Social differences in avoidable mortality between small areas of 15 European cities: an ecological study
Por:
Hoffmann, R, Borsboom, G, Saez, M, Dell'Olmo, MM, Burstrom, B, Corman, D, Costa, C, Deboosere, P, Dominguez-Berjon, MF, Dzurova, D, Gandarillas, A, Gotsens, M, Kovacs, K, Mackenbach, J, Martikainen, P, Maynou, L, Morrison, J, Palencia, L, Perez, G, Pikhart, H, Rodriguez-Sanz, M, Santana, P, Saurina, C, Tarkiainen, L, Borrell, C
Publicada:
12 mar 2014
Resumen:
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 Mollie. 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.
Filiaciones:
Hoffmann, R:
Erasmus MC, Dept Publ Hlth, NL-3000 CA Rotterdam, Netherlands
Borsboom, G:
Erasmus MC, Dept Publ Hlth, NL-3000 CA Rotterdam, Netherlands
Saez, M:
Univ Girona, Res Grp Stat Econometr & Hlth GRECS, Girona 17071, Spain
CIBERESP, Madrid, Spain
Dell'Olmo, MM:
CIBERESP, Madrid, Spain
Burstrom, B:
Karolinska Inst, Dept Publ Hlth Sci, Div Social Med, S-17177 Stockholm, Sweden
Corman, D:
Karolinska Inst, Dept Publ Hlth Sci, Div Social Med, S-17177 Stockholm, Sweden
Costa, C:
Univ Coimbra, Colegio S Jeronimo, Dept Geog, CEGOT, P-3000043 Coimbra, Portugal
Deboosere, P:
Vrije Univ Brussel, Dept Social Res, B-1050 Brussels, Belgium
Dominguez-Berjon, MF:
Consejeria Sanidad, Subdirecc Promoc Salud & Prevenc, Madrid 28037, Spain
Dzurova, D:
Charles Univ Prague, Fac Sci, Dept Social Geog & Reg Dev, Prague 12843 2, Czech Republic
Gandarillas, A:
Consejeria Sanidad, Subdirecc Promoc Salud & Prevenc, Madrid 28037, Spain
Kovacs, K:
HCSO, Demog Res Inst, H-1024 Budapest, Hungary
Mackenbach, J:
Erasmus MC, Dept Publ Hlth, NL-3000 CA Rotterdam, Netherlands
Martikainen, P:
Univ Helsinki, Dept Social Res, FIN-00014 Helsinki, Finland
Maynou, L:
Univ Girona, Res Grp Stat Econometr & Hlth GRECS, Girona 17071, Spain
CIBERESP, Madrid, Spain
London Sch Hyg & Trop Med, London WC1, England
Morrison, J:
UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England
Palencia, L:
CIBERESP, Madrid, Spain
Perez, G:
UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England
Pikhart, H:
UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England
Rodriguez-Sanz, M:
Agencia Salut Publ Barcelona, Barcelona 08023, Spain
Santana, P:
Univ Coimbra, Colegio S Jeronimo, Dept Geog, CEGOT, P-3000043 Coimbra, Portugal
Saurina, C:
Univ Girona, Res Grp Stat Econometr & Hlth GRECS, Girona 17071, Spain
CIBERESP, Madrid, Spain
Tarkiainen, L:
Univ Helsinki, Dept Social Res, FIN-00014 Helsinki, Finland
Borrell, C:
Agencia Salut Publ Barcelona, Barcelona 08023, Spain
Gold, Green Published
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