title: [Association between the social status of city districts and health risks: multilevel analyses concerning the regional distribution of overweight, hypertension and self-rated health in Augsburg, Germany].
abstract: BACKGROUND
  In empirical studies it has repeatedly been shown that the socioeconomic status (SES) of a region could infl uence the health status of its inhabitants, even if measures of individual SES are controlled for. This research has just started in Germany, but most studies focus on large geographical areas such as rural districts. Taking the example of districts in the city of Augsburg, the analyses focus on the question if these associations can also be found in a small-scale regional comparison.
  
  
  METHODS
  We included 1 888 participants of the KORA S4 Survey aged 25-74 years. The city districts were grouped according to the unemployment rate (low, medium, high). The dependent variables were self-rated health and 3 risk factors (obesity, high waist-hip ratio, hypertension). Additional individual variables included are age, sex, educational level and unemployment. The analyses were based on multilevel logistic regressions.
  
  
  RESULTS
  After adjustment for individual level variables (age, sex, education, unemployment), the analyses show a signifi cantly increased risk of 'high waist-hip ratio' in the regions with the highest unemployment rate (OR 1.53; 95 % conf. interval 1.03-2.26). A similar association was found for obesity. No signifi cant association was observed between unemployment rate on the one hand and hypertension and self-rated health on the other.
  
  
  CONCLUSIONS
  Some health risks seem to be especially high in city districts characterised by a high unemployment rate. It can be concluded that interventions aimed at reducing these risks should focus on districts with high unemployment rates. Further studies are needed for an understanding of the causes behind the social and regional inequalities shown here.
authors.affiliation: Institut für Gesundheitsökonomie und Management im Gesundheitswesen, Helmholtz Zentrum München, Deutsches Forschungszentrum für Umwelt und Gesundheit (GmbH), Neuherberg, Germany. rottmann@ibe.med.uni-muenchen.de
authors.forename: M
authors.initials: M
authors.lastname: Rottmann
authors.forename: W
authors.initials: W
authors.lastname: Maier
authors.forename: S
authors.initials: S
authors.lastname: von Klot
authors.forename: A
authors.initials: A
authors.lastname: Döring
authors.forename: A
authors.initials: A
authors.lastname: Mielck
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D002947:Cities; D015897:Comorbidity; D059026:Diagnostic Self Evaluation; D004651:Employment / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany; D006304:Health Status; D006608:Hierarchy, Social; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D050177:Overweight / Q000453:epidemiology*; D015995:Prevalence; D018570:Risk Assessment; D017678:Sex Distribution; D012959:Socioeconomic Factors