Schüle Steffen Andreas, Bolte Gabriele
Department of Social Epidemiology, Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany.
PLoS One. 2015 Apr 7;10(4):e0123456. doi: 10.1371/journal.pone.0123456. eCollection 2015.
The research question how contextual factors of neighbourhood environments influence individual health has gained increasing attention in public health research. Both socioeconomic neighbourhood characteristics and factors of the built environment play an important role for health and health-related behaviours. However, their reciprocal relationships have not been systematically reviewed so far. This systematic review aims to identify studies applying a multilevel modelling approach which consider both neighbourhood socioeconomic position (SEP) and factors of the objective built environment simultaneously in order to disentangle their independent and interactive effects on individual health.
The three databases PubMed, PsycINFO, and Web of Science were systematically searched with terms for title and abstract screening. Grey literature was not included. Observational studies from USA, Canada, Australia, New Zealand, and Western European countries were considered which analysed simultaneously factors of neighbourhood SEP and the objective built environment with a multilevel modelling approach. Adjustment for individual SEP was a further inclusion criterion.
Thirty-three studies were included in qualitative synthesis. Twenty-two studies showed an independent association between characteristics of neighbourhood SEP or the built environment and individual health outcomes or health-related behaviours. Twenty-one studies found cross-level or within-level interactions either between neighbourhood SEP and the built environment, or between neighbourhood SEP or the built environment and individual characteristics, such as sex, individual SEP or ethnicity. Due to the large variation of study design and heterogeneous reporting of results the identification of consistent findings was problematic and made quantitative analysis not possible.
There is a need for studies considering multiple neighbourhood dimensions and applying multilevel modelling in order to clarify their causal relationship towards individual health. Especially, more studies using comparable characteristics of neighbourhood SEP and the objective built environment and analysing interactive effects are necessary to disentangle health impacts and identify vulnerable neighbourhoods and population groups.
邻里环境的背景因素如何影响个人健康这一研究问题在公共卫生研究中日益受到关注。邻里社会经济特征和建筑环境因素对健康及与健康相关的行为均起着重要作用。然而，它们之间的相互关系迄今尚未得到系统综述。本系统综述旨在识别采用多水平建模方法的研究，这些研究同时考虑邻里社会经济地位（SEP）和客观建筑环境因素，以厘清它们对个人健康的独立和交互作用。
对三个数据库PubMed、PsycINFO和Web of Science进行系统检索，使用检索词进行标题和摘要筛选。未纳入灰色文献。纳入来自美国、加拿大、澳大利亚、新西兰和西欧国家的观察性研究，这些研究采用多水平建模方法同时分析邻里SEP因素和客观建筑环境因素。对个体SEP进行调整是另一纳入标准。
33项研究纳入定性综合分析。22项研究表明邻里SEP特征或建筑环境与个体健康结局或与健康相关行为之间存在独立关联。21项研究发现邻里SEP与建筑环境之间，或邻里SEP或建筑环境与个体特征（如性别、个体SEP或种族）之间存在跨水平或水平内交互作用。由于研究设计差异大且结果报告不统一，确定一致的研究结果存在问题，无法进行定量分析。
需要开展考虑多个邻里维度并应用多水平建模的研究，以阐明它们与个体健康之间的因果关系。特别是，需要更多使用邻里SEP和客观建筑环境可比特征并分析交互作用的研究，以厘清健康影响并识别脆弱邻里和人群。
