Socioeconomic inequalities in mortality in 16 European cities

Aims: To explore inequalities in total mortality between small areas of 16 European cities for men and women, as well as to analyse the relationship between these geographical inequalities and their socioeconomic indicators. Methods: A cross-sectional ecological design was used to analyse small areas in 16 European cities (26,229,104 inhabitants). Most cities had mortality data for a period between 2000 and 2008 and population size data for the same period. Socioeconomic indicators included an index of socioeconomic deprivation, unemployment, and educational level. We estimated standardised mortality ratios and controlled for their variability using Bayesian models. We estimated relative risk of mortality and excess number of deaths according to socioeconomic indicators. Results: We observed a consistent pattern of inequality in mortality in almost all cities, with mortality increasing in parallel with socioeconomic deprivation. Socioeconomic inequalities in mortality were more pronounced for men than women, and relative inequalities were greater in Eastern and Northern European cities, and lower in some Western (men) and Southern (women) European cities. The pattern of excess number of deaths was slightly different, with greater inequality in some Western and Northern European cities and also in Budapest, and lower among women in Madrid and Barcelona. Conclusions: In this study, we report a consistent pattern of socioeconomic inequalities in mortality in 16 European cities. Future studies should further explore specific causes of death, in order to determine whether the general pattern observed is consistent for each cause of death.

[1]  S. Galea,et al.  Urban as a Determinant of Health , 2007, Journal of Urban Health.

[2]  Oscar Zurriaga,et al.  Preventable avoidable mortality: evolution of socioeconomic inequalities in urban areas in Spain, 1996-2003. , 2009, Health & place.

[3]  M. Marmot,et al.  WHO European review of social determinants of health and the health divide , 2012, The Lancet.

[4]  J. K. Montez,et al.  Why is the educational gradient of mortality steeper for men? , 2009, The journals of gerontology. Series B, Psychological sciences and social sciences.

[5]  Paolo Vineis,et al.  The role of smoking and diet in explaining educational inequalities in lung cancer incidence. , 2009, Journal of the National Cancer Institute.

[6]  J. Stockman.  Socioeconomic Inequalities in Health in 22 European Countries , 2010 .

[7]  Oliver Duke-Williams,et al.  Small area inequalities in health: are we underestimating them? , 2008, Social science & medicine.

[8]  M. Pons-Vigués,et al.  Factors and processes influencing health inequalities in urban areas , 2013, Journal of Epidemiology & Community Health.

[9]  A. D. Diez Roux,et al.  Neighborhoods and health , 2010, Annals of the New York Academy of Sciences.

[10]  M. Marmot,et al.  Neighbourhoods and self rated health: a comparison of public sector employees in London and Helsinki , 2004, Journal of Epidemiology and Community Health.

[11]  A. Leyland,et al.  Comparing the effects of neighbourhood characteristics on all-cause mortality using two hierarchical areal units in the capital region of Helsinki. , 2010, Health & place.

[12]  C. Bambra,et al.  Health inequalities and welfare state regimes: theoretical insights on a public health ‘puzzle’ , 2011, Journal of Epidemiology & Community Health.

[13]  A. Dolan.  'You can't ask for a Dubonnet and lemonade!': working class masculinity and men's health practices. , 2011, Sociology of health & illness.

[14]  J. Mackenbach,et al.  Socioeconomic inequalities in mortality among women and among men: an international study. , 1999, American journal of public health.

[15]  J. Mackenbach,et al.  Socioeconomic inequalities in health in 22 European countries. , 2008, The New England journal of medicine.

[16]  E. Grundy,et al.  Socioeconomic inequalities in mortality rates in old age in the World Health Organization Europe region. , 2013, Epidemiologic reviews.

[17]  F. Berrino,et al.  The contribution of risk factors to the higher incidence of invasive and in situ breast cancers in women with higher levels of education in the European prospective investigation into cancer and nutrition. , 2011, American journal of epidemiology.

[18]  Anne Ellaway,et al.  Neighborhoods and health: overview , 2003 .

[19]  J. Besag,et al.  Bayesian image restoration, with two applications in spatial statistics , 1991 .

[20]  C. Dibben,et al.  Are health inequalities really not the smallest in the Nordic welfare states? A comparison of mortality inequality in 37 countries , 2013, Journal of Epidemiology & Community Health.

[21]  Sharon Friel,et al.  Closing the gap in a generation: health equity through action on the social determinants of health , 2008, The Lancet.

[22]  B. Wojtyniak,et al.  Educational inequalities in mortality in four Eastern European countries: divergence in trends during the post-communist transition from 1990 to 2000. , 2009, International journal of epidemiology.

[23]  S. Cummins,et al.  Place effects on health: how can we conceptualise, operationalise and measure them? , 2002, Social science & medicine.

[24]  A. D. Diez Roux,et al.  Intraurban Variations in Adult Mortality in a Large Latin American City , 2007, Journal of Urban Health.

[25]  C. Saurina,et al.  Does the effect of gender modify the relationship between deprivation and mortality? , 2012, BMC Public Health.

[26]  J. Mackenbach,et al.  The reversed social gradient: higher breast cancer mortality in the higher educated compared to lower educated. A comparison of 11 European populations during the 1990s. , 2007, European journal of cancer.

[27]  C. Borrell,et al.  Inequalities in mortality in small areas of eleven Spanish cities (the multicenter MEDEA project). , 2010, Health & place.