Tarkiainen Lasse, Martikainen Pekka
University of Helsinki, Population Research Unit, URBARIA Helsinki Institute of Urban and Regional Studies, Unioninkatu 35, 00014, Helsingin Yliopisto, Finland.
University of Helsinki, Population Research Unit, Helsinki, Finland.
SSM Popul Health. 2022 Dec 17;21:101323. doi: 10.1016/j.ssmph.2022.101323. eCollection 2023 Mar.
High-income countries yield mixed evidence concerning the long-term trends of neighbourhood inequalities in health outcomes. The reasons why these inequalities persist and the factors driving any changes over time remain unclear. We analysed trends in general neighbourhood differences in mortality and hospitalisation, compared specific area-level and individual-level income effects, and assessed whether area-level effects were attributable to the neighbourhood population composition.
This prospective cohort study used individual-level register-linked information on sociodemographic factors covering the total population of 20-64-year-olds living in Finnish cities at the beginning of seven four-year periods in 1991-2018 (N = 952,493-1,200,431). We used random-effects Poisson models to assess all-cause and external mortality and hospitalisations among individuals nested in postal-code areas.
The general contextual effect of the neighbourhood on all-cause mortality and hospitalisation was stable across time, with a median incidence-rate ratio of around 1.20-1.30, and it was mainly attributable to the population's composition. The association between area-level income and both mortality and hospitalisation was also robust and increased slightly even after accounting for population composition. The lowest neighbourhood income quintile in 2015-2018 had 15% (95% CI:5-26%) and 30% (95% CI:15-47%) excess mortality among men and women, respectively. These differentials were particularly large for external causes, but all area-level income associations were much smaller than the corresponding individual-level associations.
The overall relevance of the neighbourhood context to mortality and hospitalisation was stable across time, and generally attributable to population composition. However, there were substantial relative area-level income disparities between neighbourhoods, which had grown over time.
高收入国家关于健康结果方面邻里不平等的长期趋势呈现出复杂的证据。这些不平等持续存在的原因以及随着时间推移推动任何变化的因素仍不明确。我们分析了邻里间在死亡率和住院率方面的总体差异趋势，比较了特定区域层面和个人层面的收入影响，并评估了区域层面的影响是否可归因于邻里人口构成。
这项前瞻性队列研究使用了与个人层面登记信息相链接的社会人口学因素数据，涵盖了1991 - 2018年七个四年期开始时居住在芬兰城市的20 - 64岁总人口（N = 952,493 - 1,200,431）。我们使用随机效应泊松模型来评估邮政编码区域内个体的全因死亡率、外部死亡率和住院率。
邻里对全因死亡率和住院率的总体背景效应在不同时间是稳定的，发病率中位数比值约为1.20 - 1.30，且主要归因于人口构成。区域层面收入与死亡率和住院率之间的关联也很稳健，即使在考虑人口构成后也略有增加。2015 - 2018年邻里收入最低五分位数的男性和女性死亡率分别高出15%（95%CI：5 - 26%）和30%（95%CI：15 - 47%）。这些差异在外部原因方面尤为显著，但所有区域层面的收入关联都远小于相应的个人层面关联。
邻里环境对死亡率和住院率的总体相关性在不同时间是稳定的，且一般归因于人口构成。然而，邻里之间存在显著的相对区域层面收入差距，且这种差距随着时间推移有所扩大。
