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Bartoll-Roca X, Marí-Dell'Olmo M, Gotsens M, Palència L, Pérez K, Díez E, Borrell C. Neighbourhood income inequalities in mental health in Barcelona 2001-2016: a Bayesian smoothed estimate. GACETA SANITARIA 2022; 36:534-539. [PMID: 35644735 DOI: 10.1016/j.gaceta.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 03/17/2022] [Accepted: 03/21/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Obtaining reliable health estimates at the small area level (such as neighbourhoods) using survey data usually poses the problem of small sample sizes. To overcome this limitation, we explored smoothing techniques in order to estimate poor mental health prevalence at the neighbourhood level and analyse its profile by income in Barcelona city (Spain). METHOD A Bayesian smoothing model with a logit-normal transformation was applied to four repeated cross-sectional waves of the Barcelona health survey for 2001, 2006, 2011 and 2016. Mental health status was identified from the 12-item General Health Questionnaire. Income inequalities were analysed with neighbourhood income in quantiles for each year and trends in the pooled analysis. RESULTS The prevalence of poor mental health ranged from 14.6% in 2001 to 18.9% in 2016. The yearly difference between neighbourhoods was 12.4% in 2001, 16.7% in 2006, 14.2% in 2011, and 20.0% in 2016. The odds ratio and 95% credible interval (95%CI) of experiencing poor mental health was 1.40 times higher (95%CI: 1.02-1.91) in less advantaged neighbourhoods than in more advantaged neighbourhoods in 2001, 1.61 times higher (95%CI: 1.01-2.59) in 2006 and 2.31 times higher (95%CI: 1.57-3.40) in 2016. CONCLUSIONS This study shows that the Bayesian smoothed techniques allows detection of inequalities in health in neighbourhoods and monitoring of interventions against them. In Barcelona, mental health problems are more prevalent in low-income neighbourhoods and raised in 2016.
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Affiliation(s)
- Xavier Bartoll-Roca
- Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain; Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Barcelona, Spain.
| | - Marc Marí-Dell'Olmo
- Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain; Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Mercè Gotsens
- Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain; Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | - Laia Palència
- Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain; Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Katherine Pérez
- Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain; Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Elia Díez
- Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain; Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Carme Borrell
- Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain; Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Departament de Ciències Experimentals i de la Salut, Facultat de Ciències de la Salut i de la Vida, Universitat Pompeu Fabra, Barcelona, Spain
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Bartoll-Roca X, Rodríguez-Sanz M, Sánchez-Ledesma E, Pérez K, Borrell C. Inequalities in life expectancy by educational level and its decomposition in Barcelona, 2004-2018. GACETA SANITARIA 2022; 36:520-525. [PMID: 35337685 DOI: 10.1016/j.gaceta.2021.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 11/25/2021] [Accepted: 11/29/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To analyse the gap in life expectancy by educational level in the city of Barcelona from 2004 to 2018 and to decompose this gap by age and causes of death. METHOD We computed abridged life tables at the age of 25 years by sex from 2004 to 2018 using standard methods. Educational level was categorised in two groups (lower secondary or less vs. upper secondary or higher education). The life expectancy gap was further decomposed by age and by causes of death based in Arriaga's method in 5-year age blocks up to the age of ≥ 90 years and broad causes of death using ICD-10 codes. RESULTS The life expectancy gap at 25 years by educational level oscillated without trend at around 3.08 years for men and 1.93 years for women. Decomposition by age showed a favourable significant shift in the contribution to this gap from young to older ages for men, with few changes for women. Decomposition by causes of death showed that the diseases concentrating the largest share of the contribution were neoplasms and respiratory and circulatory disease. There was a significant downward trend in external causes for men and in infectious diseases for both men and women but a significant upward trend for respiratory disease for both sexes. CONCLUSIONS The stability of the life expectancy gap by educational level during the period analysed resulted from a combination of divergent trends by age and causes of death among high and low educational levels.
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Affiliation(s)
- Xavier Bartoll-Roca
- Agència de Salut Pública de Barcelona, Barcelona (ASPB), Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain.
| | - Maica Rodríguez-Sanz
- Agència de Salut Pública de Barcelona, Barcelona (ASPB), Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Departament de Cièncias Experimentales i de la Salut, Facultat de Ciències de la Salut i de la Vida, Universitat Pompeu Fabra, Barcelona, Spain
| | | | - Katherine Pérez
- Agència de Salut Pública de Barcelona, Barcelona (ASPB), Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Carme Borrell
- Agència de Salut Pública de Barcelona, Barcelona (ASPB), Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Departament de Cièncias Experimentales i de la Salut, Facultat de Ciències de la Salut i de la Vida, Universitat Pompeu Fabra, Barcelona, Spain
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Association of socioeconomic deprivation with life expectancy and all-cause mortality in Spain, 2011–2013. Sci Rep 2022; 12:15554. [PMID: 36114247 PMCID: PMC9481591 DOI: 10.1038/s41598-022-19859-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 09/06/2022] [Indexed: 11/08/2022] Open
Abstract
AbstractLife tables summarise a population’s mortality experience during a time period. Sex- and age-specific life tables are needed to compute various cancer survival measures. However, mortality rates vary according to socioeconomic status. We present sex- and age-specific life tables based on socioeconomic status at the census tract level in Spain during 2011–2013 that will allow estimating cancer relative survival estimates and life expectancy measures by socioeconomic status. Population and mortality data were obtained from the Spanish Statistical Office. Socioeconomic level was measured using the Spanish Deprivation Index by census tract. We produced sex- and age-specific life expectancies at birth by quintiles of deprivation, and life tables by census tract and province. Life expectancy at birth was higher among women than among men. Women and men in the most deprived census tracts in Spain lived 3.2 and 3.8 years less than their counterparts in the least deprived areas. A higher life expectancy in the northern regions of Spain was discovered. Life expectancy was higher in provincial capitals than in rural areas. We found a significant life expectancy gap and geographical variation by sex and socioeconomic status in Spain. The gap was more pronounced among men than among women. Understanding the association between life expectancy and socioeconomic status could help in developing appropriate public health programs. Furthermore, the life tables we produced are needed to estimate cancer specific survival measures by socioeconomic status. Therefore, they are important for cancer control in Spain.
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Serra-Pujadas S, Alonso-Buxadé C, Serra-Colomer J, Folguera J, Carrilero N, García-Altés A. Geographical, Socioeconomic, and Gender Inequalities in Opioid Use in Catalonia. Front Pharmacol 2021; 12:750193. [PMID: 34744729 PMCID: PMC8568127 DOI: 10.3389/fphar.2021.750193] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/24/2021] [Indexed: 01/21/2023] Open
Abstract
Background: In recent years, worldwide opioid use has seen a sharp increase, especially for the treatment of chronic non-cancer pain. Catalonia is no exception to this trend. However, no recent studies have addressed the socioeconomic and gender inequalities in opioid use in the different geographical areas of Catalonia. Methods: We performed an ecological study to analyse the associations between socioeconomic status, gender and the use of opioids in the 372 Health Areas of Catalonia. Robust Poisson models were performed to analyse the data provided from the Central Register of Insured Persons and dispensing data from the Electronic Prescription Database. Results: The results show that socioeconomic status has a major impact on opioid use, with the most deprived areas presenting the highest levels of use. There are major inequalities in the DDD/1,000 inhabitants per areas. Moreover, women have much higher utilization rates than men, especially in more deprived areas. The greatest difference is observed in the use of weak opioids in women: the DDD/1,000 inhabitants per day was 2.34 in the area with the lowest use, compared with 22.18 in the area with the highest use. Conclusions: Our findings suggest that stronger action is needed to promote best practices in prescribing for chronic pain and to reduce socioeconomic and gender variation between geographical areas. This study provides a model for routine monitoring of opioid prescription for targeted interventions aimed at lowering high-dose consumption in specifically identified areas.
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Affiliation(s)
- Sara Serra-Pujadas
- Facultat d'Economia i Empresa, Universitat Pompeu Fabra, Barcelona, Spain
| | | | | | - Júlia Folguera
- Facultat d'Economia i Empresa, Universitat Pompeu Fabra, Barcelona, Spain
| | - Neus Carrilero
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, Spain
| | - Anna García-Altés
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.,Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
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La Parra-Casado D, Arza-Porras J, Estévez JF. Health indicators of the National Roma Integration Strategy in Spain in the years 2006 and 2014. Eur J Public Health 2021; 30:906-910. [PMID: 32385497 DOI: 10.1093/eurpub/ckaa070] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In 2011, the European Commission adopted the European framework for the National Roma Integration Strategies (NRISs) 2020, which focussed on four areas: education, employment, health and housing. In 2012 Spain approved its Strategy 2012-20, one of the central aims of which is to reduce social inequalities in health that affect the Roma population. Our objective was to analyze changes in health inequalities between the Roma population and the general population in Spain in the years 2006 and 2014. METHODS The Spanish National Health Surveys (NHSs) 2006 (n = 29 478) and 2012 (n = 20 884) and the NHS of the Spanish Roma Population 2006 (n = 933) and 2014 (n = 1155) were compared. This study considered the variables included in NRIS 2012-20: self-perceived health, tobacco use in men, traffic accidents in men and women, obesity in women and gynaecological visits. RESULTS Despite the adoption of the NRIS 2012-20, there were no observed improvements in health between 2006 and 2014 in the Roma population. Nor was there a reduction in inequalities in health concerning the general population in Spain. Also, there was no reduction in the health inequalities by gender for the two populations. CONCLUSIONS Health is determined in part by social factors including education, employment, housing and also by anti-Roma discourses and discrimination. Improving the health of the Roma population requires a multi-sectoral approach with a gender perspective.
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Affiliation(s)
- Daniel La Parra-Casado
- Department of Sociology II, Interuniversity Institute of International Economics, University of Alicante, Alicante, Spain
| | - Javier Arza-Porras
- Department of Sociology and Social Work, Public University of Navarra, Pamplona-Iruña, Spain
| | - Jesús Francisco Estévez
- Department of Sociology II, Interuniversity Institute of International Economics, University of Alicante, Alicante, Spain
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Martinez-Beneito MA, Vergara-Hernández C, Botella-Rocamora P, Corpas-Burgos F, Pérez-Panadés J, Zurriaga Ó, Aldasoro E, Borrell C, Cabeza E, Cirera L, Delfrade Osinaga J, Fernández-Somoano A, Gandarillas A, Lorenzo Ruano PL, Marí-Dell’Olmo M, Nolasco A, Prieto-Salceda MD, Ramis R, Rodríguez-Sanz M, Sánchez-Villegas P. Geographical Variability in Mortality in Urban Areas: A Joint Analysis of 16 Causes of Death. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115664. [PMID: 34070635 PMCID: PMC8197960 DOI: 10.3390/ijerph18115664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/21/2021] [Accepted: 05/22/2021] [Indexed: 01/29/2023]
Abstract
The geographical distribution of mortality has frequently been studied. Nevertheless, those studies often consider isolated causes of death. In this work, we aim to study the geographical distribution of mortality in urban areas, in particular, in 26 Spanish cities. We perform an overall study of 16 causes of death, considering that their geographical patterns could be dependent and estimating the dependence between the causes of death. We study the deaths in these 26 cities during the period 1996-2015 at the census tract level. A multivariate disease mapping model is used in order to solve the potential small area estimation problems that these data could show. We find that most of the geographical patterns found show positive correlations. This suggests the existence of a transversal geographical pattern, common to most causes of deaths, which determines those patterns to a higher/lower extent depending on each disease. The causes of death that exhibit that underlying pattern in a more prominent manner are chronic obstructive pulmonary disease (COPD), lung cancer, and cirrhosis for men and cardiovascular diseases and dementias for women. Such findings are quite consistent for most of the cities in the study. The high positive correlation found between geographical patterns reflects the existence of both high and low-risk areas in urban settings, in general terms for nearly all the causes of death. Moreover, the high-risk areas found often coincide with neighborhoods known for their high deprivation. Our results suggest that dependence among causes of death is a key aspect to be taken into account when mapping mortality, at least in urban contexts.
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Affiliation(s)
- Miguel A. Martinez-Beneito
- Departament d’Estadística e Investigaciò Opertiva, Universitat de València, 46100 Burjassot, Spain
- CIBER de Epidemiología y Salud Pública, 28029 Madrid, Spain; (F.C.-B.); (Ó.Z.); (C.B.); (L.C.); (J.D.O.); (A.F.-S.); (M.M.-D.); (R.R.); (M.R.-S.)
- Correspondence:
| | | | - Paloma Botella-Rocamora
- Dirección General de Salut Pública i Adiccions, Conselleria de Sanitat Universal y Salut Pública, 46020 Valencia, Spain; (P.B.-R.); (J.P.-P.)
| | - Francisca Corpas-Burgos
- CIBER de Epidemiología y Salud Pública, 28029 Madrid, Spain; (F.C.-B.); (Ó.Z.); (C.B.); (L.C.); (J.D.O.); (A.F.-S.); (M.M.-D.); (R.R.); (M.R.-S.)
- FISABIO Foundation, 46020 Valencia, Spain;
| | - Jordi Pérez-Panadés
- Dirección General de Salut Pública i Adiccions, Conselleria de Sanitat Universal y Salut Pública, 46020 Valencia, Spain; (P.B.-R.); (J.P.-P.)
| | - Óscar Zurriaga
- CIBER de Epidemiología y Salud Pública, 28029 Madrid, Spain; (F.C.-B.); (Ó.Z.); (C.B.); (L.C.); (J.D.O.); (A.F.-S.); (M.M.-D.); (R.R.); (M.R.-S.)
- FISABIO Foundation, 46020 Valencia, Spain;
- Dirección General de Salut Pública i Adiccions, Conselleria de Sanitat Universal y Salut Pública, 46020 Valencia, Spain; (P.B.-R.); (J.P.-P.)
- Departament de Medicina Preventiva, Salut Pública, Ciències de l’Alimentación, Toxicología i Medicina Legal, Universitat de València, 46010 Valencia, Spain
| | - Elena Aldasoro
- Dirección de Salud Pública y Adicciones, 48013 Bilbao, Spain;
| | - Carme Borrell
- CIBER de Epidemiología y Salud Pública, 28029 Madrid, Spain; (F.C.-B.); (Ó.Z.); (C.B.); (L.C.); (J.D.O.); (A.F.-S.); (M.M.-D.); (R.R.); (M.R.-S.)
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain
- Institut d’Investigació Biomèdica (IIB Sant Pau), 08025 Barcelona, Spain
| | - Elena Cabeza
- Institut d’investigació sanitària de les Illes Balears, 07120 Palma de Mallorca, Spain;
| | - Lluís Cirera
- CIBER de Epidemiología y Salud Pública, 28029 Madrid, Spain; (F.C.-B.); (Ó.Z.); (C.B.); (L.C.); (J.D.O.); (A.F.-S.); (M.M.-D.); (R.R.); (M.R.-S.)
- Department of Epidemiology, Regional Health Council-IMIB-Arrixaca, 30008 Murcia, Spain
| | - Josu Delfrade Osinaga
- CIBER de Epidemiología y Salud Pública, 28029 Madrid, Spain; (F.C.-B.); (Ó.Z.); (C.B.); (L.C.); (J.D.O.); (A.F.-S.); (M.M.-D.); (R.R.); (M.R.-S.)
- Instituto de Salud Pública y Laboral de Navarra, 31003 Pamplona, Spain
| | - Ana Fernández-Somoano
- CIBER de Epidemiología y Salud Pública, 28029 Madrid, Spain; (F.C.-B.); (Ó.Z.); (C.B.); (L.C.); (J.D.O.); (A.F.-S.); (M.M.-D.); (R.R.); (M.R.-S.)
- IUOPA-Medicine Department, Universidad de Oviedo, 33006 Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33001 Oviedo, Spain
| | | | | | - Marc Marí-Dell’Olmo
- CIBER de Epidemiología y Salud Pública, 28029 Madrid, Spain; (F.C.-B.); (Ó.Z.); (C.B.); (L.C.); (J.D.O.); (A.F.-S.); (M.M.-D.); (R.R.); (M.R.-S.)
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain
- Institut d’Investigació Biomèdica (IIB Sant Pau), 08025 Barcelona, Spain
| | - Andreu Nolasco
- Universidad de Alicante, 03690 San Vicente del Raspeig, Spain;
| | | | - Rebeca Ramis
- CIBER de Epidemiología y Salud Pública, 28029 Madrid, Spain; (F.C.-B.); (Ó.Z.); (C.B.); (L.C.); (J.D.O.); (A.F.-S.); (M.M.-D.); (R.R.); (M.R.-S.)
- Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Maica Rodríguez-Sanz
- CIBER de Epidemiología y Salud Pública, 28029 Madrid, Spain; (F.C.-B.); (Ó.Z.); (C.B.); (L.C.); (J.D.O.); (A.F.-S.); (M.M.-D.); (R.R.); (M.R.-S.)
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain
- Institut d’Investigació Biomèdica (IIB Sant Pau), 08025 Barcelona, Spain
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Oliva-Arocas A, Pereyra-Zamora P, Copete JM, Vergara-Hernández C, Martínez-Beneito MA, Nolasco A. Socioeconomic Inequalities in Mortality among Foreign-Born and Spanish-Born in Small Areas in Cities of the Mediterranean Coast in Spain, 2009-2015. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E4672. [PMID: 32610538 PMCID: PMC7370214 DOI: 10.3390/ijerph17134672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/14/2020] [Accepted: 06/19/2020] [Indexed: 12/28/2022]
Abstract
Many studies have analysed socioeconomic inequalities and its association with mortality in urban areas. However, few of them have differentiated between native and immigrant populations. This study is an ecological study of mortality by overall mortality and analyses the inequalities in mortality in these populations according to the level of deprivation in small areas of large cities in the Valencian Community, from 2009 to 2015. The census tract was classified into five deprivation levels using an index based on socioeconomic indicators from the 2011 census. Rates and relative risks of death were calculated by sex, age, level of deprivation and country of birth. Poisson regression models have been used. In general, there was a higher risk of death in natives at the levels of greatest deprivation, which did not happen in immigrants. During the 2009-2015 period, there were socioeconomic inequalities in mortality, particularly in natives, who presented a higher risk of death than immigrants. Future interventions and social policies should be implemented in order to reduce inequalities in mortality amongst socioeconomic levels and to maintain the advantage that the immigrant population enjoys.
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Affiliation(s)
- Adriana Oliva-Arocas
- Research Unit for the Analysis of Mortality and Health Statistics, Department of Community Nursing, Preventive Medicine, Public Health and History of Science, University of Alicante, 03080 Alicante, Spain; (A.O.-A.); (J.M.C.); (A.N.)
| | - Pamela Pereyra-Zamora
- Research Unit for the Analysis of Mortality and Health Statistics, Department of Community Nursing, Preventive Medicine, Public Health and History of Science, University of Alicante, 03080 Alicante, Spain; (A.O.-A.); (J.M.C.); (A.N.)
| | - José M. Copete
- Research Unit for the Analysis of Mortality and Health Statistics, Department of Community Nursing, Preventive Medicine, Public Health and History of Science, University of Alicante, 03080 Alicante, Spain; (A.O.-A.); (J.M.C.); (A.N.)
| | - Carlos Vergara-Hernández
- Área de Desigualdades en Salud, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), 46035 Valencia, Spain;
| | | | - Andreu Nolasco
- Research Unit for the Analysis of Mortality and Health Statistics, Department of Community Nursing, Preventive Medicine, Public Health and History of Science, University of Alicante, 03080 Alicante, Spain; (A.O.-A.); (J.M.C.); (A.N.)
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8
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Duque I, Domínguez-Berjón MF, Cebrecos A, Prieto-Salceda MD, Esnaola S, Calvo Sánchez M, Marí-Dell'Olmo M. [Deprivation index by enumeration district in Spain, 2011]. GACETA SANITARIA 2020; 35:113-122. [PMID: 32014314 DOI: 10.1016/j.gaceta.2019.10.008] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 09/30/2019] [Accepted: 10/23/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To present the methodology used in the design and implementation of a deprivation index by enumeration district, and to describe the socioeconomic situation of Spain in 2011. METHOD The unit of analysis was the enumeration district (N=35,960). Data came from the 2011 Population and Housing Census of Spain. Given both the sampling nature of the Census and the regulatory limitations of data confidentiality, variables were calculated indirectly by using the complement of the available variables. Checks were made to ensure reliability. The selection of the indicators took into account comparability with the MEDEA index. The inclusion of additional information was explored. A deprivation index was built using Principal Component Analysis. Sensitivity analysis of the index was performed for urban areas and the rest of the regions. RESULTS Using the census information, 22 indicators were calculated for 35,917 enumeration districts. The deprivation index was based on six indicators: manual and temporary workers, unemployment, insufficient education overall and in young people (aged 16 to 29 years), and dwellings without access to the internet. The map of Spain shows a gradient of decreasing deprivation from south-west to north-east. CONCLUSIONS The socioeconomic information of the 2011 census by enumeration district was used systematically. The drafted index, similar to the MEDEA, will facilitate the updated study of health inequalities for Spain overall following the economic recession that began in 2008.
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Affiliation(s)
- Ignacio Duque
- Subdirección General de Tecnologías de la Información y las Comunicaciones, Instituto Nacional de Estadística, Madrid, España.
| | | | - Alba Cebrecos
- Grupo de Investigación Social y Cardiovascular, Universidad de Alcalá de Henares, Alcalá de Henares (Madrid), España; Departamento de Geología, Geografía y Ciencias Ambientales, Alcalá de Henares (Madrid), España
| | - María Dolores Prieto-Salceda
- Observatorio de Salud Pública de Cantabria, Fundación Marqués de Valdecilla, Consejería de Sanidad, Santander, España
| | - Santiago Esnaola
- Estudios e Investigación Sanitaria, Dirección de Planificación, Ordenación y Evaluación, Departamento de Salud, Gobierno Vasco, Vitoria (Álava), España
| | - Montserrat Calvo Sánchez
- Estudios e Investigación Sanitaria, Dirección de Planificación, Ordenación y Evaluación, Departamento de Salud, Gobierno Vasco, Vitoria (Álava), España
| | - Marc Marí-Dell'Olmo
- Agència de Salut Pública de Barcelona, Barcelona, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; Institut d'Investigació Biomèdica Sant Pau, Barcelona, España
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Assessing the Effects on Health Inequalities of Differential Exposure and Differential Susceptibility of Air Pollution and Environmental Noise in Barcelona, 2007-2014. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16183470. [PMID: 31540448 PMCID: PMC6766056 DOI: 10.3390/ijerph16183470] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 09/05/2019] [Accepted: 09/06/2019] [Indexed: 11/26/2022]
Abstract
The hypotheses we intended to contrast were, first, that the most deprived neighborhoods in Barcelona, Spain, present high exposure to environmental hazards (differential exposure) and, secondly, that the health effects of this greater exposure were higher in the most deprived neighborhoods (differential susceptibility). The population studied corresponded to the individuals residing in the neighborhoods of Barcelona in the period 2007–2014. We specified the association between the relative risk of death and environmental hazards and socioeconomic indicators by means of spatio-temporal ecological regressions, formulated as a generalized linear mixed model with Poisson responses. There was a differential exposure (higher in more deprived neighborhoods) in almost all the air pollutants considered, when taken individually. The exposure was higher in the most affluent in the cases of environmental noise. Nevertheless, for both men and women, the risk of dying due to environmental hazards in a very affluent neighborhood is about 30% lower than in a very depressed neighborhood. The effect of environmental hazards was more harmful to the residents of Barcelona’s most deprived neighborhoods. This increased susceptibility cannot be attributed to a single problem but rather to a set of environmental hazards that, overall, a neighborhood may present.
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Borrell C, Pasarín MI, Díez E, Pérez K, Malmusi D, Pérez G, Artazcoz L. [Health inequalities as a political priority in Barcelona]. GACETA SANITARIA 2019; 34:69-76. [PMID: 31288951 DOI: 10.1016/j.gaceta.2019.04.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 04/11/2019] [Accepted: 04/12/2019] [Indexed: 10/26/2022]
Abstract
There is a wealth of information and research on health inequalities in Barcelona, but this issue has not been clearly prioritised on the political agenda. The arrival in government of a new left-wing party (Barcelona en Comú) in 2015, gave an important boost to the political agenda to reduce inequalities and health inequalities. The aim of this review is to describe the progress made in relation to health inequalities in these four years and especially in the areas involving public health. With respect to evidence and communication on health inequalities, the progress made is presented in the Barcelona annual health report and the creation of the Observatory on Health, Inequalities and Impacts of Municipal Policies. The policies presented refer to different municipal strategies, the Health Plan, the promotion of the Barcelona Health in the Neighbourhoods programme and the Plan for Tackling Inequalities in the Barcelona Public Health Agency. The combination of political will, technical capacity and the drive of citizens have facilitated progress in the city of Barcelona in policies to reduce social inequalities in health.
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Affiliation(s)
- Carme Borrell
- Agència de Salut Pública de Barcelona, Barcelona, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, España; Departamento de Ciencias Experimentales y de la Salud, Universitat Pompeu Fabra, Barcelona, España.
| | - M Isabel Pasarín
- Agència de Salut Pública de Barcelona, Barcelona, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, España; Departamento de Ciencias Experimentales y de la Salud, Universitat Pompeu Fabra, Barcelona, España
| | - Elia Díez
- Agència de Salut Pública de Barcelona, Barcelona, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, España; Departamento de Ciencias Experimentales y de la Salud, Universitat Pompeu Fabra, Barcelona, España
| | - Katherine Pérez
- Agència de Salut Pública de Barcelona, Barcelona, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, España
| | - Davide Malmusi
- CIBER de Epidemiología y Salud Pública (CIBERESP), España; Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, España; Direcció de Serveis de Salut, Ajuntament de Barcelona, Barcelona, España
| | - Glòria Pérez
- Agència de Salut Pública de Barcelona, Barcelona, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, España; Departamento de Ciencias Experimentales y de la Salud, Universitat Pompeu Fabra, Barcelona, España
| | - Lucía Artazcoz
- Agència de Salut Pública de Barcelona, Barcelona, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, España; Departamento de Ciencias Experimentales y de la Salud, Universitat Pompeu Fabra, Barcelona, España
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García-Torrecillas JM, Olvera-Porcel MC, Ferrer-Márquez M, Rubio-Gil F, Sánchez MJ, Rodríguez-Barranco M. Spatial and temporal variations in Spain in the standardised ratio of in-hospital mortality due to colorectal cancer, 2008-2014. BMC Cancer 2019; 19:310. [PMID: 30943925 PMCID: PMC6448323 DOI: 10.1186/s12885-019-5502-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 03/20/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is the second cause of tumour mortality in Spain and Europe. To date, no studies have been conducted in Spain to evaluate the spatial and temporal distribution of the excess risk of death during hospitalisation for CRC. METHODS A cohort was constructed of all episodes of hospitalisation in Spain due to CRC (codes 153 and 154 of the International Classification of Diseases, 9th edition, Clinical Modification) during the period 2008-2014, based on the minimum basic data set published by the Ministry of Health. Mortality ratios were calculated per region for each of the years analyzed (spatial or cross-sectional analysis) and during the overall study period, for each region independently (temporal or longitudinal analysis). In the first of these analyses, particular note was taken of the regions and years in which the limits of two and three standard deviations were exceeded. RESULTS Two hundred and fifty eight thousand, nine hundred and twenty seven episodes of CRC were analysed. The patients were predominantly male (60.6%), with an average hospital stay of 13.16 days. Half underwent surgery during admission and on average presented more than six diagnoses at discharge. The spatial analysis revealed mortality ratios that deviated by at least three standard deviations in the following regions: Islas Canarias, Asturias, Valencia, Extremadura, País Vasco and Andalucía. The longitudinal analysis showed that most regions presented one or more years when CRC mortality was at least 15% higher than expected during the period; outstanding in this respect were Asturias, Navarra and La Rioja, where this excess risk was detected in at least 2 years. CONCLUSIONS Geographic and temporal patterns of the distribution of the excess risk of mortality from CRC in Spain are described using SMRs. We conclude that during the study period, the geographic pattern of mortality in Spain did not coincide with the excess risk of mortality calculated using the SMR method described by Jarman and Foster. This method of risk estimation can be a useful tool for the study of mortality risk and its spatial variations.
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Affiliation(s)
- J. M. García-Torrecillas
- Hospital Universitario Torrecárdenas, Almería, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | | | - F. Rubio-Gil
- Hospital Universitario Torrecárdenas, Almería, Spain
| | - M J. Sánchez
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs, Granada, Spain
- Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
| | - M. Rodríguez-Barranco
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs, Granada, Spain
- Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
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Rodríguez-Sanz M, Gotsens M, Marí dell’Olmo M, Borrell C. Trends in mortality inequalities in an urban area: the influence of immigration. Int J Equity Health 2019; 18:37. [PMID: 30808362 PMCID: PMC6390301 DOI: 10.1186/s12939-019-0939-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 02/14/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Nearly 20% of the population in Barcelona is foreign-born and this percentage rises to up to 40% in some neighborhoods. Consequently, migration health patterns may play an important role in trends in socioeconomic geographical inequalities in mortality. The objective of this study was to analyze the trend in socioeconomic inequalities in mortality between neighborhoods in Barcelona during the period 2001-2012 in the foreign-born and Spanish-born population. METHODS Repeated cross-sectional design of the population aged 25-64 years in Barcelona between 2001 and 2012. Hierarchical data consisted of yearly mortality linked-population. The variables analyzed were age, sex, education, and country of birth (Spanish-born, foreign-born), neighborhood of residence, and the socioeconomic level of the neighborhoods using quartiles of unemployment rates. Age-standardized mortality rates were estimated, and mixed Poisson regressions were applied using generalized linear mixed models, including two random effects to consider the intracorrelation within neighborhoods and across years. RESULTS The number of foreign-born residents aged 25-64 increased notably in disadvantaged neighborhoods. Approximately 9% of premature deaths occurred in foreign-born individuals. Premature mortality rates were higher in disadvantaged neighborhoods and in the Spanish-born population in all periods. Despite the stabilized socioeconomic inequalities in mortality in the Spanish-born population, no inequalities were found between neighborhoods in foreign-born men and women. CONCLUSIONS Evidence of the 'healthy migrant' effect in mortality and socioeconomic inequalities in mortality was found in Barcelona, which seems to alter the distribution of mortality through time and space, related to the low levels of premature mortality and the selective residence of immigrants in socioeconomically disadvantaged neighborhoods.
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Affiliation(s)
- Maica Rodríguez-Sanz
- Agència de Salut Pública de Barcelona, Lesseps, 1, 08023 Barcelona, Spain
- Institut d’Investigacio Biomedica (IIB Sant Pau), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Barcelona, Spain
| | - Mercè Gotsens
- Agència de Salut Pública de Barcelona, Lesseps, 1, 08023 Barcelona, Spain
- Institut d’Investigacio Biomedica (IIB Sant Pau), Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Barcelona, Spain
| | - Marc Marí dell’Olmo
- Agència de Salut Pública de Barcelona, Lesseps, 1, 08023 Barcelona, Spain
- Institut d’Investigacio Biomedica (IIB Sant Pau), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Barcelona, Spain
| | - Carme Borrell
- Agència de Salut Pública de Barcelona, Lesseps, 1, 08023 Barcelona, Spain
- Institut d’Investigacio Biomedica (IIB Sant Pau), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Barcelona, Spain
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Amadi JA, Olago DO, Ong'amo GO, Oriaso SO, Nyamongo IK, Estambale BBA. "We don't want our clothes to smell smoke": changing malaria control practices and opportunities for integrated community-based management in Baringo, Kenya. BMC Public Health 2018; 18:609. [PMID: 29743062 PMCID: PMC5944038 DOI: 10.1186/s12889-018-5513-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 04/26/2018] [Indexed: 11/30/2022] Open
Abstract
Background The decline in global malaria cases is attributed to intensified utilization of primary vector control interventions and artemisinin-based combination therapies (ACTs). These strategies are inadequate in many rural areas, thus adopting locally appropriate integrated malaria control strategies is imperative in these heterogeneous settings. This study aimed at investigating trends and local knowledge on malaria and to develop a framework for malaria control for communities in Baringo, Kenya. Methods Clinical malaria cases obtained from four health facilities in the riverine and lowland zones were used to analyse malaria trends for the 2005–2014 period. A mixed method approach integrating eight focus group discussions, 12 key informant interviews, 300 survey questionnaires and two stakeholders’ consultative forums were used to assess local knowledge on malaria risk and develop a framework for malaria reduction. Results Malaria cases increased significantly during the 2005–2014 period (tau = 0.352; p < 0.001) in the riverine zone. March, April, May, June and October showed significant increases compared to other months. Misconceptions about the cause and mode of malaria transmission existed. Gender-segregated outdoor occupation such as social drinking, farm activities, herding, and circumcision events increased the risk of mosquito bites. A positive relationship occurred between education level and opinion on exposure to malaria risk after dusk (χ2 = 2.70, p < 0.05). There was over-reliance on bed nets, yet only 68% (204/300) of respondents owned at least one net. Complementary malaria control measures were under-utilized, with 90% of respondents denying having used either sprays, repellents or burnt cow dung or plant leaves over the last one year before the study was conducted. Baraza, radios, and mobile phone messages were identified as effective media for malaria information exchange. Supplementary strategies identified included unblocking canals, clearing Prosopis bushes, and use of community volunteers and school clubs to promote social behaviour change. Conclusions The knowledge gap on malaria transmission should be addressed to minimize the impacts and enhance uptake of appropriate malaria management mechanisms. Implementing community-based framework can support significant reductions in malaria prevalence by minimizing both indoor and outdoor malaria transmissions.
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Affiliation(s)
- Jacinter A Amadi
- Institute for Climate Change and Adaptation, University of Nairobi, Nairobi, Kenya. .,Department of Plant Sciences, Kenyatta University, Nairobi, Kenya.
| | - Daniel O Olago
- Institute for Climate Change and Adaptation, University of Nairobi, Nairobi, Kenya
| | - George O Ong'amo
- School of Biological Sciences, University of Nairobi, Nairobi, Kenya
| | - Silas O Oriaso
- Institute for Climate Change and Adaptation, University of Nairobi, Nairobi, Kenya
| | - Isaac K Nyamongo
- Cooperative Development, Research and Innovation, The Cooperative University of Kenya, Nairobi, Kenya
| | - Benson B A Estambale
- Division of Research Innovation and Outreach, Jaramogi Oginga Odinga University of Science and Technology, Bondo, Kenya
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