Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
International Journal for Equity in Health
Published in: International Journal for Equity in Health 1/2015

Open Access 01-12-2015 | Research

Inequalities in mortality by socioeconomic factors and Roma ethnicity in the two biggest cities in Slovakia: a multilevel analysis

Authors: Katarina Rosicova, Sijmen A. Reijneveld, Andrea Madarasova Geckova, Roy E. Stewart, Martin Rosic, Johan W. Groothoff, Jitse P. van Dijk

Published in: International Journal for Equity in Health | Issue 1/2015

Login to get access

Abstract

Background

The socioeconomic and ethnic composition of urban neighbourhoods may affect mortality, but evidence on Central European cities is lacking. The aim of this study was to assess the associations between socioeconomic and ethnic neighbourhood indicators and the mortality of individuals aged 20–64 years old in the two biggest cities of the Slovak Republic.

Methods

We obtained data on the characteristics of neighbourhoods and districts (educational level, unemployment, income and share of Roma) and on individual mortality of residents aged 20–64 years old, for the two largest cities in the Slovak Republic (Bratislava and Kosice) in the period 2003–2005. We performed multilevel Poisson regression analyses adjusted for age and gender on the individual (mortality), neighbourhood (education level and share of Roma in population) and district levels (unemployment and income).

Results

The proportions of Roma and of low-educated residents were associated with mortality at the neighbourhood level in both cities. Mutually adjusted, only the association with the proportion of Roma remained in the model (risk ratio 1.02; 95 % confidence interval 1.01–1.04). The area indicators – high education, income and unemployment – were not associated with mortality.

Conclusion

The proportion of Roma is associated with early mortality in the two biggest cities in the Slovak Republic.
Literature
1.
Mackenbach JP, Stirbu I, Roskam AJR, Schaap MM, Menvielle G, Leinsalu M, et al. Socioeconomic inequalities in health in 22 European countries. N Engl J Med. 2008;358:2468–81.CrossRefPubMed
2.
Marmot M. Social determinants of health inequalities. Lancet. 2005;356:1099–104.CrossRef
3.
Macintyre S, Maciver S, Sooman A. Area, class and health: should we be focusing on place or people? J Soc Policy. 1993;22:213–34.CrossRef
4.
Adams RJ, Howard N, Tucker G, Appleton S, Taylor AW, Chittleborough C, et al. Effect of area deprivation on health risks and outcomes: a multilevel, cross-sectional, Australian population study. Int J Public Health. 2009;54:183–92.CrossRefPubMed
5.
Backlund E, Rowe G, Lynch J, Wolfson MC, Kaplan GA, Sorlie PD. Income inequality and mortality: a multilevel prospective study of 521 248 individuals in 50 US states. Int J Epidemiol. 2007;36:590–6.CrossRefPubMed
6.
Blomgren J, Martikainen P, Makela P, Valkonen T. The effects of regional characteristics on alcohol-related mortality - a register-based multilevel analysis of 1.1 milion men. Soc Sci Med. 2004;58:2523–35.CrossRefPubMed
7.
Breckenkamp J, Mielck A, Razum O. Health inequalities in Germany: do regional-level variables explain differentials in cardiovascular risk? BMC Public Health. 2007;7:132.PubMedCentralCrossRefPubMed
8.
Cavalini LT, Ponce de Leon ACM. Morbidity and mortality in Brazilian municipalities: a multilevel study of the association between socioeconomic and healthcare indicators. Int J Epidemiol. 2008;37:775–85.CrossRefPubMed
9.
Dalmau-Bueno A, Garcia-Altes A, Mari-Dell'olmo M, Perez K, Espelt A, Kunst AE, et al. Trends in socioeconomic inequalities in cirrhosis mortality in an urban area of Southern Europe: a multilevel approach. J Epidemiol Community Health. 2010;64:720–7.CrossRefPubMed
10.
Elstad JI. Does the socioeconomic context explain both mortality and income inequality? Prospective register-based study of Norwegian regions. Int J Equity Health. 2011;10:7.PubMedCentralCrossRefPubMed
11.
Henriksson G, Allebeck P, Weitoft GR, Thelle D. Income distribution and mortality: Implications from a comparison of individual-level analysis and multilevel analysis with Swedish data. Scand J Public Health. 2006;34:287–94.CrossRefPubMed
12.
Kravdal O. Mortality effects of average education: a multilevel study of small neighbourhoods in rural and urban areas in Norway. Int J Equity Health. 2009;8:41.PubMedCentralCrossRefPubMed
13.
Macintyre S, Ellaway A, Cummins S. Place effects on health: how can we conceptualise, operationalise and measure them? Soc Sci Med. 2002;55:125–39.CrossRefPubMed
14.
Marmot M, Commission on Social Determinants of Health. Achieving health equity: from root causes to fair outcomes. Lancet. 2007;370:1153–63.CrossRefPubMed
15.
Pinzone F, Casuccio N, Cusimano R, Mancuso A, Pitarresi A. Mortality in relation to individual- and area-level socioeconomic status in Palermo (Italy): a multilevel analysis. Epidemiol Prev. 2009;33:207–14.PubMed
16.
Reijneveld SA, Verheij RA, de Bakker DH. Relative importance of urbanicity, ethnicity and socioeconomic factors regarding area mortality differences. J Epidemiol Community Health. 1999;53:444–5.PubMedCentralCrossRefPubMed
17.
Reijneveld SA, Veenstra R, de Winter AF, Verhulst FC, Ormel J, de Meer G. Area deprivation affects behavioral problems of young adolescents in mixed urban and rural areas: the TRAILS study. J Adolescent Health. 2010;46:189–96.CrossRef
18.
Šlachtová H, Tomášková H, Šplíchalová A, Polaufová P, Fejtková P. Czech socio-economic deprivation index and its correlation with mortality data. Int J Public Health. 2009;54:1–7.
19.
Bentley R, Kavanagh AM, Subramanian SV, Turrell G. Area disadvantage, individual socio-economic position, and premature cancer mortality in Australia 1998 to 2000: a multilevel analysis. Cancer Causes Control. 2008;19:183–93.CrossRefPubMed
20.
Jackson AL, Davies CA, Leyland AH. Do differences in the administrative structure of populations confound comparisons of geographic health inequalities? BMC Med Res Methodol. 2010;10:74.PubMedCentralCrossRefPubMed
21.
Meijer M, Rohl J, Bloomfield K, Grittner U. Do neighborhoods affect individual mortality? A systematic review and meta-analysis of multilevel studies. Soc Sci Med. 2012;74:1204–12.CrossRefPubMed
22.
Turrell G, Kavanagh AM, Draper G, Subramanian SV. Do places affect the probability of death in Australia? A multilevel study of area-level disadvantage, individual-level socioeconomic position and all-cause mortality, 1998–2000. J Epidemiol Community Health. 2007;61:13–9.PubMedCentralCrossRefPubMed
23.
Suzuki E, Kashima S, Kawachi I, Subramanian SV. Social and geographic inequalities in premature adult mortality in Japan: a multilevel observational study from 1970 to 2005. BMJ Open. 2012;2, e000425.PubMedCentralCrossRefPubMed
24.
25.
26.
Mackenbach JP, Bakker MJ, European Network on Interventions and Policies to Reduce Inequalities in Health. Tackling socioeconomic inequalities in health: analysis of European experiences. Lancet. 2003;362:1409–14.CrossRefPubMed
27.
Stafford M, Martikainen P, Lahelma E, Marmot M. Neighbourhoods and self rated health: a comparison of public sector employees in London and Helsinki. J Epidemiol Community Health. 2004;58:772–8.PubMedCentralCrossRefPubMed
28.
van Lenthe FJ, Borrell LN, Costa G, Diez-Roux AV, Kauppinen TM, Marinacci C, et al. Neighbourhood unemployment and all cause mortality: a comparison of six countries. J Epidemiol Community Health. 2005;59:231–7.PubMedCentralCrossRefPubMed
29.
WHO/UN-HABITAT. Hidden cities: unmasking and overcoming health inequities in urban settings. Geneva: World Health Organization; 2010.
30.
Rosicova K, Madarasova Geckova A, van Dijk JP, Rosic M, Zezula I, Groothoff JW. Socioeconomic indicators and ethnicity as determinants of regional mortality rates in Slovakia. Int J Public Health. 2009;54:274–83.CrossRefPubMed
31.
Bopp M, Minder CE. Mortality by education in German speaking Switzerland, 1990–1997: results from the Swiss National Cohort. Int J Epidemiol. 2003;32:346–54.CrossRefPubMed
32.
Lopez R. Income inequality and self-rated health in US metropolitan areas: a multi-level analysis. Soc Sci Med. 2004;59:2409–19.CrossRefPubMed
33.
Muller A. Education, income, inequality, and mortality: a multiple regression analysis. BMC Public Health. 2002;324:1–4.
34.
Von dem Knesebeck O, Verde PE, Dragano N. Education and health in 22 European countries. Soc Sci Med. 2006;63:1344–51.CrossRef
35.
Behanova M, Nagyova I, Katreniakova Z, van Ameijden EJC, van Dijk JP, Reijneveld SA. The effect of urban-area unemployment on the mental health of citizens differs between Slovak and Dutch cities. Health Place. 2013;24:210–5.CrossRefPubMed
36.
Behanova M, Nagyova I, Katreniakova Z, van Ameijden EJC, van Dijk JP, Reijneveld SA. Health-risk behaviours in deprived urban neighbourhoods: a comparison between Slovak and Dutch cities. Int J Public Health. 2014;59:405–14.CrossRefPubMed
37.
Mackenbach JP. Health inequalities: Europe in profile. Rotterdam: University Medical Centre, Department of Public Health; 2006.
38.
Zatonski W, Manczuk M, Sulkowska U. Closing the health gap in European Union. Warsaw: Cancer Epidemiology and Prevention Division, the Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology; 2008.
39.
EU-MIDIS, European Union Minorities and Discrimination Survey. Main Results Report. 2009. European Union Agency for Fundamental Rights.
40.
Vasecka M, Dzambazovic R. Socialno-ekonomicka situacia Romov na Slovensku ako potencionalnych migrantov a ziadatelov o azyl v krajinach EU. Socialna a ekonomicka situacia potencionalnych ziadatelov o azyl zo Slovenskej Republiky. International Organization for Migration (IOM); 2000. p. 17–62.
41.
Filadelfiová J, Gerbery D, Škobla D. Správa o životných podmienkach rómskych domácností na Slovensku (Report on the Living Conditions of Roma in Slovakia). Bratislava: UNDP, Regional Bureau for Europe and the CIS; 2006.
42.
Statistical Office of the Slovak Republic. Population by education from Population and Housing Census. Bratislava: Statistical Office of the Slovak Republic; 2002.
43.
Statistical Office of the Slovak Republic. Monthly Statistics of unemployment. Bratislava: Centre of Labour, Social Affairs and Family of the Slovak Republic (UPSVAR); 2009.
44.
The Regional Statistical Yearbook of Slovakia 2006. Bratislava: Statistical Office of the Slovak Republic; 2007.
45.
Statistical Office of the Slovak Republic. Population by nationality from Population and Housing Census. Bratislava: Statistical Office of the Slovak Republic; 2011.
46.
Langford IH, Day RJ. Poisson regression. In: Leyland AH, Goldstein H, editors. Multilevel modelling of health statistics. Chichester: Wiley; 2001. p. 45–57.
47.
Korec P. Regionálny rozvoj Slovenska v rokoch 1989–2004 (Regional development of the Slovak Republic in years 1989–2004). Geografika: Bratislava; 2005.
48.
Vaňo, B, Haviarová E, 2003. Demografické trendy rómskej populácie (Demographic trends of the Roma population). In: Vašečka, M., ed., Čačipen Pal o Roma. Súhrnná správa o Rómoch na Slovensku (A Global Report on Roma in Slovakia), IVO (Institute for Public Affairs), Bratislava.
49.
Borrell C, Marí-Dell`Olmo M, Serral G, Martínez-Beneito M, Gotsens M. Inequalities in mortality in small areas of eleven Spanish cities (the multicenter MEDEA project). Health Place. 2010;16:703–11.CrossRefPubMed
50.
Diez-Roux AV, Green Franklin T, Alazraqui M, Spinelli H. Intraurban variations in adult mortality in a large Latin American city. J Urban Health. 2007;84:319–33.PubMedCentralCrossRefPubMed
51.
Rosicova K, Madarasova Geckova A, van Dijk J, Kollarova J, Rosic M, Groothoff JW. Regional socioeconomic indicators and ethnicity as predictors of regional infant mortality rate in Slovakia. Int J Public Health. 2011;56:523–31.PubMedCentralCrossRefPubMed
52.
Rosicova K, Madarasova Geckova A, Rosic M, Speybroeck N, Groothoff JW, van Dijk J. Socioeconomic factors, ethnicity and alcohol-related mortality in regions in Slovakia. What might a tree analysis add to our understanding? Health Place. 2011;17:701–9.CrossRefPubMed
53.
van Hooijdonk C, Droomers M, Deerenberg IM, Mackenbach JP, Kunst AE. Higher mortality in urban neighbourhoods in The Netherlands: who is at risk? J Epidemiol Community Health. 2008;62:499–505.CrossRefPubMed
54.
Ginter E, Krajcovicova-Kudlackova M, Kacala O, Kovacic V, Valachovicova M. Health status of Romanies (Gypsies) in the Slovak Republic and in the neighbouring countries. Bratisl Lek Listy. 2001;102:479–84.PubMed
55.
56.
Koupilova I, Epstein H, Holcik J, Hajioff S, McKee M. Health needs of the Roma population in the Czech and Slovak Republics. Soc Sci Med. 2001;53:1191–204.CrossRefPubMed
57.
Kosa Z, Szeles G, Kardos L, Kosa K, Nemeth R, Orszagh S, et al. A comparative health survey of the inhabitants of Roma settlements in Hungary. Am J Public Health. 2007;97:853–9.PubMedCentralCrossRefPubMed
58.
Kolarcik P, Madarasova Geckova A, Orosova O, van Dijk JP, Reijneveld SA. To what extent does socioeconomic status explain differences in health between Roma and non-Roma adolescents in Slovakia? Soc Sci Med. 2009;68:1279–84.CrossRefPubMed
59.
Vokó Z, Csépe P, Németh R, Kósa K, Széles G, Ádány R. Does socioeconomic status fully mediate the effect of ethnicity on the health of Roma people in Hungary? J Epidemiol Community Health. 2009;63:455–60.CrossRefPubMed
60.
Kolarcik P. Self-reported health and health risky behaviour of Roma adolescents in Slovakia: A comparison with non-Roma (PhD thesis). Rijksuniversiteit Groningen; 2012.
61.
European Union Agency for Fundamental Rights, UNDP. The situation of Roma in 11 EU Member States: Survey results at a glance. Luxembourg: Publications Office of the European Union; 2012.
62.
63.
Commission on Social Determinants of Health. Closing the gap in a generation: health equity through action on the social determinants of health. Final Report. Geneva: World Health Organization; 2008. Accessed 6 Aug 2014.
Metadata
Title
Inequalities in mortality by socioeconomic factors and Roma ethnicity in the two biggest cities in Slovakia: a multilevel analysis
Authors
Katarina Rosicova
Sijmen A. Reijneveld
Andrea Madarasova Geckova
Roy E. Stewart
Martin Rosic
Johan W. Groothoff
Jitse P. van Dijk
Publication date
01-12-2015
Publisher
BioMed Central
Published in
International Journal for Equity in Health / Issue 1/2015
Electronic ISSN: 1475-9276
DOI
https://doi.org/10.1186/s12939-015-0262-z

Other articles of this Issue 1/2015

International Journal for Equity in Health 1/2015 Go to the issue

Research

“A Somali girl is Muslim and does not have premarital sex. Is vaccination really necessary?” A qualitative study into the perceptions of Somali women in the Netherlands about the prevention of cervical cancer

Research

How an urban Aboriginal and Torres Strait Islander primary health care service improved access to mental health care

Commentary

Sex and gender matter in health research: addressing health inequities in health research reporting

Research

Refusal to enrol in Ghana’s National Health Insurance Scheme: is affordability the problem?

Research

A cohort study: temporal trends in prevalence of antecedents, comorbidities and mortality in Aboriginal and non-Aboriginal Australians with first heart failure hospitalization, 2000–2009

Research

Time trends in socio-economic inequalities in the lack of access to dental services among children in Spain 1987-2011