Area-level deprivation and overall and cause-specific mortality: 12 years' observation on British women and systematic review of prospective studies

• Published in: PloS one 2013-09, Vol.8 (9), p.e72656-e72656
• Main Authors: Sánchez-Santos, Maria T, Mesa-Frias, Marco, Choi, Minkyoung, Nüesch, Eveline, Asunsolo-Del Barco, Angel, Amuzu, Antoinette, Smith, George Davey, Ebrahim, Shah, Prieto-Merino, David, Casas, Juan P
• Format: Article
• Language: English
• Subjects: Aged; Alcohol use; Analysis; Blood pressure; Cause of Death; Deprivation; Exercise; Female; Health; Health aspects; Heart; Humans; Mortality; Older people; Prospective Studies; Regression analysis; Regression models; Respiratory diseases; Respiratory tract diseases; Rites, ceremonies and celebrations; Socioeconomic factors; Statins; Studies; Systematic review; United Kingdom - epidemiology; Women's Health
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0072656

Prospective studies have suggested a negative impact of area deprivation on overall mortality, but its effect on cause-specific mortality and the mechanisms that account for this association remain unclear. We investigate the association of area deprivation, using Index of Multiple deprivation (IMD), with overall and cause-specific mortality, contextualising findings within a systematic review. We used data from 4,286 women from the British Women's Heart Health Study (BWHHS) recruited at 1999-2001 to examine the association of IMD with overall and cause-specific mortality using Cox regression models. One standard deviation (SD) increase in the IMD score had a hazard ratio (HR) of 1.21 (95% CI: 1.13-1.30) for overall mortality after adjustment for age and lifecourse individual deprivation, which was attenuated to 1.15 (95% CI: 1.04-1.26) after further inclusion of mediators (health behaviours, biological factors and use of statins and blood pressure-lowering medications). A more pronounced association was observed for respiratory disease and vascular deaths. The meta-analysis, based on 20 published studies plus the BWHHS (n=21), yielded a summary relative risk (RR) of 1.15 (95% CI: 1.11-1.19) for area deprivation (top [least deprived; reference] vs. bottom tertile) with overall mortality in an age and sex adjusted model, which reduced to 1.06 (95% CI: 1.04-1.08) in a fully adjusted model. Health behaviours mediate the association between area deprivation and cause-specific mortality. Efforts to modify health behaviours may be more successful if they are combined with measures that tackle area deprivation.