Influence of Place of Birth on Adult Mortality: The Case of Spain

We use a unique data set from Spain and we estimate life expectancy at age 50 for males and females by place of residence and place of birth. We show that, consistent with expectations regarding the influence of early conditions on adult health and mortality, the effects of place of birth on adult mortality are very strong, irrespective of place of residence. Furthermore, we find that mortality levels observed in a place are strongly influenced by the composition of migrants by place of birth. This is reflected in a new measure of heritability of early childhood conditions that attains a value in the range 0.42-0.43, implying that as much as 43 percent of the variance in Spain's life expectancy at age 50 is explained by place of birth. Finally, we find evidence of the healthy migrant effect, that is, positive health selection of migrants, at a regional level.

Educational Differences in Cohort Fertility Across Sub-national Regions in Europe

Educational differences in female cohort fertility vary strongly across high-income countries and over time, but knowledge about how educational fertility differentials play out at the sub-national regional level is limited. Examining these sub-national regional patterns might improve our understanding of national patterns, as regionally varying contextual conditions may affect fertility. This study provides for the first time for a large number of European countries a comprehensive account of educational differences in the cohort fertility rate (CFR) at the sub-national regional level. We harmonise data from population registers, censuses, and large-sample surveys for 15 countries to measure women’s completed fertility by educational level and region of residence at the end of the reproductive lifespan. In order to explore associations between educational differences in CFRs and levels of economic development, we link our data to regional GDP per capita. Empirical Bayesian estimation is used to reduce uncertainty in the regional fertility estimates. We document an overall negative gradient between the CFR and level of education, and notable regional variation in the gradient. The steepness of the gradient is inversely related to the economic development level. It is steepest in the least developed regions and close to zero in the most developed regions. This tendency is observed within countries as well as across all regions of all countries. Our findings underline the variability of educational gradients in women’s fertility, suggest that higher levels of development may be associated with less negative gradients, and call for more in-depth sub-national-level fertility analyses by education.

[Differences in disability-free life expectancy by gender and autonomous regions in Spain]

BACKGROUND

Improvement of population health is the main aim and an important challenge for the health system. To monitor the population health indicators like disability-free life expectancy (DFLE) have been implemented. The purpose of this paper was to analyze the geographical distribution of DFLE according to autonomous regions in Spain.

METHODS

Data of mortality, population and disability for the year 1999, provided by the National Institute of Statistics (INE), were used. To calculate DFLE by gender and region we used the Sullivan method that weights the expected time to live according to the status of disablement of the population. The standard error of DFLE, the expectation of disability and the proportion of time lived free of disability have also been estimated.

RESULTS

In 1999 the DFLE at birth in Spain was 68.5 year for men and 72.2 years in women. Men lived proportionally more time free of disability than women (91% versus 87.7%) with an expectation of disability of 6.8 and 10.1 years respectively. Variability among regions was higher in DFLE than in life expectancy (LE). The regions with highest LE are not always those with the highest proportion of time lived without disability.

CONCLUSIONS

Highest life expectancy does not always mean best health as it has been assumed currently. The DFLE indicator is a useful tool to show health status differences among the Spanish population.

[Keys to demographic changes in the new millennium]

This article describes the main features of the dynamics of demographic change in the population of Spain during the twentieth century, emphasizing the most recent developments: population ageing, the establishment of a very low fertility regime and the increasing importance of foreign immigration as well as the impact which all these have on the composition of households. Those aspects most directly related to the provision of health and social services is discussed, such as the impact of increased life expectancy on the incidence of illness and handicap in the population, the role of foreign immigration in providing personal services within the family and the health implications of the new model of delayed fertility. Finally, the health implications of population projections for the next 50 years are discussed.

Desigualdades en mortalidad en la ciudad de Sevilla

OBJECTIVES

To describe social inequalities in mortality in Seville from 1994 to 1998 according to socioeconomic status.

METHODS

Life expectancy, crude and age-adjusted rates of total mortality as well as mortality by causes and potential years of life lost were estimated using the number of deaths and the population of Seville, aggregated by Basic Health Areas (BHA). BHA were divided in three levels according to the unemployment rate among men. The relative risks of total mortality and mortality by causes were estimated for men and women in each of these levels, using Poisson regression. The unemployment rate of each of the BHA was related to total mortality and to some of its causes.

RESULTS

Differences in life expectancy of up to 7.9 years for men and 4.6 years for women were found among BHA. Concerning potential years of life lost, the areas with the highest mortality showed 4.1 times greater mortality in men and 2.6 times greater mortality in women than those with the lowest mortality. Total mortality increased with unemployment rate: the BHA with the highest unemployment rate showed a 15% increase in mortality in men and a 6% increase in that in women than those with the lowest unemployment rate. Among causes of mortality, AIDS showed the greatest inequalities in both men and women.

CONCLUSIONS

From 1994 to 1998, Seville presented inequalities in total mortality and premature mortality, as well as in mortality by causes per BHA. Inequalities were present in men and women, although they were greater in men. There was a clear association between socioeconomic variables and mortality.

The role of the social condition of women in the decline of maternal and female mortality

The objective of this article is to study the changes that have occurred in the mortality pattern of women of fertile age in Spain throughout the 20th century, the significance of maternal mortality in the development of this pattern, and the other causes of death that have contributed most to such changes. Female mortality has most often been approached from the perspective of the genetic differences from males--particularly from the sexual-biological, basically reproductive, aspect--without considering other possible (social) differences. We have studied the female mortality pattern from the double incline of date of death (period) and of date of birth (cohort). Using the mortality theory of competing risks as our basis, we excluded in turn maternal mortality and mortality due to tuberculosis from overall mortality, and analyzed the transformations produced in the mortality pattern. Our results show that maternal mortality alone cannot be held responsible for the excess female mortality of the 1910s and 1920s, or for the mortality pattern among women of fertile age during the first half of this century. We suggest that the social discrimination against females from infancy has been responsible for most of the differences observed in mortality patterns.