Korevaar Hannah, Metcalf C Jessica, Grenfell Bryan T
Office of Population Research, Princeton University, Princeton, NJ, USA.
Woodrow Wilson School of Public and International Affairs, Princeton University, Princeton, NJ, USA.
J R Soc Interface. 2020 Jul;17(168):20200010. doi: 10.1098/rsif.2020.0010. Epub 2020 Jul 8.
A key concern in public health is whether disparities exist between urban and rural areas. One dimension of potential variation is the transmission of infectious diseases. In addition to potential differences between urban and rural local dynamics, the question of whether urban and rural areas participate equally in national dynamics remains unanswered. Specifically, urban and rural areas may diverge in local transmission as well as spatial connectivity, and thus risk for receiving imported cases. Finally, the potential confounding relationship of spatial proximity with size and urban/rural district type has not been addressed by previous research. It is rare to have sufficient data to explore these questions thoroughly. We use exhaustive weekly case reports of measles in 954 urban and 468 rural districts of the UK (1944-1965) to compare both local disease dynamics as well as regional transmission. We employ the time-series susceptible-infected-recovered model to estimate disease transmission, epidemic severity, seasonality and import dependence. Congruent with past results, we observe a clear dependence on population size for the majority of these measures. We use a matched-pair strategy to compare proximate urban and rural districts and control for possible spatial confounders. This analytical strategy reveals a modest difference between urban and rural areas. Rural areas tend to be characterized by more frequent, smaller outbreaks compared to urban counterparts. The magnitude of the difference is slight and the results primarily reinforce the importance of population size, both in terms of local and regional transmission. In sum, urban and rural areas demonstrate remarkable epidemiological similarity in this recent UK context.
公共卫生领域的一个关键问题是城乡之间是否存在差异。潜在差异的一个方面是传染病的传播。除了城乡局部动态可能存在差异外，城乡在国家层面动态中是否平等参与的问题仍未得到解答。具体而言，城乡在本地传播以及空间连通性方面可能存在差异，因此接收输入病例的风险也不同。最后，以往研究尚未探讨空间 proximity 与规模及城乡区域类型之间潜在的混杂关系。很少有足够的数据来全面探讨这些问题。我们利用英国954个城市和468个农村地区（1944 - 1965年）详尽的每周麻疹病例报告，来比较本地疾病动态以及区域传播情况。我们采用时间序列易感 - 感染 - 康复模型来估计疾病传播、流行严重程度、季节性和输入依赖性。与过去的结果一致，我们观察到这些指标中的大多数明显依赖于人口规模。我们采用配对策略来比较相邻的城乡地区，并控制可能的空间混杂因素。这种分析策略揭示了城乡之间存在适度差异。与城市地区相比，农村地区往往以更频繁、规模更小的疫情爆发为特征。差异幅度较小，结果主要强化了人口规模在本地和区域传播方面的重要性。总之，在近期英国的背景下，城乡地区表现出显著的流行病学相似性。
