The impact of individual and area characteristics on urban socioeconomic differences in health and smoking

Background. In general, poor health and lifestyles occur more frequently among individuals of low socioeconomic status (SES) and in deprived areas. An explanation for the latter may simply be the on average lower SES of residents of these areas. It is possible, however, that living in a deprived area contributes to poor health and lifestyles. This study examines whether such an area-contribution exists in urban settings. Methods. Data on health, smoking, and individual SES were collected on 5121 residents of Amsterdam, the Netherlands, by face-to-face interviews (response: 61.4%). Area deprivation was measured by indicators used previously, on 22 areas. Odds ratios (OR) for poor health (poor self-rated health, long-term limitations, health complaints and obesity) and smoking were computed comparing tertiles of area deprivation. All analyses employed multilevel techniques, with residents hierarchically nested within areas. Results. The age- and gender-adjusted prevalences of poor health and smoking are higher in deprived urban areas. Most of the differences in poor health can be explained by the on average lower SES of residents of deprived areas. Only for long-term limitations and obesity, some statistically significant area-differences remain. The higher prevalence of smoking in deprived areas can only partially be explained by the SES of residents. Conclusions. Adverse health status in deprived areas is mainly due to a lower individual SES and not to contextual factors. For smoking, living in a deprived area contributes to a higher prevalence. This shows the necessity of community-based preventive interventions in deprived areas