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. 2020 Nov 17;17(22):8517.
doi: 10.3390/ijerph17228517.

The Association between Material Deprivation and Avoidable Mortality in Lisbon, Portugal

Claudia Costa  1 , Angela Freitas  1 , Ricardo Almendra  1   2 , Paula Santana  1   2
Affiliations

The Association between Material Deprivation and Avoidable Mortality in Lisbon, Portugal

Claudia Costa et al. Int J Environ Res Public Health. .

Abstract

There is considerable evidence pointing to the existence of a socioeconomic gradient in mortality, which tends to be steeper in urban areas. Similar to other European cities, Lisbon is far from homogeneous since considerable geographical inequalities exist between the more advantaged and the more deprived neighborhoods. The main goals of this study are to describe the geographical pattern of premature deaths (before 65 years old), avoidable deaths (preventable and amenable to healthcare) and cause-specific mortality (HIV/AIDS and suicide) in Lisbon, at the lower administrative level (civil parish, in Portuguese: Freguesia), and analyze the statistical association between mortality risk and deprivation, before (1999-2003) and during the economic crisis (2008-2012). Smoothed Standardized Mortality Ratios (sSMR) and Relative Risk (RR) with 95% credible intervals were calculated to identify the association between mortality and deprivation. The analysis of the geographical distribution of cause-specific mortality reveals that civil parishes with high sSMR in the first period continued to present higher mortality rates in the second. Moreover, a significant statistical association was found between all the causes of death and deprivation, except suicide. These findings contribute to understanding how social conditions influence health outcomes and can offer insights about potential policy directions for local government.

Keywords: HIV/AIDS; amenable deaths due to healthcare; area deprivation; avoidable deaths; cities; geography; inequalities; premature mortality; preventable deaths; suicide; urban health.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Material Deprivation across Lisbon civil parishes, 2001. Source: based on Census data from the National Statistics Institute.Source: based on Census data from National Statistics Institute.
Figure 2
Figure 2
Premature Mortality in Lisbon Municipality. Smooth Standardized Mortality Ratio (sSMR) and probability of excess risk of dying (PrP), 1999–2003 and 2008–2012.
Figure 3
Figure 3
Preventable deaths in Lisbon Municipality. Smooth Standardized Mortality Ratio (sSMR) and probability of excess risk of dying (PrP), 1999–2003 and 2008–2012.
Figure 4
Figure 4
Amenable deaths due to healthcare in Lisbon Municipality. Smooth Standardized Mortality Ratio (sSMR) and probability of excess risk of dying (PrP), 1999–2003 and 2008–2012.
Figure 5
Figure 5
HIV/AIDS Mortality in Lisbon Municipality. Smooth Standardized Mortality Ratio (sSMR) and probability of excess risk of dying (PrP), 1999–2003 and 2008–2012.
Figure 6
Figure 6
Suicide and self-intended harm Mortality in Lisbon Municipality. Smooth Standardized Mortality Ratio (sSMR) and probability of excess risk of dying (PrP), 1999–2003 and 2008–2012.
Figure 7
Figure 7
Relative Risk (RR) and 95% Credible Intervals (95%CI) between material deprivation (the second and third tercile (most deprived) compared to the first tercile (less deprived)) and mortality by cause of death in Lisbon.
See this image and copyright information in PMC

References

    1. Santana P., Costa C., Freitas Â., Stefanik I., Quintal C., Bana e Costa C., Borrell C., Dimitroulopoulou S., Lopes Ferreira P., Krafft T., et al. Atlas of Population Health in European Union Regions. Imprensa da Universidade de Coimbra; Coimbra, Portugal: 2017.
    1. Mackenbach J.P., Stirbu I., Roskam A.-J.R., Schaap M.M., Menvielle G., Leinsalu M., Kunst A.E. Socioeconomic Inequalities in Health in 22 European Countries. N. Engl. J. Med. 2008;358:2468–2481. doi: 10.1056/NEJMsa0707519. - DOI - PubMed
    1. Ribeiro A.I., De Fátima De Pina M., Mitchell R. Development of a measure of multiple physical environmental deprivation. After United Kingdom and New Zealand, Portugal. Eur. J. Public Health. 2015 doi: 10.1093/eurpub/cku242. - DOI - PubMed
    1. Prasad A. The Urban Health Equity Assessment and Response Tool (HEART)—A Decade of Development and Implementation. J. Urban Health. 2018;95:609. doi: 10.1007/s11524-018-0317-8. - DOI - PMC - PubMed
    1. Mitsakou C., Dimitroulopoulou S., Heaviside C., Katsouyanni K., Samoli E., Rodopoulou S., Costa C., Almendra R., Santana P., Dell’Olmo M.M., et al. Environmental public health risks in European metropolitan areas within the EURO-HEALTHY project. Sci. Total Environ. 2019;658:1630–1639. doi: 10.1016/j.scitotenv.2018.12.130. - DOI - PubMed

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