Gradient In Mortality Research Articles

Income-Related Mortality Inequalities and Its Social Factors among Middle-Aged and Older Adults at the District Level in Aging Seoul: An Ecological Study Using Administrative Big Data.

This study investigated income-related health inequality at sub-national level, focusing on mortality inequality among middle-aged and older adults (MOAs). Specifically, we examined income-related mortality inequality and its social factors among MOAs across 25 districts in Seoul using administrative big data from the National Health Insurance Service (NHIS). We obtained access to the NHIS’s full-population micro-data on both incomes and demographic variables for the entire residents of Seoul. Slope Index of Inequality (SII) and Relative Index of Inequality (RII) were calculated. The effects of social attributes of districts on SIIs and RIIs were examined through ordinary least squares and spatial regressions. There were clear income-related mortality gradients. Cross-district variance of mortality rates was greater among the lowest income group. SIIs were smaller in wealthier districts. Weak spatial correlation was found in SIIs among men. Lower RIIs were linked to lower Gini coefficients of income for both genders. SIIs (men) were associated with higher proportions of special occupational pensioners and working population. Lower SIIs and RIIs (women) were associated with higher proportions of female household heads. The results suggest that increasing economic activities, targeting households with female heads, reforming public pensions, and reducing income inequality among MOAs can be good policy directions.

Inequalities in excess premature mortality in England during the COVID-19 pandemic: a cross-sectional analysis of cumulative excess mortality by area deprivation and ethnicity

ObjectivesTo examine magnitude of the impact of the COVID-19 pandemic on inequalities in premature mortality in England by deprivation and ethnicity.DesignA statistical model to estimate increased mortality in population subgroups...

Are we really all in this together? The social patterning of mortality during the first wave of the COVID-19 pandemic in Belgium

BackgroundBelgium was one of the countries that was struck hard by COVID-19. Initially, the belief was that we were ‘all in it together’. Emerging evidence showed however that deprived socioeconomic groups suffered disproportionally. Yet, few studies are available for Belgium. The main question addressed in this paper is whether excess mortality during the first COVID-19 wave followed a social gradient and whether the classic mortality gradient was reproduced.MethodsWe used nationwide individually linked data from the Belgian National Register and the Census 2011. Age-standardized all-cause mortality rates were calculated during the first COVID-19 wave in weeks 11-20 in 2020 and compared with the rates during weeks 11-20 in 2015-2019 to calculate absolute and relative excess mortality by socioeconomic and -demographic characteristics. For both periods, relative inequalities in total mortality between socioeconomic and -demographic groups were calculated using Poisson regression. Analyses were stratified by age, gender and care home residence.ResultsExcess mortality during the first COVID-19 wave was high in collective households, with care homes hit extremely hard by the pandemic. The social patterning of excess mortality was rather inconsistent and deviated from the usual gradient, mainly through higher mortality excesses among higher socioeconomic groups classes in specific age-sex groups. Overall, the first COVID-19 wave did not change the social patterning of mortality, however. Differences in relative inequalities between both periods were generally small and insignificant, except by household living arrangement.ConclusionThe social patterning during the first COVID-19 wave was exceptional as excess mortality did not follow the classic lines of higher mortality in lower classes and patterns were not always consistent. Relative mortality inequalities did not change substantially during the first COVID-19 wave compared to the reference period.

Inequality in the Face of Death: The Income Gradient in Mortality of the Spanish Pre-Recession Working-Age Population.

The purpose of this paper is to evaluate the association between socioeconomic status (SES) and mortality over a three-year period for working-age Spaniards (2007–2009), paying particular attention to the effect of income level. The analysis is relatively new in Spain, and the studies are limited. Neither income nor wealth are included in existing Spanish mortality studies. The main reason for this limitation is the nature of the data sets used, mainly Census Records. We overcome this problem by using data on 693,994 individuals taken from a Social Security sampling and used to estimate the probabilities of death for each income decile and the mortality rate ratios in three different models: (1) using only income, controlled by age and sex, (2) adding socio-economic and geographical variables, and (3) adding level of education. However, the data used here also have some limitations. They do not include government employees, the military or the Department of Justice personnel, whose exclusion we believe causes an under-representation of highly educated people in our sample. The results confirm that there is a non-linear relationship between mortality and income. This non-linear relationship implies that income redistribution resulting from progressive taxation systems could lead to higher reductions in mortality for low-income groups than the reductions induced in the mortality of the high-income population, thus reducing overall mortality.

The income gradient in COVID-19 mortality and hospitalisation: An observational study with social security administrative records in Mexico

BackgroundThe COVID-19 pandemic revealed large structural inequalities that led to disparities in health outcomes related to socioeconomic status. So far, most of the evidence is based on aggregated data or simulations with individual data, which point to various possible mechanisms behind the association. To date, there have been no studies regarding an income gradient in COVID-19 mortality based on individual-level data and adjusting for comorbidities or access to healthcare.MethodsIn this paper, we use linked employee-patient data for patients tested for COVID-19 at the Mexican Institute of Social Security. We estimate the association of the probability of dying with income centiles, using a probit estimation and adjusting for COVID-19 diagnosis, sociodemographic variables, and comorbidities.FindingsAfter controlling for all these variables, we find that persons in the lowest income decile still had a probability of dying from COVID-19 five times greater than those at the top decile.InterpretationOur results imply that the association between income and COVID outcomes is not explained by the prevalence of comorbidities or by a lack of access to healthcare among the low-income population.FundingThis study was not supported by any external funding source.

A poorly understood disease? The impact of COVID-19 on the income gradient in mortality over the course of the pandemic

Mortality inequalities remain substantial in many countries, and large shocks such as pandemics could amplify them further. The unequal distribution of COVID-19 confirmed cases suggests that this is the case. Yet, evidence on the causal effect of the epidemic on mortality inequalities remains scarce. In this paper, we exploit exhaustive municipality-level data in France, one of the most severely hit country in the world, to identify a negative relationship between income and excess mortality within urban areas, that persists over COVID-19 waves. Over the year 2020, the poorest municipalities experienced a 30% higher increase in excess mortality. Our analyses can rule out an independent contribution of lockdown policies to this heterogeneous impact. Finally, we find evidence that both labor-market exposure and housing conditions are major determinants of the epidemic-induced effects of COVID-19 on mortality inequalities, but that their respective role depends on the state of the epidemic.

Spatial disparities in mortality by causes of death in the Republic of Moldova

Background: Previous studies have shown long-term unfavourable changes in mortality in the Republic of Moldova accompanied by recent improvements. Little is known about the regional mortality differentiation which is an important tool for evidence-based public health policy. The aim of the study is to assess the current geographical disparities of all-cause and cause-specific mortality in Moldova and to identify evidence-based modalities to reduce them. Material and methods: This cross-sectional study is based on the corrected results of the 2014 census and individual death records for the 2012-2016 period provided by the National Agency for Public Health. Global Moran’s index and local indicators of spatial autocorrelation were computed based on contiguity matrix. Results: All-cause mortality gradient between the northern and central regions was found for males (Moran’s index=0.47, p<0.001) and females (Moran’s index=0.44, p<0.001). Digestive and cardiovascular diseases for both sexes and external causes of death for males had a statistically significant influence on the inter-regional mortality differentiation. Liver cirrhosis contributed the most to the geographical difference between the North and the Centre (Moran’s index=0.59, p<0.001), especially for females. Conclusions: The results of this study point to the existence of different drinking habits of the Moldovan population between the northern and central regions. The central regions that form the cluster of “high-high” mortality from liver cirrhosis should be considered as primarily targets for antialcohol policies

Immunopathology and Immunosenescence, the Immunological Key Words of Severe COVID-19. Is There a Role for Stem Cell Transplantation?

The outcomes of Coronavirus disease-2019 (COVID-19) vary depending on the age, health status and sex of an individual, ranging from asymptomatic to lethal. From an immunologic viewpoint, the final severe lung damage observed in COVID-19 should be caused by cytokine storm, driven mainly by interleukin-6 and other pro-inflammatory cytokines. However, which immunopathogenic status precedes this “cytokine storm” and why the male older population is more severely affected, are currently unanswered questions. The aging of the immune system, i.e., immunosenescence, closely associated with a low-grade inflammatory status called “inflammageing,” should play a key role. The remodeling of both innate and adaptive immune response observed with aging can partly explain the age gradient in severity and mortality of COVID-19. This review discusses how aging impacts the immune response to the virus, focusing on possible strategies to rejuvenate the immune system with stem cell-based therapies. Indeed, due to immunomodulatory and anti-inflammatory properties, multipotent mesenchymal stem cells (MSCs) are a worth-considering option against COVID-19 adverse outcomes.

1042Trends in area-level socioeconomic inequalities of lung cancer mortality by age group in Japan: 1995-2014

Abstract Background During the long-term economic recession, health inequalities have been concerned in Japan. Among cancer mortality rates, the widest socioeconomic inequalities of municipal mortality was observed in lung cancer. Our aim was to examine the trends in the inequality by sex and age group. Methods We used the areal deprivation index (ADI) to determine area-level socio-economic position at the municipality level. We calculated age-standardised lung cancer mortality rate by sex, age group (<60/60-74/75+) and ADI quintile group using the vital statistics data. Joinpoint regression models were applied to estimate the average annual percentage changes for the last five years. We also calculated absolute index and relative index of inequalities. Results Among men, a clear socioeconomic gradient in lung cancer mortality was observed for all age groups, but among women, ‘J-shape’ gradients in which Q2 or Q3 had the lowest mortality were observed. For women aged 60-74 years, increasing trends of mortality were observed in more deprived groups (Q3-Q5). Men over 75 years showed noticeably decreasing trends in mortality, while women showed no decrease. Absolute inequalities in women were smaller than those in men, but relative inequalities showed widening trends for all age groups. Conclusions We identified widening area-level gaps in all age groups and stable/increasing trends in lung cancer mortality of the 60-74 year age group. Key messages It is important to monitor mortality trends and their gaps of lung cancer mortality among deprivation groups to identify vulnerable subpopulations in order to help tackle the health inequalities.

The Income Gradient in Mortality during the Covid-19 Crisis: Evidence from Belgium

We use population-wide data from linked administrative registers to study the distributional pattern of mortality before and during the first wave of the Covid-19 pandemic in Belgium. Over the March-May 2020 study period, excess mortality is only found among those aged 65 and over. For this group, we find a significant negative income gradient in excess mortality, with excess deaths in the bottom income decile more than twice as high as in the top income decile for both men and women. However, given the high inequality in mortality in normal times, the income gradient in all-cause mortality is only marginally steeper during the peak of the health crisis when expressed in relative terms. Leveraging our individual-level data, we gauge the robustness of our results for other socioeconomic factors and decompose the role of individual vs. local effects. We provide direct evidence that geographic location effects on individual mortality are particularly strong during the first wave of the Covid-19 pandemic, channeling through the local number of Covid infections. This makes inference about the income gradient in excess mortality based on geographic variation misguided.

Geographical risk of fatal and non-fatal injuries among adults in Norway

Introduction: A rural gradient in trauma mortality disfavoring remote inhabitants is well known. Previous studies have shown higher risk of traumatic deaths in rural areas in Norway, combined with a paradoxically decreased prevalence of non-fatal injuries. We investigated the risk of fatal and severe non-fatal injuries among all adults in Norway during 2002–2016.Methods: All traumatic injuries and deaths among persons with a residential address in Norway from 2002–2016 were included. Data were collected from the Norwegian National Cause of Death Registry and the Norwegian Patient Registry. All cases were stratified into six groups of centrality based on Statistics Norway's classification system, from most urban (group one) to least urban/most rural (group six). Mortality and injury rates were calculated per 100,000 inhabitants per year.Results: The mortality rate differed significantly among the centrality groups (p<0.05). The rate was 64.2 per 100,000 inhabitants/year in the most urban group and 78.6 per 100,000 inhabitants/year in the most rural group. The lowest mortality rate was found in centrality group 2 (57.9 per 100,000 inhabitants/year). For centrality group 6 versus group 2, the risk of death was increased (relative risk, 1.36; 95%CI: 1.11–1.66; p<0.01). The most common causes of death were transport injury, self-harm, falls, and other external causes. The steepest urban–rural gradient was seen for transport injuries, with a relative risk of 3.32 (95%CI: 1.81-6.10; p<0.001) for group 6 compared with group 1. There was a significantly increasing risk for severe non-fatal injuries from urban to rural areas. Group 2 had the lowest risk for non-fatal injuries (1531 per 100,000 inhabitants/year) and group 6 the highest (1803 per 100,000 inhabitants/year). The risk for non-fatal injuries increased with increasing rurality, with a relative risk of 1.07 (95%CI: 1.02–1.11; p<0.01) for group 6 versus group 1.Conclusions: Fatal and non-fatal injury risks increased in parallel with increasing rurality. The lowest risk was in the second most urban region, followed by the most urban (capital) region, yielding a J-shaped risk curve. Transport injuries had the steepest urban–rural gradient.

Windthrows promote higher diversity of saproxylic beetles (Coleoptera: Passalidae) in a Central Amazon forest

Abstract Natural disturbances change environmental conditions that play an important role in controlling biodiversity. Large‐scale windthrows (i.e. snapped and uprooted trees) promoted by convective systems cause severe tree mortality and can alter the dynamics of several insect taxons in forests. We assessed the effect of large‐scale windthrows resulting from a squall line event in January 2005 on strictly saproxylic beetle assemblages in Central Amazonia. Using a paired sampling design comparing windthrown and old‐growth forest, we investigated the responses of different metrics of Passalidae diversity (richness, abundance and composition). We found a higher richness and abundance of species in windthrown areas compared with old‐growth forest, and a correlation between species composition and the tree mortality gradient. Differences in the richness and composition of the Passalidae assemblage between disturbed and old‐growth forest suggest that the tree mortality gradient created by windthrows promotes the diversity of saproxylic beetles in Central Amazonia.

The Socioeconomic Gradient in Epigenetic Ageing Clocks: Evidence from the Multi-Ethnic Study of Atherosclerosis and the Health and Retirement Study

ABSTRACT Epigenetic clocks have been widely used to predict disease risk in multiple tissues or cells. Their success as a measure of biological ageing has prompted research on the connection between epigenetic pathways of ageing and the socioeconomic gradient in health and mortality. However, studies examining social correlates of epigenetic ageing have yielded inconsistent results. We conducted a comprehensive, comparative analysis of associations between various dimensions of socioeconomic status (SES) (education, income, wealth, occupation, neighbourhood environment, and childhood SES) and eight epigenetic clocks in two well-powered US ageing studies: The Multi-Ethnic Study of Atherosclerosis (MESA) (n = 1,211) and the Health and Retirement Study (HRS) (n = 4,018). In both studies, we found robust associations between SES measures in adulthood and the GrimAge and DunedinPoAm clocks (Bonferroni-corrected p-value < 0.01). In the HRS, significant associations with the Levine and Yang clocks were also evident. These associations were only partially mediated by smoking, alcohol consumption, and obesity, which suggests that differences in health behaviours alone cannot explain the SES gradient in epigenetic ageing in older adults. Further analyses revealed concurrent associations between polygenic risk for accelerated intrinsic epigenetic ageing, SES, and the Levine clock, indicating that genetic risk and social disadvantage may contribute additively to faster biological aging.

Modeling Community Health with Areal Data: Bayesian Inference with Survey Standard Errors and Spatial Structure.

Epidemiologists and health geographers routinely use small-area survey estimates as covariates to model areal and even individual health outcomes. American Community Survey (ACS) estimates are accompanied by standard errors (SEs), but it is not yet standard practice to use them for evaluating or modeling data reliability. ACS SEs vary systematically across regions, neighborhoods, socioeconomic characteristics, and variables. Failure to consider probable observational error may have substantial impact on the large bodies of literature relying on small-area estimates, including inferential biases and over-confidence in results. The issue is particularly salient for predictive models employed to prioritize communities for service provision or funding allocation. Leveraging the tenets of plausible reasoning and Bayes’ theorem, we propose a conceptual framework and workflow for spatial data analysis with areal survey data, including visual diagnostics and model specifications. To illustrate, we follow Krieger et al.’s (2018) call to routinely use the Index of Concentration at the Extremes (ICE) to monitor spatial inequalities in health and mortality. We construct and examine SEs for the ICE, use visual diagnostics to evaluate our observational error model for the ICE, and then estimate an ICE–mortality gradient by incorporating the latter model into our model of sex-specific, midlife (ages 55–64), all-cause United States county mortality rates. We urge researchers to consider data quality as a criterion for variable selection prior to modeling, and to incorporate data reliability information into their models whenever possible.

Analysis of factors contributing to occupational health inequality in Korea: a cross-sectional study using nationally representative survey data

BackgroundDespite the consensus that higher occupational classes tend to have better health and lower mortality rates, one study has reported reversed occupational gradients in mortality rates among Korean men after the economic crisis in the late 2000s. To examine these patterns of health inequality in more detail, we investigated the tendency of occupational gradients in socioeconomic position and multiple pathway indicators known to affect mortality in Korea.MethodsWe used data from 4176 men aged 35–64 in Korea derived from the 2007–2009 and 2013–2015 Korean National Health and Nutrition Examination Surveys. We compared the age-standardized prevalence and age-adjusted mean values of each contributing factor to health inequality among occupational groups, which are divided into upper non-manual workers, lower non-manual workers, manual workers, and others. Contributing factors included childhood and adulthood socioeconomic position indicators, biological risk factors, health behaviors, psychosocial factors, and work environment.ResultsUpper non-manual workers had prominently higher levels of education, income, parental education, and economic activity than lower non-manual and manual workers. The rates of smoking and high-risk alcohol consumption were lower, and the rate of weight control activities was higher, in the non-manual classes. Further, the rates of depression and suicidal ideation were lower, and perceptions of the work environment were more favorable, among non-manual workers than among their manual counterparts.ConclusionsWe detected occupational inequality in a wide range of socioeconomic positions and pathway indicators in Korea with consistently favorable patterns for upper non-manual workers. These occupational gradients do not support the previously reported reversed pattern of higher mortality rates in non-manual groups versus in the manual job class in Korea.

The Importance of Education for Middle- and Old-Age Mortality in Chile: Estimates From Panel Data Linked to Death Records.

To examine the association between education and mortality by age and gender in Chile. We drew data from 10,147 adults aged 40years and over from the Chilean Social Protection Survey linked to the national death records. We specify five Cox regression models to estimate the main and interaction effects for education levels, age, sex, and mortality. The hazard ratios reduce with increasing education. Secondary and tertiary education levels are associated, respectively, with 34% and 41% lower hazard rates than 0-4years of schooling. Also, the educational gradient in mortality is significantly weaker at older ages, and it does not differ by gender. Our findings endorse the negative association of formal education with adult mortality, uncovering Chile's structural problems despite the economic improvements underway. It also corroborates the importance of novel longitudinal data for mortality analyses in Latin America.

Coral reef resilience differs among islands within the Gulf of Mannar, southeast India, following successive coral bleaching events

We used a 12-yr data set of benthic cover (2005–2017), spanning two bleaching events, to assess changes in benthic cover and coral community composition along 21 islands within Gulf of Mannar (GoM), southeast India. Overall, between 2005 and 2017 reefs had a simultaneous decrease in relative coral cover (avg. = − 36%) and increase in algal cover (avg. = + 45%). Changes in benthic cover were not consistent among islands, ranging from − 34 to + 5% for coral cover and from − 0.3 to + 50% for algae. There was a spatial gradient in coral mortality, which increased among islands from west to east. However, there was a disconnect between coral loss and subsequent increases in algae. Algal cover increased more on islands in west GoM where coral loss was minimal. Environmental co-factors (coral cover, percent bleaching, degree heating weeks, fish densities, Chl-a, pollution) explained > 50% of the benthic cover responses to successive bleaching. Coral survival was favored on islands with higher fish densities and chlorophyll-a levels, and increases in algal cover were associated with higher measures of pollution from terrestrial runoff. Coral morphotypes differed in their response following successive bleaching resulting in changes in the relative abundance of different coral morphotypes. Existing climate projections (RCP8.5) indicate a 22-yr gap in the onset of annual severe bleaching (ASB) for reefs in the east versus west GoM, and ASB was ameliorated for all reefs under the RCP4.5 projections. There is limited knowledge of the resilience of GoM reefs, and this study identifies coral morphotypes and reefs that are most likely to recover or decline from successive bleaching, in the context of forecasts of the frequency of future bleaching events in GoM.

COVID-19 Mortality in English Neighborhoods: The Relative Role of Socioeconomic and Environmental Factors

Factors underlying neighborhood variation in COVID-19 mortality are important to assess in order to prioritize resourcing and policy intervention. As well as characteristics of area populations, such as health status and ethnic mix, it is important to assess the role of more specifically environmental variables (e.g., air quality, green space access). The analysis of this study focuses on neighborhood mortality variations during the first wave of the COVID-19 epidemic in England against a range of postulated area risk factors, both socio-demographic and environmental. We assess mortality gradients across levels of each risk factor and use regression methods to control for multicollinearity and spatially correlated unobserved risks. An analysis of spatial clustering is based on relative mortality risks estimated from the regression. We find mortality gradients in most risk factors showing appreciable differences in COVID mortality risk between English neighborhoods. A regression analysis shows that after allowing for health deprivation, ethnic mix, and ethnic segregation, environment (especially air quality) is an important influence on COVID mortality. Hence, environmental influences on COVID mortality risk in the UK first wave are substantial, after allowing for socio-demographic factors. Spatial clustering of high mortality shows a pronounced metropolitan-rural contrast, reflecting especially ethnic composition and air quality.

Social deprivation as a risk factor for COVID-19 mortality among women and men in the UK Biobank: nature of risk and context suggests that social interventions are essential to mitigate the effects of future pandemics

ObjectivesTo investigate sex differences in the effects of social deprivation on COVID-19 mortality and to place these effects in context with other diseases.DesignProspective population-based study.SettingUK Biobank.Participants501 865 participants (54% women).Main...

Thermographic visualization of facial vasoconstriction is associated with 30-day all-cause mortality in medical patients; prospective observational two-site cohort study

Introduction: Quick and reliable assessment of acute patients is required for accurate triage. The temperature gradient between core and peripheral temperature could possibly instantly provide information on circulatory status. Methods: Adult medical patients, who did not receive supplementary oxygen, attending two emergency departments, had a thermographic image taken on arrival. The association between 30-day mortality and gradients was tested using logistic regression. Results: 726 patients were studied, median age was 64 years and 14 (1.9%) died within 30 days. There was a significant association between mortality and temperature gradient, comparable to vital signs, age, and clinical intuition. Conclusion: Temperature gradient between nose and eye had an acceptable discriminatory power for 30-day all-cause mortality.