M. Elisa Calle

Trends in the association between average income, poverty and income inequality and life expectancy in Spain

In this paper, we study the relation between life expectancy and both average income and measures of income inequality in 1980 and 1990, using the 17 Spanish regions as units of analysis. Average income was measured as average total income per household. The indicators of income inequality used were three measures of relative poverty-the percentage of households with total income less than 25%, 40% and 50% of the average total household income-the Gini index and the Atkinson indices with parameters alpha=1, 1.5 and 2. Pearson and partial correlation coefficients were used to evaluate the association between average income and measures of income inequality and life expectancy. None of the correlation coefficients for the association between life expectancy and average household income was significant for men. The association between life expectancy and average household income in women, adjusted for any of the measures of income inequality, was significant in 1980, although this association decreased or disappeared in 1990 after adjusting for measures of poverty. In both men and women, the partial correlation coefficients between life expectancy and the measures of relative income adjusted for average income were positive in 1980 and negative in 1990, although none of them was significant. The results with regard to women confirm the hypothesis that life expectancy in the developed countries has become more dissociated from average income level and more associated with income inequality. The absence of a relation in men in 1990 may be due to the large impact of premature mortality from AIDS in regions with the highest average total income per household and/or smallest income inequality.

Comparing social inequalities in health in Spain: 1987 and 1995/97

To evaluate the trend in social inequalities in health in Spain between 1987 and 1995/97, we carried out a secondary analysis of the Spanish National Interview Surveys from 1987, 1995 and 1997. We studied less-than-good perceived general health and four chronic conditions--heart disease, diabetes mellitus, chronic bronchitis/asthma and allergies--by social class and educational level in men and women aged 25-74 years. Among men, the age-adjusted prevalence rate ratio of less-than-good perceived general health by social class decreased from 1.32 to 1.23 between 1987 and 1995,97: however, the prevalence rate ratio by educational level increased from 1.47 to 1.57. Among women, the prevalence rate ratio of less-than-good perceived general health increased between the first and second period as much by social class from 1.18 to 1.26, as by educational level--from 1.59 to 1.66. For heart disease the age-adjusted prevalence rate ratio by social class among men was 1.12 in 1987 and 0.72 in 1995/97, while the prevalence rate ratio by educational level was around I in both periods, among women, the prevalence rate ratio for heart disease by social class was the same in 1987 and in 1995/97, but the prevalence rate ratio by educational level increased between the first and second period. For diabetes mellitus and chronic bronchitis/asthma, the prevalence rate ratio increased by social class and educational level between the first and second period in both men and women. Finally, the prevalence rate ratio for allergies was always < 1, although its magnitude increased between 1987 and 1995/97. In general, health inequalities were larger by educational level than by social class and were larger in women than in men. Inequalities in perceived general health, diabetes mellitus and chronic bronchitis/asthma increased in Spain between 1987 and 1995/97.

The size of educational differences in mortality from specific causes of death in men and women.

This study examines the association between education and mortality from specific causes of death based on mortality records for 1996 and 1997, and 1996 population census data from the Region of Madrid (Spain). Poisson regression models were used to estimate the percentage increase in mortality associated with 1 year less education. The percentage increases in mortality from stomach cancer, lung, bladder and liver cancers, for aids, chronic obstructive pulmonary disease, pneumonia and influenza, and chronic liver disease and cirrhosis were higher in men than in women, whereas the percentage increases in mortality from colon cancer, diabetes mellitus, ischemic heart disease and nephritis, nephrosis and nephrotic syndrome were higher in women. The results found for some causes of death – lung cancer, ischemic heart disease, diabetes mellitus and chronic obstructive pulmonary disease – reflect the variations by educational level in the prevalence of lifestyle-related risk factors in men and women. Various hypotheses have been suggested for other causes of death, but it is not known why the magnitude of the association between education and mortality from some causes of death differs between men and women. Future studies of this subject may provide some clues as to the underlying mechanisms of this association.

Heterogeneity in cause-specific mortality according to birthplace in immigrant men residing in Madrid, Spain.

PURPOSE To evaluate whether mortality in immigrants in the region of Madrid (Spain) differs from mortality in Spanish in-country migrants. METHODS Analyses of mortality in men aged 20 to 64 years residing in Madrid were conducted, using data from the municipal population register and the cause of death register for the period 2000 through 2004. Mortality rate ratios were used to compare mortality in immigrants from different parts of the world with mortality in men residing in Madrid who were born in other regions in Spain. RESULTS After adjustment was made for age and per capita income of the area of residence, the highest mortality rate ratio for the leading causes of death by disease category was observed in immigrants from sub-Saharan Africa and the lowest in those from South America and Asia. In immigrants from Western countries and from North Africa, the mortality rate ratios for most of the diseases studied did not differ significantly from those of Spanish in-country migrants. In general, the mortality rate ratios for external causes of death were higher than 1, and they were very high for mortality from homicide. CONCLUSIONS Mortality from the leading causes of death in immigrants shows important heterogeneity depending on the place of origin and, with some exceptions, shows a pattern similar to that observed in studies carried out in other wealthy countries.

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.

Mortalidad según características sociales y económicas: Estudio de Mortalidad de la Comunidad Autónoma de Madrid

Fundamento Estimar el efecto del estado civil, el numero de miembros del hogar, la situacion laboral, el nivel de estudios y la ocupacion sobre la mortalidad. Sujetos y metodo Alrededor de 3.100.000 personas mayores de 24 anos de edad residentes en la Comunidad Autonoma de Madrid el 1 de mayo de 1996. A partir del Registro de Mortalidad se obtuvo de cada uno de esos individuos su estado vital durante los 19 meses siguientes mediante la conexion de la informacion de este registro con la informacion de los residentes contenida en la Estadistica de Poblacion de 1996. Resultados A excepcion del numero de miembros del hogar, el efecto sobre la mortalidad de las caracteristicas analizadas fue mayor en el grupo de 25 a 44 anos que en otros grupos de edad. En general, los casados experimentaron la menor mortalidad, excepto en varones mayores de 64 anos, en quienes la mortalidad mas baja la presentaron los solteros. Los varones de 45 a 64 anos que vivian solos tuvieron mayor mortalidad que los que vivian acompanados, mientras que en las personas mayores de 64 anos la mortalidad aumento con el numero de miembros del hogar. La poblacion inactiva presento mayor mortalidad que la poblacion activa. Un mayor nivel de estudios y una mayor cualificacion profesional se asociaban con una menor mortalidad, excepto en mujeres de 45 a 64 anos. Conclusiones Este estudio ha identificado a grupos de poblacion con alto riesgo de mortalidad. La monitorizacion de la tendencia de mortalidad en esos grupos permitira sentar las bases racionales a la hora de llevar a cabo programas de intervencion sociosanitaria.

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.

Occupational social class and mortality in a population of men economically active: The contribution of education and employment situation

This study examines how education and employment situation contribute to the association between a classification of occupational class based on skill assets and mortality from different causes of death. Data were obtained by linking records from the 1996 population census for Spanish men aged 35–64 residing in Madrid with 1996 and 1997 mortality records. The risk of mortality was higher in skilled, semi-skilled and unskilled workers than in higher and lower managerial and professional workers. Adjusting for educational level substantially decreased the magnitude of the gradient. The decrease in the gradient after adjusting for employment situation was much smaller. Except in the case of mortality from respiratory diseases, the mortality gradient disappeared after adjusting for both variables. These results show that education and, to a much lesser degree, employment situation explain part of the social gradient observed in mortality from all causes and from broad causes of death, except from respiratory diseases.

Fracaso en el control del número de víctimas por accidentes de tráfico en españa: ¿La repuesta correcta a la pregunta equivocada?

En Espana se han puesto en marcha diferentes medidas de intervencion con el objeto de modificar la practica de los conductores de vehiculos de motor, sin embargo no se ha observado una tendencia descendente ni en la tasa de accidentes de trafico ni en el numero de victimas relacionadas con los mismos. Este articulo se plantea el interrogante de si las medidas tomadas para reducir el numero de victimas por accidente de trafico se han dirigido realmente hacia las causas responsables de esa tendencia. Utilizando diversas fuentes de datos se observa que en Espana al comienzo de los anos noventa se produjo una importante reduccion de la tasa de accidentes de trafico y sus consecuencias, pero en la segunda mitad de la misma decada el incremento en la tasa de lesiones por accidentes de trafico fue similar al producido en los anos ochenta. Igualmente se observa que desde 1980 el consumo per capita de alcohol ha mostrado una tendencia descendente y que el numero de lesiones por accidente de trafico durante los ultimos vente anos ha estado fuertemente asociado al ciclo economico. Se concluye senalando que las medidas para el control de este problema en Espana se han centrado principalmente en la modificacion de la conducta que incrementa el riesgo y severidad de las lesiones por accidente de trafico, pero se han ignorado los determinantes macroeconomicos que explican la tendencia de la frecuencia de este problema de salud.