AP-HP, Hôpital Saint-Antoine, Unité de Santé Publique, Paris, France.
J Epidemiol Community Health. 2011 Aug;65(8):666-70. doi: 10.1136/jech.2009.087957. Epub 2009 Sep 18.
During the early 19th century, contagionists' and anti-contagionists' explanations of disease causes opposed one another, and the Hippocratic miasma theory still predominated. According to that theory, geographic health disparities could be explained by topographical factors: differences in altitude, population density or proximity to a river. This article summarizes the life of Louis-René Villermé (1782-1863) and his major contributions to social epidemiology that proved the association between poverty and mortality.
In this study, data reported by Villermé to study the mortality-rate variations across the 12 districts (arrondissements) of Paris-that is, 1817-1826 Parisian death rates by district, population density and income indicators-are presented and reanalyzed.
Results obtained with today's statistical techniques (correlation analysis) support Villermé's claims of a direct poverty-high death rate link: the three income indicators that he chose were significantly correlated with at-home mortality: taxation index (r=-0.83, p<0.002), average rent (r=-0.83, p<0.002), trade taxation index (r=-0.67, p<0.05), while population density variables were not associated with mortality.
Villermé was not only a forerunner of social epidemiology, he was also a scientific pioneer by relying on data, not opinions, to challenge or support medical hypotheses.
19 世纪早期，传染病学家和反传染病学家对疾病病因的解释相互对立，希波克拉底瘴气理论仍然占主导地位。根据该理论，地理卫生差异可以用地形因素来解释：海拔、人口密度或靠近河流的差异。本文总结了路易斯-雷内·维勒梅（Louis-René Villermé）的生平及其对社会流行病学的主要贡献，这些贡献证明了贫困与死亡率之间存在关联。
在这项研究中，维勒梅报告的数据用于研究巴黎 12 个区（arrondissements）的死亡率变化，即 1817-1826 年巴黎各区的死亡率、人口密度和收入指标，并对这些数据进行了重新分析。
用今天的统计技术（相关分析）得到的结果支持了维勒梅关于贫困与高死亡率直接相关的说法：他选择的三个收入指标与在家中的死亡率显著相关：税收指数（r=-0.83，p<0.002）、平均租金（r=-0.83，p<0.002）、贸易税收指数（r=-0.67，p<0.05），而人口密度变量与死亡率无关。
维勒梅不仅是社会流行病学的先驱，而且还是一位科学先驱，他依靠数据而不是意见来挑战或支持医学假说。
