title: Differences in adults' health and health behaviour between 16 European urban areas and the associations with socio-economic status and physical and social environment.
abstract: With a growing proportion of the European population living in urban areas (UAs), exploring health in urban areas becomes increasingly important. The objective of this study is to assess the magnitude of differences in health and health behaviour between adults living in urban areas (UAs) across Europe. We also explored whether and to what extent such differences can be explained by socio-economic status (SES) and physical or social environment. Data were obtained from a cross-sectional questionnaire survey, performed between as part of the European Urban Health Indicator System Part 2 (EURO-URHIS 2) project. Using multi-level logistic regression analysis, UA differences in psychological distress, self-assessed health, overweight and obesity, daily smoking, binge drinking and physical exercise were assessed. Median Odds Ratios (MORs) were calculated to estimate the extent to which the observed variance is attributable to UA, individual-level SES (measured by perceived financial strains, education level and employment status) and/or characteristics of physical and social environment. The dataset included 14 022 respondents in 16 UAs within 9 countries. After correction for age and gender, all MORs, except that for daily smoking, indicated statistically significant UA health differences. SES indicators (partly) explained UA differences in psychological distress, decreasing the MOR from 1.43 [95% credible interval (Cr.I.) 1.27-1.67, baseline model], to 1.25 (95% Cr.I. 1.14-1.40, SES model): a reduction of 42%. Accounting for the quality of green areas reduced the MOR for psychological distress by an additional 40%, to 1.15 (95% Cr.I. 1.05-1.28). Our study showed large differences in health and health behaviour between European UAs. Reducing socio-economic disadvantage and improving the quality of the neighbourhood's green spaces may reduce UA differences in psychological distress.
authors.affiliation: 1 Municipal Health Service Utrecht, Utrecht, The Netherlands.
authors.forename: Rianne
authors.initials: R
authors.lastname: de Gelder
authors.affiliation: 1 Municipal Health Service Utrecht, Utrecht, The Netherlands.
authors.forename: Emmy M
authors.initials: EM
authors.lastname: Koster
authors.affiliation: 1 Municipal Health Service Utrecht, Utrecht, The Netherlands.
authors.forename: Laurens P
authors.initials: LP
authors.lastname: van Buren
authors.affiliation: 1 Municipal Health Service Utrecht, Utrecht, The Netherlands.|2 Manchester Urban Collaboration on Health, Centre for Epidemiology, Institute for Population Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, M13 9PT, UK.
authors.forename: Erik J C
authors.initials: EJC
authors.lastname: van Ameijden
authors.affiliation: 2 Manchester Urban Collaboration on Health, Centre for Epidemiology, Institute for Population Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, M13 9PT, UK.
authors.forename: Annie
authors.initials: A
authors.lastname: Harrison
authors.affiliation: 3 Division of Public Health and Policy, University of Liverpool, Liverpool, UK.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Birt
authors.affiliation: 2 Manchester Urban Collaboration on Health, Centre for Epidemiology, Institute for Population Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, M13 9PT, UK.
authors.forename: Arpana
authors.initials: A
authors.lastname: Verma
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005060:Europe / Q000453:epidemiology; D005260:Female; D015438:Health Behavior; D006304:Health Status; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D012931:Social Environment; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014504:Urban Health / Q000706:statistics & numerical data*; D014505:Urban Population / Q000706:statistics & numerical data