A key concern in public health is whether disparities exist between urban and rural areas. One dimension of potential variation is the transmission of infectious diseases. In addition to potential differences between urban and rural local dynamics, the question of whether urban and rural areas participate equally in national dynamics remains unanswered. Specifically, urban and rural areas may diverge in local transmission as well as spatial connectivity, and thus risk for receiving imported cases. Finally, the potential confounding relationship of spatial proximity with size and urban/rural district type has not been addressed by previous research. It is rare to have sufficient data to explore these questions thoroughly. We use exhaustive weekly case reports of measles in 954 urban and 468 rural districts of the UK (1944–1965) to compare both local disease dynamics as well as regional transmission. We employ the time-series susceptible–infected–recovered model to estimate disease transmission, epidemic severity, seasonality and import dependence. Congruent with past results, we observe a clear dependence on population size for the majority of these measures. We use a matched-pair strategy to compare proximate urban and rural districts and control for possible spatial confounders. This analytical strategy reveals a modest difference between urban and rural areas. Rural areas tend to be characterized by more frequent, smaller outbreaks compared to urban counterparts. The magnitude of the difference is slight and the results primarily reinforce the importance of population size, both in terms of local and regional transmission. In sum, urban and rural areas demonstrate remarkable epidemiological similarity in this recent UK context.

中文翻译：

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结构、空间和规模：城乡麻疹传播变异的竞争驱动因素

公共卫生的一个关键问题是城乡之间是否存在差异。潜在变异的一个方面是传染病的传播。除了城市和农村地方动态之间的潜在差异之外，城市和农村地区是否平等地参与国家动态的问题仍未得到解答。具体而言，城市和农村地区在本地传播和空间连通性方面可能存在差异，因此存在接收输入病例的风险。最后，空间邻近度与规模和城市/农村地区类型的潜在混杂关系尚未在先前的研究中得到解决。很少有足够的数据来彻底探讨这些问题。我们使用英国 954 个城市和 468 个农村地区（1944-1965 年）详尽的每周麻疹病例报告来比较当地疾病动态和区域传播。我们采用时间序列易感-感染-恢复模型来估计疾病传播、流行严重程度、季节性和进口依赖性。与过去的结果一致，我们观察到大多数这些措施明显依赖于人口规模。我们使用配对策略来比较邻近的城市和农村地区，并控制可能的空间混杂因素。这种分析策略揭示了城市和农村地区之间的适度差异。与城市地区相比，农村地区的特点往往是更频繁、更小规模的爆发。差异的幅度很小，结果主要强调了人口规模在地方和区域传播方面的重要性。总之，在最近的英国背景下，城市和农村地区表现出显着的流行病学相似性。