Vicenç Martínez

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.

Lesiones por caídas y factores asociados en personas mayores de Cataluña, España

OBJECTIVES To assess, based on a population health survey, what proportion of individuals in a sample of non-institutionalized older persons suffered injuries from unintentional falls, and to evaluate the associated demographic and health-related factors. METHODS A total of 3,247 individuals over 65 years of age, selected by multistage random sampling, participated in the Health Survey of Cataluña (ESCA-2006), answering an interviewer-administered questionnaire that included questions about injuries from falls, and any relevant associated factors, during the 12 months preceding the survey. RESULTS Of the respondents, 14.9% reported having been injured by falling. Multivariate analysis indicated that sex, age, living alone, taking five or more medications, and suffering from mobility problems, diabetes, or musculoskeletal disorders were associated with an increased risk of injury from falls. However, no statistically significant effect was observed from sensory or communication impairment, cardiovascular disease, cataracts, or alcohol consumption. CONCLUSIONS Health care services, which are often in contact with the elderly, can identify those who are at increased risk of falling and put into place a variety of proven, preventive interventions. Though somewhat limited, population health surveys provide useful information regarding the burden of fall-related injuries on elderly health and complement data provided by other sources.