Barnett S, Roderick P, Martin D, Diamond I
Department of Social Statistics, University of Southampton, Southampton.
J Epidemiol Community Health. 2001 Jan;55(1):44-51. doi: 10.1136/jech.55.1.44.
To examine the geographical variation in self perceived morbidity in the south west of England, and assess the associations with rurality and social deprivation.
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 Customized Deprivation Profiles (CDPs) and area characteristics improve upon the generic indices.
Nine counties in the south west of England
The population of the south west enumerated in the 1991 census.
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.
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.
考察英格兰西南部自我感知发病率的地理差异，并评估其与农村地区和社会剥夺之间的关联。
基于地理的横断面研究，使用1991年人口普查中关于过早限制长期疾病（LLTI）的数据。描述了标准化过早LLTI比率的城乡和农村内部差异，并通过相关分析和回归分析探讨通用剥夺指数对此的解释程度。多水平泊松模型研究定制剥夺概况（CDP）和区域特征是否比通用指数有所改进。
英格兰西南部的九个郡
1991年人口普查中列举的西南部人口
农村内部差异明显，偏远地区过早LLTI发生率较高。加上城市地区的高发生率和半农村地区的低发生率，这表明与农村地区存在U型关系。通用剥夺指数与城市地区的过早LLTI有很强的正相关关系，但在半农村和农村地区则弱得多。CDP比通用指数有所改进，尤其是在农村地区。在控制了当地隔离水平后，农村地区未解释的变异大幅减少，在更广泛的地理尺度上，较高的隔离程度与较高的LLTI水平相关。
本研究强调需要将农村地区视为异质的，尽管这并非健康研究中的普遍趋势。通用剥夺指数不太可能真实反映农村环境中的剥夺水平。强调了特定于地区类型和健康结果的CDP的重要性。身体隔离的重要性表明，获得公共服务和医疗服务的便利性可能是一个重要问题，需要进一步研究。
