Gaining a better understanding of respiratory health inequalities among cities: An ecological case study on elderly males in the larger French cities

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.

Clinical, humanistic, and economic burden of chronic obstructive pulmonary disease (COPD) in Canada: a systematic review

“…The relatively small number of ED visits found for Canadian COPD patients would suggest that the use of ED services for COPD patients may fall on the lower end worldwide. Hospitalization rates, hospital readmission rates, and the number of physician visits for Canadian COPD patients were found to be consistent with rates found in the US [ 62 – 64 ]. Additionally, trends of increasing healthcare resource use as COPD worsens are consistent with worldwide data [ 61 , 65 ].…”

Incidence and Prevalence of Chronic Obstructive Pulmonary Disease among Aboriginal Peoples in Alberta, Canada

“…Similarly, exposure to environmental contaminants derived from biomass fuel burned for cooking, and living in poorly ventilated areas can also increase the risk of COPD among certain Aboriginal groups who follow a traditional lifestyle or live on reserves [ 23 ]. Interactions between smoking, housing conditions and crowding, material and social deprivation [ 24 ], remote location of residence [ 25 ], low education [ 26 ], poor nutrition, and prenatal and childhood exposures to cigarette smoking are likely to be distal and intermediate mechanisms for the higher epidemiological indicators of COPD burden among Aboriginal peoples in our study.…”

Cumulative Risk and Impact Modeling on Environmental Chemical and Social Stressors

“…As shown in Table 1, among the 31 articles identified [35–70], 10 studies [37, 42, 43, 46, 52, 55, 61, 66, 68, 69] used multivariable linear/non-linear regression models to evaluate the combined effects of multiple chemical and non-chemical stressors, and 7 studies [36, 38, 40, 45, 47, 59, 68] used logistic regression models. In addition, we found 5 studies [49, 56, 57, 63, 67] that used hierarchical/multilevel regression models.…”

“…air pollution), Aschan-Leygonie et al . analyzed health data describing hospitalizations of chronic obstructive pulmonary disease and a large set of different indicator variables of both social and environmental stressors using linear correlations and multiple linear regression models in an ecological case study [37]. They found that socioeconomic features may be the major drivers for inequities of respiratory health status in urban units and concluded that better understanding of ‘differences among cities in their entirety’ is essential to develop effective urban policies.…”