Regional differences in hospital use by adults in Spain

The purpose of this paper was to study regional differencesin the use of in-patient hospital services by adults in Spainand to explore how several factors are related to hospital utilization.We studied a sample of 20,741 individuals representative ofthe non-institutionalized Spanish population older than 15 yearsold interviewed in the Spanish health interview survey, carriedout in 1993. A logistic regression model was used to obtainthe odds ratios of using the in-patient hospital services forsocioeconomic status, health care need, health services resourcescharacteristics and for the 17 autonomous communities into whichSpain is divided. Aragon, Baleares and Navarra showed a highpercentage of people using hospital services while in Madridand Asturias a low percentage was found. Indicators of needfor health care were the most important predictive factors ofhospital utilization and neither socioeconomic status nor healthcare system characteristics were associated with the use ofhospital services. Although only 5 autonomous communities showeda high or low percentage of people using hospital services,the unexplained variance needs further research in order toidentify unnecessary reasons for utilization and accessibilityproblems.     

Economic and social factors associated with body mass index and obesity in the Spanish population aged 20-64 years

Many studies have shown how greatly body mass index (BMI) andobesity vary according to different socio-economic factors.The objective of this study is to study these variations ina representative sample of the adult population in a Mediterraneanarea. The data were taken from the 1987 Spanish National HealthSurvey carried out in a representative sample of the non-institutionalizedpopulation older than 1 year of age. Multivariate statisticaltechniques are used to analyse the relation between BMI andobesity and different social and economic factors in a sampleof 21,838 men and women between 20 and 64 years of age. BMIand obesity vary directly with age in both men and women. Aninverse relation is seen with regard to the levels of education:the lower the educational level, the higher the mean BMI andthe more frequently obesity is found. This association is strongerin women and shows a significant dose-response relation. Theconsistency of the resuits obtained with those observed in otherstudies carried out In countries with very different socio-culturalpatterns and lifestyles than Spain suggests that these variationsin BMI and obesity are independent of external factors.     

Mortality by cause of death and marital status in Spain

A number of studies have shown an association between maritalstatus and mortality, with most of them finding a lower mortalityin married as compared to unmarried persons. The purpose ofthis study is to show the differences in mortality from theleading causes of death by marital status among men and womenin Spain. An analysis was made of persons aged 25 years andolder who died in Spain during 1991. The mortality differencesby marital status and sex were analysed for all the deaths andfor the most frequent causes of death, using the ratios of age-adjusteddeath rates calculated from Poisson log—linear models.For both men and women, mortality was always higher in singleand widowed persons than in married persons, except for a non-statisticallysignificant mortality from diabetes mellitus and cirrhosis ofthe liver in single women. Divorced and separated men had ahigher mortality than married men for all the causes of deathtaken together; the mortality among divorced and separated women,on the other hand, was lower than in married women. Divorcedand separated men and women generally had a lower mortalitythan married persons for the different causes of death, exceptfor traffic accidents, suicide, cirrhosis of the liver and HIVinfection, where it was higher. The results obtained are similarto the findings of most studies in other countries, in whicha lower mortality has been observed in married persons as comparedto those who are widowed or single. However, the data showingthat divorced and separated persons have a lower mortality fromsome causes of death than married persons stand in contrastto most published studies. This work has shown that unmarriedpersons are not a homogeneous group, in that divorced and separatedpersons are very different from those who are single or widowed.