Gaining a better understanding of respiratory health inequalities among cities: An ecological case study on elderly males in the larger French cities

International audienceBackground: In recent years, there has 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 their regional contexts, 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, as compared to the total number of hospitalizations (all diagnoses) as a proxy for general health. 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. Once combined to socioeconomic characteristics, physical characteristics do not always appear as explanatory variables. At the regional scale, differences arising from employment features explain respiratory health inequalities. It also appears that intra-urban spatial inequalities, when combined with regional employment indicators, more efficiently describe differences in the respiratory health status of urban units than do compositional indicators. Conclusion: 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