Conurbation, Urban, and Rural Living as Determinants of Allergies and Infectious Diseases: Royal College of General Practitioners Research and Surveillance Centre Annual Report 2016-2017

Simon de Lusignan; Christopher McGee; Rebecca Webb; Mark Joy; Rachel Byford; Ivelina Yonova; Mariya Hriskova; Filipa Matos Ferreira; Alex J Elliot; Gillian Smith; Imran Rafi

doi:10.2196/11354

Conurbation, Urban, and Rural Living as Determinants of Allergies and Infectious Diseases: Royal College of General Practitioners Research and Surveillance Centre Annual Report 2016-2017

JMIR Public Health Surveill. 2018 Nov 26;4(4):e11354. doi: 10.2196/11354.

Authors

Simon de Lusignan^#^{1

2}, Christopher McGee^{1

2}, Rebecca Webb¹, Mark Joy¹, Rachel Byford¹, Ivelina Yonova^{1

2}, Mariya Hriskova^{1

2}, Filipa Matos Ferreira¹, Alex J Elliot³, Gillian Smith³, Imran Rafi⁴

Affiliations

¹ Department of Clinical and Experimental Medicine, University of Surrey, Guildford, United Kingdom.
² Royal College of General Practitioners Research and Surveillance Centre, London, United Kingdom.
³ Real-time Syndromic Surveillance Team, Field Service, National Infection Service, Public Health England, Birmingham, United Kingdom.
⁴ Royal College of General Practitioners Clinical Innovation and Research Centre, London, United Kingdom.

^# Contributed equally.

PMID: 30478022
PMCID: PMC6288591
DOI: 10.2196/11354

Abstract

Background: Living in a conurbation, urban, or rural environment is an important determinant of health. For example, conurbation and rural living is associated with increased respiratory and allergic conditions, whereas a farm or rural upbringing has been shown to be a protective factor against this.

Objective: The objective of the study was to assess differences in general practice presentations of allergic and infectious disease in those exposed to conurbation or urban living compared with rural environments.

Methods: The population was a nationally representative sample of 175 English general practices covering a population of over 1.6 million patients registered with sentinel network general practices. General practice presentation rates per 100,000 population were reported for allergic rhinitis, asthma, and infectious conditions grouped into upper and lower respiratory tract infections, urinary tract infection, and acute gastroenteritis by the UK Office for National Statistics urban-rural category. We used multivariate logistic regression adjusting for age, sex, ethnicity, deprivation, comorbidities, and smoking status, reporting odds ratios (ORs) with 95% CIs.

Results: For allergic rhinitis, the OR was 1.13 (95% CI 1.04-1.23; P=.003) for urban and 1.29 (95% CI 1.19-1.41; P<.001) for conurbation compared with rural dwellers. Conurbation living was associated with a lower OR for both asthma (OR 0.70, 95% CI 0.67-0.73; P<.001) and lower respiratory tract infections (OR 0.94, 95% CI 0.90-0.98; P=.005). Compared with rural dwellers, the OR for upper respiratory tract infection was greater in urban (OR 1.06, 95% CI 1.03-1.08; P<.001) but no different in conurbation dwellers (OR 1.00, 95% CI 0.97-1.03; P=.93). Acute gastroenteritis followed the same pattern: the OR was 1.13 (95% CI 1.01-1.25; P=.03) for urban dwellers and 1.04 (95% CI 0.93-1.17; P=.46) for conurbation dwellers. The OR for urinary tract infection was lower for urban dwellers (OR 0.94, 95% CI 0.89-0.99; P=.02) but higher in conurbation dwellers (OR 1.06, 95% CI 1.00-1.13; P=.04).

Conclusions: Those living in conurbations or urban areas were more likely to consult a general practice for allergic rhinitis and upper respiratory tract infection. Both conurbation and rural living were associated with an increased risk of urinary tract infection. Living in rural areas was associated with an increased risk of asthma and lower respiratory tract infections. The data suggest that living environment may affect rates of consultations for certain conditions. Longitudinal analyses of these data would be useful in providing insights into important determinants.

Keywords: asthma; conjunctivitis, allergic; data collection; gastroenteritis; general practice; healthcare disparities; infectious diseases; medical records systems, computerized; population surveillance; primary health care; records as topic; respiratory tract infections; social determinants of health; socioeconomic factors; urinary tract infections.

©Simon de Lusignan, Christopher McGee, Rebecca Webb, Mark Joy, Rachel Byford, Ivelina Yonova, Mariya Hriskova, Filipa Matos Ferreira, Alex J Elliot, Gillian Smith, Imran Rafi. Originally published in JMIR Public Health and Surveillance (http://publichealth.jmir.org), 26.11.2018.