Chronic liver disease and cirrhosis mortality and social deprivation: a spatial analysis in small areas of Madrid region.
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.
Segura del Pozo
J
J
Directorate-General for Public Health, Madrid Regional Health Authority, Madrid, Spain. segurapfj@munimadrid.es
Gandarillas
A
A
Domínguez Berjón
F
F
Soto
M J
MJ
López
L
L
Marta
I
I
Abad
I
I
Zorrilla
B
B
Duque
I
I
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