Mortality, material deprivation and urbanization: exploring the social patterns of a metropolitan area

International Journal for Equity in Health

Carme Borrell³  Mercè Gotsens²  Marc Marí-Dell’Olmo²  Claudia Costa¹  Paula Santana¹ 

[1] Departamento de Geografia, Centro de Estudos de Geografia e Ordenamento do Território, Universidade de Coimbra, Colégio S. Jerónimo, Largo D. Dinis 3000-043, Coimbra, Portugal;Institut d’Investigació Biomèdica (IIB Sant Pau), Sant Antoni Maria Claret, 167, Barcelona, 08025, Spain;Universitat Pompeu Fabra, Doctor Aiguader, 80, Barcelona, 08003, Spain

关键词: Social/Spatial determinants;    Inequalities;    Bayesian Model;    Small Area;    Urbanization;    Metropolitan Area;    Material Deprivation;    Mortality;   

Others  :  1220147
DOI  :  10.1186/s12939-015-0182-y

 received in 2014-12-03, accepted in 2015-05-04,  发布年份 2015

【 摘 要 】

Introduction

Socioeconomic inequalities affecting health are of major importance in Europe. The literature enhances the role of social determinants of health, such as socioeconomic characteristics and urbanization, to achieve health equity. Yet, there is still much to know, mainly concerning the association between cause-specific mortality and several social determinants, especially in metropolitan areas.

This study aims to describe the geographical pattern of cause-specific mortality in the Lisbon Metropolitan Area (LMA), at small area level (parishes), and analyses the statistical association between mortality risk and health determinants (material deprivation and urbanization level). Fourteen causes have been selected, representing almost 60 % of total mortality between 1995 and 2008, particularly those associated with urbanization and material deprivation.

Methods

A cross-sectional ecological study was carried out. Using a hierarchical Bayesian spatial model, we estimated sex–specific smoothed Standardized Mortality Ratios (sSMR) and measured the relative risks (RR), and 95 % credible intervals, for cause-specific mortality relative to 1. urbanization level, 2. material deprivation and 3. material deprivation adjusted by urbanization.

Results

The statistical association between mortality and material deprivation and between mortality and urbanization changes by cause of death and sex. Dementia and MN larynx, trachea, bronchus and lung are the causes of death showing higher relative risk associated with urbanization. Infectious and parasitic diseases, Chronic liver disease and Diabetes are the causes of death presenting higher relative risk associated with material deprivation. Ischemic heart disease was the only cause with a statistical association with both determinants, and MN female breast was the only without any statistical association. Urbanization level reduces the impact of material deprivation for most of the causes of death. Men face a higher impact of material deprivation and urbanization level, than women, in most cause-specific mortality, even when considering the adjusted model.

Conclusions

Our findings explore the specific pattern of fourteen causes of death in LMA and reveals small areas with an excess risk of mortality associated with material deprivation, thereby identifying problematic areas that could potentially benefit from public policies effecting social inequalities.

【 授权许可】

   
2015 Santana et al.

【 图 表 】

Fig 1.

Fig. 2.

Fig. 3.

【 参考文献 】

• [1]Mackenbach JP, Stirbu I, Roskam A-JJR, Schaap MM, Menvielle G, Leinsalu M et al.. Socioeconomic inequalities in health in 22 European countries. N Engl J Med. 2008; 358:2468-81.
• [2]Diez E, Morrison J, Pons-Vigués M, Borrell C, Corman D, Burström B et al.. Municipal interventions against inequalities in health: The view of their managers. Scand J Public Health. 2014; 42(6):476-87.
• [3]Hoffmann R, Borsboom G, Saez M, Marí-Dell’Olmo M, Burström B, Corman D et al.. Social differences in avoidable mortality between small areas of 15 European cities: an ecological study. Int J Health Geogr. 2014; 13:8. BioMed Central Full Text
• [4]Carstairs V, Morris R. Deprivation and health in Scotland. Health Bull (Raleigh). 1990; 48:162-75.
• [5]Townsend P. Deprivation. J Soc Policy. 1987; 16:125-46.
• [6]Shaw M, Gordon D, Dorling D, Davey-Smith G. The Widening Gap: Health Inequalities and Policy in Britain. 1999.
• [7]Corburn J, Cohen AK. Why we need urban health equity indicators: Integrating science, policy, and community. PLoS Med. 2012; 9: Article ID e1001285
• [8]Borrell C, Marí-Dell’Olmo M, Palència L, Gotsens M, Burström B, Domínguez-Berjón F et al.. Socioeconomic inequalities in mortality in 16 European cities. Scand J Public Health. 2014; 42(3):245-54.
• [9]Diez Roux AV. Investigating neighborhood and area effects on health. Am J Public Health. 2001; 91:1783-9.
• [10]Marmot M, Friel S, Bell R, Houweling TTAJ, Taylor S, Hlt CSD. Closing the gap in a generation: health equity through action on the social determinants of health. Lancet. 2008; 372:1661-9.
• [11]Auchincloss AH, Gebreab SY, Mair C, Diez Roux AV. A review of spatial methods in epidemiology, 2000–2010. Annu Rev Public Health. 2012; 33:107-22.
• [12]Santana P, Costa C, Loureiro A, Raposo J, Boavida JM. Geografias da diabetes em Portugal. como as condições do contexto influenciam o risco de morrer. Acta Med Port. 2014; 27:309-17.
• [13]Vlahov D, Freudenberg N, Proietti F, Ompad D, Quinn A, Nandi V et al.. Urban as a determinant of health. J Urban Heal. 2007; 84(3 Suppl):i16-26.
• [14]Gotsens M, Marí-Dell’Olmo M, Pérez K, Palência L, Martinez-Beneito M-A, Rodríguez-Sanz M et al.. Socioeconomic inequalities in injury mortality in small areas of 15 European cities. Health Place. 2013; 24:165-72.
• [15]Richardson S, Thomson A, Best N, Elliott P. Interpreting posterior relative risk estimates in disease-mapping studies. Environ Health Perspect. 2004; 112:1016-25.
• [16]Benach J, Yasui Y, Borrell C, Sáez M, Pasarin MI. Material deprivation and leading causes of death by gender: evidence from a nationwide small area study. J Epidemiol Community Health. 2001; 55:239-45.
• [17]Fukuda Y, Nakamura K, Takano T. Municipal socioeconomic status and mortality in Japan: sex and age differences, and trends in 1973–1998. Soc Sci Med. 2004; 59:2435-45.
• [18]Removing obstacles to healthy development : report on infectious diseases. WHO, Geneva; 1999.
• [19]Saurina C, Saez M, Marcos-Gragera R, Barceló MA, Renart G, Martos C. Effects of deprivation on the geographical variability of larynx cancer incidence in men, Girona (Spain) 1994–2004. Cancer Epidemiol. 2010; 34:109-15.
• [20]Scazufca M, Menezes PR, Araya R, Di Rienzo VD, Almeida OP, Gunnell D et al.. Risk factors across the life course and dementia in a Brazilian population: results from the Sao Paulo Ageing & Health Study (SPAH). Int J Epidemiol. 2008; 37:879-90.
• [21]Stark C, Hopkins P, Gibbs D, Belbin A, Hay A. Population density and suicide in Scotland. Rural Remote Health. 2007; 7:672.
• [22]Gotsens M, Mari-Dell’Olmo M, Martinez-Beneito MA, Perez K, Pasarin MI, Daponte A et al.. Socio-economic inequalities in mortality due to injuries in small areas of ten cities in Spain (MEDEA Project). Accid Anal Prev. 2011; 43:1802-10.
• [23]Testi A, Ivaldi E. Material versus social deprivation and health: a case study of an urban area. Eur J Health Econ. 2009; 10:323-8.
• [24]Rey G, Jougla E, Fouillet A, Hémon D. Ecological association between a deprivation index and mortality in France over the period 1997–2001: variations with spatial scale, degree of urbanicity, age, gender and cause of death. BMC Public Health. 2009; 9:33. BioMed Central Full Text
• [25]Leon DA. Cities, urbanization and health. Int J Epidemiol. 2008; 37:4-8.
• [26]Dolk H, Mertens B, Kleinschmidt I, Walls P, Shaddick G, Elliott P. A standardisation approach to the control of socioeconomic confounding in small area studies of environment and health. J Epidemiol Community Health. 1995; 49 Suppl 2:S9-14.
• [27]Erskine S, Maheswaran R, Pearson T, Gleeson D. Socioeconomic deprivation, urban–rural location and alcohol-related mortality in England and Wales. BMC Public Health. 2010; 10:99. BioMed Central Full Text
• [28]Diez Roux AV, Green Franklin T, Alazraqui M, Spinelli H. Intraurban variations in adult mortality in a large Latin American city. J Urban Health. 2007; 84:319-33.
• [29]Yusuf S, Reddy S, Ounpuu S, Anand S. Global burden of cardiovascular diseases: Part I: General considerations, the epidemiologic transition, risk factors, and impact of urbanization. Circulation. 2001; 104:2746-53.
• [30]Hay SI, Guerra CA, Tatem AJ, Atkinson PM, Snow RW. Urbanization, malaria transmission and disease burden in Africa. Nat Rev Microbiol. 2005; 3:81-90.
• [31]Greenberg MR. Urbanization and cancer: changing mortality patterns? Int Reg Sci Rev. 1983; 8:127-45.
• [32]Bidoli E, Franceschi S, Dal Maso L, Guarneri S, Barbone F. Cancer mortality by urbanization and altitude in a limited area in Northeastern Italy. Rev Epidemiol Sante Publique. 1993; 41:374-82.
• [33]Pesonen TM, Hintikka J, Karkola KO, Saarinen PI, Antikainen M, Lehtonen J. Male suicide mortality in eastern Finland–urban–rural changes during a 10-year period between 1988 and 1997. Scand J Public Health. 2001; 29:189-93.
• [34]Arslantaş D, Ozbabalik D, Metintaş S, Ozkan S, Kalyoncu C, Ozdemir G et al.. Prevalence of dementia and associated risk factors in Middle Anatolia, Turkey. J Clin Neurosci. 2009; 16:1455-9.
• [35]Marí-Dell’Olmo M, Gotsens M, Palència L, Burström B, Corman D, Costa G et al.. Socioeconomic inequalities in cause-specific mortality in fifteen European Cities. J Epidemiol Community Health. 2015; 69((5):432-41.
• [36]Singh GK, Azuine RE, Siahpush M, Kogan MD. All-cause and cause-specific mortality among US youth: socioeconomic and rural–urban disparities and international patterns. J Urban Health. 2013; 90:388-405.
• [37]Nogueira H, Santana P. Geographies of Health and Deprivation: Relationship between them. In: Geogr dell’Alimentazione. Palagiano C, Santis G, editors. Edizioni Rux, Perugia; 2005: p.539-46.
• [38]Santana P. Poverty, social exclusion and health in Portugal. Soc Sci Med. 2002; 55:33-45.
• [39]Borrell C, Pasarín MI. Inequalities in health and urban areas. Gac Sanit. 2004; 18:1-4.
• [40]Santana P, Santos R, Nogueira H. The link between local environment and obesity: A multilevel analysis in the Lisbon Metropolitan Area, Portugal. Soc Sci Med. 2009; 68:601-9.
• [41]Chang S-S, Sterne JAC, Wheeler BW, Lu T-H, Lin J-J, Gunnell D. Geography of suicide in Taiwan: spatial patterning and socioeconomic correlates. Health Place. 2011; 17:641-50.
• [42]Tobler WR. A computer movie simulating urban growth in the detroit region. Econ Geogr. 1970; 46:234.
• [43]Besag J, York J, Mollié A. Bayesian image restoration, with two applications in spatial statistics. Ann Inst Stat Math. 1991; 43:1-20.
• [44]Graham P. Intelligent smoothing using hierarchical Bayesian models. Epidemiology. 2008; 19:493-5.
• [45]Gelman A. Prior distributions for variance parameters in hierarchical models. 2006.
• [46]Rue H, Martino S, Chopin N. Approximate Bayesian inference for latent Gaussian models by using integrated nested Laplace approximations. J R Stat Soc Ser B Stat Methodol. 2009; 71:319-92.
• [47]Fonseca ML, McGarrigle J, Esteves A, Malheiros J. Lisbon - City Report. Lisbon. 2008.
• [48]Santana P, Costa C, Cardoso G,Loureiro A, Ferrão J. Suicide in Portugal: spatial determinants in a context of economic crisis. Health & Place; 2015 (accepted).
• [49]Gusmão R, Quintão S. Suicide and death resulting from events of undetermined intent register in Portugal. Revisiting “The truth about suicide”, 20 years later. Dir Gen Heal J. 2013; 1:80-95.
• [50]McLoone P, Boddy FA. Deprivation and mortality in Scotland, 1981 and 1991. BMJ. 1994; 309:1465-70.
• [51]Ecob R, Jones K. Mortality variations in England and Wales between types of place: an analysis of the ONS longitudinal study. Office of National Statistics Soc Sci Med. 1998; 47:2055-66.
• [52]Couceiro L, Santana P, Nunes C. Pulmonary tuberculosis and risk factors in Portugal: a spatial analysis. Int J Tuberc Lung Dis. 2011; 15:1445-54.
• [53]Williamson LM, Rosato M, Teyhan A, Santana P, Harding S. AIDS mortality in African migrants living in Portugal: evidence of large social inequalities. Sex Transm Infect. 2009; 85:427-31.
• [54]Marmot M, Allen J, Bell R, Bloomer E, Goldblatt P. WHO European review of social determinants of health and the health divide. Lancet. 2012; 380:1011-29.
• [55]Frieden TR. A framework for public health action: the health impact pyramid. Am J Public Health. 2010; 100:590-5.
• [56]Diez Roux AV. Conceptual approaches to the study of health disparities. Annu Rev Public Health. 2012; 33:41-58.
• [57]José Manuel B, Pereira M, Ayala M. A mortalidade por diabetes em Portugal. Acta Med Port. 2013; 26(4):315-7.
• [58]Jokela M. Are neighborhood health associations causal? A 10-year prospective cohort study with repeated measurements. Am J Epidemiol. 2014; 180:776-84.
• [59]Borrell C, Pons-Vigués M, Morrison J, Díez E. Factors and processes influencing health inequalities in urban areas. J Epidemiol Community Health. 2013; 67:389-91.
• [60]Pons-Vigués M, Diez È, Morrison J, Salas-Nicás S, Hoffmann R, Burstrom B et al.. Social and health policies or interventions to tackle health inequalities in European cities: a scoping review. BMC Public Health. 2014; 14:198. BioMed Central Full Text
• [61]Rydin Y, Bleahu A, Davies M, Dávila JD, Friel S, De Grandis G et al.. Shaping cities for health: Complexity and the planning of urban environments in the 21st century. Lancet. 2012; 379:2079-108.
• [62]Galea S, Freudenberg N, Vlahov D. Cities and population health. Soc Sci Med. 2005; 60:1017-33.