Skip to main content
Top
Published in: BMC Public Health 1/2024

Open Access 01-12-2024 | Research

Trends in socioeconomic inequalities in cause-specific premature mortality in Belgium, 1998–2019

Authors: Martina Otavova, Bruno Masquelier, Christel Faes, Laura van den Borre, Bram Vandeninden, Eva de Clercq, Brecht Devleesschauwer

Published in: BMC Public Health | Issue 1/2024

Login to get access

Abstract

Background

Higher levels of socioeconomic deprivation have been consistently associated with increased risk of premature mortality, but a detailed analysis by causes of death is lacking in Belgium. We aim to investigate the association between area deprivation and all-cause and cause-specific premature mortality in Belgium over the period 1998–2019.

Methods

We used the 2001 and 2011 Belgian Indices of Multiple Deprivation to assign statistical sectors, the smallest geographical units in the country, into deprivation deciles. All-cause and cause-specific premature mortality rates, population attributable fraction, and potential years of life lost due to inequality were estimated by period, sex, and deprivation deciles.

Results

Men and women living in the most deprived areas were 1.96 and 1.78 times more likely to die prematurely compared to those living in the least deprived areas over the period under study (1998–2019). About 28% of all premature deaths could be attributed to socioeconomic inequality and about 30% of potential years of life lost would be averted if the whole population of Belgium faced the premature mortality rates of the least deprived areas.

Conclusion

Premature mortality rates have declined over time, but inequality has increased due to a faster pace of decrease in the least deprived areas compared to the most deprived areas. As the causes of death related to poor lifestyle choices contribute the most to the inequality gap, more effective, country-level interventions should be put in place to target segments of the population living in the most deprived areas as they are facing disproportionately high risks of dying.
Appendix
Available only for authorised users
Literature
1.
go back to reference Marmot M, et al. Closing the gap in a generation: health equity through action on the social determinants of health. Lancet. 2008;372(9650):1661–9.CrossRefPubMed Marmot M, et al. Closing the gap in a generation: health equity through action on the social determinants of health. Lancet. 2008;372(9650):1661–9.CrossRefPubMed
2.
go back to reference Datta GD, et al. Trends in Kaposi’s sarcoma survival disparities in the United States: 1980 through 2004. Cancer Epidemiol Biomarkers Prev. 2010;19(11):2718–26.CrossRefPubMed Datta GD, et al. Trends in Kaposi’s sarcoma survival disparities in the United States: 1980 through 2004. Cancer Epidemiol Biomarkers Prev. 2010;19(11):2718–26.CrossRefPubMed
3.
go back to reference Hazzouri ZA. Neighborhood socioeconomic context and cognitive decline among older Mexican americans: results from the Sacramento Area latino study on aging. Am J Epidemiol. 2011;174(4):423–31.CrossRef Hazzouri ZA. Neighborhood socioeconomic context and cognitive decline among older Mexican americans: results from the Sacramento Area latino study on aging. Am J Epidemiol. 2011;174(4):423–31.CrossRef
4.
go back to reference Lewer D, et al. Premature mortality attributable to socioeconomic inequality in England between 2003 and 2018: an observational study. Lancet Public Health. 2020;5(1):e33–e41.CrossRefPubMed Lewer D, et al. Premature mortality attributable to socioeconomic inequality in England between 2003 and 2018: an observational study. Lancet Public Health. 2020;5(1):e33–e41.CrossRefPubMed
5.
go back to reference Schwandt H et al. Inequality in mortality between Black and White Americans by age, place, and cause and in comparison to Europe, 1990 to 2018 Proc Natl Acad Sci U S A, 2021. 118(40). Schwandt H et al. Inequality in mortality between Black and White Americans by age, place, and cause and in comparison to Europe, 1990 to 2018 Proc Natl Acad Sci U S A, 2021. 118(40).
6.
go back to reference Stringhini S, et al. Health behaviours, Socioeconomic Status, and mortality: further analyses of the British Whitehall II and the French GAZEL prospective cohorts. PLoS Med. 2011;8(2):e1000419.CrossRefPubMedPubMedCentral Stringhini S, et al. Health behaviours, Socioeconomic Status, and mortality: further analyses of the British Whitehall II and the French GAZEL prospective cohorts. PLoS Med. 2011;8(2):e1000419.CrossRefPubMedPubMedCentral
8.
go back to reference Mackenbach JP, et al. Widening socioeconomic inequalities in mortality in six western European countries. Int J Epidemiol. 2003;32(5):830–7.CrossRefPubMed Mackenbach JP, et al. Widening socioeconomic inequalities in mortality in six western European countries. Int J Epidemiol. 2003;32(5):830–7.CrossRefPubMed
9.
go back to reference Mackenbach JP. The persistence of health inequalities in modern welfare states: the explanation of a paradox. Soc Sci Med. 2012;75(4):761–9.CrossRefPubMed Mackenbach JP. The persistence of health inequalities in modern welfare states: the explanation of a paradox. Soc Sci Med. 2012;75(4):761–9.CrossRefPubMed
10.
go back to reference Turrell G, Mathers C. Socioeconomic inequalities in all-cause and specific-cause mortality in Australia: 1985–1987 and 1995–1997. Int J Epidemiol. 2001;30(2):231–9.CrossRefPubMed Turrell G, Mathers C. Socioeconomic inequalities in all-cause and specific-cause mortality in Australia: 1985–1987 and 1995–1997. Int J Epidemiol. 2001;30(2):231–9.CrossRefPubMed
11.
go back to reference Leyland AH, et al. Cause-specific inequalities in mortality in Scotland: two decades of change. A population-based study. BMC Public Health. 2007;7:172.CrossRefPubMedPubMedCentral Leyland AH, et al. Cause-specific inequalities in mortality in Scotland: two decades of change. A population-based study. BMC Public Health. 2007;7:172.CrossRefPubMedPubMedCentral
12.
13.
go back to reference 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.CrossRefPubMedPubMedCentral 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.CrossRefPubMedPubMedCentral
14.
go back to reference Renard F, et al. Trends in educational inequalities in premature mortality in Belgium between the 1990s and the 2000s: the contribution of specific causes of deaths. J Epidemiol Community Health. 2017;71(4):371–80.CrossRefPubMed Renard F, et al. Trends in educational inequalities in premature mortality in Belgium between the 1990s and the 2000s: the contribution of specific causes of deaths. J Epidemiol Community Health. 2017;71(4):371–80.CrossRefPubMed
15.
go back to reference Eggerickx T, Sanderson J-P, Vandeschrick C. Les inégalités sociales et spatiales de mortalité en Belgique: 1991–2016 Espace populations sociétés, 2018. Eggerickx T, Sanderson J-P, Vandeschrick C. Les inégalités sociales et spatiales de mortalité en Belgique: 1991–2016 Espace populations sociétés, 2018.
16.
17.
go back to reference Otavova M, et al. Measuring small-area level deprivation in Belgium: the Belgian index of multiple deprivation. Spat Spatio-temporal Epidemiol. 2023;45:100587.CrossRef Otavova M, et al. Measuring small-area level deprivation in Belgium: the Belgian index of multiple deprivation. Spat Spatio-temporal Epidemiol. 2023;45:100587.CrossRef
18.
go back to reference 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.CrossRefPubMedPubMedCentral 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.CrossRefPubMedPubMedCentral
20.
go back to reference OECD/Eurostat. Avoidable mortality: OECD/Eurostat lists of preventable and treatable causes of death. OECD: Paris; 2019. OECD/Eurostat. Avoidable mortality: OECD/Eurostat lists of preventable and treatable causes of death. OECD: Paris; 2019.
21.
go back to reference Romeder JM, McWhinnie JR. The development of potential years of life lost as an indicator of premature mortality (author’s transl)]. Rev Epidemiol Sante Publique. 1978;26(1):97–115.PubMed Romeder JM, McWhinnie JR. The development of potential years of life lost as an indicator of premature mortality (author’s transl)]. Rev Epidemiol Sante Publique. 1978;26(1):97–115.PubMed
23.
go back to reference Damiens J. The impact of housing conditions on mortality in Belgium (1991–2016). J Pop Res. 2020;37:391–421.CrossRef Damiens J. The impact of housing conditions on mortality in Belgium (1991–2016). J Pop Res. 2020;37:391–421.CrossRef
24.
go back to reference Amine E, et al. Diet, nutrition and the prevention of chronic diseases. World Health Organization; 2003. Amine E, et al. Diet, nutrition and the prevention of chronic diseases. World Health Organization; 2003.
25.
go back to reference Sørensen K, et al. Health literacy and public health: a systematic review and integration of definitions and models. BMC Public Health. 2012;12(1):80.CrossRefPubMedPubMedCentral Sørensen K, et al. Health literacy and public health: a systematic review and integration of definitions and models. BMC Public Health. 2012;12(1):80.CrossRefPubMedPubMedCentral
26.
go back to reference De Pauw E, et al. Safety effects of reducing the speed limit from 90km/h to 70km/h. Accid Anal Prev. 2014;62:426–31.CrossRefPubMed De Pauw E, et al. Safety effects of reducing the speed limit from 90km/h to 70km/h. Accid Anal Prev. 2014;62:426–31.CrossRefPubMed
28.
go back to reference Van Kerrebroeck H, Makar A. Cervical cancer screening in Belgium and overscreening of adolescents. Eur J Cancer Prev. 2016;25(2):142–8.CrossRefPubMed Van Kerrebroeck H, Makar A. Cervical cancer screening in Belgium and overscreening of adolescents. Eur J Cancer Prev. 2016;25(2):142–8.CrossRefPubMed
29.
go back to reference Tran TN et al. The impact of a six-year existing Screening Programme using the Faecal Immunochemical Test in Flanders (Belgium) on Colorectal Cancer incidence, mortality and survival: a Population-based study. Int J Environ Res Public Health, 2023. 20(2). Tran TN et al. The impact of a six-year existing Screening Programme using the Faecal Immunochemical Test in Flanders (Belgium) on Colorectal Cancer incidence, mortality and survival: a Population-based study. Int J Environ Res Public Health, 2023. 20(2).
32.
go back to reference Van der Heyden JH, et al. Socioeconomic inequalities in lung cancer mortality in 16 European populations. Lung Cancer. 2009;63(3):322–30.CrossRefPubMed Van der Heyden JH, et al. Socioeconomic inequalities in lung cancer mortality in 16 European populations. Lung Cancer. 2009;63(3):322–30.CrossRefPubMed
33.
go back to reference Dai X, Gakidou E, Lopez AD. Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action. Tob Control. 2022;31(2):129–37.CrossRefPubMed Dai X, Gakidou E, Lopez AD. Evolution of the global smoking epidemic over the past half century: strengthening the evidence base for policy action. Tob Control. 2022;31(2):129–37.CrossRefPubMed
34.
go back to reference Holmes J, et al. Effects of minimum unit pricing for alcohol on different income and socioeconomic groups: a modelling study. Lancet. 2014;383(9929):1655–64. Holmes J, et al. Effects of minimum unit pricing for alcohol on different income and socioeconomic groups: a modelling study. Lancet. 2014;383(9929):1655–64.
35.
go back to reference Lorenc T, et al. What types of interventions generate inequalities? Evidence from systematic reviews. J Epidemiol Community Health. 2013;67(2):190–3. Lorenc T, et al. What types of interventions generate inequalities? Evidence from systematic reviews. J Epidemiol Community Health. 2013;67(2):190–3.
36.
go back to reference Macintyre S. What are spatial effects and how can we measure them? Exploiting National Survey Data: the role of locality and spatial effects. Faculty of Economic and Social Studies: University of Manchester, Manchester; 1997. A. Dale, Editor. Macintyre S. What are spatial effects and how can we measure them? Exploiting National Survey Data: the role of locality and spatial effects. Faculty of Economic and Social Studies: University of Manchester, Manchester; 1997. A. Dale, Editor.
38.
go back to reference Duncan C, Jones K, Moon G. Smoking and deprivation: are there neighbourhood effects? Soc Sci Med. 1999;48(4):497–505.CrossRefPubMed Duncan C, Jones K, Moon G. Smoking and deprivation: are there neighbourhood effects? Soc Sci Med. 1999;48(4):497–505.CrossRefPubMed
39.
go back to reference Pickett KE, Pearl M. Multilevel analyses of neighbourhood socioeconomic context and health outcomes: a critical review. J Epidemiol Community Health. 2001;55(2):111–22.CrossRefPubMedPubMedCentral Pickett KE, Pearl M. Multilevel analyses of neighbourhood socioeconomic context and health outcomes: a critical review. J Epidemiol Community Health. 2001;55(2):111–22.CrossRefPubMedPubMedCentral
40.
go back to reference Cubbin C, LeClere FB, Smith GS. Socioeconomic status and injury mortality: individual and neighbourhood determinants. J Epidemiol Community Health (1979). 2000;54(7):517–24.CrossRef Cubbin C, LeClere FB, Smith GS. Socioeconomic status and injury mortality: individual and neighbourhood determinants. J Epidemiol Community Health (1979). 2000;54(7):517–24.CrossRef
41.
go back to reference Dunn JR, Hayes MV. Social inequality, population health, and housing: a study of two Vancouver neighborhoods. Soc Sci Med. 2000;51(4):563–87.CrossRefPubMed Dunn JR, Hayes MV. Social inequality, population health, and housing: a study of two Vancouver neighborhoods. Soc Sci Med. 2000;51(4):563–87.CrossRefPubMed
42.
43.
go back to reference Allik M, et al. Creating small-area deprivation indices: a guide for stages and options. J Epidemiol Community Health. 2020;74(1):20–5.CrossRefPubMed Allik M, et al. Creating small-area deprivation indices: a guide for stages and options. J Epidemiol Community Health. 2020;74(1):20–5.CrossRefPubMed
45.
go back to reference Aelvoet W, Molenberghs G, van Sprundel M. Mortality statistics in Belgium 1980–1997 Quality of coding Arch Public Health, 2005. 63: p. 127–148. Aelvoet W, Molenberghs G, van Sprundel M. Mortality statistics in Belgium 1980–1997 Quality of coding Arch Public Health, 2005. 63: p. 127–148.
46.
go back to reference Bhopal RS, et al. Mortality, ethnicity, and country of birth on a national scale, 2001–2013: a retrospective cohort (Scottish Health and ethnicity linkage study). PLoS Med. 2018;15(3):e1002515.CrossRefPubMedPubMedCentral Bhopal RS, et al. Mortality, ethnicity, and country of birth on a national scale, 2001–2013: a retrospective cohort (Scottish Health and ethnicity linkage study). PLoS Med. 2018;15(3):e1002515.CrossRefPubMedPubMedCentral
47.
go back to reference Smith MP, Olatunde O, White C. Inequalities in disability-free life expectancy by area deprivation: England, 2001-04 and 2005-08. Health Stat Q, 2010(48): p. 36–57. Smith MP, Olatunde O, White C. Inequalities in disability-free life expectancy by area deprivation: England, 2001-04 and 2005-08. Health Stat Q, 2010(48): p. 36–57.
Metadata
Title
Trends in socioeconomic inequalities in cause-specific premature mortality in Belgium, 1998–2019
Authors
Martina Otavova
Bruno Masquelier
Christel Faes
Laura van den Borre
Bram Vandeninden
Eva de Clercq
Brecht Devleesschauwer
Publication date
01-12-2024
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2024
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-024-17933-z

Other articles of this Issue 1/2024

BMC Public Health 1/2024 Go to the issue