title: Neighbourhood unemployment and all cause mortality: a comparison of six countries.
abstract: OBJECTIVE
  Studies have shown that living in more deprived neighbourhoods is related to higher mortality rates, independent of individual socioeconomic characteristics. One approach that contributes to understanding the processes underlying this association is to examine whether the relation is modified by the country context. In this study, the size of the association between neighbourhood unemployment rates and all cause mortality was compared across samples from six countries (United States, Netherlands, England, Finland, Italy, and Spain).
  
  
  METHODS
  Data from three prospective cohort studies (ARIC (US), GLOBE (Netherlands), and Whitehall II (England)) and three population based register studies (Helsinki, Turin, Madrid) were analysed. In each study, neighbourhood unemployment rates were derived from census, register based data. Cox proportional hazard models, taking into account the possible correlation of outcomes among people of the same neighbourhood, were used to assess the associations between neighbourhood unemployment and all cause mortality, adjusted for education and occupation at the individual level.
  
  
  RESULTS
  In men, after adjustment for age, education, and occupation, living in the quartile of neighbourhoods with the highest compared with the lowest unemployment rates was associated with increased hazards of mortality (14%-46%), although for the Whitehall II study associations were not statistically significant. Similar patterns were found in women, but associations were not statistically significant in two of the five studies that included women.
  
  
  CONCLUSIONS
  Living in more deprived neighbourhoods is associated with increased all cause mortality in the US and five European countries, independent of individual socioeconomic characteristics. There is no evidence that country substantially modified this association.
authors.affiliation: Department of Public Health, Erasmus Medical Centre, Rotterdam, Rotterdam, The Netherlands. f.vanlenthe@erasmusmc.nl
authors.forename: F J
authors.initials: FJ
authors.lastname: van Lenthe
authors.forename: L N
authors.initials: LN
authors.lastname: Borrell
authors.forename: G
authors.initials: G
authors.lastname: Costa
authors.forename: A V
authors.initials: AV
authors.lastname: Diez Roux
authors.forename: T M
authors.initials: TM
authors.lastname: Kauppinen
authors.forename: C
authors.initials: C
authors.lastname: Marinacci
authors.forename: P
authors.initials: P
authors.lastname: Martikainen
authors.forename: E
authors.initials: E
authors.lastname: Regidor
authors.forename: M
authors.initials: M
authors.lastname: Stafford
authors.forename: T
authors.initials: T
authors.lastname: Valkonen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D011204:Poverty Areas; D011446:Prospective Studies; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D014478:Unemployment / Q000706:statistics & numerical data*