title: Chronic liver disease and cirrhosis mortality and social deprivation: a spatial analysis in small areas of Madrid region.
abstract: OBJECTIVE
  To study census-tract distribution of chronic liver disease and cirrhosis mortality in the Madrid Region and its association with socio-economic deprivation.
  
  
  METHODS
  Cross-sectional, ecological (3906 census-tract) study, using mortality data for 1996-2003 and a deprivation index drawn up on the basis of 2001 census data. Standardised mortality ratios were calculated taking Spanish rates for 2001 as reference. Smoothed census-tract relative risks were computed using the Besag-York-Mollie model. Relative risks (RRs) of dying and their 95% credibility intervals (95% CIs) were calculated according to quartiles of the deprivation index (with the fourth quartile -Q- of the indicator being the most unfavourable situation). Maps were plotted depicting the distribution of the posterior probability of RR > 1.
  
  
  RESULTS
  Census tracts with a high risk of mortality were detected, mostly located in the centre and on the eastern, south-eastern and south-western fringes of the city of Madrid. Mortality increased with deprivation. RRs of mortality according to quartíles of the deprivation index were: Q2 = 1.5 (CI: 1.3-1.6), Q3 = 1.9 (CI:1.7-2.2) and Q4 = 2.5 (CI:2.2-2.8) for men; and Q2 = 1.3 (CI:1.1-1.5), Q3 = 1.5 (CI:1.3-1.7) and Q4 = 1.6 (CI:1.3-1.8) for women.
  
  
  CONCLUSIONS
  This small-area study enabled census tracts with excess mortality eligible for a special public health intervention to be identified, and their association with socio-economic deprivation to be confirmed.
authors.affiliation: Directorate-General for Public Health, Madrid Regional Health Authority, Madrid, Spain. segurapfj@munimadrid.es
authors.forename: J
authors.initials: J
authors.lastname: Segura del Pozo
authors.forename: A
authors.initials: A
authors.lastname: Gandarillas
authors.forename: F
authors.initials: F
authors.lastname: Domínguez Berjón
authors.forename: M J
authors.initials: MJ
authors.lastname: Soto
authors.forename: L
authors.initials: L
authors.lastname: López
authors.forename: I
authors.initials: I
authors.lastname: Marta
authors.forename: I
authors.initials: I
authors.lastname: Abad
authors.forename: B
authors.initials: B
authors.lastname: Zorrilla
authors.forename: I
authors.initials: I
authors.lastname: Duque
mesh_terms: D002908:Chronic Disease; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000401:mortality*; D008107:Liver Diseases / Q000401:mortality*; D008297:Male; D011610:Psychosocial Deprivation; D013030:Spain; D014504:Urban Health