Spatiotemporal association between deprivation and mortality: trends in France during the nineties

Windenberger, Fanny; Rican, Stéphane; Jougla, Éric; Rey, Grégoire

doi:10.1093/eurpub/ckr029

Cited by 41 publications

(28 citation statements)

References 29 publications

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“…Some studies in other countries point either to an increase in socioeconomic inequalities in preventable causes [ 36 , 52 ] or to their decrease [ 13 ]. In the case of the causes analysed here, results in trends in inequality vary.…”

Section: Discussionmentioning

confidence: 99%

Trends in socioeconomic inequalities in preventable mortality in urban areas of 33 Spanish cities, 1996–2007 (MEDEA project)

Nolasco

Vasallo

Quesada

et al. 2015

Int J Equity Health

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BackgroundPreventable mortality is a good indicator of possible problems to be investigated in the primary prevention chain, making it also a useful tool with which to evaluate health policies particularly public health policies. This study describes inequalities in preventable avoidable mortality in relation to socioeconomic status in small urban areas of thirty three Spanish cities, and analyses their evolution over the course of the periods 1996–2001 and 2002–2007.MethodsWe analysed census tracts and all deaths occurring in the population residing in these cities from 1996 to 2007 were taken into account. The causes included in the study were lung cancer, cirrhosis, AIDS/HIV, motor vehicle traffic accidents injuries, suicide and homicide. The census tracts were classified into three groups, according their socioeconomic level. To analyse inequalities in mortality risks between the highest and lowest socioeconomic levels and over different periods, for each city and separating by sex, Poisson regression were used.ResultsPreventable avoidable mortality made a significant contribution to general mortality (around 7.5%, higher among men), having decreased over time in men (12.7 in 1996–2001 and 10.9 in 2002–2007), though not so clearly among women (3.3% in 1996–2001 and 2.9% in 2002–2007). It has been observed in men that the risks of death are higher in areas of greater deprivation, and that these excesses have not modified over time. The result in women is different and differences in mortality risks by socioeconomic level could not be established in many cities.ConclusionsPreventable mortality decreased between the 1996–2001 and 2002–2007 periods, more markedly in men than in women. There were socioeconomic inequalities in mortality in most cities analysed, associating a higher risk of death with higher levels of deprivation. Inequalities have remained over the two periods analysed. This study makes it possible to identify those areas where excess preventable mortality was associated with more deprived zones. It is in these deprived zones where actions to reduce and monitor health inequalities should be put into place. Primary healthcare may play an important role in this process.

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Section: Discussionmentioning

confidence: 99%

Trends in socioeconomic inequalities in preventable mortality in urban areas of 33 Spanish cities, 1996–2007 (MEDEA project)

Nolasco

Vasallo

Quesada

et al. 2015

Int J Equity Health

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“…SES is difficult to define in epidemiology and various indicators are required in health research [165]. Various deprivation indices are available as a proxy of SES [165][166][167][168] but they have been scarcely used to study the association with asthma [158,159,169]. Additional work is warranted on methodological aspects such as the accuracy and consistency of these indices and to evaluate Complex time-related relationships between socio-economic, environmental conditions and respiratory diseases Environment and asthma in adults SES through both individual and geographical indices and its relation with asthma phenotypes.…”

Section: Interrelationship Between Environmental and Behavior Factorsmentioning

confidence: 99%

Environment and asthma in adults

et al. 2013

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“…DP 2 overcomes several limitations of PCA, for instance, aggregating variables expressed in different units of measurement, arbitrary weights, and duplicate information [40-45]. The greatest advantage of DP 2 with respect to PCA consists on how each handles redundant information.…”

Section: Introductionmentioning

confidence: 99%

Does the effect of gender modify the relationship between deprivation and mortality?

et al. 2012

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BackgroundIn this study we propose improvements to the method of elaborating deprivation indexes. First, in the selection of the variables, we incorporated a wider range of both objective and subjective measures. Second, in the statistical methodology, we used a distance indicator instead of the standard aggregating method principal component analysis. Third, we propose another methodological improvement, which consists in the use of a more robust statistical method to assess the relationship between deprivation and health responses in ecological regressions.MethodsWe conducted an ecological small-area analysis based on the residents of the Metropolitan region of Barcelona in the period 1994–2007. Standardized mortality rates, stratified by sex, were studied for four mortality causes: tumor of the bronquial, lung and trachea, diabetes mellitus type II, breast cancer, and prostate cancer. Socioeconomic conditions were summarized using a deprivation index. Sixteen socio-demographic variables available in the Spanish Census of Population and Housing were included. The deprivation index was constructed by aggregating the above-mentioned variables using the distance indicator, DP2. For the estimation of the ecological regression we used hierarchical Bayesian models with some improvements.ResultsAt greater deprivation, there is an increased risk of dying from diabetes for both sexes and of dying from lung cancer for men. On the other hand, at greater deprivation, there is a decreased risk of dying from breast cancer and lung cancer for women. We did not find a clear relationship in the case of prostate cancer (presenting an increased risk but only in the second quintile of deprivation).ConclusionsWe believe our results were obtained using a more robust methodology. First off, we have built a better index that allows us to directly collect the variability of contextual variables without having to use arbitrary weights. Secondly, we have solved two major problems that are present in spatial ecological regressions, i.e. those that use spatial data and, consequently, perform a spatial adjustment in order to obtain consistent estimators.

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Spatiotemporal association between deprivation and mortality: trends in France during the nineties

Abstract: As observed at the individual level in previous studies, area-level socio-economic inequalities in health increased during the nineties, while general health improved.

Cited by 41 publications

References 29 publications

Trends in socioeconomic inequalities in preventable mortality in urban areas of 33 Spanish cities, 1996–2007 (MEDEA project)

Trends in socioeconomic inequalities in preventable mortality in urban areas of 33 Spanish cities, 1996–2007 (MEDEA project)

Environment and asthma in adults

Does the effect of gender modify the relationship between deprivation and mortality?

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