Material deprivation and leading causes of death by gender: evidence from a nationwide small area study

Abstract

Study objective-To investigate the association between material deprivation and 10 leading causes of death by gender. Design-Small area cross sectional ecological study using two dimensions of material deprivation (Index 1 and Index 2) drawn from 1991 census and cause specific mortality data aggregated for 1987-1995. Setting-2218 small areas in Spain. Main results-Strong detrimental associations of two deprivation indices were found with top six leading causes of death for men and top seven leading causes of death for women, except breast cancer. For men, the highest percentages of excess mortality (between 40% and 60%) were found for smoking and alcohol related causes of death such as lung cancer, chronic obstructive pulmonary diseases, and cirrhosis while for women the highest percentages of excess mortality (between 40% and 60%) were found for diet related causes such as diabetes and ischaemic heart disease. Conclusions-Health inequality is a widespread phenomenon in the majority of the top leading causes of deaths of the nation. Increasing levels of deprivation indices are associated with mortality risk diVerently by both cause and gender. Results suggest that deprivation eVects mainly captured by Index 2 may manifest largely as unfavourable health behaviours leading to gender specific sets of causes of deaths. Findings of this study are consistent with the idea that material deprivation determines health inequality through both an increase of general susceptibility to ill health, leading to excess mortality in a wide range of causes, and a set of specific factors, resulting in an increased risk of death from a specific set of causes in each gender. (J Epidemiol Community Health 2001;55:239-245)

The geography of the highest mortality areas in Spain: a striking cluster in the southwestern region of the country

“…1 Our research in Spain has shown that mortality inequalities at the small area level are a widespread phenomenon. 2 Here we report a striking observation in Spain that the areas with the highest increased risk of death are clustered in one specific region of the country. This presents a pressing public health concern with respect to the country's health policy and calls for attention from researchers and policy makers.…”

Distribución y tendencia de los fallecimientos en el medio hospitalario en España durante el periodo 1997-2003

“…Por otra parte, estudios previos realizados en España han descrito importantes desigualdades socioeconómicas y en la oferta de servicios sanitarios entre las distintas comunidades autónomas (CCAA) [18][19] , así como la influencia de diversas característi-cas sociodemográficas sobre el riesgo de muerte, como el desempleo, el nivel educativo, el estado civil, el número de miembros del hogar, la actividad laboral o el apoyo social 18,[20][21][22][23][24] . Nuestra hipótesis era que las muertes en hospitales serían más frecuentes en las CCAA con menos población anciana y rural, y que la proporción de muertes en urgencias se relacionaría directamente con la frecuentación hospitalaria e inversamente con las dotaciones de camas.…”

Mortality and Socioeconomic Deprivation in Census Tracts of an Urban Setting in Southern Europe

“…The reference population was that of Barcelona as a whole, according to the 1991 census. On the basis of the information available in the 1991 Spanish census, several deprivation indicators were selected following theoretical criteria 15,16 and previous experience in Spain 6,7 : (1) unemployment, as the percentage of unemployed in the population aged 15-64 years; (2) inadequate education, as the percentage of people who were illiterate or had no schooling in the population aged over 10; and (3) low social class, determined as the number of people with unskilled occupations divided by all people who ever worked. The three indicators were correlated, with Spearman correlation coefficients that ranged from 0.72 to 0.86.…”