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 Martínez Beneito, Miguel Ángel
A1 Ballesta, Mónica
A1 Calvo, Montse
A1 Cirera, Lluís
A1 Daponte, Antonio
A1 Domíguez Berjón, Felicitas
A1 Gandarillas, Ana
A1 Izco Goñi, Natividad
A1 Martos, Carmen
A1 Moreno Iribas, Conchi
A1 Nolasco, Andreu
A1 Salmerón, Diego
A1 Taracido Trunk, 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
AB Background: In Spain, several ecological studies have analyzed trends in socioeconomic inequalities in mortalityfrom all causes in urban areas over time. However, the results of these studies are quite heterogeneous finding, ingeneral, that inequalities decreased, or remained stable. Therefore, the objectives of this study are: (1) to identifytrends in geographical inequalities in all-cause mortality in the census tracts of 33 Spanish cities between the twoperiods 1996–1998 and 2005–2007; (2) to analyse trends in the relationship between these geographicalinequalities and socioeconomic deprivation; and (3) to obtain an overall measure which summarises therelationship 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 foreach census tracts in all cities was included as a covariate. A Bayesian hierarchical model was used to estimatesmoothed Standardized Mortality Ratios (sSMR) by each census tract and period. The geographical distribution ofthese sSMR was represented using maps of septiles. In addition, two different Bayesian hierarchical models wereused to measure the association between all-cause mortality and the deprivation index in each city and period, andby sex: (1) including the association as a fixed effect for each city; (2) including the association as random effects. Inboth models the data spatial structure can be controlled within each city. The association in each city wasmeasured 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 deprivationpatterns are similar in the first period, while in the second they are different for most cities. For men, RRs remain stableover time in 29 cities, in 3 diminish and in 1 increase. For women, in 30 cities, a non-significant change over time in RR isobserved. However, in 4 cities RR diminishes. In overall terms, inequalities decrease (with a probability of 0.9) inboth 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) andwomen (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 insocioeconomic inequalities in mortality and to identify (among other things) temporal factors that may influencethese inequalities
PB BMC
YR 2016
FD 2016
LK http://hdl.handle.net/10347/22959
UL http://hdl.handle.net/10347/22959
LA eng
NO Marí-Dell’Olmo, M., Gotsens, M., Palència, L. et al. Trends in socioeconomic inequalities in mortality in small areas of 33 Spanish cities. BMC Public Health 16, 663 (2016). https://doi.org/10.1186/s12889-016-3190-y
NO This article was partially funded by Plan Nacional de I + D + I 2008–2011 andInstituto de Salud Carlos III (ISCIII) –Subdirección General de Evaluación yFomento de la Investigación- (Award numbers: PI081488, PI081978, PI080367,PI08/1017, PI080330, P08/0142, PI081785, PI080662, PI081713, PI081058,PI081340, PI080803, PI126/08), Fundación Canaria de Investigación SanitariaFUNCIS 84/07 and by CIBER Epidemiología y Salud Pública (CIBERESP)
DS Minerva
RD 24 abr 2026