title: Higher mortality in urban neighbourhoods in The Netherlands: who is at risk?
abstract: BACKGROUND
  Urban residents have higher mortality risks than rural residents. These urban-rural differences might be more pronounced within certain demographic subpopulations.
  
  
  OBJECTIVE
  To determine urban-rural differences in all-cause and cause-specific mortality within specific demographic subpopulations of the Dutch population.
  
  
  METHODS
  Mortality records with information on gender, age, marital status, region of origin and place of residence were available for 1995 through 2000. Neighbourhood data on address density and socioeconomic level were linked through postcode information. Variations in all-cause and cause-specific mortality between urban and rural neighbourhoods were estimated through Poisson regression. Additionally, analyses were stratified according to demographic subpopulation.
  
  
  RESULTS
  After adjustments for population composition, urban neighbourhoods have higher all-cause mortality risks than rural neighbourhoods (RR = 1.05; CI 1.04 to 1.05), but this pattern reverses after adjustment for neighbourhood socioeconomic level (RR = 0.98; CI 0.97 to 0.99). The beneficial effect of living in an urban environment applies particularly to individuals aged 10-40 years and 80 years and above, people who never married and residents from non-Western ethnic origins. The beneficial effect of urban residence for non-married people is related to their lower cancer and heart disease mortality. The beneficial effect of urban residence for people of non-Western ethnic origin is related to their lower cancer and suicide mortality.
  
  
  CONCLUSIONS
  In The Netherlands, living in an urban environment is not consistently related to higher mortality risks. Young adults, elderly, single and non-Western residents, especially, benefit from living in an urban environment. The urban environment seems to offer these subgroups better opportunities for a healthy life.
authors.affiliation: Centre for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven, The Netherlands. c.vanhooijdonk.1@erasmusmc.nl
authors.forename: C
authors.initials: C
authors.lastname: van Hooijdonk
authors.forename: M
authors.initials: M
authors.lastname: Droomers
authors.forename: I M
authors.initials: IM
authors.lastname: Deerenberg
authors.forename: J P
authors.initials: JP
authors.lastname: Mackenbach
authors.forename: A E
authors.initials: AE
authors.lastname: Kunst
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D054242:Emigrants and Immigrants; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D017533:Marital Status; D008875:Middle Aged; D009026:Mortality; D009426:Netherlands / Q000453:epidemiology; D011156:Population Density; D011204:Poverty Areas; D012044:Regression Analysis; D012306:Risk; D012424:Rural Population; D012737:Sex Factors; D012931:Social Environment; D014505:Urban Population