Mortality In Municipalities Research Articles

Radón residencial y cáncer de pulmón. Un estudio ecológico en Galicia

Background and objectiveResidential radon is the second cause of lung cancer and the first in never smokers. Galicia is a high radon emission area. The objective of this study is to analyze the relationship between municipal lung cancer mortality and residential radon in Galician municipalities. Material and methodWe performed an ecologic study including 192 municipalities with at least 3 residential radon measurements. The observed number of lung cancer deaths was obtained from the Galician Mortality Registry. Afterwards, we calculated the standardized mortality ratios (SMRs) of lung cancer for males and females for the period comprising 1980-2009. Median municipal residential radon concentrations were correlated with lung cancer SMRs. ResultsMedian residential radon concentration for the included municipalities was 75Bq/m3, with an interquartile range of 40.7 to 154Bq/m3. The correlation between lung cancer SMRs and municipal radon concentration was statistically significant for males (P=.023) whereas it did not reach statistical significance for females (P=.087). ConclusionThere exists an association between municipal residential radon and lung cancer mortality in Galicia for males, though for women the association is not statistically significant. These results suggest that residential radon could raise the risk of lung cancer in males, though for females no association is evident.

Do unequal societies cause death among the elderly? A study of the health effects of inequality in Swedish municipalities in 2006

Background: A lively public and academic debate has highlighted the potential health risks of living in regions characterized by inequality. Research provides an ambiguous picture, however, with positive association between income equality and health mainly being found on higher levels of geographical division, such as nations, but rarely at local level.Methods: We examined the association between income inequality (using the Gini coefficient) and all-cause mortality in Swedish municipalities in the 65–74 age group. A multi-level analysis was applied and controlled for by variables including individual income and average income level in the municipality. The analyses were based on individual register data on all residents born between 1932 and 1941, outcomes were measured for the year 2006.Results: Lower individual income and lower average income in the municipality of residence were associated with significantly increased mortality. We found an association between income inequality and mortality with excessive deaths in unequal municipalities after controlling for mean income level and personal income. The results from the analysis of individual data differed substantially from the analysis of aggregate data.Conclusions: Income inequality was significantly associated with mortality in the age group 65–74 at municipality level. The association is small compared to many other variables, but is not negligible. Even in a comparatively equal society like Sweden, the potential effects of income inequality on mortality at the local level warrant consideration.

Desigualdades socioeconómicas y mortalidad infantil en Bolivia

To evaluate socioeconomic inequalities and its relation to infant mortality in Bolivia's municipalities in 2001. An ecological study based on data from the 2001 National Census on Population and Housing (Censo Nacional de Población y Vivienda) covering the 327 municipalities in Bolivia's nine departments. The dependent variable was the infant mortality rate (IMR); the independent variables were indirect socioeconomic indicators (the percentage of illiterates older than 15 years of age, and the building materials and sanitation features of the houses). The geographic distribution of each indicator was determined and the associations between IMR and each socioeconomic indicator were calculate using Spearman's rank correlation coefficient and adjusted with Poisson regression models. The resulting IMR for Bolivia in 2001 was 67 per 1000 live births. Rates ranged from <0.1 per 1000 live births in the Magdalena municipality, Beni department, to 170.0 per 1000 live births in the Caripuyo municipality, Potosí department. The mean rate of illiteracy per municipality was 17.5%; the mean percentage of houses without running water was 90.4%, and for those lacking sanitation services, 67.6%. The IMR was inversely associated with all of the socioeconomic indicators studied. The highest relative risk was found in housing without sanitation services. Multifactorial models adjusted for illiteracy showed that the following indicators were still strongly associated with the IMR: no sanitation services (Relative risk (RR)=1.54; 95% Confidence Interval (95%CI)=1.38-1.66); adobe, stone, or mud walls (RR=1.54; 95%CI: 1.43-1.67); and, corrugated metal, straw, or palm branch roof (RR=1.34; 95%CI: 1.26-1.43). A significant association was found between poor socioeconomic status and high IMR in Bolivia's municipalities in 2001. The municipalities in the country's central and southeastern areas had lower socioeconomic status and higher IMR. The lack of education, absence of basic sanitation, and precarious housing conditions were key factors that tripled the risk of death.

Income distribution and mortality in Sweden

Background: The hypothesis that a high income inequality on a societal level is associated with poor healthoutcomes has been both rejected and accepted in empirical studies. Whether the influence of economiccircumstances on health operates at the individual level or societal level has important implications on policyand intervention alternatives. The objective of this study was to analyse the relationship between incomeinequality and mortality in Swedish municipalities and if the relationship varies depending on the meanincome or on the time-lag between income inequality and mortality.Methods: The study was based on register data on mean income and income inequality (Gini coefficients)from Statistics Sweden 1982 and 1998, aggregated on the municipality level. Data on age-standardised deathrates per 100,000 persons were obtained for 1983, 1988, 1993, 1998 and 2002. The analysis on 1998 was atest of the robustness of the results.Results: The relationship between high income inequality in 1982 and mortality in 1983 was negative with asimilar relationship in 1998. Using latency periods, the results show a decreasing trend of mortality in relationto higher Gini coefficients. A positive relationship between Gini and mean income implies that municipalitieswith larger income distribution also had a higher mean income and vice versa.Conclusions: High income inequality does not have a negative effect on mortality in Swedish municipalities.The municipalities with high income inequality have also high mean income as opposed to many othercountries. The income level seems to be more substantial for mortality than the income inequality.

Impact of the Family Health Program on Infant Mortality in Brazilian Municipalities

We evaluated the effects of the Family Health Program (FHP), a strategy for reorganization of primary health care at a nationwide level in Brazil, on infant mortality at a municipality level. We collected data on FHP coverage and infant mortality rates for 771 of 5561 Brazilian municipalities from 1996 to 2004. We performed a multivariable regression analysis for panel data with a negative binomial response by using fixed-effects models that controlled for demographic, social, and economic variables. We observed a statistically significant negative association between FHP coverage and infant mortality rate. After we controlled for potential confounders, the reduction in the infant mortality rate was 13.0%, 16.0%, and 22.0%, respectively for the 3 levels of FHP coverage. The effect of the FHP was greater in municipalities with a higher infant mortality rate and lower human development index at the beginning of the study period. The FHP had an important effect on reducing the infant mortality rate in Brazilian municipalities from 1996 to 2004. The FHP may also contribute toward reducing health inequalities.

Morbidity and mortality in Brazilian municipalities: a multilevel study of the association between socioeconomic and healthcare indicators

Socioeconomic and healthcare indicators are major determinants of health outcomes. The impact of social and healthcare inequalities on Brazilian morbidity and mortality indicators is of concern but it is not well studied. A multilevel ecological study was performed in order to investigate the association between a set of socioeconomic and healthcare indicators and five morbidity and mortality outcomes. Datasets were presented at three hierarchical levels: local (lower level), regional (intermediate level) and state (higher level). A Poisson regression model was estimated for each outcome with random intercept and fixed regression coefficients for independent variables at the three levels. The magnitude of outcome variability at intermediate and higher levels was assessed for all models. All outcomes were associated with both socioeconomic and healthcare variables, with predominance of associations at the local level. General and high-complexity healthcare infrastructures were directly associated with indicators related to later stages of the demographic and epidemiological transition process. A mild effect on morbidity and mortality related to political voting patterns was found at the local level. Healthcare conditions and socioeconomic indicators are associated with health outcomes in a complex way at the local level in Brazil, but part of the variability of health outcomes is related to factors operating at higher levels. Some possible interaction effects and cross-sectional design limitations of this study must be considered.

The UPA (underprivileged area) score and mortality in Swedish municipalities

Objective - To analyse the association between the Swedish underprivileged area (UPA) score and the standardized mortality ratio in Swedish municipalities.Setting - All 284 municipalities in Sweden. Design - The UPA-score was calculated for municipalities using the proportion of persons in the following groups: elderly persons living alone, children under five, persons in one-parent families, unskilled (SEI 1), unemployed, persons living in crowded households, those who have moved house in the last year, and persons of minority ethnic origin. After transformation (arc sin) and standardization, each of the eight variables was weighted by the UK general practitioners' average weighting and added to give a composite index of socioeconomic deprivation - the UPA-score. The strength of the relationship between the UPA-score and premature mortality in Sweden was investigated by regression analysis using SMR, for people aged 20-64 years, 1989-93, as the dependent variable.Results - The mean UPA-score (standard deviation) of the 284 municipalities was 0 (10.0) and the range -43 to 28. The mean SMR for all persons was 1 and the range 0.46 to 1.81. The association between UPA-score and SMR was statistically significant and the UPA-score explained 20% of the variation between municipalities in SMR.Conclusion - The range of social deprivation at the municipality level in Sweden, as measured by a composite index such as the UPA score, is wide. A two-fold variation at municipality level was also found in premature mortality. There was a significant association between high rates of mortality and social deprivation.

Relationship between water hardness and coronary mortality in Taiwan.

A number of studies carried out in other countries have shown the existence of negative correlations between coronary mortality and the hardness of water supplies. Data on water hardness throughout Taiwan have been collected from Taiwan Water Supply Corporation (TWSC) to examine the ecological correlation between deaths from coronary disease (1981-1990) and total hardness in drinking water. Analysis demonstrates a significant negative association between drinking water hardness and coronary mortality. After adjustment for the urbanization index, coronary mortality in municipalities with soft water was estimated to be 9.6% higher than that in municipalities with hard water. The weighted multivariate-adjusted regression coefficient indicated a decrease of 0.053 in standardized mortality ratios (SMRs) for every 100 mg/L increase in total hardness in drinking water after allowing for the urbanization condition.