Spatial variability in mortality inequalities, socioeconomic deprivation, and air pollution in small areas of the Barcelona Metropolitan Region, Spain.

BACKGROUND There is evidence that geographic variability of social health inequalities continues to exist even after individual risk factors have been taken into account. However, relatively few studies have examined the contribution of exposure to air pollutants to those inequalities. OBJECTIVES To study the geographic variability of inequalities in mortality and their associations with socioeconomic and environmental inequalities in small areas of the metropolitan of Barcelona during the period 1994 to 2003. METHODS As in the MEDEA Project, the small area unit was the census tract. Study population consisted of the residents of the metropolitan area of Barcelona. Response variables were all-cause and specific-cause standardized mortality ratio (SMR). Explanatory variables were deprivation index, summarizing socioeconomic variables of the census tracts, and estimates of air pollutant exposures. Bayesian hierarchical models were used in order to reduce the extra variability when using SMR and to assess associations between mortality and deprivation and air pollution. RESULTS Statistically significant associations with deprivation were found for the causes of death related to consumption of tobacco and alcohol for men and, besides lung cancer, diet-related causes for women. Statistically significant pollution coefficients were only found in the metropolitan area of Barcelona and in men. A positive interaction between pollutants and the deprivation index was statistically significant for respiratory mortality and PM(10), and ischemic disease mortality and NO(2), both for men. CONCLUSIONS We found deprivation to be associated in a statistically significant way with the geographical variation in mortality in the census tracts of the metropolitan area of Barcelona, in the period 1994 to 2003. Those air pollutants more directly related with traffic modify some of these associations.

[1]  F. Lipfert,et al.  Urban air pollution, health, and equity , 2003, Journal of epidemiology and community health.

[2]  J. Mackenbach,et al.  Widening socioeconomic inequalities in mortality in six Western European countries. , 2003, International journal of epidemiology.

[3]  D. Rubin,et al.  Statistical Analysis with Missing Data. , 1989 .

[4]  J. Schwartz,et al.  Individual-level modifiers of the effects of particulate matter on daily mortality. , 2006, American journal of epidemiology.

[5]  C. Borrell,et al.  Material deprivation and leading causes of death by gender: evidence from a nationwide small area study , 2001, Journal of epidemiology and community health.

[6]  H. Williams,et al.  Spatial and Temporal Variation of Mortality and Deprivation 1: Widening Health Inequalities , 1998, Environment & planning A.

[7]  Simon Kingham,et al.  Mapping Urban Air Pollution Using GIS: A Regression-Based Approach , 1997, Int. J. Geogr. Inf. Sci..

[8]  D. Gray,et al.  Coronary heart disease inequalities: deaths and the socio-economic environment in Nottingham, England. , 2001, Health & place.

[9]  Alastair H Leyland,et al.  Cause-specific inequalities in mortality in Scotland: two decades of change. A population-based study , 2007, BMC public health.

[10]  Sylvia Richardson,et al.  Bayesian mapping of disease , 1995 .

[11]  A. Braga,et al.  Influence of socioeconomic conditions on air pollution adverse health effects in elderly people: an analysis of six regions in São Paulo, Brazil , 2003, Journal of epidemiology and community health.

[12]  David B. Dunson,et al.  Bayesian Data Analysis , 2010 .

[13]  M Susser,et al.  The logic in ecological: I. The logic of analysis. , 1994, American journal of public health.

[14]  Michael Jerrett,et al.  Environmental inequality and circulatory disease mortality gradients , 2005, Journal of Epidemiology and Community Health.

[15]  M. Daniel,et al.  Socio-economic Correlates of Municipal-level Pollution Emissions on Montreal Island , 2007, Canadian journal of public health = Revue canadienne de sante publique.

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

[17]  Bradley P. Carlin,et al.  Markov Chain Monte Carlo in Practice: A Roundtable Discussion , 1998 .

[18]  M. Stafoggia,et al.  Socioeconomic status, particulate air pollution, and daily mortality: differential exposure or differential susceptibility. , 2006, American journal of industrial medicine.

[19]  Daniel Krewski,et al.  Rejoinder: Reanalysis of the Harvard Six Cities Study and American Cancer Society Study of Particulate Air Pollution and Mortality , 2003 .

[20]  L. Filleul,et al.  Effect of socioeconomic status on the relationship between atmospheric pollution and mortality , 2007, Journal of Epidemiology and Community Health.

[21]  N Krieger,et al.  Epidemiology and the web of causation: has anyone seen the spider? , 1994, Social science & medicine.

[22]  Sylvia Richardson,et al.  A comparison of Bayesian spatial models for disease mapping , 2005, Statistical methods in medical research.

[23]  Sylvia Richardson,et al.  Markov Chain Monte Carlo in Practice , 1997 .

[24]  Montse Calvo,et al.  Desigualdades socioeconómicas en la mortalidad en la Comunidad Autónoma del País Vasco , 2006 .

[25]  P. Elliott,et al.  Spatial Epidemiology: Current Approaches and Future Challenges , 2004, Environmental health perspectives.

[26]  C. Muntaner,et al.  Trends in socioeconomic mortality inequalities in a southern European urban setting at the turn of the 21st century , 2008, Journal of Epidemiology & Community Health.

[27]  D. Dockery,et al.  An association between air pollution and mortality in six U.S. cities. , 1993, The New England journal of medicine.

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

[29]  C Montomoli,et al.  Spatial correlation in ecological analysis. , 1993, International journal of epidemiology.

[30]  S. Fienberg.  When did Bayesian inference become "Bayesian"? , 2006 .

[31]  Giuseppe Costa,et al.  Educational inequalities in cause-specific mortality in middle-aged and older men and women in eight western European populations , 2005, The Lancet.

[32]  M. Marmot.  Achieving health equity: from root causes to fair outcomes , 2007, The Lancet.

[33]  Andrew B. Lawson,et al.  Statistical Methods in Spatial Epidemiology , 2001 .

[34]  J. Rusanen,et al.  Small-area variation in mortality in the city of Oulu, Finland, during the period 1978--1995. , 2001, Health & place.

[35]  S. Richardson,et al.  Interpreting Posterior Relative Risk Estimates in Disease-Mapping Studies , 2004, Environmental health perspectives.

[36]  J. Besag.  Spatial Interaction and the Statistical Analysis of Lattice Systems , 1974 .

[37]  K. de Hoogh,et al.  Census data issues for epidemiology and health risk assessment: experiences from the Small Area Health Statistics Unit , 2007 .

[38]  M. Janghorbani,et al.  Neighbourhood deprivation and excess coronary heart disease mortality and hospital admissions in Plymouth, UK: an ecological study , 2006, Acta cardiologica.

[39]  J. Schwartz,et al.  Health, wealth, and air pollution: advancing theory and methods. , 2003, Environmental health perspectives.

[40]  J. Samet,et al.  Urban air pollution, health, and equity , 2003, Journal of epidemiology and community health.

[41]  A. D. Diez Roux,et al.  Neighborhoods and health: where are we and were do we go from here? , 2007, Revue d'epidemiologie et de sante publique.

[42]  C. Muntaner,et al.  Socioeconomic inequalities in mortality in Barcelona: a study based on census tracts (MEDEA Project). , 2009, Health & place.

[43]  M. F. Domínguez-Berjón,et al.  Construcción de un índice de privación a partir de datos censales en grandes ciudades españolas (Proyecto MEDEA) , 2008 .

[44]  C. García-Gil,et al.  Health inequalities in Seville, Spain: use of indicators of social deprivation and mortality in small areas. , 2004, Public health.

[45]  F J van Lenthe,et al.  Neighbourhood unemployment and all cause mortality: a comparison of six countries , 2005, Journal of Epidemiology and Community Health.

[46]  Peter J. Diggle,et al.  Modelling spatio‐temporal variation in exposure to particulate matter: a two‐stage approach , 2008 .

[47]  M. Rué,et al.  Trends in social class inequalities in health status, health-related behaviors, and health services utilization in a Southern European urban area (1983-1994). , 2000, Preventive medicine.

[48]  J. Schwartz,et al.  Residential Exposure to Traffic-Related Air Pollution and Survival after Heart Failure , 2008, Environmental health perspectives.

[49]  J. Mackenbach,et al.  Neighbourhood and individual socioeconomic inequalities in smoking: the role of physical neighbourhood stressors , 2006, Journal of Epidemiology and Community Health.

[50]  Andrew B. Lawson,et al.  Disease Mapping with WinBUGS and MLwiN , 2003 .

[51]  Modelling of nitrogen dioxide (NO2) and fine particulate matter (PM10) air pollution in the metropolitan areas of Barcelona and Bilbao, Spain , 2009 .

[52]  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.

[53]  Nelson Gouveia,et al.  Time series analysis of air pollution and mortality: effects by cause, age and socioeconomic status , 2000, Journal of epidemiology and community health.

[54]  R. Burnett,et al.  Do socioeconomic characteristics modify the short term association between air pollution and mortality? Evidence from a zonal time series in Hamilton, Canada , 2003, Journal of epidemiology and community health.

[55]  A. Gelman.  Prior distributions for variance parameters in hierarchical models (comment on article by Browne and Draper) , 2004 .

[56]  J. Benach,et al.  Area deprivation and mortality in the provincial capital cities of Andalusia and Catalonia (Spain) , 2008, Journal of Epidemiology & Community Health.

[57]  Adrian F. M. Smith,et al.  Sampling-Based Approaches to Calculating Marginal Densities , 1990 .

[58]  Andrew Gelman,et al.  General methods for monitoring convergence of iterative simulations , 1998 .

[59]  M. F. Domínguez-Berjón,et al.  Mortalidad y privación socioeconómica en las secciones censales y los distritos de Barcelona , 2005 .

[60]  J. Mackenbach,et al.  Trends in smoking behaviour between 1985 and 2000 in nine European countries by education , 2005, Journal of Epidemiology and Community Health.

[61]  M Susser,et al.  Choosing a future for epidemiology: II. From black box to Chinese boxes and eco-epidemiology. , 1996, American journal of public health.

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

[63]  Andrew Thomas,et al.  WinBUGS - A Bayesian modelling framework: Concepts, structure, and extensibility , 2000, Stat. Comput..

[64]  B. Brunekreef.  The effect of air pollution on infant mortality appears specific for respiratory causes in the postneonatal period. , 1999 .

[65]  H. Graham,et al.  Evidence for public health policy on inequalities: 2: Assembling the evidence jigsaw , 2004, Journal of Epidemiology and Community Health.

[66]  C. Borrell,et al.  Métodos para la suavización de indicadores de mortalidad: aplicación al análisis de desigualdades en mortalidad en ciudades del Estado español (Proyecto MEDEA) , 2008 .

[67]  Joel Schwartz,et al.  A Case–Control Analysis of Exposure to Traffic and Acute Myocardial Infarction , 2006, Environmental health perspectives.

[68]  G. Thurston,et al.  The burden of air pollution: impacts among racial minorities. , 2001, Environmental health perspectives.

[69]  A V Diez Roux.  Colloque : Épidémiologie sociale et inégalités de santéNeighborhoods and health: where are we and were do we go from here?Environnement résidentiel et santé : état de la question et perspectives pour le futur , 2007 .

[70]  J. L. Gutiérrez-Fisac,et al.  Trends in cigarette smoking in Spain by social class. , 2001, Preventive medicine.

[71]  J. Schwartz,et al.  Race, gender, and social status as modifiers of the effects of PM10 on mortality. , 2000, Journal of occupational and environmental medicine.

[72]  Johan P Mackenbach,et al.  Tackling socioeconomic inequalities in health: analysis of European experiences , 2003, The Lancet.