1
|
Novoa AM, Pérez G, Espelt A, Echave C, de Olalla PG, Calvo MJ, Pasarín M, Diez È, Borrell C, Calvo MJ, Cormenzana B, Cortés I, Diez È, Echave C, Espelt A, de Olalla PG, Gòmez J, Novoa AM, Pallarès M, Pérez G, Rodríguez-Sanz M. The Experience of Implementing Urban HEART Barcelona: a Tool for Action. J Urban Health 2018; 95:647-661. [PMID: 29039133 PMCID: PMC6181815 DOI: 10.1007/s11524-017-0194-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Urban Health Equity Assessment and Response Tool (HEART) is a tool developed by the World Health Organization whose objective is to provide evidence on urban health inequalities so as to help to decide the best interventions aimed to promote urban health equity. The aim of this paper is to describe the experience of implementing Urban HEART in Barcelona city, both the adaptation of Urban HEART to the city of Barcelona, its use as a means of identifying and monitoring health inequalities among city neighbourhoods, and the difficulties and barriers encountered throughout the process. Although ASPB public health technicians participated in the Urban HEART Advisory Group, had large experience in health inequalities analysis and research and showed interest in implementing the tool, it was not until 2015, when the city council was governed by a new left-wing party for which reducing health inequalities was a priority that Urban HEART could be used. A provisional matrix was developed, including both health and health determinant indicators, which allowed to show how some neighbourhoods in the city systematically fare worse for most of the indicators while others systematically fare better. It also allowed to identify 18 neighbourhoods-those which fared worse in most indicators-which were considered a priority for intervention, which entered the Health in the Barcelona Neighbourhoods programme and the Neighbourhoods Plan. This provisional version was reviewed and improved by the Urban HEART Barcelona Working Group. Technicians with experience in public health and/or in indicator and database management were asked to indicate suitability and relevance from a list of potential indicators. The definitive Urban HEART Barcelona version included 15 indicators from the five Urban HEART domains and improved the previous version in several requirements. Several barriers were encountered, such as having to estimate indicators in scarcely populated areas or finding adequate indicators for the physical context domain. In conclusion, the Urban HEART tool allowed to identify urban inequalities in the city of Barcelona and to include health inequalities in the public debate. It also allowed to reinforce the community health programme Health in the Barcelona Neighbourhoods as well as other city programmes aimed at reducing health inequalities. A strong political will is essential to place health inequalities in the political agenda and implement policies to tackle them.
Collapse
Affiliation(s)
- Ana M Novoa
- Agència de Salut Pública de Barcelona, Pl. Lesseps, 1, 08023, Barcelona, Spain. .,Institut d'Investigació Biomèdica (IIB Sant Pau), Pl. Lesseps, 1, 08023, Barcelona, Spain.
| | - Glòria Pérez
- Agència de Salut Pública de Barcelona, Pl. Lesseps, 1, 08023, Barcelona, Spain.,Institut d'Investigació Biomèdica (IIB Sant Pau), Pl. Lesseps, 1, 08023, Barcelona, Spain.,Universitat Pompeu Fabra, Barcelona, Spain.,CIBER de Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain
| | - Albert Espelt
- Agència de Salut Pública de Barcelona, Pl. Lesseps, 1, 08023, Barcelona, Spain.,Institut d'Investigació Biomèdica (IIB Sant Pau), Pl. Lesseps, 1, 08023, Barcelona, Spain.,CIBER de Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain.,Facultat de Ciències de la Salut de Manresa, Universitat de Vic Universitat Central de Catalunya (UVicUCC), Av. Universitària, 46, Manresa, 08242, Spain
| | | | - Patricia G de Olalla
- Agència de Salut Pública de Barcelona, Pl. Lesseps, 1, 08023, Barcelona, Spain.,Institut d'Investigació Biomèdica (IIB Sant Pau), Pl. Lesseps, 1, 08023, Barcelona, Spain
| | - M Jesús Calvo
- Gabinet Tècnic de Programació, Ajuntament de Barcelona, Barcelona, Spain
| | - Maribel Pasarín
- Agència de Salut Pública de Barcelona, Pl. Lesseps, 1, 08023, Barcelona, Spain.,Institut d'Investigació Biomèdica (IIB Sant Pau), Pl. Lesseps, 1, 08023, Barcelona, Spain
| | - Èlia Diez
- Agència de Salut Pública de Barcelona, Pl. Lesseps, 1, 08023, Barcelona, Spain.,Institut d'Investigació Biomèdica (IIB Sant Pau), Pl. Lesseps, 1, 08023, Barcelona, Spain
| | - Carme Borrell
- Agència de Salut Pública de Barcelona, Pl. Lesseps, 1, 08023, Barcelona, Spain.,Institut d'Investigació Biomèdica (IIB Sant Pau), Pl. Lesseps, 1, 08023, Barcelona, Spain.,Universitat Pompeu Fabra, Barcelona, Spain.,CIBER de Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
2
|
Origer A, Le Bihan E, Baumann M. A social gradient in fatal opioids and cocaine related overdoses? PLoS One 2015; 10:e0125568. [PMID: 25938451 PMCID: PMC4418844 DOI: 10.1371/journal.pone.0125568] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 03/25/2015] [Indexed: 11/28/2022] Open
Abstract
Background To determine the existence of a social gradient in fatal overdose cases related to non-prescribed opioids and cocaine use, recorded in Luxembourg between 1994 and 2011. Methods Overdose cases were individually matched with four controls in a nested case-control study design, according to sex, year of birth, drug administration route and duration of drug use. The study sample, composed of 272 cases and 1,056 controls, was stratified according to a Social Inequality Accumulation Score (SIAS), based on educational attainment, employment, income, financial situation of subjects and the professional status of their father or legal guardian. Least squares linear regression analysis on overdose mortality rates and ridit scores were applied to determine the Relative Index of Inequality (RII) of the study sample. Results A negative linear relationship between the overdose mortality rate and the relative socioeconomic position was observed. We found a difference in mortality of 29.22 overdose deaths per 100 drug users in the lowest socioeconomic group compared to the most advantaged group. In terms of the Relative Inequality Index, the overdose mortality rate of opioid and cocaine users with lowest socioeconomic profiles was 9.88 times as high as that of their peers from the highest socioeconomic group (95% CI 6.49–13.26). Conclusions Our findings suggest the existence of a marked social gradient in opioids and cocaine related overdose fatalities. Harm reduction services should integrate socially supportive offers, not only because of their general aim of social (re)integration but crucially in order to meet their most important objective, that is to reduce drug-related mortality.
Collapse
Affiliation(s)
- Alain Origer
- Drug Coordination Office, Ministry of Health, Luxembourg, Luxembourg; Research Unit INSIDE, Institute Health & Behaviour, University of Luxembourg, Walferdange, Luxembourg
| | - Etienne Le Bihan
- Research Unit INSIDE, Institute Health & Behaviour, University of Luxembourg, Walferdange, Luxembourg
| | - Michèle Baumann
- Research Unit INSIDE, Institute Health & Behaviour, University of Luxembourg, Walferdange, Luxembourg
| |
Collapse
|
3
|
Rodríguez-Fonseca M, Palència L, Marí-Dell'Olmo M, Gandarillas A, Domínguez-Berjón M, Gotsens M, Rodríguez-Sanz M, Borrell C. Evolution of socio-economic inequalities in mortality in small geographical areas of the two largest cities in Spain (Barcelona and Madrid), 1996–2007. Public Health 2013; 127:916-21. [DOI: 10.1016/j.puhe.2013.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Revised: 05/22/2013] [Accepted: 07/01/2013] [Indexed: 11/28/2022]
|
4
|
Álvarez JL, Kunst AE, Leinsalu M, Bopp M, Strand BH, Menvielle G, Lundberg O, Martikainen P, Deboosere P, Kalediene R, Artnik B, Mackenbach JP, Richardus JH. Educational inequalities in tuberculosis mortality in sixteen European populations. Int J Tuberc Lung Dis 2012; 15:1461-7, i. [PMID: 22008757 DOI: 10.5588/ijtld.10.0252] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To describe the magnitude of socioeconomic inequalities in tuberculosis (TB) mortality by level of education in male, female, urban and rural populations in several European countries. DESIGN Data were obtained from the Eurothine Project, covering 16 populations between 1990 and 2003. Age- and sex-standardised mortality rates, the relative index of inequality and the slope index of inequality were used to assess educational inequalities. RESULTS The number of TB deaths reported was 8530, with a death rate of 3 per 100 000 per year, of which 73% were males. Educational inequalities in TB mortality were present in all European populations. Inequalities in TB mortality were greater than in total mortality. Relative and absolute inequalities were large in Eastern European and Baltic countries but relatively small in Southern European countries and in Norway, Finland and Sweden. Inequalities in mortality were observed among both men and women, and in both rural and urban populations. CONCLUSIONS Socio-economic inequalities in TB mortality exist in all European countries. Firm political commitment is required to reduce inequalities in the social determinants of TB incidence. Targeted public health measures are called for to improve access to treatment of vulnerable groups and thereby reduce TB mortality.
Collapse
Affiliation(s)
- J L Álvarez
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Gotsens M, Marí-Dell'Olmo M, Martínez-Beneito MÁ, Pérez K, Pasarín MI, Daponte A, Puigpinós-Riera R, Rodríguez-Sanz M, Audicana C, Nolasco A, Gandarillas A, Serral G, Domínguez-Berjón F, Martos C, Borrell C. Socio-economic inequalities in mortality due to injuries in small areas of ten cities in Spain (MEDEA Project). ACCIDENT; ANALYSIS AND PREVENTION 2011; 43:1802-1810. [PMID: 21658508 DOI: 10.1016/j.aap.2011.04.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Revised: 04/08/2011] [Accepted: 04/10/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVES To analyse socio-economic inequalities in mortality due to injuries among census tracts of ten Spanish cities by sex and age in the period 1996-2003. METHODS This is a cross-sectional ecological study where the units of analysis are census tracts. The study population consisted of people residing in the cities during the period 1996-2003. For each census tract we obtained an index of socio-economic deprivation, and estimated standardized mortality ratios using hierarchical Bayesian models which take into account the spatial structure of the data. RESULTS In the majority of the cities, the geographical pattern of total mortality from injuries is similar to that of the socio-economic deprivation index. There is an association between mortality due to injuries and the deprivation index in the majority of the cities which is more important among men and among those younger than 45 years. In these groups, traffic injuries and overdoses are the causes most often associated with deprivation in the cities. The percentage of excess mortality from injuries related to socio-economic deprivation is higher than 20% in the majority of the cities, the cause with the highest percentage being drug overdose. CONCLUSIONS In most cities, there are socio-economic inequalities in mortality due to overdose and traffic injuries. In contrast, few cities have found association between suicide mortality and deprivation. Finally, no association was found between deprivation and deaths due to falls. Inequalities are higher in men and those under 45 years of age. These results highlight the importance of intra-urban inequalities in mortality due to injuries.
Collapse
|
6
|
Dalmau-Bueno A, García-Altés A, Marí-Dell’Olmo M, Pérez K, Kunst AE, Borrell C. Veintidós años de evolución de las desigualdades socioeconómicas en la mortalidad en la ciudad de Barcelona. GACETA SANITARIA 2010; 24:20-7. [DOI: 10.1016/j.gaceta.2009.05.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2009] [Revised: 05/20/2009] [Accepted: 06/02/2009] [Indexed: 11/25/2022]
|
7
|
Socioeconomic inequalities in mortality in Barcelona: A study based on census tracts (MEDEA Project). Health Place 2009; 15:186-92. [DOI: 10.1016/j.healthplace.2008.04.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2007] [Revised: 03/14/2008] [Accepted: 04/01/2008] [Indexed: 11/20/2022]
|
8
|
Nolasco A, Melchor I, Pina JA, Pereyra-Zamora P, Moncho J, Tamayo N, García-Senchermes C, Zurriaga O, Martínez-Beneito MA. Preventable avoidable mortality: evolution of socioeconomic inequalities in urban areas in Spain, 1996-2003. Health Place 2008; 15:702-11. [PMID: 19201247 DOI: 10.1016/j.healthplace.2008.12.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2008] [Revised: 11/26/2008] [Accepted: 12/09/2008] [Indexed: 11/16/2022]
Abstract
This study describes the inequalities in preventable avoidable mortality in relation to socioeconomic levels and analyses their evolution during the period 1996-2003 in the cities of Alicante, Castellon and Valencia. Four causes of preventable avoidable mortality were analysed according to sex: malignant tumour of the trachea, bronchus and lung, cirrhosis and other chronic diseases of the liver, motor vehicle accidents and AIDS, which had caused the death of non-institutionalised residents in the three cities during the period 1996-2003. The different census tracts were grouped into three socioeconomic levels. In general, socioeconomic inequalities in preventable avoidable mortality remain constant in time, except the ones caused by AIDS in Valencia, where they increase for men. Some census tracts in the three cities where the study was carried out were found to have significantly higher preventable mortality rates, and therefore require intervention.
Collapse
Affiliation(s)
- Andreu Nolasco
- Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia, Universidad de Alicante, Apartado 99, 03080-Alicante, Spain.
| | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Antònia Barceló M, Saez M, Cano-Serral G, Ángel Martínez-Beneito M, Miguel Martínez J, Borrell C, Ocaña-Riola R, Montoya I, Calvo M, López-Abente G, Rodríguez-Sanz M, Toro S, Tomás Alcalá J, Saurina C, Sánchez-Villegas P, Figueiras A. Métodos para la suavización de indicadores de mortalidad: aplicación al análisis de desigualdades en mortalidad en ciudades del Estado español (Proyecto MEDEA). GACETA SANITARIA 2008; 22:596-608. [DOI: 10.1016/s0213-9111(08)75362-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
10
|
Grau M, García-Altés A, Pasarín MI, Arribas P, Borrell C, Brugal T. [Utility of an information system for primary care]. Aten Primaria 2008; 40:167-73. [PMID: 18405580 DOI: 10.1157/13118058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To know the usefulness and applicability of an information system for basic health areas put into operation 16 years ago. DESIGN Descriptive study of selected indicators registered in 1994 and 2004. SETTING Basic health areas of Barcelona, Spain. PARTICIPANTS Population living in Barcelona, Spain, during 1994 and 2004. MEASUREMENTS The following indicators were described, and standardized taking the Barcelona 2004 population as reference: proportion of foreign population, proportion of unemployment, number of mothers less than 20 years old, AIDS incidence rate, tuberculosis incidence rate, and traffic accident, ischaemic disease, lung cancer (for men), breast cancer (for women), and total mortality rates. Results were presented for one basic health area, its corresponding district, and Barcelona. Moreover, users of the information system were interviewed about their level of knowledge, and the adequacy, usefulness, and limitations of the system. RESULTS Disaggregated annual information allows comparing indicators between different fields and years. The information system was found useful to users to describe the level of health of the community and to design preventive interventions. CONCLUSIONS Although some of the indicators did not show the desired level of accuracy, the information system for basic health areas showed to be useful to know the level of health of the population assigned to primary healthcare teams.
Collapse
Affiliation(s)
- María Grau
- Servei de Sistemes d'Informació Sanitària, Agència de Salut Pública de Barcelona, Barcelona, España
| | | | | | | | | | | |
Collapse
|
11
|
Marí-Dell'Olmo M, Rodríguez-Sanz M, Garcia-Olalla P, Pasarín MI, Brugal MT, Caylà JA, Borrell C. Individual and community-level effects in the socioeconomic inequalities of AIDS-related mortality in an urban area of southern Europe. J Epidemiol Community Health 2007; 61:232-40. [PMID: 17325402 PMCID: PMC2652926 DOI: 10.1136/jech.2006.048017] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To study socioeconomic inequalities in AIDS mortality in Barcelona, Spain, during the periods 1991-6 (before highly active antiretroviral therapy (HAART)) and 1997-2001 (post-HAART) taking into account individual as well as community effects of socioeconomic level. DESIGN Cross-sectional design. SETTING Barcelona, Spain. PARTICIPANTS All residents aged > or =20 years. All AIDS-related deaths occurring between 1991 and 2001 were studied. The individual variables analysed were age, sex, educational level, neighbourhood of residence and HIV transmission group. Male unemployment was used as the community-level indicator of neighbourhood deprivation. Multilevel Poisson regression models were fitted to estimate the relationship between AIDS mortality and the individual- and community-level variables. RESULTS At the individual level, AIDS mortality relative risks (RR) were higher among intravenous drug users (IDUs) with lower educational level in both periods. For the younger population, the RR of AIDS-related mortality associated with having little education compared with having a primary education or more was 4.7 (95% CI 3.6 to 6.1) in men and 5.2 (95%CI 3.6 to 7.7) in women in the pre-HAART period, and 4.7 (95% CI 2.7 to 8.1) in men and 4.5 (95% CI 1.4 to 14.1) in women in the post-HAART period. At the community level, an area effect in AIDS mortality was found, which was more important in neighbourhoods having high deprivation in both periods, although the effect was most important in the post-HAART period. CONCLUSIONS This study has shown inequalities in AIDS mortality in terms of both individual variables and a community-level variable in the pre-HAART as well as in the post-HAART period. These socioeconomic inequalities of AIDS mortality must be considered when prevention and treatment strategies are implemented.
Collapse
Affiliation(s)
- Marc Marí-Dell'Olmo
- Agència de Salut Pública de Barcelona, Plaça Lesseps 1, 08023 Barcelona, Spain
| | | | | | | | | | | | | |
Collapse
|
12
|
Magán Tapia P, Alberquilla Menéndez-Asenjo A, Ribera Casado JM, Otero Puime A. [Differences in mortality in the over-65s in a health area of the community of Madrid]. Aten Primaria 2006; 38:443-9. [PMID: 17194369 PMCID: PMC7668898 DOI: 10.1157/13094801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2005] [Accepted: 02/20/2006] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To detect the possible differences in risk of mortality of the population aged 65 and over in Health Area 11 of the Community of Madrid and to explore their relationship with economic factors. DESIGN Observational, retrospective, and ecological-style study. SETTING Districts and boroughs in Health Area 11 of the Community of Madrid, Spain. PARTICIPANTS People aged 65 and over. MAIN MEASUREMENTS The analysed variable was the total deaths occurring in the study population during the period 1996-2001. The standardized mortality rate (SMR) was calculated. As a social/economic indicator, mean available income, stratified in 3 groups, was used. The statistical method used was Poisson regression. RESULTS The mortality rates oscillated between 37.33 and 91.54 deaths for every thousand inhabitants (SMR ratio, 2.47). In urban areas, in men with level 2 income, mortality was 16% less (P=.0406) than the reference group, whereas in high-income men it was 20% less (P=.0042). In women the rate was about 8% less, though this did not attain statistical significance (P=.3039). The relationship in semi-rural areas was not demonstrated. CONCLUSIONS The existence of inequalities in the mortality of the population aged 65 or over was demonstrated. There was an inverse relationship between mean available income and mortality in urban areas.
Collapse
Affiliation(s)
- Puri Magán Tapia
- Cátedra de Familia UAM/Novartis. Facultad de Medicina de la UAM. Madrid. España.
| | | | | | | |
Collapse
|
13
|
Esnaola S, Aldasoro E, Ruiz R, Audicana C, Pérez Y, Calvo M. [Socioeconomic inequalities in mortality in the Basque Country [Spain]]. GACETA SANITARIA 2006; 20:16-24. [PMID: 16539989 DOI: 10.1157/13084123] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To describe socioeconomic inequalities in mortality in the Basque Country, using mortality and socioeconomic data by census sections. METHODS Mortality and population data were obtained from the Basque Institute of Statistics. Socioeconomic characteristics of the census sections were assigned to each death and a deprivation index combining information from four socioeconomic indicators was computed. Age-adjusted mortality rates by sex, age group (0-64 > or = 65) and cause of death were calculated for each quintile of the deprivation index. Poisson regression models were fitted to estimate age-adjusted rate ratios and excess mortality attributable to inequalities. RESULTS Mortality showed a gradient according to the deprivation index in men and women. Mortality was greater in the most deprived sections. Mortality inequalities were observed in men younger than 65 years. A total of 9.3% of deaths in men and 4.9% of those in women were attributable to socioeconomic inequalities. The relative importance of the cause of death differed according to the inequality measure used. Lifestyle-related causes of death were notable. CONCLUSION This study illustrates the potential utility of census section socioeconomic indicators both to describe socioeconomic inequalities in mortality and to identify priorities for interventions.
Collapse
Affiliation(s)
- Santiago Esnaola
- Servicio de Estudios e Investigación Sanitaria, Dirección de Planificación y Ordenación Sanitaria, Departamento de Sanidad, Gobierno Vasco, Vitoria-Gasteiz, Alava, España.
| | | | | | | | | | | |
Collapse
|
14
|
Ruiz-Ramos M, Escolar Pujolar A, Sánchez Perea J, Garrucho Rivero G. Evolución de las desigualdades sociales en la mortalidad general de la ciudad de Sevilla (1994-2002). GACETA SANITARIA 2006; 20:303-10. [PMID: 16942718 DOI: 10.1157/13091146] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To know trends of social inequalities in general mortality in Seville (Spain) between 1997 and 2002. MATERIAL AND METHOD Socioeconomic level of its the residential census tracts was assigned for each death, taken from the Socio-economic Synthetic Index built up after applying a principal components analysis from 2001 census variables. Using mortality indicators its magnitude and trend was described according socio-economic level. RESULTS General mortality standardized rates by age in the census tracts of lowest socio-economic level were 1.32 and 1.25 times greater than in the highest census tracts in men and 1.19 and 1.08 in women respectively in each periods. The truncated rates ratio and potential years of lost life in men went from 1.66 to 2.28 in men and 1.74 to 2.10 in women, respectively. The four years difference in life expectancy at birth between the census tracts of highest and lower level remained unchanged in men, and fell from 1.90 to 0.82 in women. The population attributable risk (all ages) went from 13.18% to 10.46% in men and 10.02% to 2.58% in women. CONCLUSIONS Social inequalities in mortality for the general population decreased mainly in women. The inequalities increased in the early death and between 35-64 years old in men, basically due to a reduced mortality in higher socio-economic level census tracts.
Collapse
|
15
|
Domínguez-Berjón MF, Borrell C. Mortalidad y privación socioeconómica en las secciones censales y los distritos de Barcelona. GACETA SANITARIA 2005; 19:363-9. [PMID: 16242094 DOI: 10.1157/13080134] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To analyze the association between socioeconomic deprivation and mortality in the census tracts of Barcelona and the distinct patterns of this association in the districts. METHODS We performed an ecological, cross sectional study based on the 1,812 census tracts and the 10 districts of Barcelona, using socioeconomic variables obtained from the 1991 census and mortality data for 1987-1995. A deprivation index was created through component analysis. Descriptive analyses were performed and multivariate Poisson regression models were adjusted. RESULTS The greater the socioeconomic deprivation in the census tracts, the higher the mortality. The quartile with the greatest deprivation had a relative risk (RR) of mortality of 1.24 (95% confidence interval [CI], 1.22-1.27) in males and an RR of 1.05 (95% CI, 1.02-1.07) in females (compared with the quartile of census tracts with the lowest deprivation). This association varied according to district: in the old inner-city district (district 1), which had the highest mortality and the greatest deprivation, the RR was 1.57 (95% CI, 1.21-2.05) for males, while in district 8, which also has considerable deprivation, mortality was lower. CONCLUSIONS Analysis of socioeconomic inequalities in mortality in census tracts in an urban area highlights special areas of risk not observed in analysis of districts.
Collapse
|
16
|
Domínguez-Berjón MF, Borrell C, López R, Pastor V. Mortality and socioeconomic deprivation in census tracts of an urban setting in southern Europe. J Urban Health 2005; 82:225-36. [PMID: 15888637 PMCID: PMC3456560 DOI: 10.1093/jurban/jti047] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
In southern European cities, research on deprivation and mortality inequalities using small-area analysis is recent. In many countries, the census tract (CT) is the smallest territorial unit for which population data are available. The aim of this study was to examine the association between mortality from all causes and socioeconomic deprivation in CTs in Barcelona (Spain). A cross-sectional ecologic study was carried out using mortality data for 1987-1995 and 1991 census variables. Mortality data were obtained from death certificates. Socioeconomic deprivation indicators were drawn from the census and included unemployment, inadequate education, and low social class. They were correlated, and a deprivation index was elaborated with them. The analysis was descriptive, and multivariate Poisson regression models were adjusted. The most deprived CTs tend to present higher mortality (49.7% of CT in the quartile associated with greatest deprivation were included in the top male mortality quartile and 40.4% in the top female mortality quartile), whereas the less deprived ones present lower mortality. For male mortality, the risk of dying among those in the quartile representing most deprivation is from 25 to 29% higher (depending on the indicator chosen) than the least deprived quartile, and for women, it is from 12 to 14% higher. We concluded that the mortality from all causes in the CT of a southern European city has shown a clear positive association with a variety of socioeconomic deprivation indicators drawn from the census. Studies of this nature may help to orient more specific studies in which CTs are grouped together as a function of particular population and/or health characteristics.
Collapse
|
17
|
Pasarín MI, Borrell C, Brugal MT, Díaz-Quijano E. Weighing social and economic determinants related to inequalities in mortality. J Urban Health 2004; 81:349-62. [PMID: 15273261 PMCID: PMC3455947 DOI: 10.1093/jurban/jth123] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
It is well known that there are social inequalities in health. Following the ecological approach, unemployment has been one of the most used indicators to study social inequalities. The aim of the present study was to investigate the relationships between indicators of extreme poverty and social unrest, along with unemployment, and mortality in Barcelona, during the years 1989 to 1993. A cross-sectional ecological study was carried out using Primary Health Care Areas (PHCAs) as the unit of analysis. The study population consisted of residents in Barcelona City. The indicators studied as dependent variables were the age-standardized mortality rates of the following causes of death: total mortality; lung cancer; bronchitis, emphysema, and asthma; cirrhosis; cerebrovascular disease; ischemic heart disease; breast cancer; traffic accidents; acquired immunodeficiency syndrome (AIDS); and drug overdose. Independent variables were male unemployment rate of the primary health care areas and indicators of extreme poverty and social conflict. A descriptive analysis, a bivariate analysis using Spearman correlation coefficients, and a multivariate analysis fitting Poisson regression models were carried out. For the main results, one group of causes of death was associated only with unemployment: bronchitis, emphysema and asthma, cerebrovascular disease, and ischemic heart disease (both men and women); lung cancer (only among men); total mortality and cirrhosis (only among women). Among men, another group of causes of death was associated with extreme poverty and/or social unrest, as well as unemployment: total mortality, cirrhosis, and drug overdose. AIDS in men was only associated with extreme poverty and social unrest. We concluded that we see different types of relationships between deprivation and mortality. Unemployment has been related to mortality because of pathologies with socially accepted risk factors (tobacco and alcohol). Causes of death with risk factors not socially accepted (illegal drug use) have been related to indicators of marginality as well as unemployment.
Collapse
Affiliation(s)
- M Isabel Pasarín
- Agència de Salut Pública de Barcelona, Plaza Lesseps 1, 08023 Barcelona, Spain.
| | | | | | | |
Collapse
|
18
|
|
19
|
Ruiz-Ramos M, Sánchez J, Garrucho G, Viciana F. Desigualdades en mortalidad en la ciudad de Sevilla. GACETA SANITARIA 2004; 18:16-23. [PMID: 14980168 DOI: 10.1016/s0213-9111(04)71994-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To describe social inequalities in mortality in Seville from 1994 to 1998 according to socioeconomic status. METHODS Life expectancy, crude and age-adjusted rates of total mortality as well as mortality by causes and potential years of life lost were estimated using the number of deaths and the population of Seville, aggregated by Basic Health Areas (BHA). BHA were divided in three levels according to the unemployment rate among men. The relative risks of total mortality and mortality by causes were estimated for men and women in each of these levels, using Poisson regression. The unemployment rate of each of the BHA was related to total mortality and to some of its causes. RESULTS Differences in life expectancy of up to 7.9 years for men and 4.6 years for women were found among BHA. Concerning potential years of life lost, the areas with the highest mortality showed 4.1 times greater mortality in men and 2.6 times greater mortality in women than those with the lowest mortality. Total mortality increased with unemployment rate: the BHA with the highest unemployment rate showed a 15% increase in mortality in men and a 6% increase in that in women than those with the lowest unemployment rate. Among causes of mortality, AIDS showed the greatest inequalities in both men and women. CONCLUSIONS From 1994 to 1998, Seville presented inequalities in total mortality and premature mortality, as well as in mortality by causes per BHA. Inequalities were present in men and women, although they were greater in men. There was a clear association between socioeconomic variables and mortality.
Collapse
|
20
|
Borrell C, Rodríguez M, Ferrando J, Brugal MT, Pasarín MI, Martínez V, Plaséncia A. Role of individual and contextual effects in injury mortality: new evidence from small area analysis. Inj Prev 2002; 8:297-302. [PMID: 12460966 PMCID: PMC1756581 DOI: 10.1136/ip.8.4.297] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To analyse the role of individual and contextual variables in injury mortality inequalities from a small area analysis perspective, looking at the data for the city of Barcelona (Spain) for 1992-98. SETTING Barcelona (Spain). METHODS All injury deaths in residents older than 19, which occurred in the period 1992-98 were included (n=4393). Age and sex specific mortality rates were calculated for each educational level and each cause of death (traffic injuries, falls, drug overdose, suicide, other injuries). The contextual variables included were the proportion of men unemployed, and the proportion of men in jail, in each neighbourhood. Multilevel Poisson regression models were fitted using data grouped by age, educational level, and neighbourhood for each sex. RESULTS Death rates were higher in males, at the extremes of the age distribution (under 44 and over 74 years), and for lower educational levels. The results of the Poisson multilevel models indicate that inequalities by educational level follow a gradient, with higher risks for the population with no schooling, after having adjusted for the contextual variables of the neighbourhood. Such inequalities were more important in the youngest age group (20-34 years), as relative risk of 5.41 (95% confidence interval (CI) 3.9 to 7.4) for all injury causes in males and 4.38 (95% CI 2.3 to 8.4) in females. The highest relative risks were found for drug overdose. There was a contextual neighbourhood effect (the higher the deprivation, the higher the mortality) after having taken into account individual variables. CONCLUSION The findings underscore the need to implement injury prevention strategies not only at the individual level taking into account socioeconomic position, but also at the neighbourhood level.
Collapse
Affiliation(s)
- C Borrell
- Institut Municipal de Salut Pública, Barcelona, Spain.
| | | | | | | | | | | | | |
Collapse
|
21
|
Puigpinós R, Borrell C, Pasarín MI, Montellà N, Pérez G, Plasènci A, Rué M. Inequalities in mortality by social class in men in Barcelona, Spain. Eur J Epidemiol 2001; 16:751-6. [PMID: 11142504 DOI: 10.1023/a:1026706302783] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Most of the studies of inequalities in mortality carried out in Spain have been ecological, due to the difficulty of obtaining good quality socioeconomic information at individual level. The objective of this study was to describe inequalities in mortality by social class, based on occupation, among men residents of Barcelona in 1993. A representative sample was obtained of men residents of Barcelona who died during the year 1993, aged between 15 and 65 years. It was a retrospective interview given to relatives of the deceased, or other closely related persons. The variables analysed were: age, education level, underlying cause of death, and social class based on occupation (manual and non-manual workers). Rates, relative risks (RRs) and their 95% confidence intervals (95% CIs) are presented by age groups and cause of death. The main results show that among young people, the excess of mortality due to infectious diseases is notable (RR: 1.9; 95% CI: 1.6-2.2), and also due to external causes (RR: 2.1; 95% CI: 1.8-2.4) among manual workers with respect to non-manual workers, mainly due to AIDS and drug overdose. No significant differences were found in mortality due to tumours. For respiratory and cardiovascular causes, there is an increase in mortality in the less favoured social classes, as also occurs for mortality due to diseases of the digestive system, particularly among young manual workers, with an RR: 2.6 (95% CI: 1.5-3.6) compared to non-manual workers. This study shows that it is necessary to continue exploring inequalities in health, but above all it is necessary to implement efficient preventive measures addressed mainly at young people in situations of disadvantage, in order to avoid the excess of avoidable mortality which is found.
Collapse
Affiliation(s)
- R Puigpinós
- Servei d'Informació Sanitària, Institut Municipal de Salut Pública de Barcelona
| | | | | | | | | | | | | |
Collapse
|
22
|
Borrell C, Rue M, Pasarín MI, Rohlfs I, Ferrando J, Fernandez E. Trends in social class inequalities in health status, health-related behaviors, and health services utilization in a Southern European urban area (1983-1994). Prev Med 2000; 31:691-701. [PMID: 11133336 DOI: 10.1006/pmed.2000.0751] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND The objective of this study was to describe the evolution of social class inequalities in Barcelona (Spain) residents in perceived health status, health-related behaviors, and utilization of health services between 1983 and 1994. METHODS The information was obtained from the Health Interview Surveys conducted in 1983, 1986, 1992, and 1994 in Barcelona. In this study we included noninstitutionalized people ages >14 years. Social class was obtained from the Spanish adaptation of the British Registrar General classification. We studied health status, health-related behaviors, and health services utilization variables. Age-adjusted percentages and the relative index of inequality were obtained. RESULTS Of the health status variables, having been confined to bed and acute restriction of activity in the 2 weeks prior to the interview showed an increase in inequalities by social class in 1994. The pattern of chronic conditions by social class in men did not change between 1983 and 1994. Women had a higher prevalence of chronic conditions and the inequalities among social classes had increased. In men there were no social class inequalities in smoking in 1983. In 1992 and 1994 smoking was more prevalent in men of social classes IV and V. In women, smoking was more prevalent in social classes I and II in 1983 than in social classes IV and V, something that had changed by 1994. Lack of usual physical activity in men was always more prevalent in social classes I and II, and this difference increased since more people of advantaged classes moved into inactivity. Health services utilization showed no inequalities in the years studied. CONCLUSION The changing pattern according to social class of smoking and physical activity practice needs to be taken into account by policy-makers and public health workers.
Collapse
Affiliation(s)
- C Borrell
- Institut Municipal de Salut Pública de Barcelona, Spain.
| | | | | | | | | | | |
Collapse
|