Area-level deprivation and overall and cause-specific mortality: 12 years' observation on British women and systematic review of prospective studies.
<h4>Background</h4>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 Inde...
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Public Library of Science (PLoS)
2013-01-01
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| Series: | PLoS ONE |
| Online Access: | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0072656&type=printable |
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| 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 | <h4>Background</h4>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.<h4>Methods and findings</h4>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.<h4>Conclusions</h4>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. |
| format | Article |
| id | doaj-art-ae4e65867f7d4e5aa34a471cad9a31d8 |
| institution | Kabale University |
| issn | 1932-6203 |
| language | English |
| publishDate | 2013-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj-art-ae4e65867f7d4e5aa34a471cad9a31d82025-08-20T03:49:55ZengPublic 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 Casas<h4>Background</h4>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.<h4>Methods and findings</h4>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.<h4>Conclusions</h4>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.https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0072656&type=printable |
| 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 | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0072656&type=printable |
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