title: Socio-ecological risk factors for prime-age adult death in two coastal areas of Vietnam.
abstract: BACKGROUND
  Hierarchical spatial models enable the geographic and ecological analysis of health data thereby providing useful information for designing effective health interventions. In this study, we used a Bayesian hierarchical spatial model to evaluate mortality data in Vietnam. The model enabled identification of socio-ecological risk factors and generation of risk maps to better understand the causes and geographic implications of prime-age (15 to less than 45 years) adult death.
  
  
  RESULTS
  The study was conducted in two sites: Nha Trang and Hue in Vietnam. The study areas were split into 500×500 meter cells to define neighborhoods. We first extracted socio-demographic data from population databases of the two sites, and then aggregated the data by neighborhood. We used spatial hierarchical model that borrows strength from neighbors for evaluating risk factors and for creating spatially smoothed risk map after adjusting for neighborhood level covariates. The Markov chain Monte Carlo procedure was used to estimate the parameters. Male mortality was more than twice the female mortality. The rates also varied by age and sex. The most frequent cause of mortality was traffic accidents and drowning for men and traffic accidents and suicide for women. Lower education of household heads in the neighborhood was an important risk factor for increased mortality. The mortality was highly variable in space and the socio-ecological risk factors are sensitive to study site and sex.
  
  
  CONCLUSIONS
  Our study suggests that lower education of the household head is an important predictor for prime age adult mortality. Variability in socio-ecological risk factors and in risk areas by sex make it challenging to design appropriate intervention strategies aimed at decreasing prime-age adult deaths in Vietnam.
authors.affiliation: International Vaccine Institute, SNU Research Park, Nakseongdae-dong, Gwanak-gu, Seoul, Korea.
authors.forename: Deok Ryun
authors.initials: DR
authors.lastname: Kim
authors.affiliation: International Vaccine Institute, SNU Research Park, Nakseongdae-dong, Gwanak-gu, Seoul, Korea ; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Ali
authors.affiliation: National Institute of Hygiene and Epidemiology, Hanoi, Vietnam.
authors.forename: Vu Dinh
authors.initials: VD
authors.lastname: Thiem
authors.affiliation: International Vaccine Institute, SNU Research Park, Nakseongdae-dong, Gwanak-gu, Seoul, Korea.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Wierzba
mesh_terms: D000293:Adolescent; D000328:Adult; D001499:Bayes Theorem; D002423:Cause of Death; D004522:Educational Status; D005260:Female; D005843:Geography; D006801:Humans; D008297:Male; D008962:Models, Theoretical; D009026:Mortality; D012307:Risk Factors; D012737:Sex Factors; D012959:Socioeconomic Factors; D062206:Spatial Analysis; D014744:Vietnam / Q000453:epidemiology