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Open Access 01-12-2016 | Research

The geographic pattern of Belgian mortality: can socio-economic characteristics explain area differences?

Authors: Wanda M. J. Van Hemelrijck, Didier Willaert, Sylvie Gadeyne

Published in: Archives of Public Health | Issue 1/2016

Abstract

Background

Country averages for health outcomes hide important within-country variations. This paper probes into the geographic Belgian pattern of all-cause mortality and wishes to investigate the contribution of individual and area socio-economic characteristics to geographic mortality differences in men aged 45–64 during the period 2001–2011.

Methods

Data originate from a linkage between the Belgian census of 2001 and register data on mortality and emigration during the period 2001–2011. Mortality rate ratios (MRRs) are estimated for districts and sub-districts compared to the Belgian average mortality level using Poisson regression modelling. Individual socio-economic position (SEP) indicators are added to examine the impact of these characteristics on the observed geographic pattern. In order to scrutinize the contribution of area-level socio-economic characteristics, random intercepts Poisson modelling is performed with predictors at the individual and the sub-district level. Random intercepts and slopes models are fitted to explore variability of individual-level SEP effects.

Results

All-cause MRRs for middle-aged Belgian men are higher in the geographic areas of the Walloon region and the Brussels-Capital Region (BCR) compared to those in the Flemish region. The highest MRRs are observed in the inner city of the BCR and in several Walloon cities. Their disadvantage can partially be explained by the lower individual SEP of men living in these areas. Similarly, the relatively low MRRs observed in the districts of Halle-Vilvoorde, Arlon and Virton can be related to the higher individual SEP. Among the area-level characteristics, both the percentage of men employed and the percentage of labourers in a sub-district have a protective effect on the individual MRR, regardless of individual SEP. Variability in individual-level SEP effects is limited.

Conclusions

Individual SEP partly explains the observed mortality gap in Belgium for some areas. The percentage of men employed and the percentage of labourers in a sub-district have an additional effect on the individual MRR aside from that of individual SEP. However, these socio-economic factors cannot explain all of the observed differences. Other mechanisms such as public health policy, cultural habits and environmental influences contribute to the observed geographic pattern in all-cause mortality among middle-aged men.

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Anderson R, Sorlie P, Backlund E. Mortality effects of community socioeconomic status. Epidemiology. 1997;8(1):42–7.CrossRefPubMed

Avendano M, Kunst a E, Huisman M, Lenthe FV, Bopp M, Regidor E, Mackenbach, JP. Socioeconomic status and ischaemic heart disease mortality in 10 western European populations during the 1990s. Heart. 2006;92(4):461–7. http://doi.org/10.1136/hrt.2005.065532.

Bang D, Manemann S, Gerber Y, Roger V, Lohse C, Rand-Weaver J, Juhn Y. A Novel Socioeconomic Measure Using Individual Housing Data in Cardiovascular Outcome Research. Int J Environ Res Public Health. 2014;11(11):11597–615. http://doi.org/10.3390/ijerph111111597.

Blázquez M, Cottini E, Herrarte A. The socioeconomic gradient in health: how important is material deprivation? J Econ Inequal. 2013;12(2):239–64. http://doi.org/10.1007/s10888-013-9248-5.CrossRef

Buckland ST, Burnham KP, Augustin NH. Model Selection: An Integral Part of Inference. Biometrics. 1997;53(2):603–18. http://doi.org/10.2307/2533961.CrossRef

Diez Roux AV. A glossary for multilevel analysis. J Epidemiol Community Health. 2002;56(8):588–94. http://doi.org/10.1136/jech.56.8.588.CrossRefPubMed

Ecob R, Jones K. Mortality variations in England and Wales between types of place: an analysis of the ONS longitudinal study. Soc Sci Med. 1998;47(12):2055–66. http://doi.org/10.1016/S0277-9536(98)00310-4.CrossRefPubMed

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(1):7. http://doi.org/10.1186/1475-9276-10-7.CrossRefPubMedPubMedCentral

Fang P, Dong S, Xiao J, Liu C, Feng X, Wang Y. Regional inequality in health and its determinants: evidence from China. Health Policy. 2010;94(1):14–25. http://doi.org/10.1016/j.healthpol.2009.08.002.CrossRefPubMed

10.

Fernandez-Martinez B, Prieto-Flores M-E, Forjaz MJ, Fernández-Mayoralas G, Rojo-Pérez F, Martínez-Martín P. Self-perceived health status in older adults: regional and sociodemographic inequalities in Spain. Rev Saude Publica. 2012;46:310–9.CrossRefPubMed

11.

Franzini L, Giannoni M. Determinants of health disparities between Italian regions. BMC Public Health. 2010;10:296. http://doi.org/10.1186/1471-2458-10-296.CrossRefPubMedPubMedCentral

12.

Gadeyne S. The Ultimate Inequality: Socio-economic differences in all-cause and cause-specific Mortality in Belgium in the First Part of the 1990s. Brussels: CBGS; 2006.

13.

Gadeyne S, Deboosere P. Can regional patterns of mortality in Belgium be explained by individual socio-economic characteristics? Reflets et perspectives de la vie économique, Tome XLI. 2002;41(4):87–103.

14.

Gadeyne S, Deboosere P. Socio-economische ongelijkheden in sterfte op middelbare leeftijd in België. Brussel: Een analyse van de Nationale Databank Mortaliteit; 2002.

15.

Galobardes B, Lynch J, Smith GD. Measuring socioeconomic position in health research. Br Med Bull. 2007;81–82(1):21–37. http://doi.org/10.1093/bmb/ldm001.CrossRefPubMed

16.

Galobardes B, Shaw M, Lawlor DA, Lynch JW, Davey Smith G. Indicators of socioeconomic position (part 2). J Epidemiol Community Health. 2006;60(2):95–101. http://doi.org/10.1136/jech.2004.028092.CrossRefPubMedPubMedCentral

17.

Groenewegen PP, Westert GP, Boshuizen HC. Regional differences in healthy life expectancy in the Netherlands. Public Health. 2003;117(6):424–9. http://doi.org/10.1016/S0033-3506(03)00100-8.CrossRefPubMed

18.

Haan M, Kaplan GA, Camacho T. Poverty and health. Prospective evidence from the Almeda County study. Am J Epidemiol. 1987;125(6):989–98.CrossRefPubMed

19.

Hagedoorn P, Vandenheede H, Willaert D, Vanthomme K, Gadeyne S. Regional Inequalities in Lung Cancer Mortality in Belgium at the Beginning of the 21st Century : The Contribution of Individual and Area-Level Socioeconomic Status and Industrial Exposure. PLoS One. 2016;11(1):1–18. http://doi.org/10.1371/journal.pone.0147099.CrossRef

20.

Huie SAB. The Concept of Neighborhood in Health and Mortality Research. Sociol Spectr. 2001;21:341–58. http://doi.org/10.1080/027321701300202028.CrossRef

21.

Huisman M, Kunst AE, Andersen O, Bopp M, Borgan J, Borrell C, Costa G, Deboosere P, Desplanques G, Donkin A, Gadeyne S, Minder C, Regidor E, Spadea T, Valkonen T, Mackenbach JP. Socioeconomic inequalities in mortality among elderly people in 11 European populations. J Epidemiol Community Health. 2004;58(6):468–75. http://doi.org/10.1136/jech.2003.010496.CrossRefPubMedPubMedCentral

22.

Kawachi I, Subramanian SV, Almeida-Filho N. A glossary for health inequalities. J Epidemiol Community Health. 2002;56(9):647–52. http://doi.org/10.1136/jech.56.9.647.CrossRefPubMedPubMedCentral

23.

Kibele EUB, Klüsener S, Scholz RD. Regional Mortality Disparities in Germany: Long-Term Dynamics and Possible Determinants. Kolner Zeitschrift Fur Soziologie Und Sozialpsychologie. 2015;67 Suppl 1:241–70. http://doi.org/10.1007/s11577-015-0329-2.CrossRefPubMedPubMedCentral

24.

Kuhn J, Zirngibl A, Wildner M, Caselmann WH, Kerscher G. Regional mortality differences in Bavaria. Gesundheitswesen. 2006;68(8–9):551–6. http://doi.org/10.1055/s-2006-926988.CrossRefPubMed

25.

Laaksonen M, Tarkiainen L, Martikainen P. Housing wealth and mortality: A register linkage study of the Finnish population. Soc Sci Med. 2009;69(5):754–60. http://doi.org/10.1016/j.socscimed.2009.06.035.CrossRefPubMed

26.

LeClere FB, Rogers RG, Peters KD. Ethnicity and Mortality in the United States: Individual and Community Correlates. Soc Forces. 1997;76(1):169–98. http://doi.org/10.1093/sf/76.1.169.CrossRef

27.

Luke DA. Multilevel modeling. Thousand Oaks: SAGE Publications; 2004.CrossRef

28.

Luyten S, Van Hecke E. De Belgische stadsgewesten 2001. 2007.

29.

Macintyre S. The Black Report and beyond: what are the issues? Soc Sci Med. 1997;44(6):723–45. http://doi.org/10.1016/S0277-9536(96)00183-9.CrossRefPubMed

30.

Mangano A. An analysis of the regional differences in health care utilization in Italy. Health Place. 2010;16(2):301–8. http://doi.org/10.1016/j.healthplace.2009.10.013.CrossRefPubMed

31.

Martelin T. Mortality by indicators of socioeconomic status among the Finnish elderly. Soc Sci Med. 1994;38(9):1257–78. http://doi.org/10.1016/0277-9536(94)90190-2.CrossRefPubMed

32.

Matthews FE, Miller LL, Brayne C, Jagger C. Regional differences in multidimensional aspects of health: findings from the MRC cognitive function and ageing study. BMC Public Health. 2006;6:90. http://doi.org/10.1186/1471-2458-6-90.CrossRefPubMedPubMedCentral

33.

Meijer M, Röhl J, Bloomfield K, Grittner U. Do neighborhoods affect individual mortality? A systematic review and meta-analysis of multilevel studies. Soc Sci Med. 2012;74(8):1204–12. http://doi.org/10.1016/j.socscimed.2011.11.034.CrossRefPubMed

34.

Mishra GD, Ball K, Dobson AJ, Byles JE, Warner-Smith P. The measurement of socio-economic status: investigation of gender-and age-specific indicators in Australia: National Health Survey 1995. Soc Indic Res. 2001;56(1):73–89. http://doi.org/10.1023/A:1011834621663.CrossRef

35.

Pirani E, Salvini S. Socioeconomic Inequalities and Self-Rated Health: A Multilevel Study of Italian Elderly. Popul Res Policy Rev. 2011;31(1):97–117. http://doi.org/10.1007/s11113-011-9219-0.CrossRef

36.

Raes V, Kerkhofs E, Louckx F. Sociale ongelijkheid en verschillen in gezondheid. Brussel: VUBPRESS; 1993.

37.

Renard F, Tafforeau J, Deboosere P. Premature mortality in Belgium in 1993–2009: leading causes, regional disparities and 15 years change. Arch Public Health. 2014;72(1):34. http://doi.org/10.1186/2049-3258-72-34.CrossRefPubMedPubMedCentral

38.

Renard F, Tafforeau J, Deboosere P. Mapping the cause-specific premature mortality reveals large between-districts disparity in Belgium, 2003–2009. Arch Public Health. 2015;73(1):13. http://doi.org/10.1186/s13690-015-0060-5.CrossRefPubMedPubMedCentral

39.

Riva M, Curtis S, Gauvin L, Fagg J. Unravelling the extent of inequalities in health across urban and rural areas: Evidence from a national sample in England. Soc Sci Med. 2009;68(4):654–63. http://doi.org/10.1016/j.socscimed.2008.11.024.CrossRefPubMed

40.

Romero-Lankao P, Qin H, Borbor-Cordova M. Exploration of health risks related to air pollution and temperature in three Latin American cities. Soc Sci Med. 2013;83:110–8. http://doi.org/10.1016/j.socscimed.2013.01.009.CrossRefPubMed

41.

Schwartz SH. The fallacy of the ecological fallacy: The potential misuse of a concept and the consequences. Am J Public Health. 1994;84(5):819–24. http://doi.org/10.2105/AJPH.84.5.819.CrossRefPubMedPubMedCentral

42.

Senior M, Williams H, Higgs G. Urban–rural mortality differentials: controlling for material deprivation. Soc Sci Med. 2000;51(2):289–305. http://doi.org/10.1016/S0277-9536(99)00454-2.CrossRefPubMed

43.

Smith GD, Hart C, Watt G, Hole D, Hawthorne V. Individual social class, area-based deprivation, cardiovascular disease risk factors, and mortality: the Renfrew and Paisley Study. J Epidemiol Community Health. 1998;52:399–405. http://doi.org/10.1136/jech.52.6.399.CrossRefPubMedPubMedCentral

44.

Stronks K, van de Mheen D, Mackenbach JP. Achtergronden van sociaal-economische gezondheidsverschillen. Een overzicht van de literatuur en een onderzoeksmodel. Tijdschrift Voor Sociale Gezondheidszorg. 1993;71:2–10.

45.

Sun S, Chen J, Johannesson M, Kind P, Xu L, Zhang Y, Burström K. Regional differences in health status in China: population health-related quality of life results from the National Health Services Survey 2008. Health Place. 2011;17(2):671–80. http://doi.org/10.1016/j.healthplace.2011.01.007.

46.

Tunstall HVZ, Shaw M, Dorling D. Places and health. J Epidemiol Community Health. 2004;58(1):6–10. http://doi.org/10.1136/jech.58.1.6.CrossRefPubMedPubMedCentral

47.

Van der Heyden JH, Schaap MM, Kunst AE, Esnaola S, Borrell C, Cox B, Van Oyen H. Socioeconomic inequalities in lung cancer mortality in 16 European populations. Lung Cancer. 2009;63(3):322–30. http://dx.doi.org/10.1016/j.lungcan.2008.06.006.

48.

Van Oyen H, Bossuyt N, Deboosere P, Gadeyne S, Abatih E, Demarest SS. Differential inequity in health expectancy by region in Belgium. Sozial- Und Präventivmedizin. 2005;50(5):301–10. http://doi.org/10.1007/s00038-005-5017-y.CrossRefPubMed

49.

Van Oyen H, Bossuyt N, Deboosere P, Gadeyne S, Tafforeau J. Differences in health expectancy indicators in Belgium by region. Archives of Public Health. 2002;60:341–62.

50.

Van Oyen H, Tafforeau J, Roelands M. Regional inequities in health expectancy in Belgium. Soc Sci Med. 1996;43(11):1673–8. http://doi.org//link?doi=10.1016/s0277-9536(96)00080-9.CrossRefPubMed

51.

Vanneste, D., Thomas, I., & Goossens, L. (2007). Woning en woonomgeving in België. Monografieën van de Sociaal-Economische Enquête 2001, nummer 2.

52.

Voigtländer S, Berger U, Razum O. Increasing regional disparities in living conditions in Germany and their role in the explanation of health inequalities. Gesundheitswesen (Bundesverband Der Ärzte Des Öffentlichen Gesundheitsdienstes (Germany)). 2010;72(5):301–8. http://doi.org/10.1055/s-0029-1233487.CrossRef

53.

Voigtländer S, Berger U, Razum O. The impact of regional and neighbourhood deprivation on physical health in Germany: a multilevel study. BMC Public Health. 2010;10:403. http://doi.org/10.1186/1471-2458-10-403.CrossRefPubMedPubMedCentral

54.

WHO. The World Health Organization on Health Inequality, Inequity, and Social Determinants of Health. Popul Dev Rev. 2007;33(4):839–43. http://doi.org/10.1111/j.1728-4457.2007.00200.x.CrossRef

Title: The geographic pattern of Belgian mortality: can socio-economic characteristics explain area differences?
Authors: Wanda M. J. Van Hemelrijck
Didier Willaert
Sylvie Gadeyne
Publication date: 01-12-2016
Publisher: BioMed Central
Published in: Archives of Public Health / Issue 1/2016
Electronic ISSN: 2049-3258
DOI: https://doi.org/10.1186/s13690-016-0135-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The geographic pattern of Belgian mortality: can socio-economic characteristics explain area differences?

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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