Richardson Elizabeth A, Moon Graham, Pearce Jamie, Shortt Niamh K, Mitchell Richard
Centre for Research on Environment, Society and Health (CRESH), School of GeoSciences, University of Edinburgh, Edinburgh EH8 9XP, UK.
Geography and Environment, University of Southampton, University Road, Southampton SO17 1BJ, UK.
Soc Sci Med. 2017 Apr;179:45-51. doi: 10.1016/j.socscimed.2017.02.034. Epub 2017 Feb 24.
Understanding determinants of urban health is of growing importance. Factors at multiple scales intertwine to influence health in cities but, with the growing autonomy of some cities from their countries, city population health may be becoming more a matter for city-level rather than national-level policy and action. We assess the importance of city, country, and macroregional (Western and East-Central Europe) scales to mortality change over time for 274 cities (population 80 million) from 27 European countries. We then investigate whether mortality changes over time are related to changes in city-level affluence. Using Urban Audit data, all-age all-cause standardised mortality ratios (SMRs) for males and females were calculated at three time points (wave one 1999-2002, wave two 2003-2006, and wave three 2007-2009) for each city. Multilevel regression was used to model the SMRs as a function of survey wave and city region gross domestic product (GDP) per 1000 capita. SMRs declined over time and the substantial East-West gap narrowed slightly. Variation at macroregion and country scales characterised SMRs for women in Western and East-Central European cities, and SMRs for men in East-Central European cities. Between-city variation was evident for male SMRs in Western Europe. Changes in city-region GDP per capita were not associated with changes in mortality over the study period. Our results show how geographical scales differentially impact urban mortality. We conclude that changes in urban health should be seen in both city and wider national and macroregional contexts.
了解城市健康的决定因素变得越来越重要。多个尺度的因素相互交织，影响着城市中的健康状况。然而，随着一些城市相对于其所在国家的自主权不断增加，城市人口健康可能更多地成为城市层面而非国家层面政策和行动的问题。我们评估了城市、国家和宏观区域（西欧和中东欧）尺度对于来自27个欧洲国家的274个城市（人口8000万）死亡率随时间变化的重要性。然后，我们调查死亡率随时间的变化是否与城市层面富裕程度的变化相关。利用城市审计数据，在三个时间点（第一波1999 - 2002年、第二波2003 - 2006年、第三波2007 - 2009年）为每个城市计算了男性和女性的全年龄段全死因标准化死亡率（SMR）。采用多水平回归将SMR建模为调查波次和城市区域人均国内生产总值（GDP）的函数。SMR随时间下降，东西方之间的巨大差距略有缩小。宏观区域和国家尺度的差异特征体现在西欧和中东欧城市女性的SMR以及中东欧城市男性的SMR上。西欧男性的SMR在城市之间存在明显差异。在研究期间，城市区域人均GDP的变化与死亡率的变化无关。我们的结果表明了地理尺度如何不同程度地影响城市死亡率。我们得出结论，城市健康的变化应在城市以及更广泛的国家和宏观区域背景下看待。
