Ribeiro Ana I, Fraga Sílvia, Barros Henrique
Epidemiology Research Unit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.
Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal.
Front Psychol. 2018 Jan 9;8:2319. doi: 10.3389/fpsyg.2017.02319. eCollection 2017.
About 2/3 of the Europeans reside in cities. Thus, we must expand our knowledge on how city characteristics affect health and well-being. Perceptions about cities' resources and functioning might be related with health, as they capture subjective experiences of the residents. We characterized the health status of 74 European cities, using all-cause mortality as indicator, and investigated the association of mortality with residents' dissatisfaction with key domains of urban living. We considered 74 European cities from 29 countries. Aggregated data on residents' dissatisfaction was obtained from the Flash Eurobarometer, Quality of life in European cities (2004-2015). For each city a global dissatisfaction score and a dissatisfaction score by domain (environment, social, economic, healthcare, and infrastructures/services) were calculated. Data on mortality and population was obtained from the Eurostat. Standardized Mortality Ratios, SMR, and 95% Confidence Intervals (95% CI) were calculated. The association between dissatisfaction scores and SMR was estimated using Generalized Linear Models. SMR varied markedly (range: 73.2-146.5), being highest in Eastern Europe and lowest in the South and Western European cities. Residents' dissatisfaction levels also varied greatly. We found a significant association between city SMR and residents' dissatisfaction with healthcare (β = 0.334; IC 95% 0.030-0.639) and social environment (β = 0.239; IC 95% 0.015-0.464). No significant association was found with the dissatisfaction scores related with the physical and economic environment and the infrastructures/services. We found a significant association between city levels of mortality and residents' dissatisfaction with certain urban features, suggesting subjective assessments can be also used to comprehend urban health.
约三分之二的欧洲人居住在城市。因此，我们必须拓展关于城市特征如何影响健康和幸福的知识。对城市资源和功能的认知可能与健康相关，因为它们反映了居民的主观体验。我们以全因死亡率为指标，对74个欧洲城市的健康状况进行了特征描述，并调查了死亡率与居民对城市生活关键领域不满之间的关联。我们考虑了来自29个国家的74个欧洲城市。居民不满的汇总数据来自《欧洲晴雨表快报：欧洲城市的生活质量》（2004 - 2015年）。为每个城市计算了总体不满得分以及按领域（环境、社会、经济、医疗保健和基础设施/服务）划分的不满得分。死亡率和人口数据来自欧盟统计局。计算了标准化死亡率（SMR）和95%置信区间（95%CI）。使用广义线性模型估计不满得分与SMR之间的关联。SMR差异显著（范围：73.2 - 146.5），在东欧最高，在南欧和西欧城市最低。居民的不满程度也差异很大。我们发现城市SMR与居民对医疗保健的不满（β = 0.334；95%CI 0.030 - 0.639）以及社会环境的不满（β = 0.239；95%CI 0.015 - 0.464）之间存在显著关联。未发现与物理和经济环境以及基础设施/服务相关的不满得分存在显著关联。我们发现城市死亡率水平与居民对某些城市特征的不满之间存在显著关联，这表明主观评估也可用于理解城市健康状况。
