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Socioeconomic inequalities in cause-specific mortality in 15 European cities
  1. Marc Marí-Dell'Olmo1,2,3,
  2. Mercè Gotsens1,2,3,
  3. Laia Palència1,2,3,
  4. Bo Burström4,
  5. Diana Corman4,
  6. Giuseppe Costa5,
  7. Patrick Deboosere6,
  8. Èlia Díez1,2,3,
  9. Felicitas Domínguez-Berjón7,
  10. Dagmar Dzúrová8,
  11. Ana Gandarillas7,
  12. Rasmus Hoffmann9,
  13. Katalin Kovács10,
  14. Pekka Martikainen11,
  15. Moreno Demaria12,
  16. Hynek Pikhart13,
  17. Maica Rodríguez-Sanz1,2,3,
  18. Marc Saez1,14,
  19. Paula Santana15,
  20. Cornelia Schwierz16,
  21. Lasse Tarkiainen11,
  22. Carme Borrell17,1,2,3
  1. 1CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
  2. 2Agència de Salut Pública de Barcelona, Barcelona, Spain
  3. 3Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
  4. 4Division of Social Medicine, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
  5. 5Department of Clinical and Biological Science, University of Turin, Turin, Italy
  6. 6Department of Social Research, Vrije Universiteit Brussel, Brussels, Belgium
  7. 7Subdirección de Promoción de la Salud y Prevención, Consejería de Sanidad, Comunidad de Madrid, Spain
  8. 8Department of Social Geography and Regional Development, Faculty of Science, Charles University in Prague, Prague, Czech Republic
  9. 9Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands
  10. 10Demographic Research Institute, Budapest, Hungary
  11. 11Department of Social Research, University of Helsinki, Helsinki, Finland
  12. 12Department of Epidemiology and Environmental Health, Regional Environmental Protection Agency, Piedmont, Italy
  13. 13Department of Epidemiology and Public Health, University College London, London, UK
  14. 14Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain
  15. 15Centro de Estudos de Geografia e de Ordenamento do Territorio (CEGOT), Departamento de Geografia, Colégio de S. Jerónimo, Universidade de Coimbra, Coimbra, Portugal
  16. 16Statistik Stadt Zürich, Zürich, Switzerland
  17. 17Universitat Pompeu Fabra, Barcelona, Spain
  1. Correspondence to Marc Marí-Dell'Olmo, Agència de Salut Pública de Barcelona, Plaça Lesseps 1, Barcelona 08023, Spain; mmari{at}


Background Socioeconomic inequalities are increasingly recognised as an important public health issue, although their role in the leading causes of mortality in urban areas in Europe has not been fully evaluated. In this study, we used data from the INEQ-CITIES study to analyse inequalities in cause-specific mortality in 15 European cities at the beginning of the 21st century.

Methods A cross-sectional ecological study was carried out to analyse 9 of the leading specific causes of death in small areas from 15 European cities. Using a hierarchical Bayesian spatial model, we estimated smoothed Standardized Mortality Ratios, relative risks and 95% credible intervals for cause-specific mortality in relation to a socioeconomic deprivation index, separately for men and women.

Results We detected spatial socioeconomic inequalities for most causes of mortality studied, although these inequalities differed markedly between cities, being more pronounced in Northern and Central-Eastern Europe. In the majority of cities, most of these causes of death were positively associated with deprivation among men, with the exception of prostatic cancer. Among women, diabetes, ischaemic heart disease, chronic liver diseases and respiratory diseases were also positively associated with deprivation in most cities. Lung cancer mortality was positively associated with deprivation in Northern European cities and in Kosice, but this association was non-existent or even negative in Southern European cities. Finally, breast cancer risk was inversely associated with deprivation in three Southern European cities.

Conclusions The results confirm the existence of socioeconomic inequalities in many of the main causes of mortality, and reveal variations in their magnitude between different European cities.


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