Marc Marí-Dell'Olmo1, Mercè Gotsens1, Laia Palència1, Bo Burström2, Diana Corman2, Giuseppe Costa3, Patrick Deboosere4, Èlia Díez1, Felicitas Domínguez-Berjón5, Dagmar Dzúrová6, Ana Gandarillas5, Rasmus Hoffmann7, Katalin Kovács8, Pekka Martikainen9, Moreno Demaria10, Hynek Pikhart11, Maica Rodríguez-Sanz1, Marc Saez12, Paula Santana13, Cornelia Schwierz14, Lasse Tarkiainen9, Carme Borrell15. 1. CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain Agència de Salut Pública de Barcelona, Barcelona, Spain Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain. 2. Division of Social Medicine, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. 3. Department of Clinical and Biological Science, University of Turin, Turin, Italy. 4. Department of Social Research, Vrije Universiteit Brussel, Brussels, Belgium. 5. Subdirección de Promoción de la Salud y Prevención, Consejería de Sanidad, Comunidad de Madrid, Spain. 6. Department of Social Geography and Regional Development, Faculty of Science, Charles University in Prague, Prague, Czech Republic. 7. Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands. 8. Demographic Research Institute, Budapest, Hungary. 9. Department of Social Research, University of Helsinki, Helsinki, Finland. 10. Department of Epidemiology and Environmental Health, Regional Environmental Protection Agency, Piedmont, Italy. 11. Department of Epidemiology and Public Health, University College London, London, UK. 12. CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain. 13. Centro de Estudos de Geografia e de Ordenamento do Territorio (CEGOT), Departamento de Geografia, Colégio de S. Jerónimo, Universidade de Coimbra, Coimbra, Portugal. 14. Statistik Stadt Zürich, Zürich, Switzerland. 15. Universitat Pompeu Fabra, Barcelona, Spain CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain Agència de Salut Pública de Barcelona, Barcelona, Spain Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain.
Abstract
BACKGROUND: Socioeconomic inequalities are increasingly recognised as an important public health issue, although their role in the leading causes of mortality in urban areas in Europe has not been fully evaluated. In this study, we used data from the INEQ-CITIES study to analyse inequalities in cause-specific mortality in 15 European cities at the beginning of the 21st century. METHODS: A cross-sectional ecological study was carried out to analyse 9 of the leading specific causes of death in small areas from 15 European cities. Using a hierarchical Bayesian spatial model, we estimated smoothed Standardized Mortality Ratios, relative risks and 95% credible intervals for cause-specific mortality in relation to a socioeconomic deprivation index, separately for men and women. RESULTS: We detected spatial socioeconomic inequalities for most causes of mortality studied, although these inequalities differed markedly between cities, being more pronounced in Northern and Central-Eastern Europe. In the majority of cities, most of these causes of death were positively associated with deprivation among men, with the exception of prostatic cancer. Among women, diabetes, ischaemic heart disease, chronic liver diseases and respiratory diseases were also positively associated with deprivation in most cities. Lung cancer mortality was positively associated with deprivation in Northern European cities and in Kosice, but this association was non-existent or even negative in Southern European cities. Finally, breast cancer risk was inversely associated with deprivation in three Southern European cities. CONCLUSIONS: The results confirm the existence of socioeconomic inequalities in many of the main causes of mortality, and reveal variations in their magnitude between different European cities. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
BACKGROUND: Socioeconomic inequalities are increasingly recognised as an important public health issue, although their role in the leading causes of mortality in urban areas in Europe has not been fully evaluated. In this study, we used data from the INEQ-CITIES study to analyse inequalities in cause-specific mortality in 15 European cities at the beginning of the 21st century. METHODS: A cross-sectional ecological study was carried out to analyse 9 of the leading specific causes of death in small areas from 15 European cities. Using a hierarchical Bayesian spatial model, we estimated smoothed Standardized Mortality Ratios, relative risks and 95% credible intervals for cause-specific mortality in relation to a socioeconomic deprivation index, separately for men and women. RESULTS: We detected spatial socioeconomic inequalities for most causes of mortality studied, although these inequalities differed markedly between cities, being more pronounced in Northern and Central-Eastern Europe. In the majority of cities, most of these causes of death were positively associated with deprivation among men, with the exception of prostatic cancer. Among women, diabetes, ischaemic heart disease, chronic liver diseases and respiratory diseases were also positively associated with deprivation in most cities. Lung cancer mortality was positively associated with deprivation in Northern European cities and in Kosice, but this association was non-existent or even negative in Southern European cities. Finally, breast cancer risk was inversely associated with deprivation in three Southern European cities. CONCLUSIONS: The results confirm the existence of socioeconomic inequalities in many of the main causes of mortality, and reveal variations in their magnitude between different European cities. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Entities:
Keywords:
MORTALITY; SOCIAL INEQUALITIES; SPATIAL ANALYSIS
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