J P Mackenbach1, C W Looman. 1. Department of Public Health, Erasmus University, Rotterdam, The Netherlands.
Abstract
OBJECTIVE: The association between living standards and mortality in the European Community (EC) was investigated using regional level data from all EC member countries. DATA AND METHODS: Data covering the 1980s were extracted from various publications. Data on "all cause" mortality (standardised mortality ratios, both sexes, all ages), living standards (gross domestic product, car access, unemployment rates), and some potential confounders (population density, agricultural employment, industrial employment, country) were available for 133 regions. Multiple regression analysis was used for each living standard variable, taking lnSMR as the dependent variable. RESULTS: It is only after taking into account potential confounders that higher living standards are associated with lower mortality. Unemployment rates have the strongest association--each additional percentage in unemployment in the regional population is associated with an increase in mortality by 0.81%. There is important variation between countries in the living standards--mortality relationship. The latter ranges from relatively strong in the UK to absent in Italy. DISCUSSION: The results of this study show that there is an association between living standards and mortality at the regional level in the EC, but that this association comes to light only after controlling for confounding variables. It seems that the mortality increasing effects of urbanisation and industrialization have obscured the mortality lowering effects of high living standards. In addition, factors specific to countries (such as dietary habits) act as confounders. The latter finding is interpreted in the light of differences between countries in the way in which they have gone through the "epidemiologic translation" from infectious diseases to the "western" diseases that currently dominate the mortality pattern.
OBJECTIVE: The association between living standards and mortality in the European Community (EC) was investigated using regional level data from all EC member countries. DATA AND METHODS: Data covering the 1980s were extracted from various publications. Data on "all cause" mortality (standardised mortality ratios, both sexes, all ages), living standards (gross domestic product, car access, unemployment rates), and some potential confounders (population density, agricultural employment, industrial employment, country) were available for 133 regions. Multiple regression analysis was used for each living standard variable, taking lnSMR as the dependent variable. RESULTS: It is only after taking into account potential confounders that higher living standards are associated with lower mortality. Unemployment rates have the strongest association--each additional percentage in unemployment in the regional population is associated with an increase in mortality by 0.81%. There is important variation between countries in the living standards--mortality relationship. The latter ranges from relatively strong in the UK to absent in Italy. DISCUSSION: The results of this study show that there is an association between living standards and mortality at the regional level in the EC, but that this association comes to light only after controlling for confounding variables. It seems that the mortality increasing effects of urbanisation and industrialization have obscured the mortality lowering effects of high living standards. In addition, factors specific to countries (such as dietary habits) act as confounders. The latter finding is interpreted in the light of differences between countries in the way in which they have gone through the "epidemiologic translation" from infectious diseases to the "western" diseases that currently dominate the mortality pattern.