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Epidemiology and policy
P1-233 Assessing the effect of individual and area level sociodemographic factors on regional differences in mortality amenable to healthcare
  1. A McCallum1,2,
  2. M Arfmann3,
  3. A Leyland4,
  4. S Karvonen3,
  5. K Manderbacka3,
  6. I Keskimaki3
  1. 1NHS Lothian, Edinburgh, UK
  2. 2University of Edinburgh, Edinburgh, UK
  3. 3National Institute for Health and Welfare, Helsinki, Finland
  4. 4MRC Social and Public Health Sciences Unit, Glasgow, UK

Abstract

Introduction Mortality from many causes varies geographically. We examine trends in regional differences in amenable mortality in Finland and explore the role of socioeconomic factors.

Methods We analysed deaths amenable to primary and specialist healthcare in the Finnish population aged 25–74 in 1992–2003. Sociodemographic variables were individually linked from annual employment statistics. Three area-level scores were created using factor analysis of municipal level register data; these represented standard of living, deprivation and (poor) social cohesion. Multilevel Poisson regression models were applied adjusting for sex and age, other individual-level variables and area-level factor scores.

Results Mortality from conditions amenable to primary care intervention was more common among men in 1992–1995 but differences disappeared over time. An inverse income gradient increased over time. The unemployed and those outside the labour force had higher mortality. Poor social cohesion of the area was also associated with mortality. Men had more than double the risk of dying from conditions related to specialist care compared to women. An inverse and increasing gradient was seen for income. Employment status was again associated with higher mortality. Poor social cohesion of the area increased risk as did deprivation in 1996–2003. There was little variation between areas for conditions amenable to primary healthcare, but substantial variation for mortality amenable to specialist healthcare.

Conclusion Mortality amenable to primary care is strongly patterned by individual socio-economic circumstances. Conditions amenable to specialist care also show strong social gradients but large area variances suggest that the organisation and delivery of specialist services may also influence mortality.

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