Skip to main content
NCBI home page
Journal of Urban Health : Bulletin of the New York Academy of Medicine logoLink to Journal of Urban Health : Bulletin of the New York Academy of Medicine
. 2004 Sep;81(3):349–362. doi: 10.1093/jurban/jth123

Weighing social and economic determinants related to inequalities in mortality

M Isabel Pasarín 1,✉, Carme Borrell 1, M Teresa Brugal 1, Estela Díaz-Quijano 1
PMCID: PMC3455947  PMID: 15273261

Abstract

It is well known that there are social inequalities in health. Following the ecological approach, unemployment has been one of the most used indicators to study social inequalities. The aim of the present study was to investigate the relationships between indicators of extreme poverty and social unrest, along with unemployment, and mortality in Barcelona, during the years 1989 to 1993. A cross-sectional ecological study was carried out using Primary Health Care Areas (PHCAs) as the unit of analysis. The study population consisted of residents in Barcelona City. The indicators studied as dependent variables were the age-standardized mortality rates of the following causes of death: total mortality; lung cancer; bronchitis, emphysema, and asthma; cirrhosis; cerebrovascular disease; ischemic heart disease; breast cancer; traffic accidents; acquired immunodeficiency syndrome (AIDS); and drug overdose. Independent variables were male unemployment rate of the primary health care areas and indicators of extreme poverty and social conflict. A descriptive analysis, a bivariate analysis using Spearman correlation coefficients, and a multivariate analysis fitting Poisson regression models were carried out. For the main results, one group of causes of death was associated only with unemployment; bronchitis, emphysema and asthma, cerebrovascular disease, and ischemic heart disease (both men and women); lung cancer (only among men); total mortality and cirrhosis (only among women). Among men, another group of causes of death was associated with extreme poverty and/or social unrest, as well as unemployment: total mortality, cirrhosis, and drug overdose. AIDS in men was only associated with extreme poverty and social unrest. We concluded that we see different types of relationships between deprivation and mortality. Unemployment has been related to mortality because of pathologies with socially accepted risk factors (tobacco and alcohol). Causes of death with risk factors not socially accepted (illegal drug use) have been related to indicators of marginality as well as unemployment.

Keywords: Inequalities, Mortality, Social deprivation

Full Text

The Full Text of this article is available as a PDF (224.3 KB).

References

  • 1.Black D, Morris J, Smith C, et al. The Black report. In: Townsend P, Davidson N, Whithead M, et al., editors. Inequalities in Health: the Black Report and The Health Divide. London: Penguin Books; 1988. [Google Scholar]
  • 2.Borrell C. Les Desigualtats Socials en la Salut. Revisió de la Bibliografia. Barcelona, Spain: Institut Municipal de Salut Pública, Ajuntament de Barcelona; 1998. [Google Scholar]
  • 3.Regidor E, Gutiérrez-Fisac J, Rodríguez C. Differencias y Desigualdades en Salud en España. Madrid, Spain: Díaz de Santos; 1994. [Google Scholar]
  • 4.Kogevinas M, Pearce N, Susser M, Boffetta P, editors. Social Inequalities and Cancer. Lyon, France: International Agency for Research on Cancer, World Health Organization; 1997. [Google Scholar]
  • 5.Blaxter M. Health and Lifestyles. London: Routledge; 1990. [Google Scholar]
  • 6.Fox J, editor. Health Inequalities in European Countries. Aldershot, UK: Gower; 1989. [Google Scholar]
  • 7.Carstairs V, Morris R. Deprivation and Health in Scotland. Aberdeen, Scotland: Aberdeen University Press; 1991. [Google Scholar]
  • 8.Navarro V, Benach J. Desigualdades Sociales en Salud en España. Madrid, Spain: Ministerio de Sanidad y Consumo; 1996. la Comisión Científica de Estudios de las Desigualdades en Salud en España. [Google Scholar]
  • 9.Borrell C, Pasarín MI. The study of social inequalities in health in Spain: where are we? J Epidemiol Community Health. 1999;53:388–389. doi: 10.1136/jech.53.7.388. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 10.Whitley E, Gunnell D, Dorling D, et al. Ecological study of social fragmentation, poverty, and suicide. BMJ. 1999;319:1034–1037. doi: 10.1136/bmj.319.7216.1034. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 11.Wilkinson R. Unhealthy Societies. The Afflictions of Inequality. London: Routledge; 1996. [Google Scholar]
  • 12.Wilkinson RG. The need for an interdisciplinary perspective on the social determinants of health. Health Econ. 2000;9:581–583. doi: 10.1002/1099-1050(200010)9:7<581::AID-HEC553>3.0.CO;2-D. [DOI] [PubMed] [Google Scholar]
  • 13.Borrell C, Arias A.Desigualdades en mortalidad en los barrios de Barcelona Gac Sanit 19937205–220.8225787 [Google Scholar]
  • 14.Borrell C, Arias A. Socio-economic factors and mortality in urban settings: the case of Barcelona, Spain. J Epidemiol Community Health. 1995;49:460–465. doi: 10.1136/jech.49.5.460. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 15.Borrell C, Plasència A, Pasarín I, et al. Widening social inequalities in mortality: the case of Barcelona, a southern European city. J Epidemiol Community Health. 1997;51:659–667. doi: 10.1136/jech.51.6.659. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 16.Pasarín MI, Borrell C, Plasència A. Dos patrones de desigualdades sociales en mortalidad en Barcelona? Gac Sanit. 1999;13:431–440. doi: 10.1016/s0213-9111(99)71403-2. [DOI] [PubMed] [Google Scholar]
  • 17.Rué M, Borrell C. Los métodos de estandarización de tasas. Rev Salud Pública. 1993;3:263–295. [Google Scholar]
  • 18.Wallace R. Inner-city decay and the health of the nations. Public Health. 1996;2:26–28. [Google Scholar]
  • 19.Wasylenky DA. Inner city health. CMAJ. 2001;162:214–215. [PMC free article] [PubMed] [Google Scholar]
  • 20.Wallace R. Urban desertification, public health and public order: “Planned shrinkage,” violent death, substance abuse and AIDS in the Bronx. Soc Sci Med. 1990;31:801–813. doi: 10.1016/0277-9536(90)90175-R. [DOI] [PubMed] [Google Scholar]
  • 21.Davilson PJ, McLean R, Kral AH, Gleghorn AA, Edlin BR, Moss AR. Fatal heroin-related overdose in San Francisco, 1997–2000: a case for targeted intervention. J Urban Health. 2003;80:261–273. doi: 10.1093/jurban/jtg029. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 22.Brugal MT, Domingo-Salvany A, Maguire A, Cayla JA, Villalbí JR, Hartnoll R. Small area analysis estimating the prevalence of addiction to opioids in Barcelona, 1993. J Epidemiol Community Health. 1999;53:488–494. doi: 10.1136/jech.53.8.488. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 23.Wallace R, Thompson, Fullilove M, et al. et al. Family systems and deurbanization: implications for substance abuse. In: Lewinson, et al.et al., editors. Substance Abuse. a Comprehensive Textbook. Baltimore, MD: Williams and Wilkins; 1992. pp. 944–955. [Google Scholar]
  • 24.Wilkinson RG, Kawachi I, Kennedy BP. Mortality, the social environment and violence. In: Kawachi I, Kennedy BP, Wilkinson RG, editors. The Society and Population Health Reader. Income Inequality and Health. New York: New Press; 1999. pp. 305–319. [Google Scholar]
  • 25.Torralba L, Brugal MT, Villalbí JR, et al. Mortality due to acute adverse drug reactions: opiates and cocaine in Barcelona: 1989–1993. Addiction. 1996;91:419–426. doi: 10.1111/j.1360-0443.1996.tb02291.x. [DOI] [PubMed] [Google Scholar]
  • 26.Pierce JP. International comparisons of trends in cigarette smoking prevalence. Am J Public Health. 1989;79:152–157. doi: 10.2105/ajph.79.2.152. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 27.Borrell C, Domínguez-Berjón F, Pasarín MI, et al. Social inequalities in health related behaviours in Barcelona. J Epidemiol Community Health. 2000;54:24–30. doi: 10.1136/jech.54.1.24. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 28.Adelantado J, Noguera J. Les Desigualtats Socials a Catalunya. Barcelona, Spain: Editorial Mediterrània; 1999. Informe sobre el desenvolupament i l'aplicació del PIRMI (1990–96) pp. 313–367. [Google Scholar]
  • 29.Díaz de Quijano E, Brugal MT, Pasarín MI, Galdós-Tangüis H, Caylà J, Borrell C. Influencia de las desigualdades sociales, la conflictividad social y la pobreza extrema sobre la morbilidad por tuberculosis en la ciudad de Barcelona. Rev Esp Salud Pública. 2001;75:517–527. doi: 10.1590/S1135-57272001000600004. [DOI] [PubMed] [Google Scholar]
  • 30.Gwatkin DR. Health inequalities and the health of the poor: what do we know? What can we do? Bull World Health Organ. 2000;78:3–18. [PMC free article] [PubMed] [Google Scholar]

Articles from Journal of Urban Health : Bulletin of the New York Academy of Medicine are provided here courtesy of New York Academy of Medicine

RESOURCES