Trends in socioeconomic inequalities in mortality in small areas of 33 Spanish cities
Abstract Background In Spain, several ecological studies have analyzed trends in socioeconomic inequalities in mortality from all causes in urban areas over time. However, the results of these studies are quite heterogeneous finding, in general, that inequalities decreased, or remained stable. There...
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| Format: | Article |
| Language: | English |
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BMC
2016-07-01
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| Series: | BMC Public Health |
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| Online Access: | http://link.springer.com/article/10.1186/s12889-016-3190-y |
| _version_ | 1811263824399958016 |
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| author | Marc Marí-Dell’Olmo Mercè Gotsens Laia Palència Maica Rodríguez-Sanz Miguel A. Martinez-Beneito Mónica Ballesta Montse Calvo Lluís Cirera Antonio Daponte Felicitas Domínguez-Berjón Ana Gandarillas Natividad Izco Goñi Carmen Martos Conchi Moreno-Iribas Andreu Nolasco Diego Salmerón Margarita Taracido Carme Borrell |
| author_facet | Marc Marí-Dell’Olmo Mercè Gotsens Laia Palència Maica Rodríguez-Sanz Miguel A. Martinez-Beneito Mónica Ballesta Montse Calvo Lluís Cirera Antonio Daponte Felicitas Domínguez-Berjón Ana Gandarillas Natividad Izco Goñi Carmen Martos Conchi Moreno-Iribas Andreu Nolasco Diego Salmerón Margarita Taracido Carme Borrell |
| author_sort | Marc Marí-Dell’Olmo |
| collection | DOAJ |
| description | Abstract Background In Spain, several ecological studies have analyzed trends in socioeconomic inequalities in mortality from all causes in urban areas over time. However, the results of these studies are quite heterogeneous finding, in general, that inequalities decreased, or remained stable. Therefore, the objectives of this study are: (1) to identify trends in geographical inequalities in all-cause mortality in the census tracts of 33 Spanish cities between the two periods 1996–1998 and 2005–2007; (2) to analyse trends in the relationship between these geographical inequalities and socioeconomic deprivation; and (3) to obtain an overall measure which summarises the relationship found in each one of the cities and to analyse its variation over time. Methods Ecological study of trends with 2 cross-sectional cuts, corresponding to two periods of analysis: 1996–1998 and 2005–2007. Units of analysis were census tracts of the 33 Spanish cities. A deprivation index calculated for each census tracts in all cities was included as a covariate. A Bayesian hierarchical model was used to estimate smoothed Standardized Mortality Ratios (sSMR) by each census tract and period. The geographical distribution of these sSMR was represented using maps of septiles. In addition, two different Bayesian hierarchical models were used to measure the association between all-cause mortality and the deprivation index in each city and period, and by sex: (1) including the association as a fixed effect for each city; (2) including the association as random effects. In both models the data spatial structure can be controlled within each city. The association in each city was measured using relative risks (RR) and their 95 % credible intervals (95 % CI). Results For most cities and in both sexes, mortality rates decline over time. For women, the mortality and deprivation patterns are similar in the first period, while in the second they are different for most cities. For men, RRs remain stable over time in 29 cities, in 3 diminish and in 1 increase. For women, in 30 cities, a non-significant change over time in RR is observed. However, in 4 cities RR diminishes. In overall terms, inequalities decrease (with a probability of 0.9) in both men (RR = 1.13, 95 % CI = 1.12–1.15 in the 1st period; RR = 1.11, 95 % CI = 1.09–1.13 in the 2nd period) and women (RR = 1.07, 95 % CI = 1.05–1.08 in the 1st period; RR = 1.04, 95 % CI = 1.02–1.06 in the 2nd period). Conclusions In the future, it is important to conduct further trend studies, allowing to monitoring trends in socioeconomic inequalities in mortality and to identify (among other things) temporal factors that may influence these inequalities. |
| first_indexed | 2024-04-12T19:53:25Z |
| format | Article |
| id | doaj.art-7fe7a009892544bab8a72c22d8be71a3 |
| institution | Directory Open Access Journal |
| issn | 1471-2458 |
| language | English |
| last_indexed | 2024-04-12T19:53:25Z |
| publishDate | 2016-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Public Health |
| spelling | doaj.art-7fe7a009892544bab8a72c22d8be71a32022-12-22T03:18:46ZengBMCBMC Public Health1471-24582016-07-0116111310.1186/s12889-016-3190-yTrends in socioeconomic inequalities in mortality in small areas of 33 Spanish citiesMarc Marí-Dell’Olmo0Mercè Gotsens1Laia Palència2Maica Rodríguez-Sanz3Miguel A. Martinez-Beneito4Mónica Ballesta5Montse Calvo6Lluís Cirera7Antonio Daponte8Felicitas Domínguez-Berjón9Ana Gandarillas10Natividad Izco Goñi11Carmen Martos12Conchi Moreno-Iribas13Andreu Nolasco14Diego Salmerón15Margarita Taracido16Carme Borrell17CIBER Epidemiología y Salud Pública (CIBERESP)CIBER Epidemiología y Salud Pública (CIBERESP)CIBER Epidemiología y Salud Pública (CIBERESP)CIBER Epidemiología y Salud Pública (CIBERESP)CIBER Epidemiología y Salud Pública (CIBERESP)CIBER Epidemiología y Salud Pública (CIBERESP)Estudios e investigación Sanitaria, Departamento de Sanidad y Consumo, Gobierno VascoCIBER Epidemiología y Salud Pública (CIBERESP)CIBER Epidemiología y Salud Pública (CIBERESP)Subdirección de Promoción de la Salud y Prevención, Consejería de SanidadSubdirección de Promoción de la Salud y Prevención, Consejería de SanidadRegistro de Mortalidad, Consejería de Salud y Servicios SocialesInstituto Aragonés de Ciencias de la SaludInstituto de Salud Pública de Navarra, Departamento de Salud, Gobierno de NavarraUnidad de Investigación en Análisis de la Mortalidad y Estadísticas Sanitarias, Universidad de AlicanteCIBER Epidemiología y Salud Pública (CIBERESP)CIBER Epidemiología y Salud Pública (CIBERESP)CIBER Epidemiología y Salud Pública (CIBERESP)Abstract Background In Spain, several ecological studies have analyzed trends in socioeconomic inequalities in mortality from all causes in urban areas over time. However, the results of these studies are quite heterogeneous finding, in general, that inequalities decreased, or remained stable. Therefore, the objectives of this study are: (1) to identify trends in geographical inequalities in all-cause mortality in the census tracts of 33 Spanish cities between the two periods 1996–1998 and 2005–2007; (2) to analyse trends in the relationship between these geographical inequalities and socioeconomic deprivation; and (3) to obtain an overall measure which summarises the relationship found in each one of the cities and to analyse its variation over time. Methods Ecological study of trends with 2 cross-sectional cuts, corresponding to two periods of analysis: 1996–1998 and 2005–2007. Units of analysis were census tracts of the 33 Spanish cities. A deprivation index calculated for each census tracts in all cities was included as a covariate. A Bayesian hierarchical model was used to estimate smoothed Standardized Mortality Ratios (sSMR) by each census tract and period. The geographical distribution of these sSMR was represented using maps of septiles. In addition, two different Bayesian hierarchical models were used to measure the association between all-cause mortality and the deprivation index in each city and period, and by sex: (1) including the association as a fixed effect for each city; (2) including the association as random effects. In both models the data spatial structure can be controlled within each city. The association in each city was measured using relative risks (RR) and their 95 % credible intervals (95 % CI). Results For most cities and in both sexes, mortality rates decline over time. For women, the mortality and deprivation patterns are similar in the first period, while in the second they are different for most cities. For men, RRs remain stable over time in 29 cities, in 3 diminish and in 1 increase. For women, in 30 cities, a non-significant change over time in RR is observed. However, in 4 cities RR diminishes. In overall terms, inequalities decrease (with a probability of 0.9) in both men (RR = 1.13, 95 % CI = 1.12–1.15 in the 1st period; RR = 1.11, 95 % CI = 1.09–1.13 in the 2nd period) and women (RR = 1.07, 95 % CI = 1.05–1.08 in the 1st period; RR = 1.04, 95 % CI = 1.02–1.06 in the 2nd period). Conclusions In the future, it is important to conduct further trend studies, allowing to monitoring trends in socioeconomic inequalities in mortality and to identify (among other things) temporal factors that may influence these inequalities.http://link.springer.com/article/10.1186/s12889-016-3190-yDisease mappingMultilevel analysisGeographical inequalitiesBayesian methodsTrendsUrban areas |
| spellingShingle | Marc Marí-Dell’Olmo Mercè Gotsens Laia Palència Maica Rodríguez-Sanz Miguel A. Martinez-Beneito Mónica Ballesta Montse Calvo Lluís Cirera Antonio Daponte Felicitas Domínguez-Berjón Ana Gandarillas Natividad Izco Goñi Carmen Martos Conchi Moreno-Iribas Andreu Nolasco Diego Salmerón Margarita Taracido Carme Borrell Trends in socioeconomic inequalities in mortality in small areas of 33 Spanish cities BMC Public Health Disease mapping Multilevel analysis Geographical inequalities Bayesian methods Trends Urban areas |
| title | Trends in socioeconomic inequalities in mortality in small areas of 33 Spanish cities |
| title_full | Trends in socioeconomic inequalities in mortality in small areas of 33 Spanish cities |
| title_fullStr | Trends in socioeconomic inequalities in mortality in small areas of 33 Spanish cities |
| title_full_unstemmed | Trends in socioeconomic inequalities in mortality in small areas of 33 Spanish cities |
| title_short | Trends in socioeconomic inequalities in mortality in small areas of 33 Spanish cities |
| title_sort | trends in socioeconomic inequalities in mortality in small areas of 33 spanish cities |
| topic | Disease mapping Multilevel analysis Geographical inequalities Bayesian methods Trends Urban areas |
| url | http://link.springer.com/article/10.1186/s12889-016-3190-y |
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