Abstract
BackgroundHealth and inequalities in health among inhabitants of European cities are of major importance for European public health and there is great interest in how different health care systems in Europe perform in the reduction of health inequalities. However, evidence on the spatial distribution of cause-specific mortality across neighbourhoods of European cities is scarce. This study presents maps of avoidable mortality in European cities and analyses differences in avoidable mortality between neighbourhoods with different levels of deprivation.MethodsWe determined the level of mortality from 14 avoidable causes of death for each neighbourhood of 15 large cities in different European regions. To address the problems associated with Standardised Mortality Ratios for small areas we smooth them using the Bayesian model proposed by Besag, York and Mollié. Ecological regression analysis was used to assess the association between social deprivation and mortality.ResultsMortality from avoidable causes of death is higher in deprived neighbourhoods and mortality rate ratios between areas with different levels of deprivation differ between gender and cities. In most cases rate ratios are lower among women. While Eastern and Southern European cities show higher levels of avoidable mortality, the association of mortality with social deprivation tends to be higher in Northern and lower in Southern Europe.ConclusionsThere are marked differences in the level of avoidable mortality between neighbourhoods of European cities and the level of avoidable mortality is associated with social deprivation. There is no systematic difference in the magnitude of this association between European cities or regions. Spatial patterns of avoidable mortality across small city areas can point to possible local problems and specific strategies to reduce health inequality which is important for the development of urban areas and the well-being of their inhabitants.
Highlights
Health and inequalities in health among inhabitants of European cities are of major importance for European public health and there is great interest in how different health care systems in Europe perform in the reduction of health inequalities
We have studied avoidable causes of death, first, to estimate smoothed Standardised Mortality Ratios (SMR) for the small areas of European cities in the early 21th century by gender, and to represent them on maps and, second, to estimate inequalities in the level of avoidable mortality between small areas with different level of deprivation
Our study shows clear differences in the level of avoidable mortality between neighbourhoods of European cities and the level of avoidable mortality is in general positively associated with social deprivation
Summary
Health and inequalities in health among inhabitants of European cities are of major importance for European public health and there is great interest in how different health care systems in Europe perform in the reduction of health inequalities. Charlton was the first to apply the concept at the population level in England and Wales in 1974–78, introducing the terms “avoidable deaths” and “conditions amenable to medical intervention” [4]. He narrowed the concept by excluding deaths that were not directly linked to medical care, e.g. deaths avoided by policies on tobacco control, and the concept was developed further within the Health Services Research Program of the European Community in the 1980s. In 2001 Tobias and Jackson produced an updated list of conditions derived from an expert consensus exercise in which the relative avoidability of death was distributed according to primary, secondary and tertiary actions [6]
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