The UPA (underprivileged area) score and mortality in Swedish municipalities

Objective - To analyse the association between the Swedish underprivileged area (UPA) score and the standardized mortality ratio in Swedish municipalities. Setting - All 283 municipalities in Sweden. Design - The UPA score was calculated for municipalities using the proportion of persons in the following groups: elderly persons living alone, children under five, persons In one-parent families, unskilled (SEI 1), unemployed, persons living in crowded households, those who have moved house in the last pear, and persons of minority ethnic origin. After transformation (arc sin √) and standardization, each of the eight variables was weighted by the UK general practitioners' average weighting and added to give a composite index of socioeonomic deprivation - the UPA-score. The strength of the relationship between the UPA-score and premature mortality in Sweden was investigated by regression analysis using SMR, for people aged 20-64 years, 1989-93, as the dependent variable. Results - The mean UPA-score (standard deviation) of the 284 municipalities was 0 (10.0) and the range -43 to 28. The mean SMR for all persons was 1 and the range 0.46 to 1.81. The association between UPA-score and SMR was statistically significant and the UPA-score explained 20% of the variation between municipalities in SMR. Conclusion - The range of social deprivation at the municipality level in Sweden, as measured by a composite index such as the UPA score, is wide. A two-fold variation at municipality level was also found in premature mortality. There was a significant association between high rates of mortality and social deprivation.