Urban cause-specific socioeconomic mortality differences. Which causes of death contribute most?

BACKGROUND: Cause-specific information on socioeconomic differences in health is necessary for a rational public health policy. At the local level, the Municipal Health Service studies these differences in order to support the authorities in policy making. METHODS: Mortality data of the under 65 age group in The Hague were analysed (1982-1991) at residential area level. RESULTS: Causes of death with a high socioeconomic gradient among males were: homicide, chronic liver disease, 'other' external causes of injury, diabetes, bronchitis, emphysema and asthma, and motor vehicle accidents; and among females: diabetes, ischaemic heart disease, 'other' diseases of the circulatory system, signs, symptoms and ill-defined conditions, malignant neoplasm of cervix, and 'other' diseases. Main contributors to the mortality differences between the highest and lowest socioeconomic quartiles among males were: ischaemic heart disease (17.3%), 'other' diseases of the circulatory system (10.2%), signs, symptoms and ill-defined conditions (9.0%), 'other' external causes of injury (8.6%), and chronic liver disease (7.2%); and among females: ischaemic heart disease (25.5%), 'other' diseases (20.1%), signs, symptoms and ill-defined conditions (18.6%), 'other' diseases of the circulatory system (11.0%), and diabetes (9.1%). Among females the contributions of malignant neoplasms of breast (-16.3%) and colon (-5.5%) and suicide (-4.3%) were negative. CONCLUSIONS: The diseases that are the main contributors to urban socioeconomic mortality differences can be influenced by public health policy.

[Epidemiology of attempted suicide in The Hague]. / Epidemiologie van parasuïcide in Den Haag.

OBJECTIVE: To estimate the incidence of parasuicide in a metropolitan area and to identify subgroups of individuals with the purpose of developing secondary preventive strategies. DESIGN: Longitudinal prospective case register study (1987-1993). METHOD: In the city of the Hague, the Netherlands, all individual contacts concerning parasuicidal behaviour were registered by the participating facilities i.e., hospitals, community mental health organizations and emergency services. Demographic and case-related information was recorded. Record linkage of the anonymized data including those of the municipal coroner concerning suicide was done by the project administration for longitudinal monitoring. RESULTS: Over the registration period of 7 years (1987-1993) 4458 parasuicidal acts were recorded involving 3333 individuals. The age and sex distribution was in accordance with formerly published national and local data, but the real numbers of parasuicide rates were 50-100% higher than those usually presented in the literature. Repetition of parasuicide during an average follow-up period of 3.8 years occurred in 18.2% of all cases and the repetition rate increased over time. The suicide risk within a year after the last registered parasuicide came to 1.5% for men as well as women, and that within four years to 1.9% for women and 2.9% for men. Men and women with a history of three or more acts of parasuicide had a suicide risk of over 5% in a follow-up period of 4 years. The incidence of parasuicide was highest in the younger age groups of non-European women (including Turkish women), in particular those with an ethnocultural background in Surinam.