Stafford Mai, Duke-Williams Oliver, Shelton Nicola
UCL Medical School, Department of Epidemiology and Public Health, London, United Kingdom.
Soc Sci Med. 2008 Sep;67(6):891-9. doi: 10.1016/j.socscimed.2008.05.028. Epub 2008 Jul 1.
Spatially aggregated data are frequently used for official statistics and by researchers investigating the contextual determinants of health. Results of reporting and analysis vary according to the choice of areal unit. This is the well-known Modifiable Areal Unit Problem or MAUP. Its implication for the monitoring and understanding of area inequalities in health has received little empirical attention in the public health literature. Health differences will likely be smallest across arbitrarily chosen areas whereas boundaries acknowledging the physical and social geography should indicate greater differences between areas. Here we use three methods to define area boundaries and compare the extent of health inequalities across each drawing on data from the London boroughs of Camden and Islington. Irrespective of the boundary definition used, between-area inequalities in obesity, alcohol intake, smoking, walking and self-rated health were small compared with inequalities between individuals. There was a tendency for slightly larger estimated inequalities across areas defined by socioeconomic homogeneity compared with other definitions, but differences between methods were very small in magnitude. Existing studies predominantly use area boundaries that are based on administrative boundaries. Although these have little theoretical basis for the study of neighbourhood inequalities in health, our findings indicate that alternative definitions of the neighbourhood boundaries have no substantive effect on the estimates of those inequalities. Based on these findings, we can have greater confidence in the results of numerous studies which have used administrative boundaries to define the neighbourhood.
空间聚合数据经常用于官方统计以及研究健康环境决定因素的研究人员。报告和分析的结果会因地域单元的选择而有所不同。这就是著名的可变面积单元问题（MAUP）。其对健康领域不平等监测和理解的影响在公共卫生文献中很少受到实证关注。在任意选择的区域内，健康差异可能最小，而承认自然和社会地理的边界应表明不同区域之间存在更大差异。在这里，我们使用三种方法来定义区域边界，并利用来自卡姆登和伊斯灵顿伦敦行政区的数据，比较每种边界划分下健康不平等的程度。无论使用何种边界定义，与个体间不平等相比，肥胖、酒精摄入量、吸烟、步行和自评健康方面的区域间不平等都较小。与其他定义相比，基于社会经济同质性定义的区域间估计不平等往往略大，但不同方法之间的差异在量级上非常小。现有研究主要使用基于行政边界的区域边界。尽管这些边界对于研究邻里健康不平等几乎没有理论依据，但我们的研究结果表明，邻里边界的其他定义对这些不平等的估计没有实质性影响。基于这些发现，我们可以对众多使用行政边界来定义邻里的研究结果更有信心。
