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Introduction
The administrative Region of Attica in 2021 accounted for 35% of the country’s population [1], making it the most populous region of Greece, including the country’s capital, Athens. It consists of eight regional units, as shown in Figure 1. These are Central Athens, North Athens (Voreios Tomeas Athinon) and South Athens (Notios Tomeas Athinon). To the west lies West Athens, and to the southeast, the South Athens. Between them is the Piraeus regional unit. This urban complex is surrounded by the Western (Dytiki) and Eastern (Anatoliki) Attica, as well as by the Islands of Attica. Substantial differences exist among these areas regarding demographics [2] and socioeconomic development [3].
The determinants of spatial variation in life expectancy are typically socioeconomic in nature [4,5,6,7,8,9]. Recent international literature has confirmed that the COVID-19 pandemic had additional spatial and socioeconomic dimensions, showing that life expectancy losses varied considerably across urban areas and were linked to population density and socioeconomic status [10,11,12,13]. Based on this literature framework, this paper aims to explore both long-term trends (2014–2019) and the pandemic shock (2019–2020) in the spatial distribution of life expectancy within Attica.
The paper is structured as follows. Section 2 briefly discusses the mortality transition across the country. Section 3 presents the data and method. Section 4 presents the results, and in conclusion (Section 5) the results are interpreted, and the limitations noted.
A Brief Discussion of Mortality Transition in Greece
Trying to identify the causes of the different mortality trends in Greece by period, the mortality transition that took place up to 2010 is apparently due to what Zafeiris and colleagues [17] call “enormous developments in the economic, political, and social characteristics of Greece”. However, this course was violently interrupted with the economic crisis of 2008 [18]. Phenomena such as austerity policies, cuts in the public health system, and social security, as well as rapid increases in unemployment and poverty, led to the deterioration of population health [18]. The COVID-19 pandemic added another factor to the deterioration of the health of the population, contributing decisively to a further increase in mortality (“excess mortality”) [19].
Data and Methods
In order to present the spatial variation of life expectancy at birth and at age 65 in the Region of Attica, analysis was done at the level of Regional Units — NUTS 3 level. The Attica Region includes eight Regional Units (Figure 1): 1) Kentrikos Tomeas Athinon, 2) Notios Tomeas Athinon, 3) Voreios Tomeas Athinon, 4) Dytikos Tomeas Athinon, 5) Peiraias, 6) Nisoi Attikis, 7) Dytiki Attiki, 8) Anatoliki Attiki. Because in the Eurostat database the data of Regional Units “Peiraias” and “Nisoi” are given grouped, analysis is based on seven Regional Units. The reasons for choosing NUTS 3 level include availability in Eurostat databases and the socioeconomic differences between Regional Units which cover the research aim.
Results
Life Expectancy at Birth
The temporal changes in life expectancy at birth in Attica showed that the existing mortality regimes are dichotomic in both genders. Piraeus (Peiraias, Nisoi) and Western Attica mortality is always higher than the country’s entire population. On the contrary, the lowest mortality is in Northern Athens (Voreios Tomeas Athinon), followed by Central Athens, Southern Athens, and Eastern Attica (Figure 2).
After comparing 2019 with 2014, life expectancy at birth increased (Table 1), and in fact in the Regional Unit of the Southern Sector of Athens by 2.89 years for women and 2.85 years for men. The only exception is women in the Regional Unit of Piraeus-Islands, where life expectancy at birth decreased by 1.16 years.
| Region | Females — e0 | Males — e0 | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| 2014 | 2016 | 2018 | 2019 | 2020 | 2014 | 2016 | 2018 | 2019 | 2020 | |
| Greece | 84.0 | 84.2 | 84.2 | 84.5 | 83.5 | 79.0 | 78.9 | 79.0 | 79.4 | 77.8 |
| Kentrikos Tomeas Athinon | 84.7 | 84.6 | 85.7 | 85.3 | 84.1 | 79.9 | 80.3 | 81.1 | 80.6 | 79.5 |
| Notios Tomeas Athinon | 85.1 | 85.5 | 87.0 | 87.0 | 84.0 | 80.7 | 81.1 | 82.3 | 83.6 | 80.7 |
| Voreios Tomeas Athinon | 85.7 | 85.7 | 86.7 | 87.2 | 86.7 | 81.4 | 81.7 | 82.4 | 82.4 | 82.1 |
| Dytikos Tomeas Athinon | 83.1 | 83.4 | 84.4 | 85.0 | 84.3 | 77.8 | 78.3 | 79.5 | 79.7 | 78.6 |
| Peiraias & Nisoi | 83.4 | 82.7 | 83.8 | 82.2 | 83.0 | 78.9 | 79.1 | 79.1 | 79.4 | 78.3 |
| Dytiki Attiki | 81.7 | 82.9 | 82.1 | 82.4 | 82.0 | 76.7 | 76.6 | 77.3 | 77.6 | 77.3 |
| Anatoliki Attiki | 85.0 | 85.0 | 85.6 | 85.5 | 85.1 | 79.5 | 79.8 | 80.9 | 80.9 | 80.2 |
2020 is associated with the onset of the COVID-19 pandemic, and the impact on life expectancy at birth is clear. Men and women observed decreased life expectancy at birth (Figure 2), except for the Piraeus-Islands Regional Unit. Among women, the Regional Units with the most significant decrease were those of the South (−3.06 years) and the Central Sector of Athens (−1.17 years), while among men, a similar pattern emerged.
Despite that, the gender differences in life expectancy at birth bear a more spatial character (Table 2). They are lowest in Anatoliki Attiki and clearly higher in the Dytikos Tomeas Athinon and in Piraeus-Islands. Viewed in a diachronic perspective, the gender differences decreased between 2014 and 2020 both for Greece as a whole and in four of the seven Regional Units of Attica.
| Region | 2014 | 2016 | 2018 | 2019 | 2020 | Change 2014–2020 |
|---|---|---|---|---|---|---|
| Greece | 5.0 | 5.3 | 5.2 | 5.1 | 5.7 | +0.7 |
| Kentrikos Tomeas Athinon | 4.8 | 4.3 | 4.6 | 4.7 | 4.6 | −0.2 |
| Notios Tomeas Athinon | 4.4 | 4.4 | 4.7 | 3.4 | 3.3 | −1.1 |
| Voreios Tomeas Athinon | 4.3 | 4.0 | 4.3 | 4.8 | 4.6 | +0.3 |
| Dytikos Tomeas Athinon | 5.3 | 5.1 | 4.9 | 5.3 | 5.7 | +0.4 |
| Peiraias & Nisoi | 4.5 | 3.6 | 4.7 | 2.8 | 4.7 | +0.2 |
| Dytiki Attiki | 4.9 | 6.3 | 4.8 | 4.8 | 4.7 | −0.2 |
| Anatoliki Attiki | 5.5 | 5.2 | 4.7 | 4.6 | 4.9 | −0.6 |
Life Expectancy at Age 65
Examining life expectancy at age 65, there is similar spatial differentiation in Attica as found for life expectancy at birth. More specifically, the analysis of life expectancy at age 65 in Figure 3 shows that Piraeus-Islands and Western Attica present the highest mortality at age 65, while Northern Athens presents the lowest mortality at age 65.
Discussion and Conclusion
This paper focuses on the spatial variation of life expectancy at birth and at age 65 in the Region of Attica from 2014 to 2020. The findings confirmed the existence of a spatial differentiation of life expectancy in Attica, related to the wider socioeconomic differences between Regional Units. This is consistent with the findings of previous research [4,5,6,7] that have shown that socioeconomic factors play an important role in the spatial distribution of life expectancy in Greece and at the international level.
More specifically, the findings confirmed the hypothesis regarding the COVID-19 pandemic’s impact on the spatial distribution of life expectancy in Attica. The pandemic mainly affected men over 65 years old living in disadvantaged areas. This has been the case in many European countries [10,11,12], confirming that the socioeconomic factor played an important role in the distribution of life expectancy losses due to the COVID-19 pandemic.
In general, the results of this paper show that the spatial differentiation of life expectancy in Attica is a complex phenomenon that requires a multifaceted approach. Future research should focus on a more detailed analysis of the socioeconomic factors that affect the spatial distribution of life expectancy in Attica, such as education, income, and access to health services.