Socioeconomic Inequalities in Chronic Liver Diseases and Cirrhosis Mortality in European Urban Areas before and after the Onset of the 2008 Economic Recession
Abstract
:1. Introduction
2. Methods
2.1. Design, Units of Analysis, and Study Population
2.2. Data and Measures
- Mortality, corresponding to the number of deaths due to chronic liver diseases and cirrhosis (International Classification of Diseases (ICD)–9: 571; ICD–10: K70 and K74) by area, age group, and sex. Data were obtained from registries provided by local and national statistics institutions. The indicator of chronic liver diseases and cirrhosis mortality used for the analysis was the standardised mortality ratio (SMR), calculated by dividing the observed number of deaths in the study areas by the expected number of deaths (indirect method of age standardization). The latter was calculated considering the age-specific mortality rates in the standard population of the European Union (EU)-28 in the year 2007, and the population of the city/area by age groups. For descriptive purposes, we calculated the crude mortality rate (MR), and the indirectly standardised mortality rate (ISMR). The latter was calculated by multiplying the SMR in the city/metropolitan area by the crude rate in the standard population.
- Population, corresponding to the number of inhabitants living in the study areas. Most urban areas had data for the entire period studied or for at least 2 years. These data were stratified by age (5-year groups) and sex and were obtained from census or population registries. The median population of the areas ranged from 271 (Turin) to 193,630 (Berlin) (Table 1).
- Socioeconomic data, obtained from the census, consisting of several indicators selected to identify the level of deprivation of the areas studied. We built a composite socioeconomic deprivation index using principal component analysis within each city. The variables included in the analysis for 2001 (2002, in the case of Berlin) were the percentages of: unemployed population (≥16 years, economically active population); manual workers (≥16 years); population with primary education as the highest attainment (International Standard Classification of Education 0 and 1, except for London, which was 0, 1, and 2) (25–64 years); and population with university education (25–64 years). The percentage of manual workers was not available for Stockholm and the index was calculated with the other three indicators. The index of deprivation was the first component of the principal component analysis, which was performed separately for each city; therefore, it was possible to show the pattern of deprivation in each setting. The proportion of variance explained by the first component ranged from 0.578 in Lisbon to 0.918 in the Athens metropolitan area. The principal component analysis was performed using the prcomp function of the R statistical software package. The calculation was performed by a singular value decomposition of the data matrix, which is generally the preferred method for numerical accuracy.
2.3. Data Analysis
3. Results
4. Discussion
Strengths and Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Urban Area | Short Name | Number of Small Areas | Type of Small Areas | Period Years | Population (First Year Available) | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
First Period 2000–2003 | Second Period 2004–2008 | Third Period 2009–2014 | Men | Women | ||||||||||
Total | p25 | p50 | p75 | Total | p25 | p50 | p75 | |||||||
Athens metropolitan area | Athens | 40 | municipalities | 2000–2003 | 2004–2008 | 2009–2013 | 1,577,172 | 18,565 | 29,745 | 35,489 | 1,710,446 | 20,136 | 32,163 | 39,965 |
Barcelona city | Barcelona | 1491 | census tracts | 2000–2003 | 2004–2008 | 2009–2013 | 697,563 | 365 | 457 | 577 | 796,497 | 418 | 517 | 648 |
Berlin-Brandenburg metropolitan region | Berlin | 30 | districts | 2002 | 2006 | 2011 | 2,927,616 | 66,326 | 96,176 | 129,157 | 3,047,188 | 68,041 | 97,454 | 130,560 |
Brussels capital region | Brussels | 145 | neighbourhoods | 2001–2003 | 2004–2008 | 2009–2011 | 464,364 | 2727 | 4004 | 5707 | 505,673 | 3058 | 4288 | 6172 |
Lisbon metropolitan area | Lisbon | 188 | parishes | 2000–2003 | 2004–2008 | 2009–2012 | 1275,813 | 2694 | 5437 | 8962 | 1,386,314 | 2938 | 5835 | 9904 |
Greater London | London | 983 | census tracts | 2000–2003 | 2004–2008 | 2009–2014 | 3,597,120 | 3442 | 3810 | 4284 | 3,725,283 | 3526 | 3960 | 4382 |
Prague city | Prague | 57 | districts | 2001–2003 | 2004–2008 | 2009–2014 | 549,652 | 1010 | 2206 | 15,001 | 610,466 | 1024 | 2100 | 14,838 |
Stockholm metropolitan area | Stockholm | 1299 | census tracts | 2001–2003 | 2004–2008 | 2009–2011 | 897,487 | 218 | 560 | 1050 | 936,977 | 232 | 599 | 1104 |
Turin city | Turin | 2678 | census tracts | 2000–2003 | 2004–2008 | 2009–2013 | 425,782 | 88 | 129 | 196 | 465,987 | 96 | 142 | 215 |
Men | First Period (2000–2003) | Second Period (2004–2008) | Third Period (2009–2014) | ||||||
Urban Areas | Deaths | MR | ISMR | Deaths | MR | ISMR | Deaths | MR | ISMR |
Athens | 489 | 7.8 | 8.83 | 595 | 7.85 | 8.5 | 671 | 9.08 | 9.42 |
Barcelona | 564 | 19.58 | 19.66 | 604 | 15.91 | 16.36 | 566 | 14.71 | 14.88 |
Berlin | 999 | 34.12 | 35.48 | 913 | 30.19 | 30.06 | 771 | 26.31 | 24.55 |
Brussels | 189 | - | - | 386 | - | - | 207 | - | - |
Lisbon | 1178 | 23.07 | 25.35 | 1154 | 17.87 | 19 | 862 | 16.25 | 16.73 |
London | 1953 | 13.5 | 18.63 | 2369 | 12.65 | 17.41 | 2603 | 10.65 | 14.45 |
Prague | 388 | 23.42 | 24.31 | 686 | 23.81 | 24.8 | 753 | 20.68 | 21.53 |
Stockholm | 291 | 10.73 | 12.41 | 489 | 10.38 | 11.8 | 273 | 9.41 | 10.63 |
Turin | 377 | 22.07 | 20.36 | 496 | 23.22 | 21.09 | 417 | 19.32 | 17.29 |
Women | First Period | Second Period | Third Period | ||||||
Urban Areas | Deaths | MR | ISMR | Deaths | MR | ISMR | Deaths | MR | ISMR |
Athens | 213 | 3.13 | 3.18 | 299 | 3.62 | 3.52 | 285 | 3.52 | 3.27 |
Barcelona | 364 | 11.18 | 9.82 | 398 | 9.45 | 8.46 | 362 | 8.51 | 7.61 |
Berlin | 497 | 16.31 | 15.25 | 467 | 14.99 | 13.69 | 422 | 13.82 | 12.07 |
Brussels | 101 | - | - | 221 | - | - | 121 | - | - |
Lisbon | 326 | 5.86 | 5.77 | 276 | 3.88 | 3.72 | 199 | 3.37 | 3.15 |
London | 968 | 6.48 | 8.14 | 1069 | 5.53 | 7.06 | 1254 | 5.01 | 6.38 |
Prague | 215 | 11.74 | 10.66 | 386 | 12.43 | 11.29 | 391 | 10.14 | 9.34 |
Stockholm | 136 | 4.81 | 5.17 | 230 | 4.72 | 5.04 | 127 | 4.27 | 4.55 |
Turin | 331 | 17.71 | 14.6 | 360 | 15.36 | 12.59 | 258 | 10.86 | 8.85 |
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Borrell, C.; Palència, L.; Bosakova, L.; Gotsens, M.; Morrison, J.; Costa, C.; Dzurova, D.; Deboosere, P.; Lustigova, M.; Marí-Dell’Olmo, M.; et al. Socioeconomic Inequalities in Chronic Liver Diseases and Cirrhosis Mortality in European Urban Areas before and after the Onset of the 2008 Economic Recession. Int. J. Environ. Res. Public Health 2021, 18, 8801. https://doi.org/10.3390/ijerph18168801
Borrell C, Palència L, Bosakova L, Gotsens M, Morrison J, Costa C, Dzurova D, Deboosere P, Lustigova M, Marí-Dell’Olmo M, et al. Socioeconomic Inequalities in Chronic Liver Diseases and Cirrhosis Mortality in European Urban Areas before and after the Onset of the 2008 Economic Recession. International Journal of Environmental Research and Public Health. 2021; 18(16):8801. https://doi.org/10.3390/ijerph18168801
Chicago/Turabian StyleBorrell, Carme, Laia Palència, Lucia Bosakova, Mercè Gotsens, Joana Morrison, Claudia Costa, Dagmar Dzurova, Patrick Deboosere, Michala Lustigova, Marc Marí-Dell’Olmo, and et al. 2021. "Socioeconomic Inequalities in Chronic Liver Diseases and Cirrhosis Mortality in European Urban Areas before and after the Onset of the 2008 Economic Recession" International Journal of Environmental Research and Public Health 18, no. 16: 8801. https://doi.org/10.3390/ijerph18168801
APA StyleBorrell, C., Palència, L., Bosakova, L., Gotsens, M., Morrison, J., Costa, C., Dzurova, D., Deboosere, P., Lustigova, M., Marí-Dell’Olmo, M., Rodopoulou, S., & Santana, P. (2021). Socioeconomic Inequalities in Chronic Liver Diseases and Cirrhosis Mortality in European Urban Areas before and after the Onset of the 2008 Economic Recession. International Journal of Environmental Research and Public Health, 18(16), 8801. https://doi.org/10.3390/ijerph18168801