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Luque-Fernandez MA, Thomas A, Gelaye B, Racape J, Sanchez MJ, Williams MA. Secular trends in stillbirth by maternal socioeconomic status in Spain 2007-15: a population-based study of 4 million births. Eur J Public Health 2020; 29:1043-1048. [PMID: 31121034 PMCID: PMC6896972 DOI: 10.1093/eurpub/ckz086] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Introduction Stillbirth, one of the urgent concerns of preventable perinatal deaths, has wide-reaching consequences for society. We studied secular stillbirth trends by maternal socioeconomic status (SES) in Spain. Methods We developed a population-based observational study, including 4 083 919 births during 2007–15. We estimate stillbirth rates and secular trends by maternal SES. We also evaluated the joint effect of maternal educational attainment and the Human Development Index (HDI) of women’s country of origin on the risk of stillbirth. The data and statistical analysis can be accessed for reproducibility in a GitHub repository: https://github.com/migariane/Stillbirth Results We found a consistent pattern of socioeconomic inequalities in the risk of delivering a stillborn, mainly characterized by a persistently higher risk, over time, among women with lower SES. Overall, women from countries with low HDIs and low educational attainments had approximately a four times higher risk of stillbirth (RR: 4.44; 95%CI: 3.71–5.32). Furthermore, we found a paradoxical reduction of the stillbirth gap over time between the highest and the lowest SESs, which is mostly due to the significant and increasing trend of stillbirth risk among highly educated women of advanced maternal age. Conclusion Our findings highlight no improvement in stillbirth rates among women of lower SES and an increasing trend among highly educated women of advanced maternal age over recent years. Public health policies developing preventive programmes to reduce stillbirth rates among women with lower SES are needed as well as the necessity of further study to understand the growing trend of age-related stillbirths among highly educated women in Spain.
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Affiliation(s)
- Miguel Angel Luque-Fernandez
- Andalusian School of Public Health, Biomedical Research Institute of Granada, University of Granada, Granada, Spain.,Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Public Health School, Centre de Recherche Épidémiologie, Biostatistique et Recherche Clinique, Université Libre de Bruxelles, Brussels, Belgium.,Biomedical Research Networking Centres of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Aurielle Thomas
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Bizu Gelaye
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Judith Racape
- Public Health School, Centre de Recherche Épidémiologie, Biostatistique et Recherche Clinique, Université Libre de Bruxelles, Brussels, Belgium
| | - Maria Jose Sanchez
- Andalusian School of Public Health, Biomedical Research Institute of Granada, University of Granada, Granada, Spain.,Biomedical Research Networking Centres of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Michelle A Williams
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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2
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Gotsens M, Ferrando J, Marí-Dell’Olmo M, Palència L, Bartoll X, Gandarillas A, Sanchez-Villegas P, Esnaola S, Daponte A, Borrell C. Effect of the Financial Crisis on Socioeconomic Inequalities in Mortality in Small Areas in Seven Spanish Cities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030958. [PMID: 32033162 PMCID: PMC7037194 DOI: 10.3390/ijerph17030958] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/23/2020] [Accepted: 01/30/2020] [Indexed: 01/08/2023]
Abstract
Background: The aim of this study was to analyze the trend in socioeconomic inequalities in mortality in small areas due to several specific causes before (2001–2004, 2005–2008) and during (2009–2012) the economic crisis in seven Spanish cities. Methods: This ecological study of trends, with census tracts as the areas of analysis, was based on three periods. Several causes of death were studied. A socioeconomic deprivation index was calculated for each census tract. For each small area, we estimated standardized mortality ratios, and controlled for their variability using Bayesian models (sSMR). We also estimated the relative risk of mortality according to deprivation in the different cities, periods, and sexes. Results: In general, a similar geographical pattern was found for the socioeconomic deprivation index and sSMR. For men, there was an association in all cities between the deprivation index and all-cause mortality that remained stable over the three periods. For women, there was an association in Barcelona, Granada, and Sevilla between the deprivation index and all-cause mortality in the third period. Patterns by causes of death were more heterogeneous. Conclusions: After the start of the financial crisis, socioeconomic inequalities in total mortality in small areas of Spanish cities remained stable in most cities, although several causes of death showed a different pattern.
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Affiliation(s)
- Mercè Gotsens
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain
- Institut d’Investigació Biomèdica (IIB Sant Pau), 08041 Barcelona, Spain
| | - Josep Ferrando
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain
| | - Marc Marí-Dell’Olmo
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain
- Institut d’Investigació Biomèdica (IIB Sant Pau), 08041 Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Laia Palència
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain
- Institut d’Investigació Biomèdica (IIB Sant Pau), 08041 Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Xavier Bartoll
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain
- Institut d’Investigació Biomèdica (IIB Sant Pau), 08041 Barcelona, Spain
| | - Ana Gandarillas
- Dirección General de Salud Pública, Consejería de Sanidad, Comunidad de Madrid, 28035 Madrid, Spain
| | - Pablo Sanchez-Villegas
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Observatorio de Salud y Medio Ambiente de Andalucía, Escuela Andaluza de Salud Pública, 18080 Granada, Spain
| | - Santi Esnaola
- Department of Health of the Basque Country, 01006 Vitoria-Gasteiz, Spain
| | - Antonio Daponte
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Observatorio de Salud y Medio Ambiente de Andalucía, Escuela Andaluza de Salud Pública, 18080 Granada, Spain
| | - Carme Borrell
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain
- Institut d’Investigació Biomèdica (IIB Sant Pau), 08041 Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, 08002 Barcelona, Spain
- Correspondence:
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3
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León-Gómez BB, Gotsens M, Marí-Dell'Olmo M, Domínguez-Berjón MF, Luque-Fernandez MÁ, Martin U, Rodríguez-Sanz M, Pérez G. Bayesian smoothed small-areas analysis of urban inequalities in fertility across 1999-2013. FERTILITY RESEARCH AND PRACTICE 2020; 5:17. [PMID: 31890237 PMCID: PMC6925428 DOI: 10.1186/s40738-019-0066-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 11/08/2019] [Indexed: 11/23/2022]
Abstract
Background Since the 2008 economic crisis in Spain, overall fertility has continued to decrease, while urban inequalities have increased. There is a general lack of studies of fertility patterns in small-areas of Spanish cities. We explored the effects of the economic crisis on fertility during three time periods in urban settings in Spain. Methods We studied the distribution of fertility rates among women (15–49 years) from Spain and low-middle income countries (LIC) who were living in 13 Spanish cities. We mapped fertility and the MEDEA socioeconomic deprivation index in small-areas, and analyzed age-related trends in fertility rates. We performed an ecological regression analysis of fertility and the deprivation index in two pre-crisis periods (1999–2003 and 2004–2008) and one crisis period (2009–2013). Fertility rates were calculated and smoothed using the hierarchical Bayesian model (BYM). Results Higher fertility was generally associated with socioeconomic deprivation, with adjustment for the mothers’ age and nationality. While Spanish citizens tended to delay childbearing throughout the three study periods, fertility increased among Spanish adolescents from deprived urban areas during the economic crisis. There was a general decline in fertility among immigrants after the crisis, especially in southern cities. Overall, fertility appeared to be stable, with higher fertility in more deprived areas. Conclusion Increased unemployment and changes to government family policies may have contributed to delayed childbearing in Spain. For immigrants, more restrictive immigration policies may have played a crucial role in decreasing fertility rates. Reforming such policies will be key for better reproductive rights and improved fertility rates across all population cohorts in Spain.
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Affiliation(s)
- Brenda Biaani León-Gómez
- 1Sistemes d'Informació Sanitària, Agència de Salut Pública de Barcelona, Barcelona, Spain.,2Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Mercè Gotsens
- 1Sistemes d'Informació Sanitària, Agència de Salut Pública de Barcelona, Barcelona, Spain.,3Institut de Recerca Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,4Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Marc Marí-Dell'Olmo
- 5Qualitat i Intervenció Ambiental, Agència de Salut Pública de Barcelona, Barcelona, Spain
| | | | - Miguel Ángel Luque-Fernandez
- 7Faculty of Epidemiology and Population Health, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Unai Martin
- 8Departamento de Sociología 2, Universidad del País Vasco UPV/EHU, Leoia, Bizkaia Spain
| | - Maica Rodríguez-Sanz
- 9Recerca, Docència i Comunicació, Agència de Salut Pública de Barcelona, Barcelona, Spain
| | - Gloria Pérez
- 1Sistemes d'Informació Sanitària, Agència de Salut Pública de Barcelona, Barcelona, Spain.,2Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain.,3Institut de Recerca Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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Perez G, Gotsens M, Cevallos-García C, Felicitas Domínguez-Berjón M, Díez E, Bacigalupe A, Palència L, León-Gómez BB, Luque-Fernández MA, Marí-DelĺOlmo M, Martin U, Puig-Barrachina V, Rodríguez-Sanz M, Ruiz M. The impact of the economic recession on inequalities in induced abortion in the main cities of Spain. Eur J Public Health 2018; 29:279-281. [DOI: 10.1093/eurpub/cky250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Gloria Perez
- Agència de Salut Pública de Barcelona, Barcelona, Spain
- Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
- CIBER de Epidemiología y Salud Pública, Madrid, Spain
- Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, Barcelona, Spain
| | - Mercè Gotsens
- Agència de Salut Pública de Barcelona, Barcelona, Spain
- Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
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Ferrando J, Palència L, Gotsens M, Puig-Barrachina V, Marí-Dell'Olmo M, Rodríguez-Sanz M, Bartoll X, Borrell C. Trends in cancer mortality in Spain: the influence of the financial crisis. GACETA SANITARIA 2018; 33:229-234. [PMID: 29452751 DOI: 10.1016/j.gaceta.2017.11.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 11/07/2017] [Accepted: 11/08/2017] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To determine if the onset of the economic crisis in Spain affected cancer mortality and mortality trends. METHOD We conducted a longitudinal ecological study based on all cancer-related deaths and on specific types of cancer (lung, colon, breast and prostate) in Spain between 2000 and 2013. We computed age-standardised mortality rates in men and women, and fit mixed Poisson models to analyse the effect of the crisis on cancer mortality and trends therein. RESULTS After the onset of the economic crisis, cancer mortality continued to decline, but with a significant slowing of the yearly rate of decline (men: RR = 0.987, 95%CI = 0.985-0.990, before the crisis, and RR = 0.993, 95%CI = 0.991-0.996, afterwards; women: RR = 0.990, 95%CI = 0.988-0.993, before, and RR = 1.002, 95%CI = 0.998-1.006, afterwards). In men, lung cancer mortality was reduced, continuing the trend observed in the pre-crisis period; the trend in colon cancer mortality did not change significantly and continued to increase; and the yearly decline in prostate cancer mortality slowed significantly. In women, lung cancer mortality continued to increase each year, as before the crisis; colon cancer continued to decease; and the previous yearly downward trend in breast cancer mortality slowed down following the onset of the crisis. CONCLUSIONS Since the onset of the economic crisis in Spain the rate of decline in cancer mortality has slowed significantly, and this situation could be exacerbated by the current austerity measures in healthcare.
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Affiliation(s)
| | - Laia Palència
- Agència de Salut Pública de Barcelona, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Institut d'Investigació Biomèdica IIB Sant Pau, Barcelona, Spain
| | - Mercè Gotsens
- Agència de Salut Pública de Barcelona, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Institut d'Investigació Biomèdica IIB Sant Pau, Barcelona, Spain.
| | | | - Marc Marí-Dell'Olmo
- Agència de Salut Pública de Barcelona, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Institut d'Investigació Biomèdica IIB Sant Pau, Barcelona, Spain
| | - Maica Rodríguez-Sanz
- Agència de Salut Pública de Barcelona, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Institut d'Investigació Biomèdica IIB Sant Pau, Barcelona, Spain; Departamento de Ciencias Experimentales y de la Salud, Facultad de Ciencias de la Salud y de la Vida, Universitat Pompeu Fabra, Barcelona, Spain
| | - Xavier Bartoll
- Agència de Salut Pública de Barcelona, Barcelona, Spain; Institut d'Investigació Biomèdica IIB Sant Pau, Barcelona, Spain
| | - Carme Borrell
- Agència de Salut Pública de Barcelona, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Institut d'Investigació Biomèdica IIB Sant Pau, Barcelona, Spain; Departamento de Ciencias Experimentales y de la Salud, Facultad de Ciencias de la Salud y de la Vida, Universitat Pompeu Fabra, Barcelona, Spain
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6
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Borrell C, Marí-Dell'Olmo M, Gotsens M, Calvo M, Rodríguez-Sanz M, Bartoll X, Esnaola S. Socioeconomic inequalities in suicide mortality before and after the economic recession in Spain. BMC Public Health 2017; 17:772. [PMID: 28978310 PMCID: PMC5628455 DOI: 10.1186/s12889-017-4777-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 09/20/2017] [Indexed: 11/13/2022] Open
Abstract
Background An increase in suicide mortality is often observed in economic recessions. The objective of this study was to analyse trends in socioeconomic inequalities in suicide mortality before and during the economic recession in two geographical settings in Spain. Methods This study analyses inequalities in mortality according to educational level during 3 different time periods based on individual data from the Basque Country and Barcelona city. We analysed suicide mortality data for all residents over 25 years of age from 2001 to 2012. Two periods before the crisis (2001–2004 and 2005–2008) and another during the crisis (2009–2012) were studied. We performed independent analyses for sex, age group, and for the two geographical settings. We fit Poisson regression models to study the relationship between educational level and mortality, and calculated the relative index of inequality (RII) and the slope index of inequality (SII) as comparative measures. Results For men in the Basque Country, all RII values for the three time periods were similar and almost all were greater than 2; in Barcelona the RII values were generally lower. The SII values for Barcelona tended to decrease over time, whereas in the Basque Country they showed a U-shaped pattern. Among women aged 25–44 years we found an association between educational level and suicide mortality during the first time period; however, we found no clear association for other age groups or time periods. Conclusion This study within two geographical settings in Spain shows that trends in inequalities in suicide mortality according to educational level remained stable among men before and during the economic recession.
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Affiliation(s)
- Carme Borrell
- Agència de Salut Pública de Barcelona, Plaça Lesseps 1, 08023, Barcelona, Spain. .,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain. .,Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain. .,Universitat Pompeu Fabra, Barcelona, Spain.
| | - Marc Marí-Dell'Olmo
- Agència de Salut Pública de Barcelona, Plaça Lesseps 1, 08023, Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain.,Universitat Pompeu Fabra, Barcelona, Spain
| | - Mercè Gotsens
- Agència de Salut Pública de Barcelona, Plaça Lesseps 1, 08023, Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
| | - Montse Calvo
- Department of Health of the Basque Country, Vitoria-Gasteiz, Spain
| | - Maica Rodríguez-Sanz
- Agència de Salut Pública de Barcelona, Plaça Lesseps 1, 08023, Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain.,Universitat Pompeu Fabra, Barcelona, Spain
| | - Xavier Bartoll
- Agència de Salut Pública de Barcelona, Plaça Lesseps 1, 08023, Barcelona, Spain.,Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
| | - Santiago Esnaola
- Department of Health of the Basque Country, Vitoria-Gasteiz, Spain
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