Contribution of main causes of death to social inequalities in mortality in the whole population of Scania, Sweden

An ecological study was carried out using information zones as units of analysis in order to assess the evolution of socio-spatial inequalities in mortality due to external causes and homicides in Salvador, Bahia State, Brazil, in 2000 and 2006. The Brazilian Institute of Geography and Statistics (Instituto Brasileiro de Geografia e Estatística - IBGE) and the City Health Department (Secretaria Municipal de Saúde) provided the data sources, and causes of death were reviewed and reclassified based on reports from the Institute of Legal Medicine (Instituto Médico Legal). The information zones were classified into four social strata according to income and schooling. The ratio between mortality rates (inequality ratio) was calculated and confirmed a rise of 98.5% in the homicide rate. In 2000, the risk of death due to external causes and murders in the stratum with the worst living conditions was respectively 1.40 and 1.94 times greater than in the reference stratum. In 2006 these figures were 2.02 and 2.24. The authors discuss the implications for inter-sectoral public policies, based on evidence from the study's findings.

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Exploring the evolution of health promotion in Namibia: opportunities and obstacles during the post-independence era

Global Health Promotion ◽

10.1177/1757975920938765 ◽

2020 ◽

Vol 27 (4) ◽

pp. 107-113

Author(s):

Mwakanyadzeni Abigail Chipare ◽

Roy Tapera ◽

Ronald Farayi Pachawo ◽

James January

Keyword(s):

Health Promotion ◽

Historical Development ◽

Causes Of Death ◽

African Country ◽

Social Inequalities ◽

High Coverage ◽

Live Births ◽

Southern African Country ◽

Tremendous Progress ◽

Independence Era

Namibia is a Southern African country with social inequalities. This paper discusses the historical development of health promotion in Namibia. The country has achieved tremendous progress in public health after gaining independence in March 1990, with increased life expectancy, reduced tuberculosis and AIDS mortality due to high coverage of antiretroviral therapy (90%) in 2012, and a reduced under-five mortality rate, from 74 deaths per 1000 live births in 1990 to 50 in 2013. However, challenges still exist in achieving health for all. Non-communicable diseases such as cancer, diabetes and cardiovascular diseases are among the top 10 diseases and top 15 causes of death, with diabetes emerging as one of the greatest threats to health. Opportunities and obstacles for effective health promotion are discussed. In conclusion, health promotion in Namibia has the potential to improve the health of the populace.

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Progress against inequalities in mortality: register-based study of 15 European countries between 1990 and 2015

European Journal of Epidemiology ◽

10.1007/s10654-019-00580-9 ◽

2019 ◽

Vol 34 (12) ◽

pp. 1131-1142 ◽

Cited By ~ 8

Author(s):

Johan P. Mackenbach ◽

José Rubio Valverde ◽

Matthias Bopp ◽

Henrik Brønnum-Hansen ◽

Giuseppe Costa ◽

...

Keyword(s):

Health Care ◽

Fixed Effects ◽

Causes Of Death ◽

Health Care Expenditure ◽

European Countries ◽

Mortality Data ◽

Factors Associated ◽

Country Level ◽

Low Educated ◽

Inequalities In Mortality

AbstractSocioeconomic inequalities in mortality are a challenge for public health around the world, but appear to be resistant to policy-making. We aimed to identify European countries which have been more successful than others in narrowing inequalities in mortality, and the factors associated with narrowing inequalities. We collected and harmonised mortality data by educational level in 15 European countries over the last 25 years, and quantified changes in inequalities in mortality using a range of measures capturing different perspectives on inequality (e.g., ‘relative’ and ‘absolute’ inequalities, inequalities in ‘attainment’ and ‘shortfall’). We determined which causes of death contributed to narrowing of inequalities, and conducted country- and period-fixed effects analyses to assess which country-level factors were associated with narrowing of inequalities in mortality. Mortality among the low educated has declined rapidly in all European countries, and a narrowing of absolute, but not relative inequalities was seen in many countries. Best performers were Austria, Italy (Turin) and Switzerland among men, and Spain (Barcelona), England and Wales, and Austria among women. Ischemic heart disease, smoking-related causes (men) and amenable causes often contributed to narrowing inequalities. Trends in income inequality, level of democracy and smoking were associated with widening inequalities, but rising health care expenditure was associated with narrowing inequalities. Trends in inequalities in mortality have not been as unfavourable as often claimed. Our results suggest that health care expansion has counteracted the inequalities widening effect of other influences.

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Family Health Strategy, Primary Health Care, and Social Inequalities in Mortality Among Older Adults in Bagé, Southern Brazil

American Journal of Public Health ◽

10.2105/ajph.2020.306146 ◽

2021 ◽

pp. e1-e10

Author(s):

Marciane Kessler ◽

Elaine Thumé ◽

Michael Marmot ◽

James Macinko ◽

Luiz Augusto Facchini ◽

...

Keyword(s):

Older Adults ◽

Health Care ◽

Primary Health Care ◽

Social Inequalities ◽

Family Health ◽

Primary Health ◽

Health Strategy ◽

Family Health Strategy ◽

Inequalities In Mortality

Objectives. To investigate the role of the Family Health Strategy (FHS) in reducing social inequalities in mortality over a 9-year follow-up period. Methods. We carried out a population-based cohort study of individuals aged 60 years and older from the city of Bagé, Brazil. Of 1593 participants at baseline (2008), 1314 (82.5%) were included in this 9-year follow-up (2017). We assessed type of primary health care (PHC) coverage and other variables at baseline. In 2017, we ascertained 579 deaths through mortality registers. Hazard ratios and their 95% confidence intervals modeled time to death estimated by Cox regression. We also tested the effect modification between PHC and wealth. Results. The FHS had a protective effect on mortality among individuals aged 60 to 64 years, a result not found among those not covered by the FHS. Interaction analysis showed that the FHS modified the effect of wealth on mortality. The FHS protected the poorest from all-cause mortality (hazard ratio [HR] = 0.59; 95% confidence interval [CI] = 0.36, 0.96) and avoidable mortality (HR = 0.46; 95% CI = 0.25, 0.85). Conclusions. FHS coverage reduced social inequalities in mortality among older adults. Our findings highlight the need to guarantee universal health coverage in Brazil by expanding and strengthening the FHS to promote health equity. (Am J Public Health. Published online ahead of print March 18, 2021: e1–e10. https://doi.org/10.2105/AJPH.2020.306146 )

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Education-related inequalities in cause-specific mortality: First estimates for Australia using individual-level linked census and mortality data

10.1101/2020.09.21.20193516 ◽

2020 ◽

Author(s):

Jennifer Welsh ◽

Grace Joshy ◽

Lauren Morgan ◽

Kay Soga ◽

Hsei-Di Law ◽

...

Keyword(s):

High Education ◽

Causes Of Death ◽

Negative Binomial ◽

International Comparisons ◽

Negative Binomial Regression ◽

Medical Intervention ◽

Mortality Data ◽

Individual Level ◽

Specific Mortality ◽

Inequalities In Mortality

Background: Socioeconomic inequalities in mortality are evident in all high-income countries and ongoing monitoring is recommended using linked census-mortality data. Using such data, we provide first estimates of education-related inequalities in cause-specific mortality in Australia, suitable for international comparisons. Methods: Using Australian Census (2016) linked to 13-months of Death Registrations data (2016-17), we estimated relative rates (RR) and rate differences (RD, per100 000 person-years), comparing rates in low (no qualifications) and intermediate (secondary school) with high education (tertiary), for individual causes of death (among those 25-84y) and grouped according to preventability (25-74y), separately by sex and age group, adjusting for age, using negative binomial regression. Results: Among 13.9M people contributing 14 452 732 person-years, 84 743 deaths occurred. We observed inequalities in most causes of death for each age-sex group. Among men aged 25-44y, absolute and relative inequalities (low versus high education) were largest for injuries, e.g. transport accidents (RR=10.1 [95%CI: 5.4-18.7], RD=21.1 [15.9-26.3]). Among those aged 45-64y, inequalities were greatest for chronic diseases, e.g. lung cancer (men RR=6.6 [4.9-8.9], RD=55.6 [51.1-60.1]) and ischaemic heart disease (women RR=5.8 [3.7-9.1], RD=19.2 [17.0-21.5]), with similar patterns for people aged 65-84y. When grouped according to preventability, inequalities were large for causes amenable to behaviour change and medical intervention for all ages and causes amenable to injury prevention among young men. Conclusions: Australian education-related inequalities in mortality are substantial, generally higher than international estimates, and related to preventability. Findings highlight opportunities to reduce them and the potential to improve the health of the population.

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