Boyle M H, Willms J D
Department of Psychiatry and Centre for Studies of Children Risk, McMaster University, Hamilton, Ontario, Canada.
Am J Epidemiol. 1999 Mar 15;149(6):577-85. doi: 10.1093/oxfordjournals.aje.a009855.
This study estimates the effects of place on the distribution of health problems, health-related quality of life, general well-being, and family functioning for youths and adults aged 12 years and older. Data come from the Ontario Health Survey, a cross-sectional study done in 1990 to provide baseline statistical data on population health within 42 public health units throughout the province. Place effects were generally small and were influenced by both the size of the geographic area used to define place and the health indicator selected for study. Variations in health explainable at the public health region level were less than 1%. Variations in health explainable within smaller geographic boundaries (enumeration areas) ranged from 4.7% for health problems to 0.2% for family functioning. Adjustment for area differences in the age, gender, education, marital status, income, and birthplace of inhabitants reduced these place effects at the enumeration area level to 3.7% for health problems and to less than 0.1% for family functioning. The lack of evidence for place effects within large jurisdictional boundaries raises questions about both the usefulness of carrying out health needs assessment surveys within these areas and the informativeness of these geographic boundaries for studying place effects.
本研究估计了居住地点对12岁及以上青少年和成年人的健康问题分布、健康相关生活质量、总体幸福感及家庭功能的影响。数据来自安大略省健康调查，这是一项于1990年开展的横断面研究，旨在为全省42个公共卫生单位内的人群健康提供基线统计数据。居住地点的影响通常较小，且受到用于定义居住地点的地理区域大小以及所选择用于研究的健康指标的影响。在公共卫生区域层面可解释的健康差异不到1%。在较小地理边界（枚举区域）内可解释的健康差异范围从健康问题的4.7%到家庭功能的0.2%不等。对居民年龄、性别、教育程度、婚姻状况、收入和出生地的区域差异进行调整后，枚举区域层面的这些居住地点影响在健康问题方面降至3.7%，在家庭功能方面降至不到0.1%。在大管辖范围内缺乏居住地点影响的证据，这引发了关于在这些区域内开展健康需求评估调查的有用性以及这些地理边界对于研究居住地点影响的信息价值的问题。
