荷兰城乡健康差异：选择性迁移起作用吗？
Urban-rural variations in health in The Netherlands: does selective migration play a part?
作者信息
Verheij R A, van de Mheen H D, de Bakker D H, Groenewegen P P, Mackenbach J P
机构信息
Netherlands Institute of Primary Health Care, BN Utrecht, The Netherlands.
出版信息
J Epidemiol Community Health. 1998 Aug;52(8):487-93. doi: 10.1136/jech.52.8.487.
STUDY OBJECTIVE
Urban-rural health differences are observed in many countries, even when socioeconomic and demographic characteristics are controlled for. People living in urban areas are often found to be less healthy. One of the possible causes for these differences is selective migration with respect to health or health risk factors. This hypothesis is hardly ever empirically tested. This paper tries to assess the existence of selective urban-rural migration.
DESIGN
Health indicators and health risk factors were measured in a 1991 population sample. Moves were registered between 1991 and 1995. Using logistic regression analyses, comparisons were made between, firstly, urban to rural movers and rural to urban movers and secondly, between movers and stayers.
SETTING
Region surrounding the city of Eindhoven in south eastern part of the Netherlands.
SUBJECTS
Data were used of 15,895 respondents aged 20-74 in 1991. By 1995 613 subjects had moved from urban to rural and 191 subjects from rural to urban.
MAIN RESULTS
Bivariate nor multivariate analyses show hardly and differences between movers into urban and movers into rural areas. Bivariate analyses on movers and stayers show that movers are healthier than stayers. However, when socioeconomic and demographic variables are controlled for, movers appear to be less healthy, with the exception of the younger age groups.
CONCLUSIONS
Areas that attract many migrants from and lose few migrants to other degrees of urbanicity will in the long run obtain healthier populations, because of demographic and socioeconomic characteristics. However, if these characteristics are accounted for, the opposite is true, with the exception of younger age groups. In extreme cases this may cause spurious findings in cross sectional research into the relation between urbanicity and health. Absolute numbers of migrants need to be very high, however, to make this noticeable at the aggregate level.
研究目的
即便在控制了社会经济和人口特征的情况下，许多国家仍存在城乡健康差异。人们常发现城市居民的健康状况较差。这些差异的一个可能原因是基于健康或健康风险因素的选择性迁移。这一假设几乎从未得到实证检验。本文试图评估城乡选择性迁移的存在情况。
设计
在1991年的人口样本中测量健康指标和健康风险因素。记录了1991年至1995年期间的迁移情况。使用逻辑回归分析，首先对从城市迁往农村的人和从农村迁往城市的人进行比较，其次对迁移者和留守者进行比较。
地点
荷兰东南部埃因霍温市周边地区。
研究对象
使用了1991年15895名年龄在20 - 74岁之间的受访者的数据。到1995年，有613名受试者从城市迁往农村，191名受试者从农村迁往城市。
主要结果
单变量和多变量分析均显示，迁入城市和迁入农村的人之间几乎没有差异。对迁移者和留守者的单变量分析表明，迁移者比留守者更健康。然而，在控制了社会经济和人口变量后，除了较年轻的年龄组外，迁移者似乎健康状况较差。
结论
从长远来看，吸引大量移民且向其他城市化程度地区流失移民较少的地区，由于人口和社会经济特征，将拥有更健康的人口。然而，如果考虑这些特征，情况则相反，但较年轻的年龄组除外。在极端情况下，这可能会在关于城市化与健康关系的横断面研究中导致虚假结果。不过，要在总体层面上明显体现这一点，移民的绝对数量需要非常高。
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