Background: Features of the area might contribute to differences in cardiovascular mortality. This study examined the census-tract distribution of ischaemic heart disease (IHD) and cerebrovascular disease (CeVD) mortality in the Madrid Region and its association with deprivation and environmental variables.
Methods: Cross-sectional, ecological study covering 3906 census tracts (median of around 1000 inhabitants), using mortality data (population aged <75 years) for 1996-2003, as well as socioeconomic deprivation and other environmental indicators (subjective perceptions of pollution, background noise, lack of green spaces, and delinquency) drawn from the 2001 census. Standardised mortality ratios were calculated. Smoothed census-tract relative risks were calculated using the Besag-York-Mollie model. Relative risks (RRs) of dying and their 95% credibility intervals (CI) were calculated according to the indicators considered (with the fourth quartile Q being the most unfavourable situation). Maps were plotted depicting the distribution of the posterior probability of RR>1.
Results: Census tracts with excess mortality were mostly located in the city of Madrid. Mortality increased with deprivation: RRs of IHD and CeVD mortality in Q4 with respect to Q1 were 1.42 (95% CI: 1.31-1.54) and 1.66 (95% CI: 1.45-1.88) for men, and 1.54 (95% CI: 1.33-1.79) and 1.52 (95% CI: 1.29-1.76) for women respectively. When each of remaining indicators was jointly analysed with the deprivation index, the RRs associated with deprivation decreased, and statistically significant associations with these indicators were only observed for mortality in men.
Conclusion: This type of analysis enabled areas of higher IHD and CeVD mortality risk to be identified. Deprivation and subjective perceptions of physical environmental characteristics appear to be associated with increased mortality.
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