Socioeconomic Inequalities in Chronic Liver Diseases and Cirrhosis Mortality in European Urban Areas before and after the Onset of the 2008 Economic Recession

Carme Borrell, Laia Palència, Lucia Bosakova, Mercè Gotsens, Joana Morrison, Claudia Costa, Dagmar Dzurova, Patrick Deboosere, Michala Lustigova, Marc Marí-Dell’Olmo, Sophia Rodopoulou and Paula Santana
Additional contact information
Carme Borrell: Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain
Laia Palència: CIBER Epidemiología y Salud Pública (CIBERESP), 20029 Madrid, Spain
Lucia Bosakova: Department of Health Psychology and Research Methodology, Medical Faculty, P. J. Safarik University of Kosice, 04180 Kosice, Slovakia
Mercè Gotsens: Institut d’Investigació Biomèdica (IIB Sant Pau), 08003 Barcelona, Spain
Joana Morrison: Institute of Health Equity at the Research Department of Epidemiology and Public Health, University College London, London WC1E 6BT, UK
Claudia Costa: Centre of Studies in Geography and Spatial Planning (CEGOT), University of Coimbra, 3000-370 Coimbra, Portugal
Dagmar Dzurova: Faculty of Science, Charles University, 116 36 Prague, Czech Republic
Patrick Deboosere: Department of Sociology, Interface Demography, Vrije Universiteit Brussel, 1050 Brussels, Belgium
Michala Lustigova: Faculty of Science, Charles University, 116 36 Prague, Czech Republic
Marc Marí-Dell’Olmo: CIBER Epidemiología y Salud Pública (CIBERESP), 20029 Madrid, Spain
Sophia Rodopoulou: Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 106 79 Athens, Greece
Paula Santana: Centre of Studies in Geography and Spatial Planning (CEGOT), University of Coimbra, 3000-370 Coimbra, Portugal

IJERPH, 2021, vol. 18, issue 16, 1-11

Abstract: Objective: To analyse the trends in chronic liver diseases and cirrhosis mortality, and the associated socioeconomic inequalities, in nine European cities and urban areas before and after the onset of the 2008 financial crisis. Methods: This is an ecological study of trends in three periods of time: two before (2000–2003 and 2004–2008), and one after (2009–2014) the onset of the economic crisis. The units of analysis were the geographical areas of nine cities or urban areas in Europe. We analysed chronic liver diseases and cirrhosis standardised mortality ratios, smoothing them with a hierarchical Bayesian model by each city, area, and sex. An ecological regression model was fitted to analyse the trends in socioeconomic inequalities, and included the socioeconomic deprivation index, the period, and their interaction. Results: In general, chronic liver diseases and cirrhosis mortality rates were higher in men than in women. These rates decreased in all cities during the financial crisis, except among men in Athens (rates increased from 8.50 per 100,000 inhabitants during the second period to 9.42 during the third). Socioeconomic inequalities in chronic liver diseases and cirrhosis mortality were found in six cities/metropolitan areas among men, and in four among women. Finally, in the periods studied, such inequalities did not significantly change. However, among men they increased in Turin and Barcelona and among women, several cities had lower inequalities in the third period. Conclusions: There are geographical socioeconomic inequalities in chronic liver diseases and cirrhosis mortality, mainly among men, that did not change during the 2008 financial crisis. These results should be monitored in the long term.

Keywords: chronic liver diseases; liver cirrhosis; mortality; inequalities; urban areas; financial crisis (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
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