Geographical Inequalities In Mortality Research Articles

Intraurban Geographic and Socioeconomic Inequalities of Mortality in Four Cities in Colombia.

Mortality inequalities have been described across Latin American countries, but less is known about inequalities within cities, where most populations live. We aimed to identify geographic and socioeconomic inequalities in mortality within the urban areas of four main cities in Colombia. We analyzed mortality due to non-violent causes of diseases in adults between 2015 and 2019 using census sectors as unit of analysis in Barranquilla, Bogotá, Cali, and Medellín. We calculated smoothed Bayesian mortality rates as main health outcomes and used concentration indexes (CInd) for assessing inequalities using the multidimensional poverty index (MPI) as the socioeconomic measure. Moran eigenvector spatial filters were calculated to capture the spatial patterns of mortality and then used in multivariable models of the association between mortality rates and quintiles of MPI. Social inequalities were evident but not consistent across cities. The most disadvantaged groups showed the highest mortality rates in Cali. Geographic inequalities in mortality rates, regardless of the adults and poverty distribution, were identified in each city, suggesting that other social, environmental, or individual conditions are impacting the spatial distribution of mortality rates within the four cities.

COVID-19 and deprivation amplification: An ecological study of geographical inequalities in mortality in England.

'Deprivation amplification' is used to understand the relationship between deprivation, scale and COVID-19 mortality rates. We found that more deprived Middle Super Output Areas (MSOAs) in the more deprived northern regions suffered greater COVID-19 mortality rates. Across England, the most deprived 20% of MSOAs had higher mortality than the least deprived (44.1% more COVID-19 deaths/10,000). However, the most deprived MSOAs in the north fared worse than equally deprived areas in the rest of England (14.5% more deaths/10,000, beta=0.136, p<0.01). There was also strong evidence of spatial clustering and spill-overs. We discuss these findings in relation to 'deprivation amplification', the 'syndemic pandemic', and the health and place literature.

Smoking and the widening inequality in life expectancy between metropolitan and nonmetropolitan areas of the United States.

BackgroundGeographic inequality in US mortality has increased rapidly over the last 25 years, particularly between metropolitan and nonmetropolitan areas. These gaps are sizeable and rival life expectancy differences between the US and other high-income countries. This study determines the contribution of smoking, a key contributor to premature mortality in the US, to geographic inequality in mortality over the past quarter century.MethodsWe used death certificate and census data covering the entire US population aged 50+ between Jan 1, 1990 and Dec 31, 2019. We categorized counties into 40 geographic areas cross-classified by region and metropolitan category. We estimated life expectancy at age 50 and the index of dissimilarity for mortality, a measure of inequality in mortality, with and without smoking for these areas in 1990–1992 and 2017–2019. We estimated the changes in life expectancy levels and percent change in inequality in mortality due to smoking between these periods.ResultsWe find that the gap in life expectany between metros and nonmetros increased by 2.17 years for men and 2.77 years for women. Changes in smoking-related deaths are responsible for 19% and 22% of those increases, respectively. Among the 40 geographic areas, increases in life expectancy driven by changes in smoking ranged from 0.91 to 2.34 years for men while, for women, smoking-related changes ranged from a 0.61-year decline to a 0.45-year improvement. The most favorable trends in years of life lost to smoking tended to be concentrated in large central metros in the South and Midwest, while the least favorable trends occurred in nonmetros in these same regions. Smoking contributed to increases in mortality inequality for men aged 70+, with the contribution ranging from 8 to 24%, and for women aged 50–84, ranging from 14 to 44%.ConclusionsMortality attributable to smoking is declining fastest in large cities and coastal areas and more slowly in nonmetropolitan areas of the US. Increasing geographic inequalities in mortality are partly due to these geographic divergences in smoking patterns over the past several decades. Policies addressing smoking in non-metropolitan areas may reduce geographic inequality in mortality and contribute to future gains in life expectancy.

POSB178 Geographical Inequalities in Coronavirus (SARS-COV-2) Mortality in Europe

Morbidity and mortality rates show different patterns in European countries. The aim of the study was to map geographical inequalities in mortality caused by coronavirus (Sars-COV-2) infection in Europe in 2020.

Studying Geographic Inequalities in Mortality in Contexts with Deficient Data Sources: Lessons from Ecuador.

In Ecuador, there are inequalities in the completeness and quality of the mortality registry between men and women and among geographical areas. Consequently, using cause of death statistics leads to several difficulties. Our aim was to analyze geographical inequalities in mortality due to some of the main specific causes of death in the provinces of Ecuador (2001-2016) after correction for the deficiencies found in the mortality registry. This ecologic study used mortality data from 2001 to 2016 for the 22 provinces of Ecuador at the beginning of the study period. We assessed completeness using death distribution methods for the intercensal period 2001-2010. We assessed quality by estimating the percentage of garbage codes for the entire study period. We corrected mortality using completeness as a correction factor and applying a garbage code redistribution protocol. We estimated age-standardized mortality ratios in the provinces of Ecuador for men and women, before and after applying the correction methods. We found substantial changes in the number of deaths due to the selected causes after garbage code redistribution and correction for completeness. These changes corresponded to the deficiencies in completeness and quality found in the study areas and the manner in which garbage codes were redistributed to each of the studied causes. We observed changes in the geographical patterns of mortality due to specific causes. Correcting deficiencies in the mortality registry resulted not only in changes in the number of deaths but also in the geographical patterns of mortality in Ecuador.

Geodemographic Area Classification and Association with Mortality: An Ecological Study of Small Areas of Cyprus.

Geographical investigations are a core function of public health monitoring, providing the foundation for resource allocation and policies for reducing health inequalities. The aim of this study was to develop geodemographic area classification based on several area-level indicators and to explore the extent of geographical inequalities in mortality. A series of 19 area-level socioeconomic indicators were used from the 2011 national population census. After normalization and standardization of the geographically smoothed indicators, the k-means cluster algorithm was implemented to classify communities into groups based on similar characteristics. The association between geodemographic area classification and the spatial distribution of mortality was estimated in Poisson log-linear spatial models. The k-means algorithm resulted in four distinct clusters of areas. The most characteristic distinction was between the ageing, socially isolated, and resource-scarce rural communities versus metropolitan areas with younger population, higher educational attainment, and professional occupations. By comparison to metropolitan areas, premature mortality appeared to be 44% (95% Credible Intervals [CrI] of Rate Ratio (RR): 1.06–1.91) higher in traditional rural areas and 36% (95% CrI of RR: 1.13–1.62) higher in young semi-rural areas. These findings warrant future epidemiological studies investigating various causes of the urban-rural differences in premature mortality and implementation policies to reduce the mortality gap between urban and rural areas.

Spatial Analysis of Mortality by Cardiovascular Disease in the Adult Population: A Study for Brazilian Micro-Regions Between 1996 and 2015

Cardiovascular disease (CVD) is one of the most serious health issues and the leading cause of death worldwide in both developed and developing countries, including Brazil. However, CVD mortality rates are not uniformly distributed across the country. Brazil is marked by important regional differences resulting from socioeconomic inequality and limited access to health services. Mortality varies in a number of dimensions including age, sex, race, socioeconomic status, educational level and geography/space. Geographic inequalities in mortality in Brazil appear to be greater than other countries in Latin America. Given the spatial distribution of causes and heterogeneity of deaths from cardiovascular disease in Brazil, both at macro and micro levels, the goal of this paper is to evaluate the spatial patterns of deaths from CVD in the adult population (over 30 years of age), by sex, in Brazilian micro-regions from 1996 to 2015. Our main contribution was to study an important cause of death in small areas (micro-regions), taking into consideration space, as a proxy of socioeconomic conditions, access to health care and social norms that might affect CVD, as an important variable to understand changes in the CVD mortality.

Trends in mortality inequalities in an urban area: the influence of immigration

BackgroundNearly 20% of the population in Barcelona is foreign-born and this percentage rises to up to 40% in some neighborhoods. Consequently, migration health patterns may play an important role in trends in socioeconomic geographical inequalities in mortality. The objective of this study was to analyze the trend in socioeconomic inequalities in mortality between neighborhoods in Barcelona during the period 2001–2012 in the foreign-born and Spanish-born population.MethodsRepeated cross-sectional design of the population aged 25–64 years in Barcelona between 2001 and 2012. Hierarchical data consisted of yearly mortality linked-population. The variables analyzed were age, sex, education, and country of birth (Spanish-born, foreign-born), neighborhood of residence, and the socioeconomic level of the neighborhoods using quartiles of unemployment rates. Age-standardized mortality rates were estimated, and mixed Poisson regressions were applied using generalized linear mixed models, including two random effects to consider the intracorrelation within neighborhoods and across years.ResultsThe number of foreign-born residents aged 25–64 increased notably in disadvantaged neighborhoods. Approximately 9% of premature deaths occurred in foreign-born individuals. Premature mortality rates were higher in disadvantaged neighborhoods and in the Spanish-born population in all periods. Despite the stabilized socioeconomic inequalities in mortality in the Spanish-born population, no inequalities were found between neighborhoods in foreign-born men and women.ConclusionsEvidence of the ‘healthy migrant’ effect in mortality and socioeconomic inequalities in mortality was found in Barcelona, which seems to alter the distribution of mortality through time and space, related to the low levels of premature mortality and the selective residence of immigrants in socioeconomically disadvantaged neighborhoods.

Trends and Patterns of Geographic Variation in Mortality From Substance Use Disorders and Intentional Injuries Among US Counties, 1980-2014

Substance use disorders, including alcohol use disorders and drug use disorders, and intentional injuries, including self-harm and interpersonal violence, are important causes of early death and disability in the United States. To estimate age-standardized mortality rates by county from alcohol use disorders, drug use disorders, self-harm, and interpersonal violence in the United States. Validated small-area estimation models were applied to deidentified death records from the National Center for Health Statistics (NCHS) and population counts from the US Census Bureau, NCHS, and the Human Mortality Database to estimate county-level mortality rates from 1980 to 2014 for alcohol use disorders, drug use disorders, self-harm, and interpersonal violence. County of residence. Age-standardized mortality rates by US county (N = 3110), year, sex, and cause. Between 1980 and 2014, there were 2 848 768 deaths due to substance use disorders and intentional injuries recorded in the United States. Mortality rates from alcohol use disorders (n = 256 432), drug use disorders (n = 542 501), self-harm (n = 1 289 086), and interpersonal violence (n = 760 749) varied widely among counties. Mortality rates decreased for alcohol use disorders, self-harm, and interpersonal violence at the national level between 1980 and 2014; however, over the same period, the percentage of counties in which mortality rates increased for these causes was 65.4% for alcohol use disorders, 74.6% for self-harm, and 6.6% for interpersonal violence. Mortality rates from drug use disorders increased nationally and in every county between 1980 and 2014, but the relative increase varied from 8.2% to 8369.7%. Relative and absolute geographic inequalities in mortality, as measured by comparing the 90th and 10th percentile among counties, decreased for alcohol use disorders and interpersonal violence but increased substantially for drug use disorders and self-harm between 1980 and 2014. Mortality due to alcohol use disorders, drug use disorders, self-harm, and interpersonal violence varied widely among US counties, both in terms of levels of mortality and trends. These estimates may be useful to inform efforts to target prevention, diagnosis, and treatment to improve health and reduce inequalities.

Investigation of the role of traffic police function in reducing geographical inequalities in mortality from road traffic accidents

Background and Objectives: Road traffic accident (RTA) is one of the major public health problems. Inequality in this problem and its trend has not been yet investigated in Iran. A better understanding of different contributing factors to RTA like inequalities can be helpful to reduce the negative influence of road crashes. Hence, this study aimed at examining geographical inequality in mortality from RTAs over the previous decades. Materials and Methods: In this cross-sectional study, all people who died from RTAs from March 2006 to February 2015 were selected. The data were taken from Legal Medicine Organization in Iran. The Theil index was used to estimate geographical inequality in mortality from RTA. Data were then analyzed using the Stata software. Results: During the 10-year period of this study, 210,582 people in Iran died due to RTA. The mortality rate that caused by RTAs has decreased during the study. We found a larger reduction in a mortality rate in suburban RTAs. In spite of the reduction in RTAs death, geographical inequality increased during the 10-year study. Conclusions: The findings of this study indicate that there is a geographical inequality in mortality from RTAs in Iran. This implies that effective interventions in reducing the RTAs should be distributed equally among regions of the country. Further research can be performed to investigate the causes of this inequality.

Twenty years of socioeconomic inequalities in premature mortality in Barcelona: The influence of population and neighbourhood changes

The objective of this study was to analyse trends in socioeconomic inequalities in premature mortality in Barcelona from 1992 to 2011, accounting for population changes. We conducted a repeated cross-sectional study of the Barcelona population (25–64 years) using generalized linear mixed models for trend analysis, and found that socioeconomic inequalities in premature mortality persisted between neighbourhoods, but tended to diminish. However, the reduction in inequality was related to an increase in the number of foreign-born individuals mainly in socioeconomic disadvantaged neighbourhoods, in which the decrease in premature mortality was more marked. To study trends in geographical inequalities in mortality, it is essential to understand demographic changes occurred in different places related to local levels of deprivation.

Comparative observational study of mortality amenable by health policy and care between rural and urban Finland: no excess segregation of mortality in the capital despite its increasing residential differentiation.

BackgroundLarge cities are often claimed to display more distinct geographical and socioeconomic health inequalities than other areas due to increasing residential differentiation. Our aim was to assess whether geographical inequalities in mortality within the capital (City of Helsinki) both exceeded that in other types of geographical areas in Finland, and whether those differences were dependent on socioeconomic inequalities.MethodsWe analysed the inequality of distribution separately for overall, ischemic heart disease and alcohol-related mortality, and mortality amenable (AM) to health care interventions in 1992–2008 in three types of geographical areas in Finland: City of Helsinki, other large cities, and small towns and rural areas. Mortality data were acquired as secondary data from the Causes of Death statistics from Statistics Finland. The assessment of changing geographical differences over time, that is geographical inequalities, was performed using Gini coefficients. As some of these differences might arise from socioeconomic factors, we assessed socioeconomic differences with concentration indices in parallel to an analysis of geographical differences. To conclude the analysis, we compared the changes over time of these inequalities between the three geographical areas.ResultsWhile mortality rates mainly decreased, alcohol-related mortality in the lowest income quintile increased. Statistically significant differences over time were found in all mortality groups, varying between geographical areas. Socioeconomic differences existed in all mortality groups and geographical areas. In the study period, geographical differences in mortality remained relatively stable but income differences increased substantially. For instance, the values of concentration indices for AM changed by 54 % in men (p < 0.027) and by 62 % in women (p < 0.016). Only slight differences existed in the time trends of Gini or in the concentration indices between the geographical areas.ConclusionsNo geographical or income-related differences in the distribution of mortality existed between Helsinki and other urban or rural areas of Finland. This suggests that the effect of increasing residential differentiation in the capital may have been mitigated by the policies of positive discrimination and social mixing. One of the main reasons for the increase in health inequalities was growth of alcohol-related mortality, especially among those with the lowest incomes.

Are migration patterns and mortality related among European regions?

Geographical inequalities in mortality across Europe may be influenced by migration between regions. The relationship between age- and sex-standardised death rates, 2008-2010, and population change resulting from migration 2000-2010, was analysed in 250 'Nomenclature of Statistical Territorial Units' (NUTS) level 2 regions in 26 European countries. Across Europe death rates were significantly higher in regions experiencing population loss. This association continued after adjustment for 2005 household income among all regions and Western regions but not among Eastern areas. This analysis suggests migration could contribute to Europe's persistent inequalities in mortality, and highlights the problems of Eastern regions with the highest death rates, lowest incomes and declining populations.

Small-area mapping of premature mortality, rurality and deprivation indices on the small island of Cyprus

Background The association between area-level deprivation and health is well established. However, in some European countries, including Cyprus, there are no accepted measures of deprivation while the extent of geographical inequalities in mortality, if any, remains unknown. Objectives: To investigate the magnitude of small-area inequalities in premature mortality (before 65) across 405 communities in Cyprus and its association with deprivation and rurality indices. Methods Standardised mortality ratios (SMRs) of …

Geographic Inequalities in All-Cause Mortality in Japan: Compositional or Contextual?

BackgroundA recent study from Japan suggested that geographic inequalities in all-cause premature adult mortality have increased since 1995 in both sexes even after adjusting for individual age and occupation in 47 prefectures. Such variations can arise from compositional effects as well as contextual effects. In this study, we sought to further examine the emerging geographic inequalities in all-cause mortality, by exploring the relative contribution of composition and context in each prefecture.MethodsWe used the 2005 vital statistics and census data among those aged 25 or older. The total number of decedents was 524,785 men and 455,863 women. We estimated gender-specific two-level logistic regression to model mortality risk as a function of age, occupation, and residence in 47 prefectures. Prefecture-level variance was used as an estimate of geographic inequalities in mortality, and prefectures were ranked by odds ratios (ORs), with the reference being the grand mean of all prefectures (value = 1).ResultsOverall, the degree of geographic inequalities was more pronounced when we did not account for the composition (i.e., age and occupation) in each prefecture. Even after adjusting for the composition, however, substantial differences remained in mortality risk across prefectures with ORs ranging from 0.870 (Okinawa) to 1.190 (Aomori) for men and from 0.864 (Shimane) to 1.132 (Aichi) for women. In some prefectures (e.g., Aomori), adjustment for composition showed little change in ORs, while we observed substantial attenuation in ORs in other prefectures (e.g., Akita). We also observed qualitative changes in some prefectures (e.g., Tokyo). No clear associations were observed between prefecture-level socioeconomic status variables and the risk of mortality in either sex.ConclusionsGeographic disparities in mortality across prefectures are quite substantial and cannot be fully explained by differences in population composition. The relative contribution of composition and context to health inequalities considerably vary across prefectures.

Geographical inequalities in mortality and incidence in larynx cancer in men: socioeconomic and environmental factors

Several studies suggest the relationship between lower socioeconomic status and environmental factors with increased risk of cancer. Within the framework of the MEDEA project, this work aims to identify geographic inequalities in larynx cancer (LC) mortality and incidence in men and its association with deprivation and environmental factors. Ecological study having as reference population men living in the city of Zaragoza. The study period was 1996-2003. The deaths were obtained from the Mortality Registry of Aragon, the incident cases from the Cancer Registry of Zaragoza and the socioeconomic data from the 2001 Census. We used the European Pollutant Emission Register database to locate possible polluting industries. For each census tract (CT) a deprivation index was obtained using principal components analysis. Smoothed Standardized Mortality and Incidence ratios were also calculated using Bayesian methods. We analysed 211 deaths and 569 incident cases with CT, corresponding to 95% of the total registered mortality cases and 97.8% incidence. The CTs in the highest quartile, highest deprivation index, had significantly higuer risk of mortality (2.74 times) as well as incidence (1.66 times) by LC. However, the environmental indicators have not been shown a statistically significance association. The CTs with the lowest socioeconomic status have higher risk of LC mortality and incidence. Nevertheless, the possible exposition to the polluting industrial focus does not explain the observed geographic variability.

Inequalities in premature mortality in Britain: observational study from 1921 to 2007

Objective To report on the extent of inequality in premature mortality as measured between geographical areas in Britain.Design Observational study of routinely collected mortality data and public records. Population subdivided...

Migration and geographical inequalities in health in Britain

This paper explores the role of migration in creating geographical inequalities in mortality at the district level in Britain for the British Household Panel Study sample — a representative sample of 10264 British residents born after 1890 and enumerated in 1991. Analysis of the mortality rates of migrants showed that male migration accounts for nearly all the differences in mortality rates between districts. The BHPS was then utilised to look at the lifetime socio-economic characteristics of these migrants and to compare men and women. It was found that the health of both men and women moving from high mortality districts to low mortality districts could be explained by advantage over their lifetimes. The small proportion of men and women moving from low mortality districts to high mortality districts represent a very mixed group and their contribution, whilst small, is intriguing, as is the very different mortality rates of men and women in this group.

The geographical inequalities in mortality in Africa

This paper reviews the progress that has been made in studies on geographic differentials of mortality in Africa. In general, there is very little known about adult mortality in many Third World countries, and the contributions of geographers have been limited in this area. In many African countries, enormous problems in studies on mortality were encountered due to incomplete and unreliable information. Differential levels of mortality are reported in different regions of the African continent and even within each country. Higher childhood mortality rates are recorded in West and Central Africa when compared with East and Southern Africa; relatively low rates are reported in the Magreb and the lowest in the small island territories. However, the role of geographic and environmental factors at both regional and urban levels are least exploited. Hence, many analyses of mortality in Africa have concentrated more on formal statistical materials and not on the realities of the existing ecological and environmental situation. The paper calls on geographers to exploit ways of utilizing the enormous clinic-based data in the continent. However, even more can be accomplished when geographers conduct interdisciplinary research on mortality in Africa.

Geographical inequalities in mortality in Latin America

This paper is an attempt to synthesize several models of health and levels of affluence in Latin America. An analysis is accomplished wherein various countries and regions of Latin America are classified for health purposes as either products of a poverty model or a wealth model. Variables utilized include: mortality rates in preschool children and infants; elderly mortality; life expectancy; and overall causes of death. All three of the general models can be found in different parts of Latin America. More developed countries and regions tend to approximate the wealth model where chronic and degenerative diseases dominate. Still, while life expectations are shorter in countries and regions with lower levels of development, some elderly are afflicted by chronic and degenerative diseases.