Abstract
BackgroundIn recent years, there have been a growing number of studies on spatial inequalities in health covering a variety of scales, from small areas to metropolitan areas or regions, and for various health outcomes. However, few investigations have compared health status between cities with a view to gaining a better understanding of the relationships between such inequalities and the social, economic and physical characteristics. This paper focuses on disparities in respiratory health among the 55 largest French cities. The aim is to explore the relationships between inter-urban health patterns, city characteristics and regional context, and to determine how far a city’s health status relates to the features observed on different geographical scales.MethodsWe used health data describing hospitalizations for Chronic Obstructive Pulmonary Disease (COPD) as a proxy for respiratory health, and the total number of hospitalizations (overall) as a proxy for general health. This last indicator was used as a benchmark. A large set of indicators relating to socioeconomic, physical and amenity aspects of the cities (urban units) was also constructed. Data were analyzed using linear correlations and multiple linear regression models.ResultsThe results suggest that socioeconomic characteristics are major discriminators for inequalities in respiratory health status among urban units. Indeed, once combined to socioeconomic characteristics, only a climate indicator remained significant among the physical indicators. It appeared that the pollution indicators which were significantly correlated with COPD hospitalization rates loosed significance when associated to the socio-economic indicators in a multiple regression. The analysis showed that among the socio-economic indicators, an employment indicator derived at the regional scale, and two indicators reflecting the unequal intra-urban spatial distribution of population according to their education, were the most efficient to describe differences in the respiratory health status of urban units.ConclusionIn order to design effective urban policies, it is essential to gain a better understanding of the differences among cities in their entirety, rather than solely differences across small urban areas or individuals.
Highlights
Epidemiological studies seek to identify and isolate factors that explain health inequalities in time and space, or among individuals
As air pollution monitoring is obligatory for urban units with more than 100,000 inhabitants, the 55 French urban units exceeding this threshold were included in the study
It is important to gain a better understanding of the spatial patterns of urban respiratory health problems, since respiratory health is a growing cause of morbidity worldwide
Summary
Epidemiological studies seek to identify and isolate factors that explain health inequalities in time and space, or among individuals. One approach is to observe the individual level in order to assess how far the social, economic and ecological characteristics of a place influence the health of its residents. Researchers adopting this kind of approach often use multilevel models. The aim is to explore the relationships between inter-urban health patterns, city characteristics and regional context, and to determine how far a city’s health status relates to the features observed on different geographical scales. It can be considered as one of many potential factors explaining health differences In this case, space refers to the socioeconomic and physical characteristics of the area in which the individuals studied are located. The aim is to understand how other geographical patterns are related to spatial health differentiations
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