Sánchez-Santos, MT;
Mesa-Frias, M;
Choi, M;
Nüesch, E;
Asunsolo-Del Barco, A;
Amuzu, A;
Smith, GD;
... Casas, JP; + view all
(2013)
Area-Level Deprivation and Overall and Cause-Specific Mortality: 12 Years' Observation on British Women and Systematic Review of Prospective Studies.
PLoS One
, 8
(9)
, Article e72656. 10.1371/journal.pone.0072656.
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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.
| Type: | Article |
|---|---|
| Title: | Area-Level Deprivation and Overall and Cause-Specific Mortality: 12 Years' Observation on British Women and Systematic Review of Prospective Studies |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1371/journal.pone.0072656 |
| Publisher version: | http://dx.doi.org/10.1371/journal.pone.0013947 |
| Language: | English |
| Additional information: | © 2013 Sanchez-Santos et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Health Informatics |
| URI: | https://discovery-pp.ucl.ac.uk/id/eprint/1411652 |
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