title: Gaining a better understanding of respiratory health inequalities among cities: an ecological case study on elderly males in the larger French cities.
abstract: BACKGROUND
  In recent years, there have been a growing number of studies on spatial inequalities in health covering a variety of scales, from small areas to metropolitan areas or regions, and for various health outcomes. However, few investigations have compared health status between cities with a view to gaining a better understanding of the relationships between such inequalities and the social, economic and physical characteristics. This paper focuses on disparities in respiratory health among the 55 largest French cities. The aim is to explore the relationships between inter-urban health patterns, city characteristics and regional context, and to determine how far a city's health status relates to the features observed on different geographical scales.
  
  
  METHODS
  We used health data describing hospitalizations for Chronic Obstructive Pulmonary Disease (COPD) as a proxy for respiratory health, and the total number of hospitalizations (overall) as a proxy for general health. This last indicator was used as a benchmark. A large set of indicators relating to socioeconomic, physical and amenity aspects of the cities (urban units) was also constructed. Data were analyzed using linear correlations and multiple linear regression models.
  
  
  RESULTS
  The results suggest that socioeconomic characteristics are major discriminators for inequalities in respiratory health status among urban units. Indeed, once combined to socioeconomic characteristics, only a climate indicator remained significant among the physical indicators. It appeared that the pollution indicators which were significantly correlated with COPD hospitalization rates loosed significance when associated to the socio-economic indicators in a multiple regression. The analysis showed that among the socio-economic indicators, an employment indicator derived at the regional scale, and two indicators reflecting the unequal intra-urban spatial distribution of population according to their education, were the most efficient to describe differences in the respiratory health status of urban units.
  
  
  CONCLUSIONS
  In order to design effective urban policies, it is essential to gain a better understanding of the differences among cities in their entirety, rather than solely differences across small urban areas or individuals.
authors.affiliation: UMR Environnement Ville Société, Université de Lyon, Faculté GHHAT, 5 Avenue Pierre Mendès-France, Bron Cedex 69676, France.
authors.forename: Christina
authors.initials: C
authors.lastname: Aschan-Leygonie
authors.forename: Sophie
authors.initials: S
authors.lastname: Baudet-Michel
authors.forename: Hélène
authors.initials: H
authors.lastname: Mathian
authors.forename: Lena
authors.initials: L
authors.lastname: Sanders
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000397:Air Pollution / Q000009:adverse effects* / Q000191:economics; D016022:Case-Control Studies; D002947:Cities / Q000191:economics / Q000453:epidemiology*; D032882:Comprehension; D017753:Ecosystem; D005602:France / Q000453:epidemiology; D006760:Hospitalization / Q000191:economics / Q000639:trends; D006801:Humans; D008297:Male; D012307:Risk Factors; D012959:Socioeconomic Factors; D014505:Urban Population / Q000639:trends*