Estrella Miqueleiz

Educational differences in mortality and the relative importance of different causes of death: a 7-year follow-up study of Spanish adults

Background The evidence on mortality patterns by education in Spain comes from regional areas. This study aimed to estimate these patterns in the whole Spanish population. Methods All citizens aged 25 years and over and residing in Spain in 2001 were followed during 7 years to determine their vital status, resulting in a total of 196 470 401 person-years and 2 379 558 deaths. We estimated the age-adjusted total and cause-specific mortality by educational level—primary, lower secondary, upper secondary and university education—and then calculated the relative and absolute measures of inequality in mortality and contribution of the leading causes of death to absolute inequalities. Results Except for some cancer sites, the mortality rate for the leading causes of death shows an inverse gradient with educational level. The leading causes of death with the highest relative index of inequality ratios were HIV disease (9.81 in women and 11.61 in men), diabetes in women (4.02) and suicide in men (3.52). The leading causes of death that contribute most to the absolute inequality in mortality are cardiovascular diseases (48.8%), respiratory diseases (9.3%) and diabetes mellitus (8.8%) in women, and cardiovascular diseases (20.8%), respiratory diseases (19.8%) and cancer (19.6%) in men. Conclusions Although the causes of death with the strongest gradient in mortality rate are HIV disease in both sexes, diabetes mellitus in women and suicide in men, most of the absolute education-related inequalities in total mortality are due to cardiovascular diseases, respiratory diseases and diabetes mellitus in women and to cardiovascular diseases, respiratory diseases and cancer in men.

Stabilisation of the trend in prevalence of childhood overweight and obesity in Spain: 2001–11

BACKGROUNDS To ascertain whether the prevalence of childhood overweight and obesity had stabilised in Spain, in the same way as in other developed countries. METHODS Data were drawn from the 2001, 2006 and 2011 Spanish National Health Surveys. We estimated overweight and obesity on the basis of body mass index, and then calculated the prevalence of overweight and obesity for each year studied among boys and girls, respectively, in two different age groups; 5 -9 and 10 -15 years. The statistical significance of the trend in prevalence was evaluated using the chi-squared test. RESULTS The trend in the prevalence of overweight was not significant, with the magnitude generally proving similar in 2006 and 2011, e.g. prevalence among girls was 37.2% in 2006 and 37.5% in 2011 in the 5-9 age group, and 17.7% in 2006 and 17.5% in 2011 in the 10-15 age group. The magnitude of the prevalence of obesity in each sex and age group was similar across the 3 years of study, except in the case of boys aged 5-9 years, among whom a significant downward trend was observed, with prevalence declining from 16.8% in 2001 to 14.4% in 2006 and 12.6% in 2011. CONCLUSION In Spain, the prevalence of childhood overweight and obesity stabilised during the first decade of the present century.

The role of population change in the increased economic differences in mortality: a study of premature death from all causes and major groups of causes of death in Spain, 1980–2010

BackgroundAn increase has been observed in differences in mortality between the richest and poorest areas of rich countries. This study assesses whether one of the proposed explanations, i.e., population change, might be responsible for this increase in Spain.MethodsObservational study based on average income, population change and mortality at provincial level. The premature mortality rate (ages 0–74 years) was estimated for all causes and for cancer, cardiovascular disease and external causes across the period 1980–2010. In the years analysed, provinces were grouped into tertiles based on provincial income, with the mortality rate ratio (MMR) being estimated by taking the tertile of highest-income provinces as reference. Population change was then controlled for to ascertain whether it would modify the rate ratio.ResultsIn all-cause mortality, the magnitude of the MRR for provinces in the poorest versus the richest tertile was 1.01 in 1980 and 1.12 in 2010; in cardiovascular mortality, the MMRs for these same years were 1.08 and 1.31 respectively; and in the case of cancer and external-cause mortality, MMR magnitude was similar in 1980 and 2010. The magnitude of the MMR remained unchanged in response to adjustment for population change, with the single exception of 1980, when it increased in all-cause and cardiovascular mortality.ConclusionThe increase in the difference in premature mortality between the richest and poorest areas in Spain is due to the increased difference in cardiovascular mortality. This increase is not accounted for by population change. In rich countries, more empirical evidence is thus needed to test other alternative explanations for the increase in economic differences in mortality.

Area-level socioeconomic context, total mortality and cause-specific mortality in Spain: Heterogeneous findings depending on the level of geographic aggregation.

The objective of this study was to estimate the association between area-level socioeconomic context and mortality in Spain, using two different geographic aggregations. Nation-wide prospective study covering all persons living in Spain in 2001. Mortality was analysed in Spanish citizens by province of residence and in citizens of Madrid by neighbourhood of residence. Provinces and neighbourhoods were grouped into quartiles according to two socioeconomic indicators: percentage of the population with university education and unemployment rate. The measure of association was the rate ratio for total mortality and cause-specific mortality, by each socioeconomic indicator in two age groups, 25-64 years (adult population) and 65 years and over (elderly population). After adjustment for all individual socioeconomic variables, the rate ratio for total mortality among residents in the provinces with the worst versus best socioeconomic context was 0.92 (95% CI 0.88-0.97) when the indicator was percentage of university population and 0.89 (0.85-0.93) when it was unemployment rate in the adult population, and 1.05 (1.00-1.11) and 1.08 (1.03-1.13), respectively, in the elderly population. No significant differences in mortality were observed between adults residing in neighbourhoods with the worst versus best socioeconomic context, but in the elderly population the mortality rate ratios for the two socioeconomic indicators were 1.04 (1.01-1.07) and 1.06 (1.03-1.09), respectively. Residents in provinces with the worst socioeconomic context had the lowest mortality from cancer and external causes and the highest mortality from cardiovascular diseases, while residents in neighbourhoods with the worst socioeconomic context had the highest mortality from respiratory and digestive diseases. Further research should find out the reasons for the lower total mortality in adult population residing in the Spanish provinces with the most adverse socioeconomic context and the reasons for excess mortality from digestive diseases and respiratory diseases among residents in neighbourhoods with the worst socioeconomic context.

Patrones Geográficos de la Mortalidad y de las Desigualdades Socioeconómicas en Mortalidad en España

Fundamentos: Las estimaciones sobre desigualdades socioeconomicas en mortalidad a partir de registros individuales de defunciones y poblacion son escasas y proceden unicamente de la la ciudad de Barcelona, la Comunidad de Madrid y el Pais Vasco. El objetivo del presente estudio fue mostrar el patron geografico de mortalidad en diferentes grupos socioeconomicos, asi como el de las desigualdades en mortalidad en el conjunto del territorio espanol. Metodos: Se realizo el seguimiento de todos los individuos mayores de 25 anos del censo de poblacion 2001 durante siete anos y dos meses para conocer su estado vital (196.470.401 personas-ano a riesgo y 2.379.558 defunciones). Se calculo la tasa de mortalidad ajustada por edad en hombres y mujeres por provincia y nivel de estudios. Las desigualdades en mortalidad provinciales se estimaron mediante la razon de tasas de mortalidad en los sujetos con nivel de estudios primarios o inferiores respecto a los sujetos con estudios universitarios. Resultados: En mujeres, las razones de tasas mas bajas -entre 1,06 y 1,16- se observaron Palencia, Segovia, Guadalajara y Avila. Las mas altas -entre 1,53 y 1,75- en Malaga, Las Palmas, Ceuta, Toledo y Melilla. En hombres, las razones de tasas mas bajas -entre 1,00 y 1,12- se observan en Guadalajara, Teruel, Cuenca, La Rioja y Avila y las mas altas -entre 1,47 y 1,73- en Las Palmas, Cantabria, Murcia, Melilla y Ceuta. Conclusiones: El patron geografico de las tasas de mortalidad en Espana varia segun el nivel educativo. Las desigualdades en mortalidad muestran menor magnitud en las provincias del centro peninsular.

Desigualdades en mortalidad prematura según indicadores de bienestarmaterial en Navarra. Estudio poblacional de seguimiento 2001-2008

BACKGROUND To show the inequalities in premature mortality according to indicators of material welfare in Navarre. METHODS All citizens under 75 years of age living in Navarre in 2001 were monitored for seven years to determine their vital status. House size and number of household vehicles was used as the socioeconomic status indicator. The age-adjusted total mortality rate and mortality rate from cause-specific mortality were estimated by these indicators. RESULTS The rate ratio for all causes of death in the lower categories depending on house size is 1.14 (IC 95%: 1.05-1.24) and 1.25 (IC 95%: 1.18-1.32) in women and men respectively and 1.46 (IC 95%: 1.36-1.57) and 1.97 (IC 95%: 1.89-2.05) depending on the number of vehicles. AIDS is the leading cause of death having a greater difference in mortality rates among people with lower and higher material welfare. Other causes of death with a high difference in mortality rates are digestive diseases and diabetes mellitus in women and digestive diseases and respiratory diseases in men. CONCLUSIONS The mortality rate in the Navarre population shows an inverse gradient to material welfare,except for some cancer sites. This gradient is higher among men than among women.BACKGROUND To show the inequalities in premature mortality according to indicators of material welfare in Navarre. METHODS All citizens under 75 years of age living in Navarre in 2001 were monitored for seven years to determine their vital status. House size and number of household vehicles was used as the socioeconomic status indicator. The age-adjusted total mortality rate and mortality rate from cause-specific mortality were estimated by these indicators. RESULTS The rate ratio for all causes of death in the lower categories depending on house size is 1.14 (IC 95%: 1.05-1.24) and 1.25 (IC 95%: 1.18-1.32) in women and men respectively and 1.46 (IC 95%: 1.36-1.57) and 1.97 (IC 95%: 1.89-2.05) depending on the number of vehicles. AIDS is the leading cause of death having a greater difference in mortality rates among people with lower and higher material welfare. Other causes of death with a high difference in mortality rates are digestive diseases and diabetes mellitus in women and digestive diseases and respiratory diseases in men. CONCLUSIONS The mortality rate in the Navarre population shows an inverse gradient to material welfare,except for some cancer sites. This gradient is higher among men than among women.

Lifestyles and Styles of Parental Care Related to Childhood Obesity: compare Spain with Northern European Countries: ENERGY-Project

Fundamentos: La prevalencia de obesidad infantil es mas alta en Espana que en los paises del norte de Europa por razones que todavia se desconocen. El objetivo fue comprobar si variables referentes a habitos de vida y a estilos de cuidado de los progenitores relacionados con la obesidad infantil difieren entre los paises del Norte de Europa y Espana. Metodos: Los datos fueron obtenidos del proyecto internacional ENERG. Se analizaron los de Espana, Paises Bajos, Belgica y Noruega, incluyendo a 1.937 ninos y 2.061 ninas de 10 a 12 anos de edad. Se estudiaron los comportamientos de los padres referidos a variables dieteticas, variables relacionadas con la actividad fisica y los estilos de cuidado. Se calcularon las medias y las proporciones de todas las variables y a continuacion se calculo la asociacion de las diferentes variables con el pais de origen utilizando el coeficiente beta y la Odds Ratio (OR) como medidas de asociacion. Resultados: En comparacion con los progenitores del Norte de Europa, los progenitores espanoles consumen bebidas azucaradas menos dias por semana (Media: 1,37 vs 2,16) pero consumen mas zumos de frutas (Media: 2,61 vs 2,35). Los progenitores espanoles son mas activos yendo a su trabajo, son menos sedentarios pero realizan actividad fisica en su tiempo libre menos dias por semana (Media de dias por semana que realizan actividad fisica en su tiempo libre: 1,88 vs 2,21). Ademas, son menos negociadores con sus hijos (Media (0-4): 1,26 vs 1,68) y evitan menos los modelos negativos de conducta (Media (0-4): 0,90 vs 1,29). Sin embargo, prestan mas atencion (Media (0-4): 3,42 vs 3,04) y estimulan mas los habitos saludables (Media (0-4): 2,38 vs 2,06). Conclusiones: Las variables referentes a habitos de vida y a estilos de cuidado relacionados con la obesidad infantil difieren entre los progenitores espanoles y los de los paises del Norte de Europa aunque estas diferencias no son estadisticamente significativas. Por lo tanto, las diferencias en los estilos de vida y estilos de cuidado de los progenitores probablemente no expliquen las diferencias en la obesidad infantil entre los paises del Norte y Espana.

Desigualdades en mortalidad total y por causa de muerte según el nivel de estudios en Navarra: hallazgos de un estudio longitudinal 2001-2008

Fundamentos: Dada la ausencia de evidencia cientifica, el objetivo fue mostrar las desigualdades en mortalidad segun el nivel de estudios en Navarra y la contribucion de las principales causas de defuncion a la magnitud de desigualdades en la mortalidad por todas las causas de muerte. Metodos: Todos los ciudadanos de 25 anos y mayores residentes en Navarra en 2001 fueron seguidos durante 7 anos para conocer su estado vital. El indicador de posicion socioeconomica utilizado fue el nivel de estudios. Se estimaron las tasas de mortalidad general y por causa de muerte ajustadas por edad segun la educacion. Posteriormente, se calcularon la diferencia relativa (razon) y la diferencia absoluta de tasas entre las categorias mas baja y mas alta de nivel de estudios y la contribucion de las principales causas de muerte a la diferencia absoluta. Resultados: La razon de tasas por todas las causas de muerte fue 1,37 en hombres y 1,23 en mujeres. El virus de la inmunodeficiencia humana (VIH) (25,84) y los accidentes no intencionales (3,78) presentaron las razones de tasas mas altas en los hombres y la diabetes mellitus (4,92) y el VIH (4,38) en las mujeres. Las enfermedades cardiovasculares constituyeron la causa de muerte que mas contribuyo a la diferencia absoluta en mortalidad: 26% en hombres y 48% en mujeres. Conclusiones: La tasa de mortalidad en la poblacion navarra muestra un gradiente inverso con el nivel educativo, a excepcion de algunas localizaciones de cancer. Las enfermedades cardiovasculares son la causa de muerte que mas contribuye a las desigualdades absolutas en mortalidad, mientras que otras causas de muerte que muestran importantes desigualdades relativas contribuyen poco a las desigualdades absolutas.

Influencia de la mortalidad en las personas con bajo nivel educativo en la variación de las desigualdades de mortalidad en las comunidades autónomas

Background: Given the importance of mortality rates in each socioeconomic group, as explanation for the variation in mortality inequalities across populations, the objective of the present study is to evaluate whether regional variation in mortality inequalities in Spain is related to the mortality rates in different socioeconomic groups. Methods: The study included all persons aged 30-74 years living in Spain in 2001 and followed up for mortality over 7 years. In each of the 17 autonomous communities of Spain mortality rates were estimated for those with low and high education, as well as two measures of mortality inequality according to education: mortality rate difference and mortality rate ratio. Median value of mortality inequalities was calculated for the regions with the highest and lowest mortality rates and for those with intermediate mortality rates. And the Pearson correlation coefficient was used to estimate the relation between mortality rates and the measures of mortality inequality. Results: The correlation coefficients between mortality rate in low education and mortality rate difference and mortality rate ratio were 0.87 and 0.78 in women and 0.81 and 0.73 in men, respectively. The correlation coefficients between mortality rate in high education and mortality rate difference and mortality rate ratio were -0.07 and -0.24 in women and 0.10 and -0.06 in men, respectively. Conclusion: Regions with the lowest and highest mortality rates in low education people generally had the lowest and highest inequalities in mortality. The variation in the magnitude of inequalities in mortality from one place to another can be explained by the variation in mortality in low education people. No relation was observed between mortality rate in high education and mortality inequality

The Association of Geographic Coordinates with Mortality in People with Lower and Higher Education and with Mortality Inequalities in Spain.

Objective Geographic patterns in total mortality and in mortality by cause of death are widely known to exist in many countries. However, the geographic pattern of inequalities in mortality within these countries is unknown. This study shows mathematically and graphically the geographic pattern of mortality inequalities by education in Spain. Methods Data are from a nation-wide prospective study covering all persons living in Spains 50 provinces in 2001. Individuals were classified in a cohort of subjects with low education and in another cohort of subjects with high education. Age- and sex-adjusted mortality rate from all causes and from leading causes of death in each cohort and mortality rate ratios in the low versus high education cohort were estimated by geographic coordinates and province. Results Latitude but not longitude was related to mortality. In subjects with low education, latitude had a U-shaped relation to mortality. In those with high education, mortality from all causes, and from cardiovascular, respiratory and digestive diseases decreased with increasing latitude, whereas cancer mortality increased. The mortality-rate ratio for all-cause death was 1.27 in the southern latitudes, 1.14 in the intermediate latitudes, and 1.20 in the northern latitudes. The mortality rate ratios for the leading causes of death were also higher in the lower and upper latitudes than in the intermediate latitudes. The geographic pattern of the mortality rate ratios is similar to that of the mortality rate in the low-education cohort: the highest magnitude is observed in the southern provinces, intermediate magnitudes in the provinces of the north and those of the Mediterranean east coast, and the lowest magnitude in the central provinces and those in the south of the Western Pyrenees. Conclusion Mortality inequalities by education in Spain are higher in the south and north of the country and lower in the large region making up the central plateau. This geographic pattern is similar to that observed in mortality in the low-education cohort.