Increase in socioeconomic inequalities in mortality in a Southern European region: a small-area ecological study.
This study sought to describe the total mortality trend by socioeconomic deprivation (SED) in the Madrid Autonomous Region, by sex and age group.



Cross-sectional ecological study by census tract, in two periods: 1994-2000 (P1) with SED of 1996 census and 2001-07 (P2) with SED of 2001 census. We calculated the relative risks (RRs) and their 95% credibility intervals (95% CIs) by SED quintile (Q), taking the quintile of least deprivation as reference. Besag-York-Mollié ecological regression models and the Integrated Nested Laplace Approximation procedure were applied. The absolute differences in age-standardized rates were compared by SED quintile.



Inequalities decreased in young adults: among men aged 20-39 years, the RR in Q5 versus Q1 ranged from 2.73 (95% CI, 2.51-3.02) in P1 to 1.93 (95% CI, 1.76-2.15) in P2, due to the greater improvement in the most underprivileged groups. In contrast, there was an increase in SED-related mortality in the 40-79 age group. Among men aged 40-59 years, the RR in Q5 versus Q1 rose from 1.88 (95% CI, 1.76-2.02) in P1 to 2.29 (95% CI, 2.17-2.43) in P2; the improvement was greater in the most privileged groups.



In a context of an economic boom, inequalities were observed to increase among adults by a greater improvement in the most privileged groups.
Madrid Regional Health Authority, Madrid, Spain.
A M
AM
Gandarillas
Madrid Regional Health Authority, Madrid, Spain.
M F
MF
Domínguez-Berjón
Madrid Regional Health Authority, Madrid, Spain.
M J
MJ
Soto
D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D011203:Poverty / Q000706:statistics & numerical data; D012306:Risk; D012737:Sex Factors; D012959:Socioeconomic Factors; D013030:Spain / Q000453:epidemiology; D055815:Young Adult
inequalities; mortality; small-area analysis; socioeconomic factors; trends