Latent vulnerability profiles behind mortality inequalities in Czechia

Background

Research in the Czech population indicates that higher mortality in socially deprived areas is primarily linked to individual social deprivation. However, it remains unclear whether specific population profiles exist where low social status systematically co-occurs with other risk factors, reflecting broader social and structural determinants of health, particularly in peripheral contexts.

Methods

We used linked administrative individual data from the Czech National Health Information System and the Ministry of Labour and Social Affairs (n = 6,250,778, aged 30+). A random sample of 50,000 was analysed for unemployment, social benefit receipt, general practitioner registration, and comorbidity (Deyo-Charlson index). Latent class analysis identified social-health profiles; their distribution was examined by age, sex, and settlement units categorised by the share of residents receiving social benefits to capture local socioeconomic context. Age- and sex-specific death probabilities for 2023 were calculated for each profile.

Results

A three-class solution best fitted the data: “healthy and stable”, “chronically ill”, and “extreme deprivation”. The latter represents 3–4% of the population, but its share rises from <1% in the least deprived areas to about 20% in the most deprived ones. For working-age men, the death probability in the “extreme deprivation” class was 3–4 times higher than in the “healthy and stable” class (2–3 times for women), often exceeding the “chronically ill” risk. These patterns highlight the clustering of social disadvantage, poor care access, and health burden.

Conclusions

Mortality inequalities are driven by a small group combining social and health disadvantages, concentrated in socially deprived areas. This supports targeting outreach interventions to those with multiple risks and integrating spatial and individual vulnerability. Policy should address social protection and care access to strengthen resilience in peripheral regions

Key messages

• A small group combining social and health disadvantages drives mortality inequalities. These individuals are highly concentrated in the most socially deprived areas.

• Targeting outreach interventions to individuals with multiple risks can reduce excess mortality and strengthen resilience in peripheral and structurally disadvantaged regions.