title: The Association of Geographic Coordinates with Mortality in People with Lower and Higher Education and with Mortality Inequalities in Spain.
abstract: OBJECTIVE
  Geographic patterns in total mortality and in mortality by cause of death are widely known to exist in many countries. However, the geographic pattern of inequalities in mortality within these countries is unknown. This study shows mathematically and graphically the geographic pattern of mortality inequalities by education in Spain.
  
  
  METHODS
  Data are from a nation-wide prospective study covering all persons living in Spain's 50 provinces in 2001. Individuals were classified in a cohort of subjects with low education and in another cohort of subjects with high education. Age- and sex-adjusted mortality rate from all causes and from leading causes of death in each cohort and mortality rate ratios in the low versus high education cohort were estimated by geographic coordinates and province.
  
  
  RESULTS
  Latitude but not longitude was related to mortality. In subjects with low education, latitude had a U-shaped relation to mortality. In those with high education, mortality from all causes, and from cardiovascular, respiratory and digestive diseases decreased with increasing latitude, whereas cancer mortality increased. The mortality-rate ratio for all-cause death was 1.27 in the southern latitudes, 1.14 in the intermediate latitudes, and 1.20 in the northern latitudes. The mortality rate ratios for the leading causes of death were also higher in the lower and upper latitudes than in the intermediate latitudes. The geographic pattern of the mortality rate ratios is similar to that of the mortality rate in the low-education cohort: the highest magnitude is observed in the southern provinces, intermediate magnitudes in the provinces of the north and those of the Mediterranean east coast, and the lowest magnitude in the central provinces and those in the south of the Western Pyrenees.
  
  
  CONCLUSIONS
  Mortality inequalities by education in Spain are higher in the south and north of the country and lower in the large region making up the central plateau. This geographic pattern is similar to that observed in mortality in the low-education cohort.
authors.affiliation: Department of Preventive Medicine and Public Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos IdISSC, Madrid, Spain; CIBER Epidemiología y Salud Pública CIBERESP, Madrid, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Regidor
authors.affiliation: National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Reques
authors.affiliation: Department of Preventive Medicine and Public Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos IdISSC, Madrid, Spain.
authors.forename: Carolina
authors.initials: C
authors.lastname: Giráldez-García
authors.affiliation: Departament of Sociology, Universidad Pública de Navarra, Pamplona, Spain.
authors.forename: Estrella
authors.initials: E
authors.lastname: Miqueleiz
authors.affiliation: Department of Preventive Medicine and Public Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos IdISSC, Madrid, Spain.
authors.forename: Juana M
authors.initials: JM
authors.lastname: Santos
authors.affiliation: Department of Preventive Medicine and Public Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos IdISSC, Madrid, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Martínez
authors.affiliation: CIBER Epidemiología y Salud Pública CIBERESP, Madrid, Spain; National Epidemiology Center, Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: de la Fuente
mesh_terms: D002423:Cause of Death; D005260:Female; D005843:Geography; D006801:Humans; D008297:Male; D015233:Models, Statistical; D009026:Mortality; D011159:Population Surveillance; D011446:Prospective Studies; D012959:Socioeconomic Factors; D013030:Spain