Do socioeconomic inequalities in mortality vary between different Spanish cities? a pooled cross-sectional analysis
- Equal contributors
1 Centro Superior de Investigación en Salud Pública, Av. Cataluña, 21, 46020 Valencia, Spain
2 Ciber de Epidemiología y Salud Pública-CIBERESP, Instituto de Salud Carlos III- Melchor Fernández Almagro, 3-5, 28029 Madrid, Spain
3 Dirección General de Salud Pública. Conselleria de Sanitat, Generalitat Valenciana, Av. Cataluña, 21, Valencia, 46020, Spain
4 Departamento de Ciencias Físicas, Matemáticas y de la Computación, Universidad CEU-Cardenal Herrera, C/ San Bartolomé, 55, Alfara del Patriarca, 46115, Spain
5 Agència de Salut Pública de Barcelona, Barcelona, Spain
6 Institut de Recerca Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
7 Unidad de Investigación en Análisis de la Mortalidad y Estadísticas Sanitarias. Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia, Universidad de Alicante, Campus de San Vicente del Raspeig s/n. Apartado 99, Alicante, 03080, Spain
8 Observatorio de Salud y Medio Ambiente de Andalucía (OSMAN). Escuela Andaluza de Salud Pública, Campus Universitario de Cartuja, Cuesta del Observatorio, 4. Ap. Correos 2070, Granada, 18080, Spain
9 Subdirección de Promoción de la Salud y Prevención. Dirección General de Atención Primaria, Consejería de Sanidad. Comunidad de Madrid, C/ Julián Camarillo nº 4B, 2ª planta, Madrid, 28037, Spain
10 Departamento de Sanidad del Gobierno Vasco, Alava 45, Vitoria-Gasteiz, Álava, 01001, Spain
11 Departamento de Medicina Preventiva y Salud Pública, Universidad de Santiago de Compostela, c/ San Francisco s/n, Santiago de Compostela, 15782, Spain
12 Universitat Pompeu Fabra, Barcelona, Spain
BMC Public Health 2013, 13:480 doi:10.1186/1471-2458-13-480Published: 16 May 2013
The relationship between deprivation and mortality in urban settings is well established. This relationship has been found for several causes of death in Spanish cities in independent analyses (the MEDEA project). However, no joint analysis which pools the strength of this relationship across several cities has ever been undertaken. Such an analysis would determine, if appropriate, a joint relationship by linking the associations found.
A pooled cross-sectional analysis of the data from the MEDEA project has been carried out for each of the causes of death studied. Specifically, a meta-analysis has been carried out to pool the relative risks in eleven Spanish cities. Different deprivation-mortality relationships across the cities are considered in the analysis (fixed and random effects models). The size of the cities is also considered as a possible factor explaining differences between cities.
Twenty studies have been carried out for different combinations of sex and causes of death. For nine of them (men: prostate cancer, diabetes, mental illnesses, Alzheimer’s disease, cerebrovascular disease; women: diabetes, mental illnesses, respiratory diseases, cirrhosis) no differences were found between cities in the effect of deprivation on mortality; in four cases (men: respiratory diseases, all causes of mortality; women: breast cancer, Alzheimer’s disease) differences not associated with the size of the city have been determined; in two cases (men: cirrhosis; women: lung cancer) differences strictly linked to the size of the city have been determined, and in five cases (men: lung cancer, ischaemic heart disease; women: ischaemic heart disease, cerebrovascular diseases, all causes of mortality) both kinds of differences have been found. Except for lung cancer in women, every significant relationship between deprivation and mortality goes in the same direction: deprivation increases mortality. Variability in the relative risks across cities was found for general mortality for both sexes.
This study provides a general overview of the relationship between deprivation and mortality for a sample of large Spanish cities combined. This joint study allows the exploration of and, if appropriate, the quantification of the variability in that relationship for the set of cities considered.