Do socioeconomic inequalities in mortality vary between different Spanish cities? a pooled cross-sectional analysis

BMC Public Health

Carme Borrell⁴  Margarita Taracido⁶  Pablo Sánchez-Villegas⁷  Imanol Montoya¹  Carmen Martos⁶  Ana Gandarillas³  M Felicitas Domínguez-Berjón³  Antonio Daponte⁷  Joaquín Moncho²  Andreu Nolasco²  Marc Marí-Dell'Olmo⁴  Paloma Botella-Rocamora⁸  Oscar Zurriaga⁵  Miguel A Martinez-Beneito⁶ 

[1] Departamento de Sanidad del Gobierno Vasco, Alava 45, Vitoria-Gasteiz, Álava, 01001, Spain;Unidad de Investigación en Análisis de la Mortalidad y Estadísticas Sanitarias. Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia, Universidad de Alicante, Campus de San Vicente del Raspeig s/n. Apartado 99, Alicante, 03080, Spain;Subdirección de Promoción de la Salud y Prevención. Dirección General de Atención Primaria, Consejería de Sanidad. Comunidad de Madrid, C/ Julián Camarillo nº 4B, 2ª planta, Madrid, 28037, Spain;Institut de Recerca Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain;Dirección General de Salud Pública. Conselleria de Sanitat, Generalitat Valenciana, Av. Cataluña, 21, Valencia, 46020, Spain;Ciber de Epidemiología y Salud Pública-CIBERESP, Instituto de Salud Carlos III- Melchor Fernández Almagro, 3-5, 28029 Madrid, Spain;Observatorio de Salud y Medio Ambiente de Andalucía (OSMAN). Escuela Andaluza de Salud Pública, Campus Universitario de Cartuja, Cuesta del Observatorio, 4. Ap. Correos 2070, Granada, 18080, Spain;Departamento de Ciencias Físicas, Matemáticas y de la Computación, Universidad CEU-Cardenal Herrera, C/ San Bartolomé, 55, Alfara del Patriarca, 46115, Spain

关键词: Spain;    Meta-analysis;    Pooled cross-sectional analysis;    Urban areas;    Mortality;    Deprivation;   

Others  :  1162201
DOI  :  10.1186/1471-2458-13-480

 received in 2012-05-02, accepted in 2013-05-10,  发布年份 2013

【 摘 要 】

Background

The relationship between deprivation and mortality in urban settings is well established. This relationship has been found for several causes of death in Spanish cities in independent analyses (the MEDEA project). However, no joint analysis which pools the strength of this relationship across several cities has ever been undertaken. Such an analysis would determine, if appropriate, a joint relationship by linking the associations found.

Methods

A pooled cross-sectional analysis of the data from the MEDEA project has been carried out for each of the causes of death studied. Specifically, a meta-analysis has been carried out to pool the relative risks in eleven Spanish cities. Different deprivation-mortality relationships across the cities are considered in the analysis (fixed and random effects models). The size of the cities is also considered as a possible factor explaining differences between cities.

Results

Twenty studies have been carried out for different combinations of sex and causes of death. For nine of them (men: prostate cancer, diabetes, mental illnesses, Alzheimer’s disease, cerebrovascular disease; women: diabetes, mental illnesses, respiratory diseases, cirrhosis) no differences were found between cities in the effect of deprivation on mortality; in four cases (men: respiratory diseases, all causes of mortality; women: breast cancer, Alzheimer’s disease) differences not associated with the size of the city have been determined; in two cases (men: cirrhosis; women: lung cancer) differences strictly linked to the size of the city have been determined, and in five cases (men: lung cancer, ischaemic heart disease; women: ischaemic heart disease, cerebrovascular diseases, all causes of mortality) both kinds of differences have been found. Except for lung cancer in women, every significant relationship between deprivation and mortality goes in the same direction: deprivation increases mortality. Variability in the relative risks across cities was found for general mortality for both sexes.

Conclusions

This study provides a general overview of the relationship between deprivation and mortality for a sample of large Spanish cities combined. This joint study allows the exploration of and, if appropriate, the quantification of the variability in that relationship for the set of cities considered.

【 授权许可】

   
2013 Martinez-Beneito et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Drever F, Whitehead M: Mortality in regions and local authority districts in the 1990s: exploring the relationship with deprivation. Popul Trends 1995, 82:19-26.
• [2]Eames M, Ben-Shlomo Y, Marmot M: Social deprivation and premature mortality: regional comparison across England. Br Med J 1993, 307:1097-1102.
• [3]Townsend P: Deprivation. Journal of Social Policy 1987, 16:125-146.
• [4]Besag F, York J, Mollié A: Bayesian image restoration with two applications in spatial statistics. Ann Inst Stat Math 1991, 43:1-21.
• [5]Ferrándiz J, Abellán JJ, López A, Sanmartín P, Vanaclocha H, Zurriaga O, Martínez-Beneito MA, Melchor I, Calabuig J: Geographical distribution of cardiovascular mortality in Comunidad Valenciana (Spain). In GIS for emergency preparedness and health risk reduction. Edited by Briggs DJ, Forer P, Jarup L, Stern R. Dordrecht: Springer; 2002:267-282.
• [6]Barcelo MA, Saez M, Cano-Serral G, Martinez-Beneito MA, Martinez JM, Borrell C, Ocana-Riola R, Montoya I, Calvo M, Lopez-Abente G, Rodriguez-Sanz M, Toro S, Alcala JT, Saurina C, Sanchez-Villegas P, Figueiras A: [Methods to smooth mortality indicators: application to analysis of inequalities in mortality in Spanish cities (the MEDEA Project)]. Gac Sanit 2008, 22:596-608.
• [7]Borrell C, Marí-Dell’Olmo M, Serral G, Martínez-Beneito MA, Gotsens M, MEDEA members: Inequalities in mortality in small areas of eleven Spanish cities (the multicenter MEDEA project). Health Place 2010, 16:703-711.
• [8]Domínguez-Berjón MF, Borrell C, Cano-Serral G, Esnaola S, Nolasco A, Pasarín MI, Ramis R, Saurina C, Escolar-Pujolar A: [Constructing a deprivation index based on census data in large Spanish cities (the MEDEA project)]. Gac Sanit 2008, 22:179-187.
• [9]Spiegelhalter DJ, Best NJ, Carlin BP, Van DerLinde A: Bayesian measures of model complexity and fit (with discussion). Journal of the Royal Statistical Society: Series B 2002, 64:583-641.
• [10]Roper NA, Bilous RW, Kelly WF, Unwin NC, Connolly VM: Excess mortality in a population with diabetes and the impact of material deprivation: longitudinal, population based study. Br Med J 2001, 322:1389-1393.
• [11]Exeter DJ, Boyle PJ, Norman P: Deprivation (im)mobility and cause-specific premature mortality in Scotland. Soc Sci Med 2011, 72:389-397.
• [12]Domínguez-Berjón MF, Gandarillas A, Segura del Pozo J, Zorrilla B, Soto MJ, López L, Duque I, Marta MI, Abad I: Census tract socioeconomic and physical environment and cardiovascular mortality in the Region of Madrid (Spain). J Epidemiol Community Health 2010, 64:1086-1093.
• [13]Romeri E, Baker A, Griffiths C: Mortality by deprivation and cause of death in England and Wales, 1999–2003. Health Statistics Quarterly/Office for National Statistics 2006, 2006(32):19-34.
• [14]Jordan R, Verlander N, Olowokure B, Hawker JI: Age, sex, material deprivation and respiratory mortality. Respir Med 2006, 100:1282-1285.
• [15]Batty M: The size, scale, and shape of cities. Science 2008, 8:769-771.
• [16]Harper S, Lynch J, Meersman SC, Breen N, Davis WW, Reichman MC: Trends in area-socioeconomic and race-ethnic disparities in breast cancer incidence, stage at diagnosis, screening, mortality, and survival among women ages 50 years and over (1987–2005). Cancer Epidemiol Biomarkers Prev 2009, 18:121-131.
• [17]Schootman M, Lian M, Deshpande AD, Baker EA, Pruitt SL, Aft R, Jeffe DB: Temporal trends in area socioeconomic disparities in breast-cancer incidence and mortality, 1988–2005. Breast Cancer Res Treat 2010, 122:533-543.
• [18]Walsh D, Bendel N, Jones R, Hanlon P: It’s not ‘just deprivation’: Why do equally deprived UK cities experience different health outcomes? Public Health 2010, 124:487-495.
• [19]George S: It’s not just deprivation – or is it? Public Health 2010, 124:496-497.
• [20]Graham P, Walsh D, McCartney G: Shipyards and sectarianism: How do mortality and deprivation compare in Glasgow and Belfast? Public Health 2012, 126:83-85.
• [21]Elliot P, Wartenberg D: Spatial epidemiology: current approaches and future challenges. Environ Health Perspect 2004, 112:998-1006.
• [22]Cano-Serral G, Perez G, Borrell C, COMPARA Group: Comparability between ICD-9 and ICD-10 for the leading causes of death in Spain. Rev Epidemiol Sante Publique 2006, 54:355-365.