Carme Borrell1,2,3,4, Laia Palència2,3,5, Marc Marí Dell'Olmo2,3,6, Joana Morrisson7, Patrick Deboosere8, Mercè Gotsens3,9, Dagmar Dzurova10, Claudia Costa11, Michala Lustigova10, Bo Burstrom12, Maica Rodríguez-Sanz2,3,4,13, Lucia Bosakova14,15, Nicolas Zengarini16, Klea Katsouyanni17,18, Paula Santana11. 1. Agència de Salut Pública de Barcelona, Barcelona, Spain. 2. CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain. 3. Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain. 4. Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain. 5. Service of Health Information Systems, Agència de Salut Pública de Barcelona, Barcelona, Spain. 6. Service of Environmental Quality and Intervention, Agència de Salut Pública de Barcelona, Barcelona, Spain. 7. Institute of Health Equity at the Research Department of Epidemiology and Public Health, University College London, London, UK. 8. Department of Sociology, Interface Demography, Vrije Universiteit Brussel, Brussels, Belgium. 9. Service of Prevention and Attention of Drug Use, Agència de Salut Pública de Barcelona, Barcelona, Spain. 10. Department of Social Geography and Regional Development, Faculty of Science, Charles University, Prague, Czechia. 11. Department of Geography and Tourism, Centre of Studies in Geography and Spatial Planning (CEGOT), University of Coimbra, Coimbra, Portugal. 12. Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. 13. Unit of Research, Training and Communication, Agència de Salut Pública de Barcelona, Barcelona, Spain. 14. Department of Health Psychology, Medical Faculty, P. J. Safarik University in Kosice, Kosice, Slovak Republic. 15. Olomouc University Social Health Institute (OUSHI), Palacky University in Olomouc, Olomouc, Czech Republic. 16. Department of Public Health, University of Turin, Turin, Italy. 17. Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian, University of Athens Medical School, Athens, Greece. 18. Department of Population Health Sciences, and Department of Analytical, Environmental & Forensic Sciences, School of Population Health & Environmental Sciences, King's College, London, UK.
Abstract
BACKGROUND: Few studies have assessed the impact of the financial crisis on inequalities in suicide mortality in European urban areas. The objective of the study was to analyse the trend in area socioeconomic inequalities in suicide mortality in nine European urban areas before and after the beginning of the financial crisis. METHODS: This ecological study of trends was based on three periods, two before the economic crisis (2000-2003, 2004-2008) and one during the crisis (2009-2014). The units of analysis were the small areas of nine European cities or metropolitan areas, with a median population ranging from 271 (Turin) to 193 630 (Berlin). For each small area and sex, we analysed smoothed standardized mortality ratios of suicide mortality and their relationship with a socioeconomic deprivation index using a hierarchical Bayesian model. RESULTS: Among men, the relative risk (RR) comparing suicide mortality of the 95th percentile value of socioeconomic deprivation (severe deprivation) to its 5th percentile value (low deprivation) were higher than 1 in Stockholm and Lisbon in the three periods. In Barcelona, the RR was 2.06 (95% credible interval: 1.24-3.21) in the first period, decreasing in the other periods. No significant changes were observed across the periods. Among women, a positive significant association was identified only in Stockholm (RR around 2 in the three periods). There were no significant changes across the periods except in London with a RR of 0.49 (95% CI: 0.35-0.68) in the third period. CONCLUSIONS: Area socioeconomic inequalities in suicide mortality did not change significantly after the onset of the crisis in the areas studied.
BACKGROUND: Few studies have assessed the impact of the financial crisis on inequalities in suicide mortality in European urban areas. The objective of the study was to analyse the trend in area socioeconomic inequalities in suicide mortality in nine European urban areas before and after the beginning of the financial crisis. METHODS: This ecological study of trends was based on three periods, two before the economic crisis (2000-2003, 2004-2008) and one during the crisis (2009-2014). The units of analysis were the small areas of nine European cities or metropolitan areas, with a median population ranging from 271 (Turin) to 193 630 (Berlin). For each small area and sex, we analysed smoothed standardized mortality ratios of suicide mortality and their relationship with a socioeconomic deprivation index using a hierarchical Bayesian model. RESULTS: Among men, the relative risk (RR) comparing suicide mortality of the 95th percentile value of socioeconomic deprivation (severe deprivation) to its 5th percentile value (low deprivation) were higher than 1 in Stockholm and Lisbon in the three periods. In Barcelona, the RR was 2.06 (95% credible interval: 1.24-3.21) in the first period, decreasing in the other periods. No significant changes were observed across the periods. Among women, a positive significant association was identified only in Stockholm (RR around 2 in the three periods). There were no significant changes across the periods except in London with a RR of 0.49 (95% CI: 0.35-0.68) in the third period. CONCLUSIONS: Area socioeconomic inequalities in suicide mortality did not change significantly after the onset of the crisis in the areas studied.
Authors: Mercè Gotsens; Josep Ferrando; Marc Marí-Dell'Olmo; Laia Palència; Xavier Bartoll; Ana Gandarillas; Pablo Sanchez-Villegas; Santi Esnaola; Antonio Daponte; Carme Borrell Journal: Int J Environ Res Public Health Date: 2020-02-04 Impact factor: 3.390