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      Veintidós años de evolución de las desigualdades socioeconómicas en la mortalidad en la ciudad de Barcelona Translated title: Trends in socioeconomic inequalities in mortality over a twenty-two-year period in the city of Barcelona (Spain)

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          Abstract

          Objetivo: Analizar la evolución de las desigualdades socioeconómicas en la mortalidad por todas las causas en Barcelona durante los años 1983-2004. Métodos: Estudio ecológico de tendencias con 4 cortes transversales (1983-1988, 1989-1994, 1995-1999 y 2000-2004), con el área básica de salud (ABS) como unidad de análisis. La población de estudio fueron los varones y mujeres residentes en Barcelona, de 20 o más años de edad. Las fuentes de información fueron el registro de mortalidad, el padrón municipal y el censo de habitantes y viviendas. Como variable dependiente se utilizó la tasa de mortalidad específica (TME) por todas las causas. Como variable independiente se calculó un índice compuesto de privación socioeconómica de las ABS; las ABS se agruparon en cuartiles según los valores del índice. Se ajustaron modelos de Poisson para estimar el riesgo relativo (RR) de mortalidad por todas las causas en las 4 agrupaciones de ABS, estratificado por grupos de edad y sexo. Resultados: En todos los períodos de estudio se observan desigualdades en la mortalidad según el ABS de residencia, tanto en varones como en mujeres. Las TME de las ABS con mayor privación socioeconómica fueron mayores que las de aquellas con menor privación, y también fueron mayores en los varones que en las mujeres. Asimismo, los grupos de edad más jóvenes presentan mayor RR de mortalidad que los de edad avanzada. No obstante, las desigualdades disminuyeron tanto en términos absolutos como en términos relativos a partir del segundo período de estudio, especialmente en los varones. Conclusiones: Este estudio ha demostrado que, a pesar de haber desigualdades en mortalidad en las ABS de Barcelona, éstas han disminuido a lo largo de 2 décadas. Las políticas públicas deberían tener en cuenta esta información en el abordaje de las desigualdades entre ABS.

          Translated abstract

          Objective: To analyze the trend in socioeconomic inequalities in all-cause mortality in Barcelona from 1983 to 2004. Methods: We performed an ecological study of trends over 4 cross-sections (1983-1988, 1989-1994, 1995-1999 and 2000-2004), with the basic health area (BHA) as the unit of analysis. The study population consisted of men and women aged 20 years or more living in Barcelona. The information sources were the mortality registry, the municipal census and the census of inhabitants and dwellings. The age- and sex-specific mortality rate (ASMR) for all causes was used as the dependent variable. As the independent variable, a composite index of socioeconomic deprivation of the BHA was calculated; BHAs were grouped in quartiles according to the values on the index. Poisson models were adjusted to estimate the relative risk of mortality from all causes in the 4 groups of BHA, stratified by age groups and sex. Results: In all the study periods, inequalities in mortality were found, depending on the BHA of residence, both for men and for women: the ASMR of the most deprived BHAs were greater than those of less deprived BHA, and were greater among men than among women. Likewise, relative risks in the youngest age groups were higher than in the oldest age groups. However, from the second to fourth study periods, inequalities decreased in absolute and relative terms, especially among men. Conclusions: Inequalities in mortality persist in BHA in Barcelona but have decreased over the last 2 decades. Public policies should take this information into account when tackling inequalities among BHA.

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          Most cited references 28

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          Socioeconomic inequalities in health in 22 European countries.

          Comparisons among countries can help to identify opportunities for the reduction of inequalities in health. We compared the magnitude of inequalities in mortality and self-assessed health among 22 countries in all parts of Europe. We obtained data on mortality according to education level and occupational class from census-based mortality studies. Deaths were classified according to cause, including common causes, such as cardiovascular disease and cancer; causes related to smoking; causes related to alcohol use; and causes amenable to medical intervention, such as tuberculosis and hypertension. Data on self-assessed health, smoking, and obesity according to education and income were obtained from health or multipurpose surveys. For each country, the association between socioeconomic status and health outcomes was measured with the use of regression-based inequality indexes. In almost all countries, the rates of death and poorer self-assessments of health were substantially higher in groups of lower socioeconomic status, but the magnitude of the inequalities between groups of higher and lower socioeconomic status was much larger in some countries than in others. Inequalities in mortality were small in some southern European countries and very large in most countries in the eastern and Baltic regions. These variations among countries appeared to be attributable in part to causes of death related to smoking or alcohol use or amenable to medical intervention. The magnitude of inequalities in self-assessed health also varied substantially among countries, but in a different pattern. We observed variation across Europe in the magnitude of inequalities in health associated with socioeconomic status. These inequalities might be reduced by improving educational opportunities, income distribution, health-related behavior, or access to health care. Copyright 2008 Massachusetts Medical Society.
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              The logic in ecological: I. The logic of analysis.

               M Susser (1994)
              This paper addresses ecological studies in public health research in terms of the logic of their analysis. It makes several distinctions between studies based on ecological and individual units. First, it identifies the variables common to both types of study and those particular to ecological studies. Second, it shows how ecological and individual units combine in two classes: unmixed (purely ecological, purely individual) and mixed. Third, it details how the relationships among and between individual and grouped units (expressed in terms of regression coefficients between independent and dependent variables) yield four coefficients: for all individual members; for all groups; for all individuals within each group; and for all individuals within groups (a weighted average). Equipped with an understanding of the dimensions involved at ecological and individual levels and of the relationships between them, researchers are in a position to exploit the public health potential of the ecological approach.
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                Author and article information

                Affiliations
                Rotterdam orgnameErasmus University Rotterdam orgdiv1Department of Public Health Netherlands
                Barcelona orgnameAgència de Salut Pública España
                Barcelona orgnameUniversitat Pompeu Fabra España
                orgnameCentro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP) España
                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                gs
                Gaceta Sanitaria
                Gac Sanit
                Ediciones Doyma, S.L. (Barcelona, Barcelona, Spain )
                0213-9111
                January 2010
                : 24
                : 1
                : 20-27
                S0213-91112010000100004

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

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                Figures: 0, Tables: 0, Equations: 0, References: 27, Pages: 8
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                Product Information: SciELO Spain

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