Abstract
BackgroundCountry averages for health outcomes hide important within-country variations. This paper probes into the geographic Belgian pattern of all-cause mortality and wishes to investigate the contribution of individual and area socio-economic characteristics to geographic mortality differences in men aged 45–64 during the period 2001–2011.MethodsData originate from a linkage between the Belgian census of 2001 and register data on mortality and emigration during the period 2001–2011. Mortality rate ratios (MRRs) are estimated for districts and sub-districts compared to the Belgian average mortality level using Poisson regression modelling. Individual socio-economic position (SEP) indicators are added to examine the impact of these characteristics on the observed geographic pattern. In order to scrutinize the contribution of area-level socio-economic characteristics, random intercepts Poisson modelling is performed with predictors at the individual and the sub-district level. Random intercepts and slopes models are fitted to explore variability of individual-level SEP effects.ResultsAll-cause MRRs for middle-aged Belgian men are higher in the geographic areas of the Walloon region and the Brussels-Capital Region (BCR) compared to those in the Flemish region. The highest MRRs are observed in the inner city of the BCR and in several Walloon cities. Their disadvantage can partially be explained by the lower individual SEP of men living in these areas. Similarly, the relatively low MRRs observed in the districts of Halle-Vilvoorde, Arlon and Virton can be related to the higher individual SEP. Among the area-level characteristics, both the percentage of men employed and the percentage of labourers in a sub-district have a protective effect on the individual MRR, regardless of individual SEP. Variability in individual-level SEP effects is limited.ConclusionsIndividual SEP partly explains the observed mortality gap in Belgium for some areas. The percentage of men employed and the percentage of labourers in a sub-district have an additional effect on the individual MRR aside from that of individual SEP. However, these socio-economic factors cannot explain all of the observed differences. Other mechanisms such as public health policy, cultural habits and environmental influences contribute to the observed geographic pattern in all-cause mortality among middle-aged men.Electronic supplementary materialThe online version of this article (doi:10.1186/s13690-016-0135-y) contains supplementary material, which is available to authorized users.
Highlights
Country averages for health outcomes hide important within-country variations
The geographic mortality pattern in Belgium The Belgian mortality pattern by district is characterised by a distinct north–south pattern (Additional file 2: Figure S2 and Additional file 3: Table S1)
The Mortality Rate Ratios (MRRs) of each district compared to the national average shows that most of the northern (Flemish) districts have a significantly lower MRR compared to the Belgian average, namely lower than 1
Summary
Country averages for health outcomes hide important within-country variations. Geographic patterns in health and mortality Country averages for health outcomes hide substantial within-country variation [23, 54]. Geographic differences have been observed for a variety of health outcomes in several countries [10, 11, 17, 23, 32, 35, 39, 42, 45, 52, 53]. Renard et al [38] map out cause-specific premature mortality (ages 1–74) for a number of major causes of death in Belgium. A number of causes of death such as lung, colorectal and breast cancer mortality are much less geographically patterned
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