Is area-level socioeconomic deprivation associated with mortality due to circulatory system diseases in Poland?

Abstract

Background. Socioeconomic deprivation (SED) is known to influence cardiovascular health. However, studies analyzing the relationship between deprivation and circulatory system diseases (CSD) in Central and Eastern Europe are limited. This study aimed to assess the relationship between SED and mortality due to CSD at a population level in 66 sub-regions of Poland. Methods. The data regarding mortality and SED components were obtained from the Central Statistical Office. An area-based SED index was estimated from the rates of education, structure in employment, salary, unemployment, as well as and poverty. The dynamics of changes in mortality due to CSD was calculated as the number of deaths prevented or postponed (DPP) in terciles of SED index. The associations between the mortality from CSD and SED index were analyzed using multivariate Poisson regression models and generalized estimating equations. Results. Among men, the percentage of DPP in 2014 was 13.1% for CSD, 23.4% for ischemic heart disease (IHD), and 21.4% for cerebrovascular diseases (CD). In the case of women, the proportion of DPP was 12.8%, 25.6%, and 21.6%, respectively. More deprived sub-regions experienced a greater decrease in CSD-related mortality compared to the less deprived sub-regions. The disparity in mortality reduction between more deprived and less deprived sub-regions was even more pronounced for women. After adjustment for lifestyle, population density, and changes in mortality over time, the SED index was found to be associated with CSD- and IHD-related mortality for men (β = 1.053, 95% confidence interval (CI) 1.008–1.100 and β = 1.195, 95% CI 1.005–1.419, respectively), and with IHD- and CD-related mortality for women (β = 1.303, 95% CI 1.025–1.657 and β = 1.230, 95% CI 1.025–1.477, respectively). Conclusions. A major proportion of the territorial differences in mortality due to CSD in Poland could be attributed to socioeconomic deprivation. To reduce CSD mortality, more comprehensive preventive measures, including approaches addressing the socioeconomic factors, mainly poverty, education and employment, in particular in less urbanized areas are needed.