Social inequalities and COVID-19 mortality between neighborhoods of Bariloche city, Argentina

BACKGROUND

The COVID-19 pandemic has shown how intraurban inequalities are likely to reinforce health and social inequalities. Studies at small area level help to visualize social inequialities hidden in large areas as cities or regions.

AIM

To describe the spatial patterning of COVID-19 death rates in neighborhoods of the medium-sized city of Bariloche, Argentina, and to explore its relationship with the socioeconomic characteristics of neighborhoods.

METHODS

We conducted an ecological study in Bariloche, Argentina. The outcome was counts of COVID-19 deaths between June 2020 and May 2022 obtained from the surveillance system and georeferenced to neighborhoods. We estimated crude- and age-adjusted death rates by neighborhood using a Bayesian approach through a Poisson regression that accounts for spatial-autocorrelation via Conditional Autoregressive (CAR) structure. We also analyzed associations of age-adjusted death rates with area-level socioeconomic indicators.

RESULTS

Median COVID-19 death rate across neighborhoods was 17.9 (10th/90th percentile of 6.3/35.2) per 10,000 inhabitants. We found lower age-adjusted rates in the city core and western part of the city. The age-adjusted death rate in the most deprived areas was almost double than in the least deprived areas, with an education-related relative index of inequality (RII) of 2.14 (95% CI 1.55 to 2.96).

CONCLUSION

We found spatial heterogeneity and intraurban variability in age-adjusted COVID-19 death rates, with a clear social gradient, and a higher burden in already deprived areas. This highlights the importance of studying inequalities in health outcomes across small areas to inform placed-based interventions.

Cesarean sections and social inequalities in 305 cities of Latin America

Background

Aim

Methods

Results

Conclusion

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Overall cesarean section rate was 52%, ranging across large cities from 13% to 91%.

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Lower cesarean rate was found in mothers with lower education (39%) vs higher (61%).

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Better socioeconomic conditions were associated with higher caesarean section rate.

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Reduction of caesarean rates needs concerted action on healthcare working process.

Social inequalities between neighborhoods and cardiovascular disease: a multilevel analysis in a Latin American city

Studies analyzing relations between cardiovascular diseases (CVDs) and environmental aspects in Latin American cities are relatively recent and limited, since most of them are conducted in high-income countries, analyzing mortality outcomes, and comprising large areas. This research focuses on adults with diabetes and/or hypertension under clinical follow-up who live in deprived areas. At the individual level we evaluated sociodemographic and cardiovascular risk factors from patient's records, and at the neighborhood level, socioeconomic conditions from census data. A multilevel analysis was carried out to study CVD. More women than men were under clinical follow-up, but men had higher frequency, higher odds, and shorter time to CVD diagnosis. Multilevel analysis showed that residing in neighborhoods with worst socioeconomic conditions leads to higher odds of CVDs, even after controlling for individual variables: OR (CI95%) of CVD in quartile 2 (Q2) 3.9 (1.2-12.1); Q3 4.0 (1.3-12.3); Q4 2.3 (0.7-8.0) (vs. highest socioeconomic level quartile). Among individuals living in unequal contexts, we found differences in CVD, which makes visible inequalities within inequalities. Differences between women and men should be considered through a gender perspective.

Bariloche: contrastes ocultos en un paraíso alpino. Desigualdades socio-sanitarias en el espacio urbano

Introducción. La mayor parte de las desigualdades en salud observadas están relacionadas con desigualdades de otros planos de la vida social. Estudios de pequeñas áreas nos permiten visibilizar estos gradientes al descender el análisis a escalas más pequeñas. El objetivo de este estudio es relacionar la distribución espacial de enfermedad cardiovascular según condiciones de vida y lugar de atención. Materiales y Métodos. Se caracterizó la ciudad de Bariloche en base a las condiciones de vida de sus vecindarios seleccionando indicadores mediante un análisis factorial. Se ubicó espa¬cialmente a la población atendida por diabetes e hipertensión arterial en los centros de salud. Se relevaron los registros médicos de esta población para analizar sus problemas de salud. Se analizó la distribución de cada dimensión y se calcularon las proporciones de las personas atendidas según condiciones de vida y lugar de atención. Resultados. Casi la mitad (47,6%) de la población vive en vecindarios con condiciones de vida deficitarias y críticas. El 63,2% de las personas atendidas en centros de salud viven en vecindarios con peores condiciones de vida. Y la identificación de un gradiente positivo: ante peores condiciones de vida, mayor es la proporción de enfermedad cardiovascular. Discusión. En el espacio urbano se entrelazan condiciones de vida con problemas de salud, configurándose distintas posibilidades de desarrollarlos. Al interior de una ciudad, pertenecer a determinada área implica la posibilidad/imposibilidad de acceder a niveles relativos de satisfacción de necesidades y presentar determinados problemas de salud. Permite identificar grupos y zonas críticas podría ser un insumo para el diseño de políticas públicas.

[Transformations in the management of diabetes: an analysis of the scientific evidence published by two scientific societies (1980-2010)]

The aim of this study was to describe and analyze changes in the definition of diabetes as a disease and the relationship between these changes and subsequent modifications in the therapeutic management of the disease. A content analysis was performed using articles, guidelines, and consensuses published by the Argentina Diabetes Society and the Latin American Diabetes Association between 1980 and 2010. The different classifications, values used to define a person as diabetic, and treatments were assessed and the changes and modifications discovered were critically analyzed using categories such as medicalization, risk and lifestyles. As a result of the analysis we can observe how the growing process of medicalization, the dependence on the scientific knowledge of central countries, the interests of the pharmaceutical industry, and the crucial role played by pharmacological treatments are all inscribed within the management of diabetes, which can be made visible through the changes that have taken place over the last 30 years.