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ObjectiveMany studies show the average health status in deprived areas to be poorer and the use of health care to be higher, but there is hardly any information on the impact of the geographical classification on the size of these differences. This study examines the impact of the geographical classification on the clustering of poor health per area and on the size of the differences in health by area deprivation.DesignData on self reported health regarding 5121 people were analysed using three classifications: neighbourhoods, postcode sectors and boroughs. Multilevel logistic models were used to determine the clustering of poor health per area and the size of the differences in health by area deprivation, without and subsequently with adjustment for individual socioeconomic status.SettingGeneral population aged 16 years and over of Amsterdam, the Netherlands.Main outcome measuresSelf rated health, mental symptoms (General Health Questionnaire, 12-item version), physical symptoms and long term functional limitations.Main resultsThe clustering of poor health is largest in neighbourhoods and smallest in postcode sectors. Health differences by area deprivation differ only slightly for the three geographical classifications, both with and without adjustment for individual socioeconomic status.ConclusionsIn this study, the choice of the geographical classification affects the degree of clustering of poor health by area but it has hardly any impact on the size of health differences by area deprivation.

Study objectiveUrban-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.DesignHealth 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.SettingRegion surrounding the city of Eindhoven in south eastern part of the Netherlands.SubjectsData 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 resultsBivariate nor multivariate analyses show hardly any 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.ConclusionsAreas 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.