Effects of local extrinsic mortality rate, crime and sex ratio on preventable death in Northern Ireland.

Caroline Uggla,Ruth Mace

doi:10.1093/emph/eov020

Abstract

Individual investment in health varies greatly within populations and results in significant differences in the risk of preventable death. Life history theory predicts that individuals should alter their investment in health (somatic maintenance) in response to ecological cues that shift the perceived fitness payoffs to such investments. However, previous research has failed to isolate the effects of different ecological factors on preventable death, and has often relied on macro-level data without individual controls. Here, we test some key predictions concerning the local ecology-that higher extrinsic mortality rate (EMR), crime rate and mate-scarcity (male/female-biased sex ratio) at the ward-level-will be associated with a higher risk of preventable death. We use census-based data from Northern Ireland (n = 927 150) on preventable death during an 8.7-year period from the 2001 Census and run Cox regressions for (i) accident/suicide or alcohol-related death and (ii) deaths from preventable diseases, for men and women separately, controlling for a wide range of individual variables. We find evidence of ward-level EMR and crime rate being positively associated with preventable death among men, particularly men with low socioeconomic position. There was a tentative relationship between male-biased sex ratio and preventable death among women, but not among men. Both behaviours that might lead to 'risky' death and health neglect might be adaptive responses to local ecologies. Efforts to reduce crime might be as effective as those to reduce extrinsic mortality, and both could have positive effects on various health behaviours.

Highlights

Individuals vary greatly in the effort they expend on achieving and maintaining good health
We have previously demonstrated that there is a large sex difference in accidental/suicide deaths (70% higher hazards), and higher preventable death among non-partnered men and men without dependent children in Northern Ireland [39]
We found evidence that a higher extrinsic mortality rate (EMR), crime and a femalebiased sex ratio accelerate motherhood, and that higher EMR and crime rate accelerate fatherhood [40]

Summary

Introduction

Individuals vary greatly in the effort they expend on achieving and maintaining good health. Individuals with higher SEP are healthier for a number of reasons, but in particular seem better positioned to give up behaviours with negative health repercussions and comply with treatment, demonstrating, for example, higher smoking cessation success [13] and better survival following cancer diagnosis than less wealthy peers [14]. These health differentials exist even in the presence of universal access to health care and widespread knowledge through public health campaigns about adverse effects of poor diet, smoking and excessive alcohol consumption [15]. Efforts to reduce crime might be as effective as those to reduce extrinsic mortality, and both could have positive effects on various health behaviours

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Results

Conclusion