Université de Lyon
UMR « environnement ville société »
5, avenue Pierre-Mendès-France
69676 Bron cedex
France, Universités Paris I, Paris VII
UMR « géographie-cités »
13, rue du Four
Background: Numerous studies have investigated spatial inequalities in health at a variety of scales, but only a few publications have compared the health status of different cities to examine the relations between these inequalities and the cities’ social, economic, and physical environment. Our aim was to identify the relations between inter-city differences in respiratory health and the regional context and urban features of each city. This paper focuses on respiratory health disparities among the 55 largest French cities.
Methods: Respiratory health was defined by hospitalization for COPD (chronic obstructive pulmonary disease) in 2008, and hospitalizations for all causes served as a comparative indicator. Socioeconomic dimensions were described by standard indicators including unemployment rates by age group and percentages of adults who did not complete high school. The physical environments were characterized by altitude, temperatures, humidity, pollens and air pollution concentrations (nitrogen dioxide, ozone and particulate matter). Residential intraurban inequality indicators such as concentration indexes were also used. Bivariate methods and multiple regression models were used for data analysis.
Results: Bivariate analyses showed that city COPD rates were highly correlated with most socioeconomic and some environmental indicators. Pollution was related to COPD, but not linearly. The multiple COPD regression models systematically combined socioeconomic and environmental indicators from different geographical levels: an unemployment indicator at the regional level, a climate indicator at the urban level, and intraurban residential segregation indicators. The air pollution indicators no longer appeared as explanatory variables.
Conclusion: In this exploratory work, the introduction of variables at different geographic levels sheds new light on the relations between respiratory health status and environmental and socioeconomic factors.