Spatial variation in cause-specific premature mortality and its association with socioeconomic deprivation in Belgium from 2000 to 2019

Abstract

Background: Premature mortality risks vary in space and time among subpopulations and are influenced by numerous factors, including levels of socioeconomic deprivation. In Belgium, socioeconomic deprivation has recently been quantified using the Belgian Indices of Multiple Deprivation; however, its contribution to the spatial patterns of premature mortality has not yet been assessed. This study aims to investigate the variation in premature mortality risks and their association with socioeconomic deprivation.

Methods: The Belgian Index of Multiple Deprivation 2011 and its deprivation domains, including employment, income, education, housing, and crime, are used to measure overall and domain-specific deprivation in all 589 municipalities in Belgium between 2000 and 2019. We estimate the all-cause and cause-specific relative risks of dying prematurely using Bayesian hierarchical models.

Results: The spatial patterns of relative risks varied by cause of death. The most common pattern observed was a North-South gradient, with higher risks in Wallonia and lower risks in Flanders. Subnational variation increased over time for all causes of death, differing by cause. Higher deprivation levels were linked to greater premature mortality risks, particularly associated with employment and housing deprivation. In both sexes, the strongest associations with deprivation were observed for deaths due to alcohol consumption, COPD, and diabetes mellitus.

Conclusion: This study highlights the significant associations between socioeconomic deprivation and the risk of premature death in Belgium, revealing notable spatial disparities. The North-South gradient underscores the persistent regional inequalities, with Wallonia bearing the highest burden of premature mortality risks. These results emphasize the importance of addressing the complex interplay of socioeconomic factors in shaping health outcomes and the need for targeted public health interventions to reduce premature mortality and promote health equity across Belgium.

Keywords: Belgian index of multiple deprivation; Belgium; Deprivation; Health inequality; Relative risk of premature death.

Fig. 1

Distribution of average deprivation scores assigned to deciles from 1 (most deprived) to 10 (least deprived) across Belgian municipalities in 2011

Fig. 2

Spatial and temporal patterns of relative risk of premature mortality in Belgium during the first (2000–2004) and last (2015–2019) study periods, by sex

Fig. 3

Spatial and temporal patterns of relative risk of premature mortality due to cancer of the lip, oral cavity, pharynx, larynx, and esophagus in Belgium during the first (2000–2004) and last (2015–2019) study periods, by sex

Fig. 4

Spatial and temporal patterns of relative risk of premature mortality due to breast cancer in Belgium during the first (2000–2004) and last (2015–2019) study periods, among women

Fig. 5

Spatial and temporal patterns of relative risk for premature mortality due to road accidents in Belgium during the first (2000–2004) and last (2015–2019) study periods, by sex

Fig. 6

Standard deviation of cause-specific relative risk estimates, by sex

Fig. 7

Estimated mean point estimates of relative risks and their 95% confidence intervals for all-cause and cause-specific premature mortality associated with a unit increase (i.e. 10.04) in the overall average deprivation score, by sex

Fig. 8

Estimated mean point estimates of relative risks and their 95% confidence intervals for all-cause and cause-specific premature mortality associated with a unit increase (i.e. 10.04) in the domain-specific average deprivation score, among men

Fig. 9

Estimated mean point estimates of relative risks and their 95% confidence intervals for all-cause and cause-specific premature mortality associated with a unit increase (i.e. 10.04) in the domain-specific average deprivation score, among women