Li Yu-Sheng, Chuang Ying-Chih
Center for Health Policy Research and Development, National Health Research Institutes, Miaoli County, Taiwan.
J Urban Health. 2009 Jan;86(1):5-18. doi: 10.1007/s11524-008-9306-7. Epub 2008 Jul 15.
This study suggests a multivariate-structural approach combining factor analysis and cluster analysis that could be used to examine neighborhood effects on an individual's health. Data were from the Taiwan Social Change Survey conducted in 1990, 1995, and 2000. In total, 5,784 women and men aged over 20 years living in 428 neighborhoods were interviewed. Participants' addresses were geocoded with census data for measuring neighborhood-level characteristics. The factor analysis was applied to identify neighborhood dimensions, which were used as entities in the cluster analysis to generate a neighborhood typology. The factor analysis generated three neighborhood dimensions: neighborhood education, age structure, and neighborhood family structure and employment. The cluster analysis generated six types of neighborhoods with combinations of the three neighborhood dimensions. Multilevel binomial regression models were used to assess the effects of neighborhoods on an individual's health. The results showed that the biggest health differences were between two neighborhood types: (1) the highest concentration of inhabitants younger than 15 years, a moderate education level, and a moderate level of single-parent families and (2) the highest educational level, a median level of single-parent families, and a median level of elderly concentrations. Individuals living in the first type had significantly higher chances of having functional limitations and poor self-rated health than the individuals in the second neighborhood type. Our study suggests that the multivariate-structural approach improves neighborhood measurements by addressing neighborhood diversity and examining how an individual's health varies in different neighborhood contexts.
本研究提出了一种结合因子分析和聚类分析的多变量结构方法,可用于检验社区对个体健康的影响。数据来自于1990年、1995年和2000年进行的台湾社会变迁调查。总共对居住在428个社区的5784名20岁以上的男女进行了访谈。参与者的地址通过人口普查数据进行地理编码,以测量社区层面的特征。因子分析用于识别社区维度,这些维度在聚类分析中作为实体,以生成社区类型学。因子分析产生了三个社区维度:社区教育、年龄结构以及社区家庭结构与就业。聚类分析通过这三个社区维度的组合产生了六种社区类型。多水平二项回归模型用于评估社区对个体健康的影响。结果表明,最大的健康差异存在于两种社区类型之间:(1)15岁以下居民集中度最高、教育水平中等、单亲家庭水平中等;(2)教育水平最高、单亲家庭水平中位数、老年人口集中度中位数。与第二种社区类型的个体相比,居住在第一种社区类型的个体出现功能受限和自我健康评价较差的几率显著更高。我们的研究表明,多变量结构方法通过解决社区多样性问题并考察个体健康在不同社区环境中的差异,改进了社区测量。