The objectives of this study were to identify the inequalities in mortality between the census sections of eleven Spanish cities throughout the 1996-2003 period, and to analyze the relationship between these geographical inequalities and socioeconomic deprivation.
This was a cross-sectional ecological study in which the analysis units corresponded to census sections. In addition, we developed a socioeconomic deprivation index and calculated the standardized mortality rate for each census section using hierarchical Bayesian models that consider spatial structure.
In most cities, the geographical patterns of the total mortality rates in both sexes were similar to those of the socioeconomic deprivation index. Hence, among men, four specific causes of death (lung cancer, ischemic heart disease, respiratory disease, and cirrhosis) were positively associated with socioeconomic deprivation in most cities, and, among women, specific causes of diabetes and cirrhosis were positively associated with socioeconomic deprivation, whereas lung cancer was negatively associated with this deprivation. Excess mortality related to deprivation was 59,445 deaths among men and 23,292 among women.
These results highlight the relevance of intra-urban health inequalities.