A multilevel analysis of the effects of rurality and social deprivation on premature limiting long term illness

被引:74
作者
Barnett, S
Roderick, P [1 ]
Martin, D
Diamond, I
机构
[1] Univ Southampton, Southampton Gen Hosp, Hlth Care Res Unit, Southampton SO16 6YD, Hants, England
[2] Univ Southampton, Dept Social Stat, Southampton SO9 5NH, Hants, England
[3] Univ Southampton, Dept Geog, Southampton SO9 5NH, Hants, England
关键词
D O I
10.1136/jech.55.1.44
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Study objective-To examine the geographical variation in self perceived morbidity in the south west of England, and assess the associations with rurality and social deprivation. Design-A geographically based cross sectional study using 1991 census data on premature Limiting Long Term Illness (LLTI). The urban-rural and intra-rural variation in standardised premature LLTI ratios is described, and correlation and regression analyses explore how well this is explained by generic deprivation indices. Multilevel Poisson modelling investigates whether Customised Deprivation Profiles (CDPs) and area characteristics improve upon the generic indices. Setting-Nine counties in the south west of England Participants-The population of the south west enumerated in the 1991 census. Main results-Intra-rural variation is apparent, with higher rates of premature LLTI in remoter areas. Together with high rates in urban areas and lower rates in the semi-rural areas this indicates the existence of a U shaped relation with rurality. The generic deprivation indices have strong positive relations with premature LLTI in urban areas, but these are a lot weaker in semi-rural and rural locations. CDPs improve upon the generic indices, especially in the rural settings. A substantial reduction in unexplained variation in rural areas is seen after controlling for the level of local isolation, with higher isolation, at the wider geographical scale, being related to higher levels of LLTI. Conclusions-This study highlights the need to treat rural areas as heterogeneous, although this has not been the tendency in health research. Generic deprivation indices are unlikely to be a true reflection of levels of deprivation in rural environments. The importance of CDPs that are specific to the area type and health outcome is emphasised. The significance of physical isolation suggests that accessibility to public and health services may be an important issue, and requires further research.
引用
收藏
页码:44 / 51
页数:8
相关论文
共 30 条
[1]  
Acheson D., 1999, INDEPENDENT INQUIRY
[2]  
[Anonymous], OUR HLTH NAT CONTR H
[3]  
BENTHAM CG, 1984, AREA, V16, P219
[4]  
BENTHAM G, 1995, J EPIDEMIOL COMMUNIT, V49, pS57
[5]   DEPRIVATION - EXPLAINING DIFFERENCES IN MORTALITY BETWEEN SCOTLAND AND ENGLAND AND WALES [J].
CARSTAIRS, V ;
MORRIS, R .
BRITISH MEDICAL JOURNAL, 1989, 299 (6704) :886-889
[6]  
Charlton J, 1996, Popul Trends, P17
[7]   RURALITY IN ENGLAND AND WALES 1981 - A REPLICATION OF THE 1971 INDEX [J].
CLOKE, P ;
EDWARDS, G .
REGIONAL STUDIES, 1986, 20 (04) :289-306
[8]  
COLE K, 1993, 1991 CENSUS USERS GU, P201
[9]   THE IMPACT OF AREA CONTEXT ON LONG-TERM ILLNESS AND PREMATURE MORTALITY - AN ILLUSTRATION OF MULTILEVEL ANALYSIS [J].
CONGDON, P .
REGIONAL STUDIES, 1995, 29 (04) :327-344
[10]   Poverty in rural areas [J].
Cox, J .
BRITISH MEDICAL JOURNAL, 1998, 316 (7133) :722-722