Cruz Pascual

La utilización de los servicios sanitarios por la población inmigrante en España

OBJECTIVE To compare health services utilization between the immigrant and indigenous populations in Spain. METHODS We used information provided by the following four health surveys carried out around 2005: Catalonia 2005; city of Madrid 2005, Canary Islands 2004 and the Autonomous Community of Valencia 2005. The health services studied were general practice, specialist services, emergency services, hospitalization, and two preventive services: pap smear test and mammography. RESULTS In general, most health services were less frequently used by the immigrant population than by the Spanish population. The health services showing the least differences between the two populations were general practice and hospitalization, while the greatest differences were found in the use of specialist and preventive services. The most heterogeneous results were found in general practice and hospitalization, since some immigrant groups showed a relatively high frequency of use in some geographical areas and a relatively low frequency in other areas. CONCLUSION The results of the present study reproduce those found in other studies carried out in countries with similar social and economic characteristics to Spain. Like previous results, the present results are difficult to explain. Future research should aim to use other study designs and to test hypotheses not put forward by the scientific community to date.

Decreasing socioeconomic inequalities and increasing health inequalities in Spain: a case study.

OBJECTIVES We examined the evolution of income inequalities and health inequalities in Spain from the time of the countrys entry into the European Union. METHODS We estimated distributions of provincial income and household income, relations of provincial income with mortality and disability, and relations of household income with disability in 1984-1986 and 1999-2001. RESULTS Inequalities in average provincial income and household income were lower in 2000 than in 1985. Differences in mortality and disability according to income were greater in 2000 than in 1985, in both absolute and relative terms, except for differences in mortality among individuals aged 25 to 44 years. In most cases, differences in mortality from leading causes of death and differences in major types of disabilities were also greater in 2000. CONCLUSIONS Our results show that redistribution of income might achieve greater social justice but probably does not lead to reduced health inequalities, despite observed improvements in material circumstances as well as in most health indicators among disadvantaged population groups.

Socioeconomic environment, availability of sports facilities, and jogging, swimming and gym use

The aim of the study was to evaluate the association of the availability of sports facilities and socioeconomic environment with jogging, swimming and gym use in Spain. The indicators of availability of sports facilities were the number of swimming pools and the number of gyms per 10,000 population. The indicators of socioeconomic environment were average provincial income and provincial unemployment rate. The number of sports facilities was not related with either swimming or gym use and the indicators of socioeconomic environment were not associated with swimming in either sex, or with gym use in men. The findings of this study do not support the hypotheses proposed in previous investigations to explain the consistent relation between socioeconomic environment and lack of physical activity.

Pattern of health services use by immigrants from different regions of the world residing in Spain

ObjectiveTo determine immigrants’ frequency of use of four health services by place of origin and compare it with that of the Spanish population.MethodsBased on the 2006 National Health Survey in Spain, we estimated the frequency of use of four health services in men and women from: Spain, Western countries, Eastern Europe, Latin America, North Africa, Sub Saharan Africa and Asia/Oceania. These results were compared with the Spanish population by calculating odds ratios adjusted for age, socioeconomic position, health status, and type of health coverage.ResultsImmigrant men generally use health services less frequently than Spanish nationals. The main exceptions are Latin American men, who more often use emergency services (OR 1.68, 95% CI 1.41–1.99) and Sub-Saharan men, who use specialists more frequently (OR 2.93, 1.70–5.05). Immigrant women use health services about as frequently as Spanish women. The main exceptions are North African women, who less frequently use specialists (OR 0.39, 0.22–0.71) and Sub-Saharan women who more frequently use GPs (OR 4.06, 2.21–7.44), specialists (OR 2.29, 1.06–4.95) and emergency services (OR 2.92, 1.49–5.72).ConclusionsHealth services use by the immigrant population in Spain differs by gender and place of origin.

Heterogeneous trend in smoking prevalence by sex and age group following the implementation of a national smoke-free law

Objective Given the limited evidence available about the effects of clean indoor air laws on smoking behaviour in the general population, the impact of national smoke-free workplace, bar and restaurant legislation, implemented on 1 January 2006, on smoking prevalence in Spain was assessed in this study. Methods Population-based trend analysis using estimates for 27 periods from the beginning of 2000 to the end of 2008—three periods per year. To calculate the period per cent change in smoking prevalence, the permutation test for joinpoint regression to detect significant changes was used. Results In men and women aged 15–24 years, the prevalence of smoking declined between the first period in 2000 and the third period in 2008, whereas in women aged 45–64 years, it increased by 1.7% per period. A declining trend was detected up to the first period in 2006 in men and women aged 25–44 years and in men aged 45–64 years, but between the beginning of 2006 and the end of 2008 the prevalence of smoking increased by 1.2%, 0.7% and 2.0% per period in men aged 25–44 years, in women aged 25–44 years and in men aged 45–64 years, respectively. Conclusions 3 years after a national smoke-free law was implemented, the trend in smoking prevalence in some population groups was unchanged; however, in others, the declining trend of previous years was reversed. The similarity of these findings to those observed in other countries suggests that clean indoor air laws, although effective in reducing exposure to second-hand smoke, may not achieve the secondary objective of reducing the prevalence of smoking in the population.

The role of political and welfare state characteristics in infant mortality: a comparative study in wealthy countries since the late 19th century

BACKGROUND A close examination of the literature suggests that the consistent relation between political and welfare state characteristics and infant mortality in the second half of the 20th century in wealthy countries may not be causal. METHODS The evolution of infant mortality since the late 19th century was studied in 17 wealthy countries classified according to political traditions, family policy model and period of infant mortality transition. The relation of public health expenditure and income inequality to infant mortality from 1980 to 2005 was also evaluated. RESULTS The Social Democratic and Scandinavian countries, and those with the earliest transition in infant mortality, had the lowest infant mortality rates until the early 21st century, whereas the late democracies, the Southern European countries, and those in which the transition in infant mortality took place later, had the highest rates until the late 20th century. By the early 21st century, the differences in infant mortality were negligible. Three of the four Scandinavian countries were the first to achieve infant mortality transition, whereas the Southern European countries were the last. The relation between public health expenditure and infant mortality varied depending on the time period in which the analysis was made, and increased income inequality was associated with higher infant mortality. CONCLUSIONS The relation between political and welfare state characteristics and infant mortality in previous studies probably reflects the historical moment in which the transition in infant mortality took place in each country. Methodological limitations do not allow inference of causality in the associations found between welfare state characteristics and infant mortality.

The Role of the Public Health Official in Communicating Public Health Information

The prevailing views on the role of public health professionals refer to professionals in the academic world, without taking into account the fact that many public health professionals are government employees. For example, the American Public Health Association states that public health professionals play an active role in communicating public health information to nonscientific audiences, such as the general population or the mass media. We propose that public health officials have an important responsibility to promote the practice of public health. However, they must do so within the bureaucracy. Any actions that public health officials wish to take as advocates of particular public health activities should be carried out independent of their role as government officials.

Mortalidad por enfermedades cardiovasculares en inmigrantes residentes en la Comunidad de Madrid

BACKGROUND AND OBJECTIVE To estimate the mortality from cardiovascular diseases in immigrants residing in one of the regions of Spain with the highest immigration rate during the early years of the 21st century. POPULATION AND METHOD The study included people aged 20 to 64 years of age residing in Madrid for the period 2000-2004. Mortality form cardiovascular disease in immigrants from different parts of the world was compared with the mortality in the native Spanish population. Mortality rates ratios adjusted for age, sex and per capita income in the area of residence were estimated. RESULTS Immigrants from Sub-Saharan Africa and from South America showed, respectively, the highest and the lowest mortality rate ratio of cardiovascular diseases and ischemic heart disease. Immigrants from the region of Central America and the Caribbean showed the highest mortality rate ratio of cerebrovascular disease. CONCLUSIONS The pattern of cardiovascular disease mortality in immigrants residing in Madrid is quite similar to those found in studies made in other countries, and probably reflect the burden of disease in their places of origin.

Original breveMortalidad por enfermedades cardiovasculares en inmigrantes residentes en la Comunidad de MadridMortality from cardiovascular diseases in immigrants residing in Madrid

BACKGROUND AND OBJECTIVE To estimate the mortality from cardiovascular diseases in immigrants residing in one of the regions of Spain with the highest immigration rate during the early years of the 21st century. POPULATION AND METHOD The study included people aged 20 to 64 years of age residing in Madrid for the period 2000-2004. Mortality form cardiovascular disease in immigrants from different parts of the world was compared with the mortality in the native Spanish population. Mortality rates ratios adjusted for age, sex and per capita income in the area of residence were estimated. RESULTS Immigrants from Sub-Saharan Africa and from South America showed, respectively, the highest and the lowest mortality rate ratio of cardiovascular diseases and ischemic heart disease. Immigrants from the region of Central America and the Caribbean showed the highest mortality rate ratio of cerebrovascular disease. CONCLUSIONS The pattern of cardiovascular disease mortality in immigrants residing in Madrid is quite similar to those found in studies made in other countries, and probably reflect the burden of disease in their places of origin.

Sports facilities in Madrid explain the relationship between neighbourhood economic context and physical inactivity in older people, but not in younger adults: a case study

Background Neighbourhood characteristics may contribute to differences in physical inactivity. Purpose To evaluate whether the availability of sports facilities helps explain the differences in physical inactivity according to the economic context of the neighbourhood. Methods 6607 participants representative of the population aged 16–74 years, resident in Madrid (Spain) in 2005, were analysed. Using ORs calculated by multilevel logistic regression, the association between per capita income of the neighbourhood of residence and physical inactivity was estimated, after adjusting for age, population density, individual socioeconomic characteristics and the availability of green spaces. The analysis was repeated after further adjustment for the availability of sports facilities to determine if this reduced the magnitude of the association. Results Residents in the neighbourhoods with the lowest per capita income had the highest OR for the prevalence of physical inactivity. In participants aged 16–49 years, after adjusting for the availability of sports facilities, the magnitude of the OR in the poorest neighbourhoods with respect to the richest neighbourhoods increased in men (from 2.22 to 2.35) and declined by 13% in women (from 2.13 to 1.98). In contrast, in the population aged 50–74 years, this adjustment reduced the magnitude of the OR by 21% in men (from 2.00 to 1.80) and by 53% in women (from 2.03 to 1.48). Conclusions The poorest neighbourhoods show the highest prevalence of physical inactivity. The availability of sports facilities explains an important part of this excess prevalence in participants aged 50–74 years, but not in younger individuals.