Assessing the effect of regional deprivation on mortality avoiding compositional bias
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Assessing the effect of regional deprivation on mortality avoiding compositional bias : a natural experiment. / Reiss, Katharina; Berger, Ursula; Winkler, Volker; Voigtländer, Sven; Becher, Heiko; Razum, Oliver.
In: J EPIDEMIOL COMMUN H, Vol. 67, No. 3, 01.03.2013, p. 213-8.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Assessing the effect of regional deprivation on mortality avoiding compositional bias
T2 - a natural experiment
AU - Reiss, Katharina
AU - Berger, Ursula
AU - Winkler, Volker
AU - Voigtländer, Sven
AU - Becher, Heiko
AU - Razum, Oliver
PY - 2013/3/1
Y1 - 2013/3/1
N2 - 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.
AB - 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.
KW - Adolescent
KW - Adult
KW - Age Distribution
KW - Aged
KW - Bias (Epidemiology)
KW - Cluster Analysis
KW - Cultural Deprivation
KW - Female
KW - Germany
KW - Healthcare Disparities
KW - Humans
KW - Male
KW - Middle Aged
KW - Mortality
KW - Poverty Areas
KW - Proportional Hazards Models
KW - Residence Characteristics
KW - Retrospective Studies
KW - Sensitivity and Specificity
KW - Sex Distribution
KW - Socioeconomic Factors
KW - Suburban Population
KW - Transients and Migrants
KW - Young Adult
U2 - 10.1136/jech-2012-201336
DO - 10.1136/jech-2012-201336
M3 - SCORING: Journal article
C2 - 23093522
VL - 67
SP - 213
EP - 218
JO - J EPIDEMIOL COMMUN H
JF - J EPIDEMIOL COMMUN H
SN - 0143-005X
IS - 3
ER -