Institute of Health & Society, Newcastle University, Richardson Road, Newcastle upon Tyne NE2 4AX, UK.
BMC Public Health. 2013 Mar 16;13:233. doi: 10.1186/1471-2458-13-233.
There is substantial evidence from high income countries that neighbourhoods have an influence on health independent of individual characteristics. However, neighbourhood characteristics are rarely taken into account in the analysis of urban health studies from developing countries. Informal urban neighbourhoods are home to about half of the population in Aleppo, the second largest city in Syria (population>2.5 million). This study aimed to examine the influence of neighbourhood socioeconomic status (SES) and formality status on self-rated health (SRH) of adult men and women residing in formal and informal urban neighbourhoods in Aleppo.
The study used data from 2038 survey respondents to the Aleppo Household Survey, 2004 (age 18-65 years, 54.8% women, response rate 86%). Respondents were nested in 45 neighbourhoods. Five individual-level SES measures, namely education, employment, car ownership, item ownership and household density, were aggregated to the level of neighbourhood. Multilevel regression models were used to investigate associations.
We did not find evidence of important SRH variation between neighbourhoods. Neighbourhood average of household item ownership was associated with a greater likelihood of reporting excellent SRH in women; odds ratio (OR) for an increase of one item on average was 2.3 (95% CI 1.3-4.4 (versus poor SRH)) and 1.7 (95% CI 1.1-2.5 (versus normal SRH)), adjusted for individual characteristics and neighbourhood formality. After controlling for individual and neighbourhood SES measures, women living in informal neighbourhoods were less likely to report poor SRH than women living in formal neighbourhoods (OR= 0.4; 95% CI (0.2- 0.8) (versus poor SRH) and OR=0.5; 95%; CI (0.3-0.9) (versus normal SRH).
Findings support evidence from high income countries that certain characteristic of neighbourhoods affect men and women in different ways. Further research from similar urban settings in developing countries is needed to understand the mechanisms by which informal neighbourhoods influence women's health.
高收入国家有大量证据表明，社区对健康的影响独立于个体特征。然而，在发展中国家的城市健康研究分析中，很少考虑社区特征。在叙利亚第二大城市阿勒颇（人口>250 万），约有一半的人口居住在非正规城市社区。本研究旨在探讨居住在阿勒颇正规和非正规城市社区的成年男女的社区社会经济地位（SES）和正规程度对自我报告健康（SRH）的影响。
本研究使用了 2004 年阿勒颇家庭调查（年龄在 18-65 岁之间，女性占 54.8%，应答率为 86%）的 2038 名调查对象的数据。受访者被嵌套在 45 个社区中。将五个个体层面的 SES 衡量标准，即教育、就业、汽车拥有情况、物品拥有情况和家庭密度，汇总到社区层面。使用多水平回归模型来研究关联。
我们没有发现社区之间 SRH 存在显著差异。社区家庭物品平均拥有情况与女性报告良好 SRH 的可能性增加有关；平均增加一个物品的优势比（OR）为 2.3（95%CI 1.3-4.4（与较差 SRH 相比）和 1.7（95%CI 1.1-2.5（与正常 SRH 相比）），调整个体特征和社区正规程度。在控制了个体和社区 SES 措施后，居住在非正规社区的女性报告较差 SRH 的可能性低于居住在正规社区的女性（OR=0.4；95%CI（0.2-0.8）（与较差 SRH 相比）和 OR=0.5；95%CI（0.3-0.9）（与正常 SRH 相比）。
研究结果支持了高收入国家的证据，即社区的某些特征以不同的方式影响男性和女性。需要在发展中国家类似的城市环境中开展进一步研究，以了解非正规社区影响女性健康的机制。
