The geographical epidemiology of smoking-related premature mortality: A registry-based small-area analysis of the Czech death statistics.

Objectives: Smoking-related mortality varies over different social, environmental, and policy contexts. However, spatial patterns, examined at a small area level, have been seldom considered. Therefore, the study provides a detailed analysis of socio-spatial inequalities in premature mortality related to smoking in the contemporary Czech adult population.

Design, Settings, And Methods: We conducted a population-based, cross-sectional study to investigate the spatial pattern of the age-adjusted smoking-related mortality across Czechia. The spatial inequalities, as measured at the municipality level, were investigated using geostatistical modeling techniques. The ecological regression of the local mortality risk on socioeconomic composition of municipalities was also conducted. The target population was defined as permanent adult residents of Czechia aged 25-64 years in the period of 2011-2015.

Results: Among both sexes, a significant spatial gradient in the South-East (lower relative risk) - North-West (higher relative risk) axis was detected. The local mortality risk was significantly related to the level of relative deprivation of the municipalities (a composite index comprised from unemployment rate and level of education): adjusted RR among males (for an increase by 1 SD): 1.21 [95% CI: 1.158-1.256], p < 0.001; adjusted RR among females (for an increase by 1 SD): 1.14 [95% CI: 1.090-1.186], p < 0.001. Mortality among males was approximately twice as high as opposed to females. Regarding the spatial inequalities of the phenomena, however, only rather minor sex-specific patterns were identified. Contrasted to males, mortality among females was unrelated to unemployment rates.

Conclusions: Consistent spatial patterns of the premature mortality were identified. The mortality risk was significantly related to socioeconomic composition of the Czech municipalities. The higher the level of local deprivation, the higher the local mortality risk. The results of the study can be found beneficial for planning of both socially and spatially integrated public health policy.