University of Glasgow, Centre for Research on Environment, Society and Health, Glasgow, UK.
Soc Sci Med. 2011 Oct;73(8):1113-22. doi: 10.1016/j.socscimed.2011.07.015. Epub 2011 Aug 2.
In this paper, we develop and test a method for examining the influence of national level contextual influences on population health. Acknowledging calls for the use of experimental study designs to explore contextual influences on health, we develop a study design in which sets of local areas from Britain and Belgium became akin to two 'treatment' groups; one exposed to British society and culture and the other exposed to Belgian society and culture. The areas are matched on the basis of showing very strong similarities in economic, demographic and historical characteristics. Data describing these characteristics are obtained from national census data. A principal component analysis of these variables permits areas in Britain and Belgium with similar scores on the resulting components to be matched into pairs. A sequence of logistic regression models identifies between-country difference in the risk of reporting poor health. Our final model compares the risk of reporting poor health among Belgians and people from Britain living in similar local contexts, adjusting for any residual differences in individual level characteristics. We compare results from this new method with those from more conventional approaches. All approaches show that residence in Britain is associated with a substantial and significantly higher risk of reporting poor health for both men and women, after adjustment for both individual and local contextual influences. We then critically reflect on our method and on the context-composition framework for research into area variation in health. We conclude that whilst our approach succeeded in applying the idea of comparable groups with different exposures to an observational, international comparison, it also brought associated questions about external validity and the extent to which a sample of matched areas captures a 'national' context.
在本文中，我们开发并测试了一种方法，用于检验国家层面的背景因素对人口健康的影响。鉴于呼吁使用实验研究设计来探索背景因素对健康的影响，我们设计了一种研究方案，将英国和比利时的一系列局部地区视为类似于两个“处理”组；一组暴露于英国社会和文化，另一组暴露于比利时社会和文化。这些地区是根据其在经济、人口和历史特征方面表现出非常强的相似性进行匹配的。描述这些特征的数据是从全国人口普查数据中获得的。对这些变量进行主成分分析，使英国和比利时的地区在得出的成分上具有相似的得分，可以匹配成对。一系列逻辑回归模型确定了报告健康状况不佳的风险在国家间的差异。我们的最终模型比较了报告健康状况不佳的比利时人和居住在类似当地环境中的英国人之间的风险，同时调整了个体水平特征的任何残余差异。我们将这种新方法的结果与更传统方法的结果进行了比较。所有方法都表明，在调整个体和当地背景因素的影响后，居住在英国与报告健康状况不佳的风险显著增加，这对男性和女性都是如此。然后，我们批判性地反思了我们的方法和用于研究健康区域差异的背景组成框架。我们得出的结论是，虽然我们的方法成功地将具有不同暴露的可比群体的思想应用于观察性的国际比较，但它也带来了关于外部有效性以及匹配地区样本在多大程度上捕获“国家”背景的相关问题。
