Age-period-cohort analysis of mortality and its association with deprivation in Hungary, 2007-2021

BACKGROUND: Severe spatial inequalities in health and its determinants are a well-known and long-standing phenomenon in Central-Eastern European countries, including Hungary. The aim of our study was to perform an age-period-cohort (APC) analysis to provide information on mortality trends and their association with deprivation in Hungary using the latest available data for the period 2007-2021. METHODS: The extended APC model, allowing estimation of mortality risk considering deprivation, time, age, and cohort effects and their interactions, was used to analyse the trajectories of several outcome variables along complex dimensions. Model fitting and inference were carried out by using Bayesian computation with INLA methodology. RESULTS: Mortality risk was the lowest in the 5-9 year age group and increased with age. Between 2007-19, the mortality risk showed a decreasing trend, which returned to the 2007 level by 2020-21 due to the COVID-19 pandemic. Considering the birth cohort effect, the mortality risk peaked in the 1953-57 cohort, then decreased until the 1972-76 cohort, followed by a steady state, and then decreased from the 1988-92 cohort onwards. Deprivation was positively associated with higher mortality risk. The interaction of deprivation and period effect on mortality risk showed a steeper increasing trend for deprived groups for 2020-21. In terms of the interaction of deprivation and cohort effect, the risk of mortality in the most deprived group was higher than the national risk for all birth cohorts. The risk increased until the 1967-71 cohort, then decreased until the 1992-96 cohort, and then again showed an increasing trend. The risk of mortality for the least deprived population was lower than the national average risk, while the opposite difference could be observed for the most deprived group. CONCLUSIONS: Deprivation was associated with higher mortality risk, COVID-related mortality and cohort effect during the study period. KEY MESSAGES: • The COVID epidemic-associated increase in mortality affected groups of different deprivation status to varying degree. • Different cohort effects were found behind the mortality risk in different deprivation groups.