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

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.