Measurement of the association between deprivation and mortality

dying young; implying that in our sample, fathers who ever lived with their children are over-represented. Given their lower mortality risks, the differences between childless men and fathers found in this study may be over-estimated. The literature would benefit from studies including information on residence with children throughout the children’s lives. In conclusion, childless men show an increased risk of mortality over a follow-up period of 17 years. Health behaviours, partner status and educational attainment mediate the relationship between parity and mortality risks among men. This study provides evidence that men’s reproductive patterns have long-term health implications.

Acknowledgement The Corresponding Author has the right to grant on behalf of all authors and does grant on behalf of all authors, an exclusive license on a worldwide basis to the EJPH and Oxford University Press to permit this article (if accepted) to be published in EJPH and exploit all subsidiary rights. Conflicts of interest: None declared.



Jaffe DH, Neumark YD, Eisenbach Z, Manor O. Parity-related mortality: shape of association among middle-aged and elderly men and women. Eur J Epidemiol 2009;24:9–16.


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Grundy E, Kravdal O. Reproductive history and mortality in late middle age among Norwegian men and women. Am J Epidemiol 2008;167:271–9.


Smith KR, Mineau GP, Bean LL. Fertility and post-reproductive longevity. Soc Biol 2002;49:185–205.


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Dribe M. Long-term effects of childbearing on mortality: evidence from pre-industrial Sweden. Pop Stud 2004;58:297–310.


Eggebeen DJ, Knoester C. Does fatherhood matter for men? J Marriage Fam 2001;63:381–93.

10 Mackenbach JP, Bos V, Andersen O, et al. Widening socioeconomic inequalities in mortality in six Western European countries. Int J Epidemiol 2003;32:830–7.

Key points  Several studies have reported an inverse association or U-shaped pattern between parity and mortality among women. Few studies are available on the association between parity and mortality among men and underlying mechanisms of a potential association are unclear.  This study explores the association between parity and all-cause mortality among Dutch adult men, and investigates potential mechanisms underlying this association.  Fathers of two and three children and especially fathers of four and more children are found to have lower mortality risks compared with childless men. Health behaviours, partner status and SEP mediate the relationship between men’s parity and their mortality risks.

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Hurt LS, Ronsmans C, Thomas SL. The effect of number of births on women’s mortality: systematic review of the evidence for women who have completed their childbearing. Pop Stud 2006;60:55–71.

12 Gove WR. Sex, marital status and mortality. Am J Sociol 1973;79:45–67. 13 Kirkwood TBL, Westendorp RGJ. Human longevity at the cost of reporductive success: trade-offs in the life history. In: Robine JM, Kirkwood TBL, Allard M, editors. Sex and Longevity: Sexuality, Gender, Reproduction, Parenthood. Berlin: Springer, 2001:1–6. 14 Van Lenthe FJ, Schrijvers CTM, Droomers M, et al. Investigating explanations of socio-economic inequalities in health. The Dutch GLOBE study. Eur J Public Health 2004;14:63–70. 15 Garssen J, de Beer J, Cuyvers P, de Jong A. Samenleven. Nieuwe feiten over relaties en gezinnen. (Living together. New facts about relationships and families). Voorburg/Heerlen, The Netherlands: CBS, 2001. 16 Uchino BN. Social Support and Physical Health: Understanding the Health Consequences of Relationships 2004. New Haven, CT: Yale University Press, 2004. 17 Breton D, Prioux F. The one-child family: France in the European context. Demogres Res 2004;20:657–92. 18 Kendig H, Browning C, Wells Y. Australian research on ageing, families and health promotion. Soc Policy J NZ 1998;11:169–81. 19 Ringba¨ck Weitoft G, Burstro¨m B, Rose´n M. Premature mortality among lone fathers and childless men. Soc Sci Med 2004;59:1449–59.

................................................................................................................................. European Journal of Public Health, Vol. 22, No. 3, 347–353 ß The Author 2011. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved. doi:10.1093/eurpub/ckr029 Advance Access published on 31 March 2011


Spatiotemporal association between deprivation and mortality: trends in France during the nineties Fanny Windenberger1, Ste´phane Rican1,2, Eric Jougla1, Gre´goire Rey1 1 Inserm, Ce´piDc, Le Ve´sinet, France 2 Lab Espace Sante´ et Territoires, Universite´ Paris Ouest Nanterre la De´fense, Nanterre, France Correspondence: Gre´goire Rey, 44 chemin de ronde, F-78116, Le Ve´sinet, France, tel: +33 1 34 80 24 75, fax: +33 1 34 80 24 29, e-mail: [email protected]

Background: Monitoring the time course of socio-economic inequalities in mortality is a key public health issue. The aim of this study is to analyse this trend at an ecological level, in mainland France, over the 1990s, using a deprivation index enabling time comparisons. Methods: Deprivation indexes (FDep) were built using the 1990 and 1999 data and the same methodology. The indices were defined as the first component of a principal component analysis including four specific socio-economic variables. The time course of the association between mortality and deprivation was evaluated on the ‘commune’ geographic scale (36 000 U in mainland France), without considering spatial autocorrelation and on the larger ‘canton’ scale (3700 U), considering spatial autocorrelation. The analysis was carried out by gender, age

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11 Kendig H, Dykstra PA, Van Gaalen RIA, Melkas T. Health of aging parents and childless individuals. J Fam Issues 2007;28:1457–86.


European Journal of Public Health

and degree of urbanicity and applied to general mortality and a specific subcategory: ‘avoidable’ deaths. Results: Area-level socio-economic inequalities in mortality tended to increase during the 1990s. For the period 1997–2001, the standard mortality ratio (SMR) was 24% higher for the communes in the most deprived quintile than for those in the least deprived quintile, while this differential was of 20% for the period 1988–92. This increase in the differentials concerned especially males and people in the age group of 110,0 ; >109,9)


4th quintile (>101,5 ; >101,3) 3rd quintile (>95,1 ; >95,0) 2nd quintile (>89,6 ; >88,4) _

1st quintile (