Assessing the effect of regional deprivation on mortality avoiding compositional bias

A natural experiment

Bibliographic Data

ID11178308
AuthorsKatharina Reiss (Bielefeld University), Ursula Berger (0000-0002-9809-4177, Bielefeld University), Volker Winkler (0000-0002-9974-1145, University Hospital Heidelberg), Sven Voigtländer (0000-0003-3808-9605, Bielefeld University, corresponding author), Heiko Becher (0000-0002-8808-6667, University Hospital Heidelberg), Oliver Razum (0000-0002-1244-7649, Bielefeld University)
Year2013
Volume67
Issue3
Pages213-218
Publication date2013-03-01
Open AccessNo
TypeARTICLE
VenueJournal of Epidemiology and Community Health (JOURNAL)
Journal identifiersISSN: 0143-005X • E-ISSN: 1470-2738
PublisherBMJ (PUBLISHER • GB)
DOI10.1136/jech-2012-201336
PMID23093522
OpenAlexW2118993479
LanguageEN
Citations received3
References cited15

BACKGROUND AND OBJECTIVE: We assessed the effect of regional deprivation on individual mortality by making use of a natural experiment: we followed up ethnic German resettlers from Former Soviet Union countries who were quasi-randomly distributed across the socioeconomically heterogeneous counties of Germany's federal state North Rhine-Westphalia (NRW). METHODS: We used data from the retrospective cohort study 'AMOR' on the mortality of resettlers in NRW (n=34 393). Based on the postcode of the last known residence we linked study participants to the 54 counties of NRW, which were aggregated in six deprivation clusters. Mortality rates and standardised mortality ratios (SMRs) were calculated for each cluster. After a mean follow-up of 10 years, 2580 resettlers were deceased. RESULTS: For male and female cohort members, mortality rates and SMRs were highest in the cluster 'poverty poles' (SMR men: 1.21, 95% CI 1.04 to 1.41; SMR women: 1.17, 95% CI 0.99 to 1.37), whereas they were lowest in the cluster 'prospering regions and suburban counties' (SMR women: 0.86, 95% CI 0.70 to 1.05) as well as in the cluster 'heterogeneous counties' (SMR men: 0.73, 95% CI 0.61 to 0.88). CONCLUSIONS: The population which was quasi-randomly distributed to counties of differing socioeconomic status experienced different levels of mortality. It was highest in regions with the highest level of regional deprivation. Previous studies describing this positive relationship between mortality and regional deprivation could not differentiate between compositional and contextual effects. Thus, our findings indicate that in terms of mortality, regional deprivation does matter

Cluster (spacecraft) · Cohort · Cohort study · Environmental health · Ethnic group · Mortality rate · Population · Poverty · Residence · Socioeconomic status · Demography · Health disparities and outcomes · Insurance, Mortality, Demography, Risk Management · Internal Medicine · Medicine · Migration, Health and Trauma · Surgery · Gerontology

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