Elsevier

Health & Place

Volume 24, November 2013, Pages 165-172
Health & Place

Socioeconomic inequalities in injury mortality in small areas of 15 European cities

https://doi.org/10.1016/j.healthplace.2013.09.003Get rights and content

Highlights

  • Socioeconomic inequalities exist in injury mortality at small area level in most European cities.

  • There are differences in the magnitude of these inequalities.

  • Inter-sectorial collaboration is necessary to create safe environments.

Abstract

This study analysed socioeconomic inequalities in mortality due to injuries in small areas of 15 European cities, by sex, at the beginning of this century.

A cross-sectional ecological study with units of analysis being small areas within 15 European cities was conducted. Relative risks of injury mortality associated with the socioeconomic deprivation index were estimated using hierarchical Bayesian model.

The number of small areas varies from 17 in Bratislava to 2666 in Turin. The median population per small area varies by city (e.g. Turin had 274 inhabitants per area while Budapest had 76,970). Socioeconomic inequalities in all injury mortality are observed in the majority of cities and are more pronounced in men. In the cities of northern and western Europe, socioeconomic inequalities in injury mortality are found for most types of injuries. These inequalities are not significant in the majority of cities in southern Europe among women and in the majority of central eastern European cities for both sexes.

The results confirm the existence of socioeconomic inequalities in injury related mortality and reveal variations in their magnitude between different European cities.

Introduction

Injuries due to external causes, whether intentional or unintentional, are one of the leading causes of death worldwide. In Europe injuries account for 7% of all deaths every year, with traffic injuries (16%), poisonings (13%) and falls (10%) being the main causes of death related with unintentional injuries, and suicides (19%) and homicides (7%) the leading causes of intentional injuries (WHO, 2012).

In recent decades injury mortality rates have fallen in most European countries (EUROSTAT, 2012), however, there are still differences between countries in mortality due to these causes. In concrete, people living in low and middle income countries are more likely to die from injuries than those living in high income countries. These differences have been observed for all specific causes of injuries, except for falls in women (Sethi et al., 2006). In addition, individuals of less favourable socioeconomic positions present higher risks of dying due to the leading specific causes of death by injuries (Cubbin and Smith, 2002, Laflamme et al., 2009).

In recent years there has been an increase in the number of studies of mortality inequalities in geographical areas, since area of residence has been recognised as a factor affecting health independently of individual determinants (Diez Roux, 2001). In the case of injury related mortality, some studies have found that areas with worse socioeconomic indicators present higher risks of dying, in particular for homicides (Leyland and Dundas, 2010, Krueger et al., 2004) and drug overdose (Gotsens et al., 2011a, Michelozzi et al., 1999). In the case of suicides and traffic injuries the findings are inconclusive. Some studies have found associations, both positive (Gotsens et al., 2011a, Burrows et al., 2010, Esnaola et al., 2006, Chang et al., 2011, Middleton et al., 2006) and negative (Middleton et al., 2004, Page et al., 2002) in the case of suicides, while others have found no association (Esnaola et al., 2006, Middleton et al., 2004). In the case of falls, few studies have analysed socioeconomic inequalities for this cause at area level, these studies have not found any association with socioeconomic deprivation of residence area (Gotsens et al., 2011a). Finally, it is important to note that the socioeconomic inequalities in mortality due to injuries are more pronounced among men for the majority of causes (Gotsens et al., 2011a).

In Europe, socioeconomic inequalities in injury related mortality at small area level have hardly been analysed, and the majority of studies have focused on comparisons between countries. Focus to urban population was rarely given, while, on one side, the majority of Europe's population lives in cities (United Nations, 2011), on the other it is in the urban areas where certain external causes, such as traffic injuries involving pedestrians, homicides, or substance abuse are more common (Vlahov and Galea, 2002). Thus, the objective of the present study was to analyse socioeconomic inequalities in mortality due to the leading injury related causes of death in small areas of 15 European cities by sex, at the beginning of the 21st century.

Section snippets

Design, unit of analysis and study population

This was a cross-sectional ecological study which forms part of the INEQ-CITIES project (https://www.ucl.ac.uk/ineqcities/). The units of analysis were the small areas of 15 European cities. The selected cities of the study are the ones participating in this project. These cities were located in a variety of regions of Europe: north: Helsinki (Finland) and Stockholm (Sweden); west: London (UK), Amsterdam and Rotterdam (the Netherlands), Zurich (Switzerland) and Brussels (Belgium); south: Turin

Results

Table 1 presents the number of small areas, the total population and the distribution of the population by small area in each city. The number of small areas varies from 17 in Bratislava to 2666 in Turin. The median population per small area also varies by city. For example, the median population per area in Turin was 274 inhabitants while in Budapest it was 76,970 inhabitants. Both facts indicate that the size of the small areas with available data is different in each city. This table also

Discussion

Socioeconomic inequalities in injury related mortality can be observed in the majority of the cities studied. These inequalities are more pronounced in men. Specifically, in the cities of northern and western Europe, socioeconomic inequalities in injury mortality are found for most of the specific causes studied. These inequalities are not significant in the majority of the cities of southern Europe in women and in the majority of central eastern Europe in both sexes. With regard to specific

Conclusions

This study confirms the existence of socioeconomic inequalities in injury related mortality, and highlights the differences in their magnitude between various cities from different regions of Europe, with differing socioeconomic context. Studies of this type may allow identification of geographical patterns and of areas with high mortality risk and poor socioeconomic indicators, which helps when developing interventions aimed at reducing such inequalities. Furthermore, knowing that a health

Acknowledgements

This paper has been partially funded by the project INEQ-CITIES, “Socioeconomic inequalities in mortality: evidence and policies of cities of Europe”; project funded by the Executive Agency for Health and Consumers (Commission of the European Union), project no. 2008 12 13.

References (42)

  • C. Borrell et al.

    Education level inequalities and transportation injury mortality in the middle aged and elderly in European settings

    Injury Prevention

    (2005)
  • C. Borrell et al.

    Factors and processes influencing health inequalities in urban areas

    Journal of Epidemiology and Community Health

    (2013)
  • Camprubi, L., Diez, E., Morrison, J., Borrell, C., 2013. The Ineq-Cities research project on urban health inequalities:...
  • Comisión Para Reducir Las Desigualdades Sociales En Salud En España, 2012. A proposal of policies and interventions to...
  • C. Cubbin et al.

    Socioeconomic status and injury mortality: individual and neighbourhood determinants

    Journal of Epidemiology and Community Health

    (2000)
  • C. Cubbin et al.

    Socioeconomic inequalities in injury: critical issues in design and analysis

    Annual Review of Public Health

    (2002)
  • A.V. Diez Roux

    Investigating neighborhood and area effects on health

    American Journal of Public Health

    (2001)
  • EUROSTAT, 2012. Causes of Death...
  • A. Gelman

    Prior distributions for variance parameters in hierarchical models

    Bayesian Analysis

    (2006)
  • M. Gotsens et al.

    Validation of the underlying cause of death in medicolegal deaths

    Revista Española de Salud Pública

    (2011)
  • R. Haynes et al.

    Geographical distribution of road traffic deaths in England and Wales: place of accident compared with place of residence

    Journal of Public Health (Oxford)

    (2005)
  • Cited by (0)

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