Trends in socioeconomic inequalities in preventable mortality in urban areas of 33 Spanish cities, 1996–2007 (MEDEA project)

Nolasco, Andreu; Vasallo, Joaquín Moncho; Quesada, José A.; Melchor, Inmaculada; Pereyra-Zamora, Pamela; Tamayo-Fonseca, Nayara; Martínez-Beneito, Miguel A.; Zurriaga, Óscar; Ballesta, M. Teresa Sánchez; Daponte, Antonio; Gandarillas, Ana; Domínguez‐Berjón, M. Felícitas; Marí-Dell’Olmo, Marc; Gotsens, Mercè; Izco, Natividad; Moreno, Ma Concepción; Sáez, Marc; Martos, Carmen; Sánchez‐Villegas, Pablo; Borrell, Carme

doi:10.1186/s12939-015-0164-0

Cited by 30 publications

(31 citation statements)

References 54 publications

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“…In addition, a corresponding decrease of absolute mortality and an increase of relative inequalities existed in overall and IHD mortality. Our findings differed from the urban areas of Spain, where socioeconomic inequalities of preventable mortality remained stable [ 51 ].…”

Section: Discussioncontrasting

confidence: 91%

Comparative observational study of mortality amenable by health policy and care between rural and urban Finland: no excess segregation of mortality in the capital despite its increasing residential differentiation

Lehikoinen

Arffman

Manderbacka

et al. 2016

Int J Equity Health

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BackgroundLarge cities are often claimed to display more distinct geographical and socioeconomic health inequalities than other areas due to increasing residential differentiation. Our aim was to assess whether geographical inequalities in mortality within the capital (City of Helsinki) both exceeded that in other types of geographical areas in Finland, and whether those differences were dependent on socioeconomic inequalities.MethodsWe analysed the inequality of distribution separately for overall, ischemic heart disease and alcohol-related mortality, and mortality amenable (AM) to health care interventions in 1992–2008 in three types of geographical areas in Finland: City of Helsinki, other large cities, and small towns and rural areas. Mortality data were acquired as secondary data from the Causes of Death statistics from Statistics Finland. The assessment of changing geographical differences over time, that is geographical inequalities, was performed using Gini coefficients. As some of these differences might arise from socioeconomic factors, we assessed socioeconomic differences with concentration indices in parallel to an analysis of geographical differences. To conclude the analysis, we compared the changes over time of these inequalities between the three geographical areas.ResultsWhile mortality rates mainly decreased, alcohol-related mortality in the lowest income quintile increased. Statistically significant differences over time were found in all mortality groups, varying between geographical areas. Socioeconomic differences existed in all mortality groups and geographical areas. In the study period, geographical differences in mortality remained relatively stable but income differences increased substantially. For instance, the values of concentration indices for AM changed by 54 % in men (p < 0.027) and by 62 % in women (p < 0.016). Only slight differences existed in the time trends of Gini or in the concentration indices between the geographical areas.ConclusionsNo geographical or income-related differences in the distribution of mortality existed between Helsinki and other urban or rural areas of Finland. This suggests that the effect of increasing residential differentiation in the capital may have been mitigated by the policies of positive discrimination and social mixing. One of the main reasons for the increase in health inequalities was growth of alcohol-related mortality, especially among those with the lowest incomes.

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Section: Discussioncontrasting

confidence: 91%

Comparative observational study of mortality amenable by health policy and care between rural and urban Finland: no excess segregation of mortality in the capital despite its increasing residential differentiation

Lehikoinen

Arffman

Manderbacka

et al. 2016

Int J Equity Health

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“…Different Spanish regions also have differences in MM prevalences: 47 % (ages 19+) in Catalonia [28], 37 % (15+) in Aragon [9], and 24 % (all ages) in Basque Country [28], all from EHR analysis, and 69 % (18+) in a representative survey of the Spanish population [29]. These differences may be due to the methodology used in these studies or to the effects of socioeconomic inequalities between territorial regions of Spain [30]. Nonetheless, cardiovascular diseases are present in the main MM patterns reported in most countries.…”

Section: Discussionmentioning

confidence: 99%

The burden of cardiovascular morbidity in a European Mediterranean population with multimorbidity: a cross-sectional study

et al. 2016

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BackgroundCardiovascular diseases are highly represented in multimorbidity patterns. Nevertheless, few studies have analysed the burden of these diseases in the population with multimorbidity. The objective of this study was to identify and describe the cardiovascular diseases among the patients with multimorbidity.MethodsWe designed a cross-sectional study in patients ≥19 years old assigned to 251 primary health care centres in Catalonia, Spain. The main outcome was cardiovascular morbidity burden, defined as the presence of one or more of 24 chronic cardiovascular diseases in multimorbid patients (≥2 chronic conditions). Two groups were defined, with and without multimorbidity; the multimorbidity group was further divided into cardiovascular and non-cardiovascular subgroups. The secondary outcomes were: modifiable major cardiovascular risk factors (smoking, hypertension, hypercholesterolaemia, diabetes) and cardiovascular risk score (REGICOR, Registre Gironí del Cor). Other variables analysed were: sex, age (19–24, 25–44, 45–64, 65–79, and 80+ years), number of chronic diseases, urban setting, active toxic habits (smoking and alcohol), physical parameters and laboratory tests.ResultsA total of 1,749,710 individuals were included (mean age, 47.4 years [SD: 17.8]; 50.7 % women), of which nearly half (46.8 %) had multimorbidity (95 % CI: 46.9–47.1). In patients with multimorbidity,, the cardiovascular burden was 54.1 % of morbidity (95 % CI: 54.0–54.2) and the four most prevalent cardiovascular diseases were uncomplicated hypertension (75.3 %), varicose veins of leg (20.6 %), “other” heart disease (10.5 %) and atrial fibrillation/flutter (6.7 %). In the cardiovascular morbidity subgroup, 38.2 % had more than one cardiovascular disease. The most prevalent duet and triplet combinations were uncomplicated hypertension & lipid disorder (38.8 %) and uncomplicated hypertension & lipid disorder & non-insulin dependent diabetes (11.3 %), respectively. By age groups, the same duet was the most prevalent in patients aged 45–80 years and in men aged 25–44 years. In women aged 19–44, varicose veins of leg & anxiety disorder/anxiety was the most prevalent; in men aged 19–24, it was uncomplicated hypertension & obesity. Patients with multimorbidity showed a higher cardiovascular risk profile than the non-multimorbidity group.ConclusionsMore than 50 % percent of patients with multimorbidity had cardiovascular diseases, the most frequent being hypertension. The presence of cardiovascular risk factors and the cardiovascular risk profile were higher in the multimorbidity group than the non-multimorbidity group. Hypertension, diabetes and dyslipidaemia constituted the most prevalent multimorbidity pattern.

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“…Socioeconomic indicators are related to AM, and particularly to AMM, due to a higher mortality rate among the less privileged, as has been pointed out in several studies conducted in different countries [ 2 , 4 , 5 , 6 , 7 , 8 ]. These inequalities are a risk factor for the health of the population.…”

Section: Introductionmentioning

confidence: 93%

“…Specifically, AMM may be influenced by a number of factors, such as healthcare benefits, geographical location, and other socioeconomic factors [ 1 ]. Identifying geographical areas (provinces, regions…) with higher risks of AMM would allow to carry out specific actions in health aimed at reducing mortality and, thus, inequalities [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Economic Crisis and Amenable Mortality in Spain

Nolasco

Pereyra-Zamora

Sanchis-Matea

et al. 2018

IJERPH

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Background: Both overall mortality and avoidable mortality have decreased in recent years in most European countries. It has become clear that less privileged socioeconomic groups have an increased risk of death. In 2008, most countries went into a severe economic recession, whose effects on the health of the population are still ongoing. While on the one hand, some evidence associates the economic crisis with positive health outcomes (pro-cyclical effect), on the other hand, some other evidence suggests that the economic crisis may pose serious public health problems (counter-cyclical effect), which has given rise to controversy. Objectives: To describe the evolution of overall mortality and amenable mortality in Spain between 2002–2007 (before the economic crisis) and 2008–2013 (during the economic crisis), nationally and by province, as well as to analyse trends in the risks of death and their association with indicators of the impact of the crisis. Methods: Ecological study of overall mortality and amenable mortality describing the evolution of the risks of death between 2002–2007 and 2008–2013. Age Standardised Rates were calculated, as well as their percentage change between periods. The association between percentage changes and provincial indicators of the impact of the crisis was analysed. Amenable mortality was studied both overall and categorised into five groups. Results: Amenable mortality represented 8.25% of overall mortality in 2002–2007, and 6.93% in 2008–2013. Age Standardised Rates for overall mortality and global amenable mortality generally declined, with the sharpest decline in amenable mortality. Decreases in overall mortality and amenable mortality were directly related to vulnerability indicators. The most significant decreases were registered in ischaemic heart disease, cerebrovascular disease, and other amenable causes. The relationship with vulnerability indices varied from direct (cancer) to inverse (hypertensive disease). Conclusions: Amenable mortality shows a more significant decrease than overall mortality between both study periods, albeit unevenly between provinces causes of death. Higher vulnerability indicators entail greater declines, although this trend varied for different causes. Mortality trends and their relationship with socioeconomic indicators in a situation of crisis must be conducted cautiously, taking into consideration a possible pro-cyclical effect.

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Trends in socioeconomic inequalities in preventable mortality in urban areas of 33 Spanish cities, 1996–2007 (MEDEA project)

Cited by 30 publications

References 54 publications

Comparative observational study of mortality amenable by health policy and care between rural and urban Finland: no excess segregation of mortality in the capital despite its increasing residential differentiation

Comparative observational study of mortality amenable by health policy and care between rural and urban Finland: no excess segregation of mortality in the capital despite its increasing residential differentiation

The burden of cardiovascular morbidity in a European Mediterranean population with multimorbidity: a cross-sectional study

Economic Crisis and Amenable Mortality in Spain

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