Trends in socioeconomic inequalities in cirrhosis mortality in an urban area of Southern Europe: a multilevel approach.

BACKGROUND The objective of this study was to analyse inequalities in cirrhosis mortality at individual and area levels, using data from Barcelona for two time periods. METHODS Deaths from cirrhosis in Barcelona of men and women aged 25-74 years during the periods 1992-97 and 1998-2004 were included in the study. A multilevel Poisson regression analysis was performed, with the individual and the area as the respective units of analysis. RESULTS Inequalities in cirrhosis mortality were observed in relationship to individual and area socioeconomic levels, with the highest death rates among those with lowest educational level and in socioeconomically deprived areas. In the multilevel analysis, the largest effects were observed at the individual level. Between the two periods, death rates decreased for the highest and lowest educational levels (eg, from 116.2 to 88.7 per 100 000 inhabitants among men or men with no education aged 50-74 years), but not for intermediate levels. At the area level, absolute inequalities in mortality tended to decrease; however, higher mortality RR persisted in the least favoured compared to most favoured areas (eg, in men, from 1.74 (95% CI 1.36 to 2.24) to 1.80 (95% CI 1.42 to 2.27) in the two periods). CONCLUSION This study demonstrated the persistence of socioeconomic inequalities in cirrhosis mortality in Barcelona between socioeconomic groups and city areas.