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Area-Level Deprivation and Overall and Cause-Specific Mortality: 12 Years’ Observation on British Women and Systematic Review of Prospective Studies

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  • Maria T Sánchez-Santos
  • Marco Mesa-Frias
  • Minkyoung Choi
  • Eveline Nüesch
  • Angel Asunsolo-Del Barco
  • Antoinette Amuzu
  • George Davey Smith
  • Shah Ebrahim
  • David Prieto-Merino
  • Juan P Casas

Abstract

Background: Prospective studies have suggested a negative impact of area deprivation on overall mortality, but its effect on cause-specific mortality and the mechanisms that account for this association remain unclear. We investigate the association of area deprivation, using Index of Multiple deprivation (IMD), with overall and cause-specific mortality, contextualising findings within a systematic review. Methods And Findings: We used data from 4,286 women from the British Women’s Heart Health Study (BWHHS) recruited at 1999-2001 to examine the association of IMD with overall and cause-specific mortality using Cox regression models. One standard deviation (SD) increase in the IMD score had a hazard ratio (HR) of 1.21 (95% CI: 1.13-1.30) for overall mortality after adjustment for age and lifecourse individual deprivation, which was attenuated to 1.15 (95% CI: 1.04-1.26) after further inclusion of mediators (health behaviours, biological factors and use of statins and blood pressure-lowering medications). A more pronounced association was observed for respiratory disease and vascular deaths. The meta-analysis, based on 20 published studies plus the BWHHS (n=21), yielded a summary relative risk (RR) of 1.15 (95% CI: 1.11-1.19) for area deprivation (top [least deprived; reference] vs. bottom tertile) with overall mortality in an age and sex adjusted model, which reduced to 1.06 (95% CI: 1.04-1.08) in a fully adjusted model. Conclusions: Health behaviours mediate the association between area deprivation and cause-specific mortality. Efforts to modify health behaviours may be more successful if they are combined with measures that tackle area deprivation.

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  • Maria T Sánchez-Santos & Marco Mesa-Frias & Minkyoung Choi & Eveline Nüesch & Angel Asunsolo-Del Barco & Antoinette Amuzu & George Davey Smith & Shah Ebrahim & David Prieto-Merino & Juan P Casas, 2013. "Area-Level Deprivation and Overall and Cause-Specific Mortality: 12 Years’ Observation on British Women and Systematic Review of Prospective Studies," PLOS ONE, Public Library of Science, vol. 8(9), pages 1-1, September.
    • Handle: RePEc:plo:pone00:0072656
    DOI: 10.1371/journal.pone.0072656
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    2. Watt, H.C. & Carson, C. & Lawlor, D.A. & Patel, R. & Ebrahim, S., 2009. "Influence of life course socioeconomic position on older women's health behaviors: Findings from the British Women's Heart and Health Study," American Journal of Public Health, American Public Health Association, vol. 99(2), pages 320-327.
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    4. Lawlor, D.A. & Smith, G.D. & Patel, R. & Ebrahim, S., 2005. "Life-course socioeconomic position, area deprivation, and coronary heart disease: Findings from the British women's heart and health study," American Journal of Public Health, American Public Health Association, vol. 95(1), pages 91-97.
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    1. O'Doherty, M.G. & French, D. & Steptoe, A. & Kee, F., 2017. "Social capital, deprivation and self-rated health: Does reporting heterogeneity play a role? Results from the English Longitudinal Study of Ageing," Social Science & Medicine, Elsevier, vol. 179(C), pages 191-200.
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    3. Regidor, Enrique & Vallejo, Fernando & Reques, Laura & Cea, Lucía & Miqueleiz, Estrella & Barrio, Gregorio, 2015. "Area-level socioeconomic context, total mortality and cause-specific mortality in Spain: Heterogeneous findings depending on the level of geographic aggregation," Social Science & Medicine, Elsevier, vol. 141(C), pages 142-150.

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