Trends in socioeconomic inequalities in mortality in small areas of 33 Spanish cities

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, th...

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Authors: Marí-Dell'Olmo M, Gotsens M, Palència L, Rodríguez-Sanz M, Martinez-Beneito MA, Ballesta M, Calvo M, Cirera L, Daponte A, Domínguez-Berjón F, Gandarillas A, Goñi NI, Martos C, Moreno-Iribas C, Nolasco A, Salmerón D, Taracido M, Borrell C
Format: article
Status:Published version
Publication Date:2016
Country:España
Institution:Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)
Repository:r-FISABIO. Repositorio Institucional de Producción Científica
OAI Identifier:oai:fisabio.fundanetsuite.com:p1559
Online Access:https://fisabio.portalinvestigacion.com/publicaciones/1559
Access Level:Open access
Keyword:Disease mapping
Multilevel analysis
Geographical inequalities
Bayesian methods
Trends
Urban areas
Small areas
Mortality
Inequalities in mortality
Socioeconomic inequalities
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spelling Trends in socioeconomic inequalities in mortality in small areas of 33 Spanish citiesMarí-Dell'Olmo MGotsens MPalència LRodríguez-Sanz MMartinez-Beneito MABallesta MCalvo MCirera LDaponte ADomínguez-Berjón FGandarillas AGoñi NIMartos CMoreno-Iribas CNolasco ASalmerón DTaracido MBorrell CDisease mappingMultilevel analysisGeographical inequalitiesBayesian methodsTrendsUrban areasSmall areasMortalityInequalities in mortalitySocioeconomic inequalitiesBackground: 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: 19961998 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.BMC2016info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://fisabio.portalinvestigacion.com/publicaciones/1559BMC PUBLIC HEALTHISSN: 14712458reponame:r-FISABIO. Repositorio Institucional de Producción Científicainstname:Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)Inglésinfo:eu-repo/semantics/openAccessoai:fisabio.fundanetsuite.com:p15592026-06-11T12:45:17Z
dc.title.none.fl_str_mv Trends in socioeconomic inequalities in mortality in small areas of 33 Spanish cities
title Trends in socioeconomic inequalities in mortality in small areas of 33 Spanish cities
spellingShingle Trends in socioeconomic inequalities in mortality in small areas of 33 Spanish cities
Marí-Dell'Olmo M
Disease mapping
Multilevel analysis
Geographical inequalities
Bayesian methods
Trends
Urban areas
Small areas
Mortality
Inequalities in mortality
Socioeconomic inequalities
title_short 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_sort Trends in socioeconomic inequalities in mortality in small areas of 33 Spanish cities
dc.creator.none.fl_str_mv Marí-Dell'Olmo M
Gotsens M
Palència L
Rodríguez-Sanz M
Martinez-Beneito MA
Ballesta M
Calvo M
Cirera L
Daponte A
Domínguez-Berjón F
Gandarillas A
Goñi NI
Martos C
Moreno-Iribas C
Nolasco A
Salmerón D
Taracido M
Borrell C
author Marí-Dell'Olmo M
author_facet Marí-Dell'Olmo M
Gotsens M
Palència L
Rodríguez-Sanz M
Martinez-Beneito MA
Ballesta M
Calvo M
Cirera L
Daponte A
Domínguez-Berjón F
Gandarillas A
Goñi NI
Martos C
Moreno-Iribas C
Nolasco A
Salmerón D
Taracido M
Borrell C
author_role author
author2 Gotsens M
Palència L
Rodríguez-Sanz M
Martinez-Beneito MA
Ballesta M
Calvo M
Cirera L
Daponte A
Domínguez-Berjón F
Gandarillas A
Goñi NI
Martos C
Moreno-Iribas C
Nolasco A
Salmerón D
Taracido M
Borrell C
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Disease mapping
Multilevel analysis
Geographical inequalities
Bayesian methods
Trends
Urban areas
Small areas
Mortality
Inequalities in mortality
Socioeconomic inequalities
topic Disease mapping
Multilevel analysis
Geographical inequalities
Bayesian methods
Trends
Urban areas
Small areas
Mortality
Inequalities in mortality
Socioeconomic inequalities
description 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: 19961998 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.
publishDate 2016
dc.date.none.fl_str_mv 2016
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://fisabio.portalinvestigacion.com/publicaciones/1559
url https://fisabio.portalinvestigacion.com/publicaciones/1559
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv BMC
publisher.none.fl_str_mv BMC
dc.source.none.fl_str_mv BMC PUBLIC HEALTH
ISSN: 14712458
reponame:r-FISABIO. Repositorio Institucional de Producción Científica
instname:Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)
instname_str Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)
reponame_str r-FISABIO. Repositorio Institucional de Producción Científica
collection r-FISABIO. Repositorio Institucional de Producción Científica
repository.name.fl_str_mv
repository.mail.fl_str_mv
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