Centro Superior de Investigación en Salud Pública, Av. Cataluña, 21, 46020 Valencia, Spain.
BMC Public Health. 2013 May 16;13:480. doi: 10.1186/1471-2458-13-480.
The relationship between deprivation and mortality in urban settings is well established. This relationship has been found for several causes of death in Spanish cities in independent analyses (the MEDEA project). However, no joint analysis which pools the strength of this relationship across several cities has ever been undertaken. Such an analysis would determine, if appropriate, a joint relationship by linking the associations found.
A pooled cross-sectional analysis of the data from the MEDEA project has been carried out for each of the causes of death studied. Specifically, a meta-analysis has been carried out to pool the relative risks in eleven Spanish cities. Different deprivation-mortality relationships across the cities are considered in the analysis (fixed and random effects models). The size of the cities is also considered as a possible factor explaining differences between cities.
Twenty studies have been carried out for different combinations of sex and causes of death. For nine of them (men: prostate cancer, diabetes, mental illnesses, Alzheimer's disease, cerebrovascular disease; women: diabetes, mental illnesses, respiratory diseases, cirrhosis) no differences were found between cities in the effect of deprivation on mortality; in four cases (men: respiratory diseases, all causes of mortality; women: breast cancer, Alzheimer's disease) differences not associated with the size of the city have been determined; in two cases (men: cirrhosis; women: lung cancer) differences strictly linked to the size of the city have been determined, and in five cases (men: lung cancer, ischaemic heart disease; women: ischaemic heart disease, cerebrovascular diseases, all causes of mortality) both kinds of differences have been found. Except for lung cancer in women, every significant relationship between deprivation and mortality goes in the same direction: deprivation increases mortality. Variability in the relative risks across cities was found for general mortality for both sexes.
This study provides a general overview of the relationship between deprivation and mortality for a sample of large Spanish cities combined. This joint study allows the exploration of and, if appropriate, the quantification of the variability in that relationship for the set of cities considered.
城市环境中贫困与死亡率之间的关系已得到充分证实。在西班牙城市的独立分析（MEDEA 项目）中，已经发现了几种死因存在这种关系。然而，从未进行过联合分析来汇集多个城市的这种关系的力量。这样的分析将通过关联发现的关联来确定是否存在联合关系。
对 MEDEA 项目的数据进行了一项针对每个研究死因的汇总横断面分析。具体来说，对 11 个西班牙城市的相对风险进行了荟萃分析。在分析中考虑了城市之间不同的贫困-死亡率关系（固定和随机效应模型）。城市的规模也被认为是解释城市之间差异的一个可能因素。
针对不同的性别和死因组合进行了 20 项研究。对于其中的 9 项研究（男性：前列腺癌、糖尿病、精神疾病、阿尔茨海默病、脑血管病；女性：糖尿病、精神疾病、呼吸系统疾病、肝硬化），在贫困对死亡率的影响方面，城市之间没有发现差异；在 4 个案例中（男性：呼吸系统疾病、所有死因；女性：乳腺癌、阿尔茨海默病），确定了与城市规模无关的差异；在 2 个案例中（男性：肝硬化；女性：肺癌），确定了与城市规模严格相关的差异；在 5 个案例中（男性：肺癌、缺血性心脏病；女性：缺血性心脏病、脑血管病、所有死因），发现了这两种差异。除了女性肺癌之外，每一个贫困与死亡率之间的显著关系都指向同一个方向：贫困增加死亡率。对于两性的一般死亡率，发现了城市之间相对风险的变异性。
本研究提供了对一组大型西班牙城市综合的贫困与死亡率之间关系的总体概述。这项联合研究允许探索和适当时量化考虑的城市集合中这种关系的可变性。
