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المؤلفون: David Martin, Paul Roderick, Sal Barnett, H Wrigley, Ian Diamond
المصدر: Journal of Epidemiology & Community Health. 56:754-761
مصطلحات موضوعية: Adult, Male, Gerontology, medicine.medical_specialty, Theory and Methods, Adolescent, Epidemiology, Rural Health, Urban area, Cause of Death, Poverty Areas, Environmental health, Health care, medicine, Humans, Poisson Distribution, Child, Socioeconomic status, Small-Area Analysis, Aged, Health Services Needs and Demand, geography, geography.geographical_feature_category, Geography, business.industry, Mortality rate, Rural health, Public health, Infant, Newborn, Urban Health, Public Health, Environmental and Occupational Health, Infant, Middle Aged, Survival Rate, Cross-Sectional Studies, England, Socioeconomic Factors, Child, Preschool, Chronic Disease, Female, Rural area, business, Needs Assessment
الوصف: Study objective: To examine the relations between geographical variations in mortality, morbidity, and deprivation at the small area level in the south west of England and to assess whether these relations vary between urban and rural areas. Design: A geographically based cross sectional study using 1991 census data on premature limiting long term illness (LLTI) and socioeconomic characteristics, and 1991–1996 data on all cause premature mortality. The interrelations between the three widely used proxies of health care need are examined using correlation coefficients and scatterplots. The distribution of standardised LLTI residuals from a regression analysis on mortality are mapped and compared with the distribution of urban and rural areas. Multilevel Poisson modelling investigates whether customised deprivation profiles improve upon a generic deprivation index in explaining the spatial variation in morbidity and mortality after controlling for age and sex. These relations are examined separately for urban, fringe, and rural areas. Setting: Nine counties in the south west of England. Participants: Those aged between 0–64 who reported having a LLTI in the 1991 census, and those who died during 1991–1996 aged 0–74. Main results: Relations between both health outcomes and generic deprivation indices are stronger in urban than rural areas. The replacement of generic with customised indices is an improvement in all area types, especially for LLTI in rural areas. The relation between mortality and morbidity is stronger in urban than rural areas, with levels of LLTI appearing to be greater in rural areas than would be predicted from mortality rates. Despite the weak direct relations between mortality and morbidity, there are strong relations between the customised deprivation indices computed to predict these outcomes in all area types. Conclusions: The improvement of the customised deprivation indices over the generic indices, and the similarity between the mortality and morbidity customised indices within area types highlights the importance of modelling urban and rural areas separately. Stronger relations between mortality and morbidity have been revealed at the local authority level in previous research providing empirical evidence that the inadequacy of mortality as a proxy for morbidity becomes more marked at lower levels of aggregation, especially in rural areas. Higher levels of LLTI than expected in rural areas may reflect different perceptions or differing patterns of illness. The stronger relations between the three proxies in urban than rural areas suggests that the choice of indicator will have less impact in urban than rural areas and strengthens the argument to develop better measures of health care need in rural areas.
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المؤلفون: David Martin, Sal Barnett, Ian Diamond, Paul Roderick
المصدر: Journal of Epidemiology & Community Health. 55:44-51
مصطلحات موضوعية: Adult, Male, Gerontology, Time Factors, Theory and Methods, Adolescent, Epidemiology, Population, Rural Health, Risk Assessment, Rurality, Risk Factors, Environmental health, Humans, Medicine, Statistics & numerical data, Child, education, Poverty, Analysis of Variance, education.field_of_study, business.industry, Rural health, Multilevel model, Infant, Newborn, Urban Health, Public Health, Environmental and Occupational Health, Infant, Middle Aged, Cross-Sectional Studies, Social deprivation, England, Child, Preschool, Chronic Disease, Female, Rural area, business
الوصف: STUDY OBJECTIVE—To examine the geographical variation in self perceived morbidity in the south west of England, and assess the associations with rurality and social deprivation. DESIGN—A geographically based cross sectional study using 1991 census data on premature Limiting Long Term Illness (LLTI). The urban-rural and intra-rural variation in standardised premature LLTI ratios is described, and correlation and regression analyses explore how well this is explained by generic deprivation indices. Multilevel Poisson modelling investigates whether Customised Deprivation Profiles (CDPs) and area characteristics improve upon the generic indices. SETTING—Nine counties in the south west of England PARTICIPANTS—The population of the south west enumerated in the 1991 census. MAIN RESULTS—Intra-rural variation is apparent, with higher rates of premature LLTI in remoter areas. Together with high rates in urban areas and lower rates in the semi-rural areas this indicates the existence of a U shaped relation with rurality. The generic deprivation indices have strong positive relations with premature LLTI in urban areas, but these are a lot weaker in semi-rural and rural locations. CDPs improve upon the generic indices, especially in the rural settings. A substantial reduction in unexplained variation in rural areas is seen after controlling for the level of local isolation, with higher isolation, at the wider geographical scale, being related to higher levels of LLTI. CONCLUSIONS—This study highlights the need to treat rural areas as heterogeneous, although this has not been the tendency in health research. Generic deprivation indices are unlikely to be a true reflection of levels of deprivation in rural environments. The importance of CDPs that are specific to the area type and health outcome is emphasised. The significance of physical isolation suggests that accessibility to public and health services may be an important issue, and requires further research. Keywords: rural health; limiting long term illness; deprivation indices
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