Urban cause-specific socioeconomic mortality differences. Which causes of death contribute most?
BACKGROUND
Cause-specific information on socioeconomic differences in health is necessary for a rational public health policy. At the local level, the Municipal Health Service studies these differences in order to support the authorities in policy making.


METHODS
Mortality data of the under 65 age group in The Hague were analysed (1982-1991) at residential area level.


RESULTS
Causes of death with a high socioeconomic gradient among males were: homicide, chronic liver disease, 'other' external causes of injury, diabetes, bronchitis, emphysema and asthma, and motor vehicle accidents; and among females: diabetes, ischaemic heart disease, 'other' diseases of the circulatory system, signs, symptoms and ill-defined conditions, malignant neoplasm of cervix, and 'other' diseases. Main contributors to the mortality differences between the highest and lowest socioeconomic quartiles among males were: ischaemic heart disease (17.3%), 'other' diseases of the circulatory system (10.2%), signs, symptoms and ill-defined conditions (9.0%), 'other' external causes of injury (8.6%), and chronic liver disease (7.2%); and among females: ischaemic heart disease (25.5%), 'other' diseases (20.1%), signs, symptoms and ill-defined conditions (18.6%), 'other' diseases of the circulatory system (11.0%), and diabetes (9.1%). Among females the contributions of malignant neoplasms of breast (-16.3%) and colon (-5.5%) and suicide (-4.3%) were negative.


CONCLUSIONS
The diseases that are the main contributors to urban socioeconomic mortality differences can be influenced by public health policy.
Middelkoop
B J
BJ
Department of Epidemiology, Municipal Health Service The Hague, PO Box 12652, 2500 DP The Hague, The Netherlands. b.j.c.middelkoop@ocw.denhaag.nl
Struben
H W
HW
Burger
I
I
Vroom-Jongerden
J M
JM
D000293:Adolescent; D000328:Adult; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007182:Income; D007223:Infant; D007231:Infant, Newborn; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009426:Netherlands / Q000453:epidemiology; D012111:Residence Characteristics; D017678:Sex Distribution; D017062:Small-Area Analysis; D012959:Socioeconomic Factors; D014504:Urban Health; D014505:Urban Population / Q000706:statistics & numerical data*