Socioeconomic characteristics of residential areas and risk of death: is variation in spatial units for analysis a source of heterogeneity in observed associations?

OBJECTIVES Evidence on the association between the adverse socioeconomic characteristics of residential area and mortality is mixed. We examined whether the choice of spatial unit is critical in detecting this association. DESIGN Register-linkage study. SETTING Data were from the Finnish Public Sector study's register cohort. PARTICIPANTS The place of residence of 146 600 cohort participants was linked to map grids and administrative areas, and they were followed up for mortality from 2000 to 2011. Residential area socioeconomic deprivation and household crowding were aggregated into five alternative areas based on map grids (250×250 m, 1×1 km and 10×10 km squares), and administrative borders (zip-code area and town). PRIMARY AND SECONDARY OUTCOME MEASURES All-cause mortality. RESULTS For the 250×250 m area, mortality risk increased with increasing socioeconomic deprivation (HR for top vs bottom quintile 1.36, 95% CI 1.21 to 1.52). This association was either weaker or missing when broader spatial units were used. For household crowding, excess mortality was observed across all spatial units, the HRs ranging from 1.14 (95% CI 1.03 to 1.25) for zip code, and 1.21 (95% CI 1.11 to 1.31) for 250×250 m areas to 1.28 (95% CI 1.10 to 1.50) for 10×10 km areas. CONCLUSIONS Variation in spatial units for analysis is a source of heterogeneity in observed associations between residential area characteristics and risk of death.