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首页> 外文期刊>Journal of Epidemiology & Community Health >Comparison of a spatial approach with the multilevel approach for investigating place effects on health: the example of healthcare utilisation in France.
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Comparison of a spatial approach with the multilevel approach for investigating place effects on health: the example of healthcare utilisation in France.

机译：比较空间方法与多层次方法以研究场所对健康的影响：法国的医疗保健利用示例。

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STUDY OBJECTIVE: Most studies of place effects on health have followed the multilevel analytical approach that investigates geographical variations of health phenomena by fragmenting space into arbitrary areas. This study examined whether analysing geographical variations across continuous space with spatial modelling techniques and contextual indicators that capture space as a continuous dimension surrounding individual residences provided more relevant information on the spatial distribution of outcomes. Healthcare utilisation in France was taken as an illustrative example in comparing the spatial approach with the multilevel approach. DESIGN: Multilevel and spatial analyses of cross sectional data. PARTICIPANTS: 10 955 beneficiaries of the three principal national health insurance funds, surveyed in 1998 and 2000 on continental France. MAIN RESULTS: Multilevel models showed significant geographical variations in healthcare utilisation. However, the Moran's I statistic showed spatial autocorrelation unaccounted for by multilevel models. Modelling the correlation between people as a decreasing function of the spatial distance between them, spatial mixed models gave information not only on the magnitude, but also on the scale of spatial variations, and provided more accurate standard errors for risk factors effects. The socioeconomic level of the residential context and the supply of physicians were independently associated with healthcare utilisation. Place indicators better explained spatial variations in healthcare utilisation when measured across continuous space, rather than within administrative areas. CONCLUSIONS: The kind of conceptualisation of space during analysis influences the understanding of place effects on health. In many contextual studies, viewing space as a continuum may yield more relevant information on the spatial distribution of outcomes.
机译：研究目的：大多数关于健康的场所影响研究都遵循多层次分析方法，该方法通过将空间分成任意区域来研究健康现象的地理变化。这项研究检查了是否通过使用空间建模技术和将空间捕获为围绕单个住宅的连续维度的上下文指标来分析连续空间中的地理变化是否提供了关于结果空间分布的更多相关信息。在比较空间方法与多层次方法时，以法国的医疗保健利用为例。设计：横截面数据的多层次和空间分析。参加者：1998年和2000年在法国大陆进行的三项主要国家健康保险基金的10 955名受益者。主要结果：多层次模型显示出医疗保健利用方面的重大地理差异。但是，Moran's I统计数据显示多层模型无法解释空间自相关。通过将人与人之间的相关性建模为人与人之间空间距离的递减函数，空间混合模型不仅可以提供有关大小的信息，还可以提供有关空间变化规模的信息，并且可以为风险因素的影响提供更准确的标准误差。居住环境的社会经济水平和医生的供应与医疗保健的利用独立相关。当在连续空间而不是在行政区域内进行测量时，位置指示器可以更好地说明医疗保健利用率的空间变化。结论：分析过程中对空间的概念化影响对场所影响健康的理解。在许多上下文研究中，将空间视为连续体可能会产生关于结果空间分布的更多相关信息。

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