Moustakas Aristides, Thomson Linda J M, Mughal Rabya, Chatterjee Helen J
Arts and Sciences, University College London, Gower Street, London WC1E 6BT, UK.
Natural History Museum of Crete, University of Crete, 700 13 Haraklion, Crete, Greece.
Healthcare (Basel). 2024 Aug 12;12(16):1608. doi: 10.3390/healthcare12161608.
The broader determinants of health including a wide range of community assets are extremely important in relation to public health outcomes. Multiple health conditions, multimorbidity, is a growing problem in many populations worldwide.
This paper quantified the effect of community assets on major health conditions for the population of England over six years, at a fine spatial scale using a data analytic approach. Community assets, which included indices of the health system, green space, pollution, poverty, urban environment, safety, and sport and leisure facilities, were quantified in relation to major health conditions. The health conditions examined included high blood pressure, obesity, dementia, diabetes, mental health, cardiovascular conditions, musculoskeletal conditions, respiratory conditions, kidney and liver disease, and cancer. Cluster analysis and dendrograms were calculated for the community assets and major health conditions. For each health condition, a statistical model with all community assets was fitted, and model selection was performed. The number of significant community assets for each health condition was recorded. The unique variance, explained by each significant community asset per health condition, was quantified using hierarchical variance partitioning within an analysis of variance model.
The resulting data indicate major health conditions are often clustered, as are community assets. The results suggest that diversity and richness of community assets are key to major health condition outcomes. Primary care service waiting times and distance to public parks were significant predictors of all health conditions examined. Primary care waiting times explained the vast majority of the variances across health conditions, with the exception of obesity, which was better explained by absolute poverty.
The implications of the combined findings of the health condition clusters and explanatory power of community assets are discussed. The vast majority of determinants of health could be accounted for by healthcare system performance and distance to public green space, with important covariate socioeconomic factors. Emphases on community approaches, significant relationships, and asset strengths and deficits are needed alongside targeted interventions. Whilst the performance of the public health system remains of key importance, community assets and local infrastructure remain paramount to the broader determinants of health.
包括广泛社区资产在内的更广泛健康决定因素对于公共卫生结果极为重要。多种健康状况，即多病共存，在全球许多人群中是一个日益严重的问题。
本文采用数据分析方法，在精细空间尺度上对六年内英格兰人群中社区资产对主要健康状况的影响进行了量化。社区资产包括卫生系统、绿地、污染、贫困、城市环境、安全以及体育和休闲设施等指标，并针对主要健康状况进行了量化。所考察的健康状况包括高血压、肥胖、痴呆、糖尿病、心理健康、心血管疾病、肌肉骨骼疾病、呼吸系统疾病、肾脏和肝脏疾病以及癌症。对社区资产和主要健康状况进行了聚类分析并绘制了树形图。针对每种健康状况，拟合了包含所有社区资产的统计模型，并进行了模型选择。记录了每种健康状况下显著的社区资产数量。在方差分析模型中，通过分层方差分解量化了每种健康状况下每个显著社区资产所解释的独特方差。
所得数据表明主要健康状况往往聚类，社区资产也是如此。结果表明社区资产的多样性和丰富性是主要健康状况结果的关键。初级保健服务等待时间和到公园的距离是所有考察健康状况的显著预测因素。初级保健等待时间解释了除肥胖外的绝大多数健康状况的方差，肥胖则由绝对贫困能更好地解释。
讨论了健康状况聚类和社区资产解释力的综合研究结果的意义。绝大多数健康决定因素可由医疗保健系统绩效和到公共绿地的距离以及重要的协变量社会经济因素来解释。除了有针对性的干预措施外，还需要强调社区方法、显著关系以及资产优势和不足。虽然公共卫生系统的绩效仍然至关重要，但社区资产和地方基础设施对于更广泛的健康决定因素仍然至关重要。
