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. 1999 Jul;53(7):423–431. doi: 10.1136/jech.53.7.423

Geographical patterns of excess mortality in Spain explained by two indices of deprivation

J Benach, Y Yasui
PMCID: PMC1756931  PMID: 10492736

Abstract

STUDY OBJECTIVE: To analyse the geographical patterns and the magnitude of the association between deprivation and mortality in Spain. To estimate the excess of mortality in more deprived areas of the country by region. DESIGN: Cross sectional ecological study using 1991 census variables and mortality data for 1987-1992. SETTING: 2220 small areas in Spain. MAIN RESULTS: A geographical gradient from north east to south west was shown by both mortality and deprivation levels in Spain. Two dimensions of deprivation (that is, Index 1 and Index 2) obtained by exploratory factor analysis using four census indicators were found to predict mortality: mortality over 65 years of age was more associated with Index 1, while mortality under 65 years of age was more associated with Index 2. Excess mortality in the most deprived areas accounted for about 35,000 deaths. CONCLUSIONS: Two indices of deprivation strongly predict mortality in two age groups. Excess number of deaths in the most deprived geographical areas account for 10% of total number of deaths annually. In Spain there is great potential for reducing mortality if the excess risk in more deprived areas fell to the level of the most affluent areas.

 

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Selected References

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  1. Angell M. Privilege and health--what is the connection? N Engl J Med. 1993 Jul 8;329(2):126–127. doi: 10.1056/NEJM199307083290210. [DOI] [PubMed] [Google Scholar]
  2. Arias A., Rebagliato M., Palumbo M. A., Bellver R., Ashton J., Colomer C., Costa J., Flynn P., Alvarez-Dardet C. Desigualdades en salud en Barcelona y Valencia. Med Clin (Barc) 1993 Feb 27;100(8):281–287. [PubMed] [Google Scholar]
  3. Ben-Shlomo Y., White I. R., Marmot M. Does the variation in the socioeconomic characteristics of an area affect mortality? BMJ. 1996 Apr 20;312(7037):1013–1014. doi: 10.1136/bmj.312.7037.1013. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Borrell C., Arias A. Socioeconomic factors and mortality in urban settings: the case of Barcelona, Spain. J Epidemiol Community Health. 1995 Oct;49(5):460–465. doi: 10.1136/jech.49.5.460. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Carstairs V. Deprivation indices: their interpretation and use in relation to health. J Epidemiol Community Health. 1995 Dec;49 (Suppl 2):S3–S8. doi: 10.1136/jech.49.suppl_2.s3. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Carstairs V., Morris R. Deprivation: explaining differences in mortality between Scotland and England and Wales. BMJ. 1989 Oct 7;299(6704):886–889. doi: 10.1136/bmj.299.6704.886. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Clayton D., Kaldor J. Empirical Bayes estimates of age-standardized relative risks for use in disease mapping. Biometrics. 1987 Sep;43(3):671–681. [PubMed] [Google Scholar]
  8. Eames M., Ben-Shlomo Y., Marmot M. G. Social deprivation and premature mortality: regional comparison across England. BMJ. 1993 Oct 30;307(6912):1097–1102. doi: 10.1136/bmj.307.6912.1097. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Factor R. M., Waldron I. Contemporary population densities and human health. Nature. 1973 Jun 15;243(5407):381–384. doi: 10.1038/243381a0. [DOI] [PubMed] [Google Scholar]
  10. Folwell K. Single measures of deprivation. J Epidemiol Community Health. 1995 Dec;49 (Suppl 2):S51–S56. doi: 10.1136/jech.49.suppl_2.s51. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Gordon D. Census based deprivation indices: their weighting and validation. J Epidemiol Community Health. 1995 Dec;49 (Suppl 2):S39–S44. doi: 10.1136/jech.49.suppl_2.s39. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Gove W. R., Hughes M., Galle O. R. Overcrowding in the home: an empirical investigation of its possible pathological consequences. Am Sociol Rev. 1979 Feb;44(1):59–80. [PubMed] [Google Scholar]
  13. Krieger N., Williams D. R., Moss N. E. Measuring social class in US public health research: concepts, methodologies, and guidelines. Annu Rev Public Health. 1997;18:341–378. doi: 10.1146/annurev.publhealth.18.1.341. [DOI] [PubMed] [Google Scholar]
  14. Lemkow L. Socio-economic status differences in health. Soc Sci Med. 1986;22(11):1257–1262. doi: 10.1016/0277-9536(86)90192-9. [DOI] [PubMed] [Google Scholar]
  15. Mackenbach J. P., Kunst A. E., Cavelaars A. E., Groenhof F., Geurts J. J. Socioeconomic inequalities in morbidity and mortality in western Europe. The EU Working Group on Socioeconomic Inequalities in Health. Lancet. 1997 Jun 7;349(9066):1655–1659. doi: 10.1016/s0140-6736(96)07226-1. [DOI] [PubMed] [Google Scholar]
  16. Mackenbach J. P., Kunst A. E., Looman C. W. Cultural and economic determinants of geographical mortality patterns in The Netherlands. J Epidemiol Community Health. 1991 Sep;45(3):231–237. doi: 10.1136/jech.45.3.231. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Mantel N., Stark C. R. Computation of indirect-adjusted rates in the presence of confounding. Biometrics. 1968 Dec;24(4):997–1005. [PubMed] [Google Scholar]
  18. McCarron P. G., Smith G. D., Womersley J. J. Deprivation and mortality in Glasgow: changes from 1980 to 1992. BMJ. 1994 Dec 3;309(6967):1481–1482. doi: 10.1136/bmj.309.6967.1481. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. McLoone P., Boddy F. A. Deprivation and mortality in Scotland, 1981 and 1991. BMJ. 1994 Dec 3;309(6967):1465–1470. doi: 10.1136/bmj.309.6967.1465. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Morris R., Carstairs V. Which deprivation? A comparison of selected deprivation indexes. J Public Health Med. 1991 Nov;13(4):318–326. [PubMed] [Google Scholar]
  21. Phillimore P., Beattie A., Townsend P. Widening inequality of health in northern England, 1981-91. BMJ. 1994 Apr 30;308(6937):1125–1128. doi: 10.1136/bmj.308.6937.1125. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Sloggett A., Joshi H. Higher mortality in deprived areas: community or personal disadvantage? BMJ. 1994 Dec 3;309(6967):1470–1474. doi: 10.1136/bmj.309.6967.1470. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Wilkinson R. G. "Variations" in health. BMJ. 1995 Nov 4;311(7014):1177–1178. doi: 10.1136/bmj.311.7014.1177. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Wilkinson R. G. Divided we fall. BMJ. 1994 Apr 30;308(6937):1113–1114. doi: 10.1136/bmj.308.6937.1113. [DOI] [PMC free article] [PubMed] [Google Scholar]

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