O'Reilly Gareth, O'Reilly Dermot, Rosato Michael, Connolly Sheelah
The Department of Epidemiology & Public Health, The Queen's University of Belfast, Belfast, Northern Ireland.
BMC Public Health. 2007 Jun 26;7:123. doi: 10.1186/1471-2458-7-123.
From a public health perspective and for the appropriate allocation of resources it is important to understand the differences in health between areas. This paper examines the variations in morbidity and mortality between urban and rural areas.
This is a cohort study looking at morbidity levels of the population of Northern Ireland at the time of the 2001 census, and subsequent mortality over the following four years. Individual characteristics including demographic and socio-economic factors were as recorded on census forms. The urban-rural nature of residence was based on census areas (average population c1900) classified into eight settlement bands, ranging from cities to rural settlements with populations of less than 1000.
The study shows that neither tenure nor car availability are unbiased measures of deprivation in the urban-rural context. There is no indication that social class is biased. There was an increasing gradient of poorer health from rural to urban areas, where mortality rates were about 22% (95% Confidence Intervals 19%-25%) higher than the most rural areas. Differences in death rates between rural and city areas were evident for most of the major causes of death but were greatest for respiratory disease and lung cancer. Conversely, death rates in the most rural areas were higher in children and adults aged less than 20.
Urban areas appear less healthy than the more rural areas and the association with respiratory disease and lung cancer suggests that pollution may be a factor. Rural areas however, have higher death rates amongst younger people, something which requires further research. There is also a need for additional indicators of deprivation that have equal meaning in urban and rural areas.
从公共卫生角度以及为了合理分配资源，了解不同地区之间的健康差异很重要。本文研究了城乡地区发病率和死亡率的差异。
这是一项队列研究，观察了2001年人口普查时北爱尔兰人口的发病水平以及随后四年的死亡率。个体特征包括人口统计学和社会经济因素，如人口普查表格所记录。居住的城乡性质基于普查区域（平均人口约1900人），分为八个定居类别，从城市到人口不足1000的农村定居点。
研究表明，在城乡背景下，住房保有情况和汽车拥有情况都不是衡量贫困的无偏指标。没有迹象表明社会阶层存在偏差。从农村到城市地区，健康状况越来越差，城市地区的死亡率比最偏远农村地区高出约22%（95%置信区间为19%-25%）。农村和城市地区在大多数主要死因上的死亡率差异明显，但呼吸系统疾病和肺癌的差异最大。相反，最偏远农村地区20岁以下儿童和成人的死亡率较高。
城市地区的健康状况似乎不如农村地区，与呼吸系统疾病和肺癌的关联表明污染可能是一个因素。然而，农村地区年轻人的死亡率较高，这需要进一步研究。还需要在城乡地区具有同等意义的额外贫困指标。
