UMR Environnement Ville Société, Université de Lyon, Faculté GHHAT, 5 Avenue Pierre Mendès-France, Bron Cedex 69676, France.
Int J Health Geogr. 2013 Apr 10;12:19. doi: 10.1186/1476-072X-12-19.
In recent years, there have been a growing number of studies on spatial inequalities in health covering a variety of scales, from small areas to metropolitan areas or regions, and for various health outcomes. However, few investigations have compared health status between cities with a view to gaining a better understanding of the relationships between such inequalities and the social, economic and physical characteristics. This paper focuses on disparities in respiratory health among the 55 largest French cities. The aim is to explore the relationships between inter-urban health patterns, city characteristics and regional context, and to determine how far a city's health status relates to the features observed on different geographical scales.
We used health data describing hospitalizations for Chronic Obstructive Pulmonary Disease (COPD) as a proxy for respiratory health, and the total number of hospitalizations (overall) as a proxy for general health. This last indicator was used as a benchmark. A large set of indicators relating to socioeconomic, physical and amenity aspects of the cities (urban units) was also constructed. Data were analyzed using linear correlations and multiple linear regression models.
The results suggest that socioeconomic characteristics are major discriminators for inequalities in respiratory health status among urban units. Indeed, once combined to socioeconomic characteristics, only a climate indicator remained significant among the physical indicators. It appeared that the pollution indicators which were significantly correlated with COPD hospitalization rates loosed significance when associated to the socio-economic indicators in a multiple regression. The analysis showed that among the socio-economic indicators, an employment indicator derived at the regional scale, and two indicators reflecting the unequal intra-urban spatial distribution of population according to their education, were the most efficient to describe differences in the respiratory health status of urban units.
In order to design effective urban policies, it is essential to gain a better understanding of the differences among cities in their entirety, rather than solely differences across small urban areas or individuals.
近年来，越来越多的研究关注健康的空间不平等现象，涵盖从小区域到大都市区或地区的各种规模，以及各种健康结果。然而，很少有研究比较城市之间的健康状况，以更好地了解这些不平等现象与社会、经济和物理特征之间的关系。本文聚焦于法国 55 个最大城市的呼吸健康差异。目的是探索城市间健康模式、城市特征和区域背景之间的关系，并确定城市的健康状况与不同地理尺度上观察到的特征之间的关系程度。
我们使用描述慢性阻塞性肺病（COPD）住院情况的健康数据作为呼吸健康的替代指标，以及总住院人数（总体）作为一般健康的替代指标。后一个指标被用作基准。还构建了一套与城市（城市单元）的社会经济、物理和宜人方面相关的大量指标。使用线性相关和多元线性回归模型对数据进行分析。
结果表明，社会经济特征是城市单元呼吸健康状况不平等的主要决定因素。事实上，一旦与社会经济特征相结合，只有一个气候指标在物理指标中仍然具有显著性。表明与 COPD 住院率显著相关的污染指标在与社会经济指标进行多元回归时失去了显著性。分析表明，在社会经济指标中，区域尺度上得出的就业指标，以及反映人口教育程度不均等的城市内部空间分布的两个指标，是描述城市单元呼吸健康状况差异的最有效指标。
为了制定有效的城市政策，必须更好地了解城市之间的整体差异，而不仅仅是小区域或个人之间的差异。
