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PubMed2002

Interrelations between three proxies of health care need at the small area level: an urban/rural comparison.

STUDY OBJECTIVE: To examine the relations between geographical variations in mortality, morbidity, and deprivation at the small area level in the south west of England and to assess whether these relations vary between urban and rural areas. DESIGN: A geographically based cross sectional study using 1991 census data on premature limiting long term illness (LLTI) and socioeconomic characteristics, and 1991-1996 data on all cause premature mortality. The interrelations between the three widely used proxies of health care need are examined using correlation coefficients and scatterplots. The distribution of standardised LLTI residuals from a regression analysis on mortality are mapped and compared with the distribution of urban and rural areas. Multilevel Poisson modelling investigates whether customised deprivation profiles improve upon a generic deprivation index in explaining the spatial variation in morbidity and mortality after controlling for age and sex. These relations are examined separately for urban, fringe, and rural areas. SETTING: Nine counties in the south west of England. PARTICIPANTS: Those aged between 0-64 who reported having a LLTI in the 1991 census, and those who died during 1991-1996 aged 0-74. MAIN RESULTS: Relations between both health outcomes and generic deprivation indices are stronger in urban than rural areas. The replacement of generic with customised indices is an improvement in all area types, especially for LLTI in rural areas. The relation between mortality and morbidity is stronger in urban than rural areas, with levels of LLTI appearing to be greater in rural areas than would be predicted from mortality rates. Despite the weak direct relations between mortality and morbidity, there are strong relations between the customised deprivation indices computed to predict these outcomes in all area types. CONCLUSIONS: The improvement of the customised deprivation indices over the generic indices, and the similarity between the mortality and morbidity customised indices within area types highlights the importance of modelling urban and rural areas separately. Stronger relations between mortality and morbidity have been revealed at the local authority level in previous research providing empirical evidence that the inadequacy of mortality as a proxy for morbidity becomes more marked at lower levels of aggregation, especially in rural areas. Higher levels of LLTI than expected in rural areas may reflect different perceptions or differing patterns of illness. The stronger relations between the three proxies in urban than rural areas suggests that the choice of indicator will have less impact in urban than rural areas and strengthens the argument to develop better measures of health care need in rural areas.

Adolescent↗
PubMed1999

The geography of fundholding in southwest England: implications for the evolution of primary care groups.

Using postcode-ED linkage to calculate patient-weighted deprivation indices for 330 general practices in southwest England, this study examines whether the populations served by fundholding and non-fundholding practices varied with respect to socio-economic status. Little evidence is found of systematic socio-economic bias in the uptake of fundholding. However, a distinct spatial pattern to the distribution of fundholding is revealed in this article, urban practices having adopted the scheme more readily than their rural and mixed rural/urban counterparts. As practice-level fundholding is replaced by commissioning at the locality level, such geographical variation is likely to be expressed in the way in which primary care groups evolve.

Catchment Area, Health↗
PubMed2004

Frequency and spatial distribution of environmental Campylobacter spp.

Humans are exposed to Campylobacter spp. in a range of sources via both food and environmental pathways. For this study, we explored the frequency and distribution of thermophilic Campylobacter spp. in a 10- by 10-km square rural area of Cheshire, United Kingdom. The area contains approximately 70, mainly dairy, farms and is used extensively for outdoor recreational activities. Campylobacter spp. were isolated from a range of environmental samples by use of a systematic sampling grid. Livestock (mainly cattle) and wildlife feces and environmental water and soil samples were cultured, and isolates were presumptively identified by standard techniques. These isolates were further characterized by PCR. Campylobacter jejuni was the most prevalent species in all animal samples, ranging from 11% in samples from nonavian wildlife to 36% in cattle feces, and was isolated from 15% of water samples. Campylobacter coli was commonly found in water (17%) and sheep (21%) samples, but rarely in other samples. Campylobacter lari was recovered from all sample types, with the exception of sheep feces, and was found in moderate numbers in birds (7%) and water (5%). Campylobacter hyointestinalis was only recovered from cattle (7%) and birds (1%). The spatial distribution and determinants of C. jejuni in cattle feces were examined by the use of model-based spatial statistics. The distribution was consistent with very localized within-farm or within-field transmission and showed little evidence of any larger-scale spatial dependence. We concluded that there is a potentially high risk of human exposure to Campylobacter spp., particularly C. jejuni, in the environment of our study area. The prevalence and likely risk posed by C. jejuni-positive cattle feces in the environment diminished as the fecal material aged. After we took into account the age of the fecal material, the absence or presence of rain, and the presence of bird feces, there was evidence of significant variation in the prevalence of C. jejuni-positive cattle feces between grazing fields but no evidence of spatial clustering beyond this resolution. The spatial pattern of C. jejuni is therefore consistent with that for an organism that is ubiquitous in areas contaminated with cattle feces, with a short-scale variation in infection intensity that cannot be explained solely by variations in the age of the fecal material. The observed pattern is not consistent with large-scale transmission attributable to watercourses, wildlife territories, or other geographical features that transcend field and farm boundaries.

Animals↗
PubMed1996

[Estimation of need for obstetrical interventions in Morocco. An approach based on the spatial analysis of deficits].

One of the indicators of health system effectiveness with regard to maternal health is the maternal mortality ratio. Measuring this ratio in developing countries is, however, not an easy task since reliable information on mortality is rarely available. An alternative to the maternal mortality ratio measurement, as an indicator of effectiveness, is the assessment of the coverage of obstetrical intervention needs. The authors chose to restrict the notion of "needs" to the obstetrical interventions carried out in order to save a mother's life. Using data from a survey by the Ministry of Health of the Moroccan Kingdom on all the obstetrical interventions carried out in 1989, obstetrical intervention rates for "absolute maternal indications" are analysed according to the mother's origin, by province and urban/rural environment. The spatial analysis of these rates showed large variations in each of the environments (0 to 2.14 % of the expected births in urban areas and 0 to 1.25 % in rural areas) and a significative difference between the rural and urban distributions (median 0.80 % in urban areas versus 0.30 % in rural areas). Applying a reference rate of 1 %, deficits between the expected numbers of needed obstetrical interventions and the observed numbers were calculated for every province in both urban and rural areas. In the whole of Morocco, intervention rates are markedly below what is expected. The spatial analysis of the deficits helps to identify the provinces where the problem is the most prominent in terms of numbers of women whose intervention needs have to be covered. The authors discuss the validity of the reference rate and suggest several strategies to solve the problem. They conclude that the deficits map is a useful tool to decide on priorities for planning and monitoring of strategies to be implemented. The spatial analysis of obstetrical intervention deficits seems to be an instrument both cheaper and more relevant than a maternal mortality estimates survey.

Developing Countries↗
PubMed1989

Components of change in the spatial distribution of the elderly population in Ontario, 1976-1986.

"Using data from the 1976, 1981, and 1986 [Canadian] Censuses for Ontario, components of change in the elderly population are obtained by cohort survival methods. The significance of rapid metropolitan growth of the elderly compared with the slow growth of the rural elderly is highlighted, while intra-county distributional shifts in the elderly population raise important questions for the next decade." (SUMMARY IN FRE)

Adult↗
PubMed2005

A model supported by GIS for locating and quantifying PM2.5 emission originated from residential wood burning.

A research method was presented for spatially quantifying and allocating the potential activity of a fine particle matter emission (PM2.5), which originated from residential wood burning (RWB) in this study. Demographic, hypsographic, climatic and topographic data were compiled and processed within a geographic information system (GIS), and as independent variables put into a linear regression model for describing spatial distribution of the potential activity of residential wood burning as primary heating source. In order to improve the estimation, the classifications of urban, suburban and rural were redefined to meet the specifications of this application. Also, several definitions of forest accessibility were tested for estimation. The results suggested that the potential activity of RWB was mostly determined by elevation of a location, forest accessibility, urban/non-urban position, climatic conditions and several demographic variables. The linear regression model could explain approximately 86% of the variation of surveyed potential activity of RWB. The analysis results were validated by employing survey data collected mainly from a WebGIS based phone interview over the study area in central California. Based on lots free public GIS data, the model provided an easy and ideal tool for geographic researchers, environmental planners and administrators to understand where and how much PM2.5 emission from RWB was contributed to air quality. With this knowledge they could identify regions of concern, and better plan mitigation strategies to improve air quality. Furthermore, it allows for future adjustment on some parameters as the spatial analysis method is implemented in the different regions or various eco-social models.

Air Pollutants↗
PubMed1989

[Dynamics of urban and rural population growth in the State of Bahia: 1940-1980].

"The study of the urban and rural growth in the State of Bahia [Brazil] during the period of 1940-80 is the purpose of this research. This study was done through an integrated analysis of the annual geometric growth rates, and the application of several growth models. The analysis showed that the urbanization and 'de-ruralization' processes were intense and that this trend will be stronger in the near future." (SUMMARY IN ENG)

Americas↗
PubMed2006

[Frequency and spatial distribution of Aedes aegypti and Aedes albopictus (Diptera, Culicidae) in Rio de Janeiro, Brazil].

We evaluated the intra- and peri-domiciliary distribution of Aedes aegypti and Ae. albopictus in urban, suburban, and rural districts in the municipalities of Nova Iguaçu and Rio de Janeiro, Brazil, from August 2002 to July 2004. Mostly Ae. aegypti females and males were captured in urban areas (56%) and indoors (78%), suggesting a preference by this species to rest inside houses and in areas with high human density, a behavior that favors vector-human contact. Meanwhile, Ae. albopictus females and males were much more common in rural areas (93%) and outdoors (90%), demonstrating their preference to rest in areas with more vegetation, reducing both the probability of vector-human contact and thus their potential role in dengue transmission in the area.

Aedes↗
PubMed1986

Peripheral counter-urbanization: findings from an integration of census and survey data in Northern Scotland.

"This paper systematically relates local survey data to national census data in an investigation of one peripheral form of counter-urbanization now regarded as widely present in developed countries. The recent growth and spatial distribution of long-distance English migration to the Highlands and Islands of Scotland is described, and then 'explained' through multivariate analysis of cross-sectional data and through the stated motivations and characteristics of surveyed migrants to some of the remoter, rural parts of the region. The study reveals the importance of environmental and quality of life considerations." (summary in FRE, GER)

Behavior↗
PubMed2005

Multiple sclerosis in Tayside, Scotland: detection of clusters using a spatial scan statistic.

Debate continues over the relative importance of genetic factors over infectious agents in the aetiology of multiple sclerosis (MS). Detection of clusters of MS in space and time in the Tayside region of Scotland, UK would provide valuable evidence for the movement of infectious agents into a genetically susceptible population. A spatial scan statistic was used to detect, locate and provide a robust statistical test of any clusters found, without prior knowledge of their location or size. This was applied to a population-based MS register for the Tayside region of Scotland from 1970 to 1997, allowing for age at symptom onset, gender, population density and social deprivation. There were a total of 772 cases during the study period; an annual incidence of 72 per 100000. The mean age of symptom onset was 35.7 (SD = 10.5) and 73.8% of cases were women. There was a general increase in cases over time probably reflecting gradually better detection and diagnosis. There was a peak around the mid-1990s and some evidence of periodicity. There was a highly significant temporal cluster between 1982 and 1995 (P = 0.002) for the whole region. Additionally, a significant spatial cluster for the time period 1993-1995 was found centred in the rural area south-west of Perth (P=0.016). Significant temporal and spatial-temporal clusters are consistent with exogenous factors contributing to the distribution of MS in Tayside, Scotland.

Adult↗
PubMed1988

The geographic component of U.S. nonmetropolitan population change.

"The decade of the 1970s witnessed two new trends of major significance in U.S. population distribution, the concentration of 85 to 90 percent of the nation's population growth in the South and West, and the revival of growth in many nonmetropolitan parts of the country....However, the nonmetropolitan resurgence has relaxed somewhat in the 1980s. From 1980 to mid-1986, nonmetropolitan territory...had only a 4 percent growth in population compared with 6.4 percent for the nation as a whole and 7.2 percent for metropolitan territory. During the 1970s the same geographic areas had increases of 14.4, 11.4, and 10.5 percent respectively."

Americas↗
PubMed1983

[The demographic and social characteristics of the Italian community in Australia and of the second generation].

This paper is an analysis of "the demographic and socio-professional characteristics of the Italian community settled in Australia after World War II and its spatial distribution." The authors note that the first generation of migrants, no longer replenished with new arrivals since the 1960s, is aging rapidly, is concentrated in urban areas, and is no longer engaged in independent work in rural areas. An analysis of second-generation Italian immigrants is also presented, with reference to questions of assimilation and intermarriage. Data are primarily from a survey undertaken in 1982. (summary in ENG, FRE)

Australia↗
PubMed2006

Chemical characteristics and origins of nitrogen-containing organic compounds in PM2.5 aerosols in the Lower Fraser Valley.

Some nitrogen-containing organic compounds (NOCs) in PM2.5 aerosols in forest, tunnel, urban, rural, and mixed forest/ urban areas in the Lower Fraser Valley (LFV), British Columbia, Canada, were measured to assess their chemical characteristics, temporal and spatial distributions, and origins. The levels of E-caprolactam, isoindole-1,3-dione, benzothiazolone, and N-butyl-benzensulfonamide showed significant differences among the sites, with the highest level at the mixed forest/urban site, indicating that aerosols at this site were impacted by chemical manufacturing activities. N,N-diethyl-m-toluamide (deet) was detected at all locations but was highest in the forest area, demonstrating a widespread usage as an insect repellent in the LFV and at camps at the forest site. Alkyl amides, tracers from wood burning and cooking, ranging from C6 to C20 including two unsaturated amides, hexadecenamide, and 9-octa-decenamide, were detected at all sites. Three patterns of carbon number distributions of alkyl amides varied with location and time, and were mainly impacted by biomass burning or cooking compared to levoglucosan and cholesterol in the LFV. Ratio of oleamide to stearamide (C18:1/C18:0) was discussed as a potential indicator for determining "age" or transport range of biomass combustion plumes.

Air Pollutants↗
PubMedDate not supplied

Anticipated child loss to migration and sustained high fertility in an east Caribbean population.

Development today is commonly accompanied by rapid urbanization and, where possible, high rates of migration to industrialized countries. At the same time, the expected demographic transition has often not materialized despite decreases in death rates. Child-to-woman ratios in St. Vincent and the Grenadines are related to the educational attainment of women in a census district, the percentage of men engaged in agriculture, whether the district has direct access to the outside world through a port or airport, and, when the other variables are controlled, the stability of a district's population. Those districts with the greatest stability of population had the lowest child-to-woman ratios, suggesting that the anticipated loss of children to migration may be an important factor in maintaining high reproductive rates.

Adolescent↗
PubMedDate not supplied

Evaluation of regional environmental and health hazards by applying synthetic measures.

Large geographical areas, urban and rural regions of 49 voivodships in Poland, were evaluated from the point of view of existing environmental and health hazards caused by chemical contamination of the environment. Using routine sources of information, we selected four health-related environmental indicators and eight environmental-related health indicators. All indicator values were normalized and then aggregated to synthetic measures of environmental and health hazards, using the taxonometric method. The synthetic measures characterized the urban and rural regions of the entire country and were used for their ranking for remedial purposes. A consistency of environmental and health synthetic measures was found in urban regions (correlation coefficient r = 0.58). The spatial distribution of environmental and health hazards was determined using geo-graphical information system (GIS) methods. The application of kriging and the interpolation of data improved the interpretation of the results. The worst situation was found in the southwest regions of Poland, which are heavily industrialized with a high population density.

Environmental Monitoring↗