Neighbourhood mortality inequalities in New York City, 1989-1991 and 1999-2001

OBJECTIVES: To examine whether inequalities in mortality across socioeconomically diverse neighbourhoods changed alongside the decline in mortality observed in New York City between 1990 and 2000. DESIGN: Cross-sectional analysis of neighbourhood-level vital statistics. SETTING: New York City, 1989-1991 and 1999-2001. MAIN RESULTS: In both poor and wealthy neighbourhoods, age-adjusted mortality for most causes declined between the time periods, although mortality from diabetes increased. Relative inequalities decreased slightly-largely in the under 65 years population-although all-cause rates in 1999-2001 were still 50% higher, and rates of years of potential life lost before age 65 years were 150% higher, in the poorest communities than in the wealthiest ones (relative index of inequality 1.7 and 3.3, respectively). The relative index of inequality for mortality from AIDS increased from 4.7 to 13.9. Over 50% of the excess mortality in the poorest neighbourhoods in 1999-2001 was due to cardiovascular disease, AIDS and cancer. CONCLUSIONS: In New York City, despite substantial declines in absolute mortality and rate differences between poor and wealthy neighbourhoods, great relative socioeconomic inequalities in mortality persist.