Article Text

Download PDFPDF
Trends in socioeconomic inequalities in cirrhosis mortality in an urban area of Southern Europe: a multilevel approach
  1. Albert Dalmau-Bueno1,2,
  2. Anna García-Altés1,2,
  3. Marc Marí-Dell'Olmo1,2,
  4. Katherine Pérez1,2,
  5. Albert Espelt1,3,
  6. Anton E Kunst4,
  7. Carme Borrell1,2,5
  1. 1CIBER Epidemiología y Salud Pública (CIBERESP), Spain
  2. 2Servei de Sistemes d'Informació Sanitària, Agència de Salut Pública de Barcelona, Spain
  3. 3Servei de Prevenció i Atenció a les Drogodependències, Agència de Salut Pública de Barcelona, Barcelona, Spain
  4. 4Department of Public Health, AMC, University of Amsterdam, The Netherlands
  5. 5Departament de Ciències Experimentals i de la Salut Universitat Pompeu Fabra, Barcelona, Spain
  1. Correspondence to Carme Borrell, Agència de Salut Pública de Barcelona, Plaça Lesseps, 1. 08023. Barcelona, Spain; cborrell{at}


Background The objective of this study was to analyse inequalities in cirrhosis mortality at individual and area levels, using data from Barcelona for two time periods.

Methods Deaths from cirrhosis in Barcelona of men and women aged 25–74 years during the periods 1992–97 and 1998–2004 were included in the study. 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 individual and area socioeconomic levels, with the highest death rates among those with lowest educational level and in socioeconomically deprived areas. In the multilevel analysis, the largest effects were observed at the individual level. Between the two periods, death rates decreased for the highest and lowest educational levels (eg, from 116.2 to 88.7 per 100 000 inhabitants among men or men with no education aged 50–74 years), 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 compared to most favoured areas (eg, in men, from 1.74 (95% CI 1.36 to 2.24) to 1.80 (95% CI 1.42 to 2.27) in the two periods).

Conclusion This study demonstrated the persistence of socioeconomic inequalities in cirrhosis mortality in Barcelona between socioeconomic groups and city areas.

  • Mortality
  • liver cirrhosis
  • socioeconomic factors
  • area deprivation
  • multilevel analysis
  • mortality SI
  • multilevel models
  • socioeconomic

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Funding This work was partially financed by the research project of the Instituto de Salud Carlos III - FIS PI052639.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.