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Do places affect the probability of death in Australia? A multilevel study of area-level disadvantage, individual-level socioeconomic position and all-cause mortality, 1998–2000

Turrell, Gavin, Kavanagh, Anne, Draper, Glenn, & Subramanian, S. V. (2007) Do places affect the probability of death in Australia? A multilevel study of area-level disadvantage, individual-level socioeconomic position and all-cause mortality, 1998–2000. Journal of Epidemiology and Community Health, 61(1), pp. 13-19.

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Abstract

Study objective: In Australia, studies finding an association between area-level socioeconomic disadvantage and mortality are often based on aggregate-ecologic designs which confound area- and individual-level sources of socioeconomic variation. Area-level socioeconomic differences in mortality therefore, may be an artefact of varying population compositions and not the characteristics of areas per se. We examined associations between area-level disadvantage and all-cause mortality before and after adjustment for within-area variation in individual-level socioeconomic position (SEP) using unlinked census and mortality-register data in a multilevel context.

Setting, participants and design: The study covers the total Australian continent for the period 1998-2000 and is based on decedents aged 25-64 years (n=43 257). The socioeconomic characteristics of Statistical Local Areas (SLA, n=1317) were measured using an Index of Relative Socioeconomic Disadvantage, and individual-level SEP was measured by occupation.

Main results: Living in a disadvantaged SLA was associated with higher all-cause mortality after adjustment for within-SLA variation in occupation. Death rates were highest for blue collar workers and lowest among white collar employees. Cross-level interactions showed no convincing evidence that SLA disadvantage modified the extent of mortality inequality between the occupation groups.

Conclusions Multilevel analysis can be used to examine area-variation in mortality using unlinked census and mortality data, therefore making it less necessary to use aggregate-ecologic designs. In Australia, area- and individual-level socioeconomic factors make an independent contribution to the probability of premature mortality. Policies and interventions to improve population health and reduce mortality inequalities should focus on places as well as people.

Impact and interest:

25 citations in Scopus
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23 citations in Web of Science®

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ID Code: 14001
Item Type: Journal Article
Keywords: Area disadvantage, Australia, health inequalities, mortality, multilevel, occupation, socioeconomic position
DOI: 10.1136/jech.2006.046094
ISSN: 0143-005X
Subjects: Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > PUBLIC HEALTH AND HEALTH SERVICES (111700)
Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > PUBLIC HEALTH AND HEALTH SERVICES (111700) > Epidemiology (111706)
Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > PUBLIC HEALTH AND HEALTH SERVICES (111700) > Preventive Medicine (111716)
Divisions: Current > Research Centres > Centre for Health Research
Current > QUT Faculties and Divisions > Faculty of Health
Current > Institutes > Institute of Health and Biomedical Innovation
Copyright Owner: Copyright 2007 BMJ Publishing Group
Copyright Statement: Reproduced in accordance with the copyright policy of the publisher.
Deposited On: 09 Jul 2008
Last Modified: 29 Feb 2012 23:38

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