1
|
Barrio-Cortes J, López-Rodríguez JA, Gómez-Gascón T, Rayo-Gómez Á, Del Cura-González I, Domínguez-Berjón F, Esteban-Vasallo D, Chalco-Orrego JP, Vicente-Rabaneda E, Baldini C, Seghieri C, Goules AV, Fotiadis DI, Tzioufas AG. Prevalence and comorbidities of Sjogren's syndrome patients in the Community of Madrid: A population-based cross-sectional study. Joint Bone Spine 2023; 90:105544. [PMID: 36796581 DOI: 10.1016/j.jbspin.2023.105544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/25/2023] [Accepted: 02/03/2023] [Indexed: 02/17/2023]
Abstract
OBJECTIVES To estimate the prevalence, sociodemographic characteristics and comorbidities of Sjogren's syndrome (SS) patients in the Community of Madrid. METHODS A population-based cross-sectional cohort of SS patients was derived from the information system for rare diseases in the Community of Madrid (SIERMA) and confirmed by a physician. The prevalence per 10,000 inhabitants among people aged ≥18years in June 2015 was calculated. Sociodemographic data and accompanying disorders were recorded. Univariate and bivariate analyses were performed. RESULTS A total of 4,778 SS patients were confirmed in SIERMA; 92.8% were female, with a mean age of 64.3 (standard deviation=15.4) years. A total of 3,116 (65.2%) patients were classified as primary SS (pSS), and 1,662 (34.8%) as secondary SS (sSS). The prevalence of SS among people aged ≥18 years was 8.4/10,000 (95%Confidence interval [CI]=8.2-8.7). The prevalence of pSS was 5.5/10,000 (95%CI=5.3-5.7), and that of sSS was 2.8/10,000 (95%CI=2.7-2.9), with rheumatoid arthritis (20.3%) and systemic lupus erythematosus (8.5%) being the most prevalent associated autoimmune diseases. The most common comorbidities were hypertension (40.8%), lipid disorders (32.7%), osteoarthritis (27.7%) and depression (21.1%). The most prescribed medications were nonsteroidal anti-inflammatory drugs (31.9%), topical ophthalmic therapies (31.2%) and corticosteroids (28.0%). CONCLUSION The prevalence of SS in the Community of Madrid was similar to the overall prevalence worldwide observed in previous studies. SS was more frequent in women in their sixth decade. Two out of every three SS cases were pSS, while one-third were associated predominantly with rheumatoid arthritis and systemic lupus erythematosus.
Collapse
Affiliation(s)
- Jaime Barrio-Cortes
- Foundation for Biosanitary Research and Innovation in Primary Care, Madrid, Spain; Primary Care Research Unit, Gerencia de Atención Primaria, Madrid, Spain; Faculty of Health, Universidad Camilo José Cela, Madrid, Spain; Gregorio Marañón Health Research Institute, Madrid, Spain.
| | - Juan Antonio López-Rodríguez
- Primary Care Research Unit, Gerencia de Atención Primaria, Madrid, Spain; Gregorio Marañón Health Research Institute, Madrid, Spain; Faculty of Health Sciences, Universidad Rey Juan Carlos, Madrid, Spain; General Ricardos Health Centre, Gerencia de Atención Primaria, Madrid, Spain
| | - Tomas Gómez-Gascón
- Foundation for Biosanitary Research and Innovation in Primary Care, Madrid, Spain; Hospital 12 de Octubre Health Research Institute, Madrid, Spain; Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Ángeles Rayo-Gómez
- Foundation for Biosanitary Research and Innovation in Primary Care, Madrid, Spain
| | - Isabel Del Cura-González
- Primary Care Research Unit, Gerencia de Atención Primaria, Madrid, Spain; Gregorio Marañón Health Research Institute, Madrid, Spain; Faculty of Health Sciences, Universidad Rey Juan Carlos, Madrid, Spain
| | - Felicitas Domínguez-Berjón
- Health Reports and Studies Service, Subdirección General de Vigilancia en Salud Pública, Dirección General de Salud Pública, Madrid, Spain
| | - Dolores Esteban-Vasallo
- Health Reports and Studies Service, Subdirección General de Vigilancia en Salud Pública, Dirección General de Salud Pública, Madrid, Spain
| | - Juan Pablo Chalco-Orrego
- Health Reports and Studies Service, Subdirección General de Vigilancia en Salud Pública, Dirección General de Salud Pública, Madrid, Spain
| | - Esther Vicente-Rabaneda
- Rheumatology Department, Hospital Universitario de la Princesa, Madrid, Spain; Hospital Universitario de la Princesa Health Research Institute, Madrid, Spain
| | - Chiara Baldini
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Chiara Seghieri
- Istituto di Management, EMbeDS, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Andreas V Goules
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios I Fotiadis
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, Ioannina, Greece
| | - Athanasios G Tzioufas
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
2
|
Marí-Dell’Olmo M, Gotsens M, Palència L, Rodríguez-Sanz M, Martinez-Beneito MA, Ballesta M, Calvo M, Cirera L, Daponte A, Domínguez-Berjón F, Gandarillas A, Goñi NI, Martos C, Moreno-Iribas C, Nolasco A, Salmerón D, Taracido M, Borrell C. Trends in socioeconomic inequalities in mortality in small areas of 33 Spanish cities. BMC Public Health 2016; 16:663. [PMID: 27473140 PMCID: PMC4966571 DOI: 10.1186/s12889-016-3190-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 06/08/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Spain, several ecological studies have analyzed trends in socioeconomic inequalities in mortality from all causes in urban areas over time. However, the results of these studies are quite heterogeneous finding, in general, that inequalities decreased, or remained stable. Therefore, the objectives of this study are: (1) to identify trends in geographical inequalities in all-cause mortality in the census tracts of 33 Spanish cities between the two periods 1996-1998 and 2005-2007; (2) to analyse trends in the relationship between these geographical inequalities and socioeconomic deprivation; and (3) to obtain an overall measure which summarises the relationship found in each one of the cities and to analyse its variation over time. METHODS Ecological study of trends with 2 cross-sectional cuts, corresponding to two periods of analysis: 1996-1998 and 2005-2007. Units of analysis were census tracts of the 33 Spanish cities. A deprivation index calculated for each census tracts in all cities was included as a covariate. A Bayesian hierarchical model was used to estimate smoothed Standardized Mortality Ratios (sSMR) by each census tract and period. The geographical distribution of these sSMR was represented using maps of septiles. In addition, two different Bayesian hierarchical models were used to measure the association between all-cause mortality and the deprivation index in each city and period, and by sex: (1) including the association as a fixed effect for each city; (2) including the association as random effects. In both models the data spatial structure can be controlled within each city. The association in each city was measured using relative risks (RR) and their 95 % credible intervals (95 % CI). RESULTS For most cities and in both sexes, mortality rates decline over time. For women, the mortality and deprivation patterns are similar in the first period, while in the second they are different for most cities. For men, RRs remain stable over time in 29 cities, in 3 diminish and in 1 increase. For women, in 30 cities, a non-significant change over time in RR is observed. However, in 4 cities RR diminishes. In overall terms, inequalities decrease (with a probability of 0.9) in both men (RR = 1.13, 95 % CI = 1.12-1.15 in the 1st period; RR = 1.11, 95 % CI = 1.09-1.13 in the 2nd period) and women (RR = 1.07, 95 % CI = 1.05-1.08 in the 1st period; RR = 1.04, 95 % CI = 1.02-1.06 in the 2nd period). CONCLUSIONS In the future, it is important to conduct further trend studies, allowing to monitoring trends in socioeconomic inequalities in mortality and to identify (among other things) temporal factors that may influence these inequalities.
Collapse
Affiliation(s)
- Marc Marí-Dell’Olmo
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Agència de Salut Pública de Barcelona, Plaça Lesseps 1, 08023 Barcelona, Spain
- Institut d’Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
- Universitat Rovira i Virgili, Tarragona, Spain
| | - Mercè Gotsens
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Agència de Salut Pública de Barcelona, Plaça Lesseps 1, 08023 Barcelona, Spain
- Institut d’Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
| | - Laia Palència
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Agència de Salut Pública de Barcelona, Plaça Lesseps 1, 08023 Barcelona, Spain
- Institut d’Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
| | - Maica Rodríguez-Sanz
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Agència de Salut Pública de Barcelona, Plaça Lesseps 1, 08023 Barcelona, Spain
- Institut d’Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
| | - Miguel A. Martinez-Beneito
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Fundación para el fomento de la investigación sanitaria y biomédica de la Comunidad Valenciana (FISABIO), Valencia, Spain
| | - Mónica Ballesta
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
| | - Montse Calvo
- Estudios e investigación Sanitaria, Departamento de Sanidad y Consumo, Gobierno Vasco, Vitoria-Gasteiz, Spain
| | - Lluís Cirera
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
| | - Antonio Daponte
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Observatorio de Salud y Medio Ambiente de Andalucía (OSMAN), Escuela Andaluza de Salud Pública (EASP), Granada, Spain
| | | | - Ana Gandarillas
- Subdirección de Promoción de la Salud y Prevención, Consejería de Sanidad, Comunidad de Madrid, Spain
| | - Natividad Izco Goñi
- Registro de Mortalidad, Consejería de Salud y Servicios Sociales, La Rioja, Spain
| | - Carmen Martos
- Instituto Aragonés de Ciencias de la Salud, Zaragoza, Spain
| | - Conchi Moreno-Iribas
- Instituto de Salud Pública de Navarra, Departamento de Salud, Gobierno de Navarra, Pamplona, Navarra Spain
| | - Andreu Nolasco
- Unidad de Investigación en Análisis de la Mortalidad y Estadísticas Sanitarias, Universidad de Alicante, San Vicente del Raspeig, Spain
| | - Diego Salmerón
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
| | - Margarita Taracido
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Santiago de Compostela, Santiago de Compostela, Spain
| | - Carme Borrell
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Agència de Salut Pública de Barcelona, Plaça Lesseps 1, 08023 Barcelona, Spain
- Institut d’Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
| |
Collapse
|
3
|
Esteban-Vasallo MD, Naval Pellicer S, Domínguez-Berjón F, Cantero Caballero M, Asensio Á, Saravia G, Astray-Mochales J. Clostridium difficile -related hospitalizations in Madrid (Spain) between 2003 and 2014, a rising trend. J Infect 2016; 72:401-3. [DOI: 10.1016/j.jinf.2015.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Accepted: 12/12/2015] [Indexed: 10/22/2022]
|
4
|
Pérez G, Rodríguez-Sanz M, Domínguez-Berjón F, Cabeza E, Borrell C. [Indicators to monitor the evolution of the economic crisis and its effects on health and health inequalities. SESPAS report 2014]. Gac Sanit 2015; 28 Suppl 1:124-31. [PMID: 24864001 DOI: 10.1016/j.gaceta.2014.03.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 03/17/2014] [Accepted: 03/20/2014] [Indexed: 11/30/2022]
Abstract
The economic crisis has adverse effects on determinants of health and health inequalities. The aim of this article was to present a set of indicators of health and its determinants to monitor the effects of the crisis in Spain. On the basis of the conceptual framework proposed by the Commission for the Reduction of Social Health Inequalities in Spain, we searched for indicators of social, economic, and political (structural and intermediate) determinants of health, as well as for health indicators, bearing in mind the axes of social inequality (gender, age, socioeconomic status, and country of origin). The indicators were mainly obtained from official data sources published on the internet. The selected indicators are periodically updated and are comparable over time and among territories (among autonomous communities and in some cases among European Union countries), and are available for age groups, gender, socio-economic status, and country of origin. However, many of these indicators are not sufficiently reactive to rapid change, which occurs in the economic crisis, and consequently require monitoring over time. Another limitation is the lack of availability of indicators for the various axes of social inequality. In conclusion, the proposed indicators allow for progress in monitoring the effects of the economic crisis on health and health inequalities in Spain.
Collapse
Affiliation(s)
- Glòria Pérez
- Servei de Sistemes d'Informació Sanitària, Agència de Salut Pública de Barcelona, Barcelona, España; Departamento de Ciencias Experimentales y de la Salud, Universitat Pompeu Fabra, Barcelona, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; Instituto de Investigación Biomédica Sant Pau (IIB Sant Pau), Barcelona, España.
| | - Maica Rodríguez-Sanz
- Servei de Sistemes d'Informació Sanitària, Agència de Salut Pública de Barcelona, Barcelona, España; Departamento de Ciencias Experimentales y de la Salud, Universitat Pompeu Fabra, Barcelona, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; Instituto de Investigación Biomédica Sant Pau (IIB Sant Pau), Barcelona, España
| | | | - Elena Cabeza
- Estratègia d'Alimentació i Vida Activa, Direcció General de Salut Pública i Consum, Conselleria de Salut, Família i Benestar Social, Palma de Mallorca, Mallorca, España
| | - Carme Borrell
- Servei de Sistemes d'Informació Sanitària, Agència de Salut Pública de Barcelona, Barcelona, España; Departamento de Ciencias Experimentales y de la Salud, Universitat Pompeu Fabra, Barcelona, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; Instituto de Investigación Biomédica Sant Pau (IIB Sant Pau), Barcelona, España
| |
Collapse
|
5
|
Marí-Dell'Olmo M, Gotsens M, Palència L, Burström B, Corman D, Costa G, Deboosere P, Díez È, Domínguez-Berjón F, Dzúrová D, Gandarillas A, Hoffmann R, Kovács K, Martikainen P, Demaria M, Pikhart H, Rodríguez-Sanz M, Saez M, Santana P, Schwierz C, Tarkiainen L, Borrell C. Socioeconomic inequalities in cause-specific mortality in 15 European cities. J Epidemiol Community Health 2015; 69:432-41. [PMID: 25631857 DOI: 10.1136/jech-2014-204312] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 12/29/2014] [Indexed: 12/17/2022]
Abstract
BACKGROUND Socioeconomic inequalities are increasingly recognised as an important public health issue, although their role in the leading causes of mortality in urban areas in Europe has not been fully evaluated. In this study, we used data from the INEQ-CITIES study to analyse inequalities in cause-specific mortality in 15 European cities at the beginning of the 21st century. METHODS A cross-sectional ecological study was carried out to analyse 9 of the leading specific causes of death in small areas from 15 European cities. Using a hierarchical Bayesian spatial model, we estimated smoothed Standardized Mortality Ratios, relative risks and 95% credible intervals for cause-specific mortality in relation to a socioeconomic deprivation index, separately for men and women. RESULTS We detected spatial socioeconomic inequalities for most causes of mortality studied, although these inequalities differed markedly between cities, being more pronounced in Northern and Central-Eastern Europe. In the majority of cities, most of these causes of death were positively associated with deprivation among men, with the exception of prostatic cancer. Among women, diabetes, ischaemic heart disease, chronic liver diseases and respiratory diseases were also positively associated with deprivation in most cities. Lung cancer mortality was positively associated with deprivation in Northern European cities and in Kosice, but this association was non-existent or even negative in Southern European cities. Finally, breast cancer risk was inversely associated with deprivation in three Southern European cities. CONCLUSIONS The results confirm the existence of socioeconomic inequalities in many of the main causes of mortality, and reveal variations in their magnitude between different European cities.
Collapse
Affiliation(s)
- Marc Marí-Dell'Olmo
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain Agència de Salut Pública de Barcelona, Barcelona, Spain Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
| | - Mercè Gotsens
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain Agència de Salut Pública de Barcelona, Barcelona, Spain Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
| | - Laia Palència
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain Agència de Salut Pública de Barcelona, Barcelona, Spain Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
| | - Bo Burström
- Division of Social Medicine, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Diana Corman
- Division of Social Medicine, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Giuseppe Costa
- Department of Clinical and Biological Science, University of Turin, Turin, Italy
| | - Patrick Deboosere
- Department of Social Research, Vrije Universiteit Brussel, Brussels, Belgium
| | - Èlia Díez
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain Agència de Salut Pública de Barcelona, Barcelona, Spain Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
| | | | - Dagmar Dzúrová
- Department of Social Geography and Regional Development, Faculty of Science, Charles University in Prague, Prague, Czech Republic
| | - Ana Gandarillas
- Subdirección de Promoción de la Salud y Prevención, Consejería de Sanidad, Comunidad de Madrid, Spain
| | - Rasmus Hoffmann
- Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Pekka Martikainen
- Department of Social Research, University of Helsinki, Helsinki, Finland
| | - Moreno Demaria
- Department of Epidemiology and Environmental Health, Regional Environmental Protection Agency, Piedmont, Italy
| | - Hynek Pikhart
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Maica Rodríguez-Sanz
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain Agència de Salut Pública de Barcelona, Barcelona, Spain Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
| | - Marc Saez
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain
| | - Paula Santana
- Centro de Estudos de Geografia e de Ordenamento do Territorio (CEGOT), Departamento de Geografia, Colégio de S. Jerónimo, Universidade de Coimbra, Coimbra, Portugal
| | | | - Lasse Tarkiainen
- Department of Social Research, University of Helsinki, Helsinki, Finland
| | - Carme Borrell
- Universitat Pompeu Fabra, Barcelona, Spain CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain Agència de Salut Pública de Barcelona, Barcelona, Spain Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
| |
Collapse
|
6
|
Morrison J, Pons-Vigués M, Bécares L, Burström B, Gandarillas A, Domínguez-Berjón F, Diez È, Costa G, Ruiz M, Pikhart H, Marinacci C, Hoffmann R, Santana P, Borrell C. Health inequalities in European cities: perceptions and beliefs among local policymakers. BMJ Open 2014; 4:e004454. [PMID: 24871536 PMCID: PMC4039864 DOI: 10.1136/bmjopen-2013-004454] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To describe the knowledge and beliefs of public policymakers on social inequalities in health and policies to reduce them in cities from different parts of Europe during 2010 and 2011. DESIGN Phenomenological qualitative study. SETTING 13 European cities. PARTICIPANTS 19 elected politicians and officers with a directive status from 13 European cities. MAIN OUTCOME Policymaker's knowledge and beliefs. RESULTS Three emerging discourses were identified among the interviewees, depending on the city of the interviewee. Health inequalities were perceived by most policymakers as differences in life-expectancy between population with economic, social and geographical differences. Reducing health inequalities was a priority for the majority of cities which use surveys as sources of information to analyse these. Bureaucracy, funding and population beliefs were the main barriers. CONCLUSIONS The majority of the interviewed policymakers gave an account of interventions focusing on the immediate determinants and aimed at modifying lifestyles and behaviours in the more disadvantaged classes. More funding should be put towards academic research on effective universal policies, evaluation of their impact and training policymakers and officers on health inequalities in city governments.
Collapse
Affiliation(s)
- Joana Morrison
- Department of Epidemiology and Public Health, University College London, London, UK
- CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
- Agència de Salut Pública de Barcelona, Barcelona, Spain
| | - Mariona Pons-Vigués
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Universitat de Girona, Girona, Spain
| | - Laia Bécares
- School of Social Sciences, University of Manchester, Manchester, UK
| | | | - Ana Gandarillas
- Subdirección General de Promoción de la Salud y Prevención. Consejería de Sanidad. Comunidad de Madrid (Subdirectorate-General for Health Promotion and Prevention. Madrid Regional Health Authority), Spain
| | - Felicitas Domínguez-Berjón
- Subdirección General de Promoción de la Salud y Prevención. Consejería de Sanidad. Comunidad de Madrid (Subdirectorate-General for Health Promotion and Prevention. Madrid Regional Health Authority), Spain
| | - Èlia Diez
- CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
- Agència de Salut Pública de Barcelona, Barcelona, Spain
| | - Giuseppe Costa
- Department of Clinical and Biological Science, University of Turin, Turin, Italy
| | - Milagros Ruiz
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Hynek Pikhart
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Chiara Marinacci
- Epidemiology Department, Local Health Unit TO3, Turin, Italy
- Ministry of Health, Italy, Rome, Italy
| | | | - Paula Santana
- Centro de Estudos de Geografia e Ordenamento do Território (CEGOT), Departamento de Geografia, Universidade de Coimbra, Coimbra , Portugal
| | - Carme Borrell
- CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
- Agència de Salut Pública de Barcelona, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
| | | |
Collapse
|
7
|
Borrell C, Marí-Dell'olmo M, Palència L, Gotsens M, Burström BO, Domínguez-Berjón F, Rodríguez-Sanz M, Dzúrová D, Gandarillas A, Hoffmann R, Kovacs K, Marinacci C, Martikainen P, Pikhart H, Corman D, Rosicova K, Saez M, Santana P, Tarkiainen L, Puigpinós R, Morrison J, Pasarín MI, Díez È. Socioeconomic inequalities in mortality in 16 European cities. Scand J Public Health 2014; 42:245-54. [PMID: 24567425 DOI: 10.1177/1403494814522556] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIMS To explore inequalities in total mortality between small areas of 16 European cities for men and women, as well as to analyse the relationship between these geographical inequalities and their socioeconomic indicators. METHODS A cross-sectional ecological design was used to analyse small areas in 16 European cities (26,229,104 inhabitants). Most cities had mortality data for a period between 2000 and 2008 and population size data for the same period. Socioeconomic indicators included an index of socioeconomic deprivation, unemployment, and educational level. We estimated standardised mortality ratios and controlled for their variability using Bayesian models. We estimated relative risk of mortality and excess number of deaths according to socioeconomic indicators. RESULTS We observed a consistent pattern of inequality in mortality in almost all cities, with mortality increasing in parallel with socioeconomic deprivation. Socioeconomic inequalities in mortality were more pronounced for men than women, and relative inequalities were greater in Eastern and Northern European cities, and lower in some Western (men) and Southern (women) European cities. The pattern of excess number of deaths was slightly different, with greater inequality in some Western and Northern European cities and also in Budapest, and lower among women in Madrid and Barcelona. CONCLUSIONS In this study, we report a consistent pattern of socioeconomic inequalities in mortality in 16 European cities. Future studies should further explore specific causes of death, in order to determine whether the general pattern observed is consistent for each cause of death.
Collapse
Affiliation(s)
- Carme Borrell
- 1Agència de Salut Pública de Barcelona, Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Borrell C, Domínguez-Berjón F, Galán I, Fernández E. [Farewell to paper in Gaceta Sanitaria]. Gac Sanit 2013; 27:479. [PMID: 24216121 DOI: 10.1016/j.gaceta.2013.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 10/07/2013] [Indexed: 11/18/2022]
|
9
|
Gotsens M, Marí-Dell'Olmo M, Pérez K, Palència L, Martinez-Beneito MA, Rodríguez-Sanz M, Burström B, Costa G, Deboosere P, Domínguez-Berjón F, Dzúrová D, Gandarillas A, Hoffmann R, Kovacs K, Marinacci C, Martikainen P, Pikhart H, Rosicova K, Saez M, Santana P, Riegelnig J, Schwierz C, Tarkiainen L, Borrell C. Socioeconomic inequalities in injury mortality in small areas of 15 European cities. Health Place 2013; 24:165-72. [PMID: 24112963 DOI: 10.1016/j.healthplace.2013.09.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 08/30/2013] [Accepted: 09/10/2013] [Indexed: 11/26/2022]
Abstract
This study analysed socioeconomic inequalities in mortality due to injuries in small areas of 15 European cities, by sex, at the beginning of this century. A cross-sectional ecological study with units of analysis being small areas within 15 European cities was conducted. Relative risks of injury mortality associated with the socioeconomic deprivation index were estimated using hierarchical Bayesian model. The number of small areas varies from 17 in Bratislava to 2666 in Turin. The median population per small area varies by city (e.g. Turin had 274 inhabitants per area while Budapest had 76,970). Socioeconomic inequalities in all injury mortality are observed in the majority of cities and are more pronounced in men. In the cities of northern and western Europe, socioeconomic inequalities in injury mortality are found for most types of injuries. These inequalities are not significant in the majority of cities in southern Europe among women and in the majority of central eastern European cities for both sexes. The results confirm the existence of socioeconomic inequalities in injury related mortality and reveal variations in their magnitude between different European cities.
Collapse
Affiliation(s)
- Mercè Gotsens
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Agència de Salut Pública de Barcelona, Barcelona, Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Alonso-Babarro A, Astray-Mochales J, Domínguez-Berjón F, Gènova-Maleras R, Bruera E, Díaz-Mayordomo A, Centeno Cortes C. The association between in-patient death, utilization of hospital resources and availability of palliative home care for cancer patients. Palliat Med 2013; 27:68-75. [PMID: 22492481 DOI: 10.1177/0269216312442973] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The impact of palliative home care programs on in-patient admissions and deaths has not been appropriately established. AIM The main objectives of this study have been to evaluate the frequency of in-patient hospital deaths and the use of hospital resources among cancer patients in two areas of the Madrid Region, as well as to assess differences between one area with and one without a palliative home care team (PHCT) in those variables. DESIGN AND SETTING We conducted a population-based study comparing two adjacent metropolitan areas of approximately 200,000 inhabitants each in the Madrid Region, Spain, measuring in-patient deaths, emergency room admissions and in-patient days among cancer patients who died in 2005. Only one of the two areas had a fully established PHCT. RESULTS 524/549 cancer patients (95%) had an identified place of death: 74% died in hospital, 17% at home, 6% in an in-patient hospice and 3% in a nursing home. The frequency of hospital deaths was significantly lower among patients of the PHCT area (61% versus 77%, p < 0.001), as well as the number of patients using emergency and in-patient services (68% versus 79%, p = 0.004, and 66 versus 76%, p = 0.012, respectively). After adjusting for other factors, the risk of hospital death was lower among patients older than 80 (OR, 95% CI, 0.3, 0.1-0.5), higher among patients with hematological malignancies (OR 6.1, 2.0-18.9) and lower among patients of the PHCT area (OR 0.4, 0.2-0.6). CONCLUSIONS Our findings suggest that a PHCT is associated with reduced in-patient deaths and overall hospitalization over the last two months of life.
Collapse
|
11
|
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). Accid Anal Prev 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] [What about the content of this article? (0)] [Affiliation(s)] [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
|
12
|
Borrell C, Domínguez-Berjón F, Pasarín MI, Ferrando J, Rohlfs I, Nebot M. Social inequalities in health related behaviours in Barcelona. J Epidemiol Community Health 2000; 54:24-30. [PMID: 10692958 PMCID: PMC1731540 DOI: 10.1136/jech.54.1.24] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE This study describes social class inequalities in health related behaviours (tobacco and alcohol consumption, physical activity) among a sample of general population over 14 years old in Barcelona. DESIGN Cross sectional study (Barcelona Health Interview Survey). SETTING Barcelona city (Spain). PARTICIPANTS A representative stratified sample of the non-institutionalised population resident in Barcelona was obtained. This study refers to the 4171 respondents aged over 14. DATA Social class was obtained from a Spanish adaptation of the British Registrar General classification. In addition, sociodemographic variables such as family structure and employment status were used. As health related behaviours tobacco consumption, alcohol consumption, usual physical activity and leisure time physical activity were analysed. Age adjusted percentages were compared by social class. Multivariate analysis was performed using logistic regression models. MAIN RESULTS Women in the upper social classes were more likely to smoke, the adjusted odds ratio (OR) for social class V in reference to social class I was 0.36 (95% confidence intervals (95%CI): 0.19, 0.67), while the opposite occurred among men although it was not statistically significant in multivariate analysis. Smoking cessation was more likely among men in the higher classes (OR for class V 0.41, 95%CI: 0.18, 0.90). Excessive alcohol consumption among men showed no differences between classes, while among women it was greater in the upper classes. Engaging in usual physical activity classified as "light or none" in men decreased with lowering social class (OR class IVa: 0.55 and OR class IVb: 0.47). Women of social classes IV and V were less likely to have two or more health risk behaviours (OR for class V 0.33, 95% CI: 0.18, 0.62). CONCLUSION Health damaging behaviours are differentially distributed among social classes in Barcelona. Health policies should take into account these inequalities.
Collapse
Affiliation(s)
- C Borrell
- Municipal Institute of Public Health, Barcelona, Spain
| | | | | | | | | | | |
Collapse
|
13
|
Borrell C, Rohlfs I, Ferrando J, Pasarín MI, Domínguez-Berjón F, Plasència A. Social inequalities in perceived health and the use of health services in a southern European urban area. Int J Health Serv 2000; 29:743-64. [PMID: 10615572 DOI: 10.2190/mvw3-pj88-lyg4-ewqt] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
People of lower social class have worse health and less access to health services and preventive care. This article describes social class inequalities in health status and use of services, both curative and preventive, in Barcelona, in a country with a national health service. The cross-sectional study uses information from the 1992 Barcelona Health Interview Survey. Social class was designated using an adaptation of the British Registrar General classification. The study variables measured health status, health services utilization, and preventive practices. Bivariate and multivariate analyses were used. Some 88 percent of men in social class I and 81 percent in class V had very good or good perceived health status. For women these figures were 85.2 and 57.6 percent, respectively. Chronic illness increased with lower social class. There were no social class differences in the frequency of physician visits during the two weeks prior to the interview among people with poor perceived health. Some 60.7 percent of women aged over 29 in social class I had periodic cervical smears, but only 32 percent of those in class V; the corresponding figures for mammography were 37.8 and 11.3 percent. The national health service has advantages in terms of access to health services, but more knowledge about the quality of these services is required. The study findings are sufficient to defend the undertaking of equitable health policies, especially in providing access to preventive care for the entire population.
Collapse
Affiliation(s)
- C Borrell
- Municipal Institute of Health, Barcelona, Spain
| | | | | | | | | | | |
Collapse
|
14
|
Abstract
BACKGROUND Several studies have used a simplified approach for the assessment of physical activity such as the frequency of exercise-induced sweating. In this study leisure-time physical activity has been assessed using this and another more detailed measure. SUBJECTS AND METHODS A sample of 4171 adults answered the Health Interview Survey of Barcelona in 1992. The respondents were classified into categories depending on participation in moderate and/or intense physical activity (> or =20 min) and also according to the frequency of exercise-induced sweating: 0, 1-2 and > or =3 times/week. Agreement between the two measures was calculated using the weighted Kappa (Kw) statistic with 95% confidence intervals (95% CI). Stratified analyses were performed. RESULTS Prevalence of physical activity > or =3 times/week was lower with the sweat question (12.5%) than with the questions about the frequency of performance of selected activities (19.6%). The physical activity patterns by age, gender and overweight were similar for the two measures, but differed by month of the year. Agreement was lower among the older age categories and was higher among males (Kw = 0.59, 95% CI: 0.57-0.62) than among females (Kw = 0.48, 95% CI: 0.46-0.50). Overall, the agreement was higher in the hotter months (Kw = 0.72 among males and 0.58 among females). CONCLUSIONS In the assessment of physical activity in the population by means of the sweat question there can be interference from other variables, apart from the intensity of the activity, which influence sweating during the exercise. Further assessments of the validity of exercise-induced sweating in representative samples of the general population would be useful.
Collapse
|