Difference In Mortality Research Articles

Geographical differentiation of mortality in the Republic of Moldova

Introduction. Life expectancy in Moldova after independence either fluctuated in the 1990s or stagnated in the early millennium, followed by moderate improvements since 2010. The objective of the study is to investigate the evolution of regional variations in life expectancy since independence in Moldova and to identify the main demographic components (causes of death and age groups) responsible for interregional mortality inequalities.
 Material and methods. Five-year average mortality rates by age and cause in the territorial profile were used for three periods: 1991-1995, 2002-2006 and 2012-2016. Abridged life tables and confidence intervals were computed. The difference in life expectancy between the two subpopulations was decomposed, according to Andreev’s method.
 Results. The gap in life expectancy between the best-performing and the worst-performing groups constitutes 6.0 years. Important progress has been made in the municipality of Chisinau and the northern districts of Briceni and Edinet concerning cardiovascular mortality. In 11 districts located mainly in the centre, the decline in infant mortality due to respiratory diseases was offset by the growth in adult mortality due to external causes and neoplasms.
 Conclusions. Regional disparities can be reduced through preventive measures targeting the key risk factors for cardiovascular disease, liver cirrhosis and external causes of death within the backward geographical area.

Mortality differentials by previous diagnosis of diabetes and glycemic status in the United States

AimsThis study examines mortality differences associated with current glycemic status in mortality by current glycemic status among adults with a previously diagnosed diabetes. Using previous clinical diagnosis of diabetes (diagnosed diabetes) and laboratory measures of hemoglobin A1c (HbA1c) measured at baseline, we estimated mortality differentials simultaneously by diagnosed diabetes and baseline glycemic status in the United States. MethodsData were from 39,491 adults aged 30–84 years assessed in the National Health and Nutrition Examination Survey (NHANES) III and continuous NHANES 1999–2014 linked to mortality data. We categorized participants into four mutually exclusive groups based on diagnosed diabetes and glycemic control measured by HbA1c ≥6.5 % at baseline. Relative hazard ratio (HR) of all-cause death among these four groups were estimated using Cox proportional models. ResultsThere was no significant difference in mortality by glycemic control status among adults with diagnosed diabetes. The same finding was observed among adults without diagnosed diabetes. Adults with diagnosed diabetes had higher mortality than adults without diagnosed diabetes independent of their baseline glycemic control. ConclusionsOnce diagnosed with diabetes, US adults with normal- and hyper-glycemia showed no significant difference in all-cause mortality. This finding emphasizes the importance of primary prevention interventions among adults with a sign of early-stage diabetes.

The Value of the C-Reactive Protein/Albumin and Fibrinogen/Albumin Ratios in Predicting Disease Severity and Mortality in Elderly COVID-19 Patients

Objective: Due to the high mortality levels associated with the novel coronavirus, reliable predictors for determining disease mortality and severity are needed to permit the careful allocation of health services and for earlier clinical intervention and follow-up. The purpose of this study was to determine the predictive value of the C-reactive protein (CRP)/albumin ratio (CAR) and the fibrinogen/albumin ratio (FAR) in determining mortality and evaluate correlations between these values and thoracic computed tomography (CT) findings. Material and Methods: COVID-19 patients aged over 65 presenting to the emergency department of a tertiary training and research hospital between Oct 15, 2021, and Jan 15, 2022, were examined in this single-center, retrospective study. The study population was established based on inclusion and exclusion criteria. The patients’ mortality status and pulmonary involvement percentages were compared with their laboratory parameters. Results: The relationships between patients’ CAR and FAR values and mortality and disease severity were investigated. Cut-off points of 3.0 for CAR (AUC 0.767, sensitivity 76.5% and specificity 70.1%) and 14.4 for FAR (AUC 0.731, sensitivity 75.0% and specificity 69.0%) were determined for the prediction of mortality. In terms of prediction of disease severity, cut-off points were 4.2 for CAR (AUC 0.786, sensitivity 73.7%, and specificity 75.2%) and 15.2 for FAR (AUC 0.789, sensitivity 84.2%, and specificity 69.6%). Conclusion: Based on our study findings, CAR and FAR values may be useful in the early differentiation of mortality and pulmonary parenchymal involvement in elderly COVID-19 patients.

Pre- and post-COVID-19 all-cause mortality of Japanese citizens versus foreign residents living in Japan, 2015–2021

Immigrants in Japan face multiple health care challenges. There is limited research addressing how all-cause mortality differs between foreign residents and Japanese citizens, including the impact of the COVID-19 pandemic. We assessed whether all-cause mortality rates between Japanese citizens and foreign residents living in Japan differ, and whether these differentials changed after the start of the COVID-19 pandemic. We conducted a cross-sectional analysis using vital statistical data of all deaths among citizens and foreign residents that occurred within Japanese borders aggregated every 6 months between January 1, 2015 and June 30, 2021. Data were used to calculate sex-, region-, and 20-year age group-specific standardized mortality rates using the direct method based on the population distribution of Japanese citizens in 2021 by sex, region, and 20-year age groups. Chi-squared tests and linear regression were used to assess whether the pandemic was associated with changes in mortality rates among groups and changes in the mortality differentials between citizens and non-citizens, respectively. All-cause mortality increased monotonically with age for men and women. Men had higher mortality than women, regardless of age or nationality. All-cause mortality is lower among immigrants than Japanese citizens between the ages of 20–59, but higher under the age of 20 and over the age of 59. The pandemic was associated with significant changes in mortality in most groups, but no statistically significant changes in the mortality differentials between immigrants and Japanese citizens were detected. Young immigrants are generally healthier than their Japanese counterparts, in line with the healthy migrant hypothesis. Younger migrants are at higher risk of mortality, possibly due to increased vulnerability to psychologic stress. Older migrant mortality converged with citizen mortality, consistent with acculturation that occurs with longer duration of residence. The pandemic did not exacerbate health inequities for foreign residents with respect to mortality.

Does higher early neonatal mortality in boys reverse over the neonatal period? A pooled analysis from three trials of Nepal

ObjectivesNeonatal mortality is generally 20% higher in boys than girls due to biological phenomena. Only a few studies have examined more finely categorised age patterns of neonatal mortality by sex,...

Occupational differences in mortality and life expectancy persist after retirement and throughout life.

There are substantial differences in remaining life expectancy at higher ages between occupational groups. These differences may be the effect of work-related exposures, lifestyle factors of workers in specific occupations, socioeconomic position or a combination of this. The scope of this paper is the extent to which occupational differences in remaining life expectancy persist after retirement, which would suggest that occupational exposures alone are not likely to explain all the difference. All individuals born between 1925 and 1939 who reported occupational information in the Census 1985 and were residents in Sweden to the end of 2020 or who died were included and followed for death until 2020. The Nordic Classification of Occupations was used to create nine occupational groups. Partial life expectancy and age-specific death rates were applied to examine mortality differentials. This study showed substantial differences in partial life expectancy across the occupational cohorts with the biggest difference being about 2 years. The mortality differences persisted with increasing age, both when measured as absolute numbers as well as relative numbers. The lack of convergence in mortality at high ages suggests that factors associated with lifestyle may play a larger role than occupational factors for the mortality differences between occupational groups at high ages. However, it cannot be ruled out that long-lasting effects of earlier occupational exposures also contribute. Regardless of the exact mechanism, we conclude that there is room for further reduction in mortality at high ages and, thus, for further improvement in life expectancy.

Growth and Welfare Implications of Mortality Differentials in Unfunded Social Security Systems

Several recent studies have examined the steady-state welfare implications of mortality differentials within unfunded Social Security systems, concluding that these differentials undermine the progressivity of the system and make society worse-off relative to alternative public pension schemes. This study is the first to systematically investigate the long-run implications of mortality inequality within the U.S. Social Security system. Utilizing an OLG endogenous growth model of the U.S. economy, I compare the current pay-as-you-go (PAYG) system to versions of the model without either mortality differentials or income inequality. I find that the assumption of mortality homogeneity biases the equilibrium growth rate and welfare analysis. The PAYG system is also compared to a fully funded system based on capital subsidies. The model predicts that PAYG suppresses growth and that, for a given range of subsidy rates, the fully funded system Pareto dominates PAYG in both the medium-run and the long-run.

Rural-Urban health and mortality differentials in Brazil, 2010-2013

Urbanization and economic development in developed countries fostered the debate of rural vs. urban health and mortality differentials. Low and middle-income countries experience uneven urbanization processes that result in an urban mortality penalty. Brazil is an example of this scenario of rural mortality advantage, despite the limited access to health services by rural residents. This paper assesses health and mortality differentials of rural and urban areas using morbidity prevalence data from the Brazilian National Health Survey of 2013 and the mortality information from the Brazilian National Census of 2010. The results show that urban residents display higher prevalence rates of diabetes and heart diseases, whereas rural residents display higher prevalence rates of osteoarticular diseases and functional disabilities. Indeed, adult individuals of rural areas presented better mortality indicators than those from urban areas. However, we verified that a significant share of rural individual's life co-occurs with physical and musculoskeletal related morbidities. These differences between urban and rural spaces need to be considered when making health policy decisions.

And as things have been they remain: Enteric disease and differential mortality among ethnic groups in early twentieth century Milwaukee

ObjectiveThis project aims to document enteric disease mortality differentials between German, Irish and Polish communities in Milwaukee, Wisconsin during the early twentieth century. At that time, residential segregation by ethnicity was common as was access to gainful employment. The Polish had the least access to adequately paid jobs and consequently resided in the area of the city adjacent to waterways used for waste disposal. MaterialsA total of 14,573 death certificates were examined for the years 1901 through 1905. The certificates include name, places of birth and death, age, sex and cause of death. MethodsDeaths from enteric diseases have been compiled for each ethnic group along with age and sex. Incomplete certificates were excluded from the analysis. ResultsA total of 1038 enteric disease deaths were noted. All ethnic groups were affected with the greatest impact in the Polish community. The highest risk was among infants and children in all ethnic groups. ConclusionsMortality differentials resulted from unequal access to safe water and sewage systems in neighborhoods segregated by ethnicity. SignificanceThe data demonstrate variation in the timing of the epidemiologic transition among communities separated by only a few kilometers. LimitationsWater- and food borne sources of enteric disease could not be differentiated. Suggestions for further researchThe effect of living conditions in these communities can be further studied by analyses of respiratory diseases. This can be expanded by detailed analyses of infant and child mortality.

Levels, trends and socio-demographic determinants of infant and under-five mortalities in and around slum areas of Dhaka city, Bangladesh

Infant and child mortality are often used to monitor the progress of national population health programs. The data for this study was collected from selected urban slums where icddr,b has maintained the Health and Demographic Surveillance System (HDSS). Using the HDSS database, 6,666 married women were selected and interviewed in 2018 to collect data on socioeconomic status, pregnancy history and safe motherhood practices. The study examined levels and trends of infant and under-five mortality for three periods: 1990–1999 (Period 1), 2000–2009 (Period 2), and 2010–2018 (Period 3) and examined socio-demographic differentials of infant and under-five mortality for Period 3. From Period 1 to Period 3, under-five mortality declined by 68.2%, with child mortality (1–4 years) declining more than infant mortality (84% vs. 65%). In the regression models for Period 3, infant and under-five mortality were higher for working than non-working mothers (infant: OR = 1.35*, CI: 0.98, 1.86; under-five: OR = 1.34*, CI: 0.99, 1.82), lower for girls than boys (infant: OR = 0.77*, CI: 0.57, 1.03; under-five: OR = 0.77*, CI: 0.58, 1.03), higher for small-size than normal/big-size babies (infant: OR = 4.11***, CI: 3.00, 5.64; under-five: OR = 3.68***, CI: 2.70, 5.02), higher for babies delivered vaginally than by caesarean section (infant: OR = 1.79**, CI: 1.14, 2.97; under-five: OR = 1.87***, CI: 1.21, 2.88), higher for babies delivered with complications than no complication (infant: OR = 2.16***, CI: 1.48, 3.15; under-five: OR = 2.21***, CI: 1.55, 3.18), and higher for babies born after a short (<24 months) birth interval (infant: OR = 1.71*, CI: 0.96, 3.05; under-five: OR = 1.63*, CI: 0.93, 2.86) than firstborns. While substantial progress has been made in reducing under-five and infant mortality, neonatal mortality have declined less slowly. Targeted population health interventions addressing the socio-demographic drivers of infant mortality, with a focus on the urban poor, will help Bangladesh achieve Sustainable Development Goal 3.

Mortality Rate Differentiation in Russia in 2019-2020: COVID-19 Pandemic and Other Factors

The aim of the work is to find the factors that caused the differences in the change in the mortality rate in the regions caused by the pandemic. Using the data of official statistics and the results of regionally representative data of sample socio-demographic surveys of Rosstat, the authors attempt to achieve the goal by methods of both demographic and statistical analysis. The analysis showed that a significant part of the variation of regions in terms of mortality growth is explained by the characteristics of the demographic structure of the region (a high proportion of elderly people in the region, a large household size, the proportion of people with cancer in the region), as well as high population density and frequency of social contacts (especially in large cities). It was noteworthy that there was no significant impact on the regional differentiation of mortality from the availability of medical services and the scale of health infrastructure, which apparently indicates that in 2020 the probability of dying from COVID-19 or concomitant complications did not depend much on the actions of doctors and the equipment of hospitals. The paper also highlights the problem of imperfection of the research information base in terms of the selection of objective indicators and methods for analyzing the contribution of the COVID-19 epidemic to the level and dynamics of mortality.

Racial and Ethnic Differences in Fatality Risk From COVID-19.

IntroductionStudies have reported higher infection and mortality rates from coronavirus disease 2019 (COVID-19) for disadvantaged groups in the U.S. population. However, racial and ethnic differences in fatality rates, which measure deaths among those infected, are not as clear.ObjectivesThe objectives were to (1) estimate the fatality rate after COVID-19 infection by racial and ethnic groups and (2) determine the extent preexisting health conditions account for differences in fatality rate between the racial and ethnic groups.MethodsData for all adults aged 18 and older (n = 24,834) who had a confirmed COVID-19 infection captured in the electronic health records (EHRs) of a major health care organization (HCO) from the beginning of the pandemic to March 28, 2021 were used to estimate the fatality rates for three racial and ethnic groups: Hispanic, non-Hispanic African American, and non-Hispanic White. Elixhauser's comorbidity index was calculated using the enhanced ICD-9-CM and the ICD-10 diagnosis codes. Logistic regression models were used to compare differences in fatality between racial and ethnic groups. Odds ratios and 95% confidence intervals were reported for all models.ResultsThe age-specific fatality rates non-Hispanic White, non-Hispanic African American, and Hispanic groups were 0.23%, 1.05%, 0.55% for age group 18–59 years old; 2.44%, 4.50%, 5.28% for 60–69; 5.42%, 10.11%, 8.49% for 70–79, and 17.33%, 20.79%, 20.39% for 80–90. After adjusting for age, sex, and preexisting conditions, the fatality risk remains significantly higher for non-Hispanic African American (adjusted odds ratio [adj. OR] = 1.85, 95% CI 1.41–2.44) and Hispanic individuals (adj. OR = 1.91, 95% CI = 1.53–2.39) compared to non-Hispanic White individuals.ConclusionHispanic and non-Hispanic African American individuals have a higher risk of fatality from COVID-19 compared to non-Hispanic White individuals. The higher risk remains after adjusting for sex, age, and preexisting conditions. Health care providers could help to increase vaccination rates in these vulnerable populations by addressing the social and cultural barriers with their patients.

Diferenciais de mortalidade, beneficiários do Instituto Nacional do Seguro Social do Brasil em 2015

ABSTRACT This paper aims to estimate mortality and analyze its differentials by sex, age, and groups of beneficiaries of the Brazilian National Institute of Social Security (INSS) in 2015 and make comparisons with official estimates for the general population, assessing the distribution of deaths by age and of survival after 65 years old. The results reinforce the need for more studies on mortality differentials between beneficiary groups and for continuous investment to improve the quality of the data. Population aging, among other aspects, puts pressure on the Brazilian social security system, and there is real concern about its sustainability. Life tables by population subgroups are fundamental as a tool for analyzing the financial and actuarial equilibrium of the system. The results contribute to the debate on the mortality differentials between groups of beneficiaries of the general pension and social security system in Brazil. The death and population data derive from the administrative records of the INSS. We used Gompertz and Van de Maen models and Topals regression to estimate the mortality rates above the age of 65, according to the following beneficiary groups: retirees through age of the General Social Security Regime (Regime Geral de Previdência Social - RGPS) - disaggregated by urban and rural clienteles; retirees through period of contribution; and beneficiaries of welfare support for low income seniors. Among the main results, it was possible to minimize the crossover in the mortality rates of older ages, when the mortality of the less advantaged population becomes lower than the mortality of populations with better social indicators. Cross-checking the results with the official mortality estimates, it was observed that life expectancies for the 65 and 75 year old age groups of the target population of this study are higher than in the general population.

Mortality differentials in beneficiaries of the National Institute of Social Security of Brazil in 2015

RESUMO Este trabalho tem por objetivo estimar a mortalidade e analisar seus diferenciais por sexo, idade e grupos de beneficiários do Instituto Nacional de Seguro Social (INSS) brasileiro em 2015 e fazer comparações com estimativas oficiais para a população geral, avaliando a distribuição dos óbitos por idade e da sobrevida a partir dos 65 anos. Os resultados reforçam a necessidade de mais estudos sobre diferenciais de mortalidade entre grupos de beneficiários e do contínuo investimento para a melhoria da qualidade dos dados. O envelhecimento populacional, entre outros aspectos, pressiona o sistema de previdência social brasileiro, com preocupação real sobre sua sustentabilidade. As tábuas de vida por subgrupos populacionais são fundamentais como ferramenta para análise do equilíbrio financeiro e atuarial do sistema. Os resultados contribuem para o debate sobre os diferenciais de mortalidade entre grupos de beneficiários do regimente geral de previdência e da seguridade social no Brasil. Os dados de óbitos e população são dos registros administrativos do INSS. Utilizaram-se os modelos Gompertz e Van der Maen e regressão Topals para estimar as taxas de mortalidade acima de 65 anos, segundo os seguintes grupos de beneficiários: aposentados por idade do Regime Geral de Previdência Social (RGPS) - desagregados por clientelas urbana e rural; aposentados por tempo de contribuição; e beneficiários de amparos assistenciais para idosos de baixa renda. Entre os principais resultados, foi possível minimizar o crossover nas taxas de mortalidade das idades avançadas, quando a mortalidade da população menos favorecida se torna menor do que a mortalidade de populações com melhores indicadores sociais. Cotejando os resultados com as estimativas oficiais de mortalidade, observou-se que as esperanças de vida para as idades de 65 e 75 anos para a população-alvo desse estudo são maiores do que na população geral.

Racial/Ethnic and Geo-clustering Differentials in SARS-CoV-2 (COVID-19) Cumulative Incidence, Mortality and Temporal Trend in Delaware State, USA

Purpose: COVID-19, a respiratory disease caused by SARS-CoV-2 indicates subpopulation differentials in cumulative incidence (CmI) and mortality. We aimed to assess the racial/ethnic and geo-clustering in COVID-19 CmI and mortality in Delaware. Method: A cross-sectional ecologic design was used to assess COVID-19 mortality in April, May and November 2020. The binomial and poison regression models were utilized for race/ethnic and geo-clustering risk prediction, respectively. Results: As per late April, CmI remains to be flattened in DE, with the confirmed SARS-CoV-2, n=4575 (47.5 per 10,000), Sussex county (SC), n=2,114 (111.4 per 10,000), Kent county, n=728 (41.8 per 10,000) and New Castle county, n=1,701 (28.7 per 10,000). CmI was highest for Non-Hispanic blacks (NHB), 27% (n=1250) but lowest among Asian/Pacific Islanders, n=61 (1%). The disproportionate burden of COVID-19 CmI was highest among Hispanics, 100.2 per 10,000. COVID-19 cases were more prevalent among NHB (30%) and Hispanics (19%). Mortality was higher among NHB, 1.70 per 10,000 compared to Non-Hispanic whites (NHW), 1.34 per 10,000. COVID-19 mortality differed by race, with NHB relative to NHW 27% more likely to die, risk ratio (RR)=1.27, 95%CI, 0.85-1.89. Geo-clustering indicated a significant 50% increased mortality risk in SC compared to DE, incidence rate ratio (IRR)=1.50, 95%CI, 1.11-2.03.During November, the case fatality rate (CFR) in DE was 27 per 10,000, while in the US, the CFR was 25 per 10,000. Conclusions: The Delaware COVID-19 CmI indicates disproportionate burden on NHB and Hispanics; case clustering disproportionate burden in SC; and the risk of dying was highest among NHB.

Describing Mortality Differentials from the Perspective of Various Effects on Life Expectancy and Life Disparity Using Decomposition Methods: The Case of Czechia

The growth in life expectancy has accelerated since the 1990s in Czechia, which preceded a long period of stagnation or even a decrease during the communist era from the 1960s. This article aims to evaluate differences in mortality in terms of the impact of various effects on life expectancy and life disparity before and after the Velvet Revolution in Czechia. Three indicators were considered – life expectancy at birth, temporary life expectancy between ages 0 and 65, and the life disparity measure e-dagger (e†). In the article, we followed the decomposition method according to Arriaga (1984). Based on this method, the effect of mortality was further decomposed into an exclusive effect reflecting improved or worsened mortality in the given age group and into an interaction effect reflecting changes in mortality as a whole. Based on the results, it was found that the indirect effect prevailed in the case of life expectancy, while the direct effect dominated in the life disparity measure. Furthermore, we focused on the differences in life expectancy at birth between the sexes and between the two countries forming parts of the former Czechoslovakia – Czechia and Slovakia. For this purpose, we followed the contour decomposition method, so that we distinguished the effect of changes in mortality corresponding to the initial period and the effect of changes corresponding to changes in mortality in terms of time.

Demographic and Clinical Overview of Hospitalized COVID-19 Patients during the First 17 Months of the Pandemic in Poland

Long-term analyses of demographical and clinical characteristics of COVID-19 patients can provide a better overview of the clinical course of the disease. They can also help understand whether changes in infection symptomatology, disease severity, and outcome occur over time. We aimed to analyze the demographics, early symptoms of infection, laboratory parameters, and clinical manifestation of COVID-19 patients hospitalized during the first 17 months of the pandemic in Poland (March 2020–June 2021). The patients’ demographical and clinical data (n = 5199) were extracted from the national SARSTer database encompassing 30 medical centers in Poland and statistically assessed. Patients aged 50–64 were most commonly hospitalized due to COVID-19 regardless of the pandemic period. There was no shift in the age of admitted patients and patients who died throughout the studied period. Men had higher C-reactive protein and interleukin-6 levels and required oxygenation and mechanical ventilation more often. No gender difference in fatality rate was seen, although the age of males who died was significantly lower. A share of patients with baseline SpO2 < 91%, presenting respiratory, systemic and gastrointestinal symptoms was higher in the later phase of a pandemic than in the first three months. Cough, dyspnea and fever were more often presented in men, while women had a higher frequency of anosmia, diarrhea, nausea and vomiting. This study shows some shifts in SARS-CoV-2 pathogenicity between March 2020 and July 2021 in the Polish cohort of hospitalized patients and documents various gender-differences in this regard. The results represent a reference point for further analyses conducted under the dominance of different SARS-CoV-2 variants.

Inferring “missing girls” from child sex ratios in historical census data

The topic of “missing girls” in historical Europe has not only been mostly neglected, but previous research addressing this issue usually took the available information too lightly, either rejecting or accepting the claims that there was discrimination against female children, without assessing the possibility that the observed child sex ratios could be attributable to chance, mortality differentials, or registration quality. This article contributes to this discussion by (1) using a novel dataset of historical child sex ratios that covers a large part of the European geography between 1700 and 1926; and (2) explicitly considering the effects of random variability, demographic variation, and faulty enumeration in the analysis. Our results provide evidence that some of these European populations had child sex ratios well above the levels usually considered “natural”. Although part of this variation is indeed shown to be due to random noise and structural features related to infant mortality differentials and census quality, some of the observed sex ratios are too high to be attributed solely to these proximate factors. Thus, these findings suggest that there are behavioural explanations for some of the unbalanced sex ratios observed in our data.

Intra-urban differentials of fetal mortality in clusters of social vulnerability in S\xe3o Paulo Municipality, Brazil

This study aimed to analyze the distribution of stillbirths by birth weight, type of death, the trend of Stillbirth Rate (SBR), and avoidable causes of death, according to social vulnerability clusters in São Paulo Municipality, 2007–2017. Social vulnerability clusters were created with the k-means method. The Prais-Winsten generalized linear regression was used in the trend of SBR by < 2500 g, ≥ 2500 g, and total deaths analysis. The Brazilian list of avoidable causes of death was adapted for stillbirths. There was a predominance of antepartum stillbirths (70%). There was an increase in SBR with the growth of social vulnerability from the center to the outskirts of the city. The cluster with the highest vulnerability presented SBR 69% higher than the cluster with the lowest vulnerability. SBR ≥ 2500 g was decreasing in the clusters with the high vulnerability. There was an increase in SBR of avoidable causes of death of the cluster from the lowest to the highest vulnerability. Ill-defined causes of death accounted for 75% of deaths in the highest vulnerability area. Rates of fetal mortality and avoidable causes of death increased with social vulnerability. The trend of reduction of SBR ≥ 2500 g may suggest improvement in prenatal care in areas of higher vulnerability.

Spatial differentials in mortality in Switzerland: How do contexts explain the differences between natives and migrants?

In Western societies, migrants are known to have lower mortality risks than native born, although they are characterised by a lower socioeconomic status. Academic research has found some explanations, but the causes of the migrant mortality paradox are still partially unknown. Individual factors are generally seen as the fundamental causes of death, but recent research has shown that social, economic and cultural environments also produce inequalities in mortality. This article aims at determining the influence of socioeconomic, cultural and geographic contexts in explaining the mortality differences between migrants and native-born Swiss. By running multilevel Bayesian models, the authors decompose spatial inequalities in mortality between migrants and natives of Switzerland within Swiss municipalities and neighbourhoods.