Deprived Municipalities Research Articles

Access to innovative drugs for metastatic lung cancer treatment\xa0in a French nationwide cohort: the TERRITOIRE study

BackgroundTerritorial differences in the access to innovative anticancer drugs have been reported from many countries. The objectives of this study were to evaluate access to innovative treatments for metastatic lung cancer in France, and to assess whether socioeconomic indicators were predictors of access at the level of the municipality of residence.MethodsAll incident cases of metastatic lung cancer hospitalised for a chemotherapy in public hospitals in 2011 were identified from the French National Hospital discharge database. Information on prescription of innovative drugs from an associated database (FICHCOMP) was crossed with the population density of the municipality and a social deprivation index based on national census data.ResultsOverall, 21,974 incident cases of metastatic lung cancer were identified, all of whom were followed for 2 years. Of the 11,486 analysable patients receiving chemotherapy in the public sector, 6959 were treated with a FICHCOMP drug at least once, principally pemetrexed. In multivariate analysis, prescription of FICHCOMP drugs was less frequent in patients ≥66 years compared to those ≤55 years (odds ratio: 0.49 [0.44–0.55]), in men compared to women (0.86 [0.79–0.94]) and in patients with renal insufficiency (0.55 [0.41–0.73]) and other comorbidities. Prescription rates were also associated with social deprivation, being lowest in the most deprived municipalities compared to the most privileged municipalities (odds ratio: 0.82 [0.72–0.92]). No association was observed between the population density of the municipality and access to innovative drugs.ConclusionAlthough access to innovative medication in France seems to be relatively equitable, social deprivation is associated with poorer access. The reasons for this need to be investigated and addressed.

Breast cancer screening programme participation and socioeconomic deprivation in France

The objective was to quantify the relationship between deprivation and national breast cancer screening programme (NBCSP) participation at an ecological level in mainland France.Data from 4,805,390 women—living in 36,209 municipalities within 95 departments—participating in the 2013–2014 NBCSP were analysed using the French Deprivation Index (FDep). FDep population quintiles by municipality were computed to describe NBCSP participation according to deprivation. To better examine the relationship between continuous value of deprivation index and participation rates at the municipality level, we built a generalized linear mixed model.Geographical variations in participation rates were marked. The national standardized participation rate was higher in the intermediate quintiles (55%), 45% for the least deprived one and 52% for the most deprived one. Using our model, we also obtained an inverted U-curve for the relationship between NBCSP participation and municipality deprivation: participation was lower for both the least and most deprived municipalities. This relationship was also observed for each of the two subpopulations—urban municipalities and rural ones—considered separately. Introducing the FDep in the model reduced slightly the unexplained variations in participation rates between departments and between municipalities (with a proportional change in variance of 14% and 12% respectively).We highlight major disparities in departmental participation rates and FDep/participation profiles. However, deprivation appears to have only little influence on geographical variation in participation rates. There is a need to further understand the factors affecting geographical variation in participation rates, in particular the use of opportunistic screening.

Slovenian Version of The European Deprivation Index at Municipal Level.

IntroductionEcological deprivation indices belong to essential instruments for monitoring and understanding health inequalities. Our aim was to develop the SI-EDI, a newly derived European Deprivation Index for Slovenia. We intend to provide researchers and policy-makers in our country with a relevant tool for measuring and reducing the socioeconomic inequalities in health, and even at a broader level.MethodsData from the European survey on Income and Living Conditions and Slovenian national census for the year 2011 were used in the SI-EDI construction. The concept of relative deprivation was used where deprivation refers to unmet need(s), which is caused by lack of all kinds of resources, not only material. The SI-EDI was constructed for 210 Slovenian municipalities. Its geographical distribution was compared to the distribution of two existing deprivation scores previously applied in health inequality research in Slovenia.ResultsThere were 36% of adults recognized as deprived in Slovenia in 2011. SI-EDI was calculated using 10 census variables that were associated with individual deprivation. A clear east-to-west gradient was detected with the most deprived municipalities in the eastern part of the country. The two existing deprivation scores correlate significantly with the SI-EDI.ConclusionsA new deprivation index, the SI-EDI, is grounded on the internationally established scientific concept, can be replicated over time and, crucially, provides an account of the socioeconomic and cultural particularities of the Slovenian population. The SI-EDI could be used by the stakeholders and the governmental and nongovernmental sectors in Slovenia, with the goal of better understanding health inequalities in Slovenia.

Hip fracture incidence and social deprivation: results from a French ecological study.

Regional variations in hip fracture (HF) incidence exist worldwide. Reasons for these variations remain unknown. As regional variations have also been observed for socioeconomic status, we analyzed the association between socioeconomic deprivation (SED) and HF incidence in France in 2008. From the French Hospital National Database, we selected all HF encoded as primary diagnosis in persons aged 30years and over. The recently published French version of the European Deprivation Index (EDI) was used for SED analysis, and an EDI score was measured for the year 2007 in each French local municipality. The EDI score was categorized in quintiles. Poisson regression was performed to examine the association between HF incidence and EDI adjusted for age and sex. The population attributable fraction (PAF) was measured to calculate the proportion of excess cases of HF associated with social affluence. In 2008, 83,538 HF were reported in France of which 59,143 were included in this study. Among them, 44,401 fractures occurred in women (75%) and 14,742 in men (25%). In both men and women, there was a decrease in the HF incidence with increasing SED index. In Poisson regression, the interaction of age class and sex was significant (p<0.0001) and the EDI in quintiles was significantly associated with the incidence of HF (p<0.0001). A higher number of people living in affluent residential areas corresponded to a higher risk of HF. The risk of HF is 2.42 times higher for those living in the most affluent group compared to those living in the most underprivileged group. The value of the PAF was calculated at 27.1%. Social disparities in HF incidence exist in France with the most deprived municipalities having the lowest incidence. Prior knowledge demonstrates the strong relationships between body weight and HF risk as well as between body weight and the SED. The link found in our study between EDI and HF incidence as well as regional and temporal variations in HF incidence may be partly due to the protective effect of increased body weight against HF.

Environmental justice in the epidemiological surveillance system of residents in Italian National Priority Contaminated Sites (SENTIERI Project)

descriptive evaluation of distributional justice in the epidemiological surveillance system of populations residing in Italian National priority Contaminated Sites (NPCSs) of SENTIERI project. Analysis of the feasibility of monitoring different Environmental Justice dimensions in SENTIERI. descriptive study and ecological meta-analysis. SETTING AN PARTICIPANTS: residents in 298 municipalities included in 44 NPCSs in SENTIERI. Description of their level of deprivation and mortality analysis by deprivation level in the first period evaluated in SENTIERI, years 1995-2002. an index of multiple deprivation at municipality level DI-SENTIERI, built using 4 indicators based on variables from the Italian 2001 Census, was used to describe deprivation in communities living in NPCSs. The risk of mortality for all causes and all tumors in the pool of NPCSs municipalities by deprivation level was assessed using meta-Standardized Mortality Ratios (meta-SMRs). sixty percent of municipalities (No. 179) in NPCSs belong to the two more deprived quintiles. The socioeconomic disadvantage of communities resident in NPCS has a North-South gradient: the proportion of municipalities belonging to the two more deprived quintiles is 29% in the North, 68% in the Centre, 92% in the South. Meta-SMRs for all causes in less deprived municipalities were 98 (90%CI 95-100) in men e 101 (90%CI 97-104) in women, the values for all cancers were 99 (90%CI 94-103) in men and 100 (90%CI 95-105) in women. The corresponding estimates in more deprived municipalities were, respectively in men and women, 103 (90%CI 101- 104) and 102 (90%CI 100-104) for all causes, 104 (90%CI 102-106) and 102 (90%CI 100-104) for all cancers. residents in NPCSs are exposed to environmental stressors and are generally more deprived. The socioeconomic disadvantage is mostly affecting Central and Southern Italy populations. Furthermore, in these deprived communities the risk of mortality for all diseases and all cancers is higher. Populations living in NPCSs are affected by distributional injustice. To monitor the different dimensions of Environmental Justice, the DI-SENTIERI should be developed and other socioeconomic indicators implemented.

Investigating social inequalities in exposure to drinking water contaminants in rural areas

Few studies have assessed social inequalities in exposure to drinking water contaminants. This study explores this issue in 593 rural municipalities of Québec, Canada. Quartiles of an ecological composite deprivation index were used as a proxy of socioeconomic status. Total trihalomethanes (TTHMs) and lead were chosen as proxies of chemical drinking water quality. The results show that the majority of deprived rural municipalities apply no treatment to their water (26%) or use a basic treatment (51%), whereas a relative majority of the wealthiest municipalities (40%) use advanced treatment. The proportion of municipalities having important lead (>5 μg/L) levels is highest in most deprived municipalities. Moreover, most deprived municipalities have a higher risk of high tap lead levels (RR = 1.33; 95%CI: 1.30, 1.36). Conversely, most deprived municipalities have a lower risk of high TTHMs levels (RR = 0.78; 95%CI: 0.69, 0.86). These findings suggest an environmental inequality in drinking water contaminants distribution in rural municipalities.

A30 Encouraging active travel to tackle health deprivation in Thurrock communities

Abstract Background The Borough of Thurrock, located in the South East of the UK is one of the most deprived municipalities in the country, despite being only a half hour train journey from London. Personal Travel Planning (PTP) was delivered to nearly every household in Thurrock over the past three-years. Each year, one third of the Borough was targeted for a door-to-door intervention and evaluated for evidence of mode shift towards more sustainable travel. Each year mode shift has been evidenced but in the final year, the eastern part of the Borough was targeted and found to have low car ownership and high deprivation and health inequalities, with a high proportion of elderly and disabled people, and high childhood obesity rates. This is not a typical audience for a PTP programme to create mode shift away from car trips, so some modifications to the approach would be required for it to be effective. Approach described To tailor the intervention to this audience’s needs, we identified an opportunity to intensify promotion of active travel options rather than a shift from car use as such. The result was a 27% increase in walking trips amongst participants, and a 4% increase in walking mode share (based on before and after surveys of travel habits). There was also evidence that some people drastically increased how often they walk, from walking never or very infrequently to walking every day. • This presentation covers two methods used to deliver these Results: Personal Travel Planning using Motivational Interviewing techniques from the health sector • ‘Beat the Street’, a community game to encourage walking, joint-funded with Public Health Structure of presentation The presentation will use multiple sources of evidence including quantitative evaluation tools and qualitative feedback and case studies, and cover the following key points: Background to the Travel Thurrock project, key objectives and challenges • Tailoring the programme to East Thurrock’s unique challenges following two successful years of modal shift from car trips to sustainable modes • Using Motivational Interviewing techniques to deliver mode shift to active travel, and how this is different from typical PTP programmes • Beat the Street and targeting the latent potential for active travel to school • Results, lessons learnt and practical applications for other interventions

Development of a measure of multiple physical environmental deprivation. After United Kingdom and New Zealand, Portugal.

Spatial inequalities in health have been identified, but the contribution of physical environment has been largely ignored. In Portugal, strong spatial differences in morbidity and mortality remain unexplained. Based on previous United Kingdom (UK) and New Zealand (NZ) research, we aimed to develop a Portuguese measure of multiple environmental deprivation (PT-MEDIx) to assist in understanding spatial inequalities in health. PT-MEDIx was built at municipality level in four stages: (i) identify health-relevant environmental factors; (ii) acquire datasets about selected environmental factors and calculate municipality-level measures using Geographical Information Systems; (iii) test associations between selected environmental factors and mortality using negative binomial models, adjusting for age, sex, socioeconomic deprivation and interactions and (iv) construct a summary measure and assess its association with mortality. We included five dimensions of the physical environment: air pollution, climate, drinking water quality, green space availability and industry proximity. PT-MEDIx score ranged from -1 (least environmental deprivation) to +4 (most) and depicted a clear spatial pattern: least deprived municipalities in the depopulated rural areas and most deprived in urban and industrial settings. Comparing with those in the intermediate category of environment deprivation, less deprived municipalities showed lower mortality rate ratios (MRRs) and vice versa: MRRs for all-cause mortality were 0.962 (95% confidence interval: 0.934-0.991) and 1.209 (1.086-1.344), in the least and most deprived municipalities, respectively, and for cancer, 0.957 (0.911-1.006) and 1.345 (1.123-1.598). The methods used to create UK and NZ indexes have good transferability to Portugal. MEDIx might contribute to untangle the complex pathways that link health, socioeconomic and physical environment.

Area deprivation and the prevalence of type 2 diabetes and obesity: analysis at the municipality level in Germany.

BackgroundThe objective of this study was to analyse the association between area deprivation at municipality level and the prevalence of type 2 diabetes (T2D) and obesity across Germany, controlling for individual socioeconomic status (SES).MethodsThe analyses are based on a large survey conducted in 2006. Information was included from 39,908 adults aged 20 years or above. Area deprivation was assessed using the German Index of Multiple Deprivation (GIMD) at municipality level. About 4,700 municipalities could be included and assigned to a deprivation quintile. Individual SES was assessed by income and educational level. Multilevel logistic models were used to control for individual SES and other potential confounders such as age, sex and physical activity.ResultsWe found a positive association of area deprivation with T2D and obesity. Controlling for all individual-level variables, the odds ratios for municipalities in the most deprived quintile were significantly increased for T2D (OR 1.35; 95% CI 1.12–1.64) as well as for obesity (OR 1.14; 95% CI 1.02–1.26). Further analyses showed that these associations were relatively similar for both men and women.ConclusionsBased on a nationwide dataset, we were able to show that area deprivation at municipality level is significantly associated with the prevalence of T2D and obesity. It will be important to focus preventive efforts on very deprived municipalities.

Smoking during pregnancy was up to 70% more common in the most deprived municipalities — A multilevel analysis of all singleton births during 2005–2010 in Finland

ObjectiveWe investigated whether there was an association between maternal smoking habits during pregnancy and municipality level deprivation defined based on education, income and unemployment after adjustment for individual level covariates, including socioeconomic status (SES), in Finland, a Nordic welfare state. MethodsData were gathered from the Medical Birth Register and comprised all singleton births (n=337,876) during 2005–2010. To account for any correlation of women clustered within a municipality, we fitted generalized estimating equation (GEE) models. ResultsIn total, 15.3% of the women with singleton pregnancies smoked during pregnancy. After adjustment for individual level confounders, smoking during pregnancy was 5.4-fold higher among women with the lowest as compared with highest individual SES. Controlling for individual SES, age and year of birth, women living in municipalities defined as intermediately and highly deprived based on education were 53.7% (adjusted odds ratio [aOR] 1.537, 95% confidence interval [CI] 1.493–1.583) and 71.5% (aOR 1.715, 95% CI 1.647–1.785), respectively, more likely to smoke during pregnancy than women in the least deprived municipalities. ConclusionsIndividual SES is the strongest correlate of smoking during pregnancy but conditional on individual variables; lower municipality aggregate education is associated with up to 70% higher smoking prevalence.

Deprived neighborhoods and risk of road trauma (incidence and severity) among under 25 year-olds in the Rhône Département (France)

Introduction Previous research has shown that there are inequalities with regard to traffic accident risk between different social categories. This study describes the influence of the type of residential municipality (with or without deprived urban areas, “ZUS, zones urbaines sensibles”), used as an indicator of contextual deprivation, on the incidence and severity of road trauma involving people of under 25 years of age in the Rhône. Method Injury data were taken from The Rhône Road Trauma Registry. The study covers the 2004–2007 period, with 13,589 young casualties. The incidence of traffic injury of all severities were computed according to the type of municipality and the age, gender, and type of road user. The ratios of the incidences of deprived municipalities, compared with others were calculated. Subsequently the severity factors and incidences according to the severity level (ISS 1–8, ISS 9+) were studied. Results For the main types of road users except motorized two-wheeler users, the incidences were higher in the deprived municipalities: the greatest difference was for pedestrians, where the incidences were almost twice those of other municipalities. This excess risk, constituting a health inequality topic rarely considered, was even greater in municipalities with two or three ZUSs. It was essentially observed for minor injuries among motorists, cyclists, and pedestrians. Conclusions While the incidence increased among people less than 25 years of age, the severity of road injuries was lower in deprived neighborhoods, contrary to what is suggested by other studies. This lower severity disappeared when taking into account the crash characteristics. Impact on industry The incidence of injuries as a pedestrian, cyclist or motorist is higher among young people living in deprived municipalities. These areas should therefore be the targets of dedicated education programs, as well as further investigations about urban planning.

Contextual deprivation, daily travel and road traffic injuries among the young in the Rhône Département (France)

This study investigated the effect of the socioeconomic level of the municipality of residence on personal injury road traffic accident risk among young persons of 10–24 years of age in the Rhône Département. This effect was assessed by comparing incidences of injuries ( n = 2792 casualties) on the basis of three denominators: the resident population of young people, the number of users of each mode and the distances covered by each mode. The results are presented for each type of road users (pedestrians, car passengers, car drivers, motorised two-wheeler riders, cyclists, public transport users). Young persons from deprived municipalities use motorised-two wheelers, bicycles and the car (as passengers and drivers) less frequently, they walk more and take public transports more often than those from other municipalities. When considering injury risk, motorised two wheeler injuries among adolescent males, for example, are significantly less frequent in deprived municipalities. But the motorised two-wheeler riders as well as car passengers from deprived municipalities are characterized by an excess injury risk, whether the selected denominator is the number of users or the kilometres travelled by this mode. For the first time in France, this study has enabled a comparison of the effects of a contextual socioeconomic indicator (the type of municipality of residence, deprived, or not) on daily travel practices and injury incidences among the population, among the users of each mode and per km of travel.

Infant Mortality and Proximity to Industrial Facilities Modification Effect by Neighborhood Socioeconomic Characteristics

O-30B5-5 Background/Aims: Evidence of social health inequalities is well established; socioeconomically disadvantaged populations are more strongly affected by health problems. In spite of numerous risk factors already identified, a part of these inequalities remain unexplained. Environmental nuisances are suspected to play a role in this disparity. Objective: To investigate association between infant mortality and presence of polluting industries and to assess whether the strength of the association is modified by socioeconomic characteristics. Methods: An ecological study was conducted in Lille (226,000 inhabitants) located in North France. Information on industries' location was drawn from the French database of the European-Pollutants-Emission-Register. We used census data to characterize neighborhood socioeconomic status. Mortality information was obtained at a municipality level. We investigated by logistic regression the association between infant mortality and the presence of polluting industries in the town of residence of the mother, stratified by socioeconomic characteristics. Results: There were 705 infant mortality cases in Lille between 2000 and 2009 (death rates of 4.2 per 1000 live births). A greater death risk was found in municipalities hosting 1 or more polluting industries (OR = 3.1; P = 0.043). The strength of the association was modified by socioeconomic neighborhood characteristics. While there was no association in the subgroup of municipalities with low unemployment or proportion of single-parent families, the risk was increased among municipalities with high unemployment or proportion of single-parent families (OR = 6.6; P = 0.07–OR = 8.4; P = 0.06). Conclusion: This observation may result from a greater exposure to industrial pollution due to a greater number of emitting plants in deprived municipalities. It could also stem from a vulnerability phenomenon whereby residents might be more sensitive to the exposure effect because of a poorer health status and lower access to appropriate care. More refined analyses are underway to identify the most plausible explanations and to communicate a public health message to local authorities.

Mapping Snakebite Epidemiology in Nicaragua – Pitfalls and Possible Solutions

BackgroundSnakebites are a public health problem in Nicaragua: it is a tropical developing country, venomous snakes are present and there are reports of snakebites treated both in the formal and informal health care system. We aimed to produce an incidence map using data reported by the health care system that would be used to allocate resources. However, this map may suffer from case detection bias and decisions based on this map will neglect snakebite victims who do not receive healthcare. To avoid this error, we try to identify where underreporting is likely based on available information.Method and FindingsThe Nicaraguan municipalities are categorized by precipitation, altitude and geographical location into regions of assumed homogenous snake prevalence. Socio-economic and healthcare variables hypothesized to be related to underreporting of snakebites are aggregated into an index. The environmental region variable, the underreporting index and three demographic variables (rurality, sex and age distribution) are entered in a Poisson regression model of municipality-level snakebite incidence. In this model, the underreporting index is non-linearly associated with snakebite incidence, a finding we attribute to underreporting in the most deprived municipalities. The municipalities with the worst scoring on the underreporting index and those with combined low reported incidence and large rural population are identified as likely underreporting. 3,286 snakebite cases were reported in 2005–2009, corresponding to a 5-year incidence of 56 bites per 100,000 inhabitants (municipality range: 0–600 cases per 100,000 inhabitants).ConclusionsUsing publicly available data, we identified areas likely to be underreporting snakebites and highlighted these areas instead of leaving them “white” on the incidence map. The effects of the case detection bias on the distribution of resources against snakebites could decrease. Although not yet verified empirically, our study provides an example of how snake bite epidemiology may be investigated in similar settings worldwide at a low cost.

Caractéristiques sociales individuelles, contexte résidentiel et prévalence des problèmes de poids dans la petite enfance : une analyse multiniveau

Background Few studies have examined the prevalence of weight problems before the age of 5 years although this period is critical in the development of obesity. An inverse association between socio-economic status and weight problems is well documented in adult women but not for young children. Similarly several studies of adults and adolescents or older children show that the prevalence of weight problems is associated with the level of deprivation of the neighbourhood environment and the degree of urbanization, independent of social individual factors, even though this has not been examined for young children. Methods We evaluated prevalence rates of weight problems in children aged 3.5–4.5 years in southeastern France and their association with both individual social factors and municipal environment characteristics. Random stratified cluster sampling allowed us to select 112 nursery schools. Physicians from the early childhood protective services conducted a mandatory medical examination and collected data with a new questionnaire (EVALMATER), developed to standardise these examinations. Overweight and obesity were defined by international references after calculation of each child's BMI (kg/m 2). We constructed a social disadvantage index to assess characteristics of the municipalities where the nursery schools were located and used multilevel analysis to study the associations of municipal characteristics (the disadvantage index and a urban/rural classification of the municipalities) with weight problems independently of individual socio-economic variables. Results The study included 2495/2959 (84.3%) children, with a mean age of 3.9 ± 0.3 years. The prevalence of overweight was 8.2% (CI95% = 7.1–9.3) and that of obesity 2.1% (CI95% = 1.5–2.7). Prevalence of obesity was significantly higher in girls, only children, those who had not attended day-care before nursery school, whose mother was not employed, or whose father was not a white-collar-worker. Independently of these variables, it was also significantly higher among children who lived in urban areas or deprived municipalities. None of these factors were found associated with overweight alone. Conclusion Actions of prevention in France should target parents of young children.

Individual social characteristics, municipal environment, and the prevalence of weight problems in early childhood: a multilevel analysis

Background Few studies have examined the prevalence of weight problems before the age of 5 years, even though this period is critical in the development of obesity. An inverse association between socioeconomic status and weight problems is well documented in adult women, but not for young children. Similarly, several studies on adults and adolescents or older children show that the prevalence of weight problems is associated with the level of deprivation of the neighborhood environment and the degree of urbanization, independent of individual social factors, even though this has not been examined for young children. Methods We evaluated prevalence rates of weight problems in children aged 3.5–4.5 years in southeastern France and their association with both individual social factors and municipal environment characteristics. Random stratified cluster sampling allowed us to select 112 nursery schools. Physicians from the early childhood protective services conducted a mandatory medical examination and collected data with a new questionnaire (EVALMATER), developed to standardize these examinations. Overweight and obesity were defined by international references after calculating each child's BMI (kg/m 2). We constructed a social disadvantage index to assess characteristics of the municipalities where the nursery schools were located and used multilevel analysis to study the associations of municipal characteristics (the disadvantage index and a urban/rural classification of the municipalities) with weight problems independently of individual socioeconomic variables. Results The study included 2495/2959 (84.3%) children, with a mean age of 3.9 ± 0.3 years. The prevalence of overweight was 8.2% (95%CI, 7.1–9.3) and that of obesity 2.1% (95%CI, 1.5–2.7). Prevalence of obesity was significantly higher in girls, only children, those who had not attended daycare before nursery school, whose mother was not employed, or whose father was not a white-collar worker. Independently of these variables, it was also significantly higher among children who lived in urban areas or deprived municipalities. None of these factors was found to be associated with overweight alone. Conclusion Preventive actions in France should target parents of young children.

The importance of social characteristics of communities for the medically based disability pension

The aim of this study was to look for any possible contextual effect of deprivation at municipality level on the risk of being granted the medically based disability pension, controlled for compositional effects due to spatial concentration of people with a high risk of disability. The material consists of the residentiary part of a total Norwegian county population aged 20-54 years without disability pension at baseline, n=40,083. This study was performed as a 10-year follow-up study. The relative risk of being granted a disability pension was estimated by logistic regression analyses as odds ratios (OR) between people living in different municipalities according to a municipality deprivation index at three levels, adjusted for individual factors. The OR of disability pension was 1.36 (1.22, 1.51) for people residing in intermediate deprived municipalities and 1.48 (1.31, 1.67) for people residing in the most deprived municipalities compared to the most affluent municipalities, adjusted for gender and age. After adjustment for individual risk factors the OR was 1.26 (1.12, 1.41) and 1.18 (1.04, 1.35) respectively. Analyses stratified by gender showed that the increased risk of receiving a disability pension for men in the most deprived municipalities was explained by individual factors alone. Relative municipality deprivation seems to account for an increase in the incidence of disability pension. This effect contributes to marginalization of people living in less affluent areas out of employment and thus to widening socioeconomic inequalities in the population.