Development of the Portuguese European Deprivation Index 2021 and its association with all-cause mortality across multiple spatial scales
This study developed the updated 2021 Portuguese European Deprivation Index (EDI-PT 2021) using census and survey data to map territorial inequalities and confirmed its strong, dose–response association with all-cause mortality across parish and municipality levels, establishing it as a robust tool for public health surveillance and planning.
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Health is rarely just a matter of biology or luck. It is deeply woven into the fabric of where people live, the work they do, and the resources they can access. When a community lacks steady jobs, affordable housing, or quality education, the people within it often face higher risks of illness and earlier death. This pattern is so consistent that public health experts have long sought a way to measure it precisely. They need a tool that can look at a specific neighborhood and tell them, with clarity, how much hardship its residents face compared to the rest of the country. Without such a measure, it is difficult to see the hidden inequalities that shape life and death, or to direct help to the places that need it most.
In Portugal, a team of researchers has just updated this essential tool for the year 2021. They created a new version of the European Deprivation Index, a score designed to capture the complex reality of poverty not just as a lack of money, but as a lack of the things most people consider necessary for a decent life. By combining data from a massive national survey with a detailed census, they mapped out exactly where deprivation is concentrated across the country. Their work reveals a landscape of stark inequality, showing that the risk of dying from any cause rises steadily as the level of deprivation in a neighborhood increases. This new index provides a clear, evidence-based picture of who is struggling and where, offering a vital guide for policymakers trying to build a healthier, fairer society.
The researchers started by asking a simple but profound question: what does it mean to be deprived in modern Portugal? To answer this, they looked at the daily lives of nearly 24,000 individuals through the European Union Statistics on Income and Living Conditions survey. They identified thirteen specific things that most people in the country can afford, such as covering an unexpected expense, keeping their home warm, having a car, or taking a week-long holiday. They then looked for the people who could not afford these items due to financial constraints. The study found that if a person lacks at least two of these fundamental needs, they are considered deprived. This definition captures a reality where nearly 40 percent of the population faces some form of hardship, a figure that reflects not just extreme poverty but also the inability to participate fully in ordinary social life.
With this definition in hand, the team turned to the 2021 national census to see how these individual struggles played out across the entire country. They looked for patterns in the data that matched the hardships identified in the survey. They found that areas with higher rates of deprivation shared specific characteristics: more people who were not married, more foreign-born residents, lower levels of education, and more people working in non-managerial jobs or unemployed. Housing also played a major role; neighborhoods with more rented homes, larger households, and smaller living spaces tended to be more deprived. By weighing these factors according to how strongly they predicted individual hardship, the researchers built a single score for every small neighborhood in Portugal. They calculated this score for over 10,000 small areas, then grouped them into larger parishes and municipalities to see the bigger picture.
The resulting map of Portugal tells a story of deep regional divides. The most deprived areas are not scattered randomly; they are clustered in the southern and inland regions, including parts of the Alentejo and the Algarve, as well as in the islands of the Azores and Madeira. In contrast, the least deprived areas form a corridor along the northern and central coast, surrounding the major cities of Porto and Lisbon. This pattern is not new, but the updated index confirms that these inequalities have persisted and evolved over the last decade. The researchers noted that while severe housing problems like a lack of indoor plumbing have largely disappeared, new forms of disadvantage have emerged, particularly related to family structure and the ability to afford social participation.
To test if this new index actually mattered for people's lives, the researchers linked it to death records from 2019 to 2022. They compared the risk of dying in the most deprived neighborhoods against the least deprived ones, carefully adjusting for age and sex to ensure a fair comparison. The results showed a clear and steady gradient: as deprivation increased, so did the risk of death. In the most deprived parishes, the risk of dying was about 9 percent higher than in the least deprived areas. At the level of entire municipalities, this gap widened slightly, with the most deprived areas showing a 10 percent higher risk. This relationship held true regardless of whether the researchers looked at small neighborhoods or large towns, suggesting that the index is a reliable measure of health risk across different scales.
The study concludes that this updated index is a powerful tool for understanding and addressing health inequalities. By capturing the specific ways in which modern deprivation manifests—from the inability to replace worn-out clothes to the lack of a stable job—it offers a more accurate picture than older measures that focused only on extreme material lack. The researchers emphasize that while the map shows where the problems are, it also highlights the need for targeted interventions. The consistent link between deprivation and mortality suggests that improving the economic and social conditions of these specific neighborhoods could save lives. For public health officials and planners, this new data provides a solid foundation for directing resources to the communities where they are needed most, ensuring that the effort to reduce inequality is guided by facts rather than assumptions.
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