Spatial inequalities in health result from different exposures to health risk factors according to the features of geographical contexts, in terms of physical environment, social deprivation, and health care accessibility. Using a common geographical referential, which combines indices measuring these contextual features, could improve the comparability of studies and the understanding of the spatial dimension of health inequalities. We developed the Geographical Classification for Health studies (GeoClasH) to distinguish French municipalities according to their ability to influence health outcomes. Ten contextual scores measuring physical and social environment as well as spatial accessibility of health care have been computed and combined to classify French municipalities through a K-means clustering. Age-standardized mortality rates according to the clusters of this classification have been calculated to assess its effectiveness. Significant lower mortality rates compared to the mainland France population were found in the Wealthy Metropolitan Areas (SMR = 0.868, 95% CI 0.863–0.873) and in the Residential Outskirts (SMR = 0.971, 95% CI 0.964–0.978), while significant excess mortality were found for Precarious Population Districts (SMR = 1.037, 95% CI 1.035–1.039), Agricultural and Industrial Plains (SMR = 1.066, 95% CI 1.063–1.070) and Rural Margins (SMR = 1.042, 95% CI 1.037–1.047). Our results evidence the comprehensive contribution of the geographical context in the constitution of health inequalities. To our knowledge, GeoClasH is the first nationwide classification that combines social, environmental and health care access scores at the municipality scale. It can therefore be used as a proxy to assess the geographical context of the individuals in public health studies.

中文翻译：

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超越地图：证明健康不平等的空间维度

根据地理环境、社会剥夺和医疗保健可及性等地理背景特征，健康风险因素的暴露程度不同，导致健康空间不平等。使用一个共同的地理参考，结合衡量这些背景特征的指数，可以提高研究的可比性和对健康不平等空间维度的理解。我们开发了健康研究地理分类 (GeoClasH)，以根据影响健康结果的能力区分法国城市。已经计算并结合了衡量物理和社会环境以及医疗保健空间可及性的十个上下文分数，以通过 K 均值聚类对法国城市进行分类。根据该分类的聚类计算了年龄标准化死亡率以评估其有效性。与法国大陆人口相比，富裕的大都市区 (SMR = 0.868, 95% CI 0.863–0.873) 和住宅郊区 (SMR = 0.971, 95% CI 0.964–0.978) 的死亡率显着较低，而显着过剩在不稳定人口地区 (SMR = 1.037, 95% CI 1.035–1.039)、农业和工业平原 (SMR = 1.066, 95% CI 1.063–1.070) 和农村边缘 (SMR = 1.042, 95% CI 1.035–1.039) 发现死亡率）。我们的结果证明了地理环境对健康不平等构成的综合贡献。据我们所知，GeoClasH 是第一个结合社会、市政规模的环境和医疗保健可及性得分。因此，它可以用作评估公共卫生研究中个人地理背景的代理。