Neighbourhood unemployment and all cause mortality: a comparison of six countries
- F J van Lenthe1,
- L N Borrell2,
- G Costa3,
- A V Diez Roux4,
- T M Kauppinen5,
- C Marinacci6,
- P Martikainen5,
- E Regidor7,
- M Stafford8,
- T Valkonen5
- 1Department of Public Health, Erasmus Medical Centre Rotterdam, Rotterdam, Netherlands
- 2Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
- 3Department of Public Health and Microbiology, Turin University, Turin, Italy
- 4Department of Epidemiology, University of Michigan, Ann Arbor, USA
- 5Department of Sociology, University of Helsinki, Finland
- 6Epidemiology Unit, Piedmont Region, Turin, Italy
- 7Department of Preventive Medicine and Public Health, Universidad Complutense de Madrid, Madrid, Spain
- 8Department of Epidemiology and Public Health, University College London Medical School, London, UK
- Correspondence to: Dr F J van Lenthe Department of Public Health, Erasmus Medical Centre, Rotterdam, PO Box 1738, 3000 DR Rotterdam, Netherlands; f.vanlentheerasmusmc.nl
- Accepted 6 July 2004
Abstract
Study objective: Studies have shown that living in more deprived neighbourhoods is related to higher mortality rates, independent of individual socioeconomic characteristics. One approach that contributes to understanding the processes underlying this association is to examine whether the relation is modified by the country context. In this study, the size of the association between neighbourhood unemployment rates and all cause mortality was compared across samples from six countries (United States, Netherlands, England, Finland, Italy, and Spain).
Design: Data from three prospective cohort studies (ARIC (US), GLOBE (Netherlands), and Whitehall II (England)) and three population based register studies (Helsinki, Turin, Madrid) were analysed. In each study, neighbourhood unemployment rates were derived from census, register based data. Cox proportional hazard models, taking into account the possible correlation of outcomes among people of the same neighbourhood, were used to assess the associations between neighbourhood unemployment and all cause mortality, adjusted for education and occupation at the individual level.
Results: In men, after adjustment for age, education, and occupation, living in the quartile of neighbourhoods with the highest compared with the lowest unemployment rates was associated with increased hazards of mortality (14%–46%), although for the Whitehall II study associations were not statistically significant. Similar patterns were found in women, but associations were not statistically significant in two of the five studies that included women.
Conclusions: Living in more deprived neighbourhoods is associated with increased all cause mortality in the US and five European countries, independent of individual socioeconomic characteristics. There is no evidence that country substantially modified this association.
Footnotes
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Funding: this study is the result of work carried out in Working group 3 (“Macrosocial determinants of morbidity and mortality: their contribution to the explanation of inequalities in health”) of the Programme “Social Variations in Health Expectancy in Europe”, funded by the European Science Foundation. FvL is supported by a grant from the Netherlands Organisation for Scientific Research (NWO grant number 904-66-\104). The GLOBE study is supported by grants of the Ministry of Public Health, Welfare and Sport and the Health Research and Development Council (ZonMw). ADR and LB were supported in part by R01 HL64142 from the National Institutes of Health. The Whitehall II study has been funded by the MRC, BHF, and NIH. The Helsinki study was supported by the Academy of Finland (projects 51640, 70631, 48600). The study in Madrid was supported by a grant from the Fondo de Investigaciones Sanitarias (no 00/0514/1999).
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Conflicts of interest: none declared.
