别：
Research Grants
财政年份：
2009
资助国家：
德国
起止时间：
2008-12-31 至 2016-12-31
项目状态：
已结题

来源：
https://gepris.dfg.de/gepris/projekt/161104643?language=en
关键词：
Der Einflu kontextueller Merkmale auf

项目摘要

The relationship between social inequalities and health is well documented. Until now, social factors at the individual level have predominantly been considered. In our previous DFG project we could demonstrate that factors of the small-scale environment or context of persons play a role in the production of health inequalities, and include them in a theoretical model. Due to data availability, administratively defined spatial levels had to be used; the question what geographical levels are the most relevant for understanding the association between contextual factors and health still remains to be answered. A definition of such small areas (neighbourhoods) from the point of view of an individual might be more appropriate to understand how contextual factors influence individual health and contribute to the development of health inequalities. In the present project, such a notion of neighbourhood is investigated. We will study two aspects: the neighbourhood s mediating role between place and health of an individual (subject matter aspect) and its quantitative characterisation (methodological aspect).The aim is to assess, within five distinct German and European urban areas, how the neighbourhoods are characterised and which among a range of individual and contextual variables affect those characteristics. Five different cohorts providing measures of geo-location and of individuals health are available. The covariates of interest will include demographic data, individual and contextual measures of socio-economic status and subjective measures of perception of the environment. Also a comparison of the results obtained will be performed between the German and European urban areas in order to assess which parameters could further refine our general theoretical model explaining the mediation between place and health. In terms of methodology, such a neighbourhood will be defined, on average over all individuals in a single urban area, by a disk containing neighbours whose health is correlated to the health of the individual at its centre. The neighbourhood is characterised by its range and the strength of the correlation. We will model the correlation structure using semi-variograms. The effect of covariates will be assessed by modelling the correlation of residuals. Issues around sample size and distribution of the data over the area (cluster or uniform) will be investigated through simulations in order to advise on the optimal size and sample form to obtain estimates of strength and range. This project will deepen the understanding of the mechanisms which mediate the relationship between place and health. A strong correlation between health outcomes in the neighbourhood indicates context-dependent health inequities. Understanding the factors at work will inform Public Health strategies to tackle those inequities.

社会不平等与健康之间的关系有充分的文献记载。到目前为止，主要考虑的是个人层面的社会因素。在我们以前的DFG项目中，我们可以证明小规模环境或个人背景的因素在健康不平等的产生中发挥作用，并将其纳入理论模型。由于数据的可用性，必须使用行政定义的空间级别;什么样的地理级别对于理解背景因素与健康之间的关联最相关的问题仍然有待回答。从个人的角度对这种小区域（街区）下定义可能更适合于理解背景因素如何影响个人健康并促成健康不平等的发展。在本项目中，这样一个概念的邻居进行了调查。我们将研究两个方面：邻里之间的中介作用的地方和个人的健康（主题方面）和它的定量表征（方法方面）的目的是评估，在五个不同的德国和欧洲城市地区，如何邻里的特点，以及在一系列的个人和背景变量影响这些特征。提供地理位置和个人健康测量的五个不同群组可用。相关的协变量将包括人口统计数据、社会经济地位的个人和背景测量以及对环境感知的主观测量。此外，将在德国和欧洲城市地区之间进行比较，以评估哪些参数可以进一步完善我们的一般理论模型，解释地方和健康之间的调解。在方法上，将对一个城市地区的所有个人平均划分这样一个社区，其定义是一个圆盘，其中包括其健康状况与中心个人健康状况相关的邻居。邻域的特征在于其范围和相关性的强度。我们将使用半变异函数对相关性结构进行建模。将通过对残差相关性建模来评估协变量的影响。将通过模拟研究样本大小和数据在整个区域的分布（集群或均匀）问题，以便就最佳大小和样本形式提出建议，以获得强度和范围的估计值。该项目将加深对场所与健康之间关系的调节机制的理解。邻里之间的健康结果之间存在着很强的相关性，这表明存在着取决于具体情况的健康不平等现象。了解工作中的因素将为公共卫生战略提供信息，以解决这些不平等问题。