Global Health and Society Unit, School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne VIC 3004, Australia.
BMC Public Health. 2013 May 28;13:513. doi: 10.1186/1471-2458-13-513.
Despite a plethora of studies examining the effect of increased urbanisation on health, no single study has systematically examined the measurement properties of scales used to measure urbanicity. It is critical to distinguish findings from studies that use surrogate measures of urbanicity (e.g. population density) from those that use measures rigorously tested for reliability and validity. The purpose of this study was to assess the measurement reliability and validity of the available urbanicity scales and identify areas where more research is needed to facilitate the development of a standardised measure of urbanicity.
Databases searched were MEDLINE with Full Text, CINAHL with Full Text, and PsycINFO (EBSCOhost) as well as Embase (Ovid) covering the period from January 1970 to April 2012. Studies included in this systematic review were those that focused on the development of an urbanicity scale with clearly defined items or the adoption of an existing scale, included at least one outcome measure related to health, published in peer-reviewed journals, the full text was available in English and tested for validity and reliability.
Eleven studies met our inclusion criteria which were conducted in Sri Lanka, Austria, China, Nigeria, India and Philippines. They ranged in size from 3327 to 33,404 participants. The number of scale items ranged from 7 to 12 items in 5 studies. One study measured urban area socioeconomic disadvantage instead of urbanicity. The emerging evidence is that increased urbanisation is associated with deleterious health outcomes. It is possible that increased urbanisation is also associated with access and utilisation of health services. However, urbanicity measures differed across studies, and the reliability and validity properties of the used scales were not well established.
There is an urgent need for studies to standardise measures of urbanicity. Longitudinal cohort studies to confirm the relationship between increased urbanisation and health outcomes are urgently needed.
尽管有大量研究探讨了城市化对健康的影响，但没有一项研究系统地检验了用于衡量城市化程度的量表的测量特性。区分使用城市化的替代指标（如人口密度）的研究和使用经过严格可靠性和有效性测试的指标的研究的结果至关重要。本研究的目的是评估现有城市化量表的测量可靠性和有效性，并确定需要进一步研究的领域，以促进制定标准化的城市化衡量标准。
检索的数据库包括 MEDLINE with Full Text、CINAHL with Full Text 和 PsycINFO（EBSCOhost）以及 Embase（Ovid），涵盖了 1970 年 1 月至 2012 年 4 月期间的文献。本系统评价纳入的研究是那些专注于开发具有明确项目的城市化量表或采用现有量表的研究，包括至少一项与健康相关的结果测量指标，发表在同行评议期刊上，全文为英文，并进行了有效性和可靠性测试。
有 11 项研究符合我们的纳入标准，这些研究分别在斯里兰卡、奥地利、中国、尼日利亚、印度和菲律宾进行。它们的参与者人数从 3327 人到 33404 人不等。在 5 项研究中，量表项目数量从 7 项到 12 项不等。有 1 项研究测量了城市地区的社会经济劣势，而不是城市化程度。越来越多的证据表明，城市化程度的提高与不良的健康结果有关。城市化程度的提高也可能与获得和利用卫生服务有关。然而，研究之间的城市化衡量标准存在差异，并且使用的量表的可靠性和有效性特征尚未得到很好的确定。
迫切需要对城市化衡量标准进行标准化研究。迫切需要进行纵向队列研究，以确认城市化程度的提高与健康结果之间的关系。
