Place-based structural disadvantage and mortality inequality across 379 Polish counties, 2010-2025: a spatial Mundlak analysis

Across 379 Polish counties (2010–2025), durable between-county mortality gradients persist—median partial slopes per SD were -26.1 for higher education, +29.4 for primary/lower-secondary education, and +30.2 for PM2.5 in the pre-COVID window.

• Why it matters: Mortality geography may reflect long-standing place disadvantage, but it is unclear whether it is better captured by stable between-county differences or by shifting within-county deviations, especially across COVID-19.
• What they did: Using spatial Mundlak generalized additive models with non-linear effects and county-specific spatial modification, the authors compared a pre-COVID model (2010–2019) with overlapping models through 2022 and 2025, and assessed uncertainty and leave-one-year-out validation.
• The result: Between-county gradient directions persisted across windows, while within-county associations were less stable and sometimes reversed sign; education and PM2.5 patterns were more coherent pre-COVID, and weak temporal transportability limited predictive interpretation.

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