Area-level deprivation and overall and cause-specific mortality: 12 years' observation on British women and systematic review of prospective studies.
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)...
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2013-01-01
|
| Series: | PLoS ONE |
| Online Access: | http://europepmc.org/articles/PMC3782490?pdf=render |
| _version_ | 1819089265236115456 |
|---|---|
| author | 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 |
| author_facet | 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 |
| author_sort | Maria T Sánchez-Santos |
| collection | DOAJ |
| description | 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.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.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. |
| first_indexed | 2024-12-21T22:05:11Z |
| format | Article |
| id | doaj.art-ae4e65867f7d4e5aa34a471cad9a31d8 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-21T22:05:11Z |
| publishDate | 2013-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-ae4e65867f7d4e5aa34a471cad9a31d82022-12-21T18:48:43ZengPublic Library of Science (PLoS)PLoS ONE1932-62032013-01-0189e7265610.1371/journal.pone.0072656Area-level deprivation and overall and cause-specific mortality: 12 years' observation on British women and systematic review of prospective studies.Maria T Sánchez-SantosMarco Mesa-FriasMinkyoung ChoiEveline NüeschAngel Asunsolo-Del BarcoAntoinette AmuzuGeorge Davey SmithShah EbrahimDavid Prieto-MerinoJuan P CasasProspective 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.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.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.http://europepmc.org/articles/PMC3782490?pdf=render |
| spellingShingle | 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 Area-level deprivation and overall and cause-specific mortality: 12 years' observation on British women and systematic review of prospective studies. PLoS ONE |
| title | Area-level deprivation and overall and cause-specific mortality: 12 years' observation on British women and systematic review of prospective studies. |
| title_full | Area-level deprivation and overall and cause-specific mortality: 12 years' observation on British women and systematic review of prospective studies. |
| title_fullStr | Area-level deprivation and overall and cause-specific mortality: 12 years' observation on British women and systematic review of prospective studies. |
| title_full_unstemmed | Area-level deprivation and overall and cause-specific mortality: 12 years' observation on British women and systematic review of prospective studies. |
| title_short | Area-level deprivation and overall and cause-specific mortality: 12 years' observation on British women and systematic review of prospective studies. |
| title_sort | area level deprivation and overall and cause specific mortality 12 years observation on british women and systematic review of prospective studies |
| url | http://europepmc.org/articles/PMC3782490?pdf=render |
| work_keys_str_mv | AT mariatsanchezsantos arealeveldeprivationandoverallandcausespecificmortality12yearsobservationonbritishwomenandsystematicreviewofprospectivestudies AT marcomesafrias arealeveldeprivationandoverallandcausespecificmortality12yearsobservationonbritishwomenandsystematicreviewofprospectivestudies AT minkyoungchoi arealeveldeprivationandoverallandcausespecificmortality12yearsobservationonbritishwomenandsystematicreviewofprospectivestudies AT evelinenuesch arealeveldeprivationandoverallandcausespecificmortality12yearsobservationonbritishwomenandsystematicreviewofprospectivestudies AT angelasunsolodelbarco arealeveldeprivationandoverallandcausespecificmortality12yearsobservationonbritishwomenandsystematicreviewofprospectivestudies AT antoinetteamuzu arealeveldeprivationandoverallandcausespecificmortality12yearsobservationonbritishwomenandsystematicreviewofprospectivestudies AT georgedaveysmith arealeveldeprivationandoverallandcausespecificmortality12yearsobservationonbritishwomenandsystematicreviewofprospectivestudies AT shahebrahim arealeveldeprivationandoverallandcausespecificmortality12yearsobservationonbritishwomenandsystematicreviewofprospectivestudies AT davidprietomerino arealeveldeprivationandoverallandcausespecificmortality12yearsobservationonbritishwomenandsystematicreviewofprospectivestudies AT juanpcasas arealeveldeprivationandoverallandcausespecificmortality12yearsobservationonbritishwomenandsystematicreviewofprospectivestudies |