Trends in socioeconomic inequalities in cirrhosis mortality in an urban area of Southern Europe: a multilevel approach

Dalmau-Bueno, Albert; García-Altés, Anna; Marí-Dell’Olmo, Marc; Pérez, Katherine; Espelt, Albert; Kunst, Anton E.; Borrell, Carme

doi:10.1136/jech.2008.086538

Cited by 20 publications

(22 citation statements)

References 36 publications

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“…In the majority of Spanish cities where inequalities in mortality have been studied it has been observed that they remain stable or decrease [21, 23, 24, 38, 39]. In this study, we corroborate the findings of those studies, as only in 1 city among men, we have seen that inequalities increased significantly.…”

Section: Discussionsupporting

confidence: 91%

Trends in socioeconomic inequalities in mortality in small areas of 33 Spanish cities

et al. 2016

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BackgroundIn Spain, several ecological studies have analyzed trends in socioeconomic inequalities in mortality from all causes in urban areas over time. However, the results of these studies are quite heterogeneous finding, in general, that inequalities decreased, or remained stable. Therefore, the objectives of this study are: (1) to identify trends in geographical inequalities in all-cause mortality in the census tracts of 33 Spanish cities between the two periods 1996–1998 and 2005–2007; (2) to analyse trends in the relationship between these geographical inequalities and socioeconomic deprivation; and (3) to obtain an overall measure which summarises the relationship found in each one of the cities and to analyse its variation over time.MethodsEcological study of trends with 2 cross-sectional cuts, corresponding to two periods of analysis: 1996–1998 and 2005–2007. Units of analysis were census tracts of the 33 Spanish cities. A deprivation index calculated for each census tracts in all cities was included as a covariate. A Bayesian hierarchical model was used to estimate smoothed Standardized Mortality Ratios (sSMR) by each census tract and period. The geographical distribution of these sSMR was represented using maps of septiles. In addition, two different Bayesian hierarchical models were used to measure the association between all-cause mortality and the deprivation index in each city and period, and by sex: (1) including the association as a fixed effect for each city; (2) including the association as random effects. In both models the data spatial structure can be controlled within each city. The association in each city was measured using relative risks (RR) and their 95 % credible intervals (95 % CI).ResultsFor most cities and in both sexes, mortality rates decline over time. For women, the mortality and deprivation patterns are similar in the first period, while in the second they are different for most cities. For men, RRs remain stable over time in 29 cities, in 3 diminish and in 1 increase. For women, in 30 cities, a non-significant change over time in RR is observed. However, in 4 cities RR diminishes. In overall terms, inequalities decrease (with a probability of 0.9) in both men (RR = 1.13, 95 % CI = 1.12–1.15 in the 1st period; RR = 1.11, 95 % CI = 1.09–1.13 in the 2nd period) and women (RR = 1.07, 95 % CI = 1.05–1.08 in the 1st period; RR = 1.04, 95 % CI = 1.02–1.06 in the 2nd period).ConclusionsIn the future, it is important to conduct further trend studies, allowing to monitoring trends in socioeconomic inequalities in mortality and to identify (among other things) temporal factors that may influence these inequalities.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3190-y) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 91%

Trends in socioeconomic inequalities in mortality in small areas of 33 Spanish cities

et al. 2016

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“…Grabauskas et al described a growing tendency in avoidable mortality in Lithuania [ 33 ]. By causes, in Spain, Dalmau-Bueno et al found a decrease in deaths due cirrhosis between 1992 and 2004 in Barcelona, in both men and women [ 23 ]. Other studies have described a reduction in AIDS and HIV mortality, particularly as a consequence of Highly Active Antiretroviral Therapy (HAART), among them Borrell et al in Barcelona [ 19 ] and Regidor et al in the Madrid region [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

“…In a study conducted in Barcelona using figures from the 1992–2003 period, Borrell et al [ 21 ] found that inequalities in mortality by educational level did not change substantially over time. There are studies which point to an increase in socioeconomic inequalities due to cirrhosis [ 34 , 53 ] or towards their remaining the same or increasing in certain age groups [ 23 ]. In the case of AIDS and HIV several studies show that socioeconomic inequalities have been maintained over time [ 19 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

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

Nolasco

Vasallo

Quesada

et al. 2015

Int J Equity Health

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BackgroundPreventable 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.MethodsWe 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.ResultsPreventable 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.ConclusionsPreventable 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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“…Países como Estados Unidos de Norteamérica, Australia y otros en el sur de Europa han atribuido parte de esta disminución a los cambios en la cantidad, tipo y patrones de consumo de alcohol. Así, el consumo de bebidas de alto grado alcohólico o de manera excesiva ha sido asociado al aumento de la mortalidad [12][13][14][15][16] . Esta explicación no parece ser la causa del descenso de las tasas en nuestro país, puesto que la prevalencia de consumo de alcohol en Chile ha registrado un aumento en los últimos años 8 , por lo que el descenso en la mortalidad podría atribuirse más bien a un mejor enfrentamiento terapéutico.…”

Section: Discussionunclassified

Análisis de la tendencia de la mortalidad por cirrosis hepática en Chile: Años 1990 a 2007

et al. 2010

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Mortality trend from liver cirrhosis in Chile from 1990 to 2007 Background: There is a worldwide tendency towards a reduction in the rates of deaths due to cirrhosis. In Chile, a decrease in the number of hospital admissions due to this disease has been recorded. Aim: To assess general characteristics and temporal evolution of liver cirrhosis mortality in Chile between 1990 and 2007. Material and Methods: National death records and population databases were reviewed. Crude and age-adjusted mortality rates for alcoholic and non-alcoholic cirrhosis were calculated, evaluating their evolution in the study period and the relative risk by gender. Results: In the study period, 44,894 deaths caused by cirrhosis were recorded. Mortality rate was 16.6 deaths per 100,000 inhabitants. 54% of deaths were attributed to non-alcoholic cirrhosis. There was a reduction in mortality rates for both types of cirrhosis. Males accounted for 83 and 65% of deaths caused by alcoholic and nonalcoholic cirrhosis, respectively. The figures for relative risk of death were 5 and 1.9, respectively. Conclusions: Alcoholic cirrhosis was the preponderant cause among liver cirrhosis deaths. A decrease in mortality rates was observed in the study period. Improvements in disease treatment and control could possibly explain this trend.

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Trends in socioeconomic inequalities in cirrhosis mortality in an urban area of Southern Europe: a multilevel approach

Cited by 20 publications

References 36 publications

Trends in socioeconomic inequalities in mortality in small areas of 33 Spanish cities

Trends in socioeconomic inequalities in mortality in small areas of 33 Spanish cities

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

Análisis de la tendencia de la mortalidad por cirrosis hepática en Chile: Años 1990 a 2007

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