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      Cancer mortality inequalities in urban areas: a Bayesian small area analysis in Spanish cities

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          Abstract

          Background

          Intra-urban inequalities in mortality have been infrequently analysed in European contexts. The aim of the present study was to analyse patterns of cancer mortality and their relationship with socioeconomic deprivation in small areas in 11 Spanish cities.

          Methods

          It is a cross-sectional ecological design using mortality data (years 1996-2003). Units of analysis were the census tracts. A deprivation index was calculated for each census tract. In order to control the variability in estimating the risk of dying we used Bayesian models. We present the RR of the census tract with the highest deprivation vs. the census tract with the lowest deprivation.

          Results

          In the case of men, socioeconomic inequalities are observed in total cancer mortality in all cities, except in Castellon, Cordoba and Vigo, while Barcelona (RR = 1.53 95%CI 1.42-1.67), Madrid (RR = 1.57 95%CI 1.49-1.65) and Seville (RR = 1.53 95%CI 1.36-1.74) present the greatest inequalities. In general Barcelona and Madrid, present inequalities for most types of cancer. Among women for total cancer mortality, inequalities have only been found in Barcelona and Zaragoza. The excess number of cancer deaths due to socioeconomic deprivation was 16,413 for men and 1,142 for women.

          Conclusion

          This study has analysed inequalities in cancer mortality in small areas of cities in Spain, not only relating this mortality with socioeconomic deprivation, but also calculating the excess mortality which may be attributed to such deprivation. This knowledge is particularly useful to determine which geographical areas in each city need intersectorial policies in order to promote a healthy environment.

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          Most cited references35

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          Trends in smoking behaviour between 1985 and 2000 in nine European countries by education.

          To examine whether trends in smoking behaviour in Western Europe between 1985 and 2000 differed by education group. Data of smoking behaviour and education level were obtained from national cross sectional surveys conducted between 1985 and 2000 (a period characterised by intense tobacco control policies) and analysed for countries combined and each country separately. Annual trends in smoking prevalence and the quantity of cigarettes consumed by smokers were summarised for each education level. Education inequalities in smoking were examined at four time points. Data were obtained from nine European countries: Norway, Sweden, Denmark, Finland, the United Kingdom, the Netherlands, Germany, Italy, and Spain. 451 386 non-institutionalised men and women 25-79 years old. Smoking status, daily quantity of cigarettes consumed by smokers. Combined country analyses showed greater declines in smoking and tobacco consumption among tertiary educated men and women compared with their less educated counterparts. In country specific analyses, elementary educated British men and women, and elementary educated Italian men showed greater declines in smoking than their more educated counterparts. Among Swedish, Finnish, Danish, German, Italian, and Spanish women, greater declines were seen among more educated groups. Widening education inequalities in smoking related diseases may be seen in several European countries in the future. More insight into effective strategies specifically targeting the smoking behaviour of low educated groups may be gained from examining the tobacco control policies of the UK and Italy over this period.
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            Politics and health outcomes.

            The aim of this study was to examine the complex interactions between political traditions, policies, and public health outcomes, and to find out whether different political traditions have been associated with systematic patterns in population health over time. We analysed a number of political, economic, social, and health variables over a 50-year period, in a set of wealthy countries belonging to the Organisation for Economic Co-operation and Development (OECD). Our findings support the hypothesis that the political ideologies of governing parties affect some indicators of population health. Our analysis makes an empirical link between politics and policy, by showing that political parties with egalitarian ideologies tend to implement redistributive policies. An important finding of our research is that policies aimed at reducing social inequalities, such as welfare state and labour market policies, do seem to have a salutary effect on the selected health indicators, infant mortality and life expectancy at birth.
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              Educational inequalities in smoking among men and women aged 16 years and older in 11 European countries.

              To determine those groups who are at increased risk of smoking related diseases, we assessed in which male and female generations smoking was more prevalent among lower educated groups than among the higher educated, in 11 European countries. Cross sectional analysis of data on smoking, covering the year 1998, from a social survey designed for all member states of the European Union. Higher and lower educated men and women aged 16 years and older from 11 member states of the European Union. Age standardised prevalence rates by education and prevalence odds ratios of current and ever daily smoking comparing lower educated groups with higher educated groups. A north-south gradient in educational inequalities in current and ever daily smoking was observed for women older than 24 years, showing larger inequalities in the northern countries. Such a gradient was not observed for men. A disadvantage for the lower educated in terms of smoking generally occurred later among women than among men. Indications of inequalities in smoking in the age group 16-24 years were observed for all countries, with the exception of women from Greece and Portugal. Preventing and reducing smoking among lower educated subgroups should be a priority of policies aiming to reduce inequalities in health in Europe. If steps are not taken to control tobacco use among the lower educated groups specifically, inequalities in lung cancer and other smoking related diseases should be anticipated in all populations of the European Union, and both sexes.
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                Author and article information

                Journal
                Int J Health Geogr
                International Journal of Health Geographics
                BioMed Central
                1476-072X
                2011
                13 January 2011
                : 10
                : 6
                Affiliations
                [1 ]Servei de Sistemes d'Informació Sanitaria, Agència de Salut Pública de Barcelona, Barcelona, Spain
                [2 ]CIBER Epidemiología y Salud Pública (CIBERESP), Parc de Recerca Biomédica de Barcelona, Barcelona, Spain
                [3 ]Departament de Salut Pública, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain
                [4 ]Universitat Pompeu Fabra, Barcelona, Spain
                [5 ]Estudios e investigación Sanitaria, Departamento de Sanidad y Consumo. Gobierno Vasco, Vitoria-Gasteiz, Spain
                [6 ]Observatorio de Salud y Medio Ambiente de Andalucía (OSMAN), Area de Salud Pública y Protección de la Salud, Escuela Andaluza de Salud Pública, Granada, Spain
                [7 ]Servicio de Informes de Salud y Estudios, Instituto de Salud Pública, Dirección General de Salud Pública y Alimentación, Consejería de Sanidad, Comunidad de Madrid
                [8 ]Servicio de Epidemiologia, Dirección General de Atención Primaria, Comunidad de Madrid
                [9 ]Area de Epidemiología Ambiental y Cáncer, Centro Nacional de Epidemiología, Madrid, Spain
                [10 ]Area de Desigualdades en Salud, Centro Superior de Investigación en Salud Pública de Valencia, Spain
                [11 ]Instituto Aragonés de Ciencias de la Salud, Aragón, Spain
                [12 ]Departamento de Medicina Preventiva e Saude Pública, Universidade de Santiago de Compostela, Spain
                [13 ]Unitat d'Investigació en Anàlisi de la Mortalitat i Estadística Sanitaria, Departament d'Infermeria Comunitària, Medecina Preventiva i Salut Pública i Història de la Ciencia, Universitat d'Alacant, Spain
                [14 ]Research Group on Statistics, Applied Economics and Health (GRECS), University of Girona, Spain
                Article
                1476-072X-10-6
                10.1186/1476-072X-10-6
                3033786
                21232096
                21ff7c80-9376-43e8-922d-975724d54039
                Copyright ©2011 Puigpinós-Riera et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 13 July 2010
                : 13 January 2011
                Categories
                Research

                Public health
                Public health

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