Spatial variation in cause-specific premature mortality and its association with socioeconomic deprivation in Belgium from 2000 to 2019

Spatial variation in cause-specific premature mortality and its association with socioeconomic deprivation in Belgium from 2000 to 2019 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Spatial variation in cause-specific premature mortality and its association with socioeconomic deprivation in Belgium from 2000 to 2019 Martina OTAVOVA, Bruno MASQUELIER, Christel FAES, Catherine Bouland, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5611920/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 23 Oct, 2025 Read the published version in Archives of Public Health → Version 1 posted 8 You are reading this latest preprint version Abstract Background Premature mortality risks vary in space and time between subpopulations and are influenced by numerous factors, including levels of socioeconomic deprivation. In Belgium, socioeconomic deprivation has been recently quantified by the Belgian Indices of Multiple Deprivation but their contribution to the spatial patterns of premature mortality has not been quantified yet. This study aims to investigate the variation in premature mortality risks and their association with socioeconomic deprivation. Methods The Belgian Index of Multiple Deprivation 2011 and its deprivation domains, including employment, income, education, housing, and crime, are used to measure overall and domain-specific deprivation in all 589 municipalities in Belgium between 2000 and 2019. We estimate the all-cause and cause-specific relative risks of dying prematurely using Bayesian hierarchical models. Results The spatial patterns of relative risks varied by cause of death. The most common pattern was the North-South gradient showing higher risks in Wallonia and lower risks in Flanders. Subnational variation increased over time for all causes of death, differing by cause. Higher deprivation levels were linked to greater premature mortality risks, particularly sensitive to employment and housing deprivation. In both sexes, the strongest associations with deprivation were observed for deaths due to alcohol consumption, COPD, and diabetes mellitus. Conclusion This study highlights the significant associations between socioeconomic deprivation and the risk of premature death in Belgium, revealing notable spatial disparities. The pronounced North-South gradient underscores the persistent regional inequalities, with Wallonia bearing the highest burden of premature mortality risks. These results emphasize the importance of addressing the complex interplay of socioeconomic factors in shaping health outcomes and the need for targeted public health interventions to reduce premature mortality and promote health equity across Belgium. Relative risk of premature death health inequality deprivation Belgian Index of Multiple Deprivation Belgium Full Text Additional Declarations Competing interest reported. One of the co-authors, Brecht Devleesschauwer, is serving as Editor in Chief for Archives of Public Health. Supplementary Files Supplement1010.docx Cite Share Download PDF Status: Published Journal Publication published 23 Oct, 2025 Read the published version in Archives of Public Health → Version 1 posted Editorial decision: Revision requested 05 May, 2025 Reviews received at journal 02 May, 2025 Reviews received at journal 24 Apr, 2025 Reviewers agreed at journal 24 Apr, 2025 Reviewers agreed at journal 23 Apr, 2025 Reviewers invited by journal 22 Apr, 2025 Submission checks completed at journal 21 Apr, 2025 First submitted to journal 04 Apr, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5611920","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":446173350,"identity":"ee4f7dcb-d327-47bf-b598-004235f3eb80","order_by":0,"name":"Martina OTAVOVA","email":"data:image/png;base64,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","orcid":"","institution":"Université Catholique de Louvain","correspondingAuthor":true,"prefix":"","firstName":"Martina","middleName":"","lastName":"OTAVOVA","suffix":""},{"id":446173353,"identity":"52c6e333-4e4f-45de-a7db-beac75b8e842","order_by":1,"name":"Bruno MASQUELIER","email":"","orcid":"","institution":"Université Catholique de Louvain","correspondingAuthor":false,"prefix":"","firstName":"Bruno","middleName":"","lastName":"MASQUELIER","suffix":""},{"id":446173354,"identity":"7a62dde9-5d94-4bec-b172-649ec07f3148","order_by":2,"name":"Christel FAES","email":"","orcid":"","institution":"Hasselt University","correspondingAuthor":false,"prefix":"","firstName":"Christel","middleName":"","lastName":"FAES","suffix":""},{"id":446173355,"identity":"be6f6746-734d-4b68-b148-346ed4abc492","order_by":3,"name":"Catherine Bouland","email":"","orcid":"","institution":"Université Libre de Bruxelles","correspondingAuthor":false,"prefix":"","firstName":"Catherine","middleName":"","lastName":"Bouland","suffix":""},{"id":446173356,"identity":"01420fec-ae1b-4cfe-b569-82a6b9b47be1","order_by":4,"name":"Eva M DECLERCQ","email":"","orcid":"","institution":"Sciensano (Belgium)","correspondingAuthor":false,"prefix":"","firstName":"Eva","middleName":"M","lastName":"DECLERCQ","suffix":""},{"id":446173358,"identity":"9ab3a2d1-2018-49a1-a0c6-d01d63d40933","order_by":5,"name":"Bram VANDENINDEN","email":"","orcid":"","institution":"Université Libre de Bruxelles","correspondingAuthor":false,"prefix":"","firstName":"Bram","middleName":"","lastName":"VANDENINDEN","suffix":""},{"id":446173362,"identity":"95799c9a-ac9f-41c9-b43e-362b42cfcdc2","order_by":6,"name":"Brecht DEVLEESSCHAUWER","email":"","orcid":"","institution":"Sciensano (Belgium)","correspondingAuthor":false,"prefix":"","firstName":"Brecht","middleName":"","lastName":"DEVLEESSCHAUWER","suffix":""},{"id":446173363,"identity":"ea6b1161-4f9a-4c0d-ad98-7dc7d1142397","order_by":7,"name":"Benjamin-Samuel SCHLÜTER","email":"","orcid":"","institution":"University of Toronto","correspondingAuthor":false,"prefix":"","firstName":"Benjamin-Samuel","middleName":"","lastName":"SCHLÜTER","suffix":""}],"badges":[],"createdAt":"2024-12-09 23:08:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5611920/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5611920/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s13690-025-01694-1","type":"published","date":"2025-10-23T16:16:14+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":94490587,"identity":"5b9cf033-4037-4a47-97bf-5ab98828d4d3","added_by":"auto","created_at":"2025-10-27 17:12:43","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1490231,"visible":true,"origin":"","legend":"","description":"","filename":"Manuscript164.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5611920/v1_covered_25de96bb-355a-4ed0-93bd-0beacab2b82e.pdf"},{"id":81232880,"identity":"8d13ec00-03fe-4024-b114-5755a0723dfe","added_by":"auto","created_at":"2025-04-23 18:11:27","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":7938303,"visible":true,"origin":"","legend":"","description":"","filename":"Supplement1010.docx","url":"https://assets-eu.researchsquare.com/files/rs-5611920/v1/3dfa5b503e9bc088bf6abba8.docx"}],"financialInterests":"Competing interest reported. 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In Belgium, socioeconomic deprivation has been recently quantified by the Belgian Indices of Multiple Deprivation but their contribution to the spatial patterns of premature mortality has not been quantified yet. This study aims to investigate the variation in premature mortality risks and their association with socioeconomic deprivation.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThe Belgian Index of Multiple Deprivation 2011 and its deprivation domains, including employment, income, education, housing, and crime, are used to measure overall and domain-specific deprivation in all 589 municipalities in Belgium between 2000 and 2019. We estimate the all-cause and cause-specific relative risks of dying prematurely using Bayesian hierarchical models.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe spatial patterns of relative risks varied by cause of death. The most common pattern was the North-South gradient showing higher risks in Wallonia and lower risks in Flanders. Subnational variation increased over time for all causes of death, differing by cause. Higher deprivation levels were linked to greater premature mortality risks, particularly sensitive to employment and housing deprivation. In both sexes, the strongest associations with deprivation were observed for deaths due to alcohol consumption, COPD, and diabetes mellitus.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThis study highlights the significant associations between socioeconomic deprivation and the risk of premature death in Belgium, revealing notable spatial disparities. The pronounced North-South gradient underscores the persistent regional inequalities, with Wallonia bearing the highest burden of premature mortality risks. These results emphasize the importance of addressing the complex interplay of socioeconomic factors in shaping health outcomes and the need for targeted public health interventions to reduce premature mortality and promote health equity across Belgium.\u003c/p\u003e","manuscriptTitle":"Spatial variation in cause-specific premature mortality and its association with socioeconomic deprivation in Belgium from 2000 to 2019","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-23 18:11:21","doi":"10.21203/rs.3.rs-5611920/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-05-05T08:48:20+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-02T17:07:11+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-24T15:23:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"307565621019616062518337743890518381238","date":"2025-04-24T08:08:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"187550142987844397049938067411393616528","date":"2025-04-23T06:05:44+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-22T07:56:31+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-21T06:47:22+00:00","index":"","fulltext":""},{"type":"submitted","content":"Archives of Public Health","date":"2025-04-04T14:01:27+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"archives-of-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"aoph","sideBox":"Learn more about [Archives of Public Health](http://archpublichealth.biomedcentral.com/)","snPcode":"13690","submissionUrl":"https://submission.nature.com/new-submission/13690/3","title":"Archives of Public Health","twitterHandle":"@Archpubhealth","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a31a11ba-7cd8-47d8-a7c2-c2ab99d10133","owner":[],"postedDate":"April 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-10-27T16:31:30+00:00","versionOfRecord":{"articleIdentity":"rs-5611920","link":"https://doi.org/10.1186/s13690-025-01694-1","journal":{"identity":"archives-of-public-health","isVorOnly":false,"title":"Archives of Public Health"},"publishedOn":"2025-10-23 16:16:14","publishedOnDateReadable":"October 23rd, 2025"},"versionCreatedAt":"2025-04-23 18:11:21","video":"","vorDoi":"10.1186/s13690-025-01694-1","vorDoiUrl":"https://doi.org/10.1186/s13690-025-01694-1","workflowStages":[]},"version":"v1","identity":"rs-5611920","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5611920","identity":"rs-5611920","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}