RT Journal Article
T1 Trends in socioeconomic inequalities in mortality in small areas of 33 Spanish cities.
A1 Marí-Dell'Olmo, Marc
A1 Gotsens, Mercè
A1 Palència, Laia
A1 Rodríguez-Sanz, Maica
A1 Martinez-Beneito, Miguel A
A1 Ballesta, Mónica
A1 Calvo, Montse
A1 Cirera, Lluís
A1 Daponte, Antonio
A1 Domínguez-Berjón, Felicitas
A1 Gandarillas, Ana
A1 Goñi, Natividad Izco
A1 Martos, Carmen
A1 Moreno-Iribas, Conchi
A1 Nolasco, Andreu
A1 Salmerón, Diego
A1 Taracido, Margarita
A1 Borrell, Carme
K1 Disease mapping
K1 Multilevel analysis
K1 Geographical inequalities
K1 Bayesian methods
K1 Trends
K1 Urban areas
K1 Small areas
K1 Mortality
K1 Inequalities in mortality
K1 Socioeconomic inequalities
K1 Censos
K1 Ciudades
K1 Geografía
K1 Factores socioeconómicos
K1 España
AB BACKGROUNDIn 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.METHODSEcological 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).RESULTSFor 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).CONCLUSIONSIn 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.
PB BioMed Central
YR 2016
FD 2016-07-29
LK http://hdl.handle.net/10668/2388
UL http://hdl.handle.net/10668/2388
LA en
NO Marí-Dell'Olmo M, Gotsens M, Palència L, Rodríguez-Sanz M, Martinez-Beneito MA, Ballesta M, et al. Trends in socioeconomic inequalities in mortality in small areas of 33 Spanish cities. BMC Public Health. 2016; 16:6 63
NO Journal Article;
DS RISalud
RD Apr 7, 2025