The public health burden of material deprivation:: excess mortality in leading causes of death in Spain

Objective. The aim of the study is to investigate the burden of deprivation-associated excess of deaths by 10 leading causes of death in each gender and two age groups. Design. A small-area ecological study using two indices of material deprivation drawn from 1991 census and mortality data aggregated for 1987-1995 was undertaken. Setting. 2218 small areas in Spain. Data are presented by region. Main outcome measures. The 10 leading causes of death in each gender and two age groups were determined. Results. The deprivation-associated excess mortality in the top 10 leading causes of death was 14.4 and 11% for males and females, respectively. Excess mortality in the 9-year period studied accounted for more than 222,000 deaths. A large proportion of excess deaths was found in causes related to smoking and alcohol consumption among males and diet-related causes of death among females. The most deprived regions within the country showed the highest mortality risk. Conclusions. Material deprivation appears to be manifested in high mortality rates differently by gender and region. It imposes a significant public health burden that demands urgently attention and action by health policy-makers. (C) 2003 American Health Foundation and Elsevier Science (USA). All rights reserved.