Social differences in avoidable mortality between small areas of 15 European cities: An ecological study

Abstract
Background:
Health and inequalities in health among inhabitants of European cities are of major importance for
European public health and there is great interest in how different health care systems in Europe perform in the
reduction of health inequalities. However, evidence on the spatial distribution of cause-specific mortality across
neighbourhoods of European cities is scarce. This study presents maps of avoidable mortality in European cities
and analyses differences in avoidable mortality between neighbourhoods with different levels of deprivation.
Methods:
We determined the level of mortality from 14 avoidable causes of death for each neighbourhood of 15
large cities in different European regions. To address the problems associated with Standardised Mortality Ratios for
small areas we smooth them using the Bayesian model proposed by Besag, York and Mollié. Ecological regression
analysis was used to assess the association between social deprivation and mortality.
Results:
Mortality from avoidable causes of death is higher in deprived neighbourhoods and mortality rate ratios
between areas with different levels of deprivation differ between gender and cities. In most cases rate ratios are
lower among women. While Eastern and Southern European cities show higher levels of avoidable mortality, the
association of mortality with social deprivation tends to be higher in Northern and lower in Southern Europe.
Conclusions:
There are marked differences in the level of avoidable mortality between neighbourhoods of
European cities and the level of avoidable mortality is associated with social deprivation. There is no systematic
difference in the magnitude of this association between European cities or regions. Spatial patterns of avoidable
mortality across small city areas can point to possible local problems and specific strategies to reduce health
inequality which is important for the development of urban areas and the well-being of their inhabitants.