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

Abstract：

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 Customized 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.

journal_name

J Epidemiol Community Health

journal_title

Journal of epidemiology and community health

authors

Barnett S,Roderick P,Martin D,Diamond I

doi

10.1136/jech.55.1.44

keywords:

subject

Has Abstract

pub_date

2001-01-01 00:00:00

pages

44-51

issue

eissn

0143-005X

issn

1470-2738

journal_volume

pub_type

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