Trends in socio-economic inequalities in cirrhosis mortality in an urban area of Southern Europe : A multilevel approach
- Albert Dalmau-Bueno1,
- Anna Garcia-Altes2,
- Marc Marí-Dell'Olmo1,
- Katherine Pérez2,
- Albert Espelt2,
- Anton E. Kunst3,
- Carme Borrell4,*
- 1 CIBER Epidemiología y Salud Pública (CIBERESP), Spain;
- 2 Agencia de Salut Publica de Barcelona, Spain;
- 3 Department of Public Health, AMC, University of Amsterdam, Spain;
- 4 Agencia de Salut Publica de Barcelona/ Universitat Pompeu Fabra, Spain
- Correspondence to: Carme Borrell, Agència de Salut Pública de Barcelona, Plaça Lesseps 1, Barcelona, 08023, Spain; cborrell{at}aspb.cat
- Received 26 January 2009
- Accepted 30 July 2009
- Published Online First 19 October 2009
Abstract
Background: The objective of this study was to analyse inequalities in cirrhosis mortality at individual and area level, using data from Barcelona for two periods.
Methods: The study referred to Barcelona cirrhosis deaths, corresponding to 25-74 years old men and women during the periods 1992-1997 and 1998-2004. A multilevel Poisson regression analysis was performed, with the individual and the area as the respective units of analysis.
Results: Inequalities in cirrhosis mortality were observed in relationship to both individual and area socio-economic level, with the highest mortality rates among those with lowest educational level and in socio-economically deprived areas. In the multi-level analysis, the largest effects were observed at the individual level. Between the two periods, mortality rates decreased for the highest and lowest educational levels (for example: from 116.2 to 88.7 per 100,000 inhabitants among illiterate or with no education men aged 50 to 74 years old), but not for intermediate levels. At the area level, absolute inequalities in mortality tended to decrease; however higher mortality RR persisted in the least favoured areas compared to most favoured areas (for example in men: from 1.74 (95% CI 1.36-2.24) to 1.80 (95% IC 1.42-2.27) in the two periods).
Conclusion: This study demonstrated the persistence of socio-economic inequalities in cirrhosis mortality in Barcelona between socio-economic groups and city areas.
