Impact of material and social deprivation on public health Actual causes of death in Europe

Abstract Background Adverse socioeconomic conditions at both the individual and regional levels are associated with an increased risk of mortality. However, few studies have examined this relationship using multilevel analysis, and those that have have typically focused on a single country. The aim of this study was to examine this relationship using data from several European countries. Methods Individual-level data were obtained from waves 5 to 9 of the Survey of Health, Ageing and Retirement in Europe, while regional-level data were obtained from the Luxembourg Income Study database. Cox regression analysis with gamma-shared frailty and a random intercept for country of residence was used to assess the association between individual mortality from all causes, cancer, myocardial infarction, and stroke and indicators of socioeconomic deprivation at both the individual level (including material and social deprivation indices) and the regional level (including the Gini index). Results The risk of all-cause mortality was found to be higher for respondents with material deprivation (HR = 1.77, 95% CI = [1.60, 1.96]) and social deprivation (HR = 7.63, 95% CI = [6.42, 9.07]) compared with those without. Similar associations were observed between individual deprivation and the risk of death from cancer, myocardial infarction, or stroke. Regional deprivation had a modest contextual effect on individual risk of death from all causes and cancer; however, when individual deprivation was included in the models, no contextual effects remained. Conclusions The results suggest that individual socioeconomic conditions significantly predict causes of death among older European adults, with those experiencing material and social deprivation having a higher risk of mortality from all causes, including cancer, myocardial infarction, and stroke. In contrast, the Gini index showed minimal effects, despite reflecting regional disparities across Europe. Key messages • The study reveals that individual socioeconomic deprivation significantly increases mortality risk from all causes, including cancer and heart disease, among older adults in Europe. • Although regional socioeconomic factors show some contextual influence on mortality, individual material and social deprivation remain the primary predictors of increased mortality risk.