Josep Ferrando

Propuestas de clase social neoweberiana y neomarxista a partir de la Clasificación Nacional de Ocupaciones 2011

In Spain, the new National Classification of Occupations (Clasificación Nacional de Ocupaciones [CNO-2011]) is substantially different to the 1994 edition, and requires adaptation of occupational social classes for use in studies of health inequalities. This article presents two proposals to measure social class: the new classification of occupational social class (CSO-SEE12), based on the CNO-2011 and a neo-Weberian perspective, and a social class classification based on a neo-Marxist approach. The CSO-SEE12 is the result of a detailed review of the CNO-2011 codes. In contrast, the neo-Marxist classification is derived from variables related to capital and organizational and skill assets. The proposed CSO-SEE12 consists of seven classes that can be grouped into a smaller number of categories according to study needs. The neo-Marxist classification consists of 12 categories in which home owners are divided into three categories based on capital goods and employed persons are grouped into nine categories composed of organizational and skill assets. These proposals are complemented by a proposed classification of educational level that integrates the various curricula in Spain and provides correspondences with the International Standard Classification of Education.

Role of individual and contextual effects in injury mortality: new evidence from small area analysis

Objective: To analyse the role of individual and contextual variables in injury mortality inequalities from a small area analysis perspective, looking at the data for the city of Barcelona (Spain) for 1992–98. Setting: Barcelona (Spain). Methods: All injury deaths in residents older than 19, which occurred in the period 1992–98 were included (n=4393). Age and sex specific mortality rates were calculated for each educational level and each cause of death (traffic injuries, falls, drug overdose, suicide, other injuries). The contextual variables included were the proportion of men unemployed, and the proportion of men in jail, in each neighbourhood. Multilevel Poisson regression models were fitted using data grouped by age, educational level, and neighbourhood for each sex. Results: Death rates were higher in males, at the extremes of the age distribution (under 44 and over 74 years), and for lower educational levels. The results of the Poisson multilevel models indicate that inequalities by educational level follow a gradient, with higher risks for the population with no schooling, after having adjusted for the contextual variables of the neighbourhood. Such inequalities were more important in the youngest age group (20–34 years), as relative risk of 5.41 (95% confidence interval (CI) 3.9 to 7.4) for all injury causes in males and 4.38 (95% CI 2.3 to 8.4) in females. The highest relative risks were found for drug overdose. There was a contextual neighbourhood effect (the higher the deprivation, the higher the mortality) after having taken into account individual variables. Conclusion: The findings underscore the need to implement injury prevention strategies not only at the individual level taking into account socioeconomic position, but also at the neighbourhood level.

Impact of a helmet law on two wheel motor vehicle crash mortality in a southern European urban area

Background—In Spain, a federal road safety law went into effect in the fall of 1992 extending to urban areas the unrestricted use of safety helmets by all two wheel motor vehicle occupants. Objectives—To assess the effect of the law in reducing fatal motorcycle crash injuries; to estimate the number of lives saved; and to determine changes in the distribution of severity and anatomical location of injuries. Methods—Pre-test/post-test design of all deaths of two wheel motor vehicle occupants from 1990–92 (pre-law period) and from 1993–95 (post-law period) detected by the Barcelona Forensic Institute and the city police department. Injuries were coded using the 1990 version of the abbreviated injury scale. Poisson regression methods were used to model trends in mortality ratios and to provide estimates of the number of lives saved. Results—Between 1993 and 1995, 35 lives of two wheel motor vehicle occupants were spared, representing a decrease of 25% in the observed motorcycle crash mortality in the post-law period when compared with what would be expected if no such law had gone into effect. The proportion of deaths with severe head injuries was also reduced from 76% to 67% in the post-law period. Conclusions—This study offers the first evaluation of a helmet law using combined forensic and police data in a large south European urban area where there is widespread use of motorcycles. Our results confirm the effectiveness of the helmet law, as measured by the reduction in the number of deaths and mortality ratios after the law implementation. The findings reinforce the public health benefits of mandatory non-restricted motorcycle and moped helmet use, even in urban areas with lower traffic speeds.

Social inequalities in health related behaviours in Barcelona

OBJECTIVE This study describes social class inequalities in health related behaviours (tobacco and alcohol consumption, physical activity) among a sample of general population over 14 years old in Barcelona. DESIGN Cross sectional study (Barcelona Health Interview Survey). SETTING Barcelona city (Spain). PARTICIPANTS A representative stratified sample of the non-institutionalised population resident in Barcelona was obtained. This study refers to the 4171 respondents aged over 14. DATA Social class was obtained from a Spanish adaptation of the British Registrar General classification. In addition, sociodemographic variables such as family structure and employment status were used. As health related behaviours tobacco consumption, alcohol consumption, usual physical activity and leisure time physical activity were analysed. Age adjusted percentages were compared by social class. Multivariate analysis was performed using logistic regression models. MAIN RESULTS Women in the upper social classes were more likely to smoke, the adjusted odds ratio (OR) for social class V in reference to social class I was 0.36 (95% confidence intervals (95%CI): 0.19, 0.67), while the opposite occurred among men although it was not statistically significant in multivariate analysis. Smoking cessation was more likely among men in the higher classes (OR for class V 0.41, 95%CI: 0.18, 0.90). Excessive alcohol consumption among men showed no differences between classes, while among women it was greater in the upper classes. Engaging in usual physical activity classified as “light or none” in men decreased with lowering social class (OR class IVa: 0.55 and OR class IVb: 0.47). Women of social classes IV and V were less likely to have two or more health risk behaviours (OR for class V 0.33, 95% CI: 0.18, 0.62). CONCLUSION Health damaging behaviours are differentially distributed among social classes in Barcelona. Health policies should take into account these inequalities.

Incidence trends of traumatic spinal cord injury and traumatic brain injury in Spain, 2000-2009

AIMS The aim of the present study was to estimate the incidence of hospital discharges for traumatic spinal cord injury (TSCI) and traumatic brain injury (TBI) in Spain by injury circumstances (traffic crashes and others), injury severity, gender and age group and to describe its trends over the period 2000-2009. METHODS It is a study of trends that includes hospital discharges with a primary diagnosis of TSCI or TBI. Crude and age-standardised rates were calculated per million inhabitants. Changes in rates between 2000 and 2009 were assessed through calculation of the relative risk adjusted for age, using Poisson regression. RESULTS Between 2000 and 2009 in Spain, 10,274 patients were admitted for traumatic TSCI, and 206,503 for TBI. The annual incidence rate for TSCI was 23.5 per million, that for TBI was 472.6 per million. The overall incidence rate for TSCI fell significantly between 2000 and 2009 by 24.2% (traffic-related 40.9%, other 12.9%), as did that for TBI (23.8% overall, 60.2% traffic-related, with no change for other circumstances). Among people aged 65 years and over, no change was observed for TSCI, incidence of TBI fell significantly when due to traffic crashes, but there was a dramatic increase of 87% in men and 89.3% in women when due to other circumstances. CONCLUSIONS Over the last decade the incidence of these types of injury has fallen significantly when the injury resulted from traffic crashes, and to a lesser extent when from other circumstances. However TBI incidence among people aged 65 and over injured in non-traffic-related circumstances has risen dramatically.

Impact of the penalty points system on road traffic injuries in Spain: A time-series study

OBJECTIVES We assessed the effectiveness of the penalty points system (PPS) introduced in Spain in July 2006 in reducing traffic injuries. METHODS We performed an evaluation study with an interrupted time-series design. We stratified dependent variables-numbers of drivers involved in injury collisions and people injured in traffic collisions in Spain from 2000 to 2007 (police data)--by age, injury severity, type of road user, road type, and time of collision, and analyzed variables separately by gender. The explanatory variable (the PPS) compared the postintervention period (July 2006 to December 2007) with the preintervention period (January 2000 to June 2006). We used quasi-Poisson regression, controlling for time trend and seasonality. RESULTS Among men, we observed a significant risk reduction in the postintervention period for seriously injured drivers (relative risk [RR] = 0.89) and seriously injured people (RR = 0.89). The RRs among women were 0.91 (P = .095) and 0.88 (P < .05), respectively. Risk reduction was greater among male drivers, moped riders, and on urban roads. CONCLUSIONS The PPS was associated with reduced numbers of drivers involved in injury collisions and people injured by traffic collisions in Spain.

Social Inequalities in Perceived Health and the Use of Health Services in a Southern European Urban Area

People of lower social class have worse health and less access to health services and preventive care. This article describes social class inequalities in health status and use of services, both curative and preventive, in Barcelona, in a country with a national health service. The cross-sectional study uses information from the 1992 Barcelona Health Interview Survey. Social class was designated using an adaptation of the British Registrar General classification. The study variables measured health status, health services utilization, and preventive practices. Bivariate and multivariate analyses were used. Some 88 percent of men in social class I and 81 percent in class V had very good or good perceived health status. For women these figures were 85.2 and 57.6 percent, respectively. Chronic illness increased with lower social class. There were no social class differences in the frequency of physician visits during the two weeks prior to the interview among people with poor perceived health. Some 60.7 percent of women aged over 29 in social class I had periodic cervical smears, but only 32 percent of those in class V; the corresponding figures for mammography were 37.8 and 11.3 percent. The national health service has advantages in terms of access to health services, but more knowledge about the quality of these services is required. The study findings are sufficient to defend the undertaking of equitable health policies, especially in providing access to preventive care for the entire population.

Disability among older people in a southern european city in 2006: Trends in gender and socioeconomic inequalities

BACKGROUND AND AIMS We wished to describe disability prevalence in people aged >or=65 years in Barcelona in 2006, its trends since 1992, and disability inequalities by gender and socioeconomic position (SEP). METHODS This was a cross-sectional design, including data from the 1992, 2000, and 2006 Barcelona Health Interview Surveys (noninstitutionalized population >or=65 years old). Disability was defined as having difficulty carrying out at least one of seven activities of daily living (ADL). The number of ADLs carried out with difficulty was considered a measure of disability severity. Independent variables were age and educational level as a measure of SEP. Prevalence and prevalence ratio (PR) of disability stratified by sex were obtained through log-binomial regression models or using zero-inflated Poisson regression models. RESULTS The prevalence of disability increased between 1992 and 2006 among women but not men because of the higher increase in older age among women. Disability prevalence was 30% in men and 53% in women in 2006. Disability inequalities by SEP were present in all the ADL analyzed and in all 3 years, remaining stable throughout the period. Overall, the PR of disability in lower SEP compared with higher SEP was 1.61 (95% CI 1.32-1.98) in men and 1.53 (95% CI 1.33-1.76) in women. CONCLUSIONS Disability prevalence is increasing among older women at the turn of the century in this southern European city, and socioeconomic inequalities in disability persist. Although women have longer life expectancy, their disability prevalence in older age is much higher than that of men.

Factors associated with severity and hospital admission of motor-vehicle injury cases in a southern European urban area

Objectives: To describe the characteristics of motor-vehicle (MV) injury cases admitted to Emergency departments (ED), and to assess factors related to injury severity and hospital admission. Setting: Subjects were MV injury patients, aged 16 or more, admitted to four EDs in the city of Barcelona (Spain), from July 1995 to June 1996. Methods: Cross-sectional design. The data analyzed were obtained from the information routinely transmitted from the EDs to the Municipal Institute of Health, based on the processing of ED logs. Severity was assessed with the Abbreviated Injury Scale and the Injury Severity Score. Univariate and bivariate descriptive statistical analyses were performed, as well as multiple logistic regressions. Results: For the 3791 MV-injury cases included in the study period, a larger contribution of cases was noted for males (63.1%), for cases younger than 30 years (55.3%) and for motorcycle or moped occupants (47.1%). After adjusting for age, sex and the presence of multiple injuries, pedestrians, followed by moped and motorcycle occupants were at a higher risk of a more severe injury (OR: 1.77, 1.61 and 1.50 respectively). Correspondingly, these user groups also showed a higher likelihood of a hospital admission (OR: 2.03, 1.92 and 2.00 respectively), when attended to in an ED. Injury cases attended to in the ED during night hours (OR: 2.06) were also at a higher risk of a hospital admission. Conclusions: In Barcelona, pedestrians and two-wheel MV occupants, besides accounting for two-thirds of MV injury cases, are the user groups with a greater risk of a more severe injury, as well as a higher chance of a hospital admission, independently of demographic and health care factors.

Spinal cord injury and traumatic brain injury: a cost-of-illness study

Background: Among traumatic injuries, spinal cord injuries (SCI) and traumatic brain injuries (TBI) are of major importance because of their epidemiological and economic impact on society. The overall objective of this study was to estimate the economic cost associated with people with SCI and TBI in Spain in 2007. Methods: A cost-of-illness analysis was performed, considering the perspective of society, using a 1-year time horizon. Medical costs, adaptation costs, material costs, administrative costs, and costs of police, firefighters and roadside assistance, productivity losses due to institutionalization and sick leave, as well as an estimate of productivity losses of carers, and productivity losses due to death were included. Results: The economic cost associated with people with SCI is between EUR 92,087,080.97 and 212,496,196.41 (USD 131 million and 302 million) according to the injury mechanism, and between EUR 1,079,223,688.66 and 3,833,752,692.78 (USD 1,536 million and 5,458 million) for people with TBI. Conclusions: There is an urgent need to develop effective interventions known to prevent SCI and TBI, and to evaluate their effectiveness and efficiency.