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Sanz-Mas M, Ubalde-López M, Borràs S, Brugueras S, Continente X, Daher C, Marí-Dell'Olmo M, López MJ. Adapting Schools to Climate Change with Green, Blue, and Grey Measures in Barcelona: Study Protocol of a Mixed-Method Evaluation. J Urban Health 2024; 101:141-154. [PMID: 38236429 PMCID: PMC10897086 DOI: 10.1007/s11524-023-00814-y] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/07/2023] [Indexed: 01/19/2024]
Abstract
Under the framework of the Urban Innovative Actions program of the European Commission, in 2020, 11 primary schools in Barcelona were transformed into climate shelters by implementing green, blue, and grey measures. Schoolyards were also opened to the local community to be used during non-school periods. Here we present the study protocol of a mixed-method approach to evaluate the effectiveness of the interventions in terms of improving environmental quality and health for users. We evaluated school level through the following: (1) quantitative pre-post quasi-experimental study, and (2) qualitative evaluation. The quantitative study included measures of (a) environmental variables (collected via low-cost and non-low-cost sensors), (b) students' health and well-being (collected via health questionnaires, attention levels test, and systematic observations), and (c) teachers' health and well-being (collected via thermal comfort measurements and health questionnaires). The qualitative methods evaluated the perceptions about the effects of the interventions among students (using Photovoice) and teachers (through focus groups). The impact of the interventions was assessed at community level during summer non-school periods through a spontaneous ethnographic approach. Data collection started in August 2019 and ended in July 2022. The evaluation provides the opportunity to identify those solutions that worked and those that need to be improved for future experiences, as well as improve the evaluation methodology and replication for these kinds of interventions.
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Affiliation(s)
- Marta Sanz-Mas
- Agència de Salut Pública de Barcelona (ASPB), Pl. Lesseps 1, 08023, Barcelona, Spain
- Departament de Ciències Experimentals i de La Salut (DCEXS), Universitat Pompeu Fabra, Doctor Aiguader 88, 08003, Barcelona, Spain
| | - Mònica Ubalde-López
- Departament de Ciències Experimentals i de La Salut (DCEXS), Universitat Pompeu Fabra, Doctor Aiguader 88, 08003, Barcelona, Spain
- ISGlobal, Barcelona Institute for Global Health, Doctor Aiguader 88, 08003, Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Av. Monforte de Lemos 3-5, Pabellón 11, Planta 0, 28029, Madrid, Spain
| | - Sílvia Borràs
- ISGlobal, Barcelona Institute for Global Health, Doctor Aiguader 88, 08003, Barcelona, Spain
| | - Sílvia Brugueras
- Agència de Salut Pública de Barcelona (ASPB), Pl. Lesseps 1, 08023, Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Av. Monforte de Lemos 3-5, Pabellón 11, Planta 0, 28029, Madrid, Spain
| | - Xavier Continente
- Agència de Salut Pública de Barcelona (ASPB), Pl. Lesseps 1, 08023, Barcelona, Spain.
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Av. Monforte de Lemos 3-5, Pabellón 11, Planta 0, 28029, Madrid, Spain.
- Institut de Recerca Sant Pau (IR SANT PAU), Sant Quintí 77-79, 08041, Barcelona, Spain.
| | - Carolyn Daher
- Departament de Ciències Experimentals i de La Salut (DCEXS), Universitat Pompeu Fabra, Doctor Aiguader 88, 08003, Barcelona, Spain
- ISGlobal, Barcelona Institute for Global Health, Doctor Aiguader 88, 08003, Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Av. Monforte de Lemos 3-5, Pabellón 11, Planta 0, 28029, Madrid, Spain
| | - Marc Marí-Dell'Olmo
- Agència de Salut Pública de Barcelona (ASPB), Pl. Lesseps 1, 08023, Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Av. Monforte de Lemos 3-5, Pabellón 11, Planta 0, 28029, Madrid, Spain
- Institut de Recerca Sant Pau (IR SANT PAU), Sant Quintí 77-79, 08041, Barcelona, Spain
| | - María José López
- Agència de Salut Pública de Barcelona (ASPB), Pl. Lesseps 1, 08023, Barcelona, Spain
- Departament de Ciències Experimentals i de La Salut (DCEXS), Universitat Pompeu Fabra, Doctor Aiguader 88, 08003, Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Av. Monforte de Lemos 3-5, Pabellón 11, Planta 0, 28029, Madrid, Spain
- Institut de Recerca Sant Pau (IR SANT PAU), Sant Quintí 77-79, 08041, Barcelona, Spain
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Benítez-Cano D, González-Marín P, Gómez-Gutiérrez A, Marí-Dell'Olmo M, Oliveras L. Association of drought conditions and heavy rainfalls with the quality of drinking water in Barcelona (2010-2022). J Expo Sci Environ Epidemiol 2024; 34:175-183. [PMID: 38030824 DOI: 10.1038/s41370-023-00611-4] [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] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 10/10/2023] [Accepted: 10/31/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Climate change influences the incidence and scope of climate extreme events that affect communities and the environment around the world. In an urban context such as Barcelona, these climate extremes can have a negative impact on drinking water quality. The worsening of drinking water quality can have important repercussions on human health, leading to the appearance of different diseases. OBJECTIVE Investigate the association between climate extremes, in particular heavy rainfall events and drought conditions, and the drinking water quality in the city of Barcelona from 2010 to 2022. METHODS We conducted a daily retrospective time-series study using data covering 13 years of daily monitoring of conductivity, nickel, turbidity and trihalomethanes parameters of raw water in the Llobregat River catchment area and treated water in the Drinking Water Treatment Plant (DWTP) Sant Joan Despí. We used river flow as a proxy for drought conditions and heavy rainfall events. We analyzed short-term associations between river flow rate and quality parameters in raw and treated water using generalized linear regression with distributed lag-non-linear models (DLNM). RESULTS A low flow, as an indicator of drought condition or low rainfall, was significantly associated with an increase in conductivity in raw water and nickel in both raw and treated water. A high flow, as an indicator of heavy rainfall events, was significantly associated with an increase of turbidity in raw water, and a decrease in all other quality parameters. IMPACT STATEMENT This study provides novel evidence that climate extremes have an impact on the quality of drinking water in urban areas with a Mediterranean climate. The findings of this study are significant because they suggest that as the frequency and intensity of climate extremes increase due to climate change, there will be further challenges in managing and treating drinking water, which could have a detrimental effect on public health. This study serves as an important reminder of the need to strengthen and accelerate adaptation actions in water management to ensure an adequate supply of drinking water that protects the people's health.
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Affiliation(s)
- Daniela Benítez-Cano
- Agència de Salut Pública de Barcelona, Lesseps 1, 08023, Barcelona, Catalonia, Spain
- Universitat Pompeu Fabra, Doctor Aiguader 88, 08003, Barcelona, Catalonia, Spain
| | - Patricia González-Marín
- Agència de Salut Pública de Barcelona, Lesseps 1, 08023, Barcelona, Catalonia, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Sant Quintí 77, 08041, Barcelona, Catalonia, Spain
| | - Anna Gómez-Gutiérrez
- Agència de Salut Pública de Barcelona, Lesseps 1, 08023, Barcelona, Catalonia, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Sant Quintí 77, 08041, Barcelona, Catalonia, Spain
| | - Marc Marí-Dell'Olmo
- Agència de Salut Pública de Barcelona, Lesseps 1, 08023, Barcelona, Catalonia, Spain.
- Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Sant Quintí 77, 08041, Barcelona, Catalonia, Spain.
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Catalonia, Spain.
| | - Laura Oliveras
- Agència de Salut Pública de Barcelona, Lesseps 1, 08023, Barcelona, Catalonia, Spain.
- Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Sant Quintí 77, 08041, Barcelona, Catalonia, Spain.
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Martinez-Beneito MA, Marí-Dell'Olmo M, Sánchez-Valdivia N, Rodríguez-Sanz M, Pérez G, Pasarín MI, Rius C, Artazcoz L, Prieto R, Pérez K, Borrell C. Socioeconomic inequalities in COVID-19 incidence during the first six waves in Barcelona. Int J Epidemiol 2023; 52:1687-1695. [PMID: 37494962 DOI: 10.1093/ije/dyad105] [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: 11/10/2022] [Accepted: 07/11/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND The emergence of SARS-CoV-2 affected urban areas. In Barcelona, six waves of COVID-19 hit the city between March 2020 and March 2022. Inequalities in the incidence of COVID-19 have been described. However, no studies have examined the daily trends of socioeconomic inequalities and how they changed during the different phases of the pandemic. The aim of this study is to analyse the dynamic socioeconomic inequalities in the incidence of COVID-19 during the six waves in Barcelona. METHODS We examined the proportion of daily cases observed in the census tracts in the lower income tercile compared with the proportion of daily cases observed in the sum of the lower and higher income terciles. Daily differences in these proportions were assessed as a function of the epidemic waves, sex, age group, daily incidence and daily change in the incidence. A logistic regression model with an autoregressive term was used for statistical analysis. RESULTS A time-dynamic effect was found for socioeconomic inequalities in the incidence of COVID-19. In fact, belonging to a lower-income area changed from being a risk factor (Waves 1, 2, 4 and 5) to being a protective factor in the sixth wave of the pandemic. Age also had a significant effect on incidence, which also changed over the different waves of the pandemic. Finally, the lower-income areas showed a comparatively lower incidence during the ascending phase of the epidemic waves. CONCLUSION Socioeconomic inequalities in COVID-19 changed by wave, age group and wave phase.
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Affiliation(s)
| | - Marc Marí-Dell'Olmo
- Unit of Data Management and Analysis, Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB, SANT PAU), Barcelona, Spain
| | | | - Maica Rodríguez-Sanz
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB, SANT PAU), Barcelona, Spain
- Unit of Research, Training and Communication, Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Glòria Pérez
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB, SANT PAU), Barcelona, Spain
- Unit of COVID-19, Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Maria Isabel Pasarín
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB, SANT PAU), Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
- Direction of Health Promotion, Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain
| | - Cristina Rius
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB, SANT PAU), Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
- Service of Epidemiology, Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain
| | - Lucía Artazcoz
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB, SANT PAU), Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
- Direction of Health Observatory, Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain
| | - Raquel Prieto
- Institut d'Investigació Biomèdica Sant Pau (IIB, SANT PAU), Barcelona, Spain
- Service of Epidemiology, Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain
| | - Katherine Pérez
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB, SANT PAU), Barcelona, Spain
- Service of Health Information Systems, Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain
| | - Carme Borrell
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB, SANT PAU), Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
- Executive Director, Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain
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Font-Ribera L, Rico M, Marí-Dell'Olmo M, Oliveras L, Trapero-Bertran M, Pérez G, Valero N, Bartoll X, Realp E, Gómez-Gutiérrez A. Estimating ambient air pollution mortality and disease burden and its economic cost in Barcelona. Environ Res 2023; 216:114485. [PMID: 36206924 DOI: 10.1016/j.envres.2022.114485] [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] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 09/14/2022] [Accepted: 09/30/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The new WHO air quality guidelines indicate that the air pollution disease burden is greater than previously reported. We aimed to estimate the air pollution disease burden and its economic cost in Barcelona to inform local action. METHODS We used a quantitative health impact assessment to estimate the non-accidental mortality and incidence of childhood asthma and lung cancer attributable to long-term air pollution exposure in the city of Barcelona (Spain) in 2018-2019. We used the population weighted mean of PM2.5 and NO2 assigned at the geocoded address during the study period and the 2021 WHO air quality guidelines as counterfactual scenario to estimate new annual cases attributable to each pollutant separately and combined. We estimated the social cost of attributable deaths and the health care cost of childhood asthma and lung cancer attributable cases. We also estimated attributable mortality by city district and the mortality avoidable by achieving the WHO air quality interim targets. RESULTS Mean exposure was 17 μg/m3 for PM2.5 and 39 μg/m3 for NO2. Total combined air pollution attributable mortality was 13% (95%CI = 9%-17%), corresponding to 1,886 deaths (95%CI = 1,296-2,571) and a social cost of €1,292 million (95%CI = 888-1,762) annually. Fifty-one percent (95%CI = 21%-71%) and 17% (95%CI = 7%-29%) of new cases of childhood asthma and lung cancer were attributable to air pollution with a health care cost of €4.3 and €2.7 million, respectively. Achieving the first unmet WHO air quality interim targets for PM2.5 and for NO2 would avoid 410 deaths and €281 million annually. CONCLUSION Air pollution in Barcelona represents a huge disease and economic burden, which is greater than previous estimates. Much stronger measures to reduce PM2.5 and NO2 levels are urgently needed. Until the WHO air quality guidelines are met in the city, achieving each WHO air quality interim targets would avoid hundreds of deaths each year.
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Affiliation(s)
- Laia Font-Ribera
- Agència de Salut Pública de Barcelona (ASPB), Spain; Institut de Recerca de Sant Pau (IIB Sant Pau), Spain.
| | - Marc Rico
- Agència de Salut Pública de Barcelona (ASPB), Spain
| | - Marc Marí-Dell'Olmo
- Agència de Salut Pública de Barcelona (ASPB), Spain; Institut de Recerca de Sant Pau (IIB Sant Pau), Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Laura Oliveras
- Agència de Salut Pública de Barcelona (ASPB), Spain; Institut de Recerca de Sant Pau (IIB Sant Pau), Spain
| | - Marta Trapero-Bertran
- Basic Sciences Department. University Institute for Patient Care. Universitat Internacional de Catalunya (UIC), Spain
| | - Glòria Pérez
- Agència de Salut Pública de Barcelona (ASPB), Spain; Institut de Recerca de Sant Pau (IIB Sant Pau), Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Universitat Pompeu Fabra (UPF), Spain
| | | | - Xavier Bartoll
- Agència de Salut Pública de Barcelona (ASPB), Spain; Institut de Recerca de Sant Pau (IIB Sant Pau), Spain
| | | | - Anna Gómez-Gutiérrez
- Agència de Salut Pública de Barcelona (ASPB), Spain; Institut de Recerca de Sant Pau (IIB Sant Pau), Spain
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5
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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. Gac Sanit 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] [What about the content of this article? (0)] [Affiliation(s)] [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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6
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Carrere J, Belvis F, Peralta A, Marí-Dell'Olmo M, López MJ, Benach J, Novoa AM. Effectiveness of an Energy-Counseling Intervention in Reducing Energy Poverty: Evidence from a Quasi-Experimental Study in a Southern European City. J Urban Health 2022; 99:549-561. [PMID: 35622196 PMCID: PMC9187783 DOI: 10.1007/s11524-022-00642-6] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/29/2022] [Indexed: 11/30/2022]
Abstract
Energy poverty is a serious social problem with well-known adverse health consequences. This problem has been addressed mainly through improvements in the energy efficiency of housing. Still, little is known about the effects of information-based measures on energy poverty and their impacts on health. A quasi-experimental study was implemented to assess the effectiveness of an energy-counseling home visit intervention targeting the vulnerable population in a southern European city, Barcelona, in alleviating energy poverty and improving health. The intervention had beneficial impacts on keeping homes at an adequate indoor temperature and reducing primary care visits. No effects were found on self-perceived health or self-reported anxiety and depression. After the intervention, participants reported a decrease in arrears on utility bills, but less pronounced than in the comparison group. In conclusion, the study showed that information-based measures lead to psychosocial gains and reduced healthcare use. Nevertheless, the impact of these measures could be enhanced by combining them with policies and programmes that address the structural determinants of energy poverty.
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Affiliation(s)
- Juli Carrere
- Agència de Salut Pública de Barcelona, 08023, Pl. Lesseps 1, Barcelona, Spain. .,Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain. .,Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain.
| | - Francesc Belvis
- Research Group on Health Inequalities, Environment, and Employment Conditions (GREDS-EMCONET) Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Spain.,Johns Hopkins University-Universitat Pompeu Fabra Public Policy Center (JHU-UPF PPC), Barcelona, Spain
| | - Andrés Peralta
- Instituto de Salud Pública, Facultad de Medicina, Pontificia Universidad Católica del Ecuador, Quito, Ecuador
| | - Marc Marí-Dell'Olmo
- Agència de Salut Pública de Barcelona, 08023, Pl. Lesseps 1, Barcelona, Spain.,Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - María José López
- Agència de Salut Pública de Barcelona, 08023, Pl. Lesseps 1, Barcelona, Spain.,Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Joan Benach
- Research Group on Health Inequalities, Environment, and Employment Conditions (GREDS-EMCONET) Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Spain.,Johns Hopkins University-Universitat Pompeu Fabra Public Policy Center (JHU-UPF PPC), Barcelona, Spain.,UPF Barcelona School of Management (UPF-BSM), Barcelona, Spain
| | - Ana M Novoa
- Agència de Salut Pública de Barcelona, 08023, Pl. Lesseps 1, Barcelona, Spain.,Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
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7
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López-Gay A, Spijker J, Cole HVS, Marques AG, Triguero-Mas M, Anguelovski I, Marí-Dell'Olmo M, Módenes JA, Álamo-Junquera D, López-Gallego F, Borrell C. Sociodemographic determinants of intraurban variations in COVID-19 incidence: the case of Barcelona. J Epidemiol Community Health 2022; 76:1-7. [PMID: 34158409 PMCID: PMC8228814 DOI: 10.1136/jech-2020-216325] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [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: 12/27/2020] [Accepted: 05/30/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Intraurban sociodemographic risk factors for COVID-19 have yet to be fully understood. We investigated the relationship between COVID-19 incidence and sociodemographic factors in Barcelona at a fine-grained geography. METHODS This cross-sectional ecological study is based on 10 550 confirmed cases of COVID-19 registered during the first wave in the municipality of Barcelona (population 1.64 million). We considered 16 variables on the demographic structure, urban density, household conditions, socioeconomic status, mobility and health characteristics for 76 geographical units of analysis (neighbourhoods), using a lasso analysis to identify the most relevant variables. We then fitted a multivariate Quasi-Poisson model that explained the COVID-19 incidence by neighbourhood in relation to these variables. RESULTS Neighbourhoods with: (1) greater population density, (2) an aged population structure, (3) a high presence of nursing homes, (4) high proportions of individuals who left their residential area during lockdown and/or (5) working in health-related occupations were more likely to register a higher number of cases of COVID-19. Conversely, COVID-19 incidence was negatively associated with (6) percentage of residents with post-secondary education and (7) population born in countries with a high Human Development Index. CONCLUSION Like other historical pandemics, the incidence of COVID-19 is associated with neighbourhood sociodemographic factors with a greater burden faced by already deprived areas. Because urban social and health injustices already existed in those geographical units with higher COVID-19 incidence in Barcelona, the current pandemic is likely to reinforce both health and social inequalities, and urban environmental injustice all together.
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Affiliation(s)
- Antonio López-Gay
- Department of Geography, Autonomous University of Barcelona, Barcelona, Spain
- Center for Demographic Studies, Bellaterra, Spain
| | | | - Helen V S Cole
- Barcelona Lab for Urban Environmental Justice and Sustainability, Autonomous University of Barcelona, Barcelona, Spain
| | - Antonio G Marques
- Department of Signal Theory and Communications, Rey Juan Carlos University, Madrid, Spain
| | - Margarita Triguero-Mas
- Institute for Environmental Science and Technology-Barcelona Lab for Urban Environmental Justice and Sustainability, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
- Department of Urban Studies and Planning-Mariana Arcaya's Research Lab, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Isabelle Anguelovski
- Autonomous University of Barcelona, Bellaterra, Spain
- Catalan Institution for Research and Advanced Studies, Barcelona, Spain
| | - Marc Marí-Dell'Olmo
- Agència de Salut Pública de Barcelona, Barcelona, Spain
- CIBER de Epidemiología y Salud Pública, Madrid, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
| | | | | | | | - Carme Borrell
- Agència de Salut Pública de Barcelona, Barcelona, Spain
- CIBER de Epidemiología y Salud Pública, Madrid, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
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8
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Palència L, Ferrando J, Marí-Dell'Olmo M, Gotsens M, Morrison J, Dzurova D, Lustigova M, Costa C, Rodríguez-Sanz M, Bosakova L, Santana P, Borrell C. Socio-economic inequalities on cancer mortality in nine European areas: The effect of the last economic recession. Cancer Epidemiol 2020; 69:101827. [PMID: 33038640 DOI: 10.1016/j.canep.2020.101827] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 02/25/2020] [Revised: 09/10/2020] [Accepted: 09/13/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND The effect of inequalities aggravated by economic recessions in the mortality rates of certain diseases has been previously described. In this study, we analyzed the relationship between socio-economic deprivation and cancer mortality. We focused on lung, colon, prostate, and breast cancers in nine European urban areas over three periods: two before (2000-2003 and 2004-2008) and one after (2009-2014) the onset of the 2008 financial crisis. METHODS This is an ecological study of trends. The units of analysis were small areas within nine European urban areas. We used a composite deprivation index as a socio-economic indicator. As a mortality indicator, we used the smoothed standardized mortality ratio, calculated using the hierarchical Bayesian model proposed by Besag, York and Mollié. To analyze the evolution of socio-economic inequalities, we fitted an ecological regression model that included the socio-economic indicator, the period of time, and the interaction between these terms. RESULTS In men, socio-economic inequalities in all-cancer and lung cancer mortality were observed in most of the cities studied, but did not increase after the onset of the economic crisis. In women, only two cities (Stockholm and London) showed socio-economic inequalities in all-cancer and lung cancer mortality; there was also no increase in inequalities. CONCLUSIONS Our results did not validate our hypothesis that inequalities increase in times of crisis. However, they emphasize the importance of socio-economic measurements for understanding mortality inequalities, and can be used to inform prevention strategies and help plan local health programs aimed at reducing health inequalities.
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Affiliation(s)
- Laia Palència
- Agència de Salut Pública de Barcelona, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain.
| | | | - Marc Marí-Dell'Olmo
- Agència de Salut Pública de Barcelona, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain.
| | - Mercè Gotsens
- Agència de Salut Pública de Barcelona, Barcelona, Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
| | - Joana Morrison
- Institute of Health Equity at the Research Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Dagmar Dzurova
- Department of Social Geography and Regional Development, Faculty of Science, Charles University, Prague, Czechia
| | - Michala Lustigova
- Department of Social Geography and Regional Development, Faculty of Science, Charles University, Prague, Czechia
| | - Claudia Costa
- Centre of Studies in Geography and Spatial Planning, University of Coimbra, Coimbra, Portugal
| | - Maica Rodríguez-Sanz
- Agència de Salut Pública de Barcelona, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain
| | - Lucia Bosakova
- Department of Health Psychology and Research Methodology, Medical Faculty, P. J. Safarik University in Kosice, Kosice, Slovak Republic; Olomouc University Social Health Institute (OUSHI), Palacky University in Olomouc, Olomouc, Czech Republic
| | - Paula Santana
- Centre of Studies in Geography and Spatial Planning, University of Coimbra, Coimbra, Portugal
| | - Carme Borrell
- Agència de Salut Pública de Barcelona, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain
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9
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Santana P, Freitas Â, Stefanik I, Costa C, Oliveira M, Rodrigues TC, Vieira A, Ferreira PL, Borrell C, Dimitroulopoulou S, Rican S, Mitsakou C, Marí-Dell'Olmo M, Schweikart J, Corman D, Bana E Costa CA. Advancing tools to promote health equity across European Union regions: the EURO-HEALTHY project. Health Res Policy Syst 2020; 18:18. [PMID: 32054540 PMCID: PMC7020561 DOI: 10.1186/s12961-020-0526-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 06/19/2019] [Accepted: 01/15/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Population health measurements are recognised as appropriate tools to support public health monitoring. Yet, there is still a lack of tools that offer a basis for policy appraisal and for foreseeing impacts on health equity. In the context of persistent regional inequalities, it is critical to ascertain which regions are performing best, which factors might shape future health outcomes and where there is room for improvement. METHODS Under the EURO-HEALTHY project, tools combining the technical elements of multi-criteria value models and the social elements of participatory processes were developed to measure health in multiple dimensions and to inform policies. The flagship tool is the Population Health Index (PHI), a multidimensional measure that evaluates health from the lens of equity in health determinants and health outcomes, further divided into sub-indices. Foresight tools for policy analysis were also developed, namely: (1) scenarios of future patterns of population health in Europe in 2030, combining group elicitation with the Extreme-World method and (2) a multi-criteria evaluation framework informing policy appraisal (case study of Lisbon). Finally, a WebGIS was built to map and communicate the results to wider audiences. RESULTS The Population Health Index was applied to all European Union (EU) regions, indicating which regions are lagging behind and where investments are most needed to close the health gap. Three scenarios for 2030 were produced - (1) the 'Failing Europe' scenario (worst case/increasing inequalities), (2) the 'Sustainable Prosperity' scenario (best case/decreasing inequalities) and (3) the 'Being Stuck' scenario (the EU and Member States maintain the status quo). Finally, the policy appraisal exercise conducted in Lisbon illustrates which policies have higher potential to improve health and how their feasibility can change according to different scenarios. CONCLUSIONS The article makes a theoretical and practical contribution to the field of population health. Theoretically, it contributes to the conceptualisation of health in a broader sense by advancing a model able to integrate multiple aspects of health, including health outcomes and multisectoral determinants. Empirically, the model and tools are closely tied to what is measurable when using the EU context but offering opportunities to be upscaled to other settings.
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Affiliation(s)
- Paula Santana
- Department of Geography and Tourism, Faculty of Arts and Humanities, University of Coimbra, Colégio S. Jerónimo, Largo D. Dinis, 3001-401, Coimbra, Portugal.
- CEGOT-UC, Centre of Studies in Geography and Territorial Planning, University of Coimbra, Coimbra, Portugal.
| | - Ângela Freitas
- CEGOT-UC, Centre of Studies in Geography and Territorial Planning, University of Coimbra, Coimbra, Portugal
| | - Iwa Stefanik
- CEGOT-UC, Centre of Studies in Geography and Territorial Planning, University of Coimbra, Coimbra, Portugal
| | - Cláudia Costa
- CEGOT-UC, Centre of Studies in Geography and Territorial Planning, University of Coimbra, Coimbra, Portugal
| | - Mónica Oliveira
- CEG-IST, Centre for Management Studies of Instituto Superior Técnico, Universidade de Lisboa, Avenida Rovisco Pais, 1049-001, Lisbon, Portugal
| | - Teresa C Rodrigues
- CEG-IST, Centre for Management Studies of Instituto Superior Técnico, Universidade de Lisboa, Avenida Rovisco Pais, 1049-001, Lisbon, Portugal
| | - Ana Vieira
- CEG-IST, Centre for Management Studies of Instituto Superior Técnico, Universidade de Lisboa, Avenida Rovisco Pais, 1049-001, Lisbon, Portugal
| | - Pedro Lopes Ferreira
- CEISUC, Center for Health Studies and Research, Faculty of Economics, University of Coimbra, Coimbra, Portugal
| | - Carme Borrell
- ASPB, Agència de Salut Pública de Barcelona, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
| | - Sani Dimitroulopoulou
- PHE-CRCE, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Didcot, OX11 0RQ, United Kingdom
| | - Stéphane Rican
- LAboratoire DYnamiques Sociales et Recomposition des espaceS (LADYSS), Paris Nanterre University, Paris, France
| | - Christina Mitsakou
- PHE-CRCE, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Didcot, OX11 0RQ, United Kingdom
| | - Marc Marí-Dell'Olmo
- ASPB, Agència de Salut Pública de Barcelona, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
| | | | | | - Carlos A Bana E Costa
- CEG-IST, Centre for Management Studies of Instituto Superior Técnico, Universidade de Lisboa, Avenida Rovisco Pais, 1049-001, Lisbon, Portugal
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10
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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]. Gac Sanit 2020; 35:113-122. [PMID: 32014314 DOI: 10.1016/j.gaceta.2019.10.008] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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11
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Palència L, Gotsens M, Marí-Dell'Olmo M, Bosakova L, Burström B, Costa C, Deboosere P, Dzurova D, Lustigova M, Morrison J, Santana P, Borrell C. Effect of the recent economic crisis on socioeconomic inequalities in mortality in nine urban areas in Europe. Gac Sanit 2020; 34:253-260. [PMID: 31983478 DOI: 10.1016/j.gaceta.2019.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/31/2019] [Accepted: 11/05/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To analyse socioeconomic inequalities in all-cause mortality among men and women in nine European urban areas during the recent economic crisis, and to compare the results to those from two periods before the crisis. METHOD This is an ecological study of trends based on three time periods (2000-2003, 2004-2008 and 2009-2014). The units of analysis were the small areas of nine European urban areas. We used a composite deprivation index as a socioeconomic indicator, along with other single indicators. As a mortality indicator, we used the smoothed standardized mortality ratio, calculated using the hierarchical Bayesian model proposed by Besag, York and Mollié. To analyse the evolution of socioeconomic inequalities, we fitted an ecological regression model that included the socioeconomic indicator, the period of time, and the interaction between these terms. RESULTS We observed significant inequalities in mortality among men for almost all the socioeconomic indicators, periods, and urban areas studied. However, no significant changes occurred during the period of the economic crisis. While inequalities among women were less common, there was a statistically significant increase in inequality during the crisis period in terms of unemployment and the deprivation index in Prague and Stockholm, respectively. CONCLUSIONS Future analyses should also consider time-lag in the effect of crises on mortality and specific causes of death, and differential effects between genders.
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Affiliation(s)
- Laia Palència
- Agència de Salut Pública de Barcelona, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain.
| | - Mercè Gotsens
- Agència de Salut Pública de Barcelona, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
| | - Marc Marí-Dell'Olmo
- Agència de Salut Pública de Barcelona, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
| | - Lucia Bosakova
- Department of Health Psychology, Medical Faculty, P.J. Safarik University in Kosice, Kosice, Slovak Republic; Olomouc University Social Health Institute, Palacky University in Olomouc, Olomouc, Czech Republic
| | - Bo Burström
- Department of Public Health Sciences, Equity and Health Policy Research Group, Karolinska Institutet, Stockholm, Sweden
| | - Cláudia Costa
- Centre of Studies in Geography and Spatial Planning, University of Coimbra, Coimbra, Portugal
| | - Patrick Deboosere
- Interface Demography, Section Social Research, Vrije Universiteit Brussels, Brussels, Belgium
| | - Dagmar Dzurova
- Department of Social Geography and Regional Development, Faculty of Science, Charles University, Prague, Czech Republic
| | - Michala Lustigova
- Department of Social Geography and Regional Development, Faculty of Science, Charles University, Prague, Czech Republic
| | - Joana Morrison
- Research Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Paula Santana
- Centre of Studies in Geography and Spatial Planning, University of Coimbra, Coimbra, Portugal; Department of Geography and Tourism, Humanities Faculty, University of Coimbra, Coimbra, Portugal
| | - Carme Borrell
- Agència de Salut Pública de Barcelona, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
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12
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León-Gómez BB, Gotsens M, Marí-Dell'Olmo M, Domínguez-Berjón MF, Luque-Fernandez MÁ, Martin U, Rodríguez-Sanz M, Pérez G. Bayesian smoothed small-areas analysis of urban inequalities in fertility across 1999-2013. Fertil Res Pract 2020; 5:17. [PMID: 31890237 PMCID: PMC6925428 DOI: 10.1186/s40738-019-0066-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 11/08/2019] [Indexed: 11/23/2022]
Abstract
Background Since the 2008 economic crisis in Spain, overall fertility has continued to decrease, while urban inequalities have increased. There is a general lack of studies of fertility patterns in small-areas of Spanish cities. We explored the effects of the economic crisis on fertility during three time periods in urban settings in Spain. Methods We studied the distribution of fertility rates among women (15–49 years) from Spain and low-middle income countries (LIC) who were living in 13 Spanish cities. We mapped fertility and the MEDEA socioeconomic deprivation index in small-areas, and analyzed age-related trends in fertility rates. We performed an ecological regression analysis of fertility and the deprivation index in two pre-crisis periods (1999–2003 and 2004–2008) and one crisis period (2009–2013). Fertility rates were calculated and smoothed using the hierarchical Bayesian model (BYM). Results Higher fertility was generally associated with socioeconomic deprivation, with adjustment for the mothers’ age and nationality. While Spanish citizens tended to delay childbearing throughout the three study periods, fertility increased among Spanish adolescents from deprived urban areas during the economic crisis. There was a general decline in fertility among immigrants after the crisis, especially in southern cities. Overall, fertility appeared to be stable, with higher fertility in more deprived areas. Conclusion Increased unemployment and changes to government family policies may have contributed to delayed childbearing in Spain. For immigrants, more restrictive immigration policies may have played a crucial role in decreasing fertility rates. Reforming such policies will be key for better reproductive rights and improved fertility rates across all population cohorts in Spain.
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Affiliation(s)
- Brenda Biaani León-Gómez
- 1Sistemes d'Informació Sanitària, Agència de Salut Pública de Barcelona, Barcelona, Spain.,2Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Mercè Gotsens
- 1Sistemes d'Informació Sanitària, Agència de Salut Pública de Barcelona, Barcelona, Spain.,3Institut de Recerca Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,4Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Marc Marí-Dell'Olmo
- 5Qualitat i Intervenció Ambiental, Agència de Salut Pública de Barcelona, Barcelona, Spain
| | | | - Miguel Ángel Luque-Fernandez
- 7Faculty of Epidemiology and Population Health, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Unai Martin
- 8Departamento de Sociología 2, Universidad del País Vasco UPV/EHU, Leoia, Bizkaia Spain
| | - Maica Rodríguez-Sanz
- 9Recerca, Docència i Comunicació, Agència de Salut Pública de Barcelona, Barcelona, Spain
| | - Gloria Pérez
- 1Sistemes d'Informació Sanitària, Agència de Salut Pública de Barcelona, Barcelona, Spain.,2Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain.,3Institut de Recerca Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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13
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Peralta A, Espinel-Flores V, Gotsens M, Pérez G, Benach J, Marí-Dell'Olmo M. Developing a deprivation index to study geographical health inequalities in Ecuador. Rev Saude Publica 2019; 53:97. [PMID: 31800910 PMCID: PMC9586448 DOI: 10.11606/s1518-8787.2019053001410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 03/11/2019] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES: To develop a deprivation index to study health inequalities in 221 areas of Ecuador, to describe the pattern of deprivation in Ecuador, and to explore the applications of the index to study health inequalities by analysing the association between deprivation and mortality in the study areas. METHODS: We performed principal component analyses of available indicators of the 221 cantons of Ecuador. A set of 41 sociodemographic, social capital, and subjective well-being variables were obtained from the 2010 National Population Census and the National Living Conditions Survey 2013–2014. To explore the application of the index in public health, the association between the index and standardised mortality ratios was estimated through a Poisson regression model. RESULTS: The final index was constructed with 17 indicators. The first component explained 51.8% of the total variance of the data. A geographic pattern and a positive association of the index with the standardised mortality ratios of the cantons were observed in both men and women. CONCLUSIONS: We constructed a deprivation index that can identify disadvantaged areas in Ecuador. This index could be a valuable tool for the detection of vulnerabilised populations and the development of interventions and policies adapted to local needs.
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Affiliation(s)
- Andrés Peralta
- Agència de Salut Pública de Barcelona. Barcelona, Catalonia, Spain.,Universitat Pompeu Fabra. Department of Political and Social Sciences. Health Inequalities Research Group, Employment Conditions Knowledge Network (GREDS-EMCONET). Barcelona, Spain.,Johns Hopkins University - Pompeu Fabra University Public Policy Center, Barcelona, Spain
| | - Verónica Espinel-Flores
- Agència de Salut Pública de Barcelona. Barcelona, Catalonia, Spain.,Universitat Pompeu Fabra. Department of Experimental and Health Sciences. Barcelona, Catalonia, Spain
| | - Mercè Gotsens
- Agència de Salut Pública de Barcelona. Barcelona, Catalonia, Spain.,Institut d'Investigació Biomèdica (IIB Sant Pau). Barcelona, Spain
| | - Glòria Pérez
- Agència de Salut Pública de Barcelona. Barcelona, Catalonia, Spain.,Universitat Pompeu Fabra. Department of Experimental and Health Sciences. Barcelona, Catalonia, Spain.,Institut d'Investigació Biomèdica (IIB Sant Pau). Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Joan Benach
- Universitat Pompeu Fabra. Department of Political and Social Sciences. Health Inequalities Research Group, Employment Conditions Knowledge Network (GREDS-EMCONET). Barcelona, Spain.,Johns Hopkins University - Pompeu Fabra University Public Policy Center, Barcelona, Spain.,Universidad Autónoma Madrid. Transdisciplinary Research Group on Socioecological Transitions (GinTRANS2). Madrid, Spain
| | - Marc Marí-Dell'Olmo
- Agència de Salut Pública de Barcelona. Barcelona, Catalonia, Spain.,Institut d'Investigació Biomèdica (IIB Sant Pau). Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Spain
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14
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Jacques-Aviñó C, Dvorzak JL, Marí-Dell'Olmo M, Arjona DR, Peralta A, Carrere J, Benach J, Ramos C, Plana M, López MJ. Qualitative evaluation of an intervention to reduce energy poverty. Rev Saude Publica 2019; 53:62. [PMID: 31483004 PMCID: PMC6707618 DOI: 10.11606/s1518-8787.2019053001212] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 11/14/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To evaluate the “ Energía, la justa ” program, aimed at reducing energy poverty in the city of Barcelona, from the point of view of the target population and the workers involved in the intervention. METHODS A qualitative, descriptive and exploratory pilot study was carried out, with a phenomenological approach. Twelve semi-structured interviews were conducted: to three users, three energy agents who performed interventions in the homes, and six professionals who participated in the program coordination. A thematic content analysis was carried out using Atlas-ti software . Interviews were conducted between October 2016 and March 2017. RESULTS Trust in a contact person (e.g. social workers) facilitated the participation, although there were difficulties reaching people who had illegal energy supplies, immigrant women or immigrants who subrent properties. Regarding implementation, home visits, energy efficiency advice and the relationship with energy agents were the best assessed aspects. However, not being able to carry out reforms in deteriorated dwellings was considered a limitation. The program also contributed to raise awareness on energy rights, to save on utility bills and to generate tranquility and social support. CONCLUSIONS Programs such as this one can promote energy empowerment and improve psychosocial status. However, strategies with a gender and equity perspective should be considered to reach other vulnerable groups.
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Affiliation(s)
- Constanza Jacques-Aviñó
- Servei d'Avaluació i Mètodes d'Intervenció. Agència de Salut Pública de Barcelona. Barcelona, España
| | - José Luis Dvorzak
- Servicio de Medicina Preventiva y Salud Pública. Hospital Universitario de Bellvitge.,Hospitalet de Llobregat. Barcelona, España
| | - Marc Marí-Dell'Olmo
- Servei de Qualitat i Intervenció Ambiental (SEQUIA). Agència de Salut Pública de Barcelona. Barcelona, España.,CIBER de Epidemiolgía y Salud Pública, (CIBERESP). Barcelona, España
| | | | - Andrés Peralta
- Servei de Qualitat i Intervenció Ambiental (SEQUIA). Agència de Salut Pública de Barcelona. Barcelona, España
| | - Juli Carrere
- Servei de Sistemes d'Informació Sanitària. Agència de Salut Pública de Barcelona. Barcelona, España
| | - Joan Benach
- Universidad Pompeu Fabra. GREDS-EMCONET Grupo de Investigación en Desigualdades en Salud - Employment Conditions Network. Departamento de Ciencias Politicas y Sociales. Barcelona, España
| | | | - Mònica Plana
- Asociación Bienestar y Desarrollo. Barcelona, España
| | - María José López
- Servei d'Avaluació i Mètodes d'Intervenció. Agència de Salut Pública de Barcelona. Barcelona, España.,CIBER de Epidemiolgía y Salud Pública, (CIBERESP). Barcelona, España
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15
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Pérez G, Gotsens M, Palència L, Marí-Dell'Olmo M, Domínguez-Berjón MF, Rodríguez-Sanz M, Puig V, Bartoll X, Gandarillas A, Martín U, Bacigalupe A, Díez E, Ruiz M, Esnaola S, Calvo M, Sánchez P, Luque Fernández MÁ, Borrell C. [Erratum to: Study protocol on the effect of the economic crisis on mortality and reproductive health and health inequalities in Spain]. Gac Sanit 2019; 33:496. [PMID: 31176463 DOI: 10.1016/j.gaceta.2019.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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, Barcelona, España.
| | - Mercè Gotsens
- Servei de Sistemes d'Informació Sanitària, Agència de Salut Pública de Barcelona, Barcelona, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; Instituto de Investigación Biomédica Sant Pau, Barcelona, España
| | - Laia Palència
- Servei de Sistemes d'Informació Sanitària, Agència de Salut Pública de Barcelona, Barcelona, España; Instituto de Investigación Biomédica Sant Pau, Barcelona, España
| | - Marc Marí-Dell'Olmo
- Servei de Sistemes d'Informació Sanitària, Agència de Salut Pública de Barcelona, Barcelona, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; Instituto de Investigación Biomédica Sant Pau, Barcelona, España; Universitat Rovira i Virgili, Tarragona, España
| | - M Felicitas Domínguez-Berjón
- Servicio de Informes de Salud y Estudios, Dirección General de Salud Pública, Consejería de Sanidad, Comunidad de Madrid, Madrid, España
| | - Maica Rodríguez-Sanz
- Àrea de Recerca i Docencia, Agència de Salut Pública de Barcelona, Barcelona, España
| | - Vanessa Puig
- Servei de Sistemes d'Informació Sanitària, Agència de Salut Pública de Barcelona, Barcelona, España
| | - Xavier Bartoll
- Servei de Sistemes d'Informació Sanitària, Agència de Salut Pública de Barcelona, Barcelona, España
| | - Ana Gandarillas
- Servicio de Epidemiología, Dirección General de Salud Pública, Consejería de Sanidad, Comunidad de Madrid, Madrid, España
| | - Unai Martín
- Departamento de Sociología 2, Universidad del País Vasco UPV/EHU, Leioa, Bizkaia, España; Grupo de Investigación en Determinantes Sociales de la Salud y Cambio Demográfico-OPIK, Leoia, Bizkaia, España
| | - Amaia Bacigalupe
- Departamento de Sociología 2, Universidad del País Vasco UPV/EHU, Leioa, Bizkaia, España; Grupo de Investigación en Determinantes Sociales de la Salud y Cambio Demográfico-OPIK, Leoia, Bizkaia, España
| | - Elia Díez
- Servei de Programes d'Intervencions Preventives, Agència de Salut Pública de Barcelona, Barcelona, España
| | - Miguel Ruiz
- Consejería de Salud, Junta de Andalucía, Sevilla, España
| | | | | | - Pablo Sánchez
- Observatorio de Salud y Medio Ambiente de Andalucía (OSMAN), Escuela Andaluza de Salud Pública, Granada, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España
| | - Miguel Ángel Luque Fernández
- Faculty of Epidemiology and Population Health, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Carme Borrell
- Gerencia, Agència de Salut Pública de Barcelona, Barcelona, España
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16
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Samoli E, Stergiopoulou A, Santana P, Rodopoulou S, Mitsakou C, Dimitroulopoulou C, Bauwelinck M, de Hoogh K, Costa C, Marí-Dell'Olmo M, Corman D, Vardoulakis S, Katsouyanni K. Spatial variability in air pollution exposure in relation to socioeconomic indicators in nine European metropolitan areas: A study on environmental inequality. Environ Pollut 2019; 249:345-353. [PMID: 30909127 DOI: 10.1016/j.envpol.2019.03050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 02/12/2019] [Accepted: 03/13/2019] [Indexed: 05/22/2023]
Abstract
A limited number of studies have addressed environmental inequality, using various study designs and methodologies and often reaching contradictory results. Following a standardized multi-city data collection process within the European project EURO-HEALTHY, we conducted an ecological study to investigate the spatial association between nitrogen dioxide (NO2), as a surrogate for traffic related air pollution, and ten socioeconomic indicators at local administrative unit level in nine European Metropolitan Areas. We applied mixed models for the associations under investigation with random intercepts per Metropolitan Area, also accounting for the spatial correlation. The stronger associations were observed between NO2 levels and population density, population born outside the European Union (EU28), total crimes per 100,000 inhabitants and unemployment rate that displayed a highly statistically significant trend of increasing concentrations with increasing levels of the indicators. Specifically, the highest vs the lowest quartile of each indicator above was associated with 48.7% (95% confidence interval (CI): 42.9%, 54.8%), 30.9% (95%CI: 22.1%, 40.2%), 19.8% (95%CI: 13.4%, 26.6%) and 15.8% (95%CI: 9.9%, 22.1%) increase in NO2 respectively. The association with population density most probably reflects the higher volume in vehicular traffic, which is the main source of NO2 in urban areas. Higher pollution levels in areas with higher percentages of people born outside EU28, crime or unemployment rates indicate that worse air quality is typically encountered in deprived European urban areas. Policy makers should consider spatial environmental inequalities to better inform actions aiming to lower urban air pollution levels that will subsequently lead to improved quality of life, public health and health equity across the population.
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Affiliation(s)
- E Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece.
| | - A Stergiopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece
| | - P Santana
- Centre of Studies in Geography and Spatial Planning, Department of Geography and Tourism, University of Coimbra, Portugal
| | - S Rodopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece
| | - C Mitsakou
- Environmental Hazards and Emergencies Department, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, UK
| | - C Dimitroulopoulou
- Environmental Hazards and Emergencies Department, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, UK
| | - M Bauwelinck
- Interface Demography - Department of Sociology, Vrije Universiteit Brussel, Belgium
| | - K de Hoogh
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - C Costa
- Centre of Studies in Geography and Spatial Planning, Department of Geography and Tourism, University of Coimbra, Portugal
| | - M Marí-Dell'Olmo
- Agència de Salut Pública de Barcelona, Barcelona, Spain; CIBER Epidemiología y Salud Pública, Madrid, Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
| | - D Corman
- Department of Public Health Sciences, Karolinksa Institute, Stockholm, Sweden
| | - S Vardoulakis
- Environmental Hazards and Emergencies Department, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, UK; Institute of Occupational Medicine, UK
| | - K Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece; Department Population Health Sciences and Department of Analytical, Environmental and Forensic Sciences, School of Population Health & Environmental Sciences, King's College London, UK
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17
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Samoli E, Stergiopoulou A, Santana P, Rodopoulou S, Mitsakou C, Dimitroulopoulou C, Bauwelinck M, de Hoogh K, Costa C, Marí-Dell'Olmo M, Corman D, Vardoulakis S, Katsouyanni K. Spatial variability in air pollution exposure in relation to socioeconomic indicators in nine European metropolitan areas: A study on environmental inequality. Environ Pollut 2019; 249:345-353. [PMID: 30909127 DOI: 10.1016/j.envpol.2019.03.050] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 02/12/2019] [Accepted: 03/13/2019] [Indexed: 05/17/2023]
Abstract
A limited number of studies have addressed environmental inequality, using various study designs and methodologies and often reaching contradictory results. Following a standardized multi-city data collection process within the European project EURO-HEALTHY, we conducted an ecological study to investigate the spatial association between nitrogen dioxide (NO2), as a surrogate for traffic related air pollution, and ten socioeconomic indicators at local administrative unit level in nine European Metropolitan Areas. We applied mixed models for the associations under investigation with random intercepts per Metropolitan Area, also accounting for the spatial correlation. The stronger associations were observed between NO2 levels and population density, population born outside the European Union (EU28), total crimes per 100,000 inhabitants and unemployment rate that displayed a highly statistically significant trend of increasing concentrations with increasing levels of the indicators. Specifically, the highest vs the lowest quartile of each indicator above was associated with 48.7% (95% confidence interval (CI): 42.9%, 54.8%), 30.9% (95%CI: 22.1%, 40.2%), 19.8% (95%CI: 13.4%, 26.6%) and 15.8% (95%CI: 9.9%, 22.1%) increase in NO2 respectively. The association with population density most probably reflects the higher volume in vehicular traffic, which is the main source of NO2 in urban areas. Higher pollution levels in areas with higher percentages of people born outside EU28, crime or unemployment rates indicate that worse air quality is typically encountered in deprived European urban areas. Policy makers should consider spatial environmental inequalities to better inform actions aiming to lower urban air pollution levels that will subsequently lead to improved quality of life, public health and health equity across the population.
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Affiliation(s)
- E Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece.
| | - A Stergiopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece
| | - P Santana
- Centre of Studies in Geography and Spatial Planning, Department of Geography and Tourism, University of Coimbra, Portugal
| | - S Rodopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece
| | - C Mitsakou
- Environmental Hazards and Emergencies Department, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, UK
| | - C Dimitroulopoulou
- Environmental Hazards and Emergencies Department, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, UK
| | - M Bauwelinck
- Interface Demography - Department of Sociology, Vrije Universiteit Brussel, Belgium
| | - K de Hoogh
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - C Costa
- Centre of Studies in Geography and Spatial Planning, Department of Geography and Tourism, University of Coimbra, Portugal
| | - M Marí-Dell'Olmo
- Agència de Salut Pública de Barcelona, Barcelona, Spain; CIBER Epidemiología y Salud Pública, Madrid, Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
| | - D Corman
- Department of Public Health Sciences, Karolinksa Institute, Stockholm, Sweden
| | - S Vardoulakis
- Environmental Hazards and Emergencies Department, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, UK; Institute of Occupational Medicine, UK
| | - K Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece; Department Population Health Sciences and Department of Analytical, Environmental and Forensic Sciences, School of Population Health & Environmental Sciences, King's College London, UK
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18
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Cabrera-León A, Daponte-Codina A, Mateo I, Arroyo-Borrell E, Bartoll X, Bravo MJ, Domínguez-Berjón MF, Renart G, Álvarez-Dardet C, Marí-Dell'Olmo M, Bolívar-Muñoz J, Saez M, Escribà-Agüir V, Palència L, López MJ, Saurina C, Puig V, Martín U, Gotsens M, Borrell C, Serra-Saurina L, Sordo L, Bacigalupe A, Rodríguez-Sanz M, Pérez G, Espelt A, Ruiz M, Bernal M. [Corrigendum to: Contextual indicators to assess social determinants of health and the Spanish economic recession]. Gac Sanit 2019; 33:497. [PMID: 31122670 DOI: 10.1016/j.gaceta.2019.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Andrés Cabrera-León
- CIBER de Epidemiología y Salud Pública (CIBERESP), España; Escuela Andaluza de Salud Pública, Granada, España; Departamento de Estadística e Investigación Operativa, Facultad de Ciencias, Universidad de Granada, Granada, España
| | - Antonio Daponte-Codina
- CIBER de Epidemiología y Salud Pública (CIBERESP), España; Observatorio de Salud y Medio Ambiente de Andalucía (OSMAN), Escuela Andaluza de Salud Pública, Granada, España.
| | - Inmaculada Mateo
- CIBER de Epidemiología y Salud Pública (CIBERESP), España; Escuela Andaluza de Salud Pública, Granada, España
| | - Elena Arroyo-Borrell
- CIBER de Epidemiología y Salud Pública (CIBERESP), España; Grupo de Investigación en Estadística, Econometría y Salud (GRECS), Universidad de Girona, Girona, España
| | - Xavier Bartoll
- Agència de Salut Pública de Barcelona, Barcelona, España; Institut d'Investigacións Biomèdiques Sant Pau (IIB-Sant Pau), Barcelona, España
| | - María José Bravo
- CIBER de Epidemiología y Salud Pública (CIBERESP), España; Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, España
| | | | - Gemma Renart
- CIBER de Epidemiología y Salud Pública (CIBERESP), España; Grupo de Investigación en Estadística, Econometría y Salud (GRECS), Universidad de Girona, Girona, España
| | - Carlos Álvarez-Dardet
- CIBER de Epidemiología y Salud Pública (CIBERESP), España; Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia, Facultad de Ciencias de la Salud, Universidad de Alicante, Alicante, España
| | - Marc Marí-Dell'Olmo
- CIBER de Epidemiología y Salud Pública (CIBERESP), España; Agència de Salut Pública de Barcelona, Barcelona, España; Institut d'Investigacións Biomèdiques Sant Pau (IIB-Sant Pau), Barcelona, España; Universitat Rovira i Virgili, Tarragona, España
| | - Julia Bolívar-Muñoz
- CIBER de Epidemiología y Salud Pública (CIBERESP), España; Escuela Andaluza de Salud Pública, Granada, España
| | - Marc Saez
- CIBER de Epidemiología y Salud Pública (CIBERESP), España; Grupo de Investigación en Estadística, Econometría y Salud (GRECS), Universidad de Girona, Girona, España
| | - Vicenta Escribà-Agüir
- CIBER de Epidemiología y Salud Pública (CIBERESP), España; Àrea de Desigualtats Socials i Salut, Fundació par al Foment de la Investigació Sanitària i Biomèdica de la Comunitat Valenciana (FISABIO) - Salut Pública, València, España
| | - Laia Palència
- CIBER de Epidemiología y Salud Pública (CIBERESP), España; Agència de Salut Pública de Barcelona, Barcelona, España; Institut d'Investigacións Biomèdiques Sant Pau (IIB-Sant Pau), Barcelona, España
| | - María José López
- CIBER de Epidemiología y Salud Pública (CIBERESP), España; Agència de Salut Pública de Barcelona, Barcelona, España; Institut d'Investigacións Biomèdiques Sant Pau (IIB-Sant Pau), Barcelona, España
| | - Carme Saurina
- CIBER de Epidemiología y Salud Pública (CIBERESP), España; Grupo de Investigación en Estadística, Econometría y Salud (GRECS), Universidad de Girona, Girona, España
| | - Vanessa Puig
- CIBER de Epidemiología y Salud Pública (CIBERESP), España; Agència de Salut Pública de Barcelona, Barcelona, España; Institut d'Investigacións Biomèdiques Sant Pau (IIB-Sant Pau), Barcelona, España
| | - Unai Martín
- Departamento de Sociología 2, Universidad del País Vasco UPV/EHU, Leoia, Bizkaia, España
| | - Mercè Gotsens
- CIBER de Epidemiología y Salud Pública (CIBERESP), España; Agència de Salut Pública de Barcelona, Barcelona, España; Institut d'Investigacións Biomèdiques Sant Pau (IIB-Sant Pau), Barcelona, España
| | - Carme Borrell
- CIBER de Epidemiología y Salud Pública (CIBERESP), España; Agència de Salut Pública de Barcelona, Barcelona, España; Institut d'Investigacións Biomèdiques Sant Pau (IIB-Sant Pau), Barcelona, España
| | - Laura Serra-Saurina
- CIBER de Epidemiología y Salud Pública (CIBERESP), España; Grupo de Investigación en Estadística, Econometría y Salud (GRECS), Universidad de Girona, Girona, España; Centro de Investigación en Salud Laboral, Universitat Pompeu Fabra, Barcelona, España; Institut Municipal d'Investigacions Mèdiques (IMIM), Parc de Salut Mar, Barcelona, España
| | - Luis Sordo
- CIBER de Epidemiología y Salud Pública (CIBERESP), España; Consejería de Sanidad, Comunidad de Madrid, Madrid, España; Departamento de Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad Complutense, Madrid, España
| | - Amaia Bacigalupe
- Departamento de Sociología 2, Universidad del País Vasco UPV/EHU, Leoia, Bizkaia, España
| | - Maica Rodríguez-Sanz
- CIBER de Epidemiología y Salud Pública (CIBERESP), España; Agència de Salut Pública de Barcelona, Barcelona, España; Institut d'Investigacións Biomèdiques Sant Pau (IIB-Sant Pau), Barcelona, España
| | - Glòria Pérez
- CIBER de Epidemiología y Salud Pública (CIBERESP), España; Agència de Salut Pública de Barcelona, Barcelona, España; Institut d'Investigacións Biomèdiques Sant Pau (IIB-Sant Pau), Barcelona, España
| | - Albert Espelt
- CIBER de Epidemiología y Salud Pública (CIBERESP), España; Agència de Salut Pública de Barcelona, Barcelona, España; Institut d'Investigacións Biomèdiques Sant Pau (IIB-Sant Pau), Barcelona, España
| | - Miguel Ruiz
- Consejería de Salud, Junta de Andalucía, Sevilla, España
| | - Mariola Bernal
- CIBER de Epidemiología y Salud Pública (CIBERESP), España
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Peralta A, Benach J, Borrell C, Espinel-Flores V, Cash-Gibson L, Queiroz BL, Marí-Dell'Olmo M. Correction to: Evaluation of the mortality registry in Ecuador (2001-2013) - social and geographical inequalities in completeness and quality. Popul Health Metr 2019; 17:5. [PMID: 30999921 PMCID: PMC6474044 DOI: 10.1186/s12963-019-0185-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 03/29/2019] [Indexed: 11/15/2022] Open
Affiliation(s)
- Andrés Peralta
- Agència de Salut Pública de Barcelona, Plaça Lesseps 1, 08023, Barcelona, Catalonia, Spain. .,Health Inequalities Research Group, Employment Conditions Knowledge Network (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, Ramon Trias Fargas, 25-27, 08005, Barcelona, Spain. .,Johns Hopkins University, Pompeu Fabra University Public Policy Center, Barcelona, Spain.
| | - Joan Benach
- Health Inequalities Research Group, Employment Conditions Knowledge Network (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, Ramon Trias Fargas, 25-27, 08005, Barcelona, Spain.,Johns Hopkins University, Pompeu Fabra University Public Policy Center, Barcelona, Spain.,Transdisciplinary Research Group on Socioecological Transitions (GinTRANS2), Universidad Autónoma Madrid, 28049, Madrid, Spain
| | - Carme Borrell
- Agència de Salut Pública de Barcelona, Plaça Lesseps 1, 08023, Barcelona, Catalonia, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain.,Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Catalonia, Spain
| | - Verónica Espinel-Flores
- Agència de Salut Pública de Barcelona, Plaça Lesseps 1, 08023, Barcelona, Catalonia, Spain.,Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Catalonia, Spain
| | - Lucinda Cash-Gibson
- Health Inequalities Research Group, Employment Conditions Knowledge Network (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, Ramon Trias Fargas, 25-27, 08005, Barcelona, Spain.,Johns Hopkins University, Pompeu Fabra University Public Policy Center, Barcelona, Spain
| | - Bernardo L Queiroz
- Department of Demography and Cedeplar, Faculdade de Ciências Econômicas, FACE/UFMG, Campus Pampulha, Av. Antônio Carlos, 6627, Pampulha, Belo Horizonte, MG, CEP 31270-901, Brazil
| | - Marc Marí-Dell'Olmo
- Agència de Salut Pública de Barcelona, Plaça Lesseps 1, 08023, Barcelona, Catalonia, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain.,Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Catalonia, Spain
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20
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Peralta A, Benach J, Borrell C, Espinel-Flores V, Cash-Gibson L, Queiroz BL, Marí-Dell'Olmo M. Evaluation of the mortality registry in Ecuador (2001-2013) - social and geographical inequalities in completeness and quality. Popul Health Metr 2019; 17:3. [PMID: 30922340 PMCID: PMC6437878 DOI: 10.1186/s12963-019-0183-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 02/06/2019] [Indexed: 01/08/2023] Open
Abstract
Background Mortality registries are an essential data source for public health surveillance and for planning and evaluating public policy. Nevertheless, there are still large inequalities in the completeness and quality of mortality registries between and within countries. In Ecuador, there have been few nationwide evaluations of the mortality registry and no evaluations of inequalities between provinces. This kind of analysis is fundamental for strengthening the vital statistics system. Methods Ecological study assessing the completeness, quality and internal consistency of mortality data in the provinces of Ecuador, using 13 years of mortality data (2001–2013). Completeness was assessed using three types of death distribution methods (DDMs), quality by estimating the percentages of garbage codes and deaths with unspecified age or sex in the registered deaths, and internal consistency by estimating the percentage of deaths with reported causes of deaths considered impossible in some age–sex combinations. Finally, we propose a classification of the mortality registry in the studied areas based on completeness and quality. Results Completeness estimates (mean of the three methods used) in the provinces ranged from 21 to 87% in women and from 35 to 89% in men. The percentage of garbage codes in the provinces ranged from 21 to 56% in women and from 25 to 52% in men. Garbage coding was higher in women and in older age groups. The percentage of deaths with unspecified age or sex, and the percentage of deaths with reported causes of deaths considered impossible in some age–sex combinations was low in all the studied areas. The mortality registry could only be classified as acceptable in one area for men and one area for women. Conclusions We found substantial inequalities by sex, geographical areas and age in the completeness and quality of the mortality registry of Ecuador. The findings of this study will be helpful to direct measures to improve Ecuador’s vital statistics system and to generate strategies to reduce bias when using mortality data to analyse health inequalities in the country. Electronic supplementary material The online version of this article (10.1186/s12963-019-0183-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Andrés Peralta
- Agència de Salut Pública de Barcelona, Plaça Lesseps 1, 08023, Barcelona, Catalonia, Spain. .,Health Inequalities Research Group, Employment Conditions Knowledge Network (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, Ramon Trias Fargas, 25-27, 08005, Barcelona, Spain. .,Johns Hopkins University, Pompeu Fabra University Public Policy Center, Barcelona, Spain.
| | - Joan Benach
- Health Inequalities Research Group, Employment Conditions Knowledge Network (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, Ramon Trias Fargas, 25-27, 08005, Barcelona, Spain.,Johns Hopkins University, Pompeu Fabra University Public Policy Center, Barcelona, Spain.,Transdisciplinary Research Group on Socioecological Transitions (GinTRANS2), Universidad Autónoma Madrid, 28049, Madrid, Spain
| | - Carme Borrell
- Agència de Salut Pública de Barcelona, Plaça Lesseps 1, 08023, Barcelona, Catalonia, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain.,Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Catalonia, Spain
| | - Verónica Espinel-Flores
- Agència de Salut Pública de Barcelona, Plaça Lesseps 1, 08023, Barcelona, Catalonia, Spain.,Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Catalonia, Spain
| | - Lucinda Cash-Gibson
- Health Inequalities Research Group, Employment Conditions Knowledge Network (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, Ramon Trias Fargas, 25-27, 08005, Barcelona, Spain.,Johns Hopkins University, Pompeu Fabra University Public Policy Center, Barcelona, Spain
| | - Bernardo L Queiroz
- Department of Demography and Cedeplar, Faculdade de Ciências Econômicas, FACE/UFMG, Campus Pampulha, Av. Antônio Carlos, 6627, Pampulha, Belo Horizonte, MG, CEP 31270-901, Brazil
| | - Marc Marí-Dell'Olmo
- Agència de Salut Pública de Barcelona, Plaça Lesseps 1, 08023, Barcelona, Catalonia, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain.,Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Catalonia, Spain
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21
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Ferrando J, Palència L, Gotsens M, Puig-Barrachina V, Marí-Dell'Olmo M, Rodríguez-Sanz M, Bartoll X, Borrell C. Trends in cancer mortality in Spain: the influence of the financial crisis. Gac Sanit 2018; 33:229-234. [PMID: 29452751 DOI: 10.1016/j.gaceta.2017.11.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 11/07/2017] [Accepted: 11/08/2017] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To determine if the onset of the economic crisis in Spain affected cancer mortality and mortality trends. METHOD We conducted a longitudinal ecological study based on all cancer-related deaths and on specific types of cancer (lung, colon, breast and prostate) in Spain between 2000 and 2013. We computed age-standardised mortality rates in men and women, and fit mixed Poisson models to analyse the effect of the crisis on cancer mortality and trends therein. RESULTS After the onset of the economic crisis, cancer mortality continued to decline, but with a significant slowing of the yearly rate of decline (men: RR = 0.987, 95%CI = 0.985-0.990, before the crisis, and RR = 0.993, 95%CI = 0.991-0.996, afterwards; women: RR = 0.990, 95%CI = 0.988-0.993, before, and RR = 1.002, 95%CI = 0.998-1.006, afterwards). In men, lung cancer mortality was reduced, continuing the trend observed in the pre-crisis period; the trend in colon cancer mortality did not change significantly and continued to increase; and the yearly decline in prostate cancer mortality slowed significantly. In women, lung cancer mortality continued to increase each year, as before the crisis; colon cancer continued to decease; and the previous yearly downward trend in breast cancer mortality slowed down following the onset of the crisis. CONCLUSIONS Since the onset of the economic crisis in Spain the rate of decline in cancer mortality has slowed significantly, and this situation could be exacerbated by the current austerity measures in healthcare.
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Affiliation(s)
| | - Laia Palència
- Agència de Salut Pública de Barcelona, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Institut d'Investigació Biomèdica IIB Sant Pau, Barcelona, Spain
| | - Mercè Gotsens
- Agència de Salut Pública de Barcelona, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Institut d'Investigació Biomèdica IIB Sant Pau, Barcelona, Spain.
| | | | - Marc Marí-Dell'Olmo
- Agència de Salut Pública de Barcelona, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Institut d'Investigació Biomèdica IIB Sant Pau, Barcelona, Spain
| | - Maica Rodríguez-Sanz
- Agència de Salut Pública de Barcelona, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Institut d'Investigació Biomèdica IIB Sant Pau, Barcelona, Spain; Departamento de Ciencias Experimentales y de la Salud, Facultad de Ciencias de la Salud y de la Vida, Universitat Pompeu Fabra, Barcelona, Spain
| | - Xavier Bartoll
- Agència de Salut Pública de Barcelona, Barcelona, Spain; Institut d'Investigació Biomèdica IIB Sant Pau, Barcelona, Spain
| | - Carme Borrell
- Agència de Salut Pública de Barcelona, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Institut d'Investigació Biomèdica IIB Sant Pau, Barcelona, Spain; Departamento de Ciencias Experimentales y de la Salud, Facultad de Ciencias de la Salud y de la Vida, Universitat Pompeu Fabra, Barcelona, Spain
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22
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Borrell C, Marí-Dell'Olmo M, Gotsens M, Calvo M, Rodríguez-Sanz M, Bartoll X, Esnaola S. Socioeconomic inequalities in suicide mortality before and after the economic recession in Spain. BMC Public Health 2017; 17:772. [PMID: 28978310 PMCID: PMC5628455 DOI: 10.1186/s12889-017-4777-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 09/20/2017] [Indexed: 11/13/2022] Open
Abstract
Background An increase in suicide mortality is often observed in economic recessions. The objective of this study was to analyse trends in socioeconomic inequalities in suicide mortality before and during the economic recession in two geographical settings in Spain. Methods This study analyses inequalities in mortality according to educational level during 3 different time periods based on individual data from the Basque Country and Barcelona city. We analysed suicide mortality data for all residents over 25 years of age from 2001 to 2012. Two periods before the crisis (2001–2004 and 2005–2008) and another during the crisis (2009–2012) were studied. We performed independent analyses for sex, age group, and for the two geographical settings. We fit Poisson regression models to study the relationship between educational level and mortality, and calculated the relative index of inequality (RII) and the slope index of inequality (SII) as comparative measures. Results For men in the Basque Country, all RII values for the three time periods were similar and almost all were greater than 2; in Barcelona the RII values were generally lower. The SII values for Barcelona tended to decrease over time, whereas in the Basque Country they showed a U-shaped pattern. Among women aged 25–44 years we found an association between educational level and suicide mortality during the first time period; however, we found no clear association for other age groups or time periods. Conclusion This study within two geographical settings in Spain shows that trends in inequalities in suicide mortality according to educational level remained stable among men before and during the economic recession.
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Affiliation(s)
- Carme Borrell
- Agència de Salut Pública de Barcelona, Plaça Lesseps 1, 08023, Barcelona, Spain. .,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain. .,Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain. .,Universitat Pompeu Fabra, Barcelona, Spain.
| | - Marc Marí-Dell'Olmo
- Agència de Salut Pública de Barcelona, Plaça Lesseps 1, 08023, Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain.,Universitat Pompeu Fabra, Barcelona, Spain
| | - Mercè Gotsens
- Agència de Salut Pública de Barcelona, Plaça Lesseps 1, 08023, Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
| | - Montse Calvo
- Department of Health of the Basque Country, Vitoria-Gasteiz, Spain
| | - Maica Rodríguez-Sanz
- Agència de Salut Pública de Barcelona, Plaça Lesseps 1, 08023, Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain.,Universitat Pompeu Fabra, Barcelona, Spain
| | - Xavier Bartoll
- Agència de Salut Pública de Barcelona, Plaça Lesseps 1, 08023, Barcelona, Spain.,Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
| | - Santiago Esnaola
- Department of Health of the Basque Country, Vitoria-Gasteiz, Spain
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23
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Aguilar-Palacio I, Martinez-Beneito MA, Rabanaque MJ, Borrell C, Cirera L, Daponte A, Domínguez-Berjón MF, Gandarillas A, Gotsens M, Lorenzo-Ruano P, Marí-Dell'Olmo M, Nolasco A, Saez M, Sánchez-Villegas P, Saurina C, Martos C. Diabetes mellitus mortality in Spanish cities: Trends and geographical inequalities. Prim Care Diabetes 2017; 11:453-460. [PMID: 28623082 DOI: 10.1016/j.pcd.2017.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 05/08/2017] [Accepted: 05/18/2017] [Indexed: 01/24/2023]
Abstract
AIM To analyze the geographical pattern of diabetes mellitus (DM) mortality and its association with socioeconomic factors in 26 Spanish cities. METHODS We conducted an ecological study of DM mortality trends with two cross-sectional cuts (1996-2001; 2002-2007) using census tract (CT) as the unit of analysis. Smoothed standardized mortality rates (sSMR) were calculated using Bayesian models, and a socioeconomic deprivation score was calculated for each CT. RESULTS In total, 27,757 deaths by DM were recorded, with higher mortality rates observed in men and in the period 1996-2001. For men, a significant association between CT deprivation score and DM mortality was observed in 6 cities in the first study period and in 7 cities in the second period. The highest relative risk was observed in Pamplona (RR, 5.13; 95% credible interval (95%CI), 1.32-15.16). For women, a significant association between CT deprivation score and DM mortality was observed in 13 cities in the first period and 8 in the second. The strongest association was observed in San Sebastián (RR, 3.44; 95%CI, 1.25-7.36). DM mortality remained stable in the majority of cities, although a marked decrease was observed in some cities, including Madrid (RR, 0.67 and 0.64 for men and women, respectively). CONCLUSIONS Our findings demonstrate clear inequalities in DM mortality in Spain. These inequalities remained constant over time are were more marked in women. Detection of high-risk areas is crucial for the implementation of specific interventions.
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Affiliation(s)
- I Aguilar-Palacio
- Departamento de Microbiología, Medicina Preventiva y Salud Pública, Universidad de Zaragoza, Zaragoza, Spain; Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Spain.
| | - M A Martinez-Beneito
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO-Salud Pública), Valencia, Spain; Ciber de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - M J Rabanaque
- Departamento de Microbiología, Medicina Preventiva y Salud Pública, Universidad de Zaragoza, Zaragoza, Spain; Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Spain
| | - C Borrell
- Ciber de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Agència de Salut Pública de Barcelona, Barcelona, Spain
| | - L Cirera
- Ciber de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Servicio de Epidemiología, Consejería de Sanidad, IMIB - Arrrixaca, Murcia, Spain
| | - A Daponte
- Ciber de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Observatorio de Salud y Medio Ambiente de Andalucía (OSMAN), Escuela Andaluza de Salud Pública, Consejería de Salud, Junta de Andalucía, Granada, Spain
| | - M F Domínguez-Berjón
- Subdirección de Promoción de la Salud y Prevención, Consejería de Sanidad, Comunidad de Madrid, Madrid, Spain
| | - A Gandarillas
- Subdirección de Promoción de la Salud y Prevención, Consejería de Sanidad, Comunidad de Madrid, Madrid, Spain
| | - M Gotsens
- Ciber de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Agència de Salut Pública de Barcelona, Barcelona, Spain
| | - P Lorenzo-Ruano
- Dirección General de Salud Pública, Servicio Canario de Salud, Spain
| | - M Marí-Dell'Olmo
- Ciber de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Agència de Salut Pública de Barcelona, Barcelona, Spain
| | - A Nolasco
- Unidad de Investigación en Análisis de la Mortalidad y Estadísticas Sanitarias, Universidad de Alicante, Alicante, Spain
| | - M Saez
- Ciber de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Grupo de Investigación en Estadística, Econometría y Salud (GRECS), Universidad de Girona, Girona, Spain
| | - P Sánchez-Villegas
- Ciber de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Observatorio de Salud y Medio Ambiente de Andalucía (OSMAN), Escuela Andaluza de Salud Pública, Consejería de Salud, Junta de Andalucía, Granada, Spain
| | - C Saurina
- Ciber de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Grupo de Investigación en Estadística, Econometría y Salud (GRECS), Universidad de Girona, Girona, Spain
| | - C Martos
- Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Spain; Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO-Salud Pública), Valencia, Spain; Ciber de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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24
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Peralta A, Camprubí L, Rodríguez-Sanz M, Basagaña X, Borrell C, Marí-Dell'Olmo M. Impact of energy efficiency interventions in public housing buildings on cold-related mortality: a case-crossover analysis. Int J Epidemiol 2017; 46:1192-1201. [PMID: 28052930 DOI: 10.1093/ije/dyw335] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2016] [Indexed: 11/14/2022] Open
Abstract
Background Interventions to mitigate fuel poverty and particularly energy efficiency façade retrofitting (EEFR) have demonstrated positive impacts on health but the impacts of EEFR interventions on cold-related mortality have not been studied in depth. We evaluated the impact of EEFR interventions in Barcelona on the association between cold outdoor temperatures and mortality (from all natural causes and from neoplasms, circulatory system and respiratory system causes) from 1986 to 2012. Methods A time-stratified case-crossover analysis was used. Relative risks (RR) for death related to extreme cold (lowest fifth percentile) in the no-intervention and intervention groups were obtained for temperature lag windows covering the day of the death and the previous 20 days (0-2, 3-5, 6-8, 9-11, 12-14, 15-17, 18-20). The statistical significance of the observed changes was evaluated using the RR for the cold temperature-intervention interaction. Results In men, interventions significantly increased the extreme cold-death association for the lag window 15-17 [interaction RR 2.23, 95% confidence interval (CI) 1.14-4.36]. The impacts were stronger for respiratory system causes and in men aged 75 or older. In women, on lag window 0-2, the extreme cold-death association was not significantly reduced when analysing all natural causes of death (interaction RR 0.46, 95% CI 0.21-1.01), but it was reduced significantly when analysing only deaths from neoplasms, circulatory system and respiratory system causes together. The impacts were stronger in women who died from circulatory system causes, in women with no education and in those aged 75 or older. Conclusions EEFR interventions had differentiated effects on cold-related mortality in men and women. Differentiated effects were also observed by cause, educational level and age.
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Affiliation(s)
- Andrés Peralta
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Catalonia, Spain.,Agència de Salut Pública de Barcelona, Barcelona, Catalonia, Spain
| | - Lluís Camprubí
- Agència de Salut Pública de Barcelona, Barcelona, Catalonia, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Maica Rodríguez-Sanz
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Catalonia, Spain.,Agència de Salut Pública de Barcelona, Barcelona, Catalonia, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Catalonia, Spain
| | - Xavier Basagaña
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Catalonia, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Catalonia, Spain
| | - Carme Borrell
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Catalonia, Spain.,Agència de Salut Pública de Barcelona, Barcelona, Catalonia, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Catalonia, Spain
| | - Marc Marí-Dell'Olmo
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Catalonia, Spain.,Agència de Salut Pública de Barcelona, Barcelona, Catalonia, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Catalonia, Spain
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25
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Marí-Dell'Olmo M, Novoa AM, Camprubí L, Peralta A, Vásquez-Vera H, Bosch J, Amat J, Díaz F, Palència L, Mehdipanah R, Rodríguez-Sanz M, Malmusi D, Borrell C. Housing Policies and Health Inequalities. Int J Health Serv 2016; 47:207-232. [PMID: 28030990 DOI: 10.1177/0020731416684292] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A large body of literature shows the link between inadequate housing conditions and poor physical and mental health. The aim of this paper is to summarize the research on the impact of local housing policies on health inequalities, focusing on the issues of access to housing and fuel poverty as studied in the SOPHIE project. Our case studies in Spain showed that people facing housing insecurity, experienced intense levels of mental distress. We found that access to secure and adequate housing can improve the health of these populations, therefore, public policies that address housing instability and their consequences are urgently needed. Housing conditions related to fuel poverty are associated with poorer health and are unevenly distributed across Europe. We found possible positive effects of façade insulation interventions on cold-related mortality in women living in social housing; but not in men. Policies on housing energy efficiency can reduce the health consequences of fuel poverty, but need to be free to users, target the most vulnerable groups and be adaptable to their needs.
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Affiliation(s)
- Marc Marí-Dell'Olmo
- 1 Agència de Salut Pública de Barcelona, Barcelona, Spain.,2 CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,3 Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain.,4 Universitat Pompeu Fabra, Barcelona, Spain
| | - Ana M Novoa
- 1 Agència de Salut Pública de Barcelona, Barcelona, Spain.,3 Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
| | - Lluís Camprubí
- 1 Agència de Salut Pública de Barcelona, Barcelona, Spain.,2 CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Andrés Peralta
- 1 Agència de Salut Pública de Barcelona, Barcelona, Spain.,4 Universitat Pompeu Fabra, Barcelona, Spain
| | - Hugo Vásquez-Vera
- 1 Agència de Salut Pública de Barcelona, Barcelona, Spain.,4 Universitat Pompeu Fabra, Barcelona, Spain.,5 Universidad de La Frontera, Temuco, Chile
| | - Jordi Bosch
- 4 Universitat Pompeu Fabra, Barcelona, Spain
| | - Jordi Amat
- 1 Agència de Salut Pública de Barcelona, Barcelona, Spain
| | | | - Laia Palència
- 1 Agència de Salut Pública de Barcelona, Barcelona, Spain.,2 CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,3 Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
| | - Roshanak Mehdipanah
- 1 Agència de Salut Pública de Barcelona, Barcelona, Spain.,7 University of Michigan School of Public Health, Michigan, USA
| | - Maica Rodríguez-Sanz
- 1 Agència de Salut Pública de Barcelona, Barcelona, Spain.,2 CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,3 Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain.,4 Universitat Pompeu Fabra, Barcelona, Spain
| | - Davide Malmusi
- 1 Agència de Salut Pública de Barcelona, Barcelona, Spain.,2 CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,3 Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
| | - Carme Borrell
- 1 Agència de Salut Pública de Barcelona, Barcelona, Spain.,2 CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,3 Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain.,4 Universitat Pompeu Fabra, Barcelona, Spain
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26
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Pérez G, Gotsens M, Palència L, Marí-Dell'Olmo M, Domínguez-Berjón MF, Rodríguez-Sanz M, Puig V, Bartoll X, Gandarillas A, Martín U, Bacigalupe A, Díez E, Ruiz M, Esnaola S, Calvo M, Sánchez P, Luque Fernández MÁ, Borrell C. Protocolo del estudio sobre el efecto de la crisis económica en la mortalidad, la salud reproductiva y las desigualdades en salud en España. Gaceta Sanitaria 2016; 30:472-476. [PMID: 27474486 DOI: 10.1016/j.gaceta.2016.05.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 04/27/2016] [Accepted: 05/02/2016] [Indexed: 11/18/2022]
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, Barcelona, España.
| | - Mercè Gotsens
- Servei de Sistemes d'Informació Sanitària, Agència de Salut Pública de Barcelona, Barcelona, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; Instituto de Investigación Biomédica Sant Pau, Barcelona, España
| | - Laia Palència
- Servei de Sistemes d'Informació Sanitària, Agència de Salut Pública de Barcelona, Barcelona, España; Instituto de Investigación Biomédica Sant Pau, Barcelona, España
| | - Marc Marí-Dell'Olmo
- Servei de Sistemes d'Informació Sanitària, Agència de Salut Pública de Barcelona, Barcelona, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; Instituto de Investigación Biomédica Sant Pau, Barcelona, España; Universitat Rovira i Virgili, Tarragona, España
| | - M Felicitas Domínguez-Berjón
- Servicio de Informes de Salud y Estudios, Dirección General de Salud Pública, Consejería de Sanidad, Comunidad de Madrid, Madrid, España
| | - Maica Rodríguez-Sanz
- Area de Recerca i Docencia, Agència de Salut Pública de Barcelona, Barcelona, España
| | - Vanessa Puig
- Servei de Sistemes d'Informació Sanitària, Agència de Salut Pública de Barcelona, Barcelona, España
| | - Xavier Bartoll
- Servei de Sistemes d'Informació Sanitària, Agència de Salut Pública de Barcelona, Barcelona, España
| | - Ana Gandarillas
- Servicio de Epidemiología, Dirección General de Salud Pública, Consejería de Sanidad, Comunidad de Madrid, Madrid, España
| | - Unai Martín
- Departamento de Sociología 2, Universidad del País Vasco UPV/EHU, Leioa, Bizkaia, España; Grupo de Investigación en Determinantes Sociales de la Salud y Cambio Demográfico-OPIK, Leoia, Bizkaia, España
| | - Amaia Bacigalupe
- Departamento de Sociología 2, Universidad del País Vasco UPV/EHU, Leioa, Bizkaia, España; Grupo de Investigación en Determinantes Sociales de la Salud y Cambio Demográfico-OPIK, Leoia, Bizkaia, España
| | - Elia Díez
- Servei de Programes d'Intervencions Preventives, Agència de Salut Pública de Barcelona, Barcelona, España
| | - Miguel Ruiz
- Consejería de Salud, Junta de Andalucía, Sevilla, España
| | | | | | - Pablo Sánchez
- Observatorio de Salud y Medio Ambiente de Andalucía (OSMAN), Escuela Andaluza de Salud Pública, Granada, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España
| | - Miguel Ángel Luque Fernández
- Faculty of Epidemiology and Population Health, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Carme Borrell
- Gerencia, Agència de Salut Pública de Barcelona, Barcelona, España
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27
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Pessoa DMDV, Pérez G, Marí-Dell'Olmo M, Cornejo-Ovalle M, Borrell C, Piuvezam G, Lima KCD. Comparative Study of the Oral Health Profile of Institutionalized Elderly Persons in Brazil and Barcelona, Spain. Rev bras geriatr gerontol 2016. [DOI: 10.1590/1809-98232016019.160013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Objective: To compare the oral health profile of institutionalized elderly persons in Brazil and in Barcelona, Spain, by gender and country of residence. Methods: A cross-sectional study was performed of individuals aged 65 years and above (n=1,440), resident in the health region of Barcelona and in Brazil. Two surveys and exams relating to the oral health status of institutionalized elderly persons in Brazil (in 2008) and in Barcelona, Spain (in 2009) were carried out. Periodontal disease, tooth loss and dental caries were analyzed, considering age and cognitive ability. The sample was stratified by gender and country. Bivariate and multivariate Robust Poisson Regression models were used to obtain adjusted Prevalence Ratios (aPR), and a 95% confidence interval (95%CI) was employed. Results: In Barcelona, men and women had a higher prevalence of periodontal illness: Men - calculus (aPR:1.5; CI:1.08-2.19) and pocket (aPR:2.05; CI:1.43-2.93) results. Women - calculus (aPR:2.4; CI:1.77-3.24) and pocket (aPR:3.2; CI:2.29-4.53) results. In Barcelona there was a lower prevalence of edentulism (aPR:0.49; CI:0.37-0.65) and functional edentulism (aPR:0.49; CI:0.40-0.60) among men. The same results were found among women with a lower prevalence of edentulism (aPR:0.49; CI: 0.41-0.58) and functional edentulism (aPR:0.42; CI: 0.30-0.49). Conclusions: A poor state of oral health of men and women was observed in both countries, with the elderly from Barcelona having worse periodontal health and the elderly from Brazil having greater tooth loss.
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Bartoll X, Marí-Dell'Olmo M. Patterns of life expectancy before and during economic recession, 2003-12: a European regions panel approach. Eur J Public Health 2016; 26:783-788. [PMID: 27371666 DOI: 10.1093/eurpub/ckw075] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Previous research has reported a decrease in all-cause mortality during times of economic recession. Our objective was to identify the short-term effects of the current Great Recession on life expectancy at birth in Europe, and the role of social protection typology, income and gender. METHODS We used a pooled time series cross-sectional design, with 232 European regions (level 2 of the Nomenclature of Territorial Units for Statistics) as the unit of analysis over 10 years (2003-12). The dependent variable was life expectancy at birth, and the independent variable was unemployment rate. We fit a model in first differences for the periods before and during the Great Recession (2003-07 and 2008-12, respectively), and stratified by sex, social protection typology (Eastern, Mediterranean and Northern) and regional income per capita RESULTS: We observed a negative association during the Great Recession between life expectancy (in years) and in unit change in unemployment among men and women in low-income Mediterranean regions [-0.048(95%CI: -0.081,-0.014) and -0.050(95%CI:-0.091,-0.007), respectively] but no change in trend, and a change in trend to a non-significant negative association among men in high-income Mediterranean and Northern regions (P = 0.005 and P = 0.002, respectively). We also observed a positive association among men in middle-income Mediterranean regions [0.044 (95%CI:0.004,0.084)], with change in trend (P = 0.047), and Eastern regions [0.042 (95%CI:0.001,0.072)] without change in trend. CONCLUSION Overall, our data do not support the notion that increased life expectancy is associated with unemployment during the Great Recession.
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Affiliation(s)
- Xavier Bartoll
- Agència de Salut Pública de Barcelona, Barcelona, Barcelona, Spain .,Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
| | - Marc Marí-Dell'Olmo
- Agència de Salut Pública de Barcelona, Barcelona, Barcelona, Spain.,Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Spain
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Espelt A, Marí-Dell'Olmo M, Penelo E, Bosque-Prous M. Applied Prevalence Ratio estimation with different Regression models: An example from a cross-national study on substance use research. Adicciones 2016; 29:105-112. [PMID: 27391846 DOI: 10.20882/adicciones.823] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To examine the differences between Prevalence Ratio (PR) and Odds Ratio (OR) in a cross-sectional study and to provide tools to calculate PR using two statistical packages widely used in substance use research (STATA and R). METHODS We used cross-sectional data from 41,263 participants of 16 European countries participating in the Survey on Health, Ageing and Retirement in Europe (SHARE). The dependent variable, hazardous drinking, was calculated using the Alcohol Use Disorders Identification Test - Consumption (AUDIT-C). The main independent variable was gender. Other variables used were: age, educational level and country of residence. PR of hazardous drinking in men with relation to women was estimated using Mantel-Haenszel method, log-binomial regression models and poisson regression models with robust variance. These estimations were compared to the OR calculated using logistic regression models. RESULTS Prevalence of hazardous drinkers varied among countries. Generally, men have higher prevalence of hazardous drinking than women [PR=1.43 (1.38-1.47)]. Estimated PR was identical independently of the method and the statistical package used. However, OR overestimated PR, depending on the prevalence of hazardous drinking in the country. CONCLUSIONS In cross-sectional studies, where comparisons between countries with differences in the prevalence of the disease or condition are made, it is advisable to use PR instead of OR.
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Guillaume E, Pornet C, Dejardin O, Launay L, Lillini R, Vercelli M, Marí-Dell'Olmo M, Fernández Fontelo A, Borrell C, Ribeiro AI, de Pina MF, Mayer A, Delpierre C, Rachet B, Launoy G. Development of a cross-cultural deprivation index in five European countries. J Epidemiol Community Health 2016; 70:493-9. [PMID: 26659762 PMCID: PMC4853548 DOI: 10.1136/jech-2015-205729] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 10/25/2015] [Accepted: 11/13/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Despite a concerted policy effort in Europe, social inequalities in health are a persistent problem. Developing a standardised measure of socioeconomic level across Europe will improve the understanding of the underlying mechanisms and causes of inequalities. This will facilitate developing, implementing and assessing new and more effective policies, and will improve the comparability and reproducibility of health inequality studies among countries. This paper presents the extension of the European Deprivation Index (EDI), a standardised measure first developed in France, to four other European countries-Italy, Portugal, Spain and England, using available 2001 and 1999 national census data. METHODS AND RESULTS The method previously tested and validated to construct the French EDI was used: first, an individual indicator for relative deprivation was constructed, defined by the minimal number of unmet fundamental needs associated with both objective (income) poverty and subjective poverty. Second, variables available at both individual (European survey) and aggregate (census) levels were identified. Third, an ecological deprivation index was constructed by selecting the set of weighted variables from the second step that best correlated with the individual deprivation indicator. CONCLUSIONS For each country, the EDI is a weighted combination of aggregated variables from the national census that are most highly correlated with a country-specific individual deprivation indicator. This tool will improve both the historical and international comparability of studies, our understanding of the mechanisms underlying social inequalities in health and implementation of intervention to tackle social inequalities in health.
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Affiliation(s)
- Elodie Guillaume
- French Institute of Health and Medical Research—Caen University, U1086 “Cancers & Préventions”, Caen, France
| | - Carole Pornet
- French Institute of Health and Medical Research—Caen University, U1086 “Cancers & Préventions”, Caen, France
- Pôle Recherche, University Hospital of Caen, Caen, France
| | - Olivier Dejardin
- French Institute of Health and Medical Research—Caen University, U1086 “Cancers & Préventions”, Caen, France
- Pôle Recherche, University Hospital of Caen, Caen, France
| | - Ludivine Launay
- French Institute of Health and Medical Research—Caen University, U1086 “Cancers & Préventions”, Caen, France
- Centre François Baclesse, Avenue du Général Harris—BP5026, Caen, France
| | - Roberto Lillini
- Department of Sociology, PhD School in Applied Sociology and Methodology of Research, University of Milan-Bicocca, Genoa, Italy
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Marina Vercelli
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - 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
| | | | - Carme Borrell
- 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
- Universitat Pompeu Fabra, Barcelona, Spain
| | - Ana Isabel Ribeiro
- Instituto de Engenharia Biomédica—INEB, Universidade do Porto—Departamento de Epidemiologia Clínica, Medicina Preditiva e Saúde Pública, Faculdade de Medicina do Porto, Universidade do Porto—Instituto de Saúde Pública da Universidade do Porto—ISPUP, Porto, Portugal
| | - Maria Fatima de Pina
- Instituto de Engenharia Biomédica—INEB, Universidade do Porto—Departamento de Epidemiologia Clínica, Medicina Preditiva e Saúde Pública, Faculdade de Medicina do Porto, Universidade do Porto—Instituto de Saúde Pública da Universidade do Porto—ISPUP, Porto, Portugal
| | | | - Cyrille Delpierre
- INSERM, U1027, Toulouse F-31300, Toulouse, France
- Université Toulouse III Paul-Sabatier, UMR1027, Toulouse F-31300, Toulouse, France
| | - Bernard Rachet
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Guy Launoy
- French Institute of Health and Medical Research—Caen University, U1086 “Cancers & Préventions”, Caen, France
- Pôle Recherche, University Hospital of Caen, Caen, France
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31
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Rodríguez-Sanz M, Gotsens M, Marí-Dell'Olmo M, Mehdipanah R, Borrell C. Twenty years of socioeconomic inequalities in premature mortality in Barcelona: The influence of population and neighbourhood changes. Health Place 2016; 39:142-52. [PMID: 27105035 DOI: 10.1016/j.healthplace.2016.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 04/09/2015] [Revised: 02/18/2016] [Accepted: 03/04/2016] [Indexed: 11/30/2022]
Abstract
The objective of this study was to analyse trends in socioeconomic inequalities in premature mortality in Barcelona from 1992 to 2011, accounting for population changes. We conducted a repeated cross-sectional study of the Barcelona population (25-64 years) using generalized linear mixed models for trend analysis, and found that socioeconomic inequalities in premature mortality persisted between neighbourhoods, but tended to diminish. However, the reduction in inequality was related to an increase in the number of foreign-born individuals mainly in socioeconomic disadvantaged neighbourhoods, in which the decrease in premature mortality was more marked. To study trends in geographical inequalities in mortality, it is essential to understand demographic changes occurred in different places related to local levels of deprivation.
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Affiliation(s)
- Maica Rodríguez-Sanz
- Agència de Salut Pública de Barcelona, Barcelona, Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Universitat Pompeu Fabra, Barcelona, Spain.
| | - 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
| | - Marc Marí-Dell'Olmo
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Agència de Salut Pública de Barcelona, Barcelona, Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
| | - Roshanak Mehdipanah
- Agència de Salut Pública de Barcelona, Barcelona, Spain; Department of Health Behavior & Health Education, University of Michigan School of Public Health, USA
| | - Carme Borrell
- Agència de Salut Pública de Barcelona, Barcelona, Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Universitat Pompeu Fabra, Barcelona, Spain
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32
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Santana P, Costa C, Marí-Dell'Olmo M, Gotsens M, Borrell C. Mortality, material deprivation and urbanization: exploring the social patterns of a metropolitan area. Int J Equity Health 2015; 14:55. [PMID: 26051558 PMCID: PMC4483227 DOI: 10.1186/s12939-015-0182-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 05/04/2015] [Indexed: 11/16/2022] Open
Abstract
Introduction Socioeconomic inequalities affecting health are of major importance in Europe. The literature enhances the role of social determinants of health, such as socioeconomic characteristics and urbanization, to achieve health equity. Yet, there is still much to know, mainly concerning the association between cause-specific mortality and several social determinants, especially in metropolitan areas. This study aims to describe the geographical pattern of cause-specific mortality in the Lisbon Metropolitan Area (LMA), at small area level (parishes), and analyses the statistical association between mortality risk and health determinants (material deprivation and urbanization level). Fourteen causes have been selected, representing almost 60 % of total mortality between 1995 and 2008, particularly those associated with urbanization and material deprivation. Methods A cross-sectional ecological study was carried out. Using a hierarchical Bayesian spatial model, we estimated sex–specific smoothed Standardized Mortality Ratios (sSMR) and measured the relative risks (RR), and 95 % credible intervals, for cause-specific mortality relative to 1. urbanization level, 2. material deprivation and 3. material deprivation adjusted by urbanization. Results The statistical association between mortality and material deprivation and between mortality and urbanization changes by cause of death and sex. Dementia and MN larynx, trachea, bronchus and lung are the causes of death showing higher relative risk associated with urbanization. Infectious and parasitic diseases, Chronic liver disease and Diabetes are the causes of death presenting higher relative risk associated with material deprivation. Ischemic heart disease was the only cause with a statistical association with both determinants, and MN female breast was the only without any statistical association. Urbanization level reduces the impact of material deprivation for most of the causes of death. Men face a higher impact of material deprivation and urbanization level, than women, in most cause-specific mortality, even when considering the adjusted model. Conclusions Our findings explore the specific pattern of fourteen causes of death in LMA and reveals small areas with an excess risk of mortality associated with material deprivation, thereby identifying problematic areas that could potentially benefit from public policies effecting social inequalities. Electronic supplementary material The online version of this article (doi:10.1186/s12939-015-0182-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Paula Santana
- Departamento de Geografia, Centro de Estudos de Geografia e Ordenamento do Território, Universidade de Coimbra, Colégio S. Jerónimo, Largo D. Dinis, 3000-043, Coimbra, Portugal.
| | - Claudia Costa
- Departamento de Geografia, Centro de Estudos de Geografia e Ordenamento do Território, Universidade de Coimbra, Colégio S. Jerónimo, Largo D. Dinis, 3000-043, Coimbra, Portugal.
| | - Marc Marí-Dell'Olmo
- CIBER Epidemiología y Salud Pública (CIBERESP), 3-5, Pabellón 11. Planta 0, Monforte de Lemos, 28029, Madrid, Spain. .,Agència de Salut Pública de Barcelona, Plaça Lesseps, 1, 08023, Barcelona, Spain. .,Institut d'Investigació Biomèdica (IIB Sant Pau), Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain.
| | - Mercè Gotsens
- CIBER Epidemiología y Salud Pública (CIBERESP), 3-5, Pabellón 11. Planta 0, Monforte de Lemos, 28029, Madrid, Spain. .,Agència de Salut Pública de Barcelona, Plaça Lesseps, 1, 08023, Barcelona, Spain. .,Institut d'Investigació Biomèdica (IIB Sant Pau), Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain.
| | - Carme Borrell
- CIBER Epidemiología y Salud Pública (CIBERESP), 3-5, Pabellón 11. Planta 0, Monforte de Lemos, 28029, Madrid, Spain. .,Agència de Salut Pública de Barcelona, Plaça Lesseps, 1, 08023, Barcelona, Spain. .,Institut d'Investigació Biomèdica (IIB Sant Pau), Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain. .,Universitat Pompeu Fabra, Doctor Aiguader, 80, 08003, Barcelona, Spain.
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33
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Nolasco A, Moncho J, Quesada JA, Melchor I, Pereyra-Zamora P, Tamayo-Fonseca N, Martínez-Beneito MA, Zurriaga O, Ballesta M, Daponte A, Gandarillas A, Domínguez-Berjón MF, Marí-Dell'Olmo M, Gotsens M, Izco N, Moreno MC, Sáez M, Martos C, Sánchez-Villegas P, Borrell C. Trends in socioeconomic inequalities in preventable mortality in urban areas of 33 Spanish cities, 1996-2007 (MEDEA project). Int J Equity Health 2015; 14:33. [PMID: 25879739 PMCID: PMC4392789 DOI: 10.1186/s12939-015-0164-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 03/17/2015] [Indexed: 11/30/2022] Open
Abstract
Background Preventable mortality is a good indicator of possible problems to be investigated in the primary prevention chain, making it also a useful tool with which to evaluate health policies particularly public health policies. This study describes inequalities in preventable avoidable mortality in relation to socioeconomic status in small urban areas of thirty three Spanish cities, and analyses their evolution over the course of the periods 1996–2001 and 2002–2007. Methods We analysed census tracts and all deaths occurring in the population residing in these cities from 1996 to 2007 were taken into account. The causes included in the study were lung cancer, cirrhosis, AIDS/HIV, motor vehicle traffic accidents injuries, suicide and homicide. The census tracts were classified into three groups, according their socioeconomic level. To analyse inequalities in mortality risks between the highest and lowest socioeconomic levels and over different periods, for each city and separating by sex, Poisson regression were used. Results Preventable avoidable mortality made a significant contribution to general mortality (around 7.5%, higher among men), having decreased over time in men (12.7 in 1996–2001 and 10.9 in 2002–2007), though not so clearly among women (3.3% in 1996–2001 and 2.9% in 2002–2007). It has been observed in men that the risks of death are higher in areas of greater deprivation, and that these excesses have not modified over time. The result in women is different and differences in mortality risks by socioeconomic level could not be established in many cities. Conclusions Preventable mortality decreased between the 1996–2001 and 2002–2007 periods, more markedly in men than in women. There were socioeconomic inequalities in mortality in most cities analysed, associating a higher risk of death with higher levels of deprivation. Inequalities have remained over the two periods analysed. This study makes it possible to identify those areas where excess preventable mortality was associated with more deprived zones. It is in these deprived zones where actions to reduce and monitor health inequalities should be put into place. Primary healthcare may play an important role in this process.
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Affiliation(s)
- Andreu Nolasco
- Unidad de Investigación de Análisis de la Mortalidad y Estadísticas Sanitarias. Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia. Campus de San Vicente del Raspeig s/n. Apartado 99, Universidad de Alicante, 03080, Alicante, España.
| | - Joaquin Moncho
- Unidad de Investigación de Análisis de la Mortalidad y Estadísticas Sanitarias. Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia. Campus de San Vicente del Raspeig s/n. Apartado 99, Universidad de Alicante, 03080, Alicante, España.
| | - Jose Antonio Quesada
- Unidad de Investigación de Análisis de la Mortalidad y Estadísticas Sanitarias. Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia. Campus de San Vicente del Raspeig s/n. Apartado 99, Universidad de Alicante, 03080, Alicante, España.
| | - Inmaculada Melchor
- Unidad de Investigación de Análisis de la Mortalidad y Estadísticas Sanitarias. Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia. Campus de San Vicente del Raspeig s/n. Apartado 99, Universidad de Alicante, 03080, Alicante, España. .,Registro de Mortalidad de la Comunidad Valenciana, Servicio de Estudios Epidemiológicos y Estadísticas Sanitarias, Subdirección General de Epidemiología y Vigilancia de la Salud. Conselleria de Sanitat, Plaza de España 6, 03010, Alicante, España.
| | - Pamela Pereyra-Zamora
- Unidad de Investigación de Análisis de la Mortalidad y Estadísticas Sanitarias. Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia. Campus de San Vicente del Raspeig s/n. Apartado 99, Universidad de Alicante, 03080, Alicante, España.
| | - Nayara Tamayo-Fonseca
- Unidad de Investigación de Análisis de la Mortalidad y Estadísticas Sanitarias. Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia. Campus de San Vicente del Raspeig s/n. Apartado 99, Universidad de Alicante, 03080, Alicante, España.
| | - Miguel Angel Martínez-Beneito
- Área de Desigualdades en Salud. FISABIO-CSISP, Conselleria de Sanitat, Avenida de Cataluña, 21, 46020, Valencia, España. .,Ciber de Epidemiología y Salud Pública CIBERESP, Instituto de Salud Carlos III, Melchor Fernández Almagro, 3-5 28029, Madrid, España.
| | - Oscar Zurriaga
- Área de Desigualdades en Salud. FISABIO-CSISP, Conselleria de Sanitat, Avenida de Cataluña, 21, 46020, Valencia, España. .,Servicio de Estudios Epidemiológicos y Estadísticas Sanitarias, Subdirección General de Epidemiología y Vigilancia de la Salud. Conselleria de Sanitat, Avenida de Cataluña, 21, 46020, Valencia, España. .,Ciber de Epidemiología y Salud Pública CIBERESP, Instituto de Salud Carlos III, Melchor Fernández Almagro, 3-5 28029, Madrid, España.
| | - Mónica Ballesta
- Department of Epidemiology, Regional Health Council, Murcia, Spain.
| | - Antonio Daponte
- Observatorio de Salud y Medio Ambiente de Andalucía (OSMAN). Escuela Andaluza de Salud Pública, Campus Universitario de Cartuja, Cuesta del Observatorio, 4. Ap. Correos 2070, Granada, 18080, España.
| | - Ana Gandarillas
- Servicio de Epidemiología. Subdirección de Promoción de la Salud y Prevención. Dirección General de Atención Primaria, Consejería de Sanidad Comunidad de Madrid, C/ San Martín de Porres, n° 6, 1ª planta, 28035, Madrid, España.
| | - M Felicitas Domínguez-Berjón
- Servicio de Informes de Salud y Estudios. Subdirección de Promoción de la Salud y Prevención. Dirección General de Atención Primaria, Consejería de Sanidad Comunidad de Madrid, C/ San Martín de Porres, n° 6, 1ª planta, 28035, Madrid, España.
| | - Marc Marí-Dell'Olmo
- Ciber de Epidemiología y Salud Pública CIBERESP, Instituto de Salud Carlos III, Melchor Fernández Almagro, 3-5 28029, Madrid, España. .,Agència de Salut Pública de Barcelona, Plaça Lesseps, 1, 08023, Barcelona, España. .,Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain.
| | - Mercè Gotsens
- Ciber de Epidemiología y Salud Pública CIBERESP, Instituto de Salud Carlos III, Melchor Fernández Almagro, 3-5 28029, Madrid, España. .,Agència de Salut Pública de Barcelona, Plaça Lesseps, 1, 08023, Barcelona, España. .,Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain.
| | - Natividad Izco
- Dirección General de Salud Pública y Consumo, Gobierno de La Rioja, Calle Vara de Rey n° 8, 1ª planta, 26071, Logroño, España.
| | - M Concepción Moreno
- Ciber de Epidemiología y Salud Pública CIBERESP, Instituto de Salud Carlos III, Melchor Fernández Almagro, 3-5 28029, Madrid, España. .,Instituto de Salud Pública y Laboral de Navarra, C/ Leyre, 15, 31003, Pamplona, Navarra, Spain.
| | - Marc Sáez
- Ciber de Epidemiología y Salud Pública CIBERESP, Instituto de Salud Carlos III, Melchor Fernández Almagro, 3-5 28029, Madrid, España. .,Grupo de Investigación en Estadística, Econometría y Salud (GRECS), [Research Group on Statistics, Econometrics and Health (GRECS)], Universidad de Girona. Calle de la Universidad 10, Campus de Montilivi, 17071, Girona, España.
| | - Carmen Martos
- Ciber de Epidemiología y Salud Pública CIBERESP, Instituto de Salud Carlos III, Melchor Fernández Almagro, 3-5 28029, Madrid, España. .,Instituto Aragonés de Ciencias de la Salud, Avda. San Juan Bosco, n°13, 50009, Zaragoza, España.
| | - Pablo Sánchez-Villegas
- Observatorio de Salud y Medio Ambiente de Andalucía (OSMAN). Escuela Andaluza de Salud Pública, Campus Universitario de Cartuja, Cuesta del Observatorio, 4. Ap. Correos 2070, Granada, 18080, España.
| | - Carme Borrell
- Ciber de Epidemiología y Salud Pública CIBERESP, Instituto de Salud Carlos III, Melchor Fernández Almagro, 3-5 28029, Madrid, España. .,Agència de Salut Pública de Barcelona, Plaça Lesseps, 1, 08023, Barcelona, España.
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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.
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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
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García-Altés A, Pinilla J, Marí-Dell'Olmo M, Fernández E, López MJ. Economic Impact of Smoke-Free Legislation: Did the Spanish Tobacco Control Law Affect the Economic Activity of Bars and Restaurants? Nicotine Tob Res 2015; 17:1397-400. [PMID: 25586775 DOI: 10.1093/ntr/ntu346] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 12/29/2014] [Indexed: 11/14/2022]
Abstract
INTRODUCTION The potential of smoke-free bans to negatively impact the hospitality business has been an argument of the hospitality and tobacco industry against such legislation. A partial smoke-free legislation was introduced in Spain in 2006 allowing smoking in most bars and restaurants due to the pressure of the hospitality sector. However, this partial ban was later amended in 2011 to include all the hospitality premises without exceptions. The stepped Spanish process permits to evaluate whether the entry into force of the smoke-free legislation had any effect on the economic activity of the hospitality sector. METHODS We employed a pooled time series cross-sectional design, with national data over 6 years (2006-2011). The dependent variable used was the total number of bars and restaurants per 100,000 inhabitants. The explanatory variables used were the average amount of spending per household in bars and restaurants, and the total unemployment rate in Spain by regions. RESULTS For every 1% increase in the unemployment rate there was a 0.05% decrease in the number of bars and restaurants. In 2007, the number of bars and restaurants was significantly reduced by 13.06% (all others factors being held constant), 4.87% in 2008, and 10.42% in 2009. No statistically significant effect of the smoke-free legislation emerged from 2010 (6.76%) to 2011 (7.69%). CONCLUSION The new Spanish smoke-free legislation had no effect on the number of bars and restaurants.
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Affiliation(s)
- Anna García-Altés
- Fundación Instituto de Investigación en Servicios Sanitarios (IISS), València, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
| | - Jaime Pinilla
- Department of Quantitative Methods in Economics, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Marc Marí-Dell'Olmo
- CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain; Agència de Salut Pública de Barcelona, Barcelona, Spain
| | - Esteve Fernández
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, Universitat de Barcelona, Barcelona, Spain
| | - Maria José López
- CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain; Agència de Salut Pública de Barcelona, Barcelona, Spain
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Rodríguez-Fonseca M, Palència L, Marí-Dell'Olmo M, Gandarillas A, Domínguez-Berjón M, Gotsens M, Rodríguez-Sanz M, Borrell C. Evolution of socio-economic inequalities in mortality in small geographical areas of the two largest cities in Spain (Barcelona and Madrid), 1996–2007. Public Health 2013; 127:916-21. [DOI: 10.1016/j.puhe.2013.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Revised: 05/22/2013] [Accepted: 07/01/2013] [Indexed: 11/28/2022]
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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.
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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.
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Xu Y, Dadvand P, Barrera-Gómez J, Sartini C, Marí-Dell'Olmo M, Borrell C, Medina-Ramón M, Sunyer J, Basagaña X. Differences on the effect of heat waves on mortality by sociodemographic and urban landscape characteristics. J Epidemiol Community Health 2013; 67:519-525. [PMID: 23443960 DOI: 10.1136/jech2012-201899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
BACKGROUND Mortality increases during heat waves have been reported worldwide. The magnitude of these increases can vary within regions according to sociodemographic and urban landscape characteristics. The objectives of this study were to explore this variation and its determinants, and to identify the most heat-vulnerable areas by mapping heat vulnerability. METHODS We conducted a time-stratified case-crossover analysis using daily mortality in the Barcelona metropolitan area during the warm seasons of 1999-2006. Temperature data on the date of death were assigned to each individual, which were assigned to their census tract of residence. Eight census tract-level variables on socioeconomic or built environment characteristics were obtained from the census. Residence surrounding greenness was obtained from satellite data. The relative risk (RR) of mortality after three consecutive hot days (defined as those exceeding the 95th percentile of maximum temperature) was calculated via conditional logistic regression. Effect modification was examined by including interaction terms. RESULTS Analyses were based on 52 806 deaths. The effect of three consecutive hot days was a 30% increase in all-cause mortality (RR=1.30, 95% CI 1.24 to 1.38). Heterogeneity of this effect was observed across census tracts. The effect of heat on mortality was higher in the census tracts with a large percentage of old buildings (RR=1.21, 95% CI 1.00 to 1.46), manual workers (RR=1.25, 95% CI 0.96 to 1.64) and residents perceiving little surrounding greenness (RR=1.29, 95% CI 1.01 to 1.65). After three consecutive hot days, mortality doubled in the most heat-vulnerable census tracts. CONCLUSIONS Sociodemographic and urban landscape characteristics are associated to mortality risk during heat waves and are useful to build heat vulnerability maps.
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Affiliation(s)
- Yihan Xu
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Catalonia, Spain
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Villalonga-Olives E, Marí-Dell'Olmo M, Gotsens M, Ramos M, Ramon J, Cabeza E, Borrell C. [Analysis of inequalities in mortality in small areas: obstacles to overcome]. Gac Sanit 2013; 27:378-80. [PMID: 23537857 DOI: 10.1016/j.gaceta.2013.01.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 01/29/2013] [Accepted: 01/31/2013] [Indexed: 10/27/2022]
Abstract
No analyses have been performed in the Balearic Islands (Spain) to assess health inequalities in mortality in small areas. The objective of this study was to construct a mortality atlas using geocoding of mortality records. During this process, several problems were encountered, which are summarized in this article. These problems were based on the lack of stable small geographical areas, difficulties in obtaining the population for small areas divided by age and sex for the study period, problems with the quality of the cartography, and the poor quality of the mortality records. The methodological problems identified in this process should be considered in future studies.
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Xu Y, Dadvand P, Barrera-Gómez J, Sartini C, Marí-Dell'Olmo M, Borrell C, Medina-Ramón M, Sunyer J, Basagaña X. Differences on the effect of heat waves on mortality by sociodemographic and urban landscape characteristics. J Epidemiol Community Health 2013; 67:519-25. [DOI: 10.1136/jech-2012-201899] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Abstract
Evaluation of public health interventions poses numerous methodological challenges. Randomization of individuals is not always feasible and interventions are usually composed of multiple factors. To face these challenges, certain elements, such as the selection of the most appropriate design and the use of a statistical analysis that includes potential confounders, are essential. The objective of this article was to describe the most frequently used designs in the evaluation of public health interventions (policies, programs or campaigns). The characteristics, strengths and weaknesses of each of these evaluative designs are described. Additionally, a brief explanation of the most commonly used statistical analysis in each of these designs is provided.
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Gotsens M, Marí-Dell'Olmo M, Rodríguez-Sanz M, Martos D, Espelt A, Pérez G, Pérez K, Teresa Brugal M, Barbería Marcalain E, Borrell C. [Validation of the underlying cause of death in medicolegal deaths]. Rev Esp Salud Publica 2011; 85:163-74. [PMID: 21826379 DOI: 10.1590/s1135-57272011000200005] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Deaths due to external causes require additional medical tests in order to determine the cause of death. If these results are not incorporated into the death register these causes may be misclassified. The objective of this study is to validate the underlying cause of death of the Mortality Register with information obtained from forensic sources in Barcelona between 2004 and 2006. METHODS Cross-sectional design. The study population consisted of deceased residents in Barcelona with a medicolegal intervention between 2004 and 2006. The sources of information are the Mortality Registry and the forensic pathology file filled in by Institute of Legal Medicine of Catalonia (ILMC) (gold standard). The study variables are the cause of death, sex and age. Sensitivity and percentage of confirmation (PC) with 95% confidence intervals (95% CI) are calculated. RESULTS The sensitivity of external causes is 59.7% (95% CI:56.5-62.9) and PC is 96.7% (95% CI:94.8-98.0). Traffic injuries, poisonings and suicides are under-reported in the Mortality Register with a sensitivity lower than 45% and a PC higher than 80%. Symptoms, signs and ill-defined conditions are over-reported with a sensitivity of 89.2% (95% CI:83.4-93.4) and a PC of 28.0% (95% CI:24.2-32.1). There are no differences by sex and age. CONCLUSIONS The validity of the external causes in the Mortality Register is low due to under-reporting and the high proportion of symptoms signs and ill-defined causes. According to the results, incorporating information from forensic sources to the Mortality Register increases the quality of mortality statistics.
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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.
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Abstract
BACKGROUND To perform a cost-benefit analysis of the installation of speed cameras on the beltways of Barcelona. METHODS The analysis was performed from the society perspective over a 2-year period using a controlled before-and-after study design. The net benefit was calculated using, as benefits, the willingness to pay for the estimated number of people who avoided injury as a consequence of the intervention, subtracting costs and savings. Sensitivity analyses were performed using the maximum and minimum estimated number of people who avoided injury, assuming that there was a minimum of one death avoided, using the maximum value of a statistical life, assigning all implementation costs to the first year and assuming there was no time lost due to speed reduction. RESULTS Base case results showed a net benefit of €6.8 million. Sensitivity analyses suggested that net benefits could range from €5.6 to €23.1 million over 2 years. CONCLUSIONS The use of speed cameras in urban areas has a favourable economic impact even when assessed using conservative assumptions.
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Affiliation(s)
- Joan Mendivil
- Agència de Salut Pública de Barcelona, Barcelona, Spain
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Muntaner C, Borrell C, Solà J, Marí-Dell'Olmo M, Chung H, Rodríguez-Sanz M, Benach J, Rocha KB, Ng E. Class Relations and All-Cause Mortality: A Test of Wright's Social Class Scheme Using the Barcelona 2000 Health Interview Survey. Int J Health Serv 2011; 41:431-58. [DOI: 10.2190/hs.41.3.c] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The aim of this study is to test the effects of neo-Marxian social class and potential mediators such as labor market position, work organization, material deprivation, and health behaviors on all-cause mortality. The authors use longitudinal data from the Barcelona 2000 Health Interview Survey (N = 7,526), with follow-up interviews through the municipal census in 2008 (95.97% response rate). Using data on relations of property, organizational power, and education, the study groups social classes according to Wright's scheme: capitalists, petit bourgeoisie, managers, supervisors, and skilled, semi-skilled, and unskilled workers. Findings indicate that social class, measured as relations of control over productive assets, is an important predictor of mortality among working-class men but not women. Workers (hazard ratio = 1.60; 95% confidence interval, 1.10–2.35) but also managers and small employers had a higher risk of death compared with capitalists. The extensive use of conventional gradient measures of social stratification has neglected sociological measures of social class conceptualized as relations of control over productive assets. This concept is capable of explaining how social inequalities are generated. To confirm the protective effect of the capitalist class position and the “contradictory class location hypothesis,” additional efforts are needed to properly measure class among low-level supervisors, capitalists, managers, and small employers.
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Puigpinós-Riera R, Marí-Dell'Olmo M, Gotsens M, Borrell C, Serral G, Ascaso C, Calvo M, Daponte A, Domínguez-Berjón FM, Esnaola S, Gandarillas A, López-Abente G, Martos CM, Martínez-Beneito MA, Montes-Martínez A, Montoya I, Nolasco A, Pasarín IM, Rodríguez-Sanz M, Sáez M, Sánchez-Villegas P. Cancer mortality inequalities in urban areas: a Bayesian small area analysis in Spanish cities. Int J Health Geogr 2011; 10:6. [PMID: 21232096 PMCID: PMC3033786 DOI: 10.1186/1476-072x-10-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Accepted: 01/13/2011] [Indexed: 11/10/2022] Open
Abstract
Background Intra-urban inequalities in mortality have been infrequently analysed in European contexts. The aim of the present study was to analyse patterns of cancer mortality and their relationship with socioeconomic deprivation in small areas in 11 Spanish cities. Methods It is a cross-sectional ecological design using mortality data (years 1996-2003). Units of analysis were the census tracts. A deprivation index was calculated for each census tract. In order to control the variability in estimating the risk of dying we used Bayesian models. We present the RR of the census tract with the highest deprivation vs. the census tract with the lowest deprivation. Results In the case of men, socioeconomic inequalities are observed in total cancer mortality in all cities, except in Castellon, Cordoba and Vigo, while Barcelona (RR = 1.53 95%CI 1.42-1.67), Madrid (RR = 1.57 95%CI 1.49-1.65) and Seville (RR = 1.53 95%CI 1.36-1.74) present the greatest inequalities. In general Barcelona and Madrid, present inequalities for most types of cancer. Among women for total cancer mortality, inequalities have only been found in Barcelona and Zaragoza. The excess number of cancer deaths due to socioeconomic deprivation was 16,413 for men and 1,142 for women. Conclusion This study has analysed inequalities in cancer mortality in small areas of cities in Spain, not only relating this mortality with socioeconomic deprivation, but also calculating the excess mortality which may be attributed to such deprivation. This knowledge is particularly useful to determine which geographical areas in each city need intersectorial policies in order to promote a healthy environment.
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Affiliation(s)
- Rosa Puigpinós-Riera
- Servei de Sistemes d'Informació Sanitaria, Agència de Salut Pública de Barcelona, Barcelona, Spain.
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Puigpinós-Riera R, Marí-Dell'Olmo M, Gotsens M, Borrell C, Serral G, Ascaso C, Calvo M, Daponte A, Domínguez-Berjón FM, Esnaola S, Gandarillas A, López-Abente G, Martos CM, Martínez-Beneito MA, Montes-Martínez A, Montoya I, Nolasco A, Pasarín IM, Rodríguez-Sanz M, Sáez M, Sánchez-Villegas P. Cancer mortality inequalities in urban areas: a Bayesian small area analysis in Spanish cities. Int J Health Geogr 2011. [PMCID: PMC3090312 DOI: 10.1186/1476-072x-10-27] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Novoa AM, Pérez K, Santamariña-Rubio E, Marí-Dell'Olmo M, Ferrando J, Peiró R, Tobías A, Zori P, Borrell C. Impact of the penalty points system on road traffic injuries in Spain: a time-series study. Am J Public Health 2010; 100:2220-7. [PMID: 20864703 DOI: 10.2105/ajph.2010.192104] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We assessed the effectiveness of the penalty points system (PPS) introduced in Spain in July 2006 in reducing traffic injuries. METHODS We performed an evaluation study with an interrupted time-series design. We stratified dependent variables-numbers of drivers involved in injury collisions and people injured in traffic collisions in Spain from 2000 to 2007 (police data)--by age, injury severity, type of road user, road type, and time of collision, and analyzed variables separately by gender. The explanatory variable (the PPS) compared the postintervention period (July 2006 to December 2007) with the preintervention period (January 2000 to June 2006). We used quasi-Poisson regression, controlling for time trend and seasonality. RESULTS Among men, we observed a significant risk reduction in the postintervention period for seriously injured drivers (relative risk [RR] = 0.89) and seriously injured people (RR = 0.89). The RRs among women were 0.91 (P = .095) and 0.88 (P < .05), respectively. Risk reduction was greater among male drivers, moped riders, and on urban roads. CONCLUSIONS The PPS was associated with reduced numbers of drivers involved in injury collisions and people injured by traffic collisions in Spain.
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Affiliation(s)
- Ana M Novoa
- Agència de Salut Pública de Barcelona, Barcelona, Spain
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Giné-Garriga M, Guerra M, Pagès E, Manini TM, Marí-Dell'Olmo M, Jiménez R, Unnithan VB. The Effect of Functional Circuit Training on Balance and Strength in Physically Frail Older Adults. Med Sci Sports Exerc 2010. [DOI: 10.1249/01.mss.0000386381.06562.b0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Novoa AM, Pérez K, Santamariña-Rubio E, Marí-Dell'Olmo M, Cozar R, Ferrando J, Peiró R, Tobías A, Zori P, Borrell C. Road safety in the political agenda: the impact on road traffic injuries. J Epidemiol Community Health 2009; 65:218-25. [PMID: 19959650 DOI: 10.1136/jech.2009.094029] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND This paper aims at assessing the effectiveness of the package of road safety measures implemented after road safety was included in the political agenda in the year 2004 on the number of road traffic-injured people in Spain. METHODS An evaluation study was performed using an interrupted time-series design. The study population was people injured in road traffic crashes in Spain between 1 January 2000 and 31 December 2006. The road traffic crashes database of the General Directorate for Traffic was used. The dependent variable was the monthly number of people injured, stratified by sex, age, severity and type of road user. The explanatory variable (intervention) compared the post-intervention period (2004-6) with the pre-intervention period (2000-3). Quasi-Poisson regression models were adjusted, controlling for time trend and for seasonality. RESULTS Results show a reduction in the risk of being injured for both men (RR 0.91; 95% CI 0.87 to 0.95) and women (RR 0.89; 95% CI 0.85 to 0.94). Risk reductions were observed across all age groups and all road users, except for pedestrians. CONCLUSIONS The present study suggests that prioritising road safety reduces the number of people injured in road traffic collisions.
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Affiliation(s)
- Ana M Novoa
- Agència de Salut Pública de Barcelona, Barcelona, Spain
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