Int J Health Geogr - Does context matter for the relationship between deprivation and all-cause mortality? The West vs. the rest of Scotland.


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CKGROUND: A growing body of research emphasizes the importance of contextual factors on health outcomes. Using postcode sector data for Scotland (UK), this study tests the hypothesis of spatial heterogeneity in the relationship between area-level deprivation and mortality to determine if contextual differences in the West vs. the rest of Scotland influence this relationship. Research into health inequalities frequently fails to recognise spatial heterogeneity in the deprivation-health relationship, assuming that global relationships apply uniformly across geographical areas. In this study, exploratory spatial data analysis methods are used to assess local patterns in deprivation and mortality. Spatial regression models are then implemented to examine the relationship between deprivation and mortality more formally.RESULTS: The initial exploratory spatial data analysis reveals concentrations of high standardized mortality ratios (SMR) and deprivation (hotspots) in the West of Scotland and concentrations of low values (coldspots) for both variables in the rest of the country. The main spatial regression result is that deprivation is the only variable that is highly significantly correlated with all-cause mortality in all models. However, in contrast to the expected spatial heterogeneity in the deprivation-mortality relationship, this relation does not vary between regions in any of the models. This result is robust to a number of specifications, including weighting for population size, controlling for spatial autocorrelation and heteroskedasticity, assuming a non-linear relationship between mortality and socio-economic deprivation, separating the dependent variable into male and female SMRs, and distinguishing between West, North and Southeast regions. The rejection of the hypothesis of spatial heterogeneity in the relationship between socio-economic deprivation and mortality complements prior research on the stability of the deprivation-mortality relationship over time.CONCLUSIONS: The homogeneity we found in the deprivation-mortality relationship across the regions of Scotland and the absence of a contextualized effect of region highlights the importance of taking a broader strategic policy that can combat the toxic impacts of socio-economic deprivation on health. Focusing on a few specific places (e.g. 15% of the poorest areas) to concentrate resources might be a good start but the impact of socio-economic deprivation on mortality is not restricted to a few places. A comprehensive strategy that can be sustained over time might be needed to interrupt the linkages between poverty and mortality.

Resumo Limpo

ckground grow bodi research emphas import contextu factor health outcom use postcod sector data scotland uk studi test hypothesi spatial heterogen relationship arealevel depriv mortal determin contextu differ west vs rest scotland influenc relationship research health inequ frequent fail recognis spatial heterogen deprivationhealth relationship assum global relationship appli uniform across geograph area studi exploratori spatial data analysi method use assess local pattern depriv mortal spatial regress model implement examin relationship depriv mortal formallyresult initi exploratori spatial data analysi reveal concentr high standard mortal ratio smr depriv hotspot west scotland concentr low valu coldspot variabl rest countri main spatial regress result depriv variabl high signific correl allcaus mortal model howev contrast expect spatial heterogen deprivationmort relationship relat vari region model result robust number specif includ weight popul size control spatial autocorrel heteroskedast assum nonlinear relationship mortal socioeconom depriv separ depend variabl male femal smrs distinguish west north southeast region reject hypothesi spatial heterogen relationship socioeconom depriv mortal complement prior research stabil deprivationmort relationship timeconclus homogen found deprivationmort relationship across region scotland absenc contextu effect region highlight import take broader strateg polici can combat toxic impact socioeconom depriv health focus specif place eg poorest area concentr resourc might good start impact socioeconom depriv mortal restrict place comprehens strategi can sustain time might need interrupt linkag poverti mortal

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