Norwegian Institute of Public Health, PO Box 4404 Nydalen, 0403 Oslo, Norway.
Int J Equity Health. 2009 Dec 9;8:41. doi: 10.1186/1475-9276-8-41.
The intention was to find out whether there was an association between the socio-economic resources in a small neighbourhood ("basic statistical unit"; BSU) and individual mortality, net of individual resources, and whether this association differed between municipalities including a quite large city and others. The possibility of a rural-urban difference in the health effect of community resources has not been checked earlier.
Discrete-time hazard models for mortality at age 60-89 were estimated for 1990-1992 and 2000-2002, using register data that cover the entire Norwegian population. For each person, the educational level and the municipality and BSU of residence in 1990 and 2000 were known. Average education was computed by aggregating over the individual data. In total, there were about 200000 deaths in more than 13000 BSUs during 5 million person-years of observation.
There was a significant relationship between average education in the BSU and individual mortality, but only in the medium-sized and largest municipalities. The sharpest relationship was seen in the latter, where for example OR per year of education was 0.908 (95% CI 0.887-0.929) in the 1990-92 period. The findings were robust to various alternative specifications.
These results from a large data set are consistent with the idea that neighbourhood socio-economic resources may affect individual mortality, but suggest that distinctions according to population size or density be made in future research and that one should be careful, if focusing on cities, to generalize beyond that setting. With these data, one can only speculate about the reasons for the rural-urban difference. A stronger higher-level spatial segregation in urban areas may be one explanation.
本研究旨在探讨小邻里社区（“基本统计单位”；BSU）的社会经济资源与个体死亡率之间是否存在关联，且这种关联是否因包含一个较大城市在内的不同城市而有所差异。此前尚未有研究检查社区资源的健康效应在城乡之间是否存在差异。
利用涵盖挪威全部人口的登记数据，针对 1990-1992 年和 2000-2002 年的死亡率，使用离散时间风险模型进行了估计。对于每一个人，我们了解其在 1990 年和 2000 年的教育水平和居住的市镇以及 BSU。通过对个人数据进行汇总，计算出平均教育水平。在总计超过 500 万人年的观察期间，在 13000 多个 BSU 中发生了约 200000 例死亡。
BSU 中的平均教育水平与个体死亡率之间存在显著关系，但仅在中等规模和最大规模的市镇中存在。在后者中，关系最为明显，例如，1990-1992 年期间，BSU 中每增加一年教育，死亡风险 OR 为 0.908（95%CI 0.887-0.929）。各种替代规范的结果均稳健。
这些来自大型数据集的结果与邻里社区社会经济资源可能影响个体死亡率的观点一致，但建议在未来的研究中根据人口规模或密度进行区分，并在关注城市时，谨慎地将研究结果推广到城市以外的范围。根据这些数据，我们只能推测城乡差异的原因。城市中更高水平的空间隔离可能是一个解释。
