Urban Health at a Glance in Italy by PASSI and PASSI d’Argento Surveillance Systems Data

Round 1

Reviewer 1 Report

This manuscript describes an epidemiologic study in which basic data from two cross-sectional studies were collected and analyzed to find the higher prevalence of multiple unhealthy issues in urban area, at the same time, some benefit on alcohol consumption. This study has some novelty since it uses the PASSI and PASSI d’Argento surveillance system data to figure out the prevalence of unhealthy issues in urban and rural areas in Italy.  I listed several major concerns need to be addressed.

1. All the tables use 95% confidence interval. But P value is still preferred to show a significant difference.
2. There should be a limitation part to talk about all the limits. For example, the possible confounding factors, the subjective diagnosis in PASSI and PASSI d’Argento survey and population migration between urban and rural regions.
3. The time point or time period of conduction is always important to a cross-sectional study and should be highlighted.

Author Response

Reviewer #1

Comment 1

This manuscript describes an epidemiologic study in which basic data from two cross-sectional studies were collected and analyzed to find the higher prevalence of multiple unhealthy issues in urban area, at the same time, some benefit on alcohol consumption. This study has some novelty since it uses the PASSI and PASSI d’Argento surveillance system data to figure out the prevalence of unhealthy issues in urban and rural areas in Italy.  I listed several major concerns need to be addressed.

1. All the tables use 95% confidence interval. But P value is still preferred to show a significant difference.

Answer 1

We would like to thank the reviewer #1 for this suggestion. We added statistically significance levels based on p-value to make the significant differences more evident but not to change the layout of the tables.

Comment 2

2. There should be a limitation part to talk about all the limits. For example, the possible confounding factors, the subjective diagnosis in PASSI and PASSI d’Argento survey and population migration between urban and rural regions.

Answer 2

Thanks to the reviewer’s comment on the limitations. We inserted a paragraph on limits of the study but also on the strengths.

Lines 445-457

“This study has some limitations. The PASSI and PdA surveillance systems are based on self-reported data collected by a telephone interview, therefore there may be some bias in the obtained information. We adjusted the estimations to socio-demographic confounders and other covariates related to each specific outcome, but there may still be some residual confounding. We considered individuals’ municipalities of residence and not possible temporary changes of municipality of domicile; however, we assume that the usual life environment of individuals can correspond with residence.

Finally, this research has major strengths. To our best knowledge, it is the only study so far considering the whole of Italy and connects different health dimensions with the urbanization degree of the municipality of residence. It analyzes a heterogeneous population, made up of both adults and the elderly. In fact, PASSI and PdA surveillance systems allow exploring a large amount of data: due to their standardized procedures of contacts and recall techniques, they have high response rates (81% in PASSI and 86% in PdA).”

Comment 3

3. The time point or time period of conduction is always important to a cross-sectional study and should be highlighted.

Answer 3

The authors want to thank again the reviewer for the appropriate comment. The analysed periods were 2014-2018 for PASSI surveillance system and 2016-2018 for Passi d’Argento surveillance system. We highlighted them in lines 146-147 in the beginning of paragraph 2.2 “Statistical analysis”.

Reviewer 2 Report

The paper entitled “Urban health at a glance in Italy by PASSI and PASSI d’Argento surveillance systems data”
aimed to investigate dimensions of individual health, relating them to the type of municipality of residence.

 

The manuscript is well written and well supported by consistent references. The conclusions are largely sound and improve the existing knowledge.

Only a suggestion: it is not clear why the authors reported AdjPR instead of Adjusted odds ratio (AOR) in the tables.

Author Response

Reviewer #2

Comment

The paper entitled “Urban health at a glance in Italy by PASSI and PASSI d’Argento surveillance systems data”
aimed to investigate dimensions of individual health, relating them to the type of municipality of residence.

The manuscript is well written and well supported by consistent references. The conclusions are largely sound and improve the existing knowledge.

Only a suggestion: it is not clear why the authors reported AdjPR instead of Adjusted odds ratio (AOR) in the tables.

Answer

We would like to thank the reviewer #2 for appreciation of the relevance of our work. We are sorry for typos in the tables: we changed AdjPR with Adjusted Odds Ratio (OR). Furthermore, we standardized the wording AOR with the more usual OR.

Reviewer 3 Report

This study aims to evaluate the association between three fundamental dimen- 67 sions of individual health (lifestyles, health conditions, and prevention) and “urbanization 68 degree” of the municipality in which people live.The conclusions of the conducted research are clear and result from the obtained research results. The material used for the research is sufficient, the research methods have been selected appropriately. The arrangement of the figure and tabels is clear and presents the obtained results very well. Discussing the results against the background of other authors is very detailed. The publications cited by the authors of the article are well selected. For the most part, the authors refer to the latest knowledge published in renowned scientific journals. I could not find any mistakes in the scientific aspect of the manuscript.

However, the authors did not avoid a few mistakes, which I will list below:

- A few punctuation problems are present in the manuscript. I suggest the Authors to double-check the text.

Author Response

Reviewer #3

Comment

This study aims to evaluate the association between three fundamental dimen- 67 sions of individual health (lifestyles, health conditions, and prevention) and “urbanization 68 degree” of the municipality in which people live.The conclusions of the conducted research are clear and result from the obtained research results. The material used for the research is sufficient, the research methods have been selected appropriately. The arrangement of the figure and tabels is clear and presents the obtained results very well. Discussing the results against the background of other authors is very detailed. The publications cited by the authors of the article are well selected. For the most part, the authors refer to the latest knowledge published in renowned scientific journals. I could not find any mistakes in the scientific aspect of the manuscript.

However, the authors did not avoid a few mistakes, which I will list below:

- A few punctuation problems are present in the manuscript. I suggest the Authors to double-check the text.

Answer

We would like to thanks the reviewer #3 for comments about the appropriateness of our references, methods, results and discussions. As suggested, we double-checked the text and we corrected some typos.