Social differences in avoidable mortality between small areas of 15 European cities: an ecological study

International Journal of Health Geographics

Carme Borrell⁹  Lasse Tarkiainen^1,10  Carme Saurina⁶  Paula Santana⁵  Maica Rodríguez-Sanz⁹  Hynek Pikhart^1,11  Gloria Pérez^1,11  Laia Palència⁶  Joana Morrison^1,11  Laia Maynou⁶  Pekka Martikainen^1,10  Johan Mackenbach⁸  Katalin Kovács⁷  Mercè Gotsens⁶  Ana Gandarillas³  Dagmar Dzúrová¹  M Felicitas Domínguez-Berjón³  Patrick Deboosere⁴  Claudia Costa⁵  Diana Corman²  Bo Burström²  Marc Mari Dell’Olmo⁶  Marc Saez⁶  Gerard Borsboom⁸  Rasmus Hoffmann⁸ 

[1] Department of Social Geography and Regional Development, Faculty of Science, Charles University in Prague, Albertov 6, Prague 2 12843, Czech Republic;Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, Stockholm 17177, Sweden;Subdirección de Promoción de la Salud y Prevención. Consejería de Sanidad, San Martín de Porres, 6, 28035, Madrid 28037, Spain;Department of Social research, Vrije Universiteit Brussel, Pleinlaan 2, Elsene, Brussels 1050, Belgium;Centro de Estudos de Geografia e de Ordenamento do Territorio (CEGOT), Departamento de Geografia, Colégio de S. Jerónimo, Universidade de Coimbra, Coimbra 3000-043, Portugal;CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain;Demographic Research Institute, HCSO, 1024, 1/3 Buday L. u., Budapest, Hungary;Department of Public Health, Erasmus Medical Center, P.O. Box 2040, Rotterdam, CA 3000, The Netherlands;Agència de Salut Pública de Barcelona, Plaça Lesseps, 1, Barcelona 08023, Spain;Department of Social Research, University of Helsinki, P.O. Box 18, Helsinki 00014, Finland;Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, United Kingdom

关键词: Bayesian methods;    Spatial analysis;    Urban health;    Small area;    Health inequality;    Avoidable mortality;   

Others  :  804828
DOI  :  10.1186/1476-072X-13-8

 received in 2014-01-15, accepted in 2014-03-03,  发布年份 2014

【 摘 要 】

Background

Health and inequalities in health among inhabitants of European cities are of major importance for European public health and there is great interest in how different health care systems in Europe perform in the reduction of health inequalities. However, evidence on the spatial distribution of cause-specific mortality across neighbourhoods of European cities is scarce. This study presents maps of avoidable mortality in European cities and analyses differences in avoidable mortality between neighbourhoods with different levels of deprivation.

Methods

We determined the level of mortality from 14 avoidable causes of death for each neighbourhood of 15 large cities in different European regions. To address the problems associated with Standardised Mortality Ratios for small areas we smooth them using the Bayesian model proposed by Besag, York and Mollié. Ecological regression analysis was used to assess the association between social deprivation and mortality.

Results

Mortality from avoidable causes of death is higher in deprived neighbourhoods and mortality rate ratios between areas with different levels of deprivation differ between gender and cities. In most cases rate ratios are lower among women. While Eastern and Southern European cities show higher levels of avoidable mortality, the association of mortality with social deprivation tends to be higher in Northern and lower in Southern Europe.

Conclusions

There are marked differences in the level of avoidable mortality between neighbourhoods of European cities and the level of avoidable mortality is associated with social deprivation. There is no systematic difference in the magnitude of this association between European cities or regions. Spatial patterns of avoidable mortality across small city areas can point to possible local problems and specific strategies to reduce health inequality which is important for the development of urban areas and the well-being of their inhabitants.

【 授权许可】

   
2014 Hoffmann et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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