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      Mortalidad y privación socioeconómica en las secciones censales y los distritos de Barcelona Translated title: Mortality and socioeconomic deprivation in the census tracts and districts of Barcelona (Spain)

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          Abstract

          Objetivos: Analizar la asociación entre privación socioeconómica y mortalidad en las secciones censales de Barcelona y las variaciones de esta asociación en los distritos. Métodos: Estudio ecológico transversal de las 1.812 secciones censales y los 10 distritos de la ciudad de Barcelona mediante la utilización de variables socioeconómicas obtenidas del censo de 1991 y la mortalidad de 1987 a 1995. Por medio del análisis de los componentes principales se elaboró un índice de privación socioeconómica. El análisis fue descriptivo y mediante modelos de regresión de Poisson. Resultados: En las secciones censales de Barcelona se observa un incremento en la mortalidad al empeorar la situación socioeconómica, de manera que en el cuartil más desfavorable del índice de privación, respecto al menos desfavorable, el riesgo relativo de mortalidad es de 1,24 (intervalo de confianza [IC] del 95%, 1,22-1,27) para los varones y de 1,05 (IC del 95%, 1,02-1,07) para las mujeres. Esta asociación varía en cada distrito; así, en el distrito 1 (zona centro), que destaca por la peor situación socioeconómica y la mortalidad más elevada, el riesgo relativo es de 1,57 (IC del 95%, 1,21-2,05) para la mortalidad en varones, mientras que el distrito 8, con una situación socioeconómica también desfavorable, no destaca por una elevada mortalidad. Conclusiones: El análisis de las desigualdades socioeconómicas en relación con la mortalidad en las secciones censales de una ciudad complementa el análisis en otras áreas mayores, como pueden ser los distritos.

          Translated abstract

          Objectives: To analyze the association between socioeconomic deprivation and mortality in the census tracts of Barcelona and the distinct patterns of this association in the districts. Methods: We performed an ecological, cross sectional study based on the 1,812 census tracts and the 10 districts of Barcelona, using socioeconomic variables obtained from the 1991 census and mortality data for 1987-1995. A deprivation index was created through component analysis. Descriptive analyses were performed and multivariate Poisson regression models were adjusted. Results: The greater the socioeconomic deprivation in the census tracts, the higher the mortality. The quartile with the greatest deprivation had a relative risk (RR) of mortality of 1.24 (95% confidence interval [CI], 1.22-1.27) in males and an RR of 1.05 (95% CI, 1.02-1.07) in females (compared with the quartile of census tracts with the lowest deprivation). This association varied according to district: in the old inner-city district (district 1), which had the highest mortality and the greatest deprivation, the RR was 1.57 (95% CI, 1.21-2.05) for males, while in district 8, which also has considerable deprivation, mortality was lower. Conclusions: Analysis of socioeconomic inequalities in mortality in census tracts in an urban area highlights special areas of risk not observed in analysis of districts.

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          Bringing context back into epidemiology: variables and fallacies in multilevel analysis.

          A large portion of current epidemiologic research is based on methodologic individualism: the notion that the distribution of health and disease in populations can be explained exclusively in terms of the characteristics of individuals. The present paper discusses the need to include group- or macro-level variables in epidemiologic studies, thus incorporating multiple levels of determination in the study of health outcomes. These types of analyses, which have been called contextual or multi-level analyses, challenge epidemiologists to develop theoretical models of disease causation that extend across levels and explain how group-level and individual-level variables interact in shaping health and disease. They also raise a series of methodological issues, including the need to select the appropriate contextual unit and contextual variables, to correctly specify the individual-level model, and, in some cases, to account for residual correlation between individuals within contexts. Despite its complexities, multilevel analysis holds potential for reemphasizing the role of macro-level variables in shaping health and disease in populations.
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            Multivariate satatistical methods

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              Deprivation and mortality in Scotland, 1981 and 1991.

              To compare the mortality experience of Scottish postcode sectors characterised by socioeconomic census variables (Carstairs scores) in 1980-2 and 1990-2. Variables derived from the 1981 and 1991 censuses were combined according to the method devised by Carstairs and Morris to obtain Carstairs scores for 1010 postcode sectors in Scotland in 1981 and 1001 sectors in 1991. For most analyses, these scores were grouped into seven deprivation categories ranging from affluent (category 1) to deprived (category 7) localities. Death rates and standardised mortality ratios for localities according to deprivation category. Postcode sectors in Scotland that were categorised as deprived in 1981 were relatively more deprived at the time of the 1991 census; the mortality experience of deprived localities relative to either Scotland or affluent neighbourhoods worsened over this period, with a 162% difference between the most affluent and most deprived categories in 1991-2. Although the age and sex standardised mortality for ages 0-64 in Scotland declined by 22% during the 1980s, the reduction in the deprived categories was only about half that of the affluent groups. Increases in the death rate for men (29%) and women (11%) aged 20-29 in the deprived groups were largely attributable to an increase in the rates of suicide. Death rates from ischaemic heart disease and carcinoma of the lung and bronchus at ages 40-69 were lower in all deprivation categories in 1990-2, but the reduction was greater in more affluent areas; the difference in rates for these conditions between affluent and deprived groups therefore increased over the decade. The observed worsening of the standardised mortality ratio for Glasgow relative to Scotland could be explained on the basis of these mortality differentials and the concentration of deprived postcode sectors in Glasgow. Differences in mortality experience linked to relative poverty increased in the 10 years between 1981 and 1991 censuses. Although mortality for Scotland as a whole is improving, the picture is one of an increasing distinction between the experience of the majority and that of a substantial minority of the population.
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                Author and article information

                Journal
                gs
                Gaceta Sanitaria
                Gac Sanit
                Ediciones Doyma, S.L. (Barcelona, Barcelona, Spain )
                0213-9111
                October 2005
                : 19
                : 5
                : 363-369
                Affiliations
                [02] Barcelona orgnameAgencia de Salud Pública de Barcelona España
                [01] Madrid orgnameComunidad de Madrid orgdiv1Instituto de Salud Pública orgdiv2Servicio de Salud Pública del Área 2 España
                Article
                S0213-91112005000500004 S0213-9111(05)01900500004
                10.1157/13080134
                4248616f-d93f-4981-a25f-fe7adbd989a5

                This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 International License.

                History
                : 09 June 2004
                : 07 March 2005
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 30, Pages: 7
                Product

                SciELO Public Health

                Categories
                Originales

                Desigualdades sociales en salud,Mortalidad,Privación,Áreas pequeñas,Censo,Social inequalities in health,Mortality,Deprivation,Small areas,Census

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