Inequalities in mortality in small areas of eleven Spanish cities (the multicenter MEDEA project)

The objectives of this study are to identify inequalities in mortality among census tracts of 11 Spanish cities in the period 1996–2003 and to analyse the relationship between these geographical inequalities and socioeconomic deprivation. It is a cross-sectional ecological study where the units of a...

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Bibliographic Details
Published in:Health & place 2010-07, Vol.16 (4), p.703-711
Main Authors: Borrell, Carme, Marí-Dell’Olmo, Marc, Serral, Gemma, Martínez-Beneito, Miguel, Gotsens, Mercè
Format: Article
Language:English
Subjects:
Age Distribution
Analysis of Variance
Cause of Death
Cross-Sectional Studies
Death
Deprivation
Economic deprivation
Educational Status
Employment - statistics & numerical data
Estimation
Female
Geographical inequalities
Health inequality
Health Status Disparities
Health technology assessment
Humans
Inequalities
International Classification of Diseases - statistics & numerical data
Lung cancer
Male
Modelling
Mortality
Population Surveillance
Poverty Areas
Principal Component Analysis
Registries
Regression Analysis
Residence Characteristics - statistics & numerical data
Sex Distribution
Small areas
Small-Area Analysis
Socioeconomic Factors
Socioeconomic status
Spain
Spain - epidemiology
Urban areas
Urban Health - statistics & numerical data
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Summary:The objectives of this study are to identify inequalities in mortality among census tracts of 11 Spanish cities in the period 1996–2003 and to analyse the relationship between these geographical inequalities and socioeconomic deprivation. It is a cross-sectional ecological study where the units of analysis are census tracts. We obtained an index of socioeconomic deprivation and estimated SMR by each census tract using hierarchical Bayesian models which take into account the spatial structure. In the majority of the cities geographical patterns in total mortality were found in both sexes, which were similar to those for the index of socioeconomic deprivation. Among men, four specific causes of death (lung cancer, ischemic heart diseases, respiratory diseases and cirrhosis) were positively associated with deprivation in the majority of cities. Among women the specific causes diabetes and cirrhosis were positively associated, while lung cancer was negatively associated with deprivation. The excess of mortality related with deprivation was 59,445 deaths among men and 23,292 among women. These results highlight the importance of intra-urban inequalities in health.
ISSN:1353-8292
1873-2054
DOI:10.1016/j.healthplace.2010.03.002