Journal of Preventive Medicine and Public Health

The Korean Society for Preventive Medicine (대한예방의학회)
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Deprivation and Mortality at the Town Level in Busan, Korea: An Ecological Study

  • Choi, Min-Hyeok (Department of Preventive & Occupational Medicine, School of Medicine, Pusan National University) ;
  • Cheong, Kyu-Seok (Department of Preventive & Occupational Medicine, School of Medicine, Pusan National University) ;
  • Cho, Byung-Mann (Department of Preventive & Occupational Medicine, School of Medicine, Pusan National University) ;
  • Hwang, In-Kyung (Department of Preventive & Occupational Medicine, School of Medicine, Pusan National University) ;
  • Kim, Chang-Hun (Office of Public Health Care Service, Pusan National University Hospital) ;
  • Kim, Myoung-Hee (People's Health Institute) ;
  • Hwang, Seung-Sik (Department of Social & Preventive Medicine, School of Medicine, Inha University) ;
  • Lim, Jeong-Hun (Graduate School of Public Health, Seoul National University) ;
  • Yoon, Tae-Ho (Department of Preventive & Occupational Medicine, School of Medicine, Pusan National University)
  • Received : 2011.04.18
  • Accepted : 2011.07.19
  • Published : 2011.11.30
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Abstract

Objectives: Busan is reported to have the highest mortality rate among 16 provinces in Korea, as well as considerable health inequality across its districts. This study sought to examine overall and cause-specific mortality and deprivation at the town level in Busan, thereby identifying towns and causes of deaths to be targeted for improving overall health and alleviating health inequality. Methods: Standardized mortality ratios (SMRs) for all-cause and four specific leading causes of death were calculated at the town level in Busan for the years 2005 through 2008. To construct a deprivation index, principal components and factor analysis were adopted, using 10% sample data from the 2005 census. Geographic information system (GIS) mapping techniques were applied to compare spatial distributions between the deprivation index and SMRs. We fitted the Gaussian conditional autoregressive model (CAR) to estimate the relative risks of mortality by deprivation level, controlling for both the heterogeneity effect and spatial autocorrelation. Results: The SMRs of towns in Busan averaged 100.3, ranging from 70.7 to 139.8. In old inner cities and towns reclaimed for replaced households, the deprivation index and SMRs were relatively high. CAR modeling showed that gaps in SMRs for heart disease, cerebrovascular disease, and physical injury were particularly high. Conclusions: Our findings indicate that more deprived towns are likely to have higher mortality, in particular from cardiovascular disease and physical injury. To improve overall health status and address health inequality, such deprived towns should be targeted.

Keywords

References

  1. Busan Metropolitan City. The 5th regional health care planning (2011-2014). Busan: Busan Metropolitan City; 2011. (Korean)
  2. WHO Commission on Social Determinants of Health; World Health Organization. Closing the gap in a generation: health equity through action on the social determinants of health: final report of the Commission on Social Determinants of Health. Geneva: World Health Organization; 2008.
  3. Korea National Statistical Office. 2008 life tables for Korea. Seoul: Korea National Statistical Office; 2009. (Korean)
  4. Townsend P, Phillimore P, Beattie A. Health and deprivation: inequality and the North. London: Croom Helm;1988.
  5. Carstairs V, Morris R. Deprivation: explaining differences in mortality between Scotland and England and Wales. BMJ 1989; 299(6704): 886-889. https://doi.org/10.1136/bmj.299.6704.886
  6. Jarman B. Underprivileged areas: validation and distribution of scores. Br Med J (Clin Res Ed) 1984; 289(6458): 1587- 1592. https://doi.org/10.1136/bmj.289.6458.1587
  7. Jeong BG, Jung KY, Kim JY, Moon OR, Lee YH, Hong YS, et al. The relationship between regional material deprivation and the standardized mortality ratio of the community residents aged 15-64 in Korea. J Prev Med Public Health 2006; 39(1): 46-52.
  8. Kim MH. Multilevel analysis on the association between socioeconomic factors and the metabolic syndrome [dissertation]. Seoul: Hanyang University; 2002. (Korean)
  9. Son M. The relationships of occupational class, educational level and deprivation with mortality in Korea. Korean J Prev Med 2002; 35(1): 76-82. (Korean)
  10. Shin H, Lee S, Chu JM. Development of composite deprivation index for Korea: the correlation with standardized mortality ratio. J Prev Med Public Health 2009; 42(6): 392-402. (Korean) https://doi.org/10.3961/jpmph.2009.42.6.392
  11. Korea National Statistical Office. 2008 cause of death statistics by provinces. Seoul: Korea National Statistical Office; 2009. (Korean)
  12. Carstairs V. Deprivation indices: their interpretation and use in relation to health. J Epidemiol Community Health 1995; 49(Suppl 2): S3-S8. https://doi.org/10.1136/jech.49.Suppl_2.S3
  13. Gordis L. Epidemiology. 4th ed. Philadelphia: Elsevier/ Saunders; 2009.
  14. Vandenbroucke JP. A shortcut method for calculating the 95 per cent confidence interval of the standardized mortality ratio. Am J Epidemiol 1982; 115(2): 303-304.
  15. Townsend P. Deprivation. J Soc Policy 1987; 16(2): 125- 146. https://doi.org/10.1017/S0047279400020341
  16. Pampalon R, Raymond G. A deprivation index for health and welfare planning in Quebec. Chronic Dis Can 2000; 21(3): 104-113.
  17. Chu JM, Park JI, Jeon SW, Bae HJ, Shin JY, Im YR. Environment policy study for protecting low social class in city I-1. Seoul: Korea Environment Institute; 2007. (Korean)
  18. Great Britain, Office of the Deputy Prime Minister Government. The English indices of deprivation 2004: summary (revised). London: Office of the Deputy Prime Minister; 2004.
  19. Yoon TH. The relationship between social class distribution and mortality. Korean J Health Policy Adm 2003; 13(4): 99-114. (Korean) https://doi.org/10.4332/KJHPA.2003.13.4.099
  20. Benach J, Yasui Y, Borrell C, Saez M, Pasarin MI. Material deprivation and leading causes of death by gender: evidence from a nationwide small area study. J Epidemiol Community Health 2001; 55(4): 239-245. https://doi.org/10.1136/jech.55.4.239
  21. Moran PA. Notes on continuous stochastic phenomena. Biometrika 1950; 37(1-2): 17-23. https://doi.org/10.1093/biomet/37.1-2.17
  22. Besag J, York J, Mollié A. Bayesian image restoration, with two applications in spatial statistics. Ann Inst Stat Math 1991; 43(1): 1-20. https://doi.org/10.1007/BF00116466
  23. Brooks SP, Gelman A. General methods for monitoring convergence of iterative simulations. J Comput Graph Stat 1998; 7(4): 434-455.
  24. Nakaya T. An information statistical approach to the modifiable areal unit problem in incidence rate maps. Environ Plan A 2000; 32(1): 91-110. https://doi.org/10.1068/a31145
  25. Talbot RJ. Underprivileged areas and health care planning: implications of use of Jarman indicators of urban deprivation. BMJ 1991; 302(6773): 383-386. https://doi.org/10.1136/bmj.302.6773.383
  26. Slachtova H, Tomáskova H, Splichalová A, Polaufova P, Fejtkova P. Czech socio-economic deprivation index and its correlation with mortality data. Int J Public Health 2009; 54(4): 267-273. https://doi.org/10.1007/s00038-008-7092-3
  27. Elliott P, Wartenberg D. Spatial epidemiology: current approaches and future challenges. Environ Health Perspect 2004; 112(9): 998-1006. https://doi.org/10.1289/ehp.6735
  28. Lawson A. Bayesian disease mapping: hierarchical modeling in spatial epidemiology. Boca Raton: CRC Press; 2009.
  29. Beaglehole R. Medical management and the decline in mortality from coronary heart disease. Br Med J (Clin Res Ed) 1986; 292(6512): 33-35. https://doi.org/10.1136/bmj.292.6512.33
  30. Bots ML, Grobbee DE. Decline of coronary heart disease mortality in The Netherlands from 1978 to 1985: contribution of medical care and changes over time in presence of major cardiovascular risk factors. J Cardiovasc Risk 1996; 3(3): 271-276. https://doi.org/10.1097/00043798-199606000-00002
  31. Hunink MG, Goldman L, Tosteson AN, Mittleman MA, Goldman PA, Williams LW, et al. The recent decline in mortality from coronary heart disease, 1980-1990. The effect of secular trends in risk factors and treatment. JAMA 1997; 277(7): 535-542. https://doi.org/10.1001/jama.1997.03540310033031
  32. Thunhurst C. The analysis of small area statistics and planning for health. Statistician 1985; 34(1): 93-106. https://doi.org/10.2307/2987507
  33. Shin YJ, Yoon TH, Kim MH. Health promotion strategies and programmes development for health inequalities alleviation. Seoul: Ministry for Health, Welfare and Family Affairs; 2009. (Korean)
  34. Deguen S, Lalloue B, Bard D, Havard S, Arveiler D, Zmirou-Navier D. A small-area ecologic study of myocardial infarction, neighborhood deprivation, and sex: a Bayesian modeling approach. Epidemiology 2010; 21(4): 459-466. https://doi.org/10.1097/EDE.0b013e3181e09925
  35. Dominguez-Berjon MF, Borrell C, Lopez R, Pastor V. Mortality and socioeconomic deprivation in census tracts of an urban setting in southern Europe. J Urban Health 2005; 82(2): 225-236. https://doi.org/10.1093/jurban/jti047
  36. Caranci N, Biggeri A, Grisotto L, Pacelli B, Spadea T, Costa G. The Italian deprivation index at census block level: definition, description and association with general mortality. Epidemiol Prev 2010; 34(4): 167-176.
  37. Dyck I, Lewis N, McLafferty S. Geographies of women's health. New York: Routledge; 2001.
  38. Molinari C, Ahern M, Hendryx M. The relationship of community quality to the health of women and men. Soc Sci Med 1998; 47(8): 1113-1120. https://doi.org/10.1016/S0277-9536(98)00114-2
  39. Rey G, Jougla E, Fouillet A, Hemon D. Ecological association between a deprivation index and mortality in France over the period 1997 - 2001: variations with spatial scale, degree of urbanicity, age, gender and cause of death. BMC Public Health 2009; 9: 33. https://doi.org/10.1186/1471-2458-9-33

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