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Title: Socioeconomic Inequalities in Chronic Liver Diseases and Cirrhosis Mortality in European Urban Areas before and after the Onset of the 2008 Economic Recession
Authors: Borrell, Carme 
Palència, Laia 
Bosakova, Lucia
Gotsens, Mercè 
Morrison, Joana
Costa, Claudia 
Dzúrová, Dagmar 
Deboosere, Patrick 
Lustigova, Michala
Marí-Dell'Olmo, Marc 
Rodopoulou, Sophia
Rodrigues, Paula Santana 
Keywords: chronic liver diseases; financial crisis; inequalities; liver cirrhosis; mortality; urban areas
Issue Date: 2021
Publisher: MDPI
Project: info:eu-repo/grantAgreement/EC/H2020/643398/EU/Shaping EUROpean policies to promote HEALTH equitY 
Serial title, monograph or event: International Journal of Environmental Research and Public Health
Volume: 18
Issue: 16
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. © 2021 by the authors. Licensee MDPI, Basel, Switzerland.
ISSN: 1660-4601
DOI: 10.3390/ijerph18168801
Rights: openAccess
Appears in Collections:I&D CEGOT - Artigos em Revistas Internacionais
FLUC Geografia - Artigos em Revistas Internacionais

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