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. 1998 Aug;52(8):487–493. doi: 10.1136/jech.52.8.487

Urban-rural variations in health in The Netherlands: does selective migration play a part?

R A Verheij, H D van de Mheen, D H de Bakker, P P Groenewegen, J P Mackenbach
PMCID: PMC1756752  PMID: 9876359

Abstract

STUDY OBJECTIVE: Urban-rural health differences are observed in many countries, even when socioeconomic and demographic characteristics are controlled for. People living in urban areas are often found to be less healthy. One of the possible causes for these differences is selective migration with respect to health or health risk factors. This hypothesis is hardly ever empirically tested. This paper tries to assess the existence of selective urban-rural migration. DESIGN: Health indicators and health risk factors were measured in a 1991 population sample. Moves were registered between 1991 and 1995. Using logistic regression analyses, comparisons were made between, firstly, urban to rural movers and rural to urban movers and secondly, between movers and stayers. SETTING: Region surrounding the city of Eindhoven in south eastern part of the Netherlands. SUBJECTS: Data were used of 15,895 respondents aged 20-74 in 1991. By 1995 613 subjects had moved from urban to rural and 191 subjects from rural to urban. MAIN RESULTS: Bivariate nor multivariate analyses show hardly and differences between movers into urban and movers into rural areas. Bivariate analyses on movers and stayers show that movers are healthier than stayers. However, when socioeconomic and demographic variables are controlled for, movers appear to be less healthy, with the exception of the younger age groups. CONCLUSIONS: Areas that attract many migrants from and lose few migrants to other degrees of urbanicity will in the long run obtain healthier populations, because of demographic and socioeconomic characteristics. However, if these characteristics are accounted for, the opposite is true, with the exception of younger age groups. In extreme cases this may cause spurious findings in cross sectional research into the relation between urbanicity and health. Absolute numbers of migrants need to be very high, however, to make this noticeable at the aggregate level.

 

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Selected References

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  1. Bentham G. Migration and morbidity: implications for geographical studies of disease. Soc Sci Med. 1988;26(1):49–54. doi: 10.1016/0277-9536(88)90044-5. [DOI] [PubMed] [Google Scholar]
  2. Blazer D., George L. K., Landerman R., Pennybacker M., Melville M. L., Woodbury M., Manton K. G., Jordan K., Locke B. Psychiatric disorders. A rural/urban comparison. Arch Gen Psychiatry. 1985 Jul;42(7):651–656. doi: 10.1001/archpsyc.1985.01790300013002. [DOI] [PubMed] [Google Scholar]
  3. Diderichsen F., Janlert U. Effects of economic change on male morbidity in neighbouring industrial and rural municipalities in northern Sweden. J Epidemiol Community Health. 1992 Dec;46(6):605–607. doi: 10.1136/jech.46.6.605. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Fang J., Madhavan S., Alderman M. H. The association between birthplace and mortality from cardiovascular causes among black and white residents of New York City. N Engl J Med. 1996 Nov 21;335(21):1545–1551. doi: 10.1056/NEJM199611213352101. [DOI] [PubMed] [Google Scholar]
  5. Fox A. J., Goldblatt P. O., Adelstein A. M. Selection and mortality differentials. J Epidemiol Community Health. 1982 Jun;36(2):69–79. doi: 10.1136/jech.36.2.69. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Garretsen H. F., Raat H. Urban health in The Netherlands: health situation, health facilities and public health policy. Health Policy. 1991 Jul;18(2):159–168. doi: 10.1016/0168-8510(91)90097-h. [DOI] [PubMed] [Google Scholar]
  7. Giggs J. A., Bourke J. B., Katschinski B. The epidemiology of primary acute pancreatitis in Greater Nottingham: 1969-1983. Soc Sci Med. 1988;26(1):79–89. doi: 10.1016/0277-9536(88)90047-0. [DOI] [PubMed] [Google Scholar]
  8. Green M. Air pollution and health. BMJ. 1995 Aug 12;311(7002):401–402. doi: 10.1136/bmj.311.7002.401. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Greenberg M., Schneider D. Region of birth and mortality of blacks in the United States. Int J Epidemiol. 1992 Apr;21(2):324–328. doi: 10.1093/ije/21.2.324. [DOI] [PubMed] [Google Scholar]
  10. Jones T. L., Shih C. H., Thurston D. H., Ware B. J., Cole P. Selection bias from differential residential mobility as an explanation for associations of wire codes with childhood cancer. J Clin Epidemiol. 1993 Jun;46(6):545–548. doi: 10.1016/0895-4356(93)90127-m. [DOI] [PubMed] [Google Scholar]
  11. Khoury M. J., Stewart W., Weinstein A., Panny S., Lindsay P., Eisenberg M. Residential mobility during pregnancy: implications for environmental teratogenesis. J Clin Epidemiol. 1988;41(1):15–20. doi: 10.1016/0895-4356(88)90004-2. [DOI] [PubMed] [Google Scholar]
  12. Krout J. A. Rural versus urban differences in health dependence among the elderly population. Int J Aging Hum Dev. 1989;28(2):141–156. doi: 10.2190/XN5P-P2X0-MLUD-0HRM. [DOI] [PubMed] [Google Scholar]
  13. Lewis G., David A., Andréasson S., Allebeck P. Schizophrenia and city life. Lancet. 1992 Jul 18;340(8812):137–140. doi: 10.1016/0140-6736(92)93213-7. [DOI] [PubMed] [Google Scholar]
  14. Mackenbach J. P., van de Mheen H., Stronks K. A prospective cohort study investigating the explanation of socio-economic inequalities in health in The Netherlands. Soc Sci Med. 1994 Jan;38(2):299–308. doi: 10.1016/0277-9536(94)90399-9. [DOI] [PubMed] [Google Scholar]
  15. Reijneveld S. A. Causes of death contributing to urban socioeconomic mortality differences in Amsterdam. Int J Epidemiol. 1995 Aug;24(4):740–749. doi: 10.1093/ije/24.4.740. [DOI] [PubMed] [Google Scholar]
  16. Rosenberg E. E., Steinert Y. E. Psychosocial problems: what help do rural and urban patients want from their family physicians? CMAJ. 1987 Jan 15;136(2):137–141. [PMC free article] [PubMed] [Google Scholar]
  17. Strachan D. P., Golding J., Anderson H. R. Regional variations in wheezing illness in British children: effect of migration during early childhood. J Epidemiol Community Health. 1990 Sep;44(3):231–236. doi: 10.1136/jech.44.3.231. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Verheij R. A. Explaining urban-rural variations in health: a review of interactions between individual and environment. Soc Sci Med. 1996 Mar;42(6):923–935. doi: 10.1016/0277-9536(95)00190-5. [DOI] [PubMed] [Google Scholar]
  19. Zahner G. E., Jacobs J. H., Freeman D. H., Jr, Trainor K. F. Rural-urban child psychopathology in a Northeastern U.S. state: 1986-1989. J Am Acad Child Adolesc Psychiatry. 1993 Mar;32(2):378–387. doi: 10.1097/00004583-199303000-00020. [DOI] [PubMed] [Google Scholar]

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