Socioeconomic inequalities in injury mortality in small areas of 15 European cities

Highlights

• Socioeconomic inequalities exist in injury mortality at small area level in most European cities.

• There are differences in the magnitude of these inequalities.

• Inter-sectorial collaboration is necessary to create safe environments.

Abstract

This study analysed socioeconomic inequalities in mortality due to injuries in small areas of 15 European cities, by sex, at the beginning of this century.

A cross-sectional ecological study with units of analysis being small areas within 15 European cities was conducted. Relative risks of injury mortality associated with the socioeconomic deprivation index were estimated using hierarchical Bayesian model.

The number of small areas varies from 17 in Bratislava to 2666 in Turin. The median population per small area varies by city (e.g. Turin had 274 inhabitants per area while Budapest had 76,970). Socioeconomic inequalities in all injury mortality are observed in the majority of cities and are more pronounced in men. In the cities of northern and western Europe, socioeconomic inequalities in injury mortality are found for most types of injuries. These inequalities are not significant in the majority of cities in southern Europe among women and in the majority of central eastern European cities for both sexes.

The results confirm the existence of socioeconomic inequalities in injury related mortality and reveal variations in their magnitude between different European cities.

Introduction

Injuries due to external causes, whether intentional or unintentional, are one of the leading causes of death worldwide. In Europe injuries account for 7% of all deaths every year, with traffic injuries (16%), poisonings (13%) and falls (10%) being the main causes of death related with unintentional injuries, and suicides (19%) and homicides (7%) the leading causes of intentional injuries (WHO, 2012).

In recent decades injury mortality rates have fallen in most European countries (EUROSTAT, 2012), however, there are still differences between countries in mortality due to these causes. In concrete, people living in low and middle income countries are more likely to die from injuries than those living in high income countries. These differences have been observed for all specific causes of injuries, except for falls in women (Sethi et al., 2006). In addition, individuals of less favourable socioeconomic positions present higher risks of dying due to the leading specific causes of death by injuries (Cubbin and Smith, 2002, Laflamme et al., 2009).

In recent years there has been an increase in the number of studies of mortality inequalities in geographical areas, since area of residence has been recognised as a factor affecting health independently of individual determinants (Diez Roux, 2001). In the case of injury related mortality, some studies have found that areas with worse socioeconomic indicators present higher risks of dying, in particular for homicides (Leyland and Dundas, 2010, Krueger et al., 2004) and drug overdose (Gotsens et al., 2011a, Michelozzi et al., 1999). In the case of suicides and traffic injuries the findings are inconclusive. Some studies have found associations, both positive (Gotsens et al., 2011a, Burrows et al., 2010, Esnaola et al., 2006, Chang et al., 2011, Middleton et al., 2006) and negative (Middleton et al., 2004, Page et al., 2002) in the case of suicides, while others have found no association (Esnaola et al., 2006, Middleton et al., 2004). In the case of falls, few studies have analysed socioeconomic inequalities for this cause at area level, these studies have not found any association with socioeconomic deprivation of residence area (Gotsens et al., 2011a). Finally, it is important to note that the socioeconomic inequalities in mortality due to injuries are more pronounced among men for the majority of causes (Gotsens et al., 2011a).

In Europe, socioeconomic inequalities in injury related mortality at small area level have hardly been analysed, and the majority of studies have focused on comparisons between countries. Focus to urban population was rarely given, while, on one side, the majority of Europe's population lives in cities (United Nations, 2011), on the other it is in the urban areas where certain external causes, such as traffic injuries involving pedestrians, homicides, or substance abuse are more common (Vlahov and Galea, 2002). Thus, the objective of the present study was to analyse socioeconomic inequalities in mortality due to the leading injury related causes of death in small areas of 15 European cities by sex, at the beginning of the 21st century.