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Open AccessArticle

Geodemographic Area Classification and Association with Mortality: An Ecological Study of Small Areas of Cyprus

1
Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia 1516, Cyprus
2
Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol 3041, Cyprus
3
Healthcare Management Postgraduate Program, Open University Cyprus, P.O. Box 12794, Nicosia 2252, Cyprus
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2019, 16(16), 2927; https://doi.org/10.3390/ijerph16162927
Received: 4 July 2019 / Revised: 10 August 2019 / Accepted: 12 August 2019 / Published: 15 August 2019
Geographical investigations are a core function of public health monitoring, providing the foundation for resource allocation and policies for reducing health inequalities. The aim of this study was to develop geodemographic area classification based on several area-level indicators and to explore the extent of geographical inequalities in mortality. A series of 19 area-level socioeconomic indicators were used from the 2011 national population census. After normalization and standardization of the geographically smoothed indicators, the k-means cluster algorithm was implemented to classify communities into groups based on similar characteristics. The association between geodemographic area classification and the spatial distribution of mortality was estimated in Poisson log-linear spatial models. The k-means algorithm resulted in four distinct clusters of areas. The most characteristic distinction was between the ageing, socially isolated, and resource-scarce rural communities versus metropolitan areas with younger population, higher educational attainment, and professional occupations. By comparison to metropolitan areas, premature mortality appeared to be 44% (95% Credible Intervals [CrI] of Rate Ratio (RR): 1.06–1.91) higher in traditional rural areas and 36% (95% CrI of RR: 1.13–1.62) higher in young semi-rural areas. These findings warrant future epidemiological studies investigating various causes of the urban-rural differences in premature mortality and implementation policies to reduce the mortality gap between urban and rural areas. View Full-Text
Keywords: health inequalities; mortality; area classification; cluster analysis; geodemographics; Poisson spatial model; Cyprus health inequalities; mortality; area classification; cluster analysis; geodemographics; Poisson spatial model; Cyprus
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Lamnisos, D.; Middleton, N.; Kyprianou, N.; Talias, M.A. Geodemographic Area Classification and Association with Mortality: An Ecological Study of Small Areas of Cyprus. Int. J. Environ. Res. Public Health 2019, 16, 2927.

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