Merkin Sharon Stein, Abu-Saad Kathleen
Gertner Institute of Epidemiology and Health Policy, Sheba Medical Center, Tel Hashomer, Israel.
Isr J Health Policy Res. 2025 May 27;14(1):30. doi: 10.1186/s13584-025-00695-3.
Social disparities in health persist in Israel despite universal health care. Few studies have focused on the impact of neighborhood disadvantage on health in a representative sample of the Israeli population while accounting for multiple socioeconomic factors. The objective of this study was to assess the independent association between perceived neighborhood disadvantage and self-reported poor chronic health.
Self-reported poor chronic health was defined as (1) reported not very good/poor health, and (2) having a chronic health/physical problem for > = 6 months disrupting daily life activities. Neighborhood disadvantage was based on self-reported measures of residential environment (scale of dissatisfaction with transportation, parks, cleanliness, waste removal, noise, pollution, safety, and walkability) and social problems (dissatisfaction related to neighbors, and neighbors interacting to improve the environment). High levels of neighborhood problems were defined as top 25th percentile of dissatisfaction scales. Logistic regression models included incremental adjustment for sex, age, ethnicity/religion, immigration status, peripheral region and then income, education and employment status.
A total of n = 7,020 participants with non-missing data were included. High levels of neighborhood environmental and social problems were independently associated with poor chronic health even after adjustment for sex, age, ethnicity/religion, immigration status, and peripheral region, and remained statistically significant after additionally adjusting for income, education, employment and lifestyle factors (odds ratio (OR) 1.5, 95% confidence interval (CI) 1.2-1.9 for environmental problems; OR 1.3, 95% CI 1.1-1.6 for social problems).
Living in areas of perceived disadvantage conferred health risks beyond those related to ethnicity or socioeconomic status. These findings suggest that neighborhood-level factors contribute significantly to health disparities in Israel and should be included in national efforts to evaluate and minimize these health disparities. Future research is needed to also consider objective measures of neighborhood disadvantage, in order to determine the more salient neighborhood measures with respect to health outcomes and to effectively develop targeted interventions to reduce area-level health disparities.
尽管以色列实行全民医疗保健，但健康方面的社会差异依然存在。很少有研究在考虑多种社会经济因素的情况下，关注邻里劣势对以色列代表性人群健康的影响。本研究的目的是评估感知到的邻里劣势与自我报告的慢性健康状况不佳之间的独立关联。
自我报告的慢性健康状况不佳定义为：（1）报告健康状况不太好/差；（2）患有慢性健康/身体问题≥6个月，影响日常生活活动。邻里劣势基于对居住环境（对交通、公园、清洁、垃圾清理、噪音、污染、安全和步行便利性的不满程度）和社会问题（与邻居相关的不满以及邻居为改善环境而进行的互动）的自我报告测量。邻里问题程度高被定义为不满程度量表的前25%。逻辑回归模型逐步对性别、年龄、种族/宗教、移民身份、周边地区进行调整，然后对收入、教育和就业状况进行调整。
总共纳入了n = 7020名无缺失数据的参与者。即使在对性别、年龄、种族/宗教、移民身份和周边地区进行调整后，邻里环境和社会问题程度高仍与慢性健康状况不佳独立相关，在进一步对收入、教育、就业和生活方式因素进行调整后，仍具有统计学意义（环境问题的比值比（OR）为1.5，95%置信区间（CI）为1.2 - 1.9；社会问题的OR为1.3，95%CI为1.1 - 1.6）。
生活在感知到的劣势地区会带来超出种族或社会经济地位相关风险的健康风险。这些发现表明，邻里层面的因素对以色列的健康差异有显著影响，应纳入国家评估和尽量减少这些健康差异的努力中。未来的研究还需要考虑邻里劣势的客观测量方法，以确定与健康结果更相关的邻里测量指标，并有效地制定有针对性的干预措施，以减少地区层面的健康差异。
