Section 'Quality of Health Care, Health Economics, Health System Analysis' (GE 6), Bavarian Health and Food Safety Authority (LGL), Schweinauer Hauptstraße 80, 90441, Nürnberg, Germany,
Int J Public Health. 2014 Jun;59(3):427-38. doi: 10.1007/s00038-014-0556-8. Epub 2014 Apr 26.
Material and social living conditions at the small-area level are assumed to have an effect on individual health. We review existing explanatory models concerning the effects of small-area characteristics on health and describe the gaps future research should try to fill.
Systematic literature search for, and analysis of, studies that propose an explanatory model of the relationship between small-area characteristics and health.
Fourteen studies met our inclusion criteria. Using various theoretical approaches, almost all of the models are based on a three-tier structure linking social inequalities (posited at the macro-level), small-area characteristics (posited at the meso-level) and individual health (micro-level). No study explicitly defines the geographical borders of the small-area context. The health impact of the small-area characteristics is explained by specific pathways involving mediating factors (psychological, behavioural, biological). These pathways tend to be seen as uni-directional; often, causality is implied. They may be modified by individual factors.
A number of issues need more attention in research on explanatory models concerning small-area effects on health. Among them are the (geographical) definition of the small-area context; the systematic description of pathways comprising small-area contextual as well as compositional factors; questions of direction of association and causality; and the integration of a time dimension.
人们认为小区域层面的物质和社会生活条件会对个人健康产生影响。我们回顾了现有关于小区域特征对健康影响的解释模型，并描述了未来研究应努力填补的空白。
系统地搜索和分析提出小区域特征与健康之间关系的解释模型的研究。
符合纳入标准的研究有 14 项。几乎所有的模型都基于一个三层结构，将社会不平等（置于宏观层面）、小区域特征（置于中观层面）和个人健康（微观层面）联系起来，使用了各种理论方法。没有研究明确界定小区域背景的地理边界。小区域特征对健康的影响通过涉及中介因素（心理、行为、生物）的特定途径来解释。这些途径往往被视为单向的；通常暗示着因果关系。它们可能会被个体因素所改变。
在关于小区域对健康影响的解释模型的研究中，有一些问题需要更多关注。其中包括（地理）定义小区域背景；系统描述包含小区域背景和组成因素的途径；关联和因果关系的方向问题；以及时间维度的整合。
