Two patterns of social inequalities in mortality in Barcelona, Spain?

BACKGROUND: The aims of this study were to describe social inequalities in mortality amongst Basic Health Areas in Barcelona Spain and to analyze the patterns of social inequalities in health. METHODS: This is an ecological study of all deaths of residents in Barcelona in 1989-93. The unit of analysis was the Basic Health Area. Socio-economic and mortality indicators (overall mortality and the main causes of death) were studied. Relative risk estimates between socio-economic and mortality indicators were calculated through Poisson regression models. RESULTS: An unequal socioeconomical and mortality distribution was observed between areas. The following variables were found to be associated with lower socio-economic conditions: overall mortality (RR = 1,48, males), specific mortality: malignant neoplasm of trachea, bronchus and lung (RR = 1, 64, males), chronic liver disease and cirrhosis (RR = 2,33, males), AIDS (RR = 3,42, males and females), drug overdose (RR = 5,18, males and females), tuberculosis (RR = 6,3, males and females), pneumonia, bronchitis, emphysema and asthma (RR = 1,41, males), and external causes (RR = 2,29, males). The increase in risk with deteriorating socioeconomic situation was linear for cirrhosis and bronchitis, emphysema and asthma, and close to linearity for malignant neoplasm of trachea, bronchus and lung. For AIDS, drug overdose, and tuberculosis, the increase in risk was not linear, being much higher for those areas with higher levels of unemployment. CONCLUSIONS: All causes of death that have been found to be associated with social inequalities are related with life-styles (smoking, excessive alcohol consumption and parenteral drug use). There are two patterns of social inequalities in health: AIDS, drug overdose and tuberculosis stand out as pathologies associated to extreme unfavourable socioeconomic situation, for which it is likely that there are some conditions favouring health problems associated with margination.     

Trends in diet and breast cancer mortality in England and Wales 1928–1977

Trends in age‐adjusted breast cancer mortality and consumption of meat, fat, sugar, cereal, and fruit and vegetables were studied for England and Wales over the 50‐year period from 1928 to 1977. At the onset of World War II, there was a marked reduction in both breast cancer mortality and intake of sugar, meat and fat, and an increased consumption of cereals and vegetables. Consumption of these foodstuffs returned to pre‐war levels by 1954, but breast cancer mortality did not return to pre‐war levels until some 15 years later. The association between the various dietary components and subsequent breast cancer mortality was determined for various lag intervals. Significant correlations were found for cereal, fat, sugar and meat consumption, the correlation being maximal for a diet‐breast cancer death lag interval of 12 years.

These findings add weight to the hypothesis that breast cancer development is related to a diet rich in meat, fat and sugar, and that some protection against cancer may be afforded by a reduction in these dietary components and an increase in cereal consumption.     

Trends in cancer mortality of the digestive tract in Belgrade,Yugoslavia, 1975–1989

During the period of 1975–1989, in the Belgrade population increasing mortality trends were established for colon and rectal cancer, cancer of the pancreas and gallbladder and bile ducts cancer, for both sexes, and for esophageal cancer in males. Stomach and liver cancer mortality decreased in females. In males, stomach cancer mortality after a prolonged steady decrease suddenly rose in the years 1988 and 1989. Mortality rates series for esophageal cancer in females and for liver cancer in males did not fit any usual trend function.     

Do social and economic reforms change socioeconomic inequalities in child mortality? A case study: New Zealand 1981–1999

BACKGROUND: Socioeconomic inequalities in child mortality are known to exist; however the trends in these inequalities have not been well examined. This study examines the trends in child mortality inequality between 1981 and 1999 against the background of the rapid and dramatic social and economic restructuring in New Zealand during this time period. METHODS: Record linkage studies of census and mortality records of all New Zealand children aged 0-14 years on census night 1981, 1986, 1991, 1996, each followed up for three years for mortality between ages 1-14 years. Socioeconomic position was measured using maternal education, household income, and highest occupational class in the household. Standardised mortality rates, rate ratios, and rates differences as well as regression based measures of inequality were calculated. RESULTS: Mortality in all socioeconomic groups fell between 1981 and 1999. Socioeconomic inequality in child mortality existed by all measures of socioeconomic position, however only trends by income suggested a change over time: the relative index of inequality increased from 1.5 in 1981-84 to 1.8 in 1996-99 (p trend 0.06), but absolute inequality remained stable (slope index of inequality 15/100 000 in 1981-84 and 14/100 000 in 1996-99. CONCLUSIONS: Dramatic changes in income in New Zealand possibly translated into increasing relative inequality in child mortality by income, but not by education or occupational class. The a priori hypothesis that socioeconomic inequalities in child mortality would have increased in New Zealand during a period of rapid structural reform and widening income inequalities was only partly supported.     

Urban–rural inequalities in suicide mortality: a comparison of urbanicity indicators

Background

Urban–rural disparities in suicide mortality have received considerable attention. Varying conceptualizations of urbanity may contribute to the conflicting findings. This ecological study on Germany assessed how and to what extent urban–rural suicide associations are affected by 14 different urban–rural indicators.

Methods

Indicators were based on continuous or k-means classified population data, land-use data, planning typologies, or represented population-based accessibility indicators. Agreements between indicators were tested with correlation analyses. Spatial Bayesian Poisson regressions were estimated to examine urban–rural suicide associations while adjusting for risk and protective factors.

Results

Urban–rural differences in suicide rates per 100,000 persons were found irrespective of the indicator. Strong and significant correlation was observed between different urban–rural indicators. Although the effect sign consistently referred to a reduced risk in urban areas, statistical significance was not universally confirmed by all regressions. Goodness-of-fit statistics suggested that the population potential score performs best, and that population density is the second best indicator of urbanicity. Numerical indicators are favored over classified ones. Regional planning typologies are not supported.

Conclusions

The strength of suicide urban–rural associations varies with respect to the applied indicator of urbanicity. Future studies that put urban–rural inequalities central are recommended to apply either unclassified population potentials or population density indicators, but sensitivity analyses are advised.

     

Trends in food availability in Portugal in 1966–2003

BACKGROUND: Dietary intake has changed considerably in South European countries, but whether those changes were similar between countries is currently unknown. AIM OF THE STUDY: To assess the trends in food availability in Portugal and four other Mediterranean countries from 1966 to 2003. METHODS: Food and Agricultural Organization food balance sheets from Portugal, France, Italy, Greece and Spain. Trends were assessed by linear regression. RESULTS: The per capita availability of calories has increased in Portugal, France, Greece, Italy and Spain in the past 40 years. Portugal presented the most rapid growth with an annual increase of 28.5 +/- 2.2 kcal (slope +/- standard error), or +1000 kcal overall. In animal products, Portugal had an annual increase of 20.7 +/- 0.9 kcal, much higher than the other four countries. Conversely, the availabilities of vegetable and fruit only showed a slight growth of 1.0 +/- 0.1 kcal/year and 2.5 +/- 0.4 kcal/year, respectively, thus increasing the ration of animal to vegetable products. Olive oil availability increased in all countries with the notable exception of Portugal, where a significant decrease was noted. Wine supply decreased in all five countries; in contrast, beer supply started to take up more alcohol share. Percentage of total calories from fat increased from nearly 25% to almost 35% in Portugal during the study period, mainly at the expenses of calories from carbohydrates, whereas the share of protein showed just a slight increase. Furthermore, fat and protein were increasingly provided by animal products. CONCLUSIONS: Portugal is gradually moving away from the traditional Mediterranean diet to a more Westernized diet as well as France, Greece, Italy and Spain. Noticeably, the trends of diet transition were observed relatively faster in Portugal than in the other four Mediterranean countries.     

Socioeconomic inequalities and mortality trends in BRICS, 1990–2010

Objective

To explore the presence and magnitude of – and change in – socioeconomic and health inequalities between and within Brazil, the Russian Federation, India, China and South Africa – the countries known as BRICS – between 1990 and 2010.

Methods

Comparable data on socioeconomic and health indicators, at both country and primary subnational levels, were obtained from publicly available sources. Health inequalities between and within countries were identified and summarized by using standard gap and gradient metrics.

Findings

Four of the BRICS countries showed increases in both income level and income inequality between 1990 and 2010. The exception was Brazil, where income inequality decreased over the same period. Between-country inequalities in level of education and access to sanitation remained mostly unchanged but the largest between-country difference in mean life expectancy increased, from 9 years in 1990 to 20 years in 2010. Throughout the study period, there was disproportionality in the burden of disease between BRICS. However, the national infant mortality rate fell substantially over the study period in all five countries. In Brazil and China, the magnitude of subnational income-related inequalities in infant mortality, both absolute and relative, also decreased substantially.

Conclusion

Despite the economic prosperity and general improvements in health seen since 1990, profound inequalities in health persist both within and between BRICS. However, the substantial reductions observed – within Brazil and China – in the inequalities in income-related levels of infant mortality are encouraging.     

Trends in mortality from homicide in Medellín (Colombia): 1975-2003

OBJECTIVE: To describe and evaluate homicide mortality trends in the city of Medellin, Colombia, between 1975 and 2003. METHOD: Deaths from homicide between January, 1975 and December, 2003 were studied. With the aid of the SSS1 program, an analysis of temporary series was run using iterative procedures for ARIMA model construction. RESULTS: The mean monthly homicide mortality rate was 13.2 x 10(5) (minimum 1.94 February 1977 and maximum 38.78 December 1992). A peak was observed in the central period of the series. Several models were studied and an ARIMA (0,1,1)(0,0,1)12 model was selected. CONCLUSIONS: Marked annual seasonal variation was found in mortality from homicide in the city of Medellín. The highest rates were found in the month of December.     

Trends in income-related health inequalities in self-assessed health in Korea, 1998–2011

This study assesses income-related health inequalities in self-assessed health (SAH) and its trend from 1998 to 2011 in Korea that covers important time periods of financial crisis and post-crisis. Data came from the Korean National Health and Nutrition Examination Survey from 1998 to 2011. A population-representative sample aged 46 years and older was analysed. SAH was used as an indicator of health status, with household equivalence income as a proxy for socio-economic position. Age-adjusted prevalence rates of SAH were analysed to estimate both absolute and relative measures of health inequalities and the trend over time by the relative index of inequality (RII) and the slope index of inequality (SII). Results indicated that the highest level of health inequalities was found among men aged 46–59 years, especially in 2001 and 2005. For men, there was no clear, consistent pattern of increase or decrease in the trend over time. On the other hand, increasing trends in the RII and SII were found for women, except for women aged 46–59 years who reported a decreasing trend in the SII. Trends in health inequalities over time were influenced by economic crisis, demonstrating the need for macro-level economic policies as well as health policies addressing health gaps.     

Trends in asthma mortality in Italy and Spain, 1980–1996

Asthma is a major public health problem, with variable trends in several countries. We analysed mortality trends from asthma in Italy and Spain between 1980 and 1996. Overall asthma-related mortality at all ages increased between 1980 and 1987 in both sexes in Italy, from 16.6 in 1980–1981 to 29.0 in 1986–1987 per million males, and from 8.0 in 1980–1981 to 13.8 in 1986–1987 per million females, but decreased thereafter to reach 14.6 per million in males and 8.7 in females in 1996. The downward trends after 1987 were consistent in middle age and elderly population, but asthma mortality tended to rise in children and young adults over the last few years. In Spain, overall age-standardized mortality rates from asthma declined in men from 37.8 in 1980–1981 to 10.1 in 1996, and from 19.5 in 1980–1981 to 13.2 per million females in 1996. In women, the fall in mortality rates was smaller, and overall mortality was higher than in males since early 1990s. Trends of asthma mortality in Italy and Spain were favourable over the last decade.     

Trends in migrant mortality rates in Australia 1981–2007: a focus on the National Health Priority Areas other than cancer

Introduction. Migrants generally have more favourable mortality outcomes than the Australian-born population. The aim of this study is to update knowledge and inform future research in this field by examining mortality from musculoskeletal conditions, asthma, cardiovascular disease, diabetes mellitus, injuries and mental conditions between 1981 and 2007 among migrants in Australia.

Methods. Average annual sex- and age-standardised mortality rates were calculated for each migrant group, period of death registration and cause of death.

Results and Conclusions. Mortality rates decreased among most groups for asthma, cardiovascular disease and motor vehicle accidents, with rates diverging in the later time periods. The reverse was true for mental disorders, where Australian-born individuals experienced the greatest increase in mortality. Migrants generally displayed more favourable mortality outcomes than their Australian-born counterparts. Migrants from Southern Europe appeared to have the greatest advantage. However, some migrants appeared to be over-represented in the areas of diabetes, suicide and mental health.     

Spatial and temporal inequalities in mortality in the USA, 1968–2016

Previous UK and European research has highlighted important variations in mortality between populations after adjustment for key determinants such as poverty and deprivation. The aim here was to establish whether similar populations could be identified in the US, and to examine changes over time. We employed Poisson regression models to compare county-level mortality with national rates between 1968 and 2016, adjusting for poverty, education, race (a proxy for exposure to racism), population change and deindustrialisation. Results are presented by means of population-weighted cartograms, and highlight widening spatial inequalities in mortality over time, including an urban to rural, and south-westward, shift in areas with the highest levels of such unexplained ‘excess’ mortality. There is a need to understand the causes of the excess in affected communities, given that it persists after adjustment for such a broad range of important health determinants.     

Socioeconomic inequalities in cancer incidence and mortality—a spatial analysis in Bremen, Germany

Aim

Several international studies have already investigated the influence of socioeconomic factors on the risk of cancer. For Germany, however, the data are still insufficient. We examined the effects of social differences on cancer incidence and mortality on the population of Bremen, a town in northwest Germany.

Subjects and methods

Data were obtained from the Bremen Cancer Registry, a population-based registry. The database comprised 27,430 incident cases, newly diagnosed between 2000 and 2006. The allocation of social class for each patient was based on the home address at the time of diagnosis, which led to the corresponding town district, which again could be linked to the “Bremen discrimination index.” Based on this index, cases were allocated to five categories, for which we compared standardized incidence ratios (SIR) and mortality ratios (SMR) for different cancers: prostate, breast, lung, colorectal, bladder, uterine, ovarian, cervical, malignant melanoma of the skin, non-melanoma skin cancer and all cancer sites summarized.

Results

The influence of social status was observed for different cancer sites. An inverse association was ascertained for all cancer sites (only men) and for tumors of the oral cavity and pharynx, and for lung, cervical and bladder cancers. A positive correlation was observed for female breast cancer, malignant melanoma, non-melanoma skin tumors and prostate cancer.

Conclusions

In spite of the methodical restrictions, our analyses suggest an association between social factors and cancer incidence and mortality. The results are in agreement with international studies. Many of the observed social class differences could probably be explained by known risk factors, such as smoking, alcohol consumption, diet and physical activity.     

Evolution of socio-economic inequalities in mortality in small geographical areas of the two largest cities in Spain (Barcelona and Madrid), 1996–2007

Objectives

To describe the evolution of socio-economic inequalities in mortality in small areas of two Spanish cities (Barcelona and Madrid) from 1996 to 2001 and from 2002 to 2007.

Study design

A small-area ecological study of trends was performed, in which the units of analysis were census tracts.

Methods

The association between mortality and socio-economic deprivation was assessed through Poisson regression analysis. Models were stratified by sex, age group and period of study. The trend in inequalities in mortality was assessed by introducing an interaction term between deprivation and the period of study.

Results

Mortality in the most-deprived areas was significantly higher than mortality in the less-deprived areas in both periods and most age groups. However, inequalities seemed to diminish in young people and elderly women, especially in Barcelona.

Conclusions

There is a need to monitor inequalities in mortality in the near future because the current financial crisis could change this situation.     

Trends in smoking prevalence and attributable mortality in China, 1991–2011

ObjectiveChina is the largest producer of tobacco worldwide. We assessed secular trends in prevalence of smoking, average cigarettes per day, mean age of initiation, and mortality attributable to smoking among the Chinese population between 1991 and 2011.DesignData came from the China Health and Nutrition Survey, conducted eight times between 1991 and 2011. A total of 83,447 participants aged 15 years or older were included in this study. Trends in smoking were stratified by sex, age, and region (urban vs. rural).ResultsIn 2011, 311 millions individuals were current smokers in China, with 295 million men and 16 million women, respectively. Between 1991 and 2011, the prevalence of current smoking decreased from 60.6% to 51.6% in men, and from 4.0% to 2.9% in women. However, during this period, the average number of cigarettes smoked per day per smoker increased from 15.0 to 16.5 in males, and from 8.5 to 12.4 in females. Further, age of smoking initiation decreased from 21.9 to 21.4 years in men and from 31.4 to 28.4 years in women. In 2011, 16.5% of all deaths in men and 1.7% in women were due to smoking. Between 1991 and 2011, the total number of deaths caused by smoking increased from 800,000 to 900,000.ConclusionsDuring the past 20 years, a slight decrease in smoking prevalence was observed in the Chinese population. However, cigarette smoking remains a major cause of death in China, especially in men.     

Trends in mortality from diseases of the circulatory system and cancer by site in Antwerp,Belgium 1900–1975

After studying the shortcomings of source materials, crude and age-adjusted death rates for diseases of the circulatory system and cancer by site in Antwerp have been compared for the period 1900–1975. Although the crude death rates of the most important causes of death show an increase until 1964, after age-adjustment it is possible to divide these in two groups. The first group shows after age-adjustment a decreasing trend suggesting crude mortality increases appear mostly in the oldest age-groups. The second group consists of mortality causes which after age-adjustment continue to increase. These increases appear to be linked to factors other than the ageing of the population. The evolution of the total cancer mortality shows that until 1940, it was dominated by the first group, while after 1950 a switch to the second group can be noticed.     

Population-Based Trends in Male Adolescent Obesity in Israel 1967–2003

Obesity increased monotonically from 1.2% to 3.8% of males age 17 (1967–2003). Low socioeconomic status had an independent positive effect on obesity. The likelihood of obesity had risen more steeply over time among the low socioeconomic status group than among other adolescents. Rise in obesity, standard of living, and income inequality (as measured by the Gini index) increased concomitantly.     

Income related inequalities in avoidable mortality in Norway: A population-based study using data from 1994–2011

ObjectiveThe aim of this study was to measure income-related inequalities in avoidable, amenable and preventable mortality in Norway over the period 1994–2011.MethodsWe undertook a register-based population study of Norwegian residents aged 18–65 years between 1994 and 2011, using data from the Norwegian Income Register and the Cause of Death Registry. Concentration indices were used to measure income-related inequalities in avoidable, amenable and preventable mortality for each year. We compared the trend in income-related inequality in avoidable mortality with the trend in income inequality, measured by the Gini coefficient for income.ResultsAvoidable, amenable and preventable deaths in Norway have declined over time. There were persistent pro-poor socioeconomic inequalities in avoidable, amenable and preventable mortality, and the degree of inequality was larger in preventable mortality than in amenable mortality throughout the period. The income-avoidable mortality association was positively correlated with income inequalities in avoidable mortality over time. There was little or no relationship between variations in the Gini coefficient due to tax reforms and socioeconomic inequalities in avoidable mortality.ConclusionsIncome-related inequalities in avoidable, amenable and preventable mortality have remained relatively constant between 1994 and 2011 in Norway. They were mainly correlated with the relationship between income and avoidable mortality rather than with variations in the Gini coefficient of income inequality.