Regional disparities in cause-specific mortality in Europe: the role of local context and national health policies

Project Information

REDIM

Grant agreement ID: 851485

DOI

10.3030/851485

EC signature date 25 November 2019

Start date 1 August 2020

End date 31 July 2026

Funded under

• EXCELLENT SCIENCE - European Research Council (ERC)

Total cost

€ 1 423 858,00

EU contribution

€ 1 423 858,00

Coordinated by

BUNDESINSTITUT FUR BEVOLKERUNGSFORSCHUNG
Germany

Periodic Reporting for period 3 - REDIM (Regional disparities in cause-specific mortality in Europe: the role of local context and national health policies)

Reporting period: 2023-08-01 to 2025-01-31

Summary of the context and overall objectives of the project

The majority of previous studies on international differences in mortality have focused on cross-country comparisons, without taking the substantial regional variation within national populations into account. REDIM goes beyond the state of the art through performing large-scale systematic investigation of the causes of persisting and emerging spatial disparities in mortality across and within European countries. The scientific output of the project is crucial for the development and coordination of health policies aimed at reducing geographical inequalities in mortality.

How does the interplay between local context and national health policies shape the observed regional mortality patterns? To what extent are spatial divides in cause-specific mortality, so-called health borders, following national borders? Those are the central research questions tackled by the REDIM project through analyzing cause-specific mortality patterns and trends at NUTS–3, NUTS–2, and LAU levels across about 25 European countries using advanced research methods. Mortality indicators are interpreted with contextual variables capturing the effects of the local context and the effectiveness of national health policies.

The REDIM has three main objectives: i) measuring spatial disparities and the degree of convergence/divergence in cause-specific mortality across subnational entities of European countries ii) interpreting the observed patterns and trends by linking mortality data to contextual variables and national health policies iii) identifying evidence-based strategies and interventions to reduce regional disparities in mortality. In terms of the project timeline, REDIM is divided into three major stages (tasks): i) collecting and harmonizing mortality data and contextual variables ii) measuring geographical differences, identifying spatial clusters of cause-specific mortality, detecting discontinuities of mortality patterns at national borders iii) explaining and interpreting geographical differences in mortality.

The research agenda of the project is relevant to one of the fundamental goals of the European Spatial Development Perspective, which is the achievement of economic and social cohesion in all the regions of the European Union. The REDIM research agenda is also relevant to the COVID–19 pandemic, which has had unforeseeable, long-lasting, and very heterogeneous effects on regional mortality trends and differentials across Europe.

Work performed from the beginning of the project to the end of the period covered by the report and main results achieved so far

The REDIM Team reached significant progress in both building research infrastructure (new data collection and harmonization) and fulfilling the scientific objectives of the project. Collecting and harmonizing cause-specific regional mortality data as well as data on contextual variables and policy indicators is essential for addressing the main research questions. This laborious task, which was planned for the first 18 months of the project, has been successfully accomplished, despite unforeseeable delays in data provision caused by the COVID–19 pandemic. The regional mortality at different geographical levels (e.g. NUTS–2, NUTS–3, and LAU) data have been collected for about 25 countries/territories, which is more than it was initially planned.

Despite a heavy workload related to the need to complete the technical part of the project, the REDIM team, with collaboration with the international partners, has succeeded to complete/initiate many methodological and empirical studies. Their results were presented at the major international conferences and published in peer-reviewed journals:

https://www.bib.bund.de/P/redim/EN/Publications/Publications.html;jsessionid=BD6727EE427315845368AB2910BC9A4F.intranet232.

The accomplished work on research methodology includes i) systematic assessment of subnational consistency and comparability of cause-of-death statistics ii) the development of the method for redistributing misclassified causes of death iii) thorough evaluation of the state-of-the art methods for estimating mortality in small areas.

To the main empirical (accomplished) studies belong i) analysis of the burden of the COVID–19 at the subnational level in 21 European countries ii) first comprehensive spatially-detailed analysis of cause-specific mortality trends and patterns in Ukraine iii) evaluation of the impact of the different health systems on mortality differentials across three German-speaking countries using long-term series of subnational data and the concept of avoidable mortality iv) estimation of the contribution of past smoking to regional mortality differentials in Germany v) assessment of the contribution of specific causes of death to the evolution of the sex mortality differential at the subnational level in seven European countries.

Progress beyond the state of the art and expected potential impact (including the socio-economic impact and the wider societal implications of the project so far)

The project has significantly advanced the field of mortality research in terms of new research infrastructure. The REDIM Data Repository represents a novel and unique collection of regional cause-specific mortality data across many European countries, including the countries of the former USSR. In the years to come, it will serve the needs of the research community.

Because of the emergence of long time harmonized series of regional mortality data for many European countries, it was possible to use an advanced statistical model to measure for the first time in a coherent way the excess mortality due to the COVID–19 pandemic in 21 countries simultaneously.

Another example of a breakthrough in the field is the original assessment of long-term trends in amenable and preventable mortality at the sub-national level across Germany, Austria, and Switzerland. Evaluating the efficiency of different health policies on premature mortality in an international context is a complex task, as it requires accounting for the influence of contextual factors. With this respect, the three German-speaking regions represent a unique ‘natural experiment’ setting: while being exposed to different health systems and policies, they share a similar culture and language.

Exploring long-term cause-specific mortality trends and patterns in Ukraine before the pandemic and the Russian invasion was the first study of this kind in Ukraine, and a significant advancement as well. These analyses will serve as an important reference point for both the research community and policymakers elaborating strategies to rebuild Ukraine’s public health after the end of the war.

Likewise, the study measuring the contribution of past smoking to regional mortality differentials in Germany over the last four decades was significant for the advancement of the field. It has shown that the regional differences in past smoking behavior can have a notable impact on contemporary regional mortality differentials. This work has created a solid departure point for future research focusing on smoking-attributable mortality in a broader, European perspective, analyzing both the time trends and spatial patterns across numerous of countries.

By the end of the project, the REDIM is expected to yield more empirical evidence supporting the theory that contextual effects do influence geographical variation in health through i) spatial patterning and diffusion of physical and biological risk factors, and ii) social relations important to health.