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Journal of Urban Health

, Volume 82, Issue 2, pp 225–236 | Cite as

Mortality and socioeconomic deprivation in census tracts of an urban setting in Southern Europe

  • M. Felícitas Domínguez-Berjón
  • Carme Borrell
  • Rosario López
  • Vicente Pastor
Article

Abstract

In southern European cities, research on deprivation and mortality inequalities using small-area analysis is recent. In many countries, the census tract (CT) is the smallest territorial unit for which population data are available. The aim of this study was to examine the association between mortality from all causes and socioeconomic deprivation in CTs in Barcelona (Spain). A cross-sectional ecologic study was carried out using mortality data for 1987–1995 and 1991 census variables. Mortality data were obtained from death certificates. Socioeconomic deprivation indicators were drawn from the census and included unemployment, inadequate education, and low social class. They were correlated, and a deprivation index was elaborated with them. The analysis was descriptive, and multivariate Poisson regression models were adjusted. The most deprived CTs tend to present higher mortality (49.7% of CT in the quartile associated with greatest deprivation were included in the top male mortality quartile and 40.4% in the top female mortality quartile), whereas the less deprived ones present lower mortality. For male mortality, the risk of dying among those in the quartile representing most deprivation is from 25 to 29% higher (depending on the indicator chosen) than the least deprived quartile, and for women, it is from 12 to 14% higher. We concluded that the mortality from all causes in the CT of a southern European city has shown a clear positive association with a variety of socioeconomic deprivation indicators drawn from the census. Studies of this nature may help to orient more specific studies in which CTs are grouped together as a function of particular population and/or health characteristics.

Keywords

Census Health inequalities Mortality Small areas Socioeconomic factors 

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References

  1. 1.
    Townsend P, Phillimore P, Beattie A. Health and Deprivation: Inequality and the North. London: Croom-Helm; 1988.Google Scholar
  2. 2.
    Phillimore P, Beattie A, Townsend P. Widening inequality of health in northern England, 1981–91. BMJ. 1994;308:1125–1128.PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Carstairs V, Morris R. Deprivation and Health in Scotland. Aberdeen: Aberdeen University Press; 1991.Google Scholar
  4. 4.
    McLoone P, Boddy FA. Deprivation and mortality in Scotland, 1981 and 1991. BMJ. 1994;309:1465–1470.PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    Mackenbach JP, Kunst AE, Looman CWN. Cultural and economic determinants of geographical mortality patterns in The Netherlands. J Epidemiol Community Health. 1991;45:231–237.PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Benach J, Yasui Y. Geographical patterns of excess mortality in Spain explained by two indices of deprivation. J. Epidemiol Community Health. 1999;53:423–431.PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Benach J, Yasui Y, Borrell C, Sáez M, Pasarín MI. Material deprivation and leading causes of death by gender: evidence from a nationwide small area based study. J Epidemiol Community Health. 2001;55:239–245.PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Borrell C, Pasarín MI. Desigualdad en salud y territorio urbano. Gac Sanit. 2004;18:1–4.PubMedCrossRefGoogle Scholar
  9. 9.
    Borrell C, Arias A. Socio-economic factors and mortality in urban settings: the case of Barcelona (Spain). J Epidemiol Community Health. 1995;49:460–465.PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Pasarín MI, Borrell C, Plasència A. Dos patrones de desigualdades sociales en mortalidad en Barcelona? Gac Sanit. 1999;13:431–440.PubMedCrossRefGoogle Scholar
  11. 11.
    Krieger N. Overcoming the absence of socioeconomic data in medical records: validation and application of a census-based methodology. Am J Public Health. 1992;92:703–710.CrossRefGoogle Scholar
  12. 12.
    Michelozzi P, Perucci CA, Forastiere F, Fusco D, Ancona C, Dell’Orco V. Inequality in health: socioeconomic differentials in mortality in Rome, 1990–95. J Epidemiol Community Health. 1999;53:687–693.PubMedCentralPubMedCrossRefGoogle Scholar
  13. 13.
    Krieger N, Chen JT, Waterman PD, Soobader MJ, Subramanian SV, Carson R. Geocoding and monitoring of US socioeconomic inequalities in mortality and cancer incidence: does the choice of area-based measure and geographic level matter? The Public Health Disparities Geocoding Project. Am J Epidemiol. 2002;156:471–482.PubMedCrossRefGoogle Scholar
  14. 14.
    Domínguez-Berjón MF, Borrell C, Pastor V. The usefulness of area-based socioeconomic measures to monitor social inequalities in health in Southern Europe. Eur J Public Health. In press.Google Scholar
  15. 15.
    Krieger N, Williams DR, Moss EN. Measuring social class in US public health research. Annu Rev Public Health. 1997;18:341–378.PubMedCrossRefGoogle Scholar
  16. 16.
    Liberatos P, Link GB, Kelsey LJ. The measurement of social class in epidemiology. Epidemiol Rev. 1988;10:87–121.PubMedGoogle Scholar
  17. 17.
    Kleinbaum DG, Kupper LL, Muller KE. Applied Regression Analysis and Other Multivariable Methods. 2nd ed. Belmont, CA: Duxbury Press; 1988.Google Scholar
  18. 18.
    Wakefield J, Elliott P. Issues in the statistical analysis of small area health data. Stat Med. 1999;18:2377–2399.PubMedCrossRefGoogle Scholar
  19. 19.
    Borrell C, Plasència A, Pasarín I, Ortún V. Widening social inequalities in mortality: the case of a southern European city (Barcelona). J Epidemiol Community Health. 1997;51:659–667.PubMedCentralPubMedCrossRefGoogle Scholar
  20. 20.
    Torralba L, Brugal MT, Villalbí JR, Tortosa MT, Toribio A, Valverde JL. Mortality due to acute adverse drug reactions: opiates and cocaine in Barcelona: 1989–93. Addiction. 1996;91:419–426.PubMedCrossRefGoogle Scholar
  21. 21.
    Wallace R, Wallace D. Socioeconomic determinants of health: community marginalisation and the diffusion of disease and disorder in the United States. BMJ. 1997;314:1341–1345.PubMedCentralPubMedCrossRefGoogle Scholar
  22. 22.
    Wasylenki DA. Inner city health. CMAJ. 2001;164:214–215.PubMedCentralPubMedGoogle Scholar
  23. 23.
    Pasarín Rua MI. Estudio de las desigualdades sociales en mortalidad en las Áreas Básicas de Salud de Barcelona [trabajo de investigación de tercer ciclo]. Barcelona: Universitat Autònoma de Barcelona; 1996.Google Scholar
  24. 24.
    Wallace R. Urban desertification, public health and public order: planned shrinkage’, violent death, substance abuse and AIDS in the Bronx. Soc Sci Med. 1990;31:801–813.PubMedCrossRefGoogle Scholar
  25. 25.
    Pasarín MI, Borrell C, Brugal MT, Díaz-Quijano E. Weighing social and economic determinants related to inequalities in mortality. J Urban Health 2004;81:349–362.PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Morris R, CArstairs V. Which deprivation? A comparison of selected deprivation indexes. J Public Health Med. 1991;4:318–326.Google Scholar
  27. 27.
    Diez-Roux AV. Multilevel analysis in public health research. Annu Rev Public Health. 2000;21:193–221.CrossRefGoogle Scholar
  28. 28.
    Díez E, Villalbí JR, Benaque A, Nebot M. Desigualdades en salud materno-infantil: impacto de una intervención. Gac Sanit. 1995;9:224–231.PubMedCrossRefGoogle Scholar
  29. 29.
    Diez-Roux AV. Investigating neighborhood and area effects on health. Am J Public Health, 2001;91:1783–1789.PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Oxford University Press on behalf of the New York Academy of Medicine 2005

Authors and Affiliations

  • M. Felícitas Domínguez-Berjón
    • 1
  • Carme Borrell
    • 2
  • Rosario López
    • 3
  • Vicente Pastor
    • 3
  1. 1.Servicio de Salud Pública del Área 2, Instituto de Salud PúblicaComunidad de MadridMadridSpain
  2. 2.Agencia de Salut Pública de BarcelonaBarcelonaSpain
  3. 3.Departamento de Medicina Preventiva y Salud PúblicaUniversidad Autónoma de MadridMadridSpain

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