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      Diferencias por sexo y nivel de renta en la mortalidad por causas directamente relacionadas con el alcohol en Navarra, 1993-2017 Translated title: Differences by sex and income level in mortality from causes directly related to alcohol in Navarre, 1993-2017

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          Abstract

          Resumen Fundamento El consumo de alcohol es factor de riesgo para muchos problemas de salud. Se estudia la mortalidad por causas directamente atribuibles al consumo de alcohol por sexo y nivel de renta y se analizan las tendencias en el periodo 1993-2017 en Navarra. Método Se seleccionaron mediante los códigos CIE-9 y CIE-10 los fallecimientos por trastornos mentales inducidos por alcohol, dependencia y abuso, cardiomiopatía alcohólica, cirrosis alcohólica y otras enfermedades alcohólicas del hígado, y envenenamiento accidental por alcohol. Se utilizaron las categorías de renta asociadas al copago farmacéutico como indicador de la posición socioeconómica. Finalmente, se calcularon las tasas de mortalidad ajustadas a la población estándar europea mediante el método directo y se utilizó regresión joinpoint para evaluar la tendencia temporal. Resultados Se registraron un total de 441 fallecimientos en la población de 35-79 años, siendo la cirrosis hepática la causa más frecuente (77,5%). En 1993-1997 y 2013-2017, las tasas de mortalidad en los hombres eran diez y cinco veces más altas que en las mujeres, respectivamente. Las tasas de mortalidad fueron cinco veces más elevadas en hombres con rentas menores de 18.000 €. No se observaron cambios estadísticamente significativos en la tendencia de las tasas de mortalidad en el periodo estudiado. Conclusiones La mortalidad por causas totalmente atribuibles alcohol no ha disminuido en Navarra en las últimas tres décadas, siendo superior en hombres y en la población con menores rentas económicas.

          Translated abstract

          Abstract Background Alcohol consumption is a risk factor for many health problems. Mortality from causes of death wholly attributable to alcohol consumption by sex and income level was studied and trends in the 1993-2017 period were analyzed in Navarre (Spain). Methods Deaths due to alcohol-induced mental disorders, dependence and abuse, alcoholic cardiomyopathy, alcoholic cirrhosis and other alcoholic liver diseases, and accidental alcohol poisoning were selected through codes ICD-9 and ICD-10. Annual income that determines copayment level was used as an indicator of socioeconomic status. Mortality rates adjusted to the European standard population were calculated using the direct method and joinpoint regression was used to evaluate the temporal trend. Results A total of 441 deaths were recorded in the population aged 35-79 years. It highlights liver cirrhosis as the most common cause (77,5%). Death rates in men were ten and five times higher than in women in 1993-1997 and 2013-2017 periods, respectively. Compared to men with incomes above 18,000 €, mortality rates were five times higher in the population with incomes below 18,000 €. No statistically significant changes were observed in the trend of mortality rates throughout the period studied. Conclusions Mortality by causes of death wholly attributable to alcohol has not decreased in Navarre in the last three decades, it is higher in men than in women and in the population with lower incomes.

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          Inequalities in mortality in small areas of eleven Spanish cities (the multicenter MEDEA project).

          The objectives of this study are to identify inequalities in mortality among census tracts of 11 Spanish cities in the period 1996-2003 and to analyse the relationship between these geographical inequalities and socioeconomic deprivation. It is a cross-sectional ecological study where the units of analysis are census tracts. We obtained an index of socioeconomic deprivation and estimated SMR by each census tract using hierarchical Bayesian models which take into account the spatial structure. In the majority of the cities geographical patterns in total mortality were found in both sexes, which were similar to those for the index of socioeconomic deprivation. Among men, four specific causes of death (lung cancer, ischemic heart diseases, respiratory diseases and cirrhosis) were positively associated with deprivation in the majority of cities. Among women the specific causes diabetes and cirrhosis were positively associated, while lung cancer was negatively associated with deprivation. The excess of mortality related with deprivation was 59,445 deaths among men and 23,292 among women. These results highlight the importance of intra-urban inequalities in health. 2010 Elsevier Ltd. All rights reserved.
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            Comparison of different approaches for estimating age-specific alcohol-attributable mortality: The cases of France and Finland

            Background Accurate estimates of the impact of alcohol on overall and age-specific mortality are crucial for formulating health policies. However, different approaches to estimating alcohol-attributable mortality provide different results, and a detailed comparison of age-specific estimates is missing. Methods Using data on cause of death, alcohol consumption, and relative risks of mortality at different consumption levels, we compare eight estimates of sex- and age-specific alcohol-attributable mortality in France (2010) and Finland (2013): five estimates using cause-of-death approaches (with one accounting for contributory causes), and three estimates using attributable fraction (AF) approaches. Results AF-related approaches and the approach based on alcohol-related underlying and contributory causes of death provided estimates of alcohol-attributable mortality that were twice as high as the estimates found using underlying cause-of-death approaches in both countries and sexes. The differences across the methods were greatest among older age groups An inverse U-shape in age-specific alcohol-attributable mortality (peaking at around age 65) was observed for cause-of-death approaches, with this shape being more pronounced in Finland. AF-related approaches resulted in different estimates at older ages: i.e., mortality was found to increase with age in France; whereas in Finland mortality estimates depended on the underlying assumptions regarding the effects of alcohol consumption on cardiovascular mortality. Conclusions While the most detailed approaches (i.e., the AF-related approach and the approach that includes underlying and contributory causes) are theoretically able to provide more accurate estimates of alcohol-attributable mortality, they–especially the AF approaches- depend heavily on data availability and quality. To enhance the reliability of alcohol-attributable mortality estimates, data quality for older age groups needs to be improved.
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              Socioeconomic inequalities in cardiometabolic control in patients with type 2 diabetes

              Background The aim of this study was to determine if the achievement of control targets in patients with type 2 diabetes was associated with personal socioeconomic factors and if these associations were sex-dependent. Methods This cross-sectional, population-based study was conducted in Spain. Glycated haemoglobin (HbA1c) level and other clinical parameters were obtained from electronic primary care records (n = 32,638 cases). Socioeconomic status was determined using education level and yearly income. Among patients, having their HbA1c level checked during the previous year was considered as an indirect measure of the process of care, whereas tobacco use and clinical parameters such as HbA1c, low-density lipoprotein cholesterol (LDL-c) and blood pressure (BP) were considered intermediate control outcomes. General linear mixed effect models were used to assess associations. Results The achievement of metabolic and cardiovascular control targets in patients with type 2 diabetes was associated with educational level and income, and socioeconomic gradients differed by sex. The probability of having had an HbA1c test performed in the previous year was higher in patients with lower education levels. Patients in the lowest income and education level categories were less likely to have reached the recommended HbA1c level. Males in the lowest education level categories were less likely to be non-smokers or to have achieved the blood pressure targets. In contrast, patients within the low income categories had a higher probability of reaching the recommended LDL-c level. Conclusions Our results suggest the presence of socioeconomic inequalities in the achievement of cardiovascular and metabolic control that differed in direction and magnitude depending on the measured outcome and sex of the patient. These findings may help health professionals focus on high-risk individuals to decrease health inequalities.
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                Author and article information

                Journal
                asisna
                Anales del Sistema Sanitario de Navarra
                Anales Sis San Navarra
                Gobierno de Navarra. Departamento de Salud (Pamplona, Navarra, Spain )
                1137-6627
                April 2020
                : 43
                : 1
                : 9-15
                Affiliations
                [2] orgnameInstituto de Investigación Sanitaria de Navarra (IdiSNA)
                [3] orgnameCentro de Investigación Biomédica en Red de Epidemiología y Salud Pública
                [4] orgnameComplejo Hospitalario de Navarra orgdiv1Servicio de Medicina Preventiva e Higiene Hospitalaria
                [5] orgnameRed de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC)
                [1] orgnameInstituto de Salud Pública y Laboral de Navarra
                Article
                S1137-66272020000100002 S1137-6627(20)04300100002
                10.23938/assn.0750
                31999271
                8c97b9a5-c503-4eb1-ac4d-68cd4a7a150e

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

                History
                : 23 December 2019
                : 13 August 2019
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 18, Pages: 7
                Product

                SciELO Spain

                Categories
                Artículos Originales

                Alcohol,Mortality,Trend,Income,Mortalidad,Nivel de renta,Tendencias
                Alcohol, Mortality, Trend, Income, Mortalidad, Nivel de renta, Tendencias

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