Trends in socioeconomic inequalities in mortality in small areas of 33 Spanish cities
Por:
Mari-Dell'Olmo, M, Gotsens, M, Palencia, L, Rodriguez-Sanz, M, Martinez-Beneito, MA, Ballesta, M, Calvo, M, Cirera, L, Daponte, A, Dominguez-Berjon, F, Gandarillas, A, Goni, NI, Martos, C, Moreno-Iribas, C, Nolasco, A, Salmeron, D, Taracido, M, Borrell, C
Publicada:
29 jul 2016
Resumen:
Background: In Spain, several ecological studies have analyzed trends in socioeconomic inequalities in mortality from all causes in urban areas over time. However, the results of these studies are quite heterogeneous finding, in general, that inequalities decreased, or remained stable. Therefore, the objectives of this study are: (1) to identify trends in geographical inequalities in all-cause mortality in the census tracts of 33 Spanish cities between the two periods 1996-1998 and 2005-2007; (2) to analyse trends in the relationship between these geographical inequalities and socioeconomic deprivation; and (3) to obtain an overall measure which summarises the relationship found in each one of the cities and to analyse its variation over time.
Methods: Ecological study of trends with 2 cross-sectional cuts, corresponding to two periods of analysis: 19961998 and 2005-2007. Units of analysis were census tracts of the 33 Spanish cities. A deprivation index calculated for each census tracts in all cities was included as a covariate. A Bayesian hierarchical model was used to estimate smoothed Standardized Mortality Ratios (sSMR) by each census tract and period. The geographical distribution of these sSMR was represented using maps of septiles. In addition, two different Bayesian hierarchical models were used to measure the association between all-cause mortality and the deprivation index in each city and period, and by sex: (1) including the association as a fixed effect for each city; (2) including the association as random effects. In both models the data spatial structure can be controlled within each city. The association in each city was measured using relative risks (RR) and their 95 % credible intervals (95 % CI).
Results: For most cities and in both sexes, mortality rates decline over time. For women, the mortality and deprivation patterns are similar in the first period, while in the second they are different for most cities. For men, RRs remain stable over time in 29 cities, in 3 diminish and in 1 increase. For women, in 30 cities, a non-significant change over time in RR is observed. However, in 4 cities RR diminishes. In overall terms, inequalities decrease (with a probability of 0.9) in both men (RR = 1.13, 95 % CI = 1.12-1.15 in the 1st period; RR = 1.11, 95 % CI = 1.09-1.13 in the 2nd period) and women (RR = 1.07, 95 % CI = 1.05-1.08 in the 1st period; RR = 1.04, 95 % CI = 1.02-1.06 in the 2nd period).
Conclusions: In the future, it is important to conduct further trend studies, allowing to monitoring trends in socioeconomic inequalities in mortality and to identify (among other things) temporal factors that may influence these inequalities.
Filiaciones:
Mari-Dell'Olmo, M:
CIBERESP, Madrid, Spain
Agencia Salut Publ Barcelona, Pl Lesseps 1, Barcelona 08023, Spain
Inst Invest Biomed IIB St Pau, Barcelona, Spain
Univ Rovira & Virgili, Tarragona, Spain
Gotsens, M:
CIBERESP, Madrid, Spain
Agencia Salut Publ Barcelona, Pl Lesseps 1, Barcelona 08023, Spain
Inst Invest Biomed IIB St Pau, Barcelona, Spain
Palencia, L:
CIBERESP, Madrid, Spain
Agencia Salut Publ Barcelona, Pl Lesseps 1, Barcelona 08023, Spain
Inst Invest Biomed IIB St Pau, Barcelona, Spain
Rodriguez-Sanz, M:
CIBERESP, Madrid, Spain
Agencia Salut Publ Barcelona, Pl Lesseps 1, Barcelona 08023, Spain
Inst Invest Biomed IIB St Pau, Barcelona, Spain
Martinez-Beneito, MA:
CIBERESP, Madrid, Spain
Fdn Fomento Invest Sanitaria & Biomed Comunida Va, Valencia, Spain
Ballesta, M:
CIBERESP, Madrid, Spain
IMIB Arrixaca, Murcia Reg Hlth Council, Dept Epidemiol, Murcia, Spain
Calvo, M:
Gobierno Vasco, Dept Sanidad & Consumo, Estudios & Invest Sanitaria, Vitoria, Spain
Cirera, L:
CIBERESP, Madrid, Spain
IMIB Arrixaca, Murcia Reg Hlth Council, Dept Epidemiol, Murcia, Spain
Daponte, A:
CIBERESP, Madrid, Spain
EASP, Observ Salud & Medio Ambiente Andalucia OSMAN, Granada, Spain
Dominguez-Berjon, F:
Consejeria Sanidad, Subdirecc Promoc Salud & Prevenc, Comunidad De Madrid, Spain
Gandarillas, A:
Consejeria Sanidad, Subdirecc Promoc Salud & Prevenc, Comunidad De Madrid, Spain
Goni, NI:
Consejeria Salud & Serv Sociales, Registro Mortalidad, La Rioja, Spain
Martos, C:
Inst Aragones Ciencias Salud, Zaragoza, Spain
Moreno-Iribas, C:
Gobierno Navarra, Dept Salud, Inst Salud Publ Navarra, Pamplona, Navarra, Spain
Nolasco, A:
Univ Alicante, Unidad Invest Anal Mortalidad & Estadast Sanitari, San Vicente Del Raspeig, Spain
Salmeron, D:
CIBERESP, Madrid, Spain
IMIB Arrixaca, Murcia Reg Hlth Council, Dept Epidemiol, Murcia, Spain
Taracido, M:
CIBERESP, Madrid, Spain
Univ Santiago de Compostela, Dept Med Prevent & Salud Publ, Santiago De Compostela, Spain
Borrell, C:
CIBERESP, Madrid, Spain
Agencia Salut Publ Barcelona, Pl Lesseps 1, Barcelona 08023, Spain
Inst Invest Biomed IIB St Pau, Barcelona, Spain
Univ Pompeu Fabra, Barcelona, Spain
Gold, Green Published
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