The effect of socio-economic status in small population areas on the morbidity and mortality in Mani̇sa

INTRODUCTION AND OBJECTIVES: It was realized that serious diseases and early deaths in lower social classes had been more frequent than the affluent social classes by the mid of 19th century. The Black Report, which was prepared with the lead of Department of Health in England, was an important corner stone; in view of the fact that social and economical effects out of health services had people think they caused inequalities in health in years. Then, in 1998, the report 'Social Determinants of Health, Solid Facts' published under the leadership of WHO was an important step since it brought out the issue in global level. In this Report, 10 basic determinants of health (social gradient, stress, early life experiences, social exclusion, work, unemployment, social support, addiction, food, transport) that are related to social politics were explained in detail. Recently, researchers have been examining the effects of neighborhood and social factors on the health of inhabitants in terms of spatial content. The aim of this study is to examine the relation between the socio-economical status (SES) of central neighborhoods in all districts of Manisa and the incidence of ischemic heart diseases (IHD) and standardized mortality rate from all causes. METHOD: This ecological research was carried out in 230 central neighborhoods in 17 districts of Manisa. Neighborhood is a small population area and the median population size is 3,084 (min=244, max=18,135). Dependent variables are mortality rate from all causes and incidence of ischemic heart diseases standardized to age and gender; the independent variable is socio-economical status of the neighborhood. The data on mortality and diseases have been obtained from the database of Public Health Directorate of Manisa. The socio-economical status of neighborhoods have been obtained from face-to-face interviews with headmens via questionnaire. IHD incidence and the mortality rates and %95 confidence interval have been calculated for each socio-economical status quintiles. Neighborhoods have been mapped according to SES, the incidence and the mortality rate of quintiles. RESULTS: The standardized IHD incidence were calculated in accordance to the most affluent quintiles as follows determined in the second quintile 1.11 fold (95% CI: 1.10-1.11), in the third quintile 1.05 fold (95% CI: 1.04-1.06), in the fourth quintile 1.14 fold (95% CI:1.13-1.15). The standardized mortality rate was determined in according to richest quintile; in the second quintile 1.20 fold (95% CI: 1.18-1.23), in the third quintile 1.24 fold (95% CI: 1.22-1.27), in the fourth quintile 1.37 fold (95% CI: 1.35-1.40), in the fifth quintile 1.22 fold (95% CI: 1.20-1.25). CONCLUSION AND RECOMMENDATIONS: It has been found out that there is an association between SES of the neighborhood and IHD incidence and all cause mortality rate. The ischemic heart disease incidence and mortality rate increased with increasing poverty of the neighborhood. KEY WORDS: Inequality, small population area, ischemic heart diseases, mortality rate, geographic information systems