Occupational health, frontline workers and COVID-19 lockdown : new gender-related inequalities?

The abrupt onset of COVID-19, with its rapid spread, has had brutal consequences in all areas of society, including the workplace. In this paper, we report the working conditions, health, and tranquilisers and opioid analgesics use of workers during the first months of the ensuing pandemic, according to whether they were frontline workers or not and also according to sex. Our analysis is based on cross-sectional survey data (collected during April and May 2020) from the wage-earning population in Spain (n=15 070). We estimate prevalences, adjusted prevalence differences and adjusted prevalence ratios by sex and according to whether the worker is a frontline worker or not. Employment and working conditions, exposure to psychosocial risks, as well as health status and the consumption of tranquilisers and opioid analgesics all showed sex and sectoral (frontline vs non-frontline) inequalities, which placed essential women workers in a particularly vulnerable position. Moreover, the consumption of tranquilisers and opioid analgesics increased during the pandemic and health worsened significantly among frontline women workers. The exceptional situation caused by the COVID-19 pandemic provides an opportunity to revalue essential sectors and to dignify such employment and working conditions, especially among women. There is an urgent need to improve working conditions and reduce occupational risk, particularly among frontline workers. In addition, this study highlights the public health problem posed by tranquilisers and opioid analgesics consumption, especially among frontline women

Migraciones internas en España durante el siglo xx: un nuevo eje para el estudio de las desigualdades sociales en salud

ResumenObjetivoCatalunya y Euskadi recibieron durante el siglo xx importantes contingentes de inmigración del resto de España. El objetivo es analizar las desigualdades en salud según el lugar de nacimiento (población autóctona y nacida en otras comunidades autónomas).MétodosEstudio transversal sobre población no institucionalizada de 50 a 79 años de edad, con datos de las encuestas de salud de Catalunya 2006 (n=5.483) y de Euskadi 2007 (n=3.424). Se utilizaron modelos log-binomiales para calcular las razones de prevalencia (RP) de mala salud percibida según el lugar de nacimiento, estratificadas por sexo y clase social, y ajustadas sucesivamente por edad, clase social y nivel de estudios.ResultadosLas personas procedentes de otras comunidades autónomas valoraban peor su salud que las autóctonas, tanto en Euskadi (RP ajustada por edad en hombres de 1,30, intervalo de confianza del 95% [IC95%] 1,11-1,54; y en mujeres RP de 1,42 e IC95% de 1,25-1,62) como en Catalunya (en hombres RP 1,41 e IC95% de 1,26-1,62; en mujeres RP de 1,25 e IC95% de 1,16-1,35). Las RP se redujeron, pero permanecieron significativas tras ajustar por clase social y nivel de estudios, y estratificando por clase social manual y no manual.ConclusionesEn ambas comunidades existen desigualdades en salud en detrimento de la población procedente del resto de España, que constituye alrededor de la mitad de la población en las cohortes de edad estudiadas. Futuros estudios deberían explorar la persistencia de estas desigualdades en otros indicadores de salud y su reproducción en las segundas generaciones, así como identificar puntos de entrada para políticas preventivas.AbstractObjectiveCatalonia and the Basque Country received substantial immigration quotas from the rest of Spain during the twentieth century. This study aimed to analyze inequalities in health by birthplace (the population born in the same region or other autonomous regions) in these two geographical areas.MethodsWe conducted a cross-sectional study in the non-institutionalized population aged 50 to 79 years, with data from the health surveys of Catalonia 2006 (n=5,483) and the Basque Country 2007 (n=3,424). We used log-binomial models to estimate the prevalence ratios (PR) of poor self-rated health by birthplace, stratified by sex and social class, and successively adjusted for age, social class and educational attainment.ResultsImmigrants from other autonomous regions had poorer self-rated health than the native-born population, both in the Basque Country (age-adjusted PR in men 1.30, 95% CI 1.11-1.54; women 1.42, 95% CI 1.25-1.62,) and in Catalonia (PR in men 1.41, 95% CI 1.26-1.62; PR in women 1.25, 95% CI 1.16-1.35). PRs were reduced but remained significant after adjustment for social class and educational attainment and stratification by manual or non-manual social class.ConclusionsIn both communities there are health inequalities that are detrimental to the immigrant population from the rest of Spain, which constitutes approximately half of the population in the studied age cohorts. Future studies should explore the persistence of these inequalities in other health indicators and their reproduction in second generations, and identify entry points for preventive policies

Las rentas mínimas de inserción en época de crisis : ¿Existen diferencias en la respuesta de las comunidades autónomas?

En el presente artículo, realizamos un análisis de la reciente evolución de las rentas mínimas de inserción (RMI) en el conjunto de las comunidades autónomas de España. El trabajo ofrece una clasificación de estas según las características de su política de RMI, tanto en el inicio de la crisis (2008) como respecto a su evolución hasta el año 2014. Se han analizado variables relativas a las dimensiones de recursos y a las coberturas, a los rasgos básicos y a las condiciones de acceso, con el fin de conocer las características, el desarrollo reciente y la capacidad de respuesta de esos programas respecto a la crisis. Los resultados muestran que, si bien los programas de RMI en su conjunto experimentan una cierta mejoría, persisten grandes diferencias autonómicas, ciertas desigualdades sociales en el acceso a las mismas y un impacto aún limitado como herramienta para paliar la pobreza y la exclusión social.This article examines the recent evolution of the minimum insertion income (MII) programmes in all of Spain's autonomous communities. The autonomous communities are classified according to the specifications of their MII programme policies at the beginning of the crisis (2008) and their evolution until 2014. For this purpose, variables related to resources, coverage, basic features and access requirements are analysed to determine the characteristics, recent development and ability of these programmes to respond to the economic crisis. The results reveal that although MII programmes as a whole show some improvement, major differences remain between autonomous communities, as well as some social inequalities regarding access to the programmes, thus suggesting that they have a limited impact as a tool to reduce poverty and social exclusion.En aquest article fem una anàlisi de l'evolució recent de les rendes mínimes d'inserció (RMI) en el conjunt de les comunitats autònomes d'Espanya. El treball n'ofereix una classificació segons les característiques de la seva política d'RMI, tant a l'inici de la crisi (2008) com respecte de la seva evolució fins a l'any 2014. S'han analitzat variables relatives a les dimensions de recursos i a les cobertures, als trets bàsics i a les condicions d'accés, amb la finalitat de conèixer les característiques, el desenvolupament recent i la capacitat de resposta d'aquests programes respecte de la crisi. Els resultats mostren que, si bé els programes d'RMI en conjunt experimenten una certa millora, persisteixen grans diferències autonòmiques, certes desigualtats socials en l'accés a aquestes i un impacte encara limitat com a eina per pal·liar la pobresa i l'exclusió social

Diagnosis and Treatment of Depression in Spain: Are There Gender Inequalities?

It is well known that women are more likely than men to be diagnosed with depression and to consume antidepressants. The factors related to the medicalisation of depression and their social distribution remain unclear. The aim of this study was to analyse gender inequalities in the medicalisation of depression from an intersectional perspective. This was a cross-sectional study based on data from the European Health Survey relating to Spain. Gender inequalities were calculated using prevalence ratios of women compared to men with a diagnosis of depression and antidepressant use, adjusted for age, depressive symptoms, primary care visits and diagnosis of depression in the case of antidepressant use. After adjustments, the diagnosis of depression and the use of antidepressants were more prevalent in women, especially of lower socioeconomic levels. Gender inequalities in the diagnosis of depression also increased with decreasing level of education. Regarding the use of antidepressants, gender inequalities were not significant in university graduates and people of higher social. The gender inequalities found in the diagnosis and treatment of depression cannot be completely attributed to a higher level of depressive symptoms in women or their greater frequency of visits to primary care. Inequalities are greater in more vulnerable social groups.This research was funded by the Ministry of Science, Innovation and Universities of the Spanish Government. Call 2018 for R + D + I projects “Research Challenges” of the state program of R + D + I oriented to the challenges of society, grant number RTI2018-098796-A-I00

Gender Inequalities in Publications about COVID-19 in Spain: Authorship and Sex-Disaggregated Data

Gender inequalities in biomedical literature have been widely reported in authorship as well as the scarcity of results that are stratified by sex in the studies. We conducted a bibliometric review of articles on COVID-19 published in the main Spanish medical journals between April 2020 and May 2021. The purpose of this study was to analyse differences in authorship order and composition by sex and their evolution over time, as well as the frequency of sex-disaggregated empirical results and its relationship with the author sex in articles on COVID-19 in the main Spanish biomedical journals. We identified 914 articles and 4921 authors, 57.5% men and 42.5% women. Women accounted for 36.7% of first authors and for 33.7% of last authors. Monthly variation in authorship over the course of the pandemic indicates that women were always less likely to publish as first authors. Only 1.0% of the articles broke down empirical results by sex. Disaggregation of results by sex was significantly more frequent when women were first authors and when women were the majority in the authorship. It is important to make gender inequalities visible in scientific dissemination and to promote gender-sensitive research, which can help to reduce gender bias in clinical studies as well as to design public policies for post-pandemic recovery that are more gender-equitable

Les rendes mínimes d’inserció en època de crisi. Existeixen diferències en la resposta de les comunitats autònomes?

En el presente artículo, realizamos un análisis de la reciente evolución de las rentas mínimas de inserción (RMI) en el conjunto de las comunidades autónomas de España. El trabajo ofrece una clasificación de estas según las características de su política de RMI, tanto en el inicio de la crisis (2008) como respecto a su evolución hasta el año 2014. Se han analizado variables relativas a las dimensiones de recursos y a las coberturas, a los rasgos básicos y a las condiciones de acceso, con el fin de conocer las características, el desarrollo reciente y la capacidad de respuesta de esos programas respecto a la crisis. Los resultados muestran que, si bien los programas de RMI en su conjunto experimentan una cierta mejoría, persisten grandes diferencias autonómicas, ciertas desigualdades sociales en el acceso a las mismas y un impacto aún limitado como herramienta para paliar la pobreza y la exclusión social.This article examines the recent evolution of the minimum insertion income (MII) programmes in all of Spain’s autonomous communities. The autonomous communities are classified according to the specifications of their MII programme policies at the beginning of the crisis (2008) and their evolution until 2014. For this purpose, variables related to resources, coverage, basic features and access requirements are analysed to determine the characteristics, recent development and ability of these programmes to respond to the economic crisis. The results reveal that although MII programmes as a whole show some improvement, major differences remain between autonomous communities, as well as some social inequalities regarding access to the programmes, thus suggesting that they have a limited impact as a tool to reduce poverty and social exclusion.En aquest article fem una anàlisi de l’evolució recent de les rendes mínimes d’inserció (RMI) en el conjunt de les comunitats autònomes d’Espanya. El treball n’ofereix una classificació segons les característiques de la seva política d’RMI, tant a l’inici de la crisi (2008) com respecte de la seva evolució fins a l’any 2014. S’han analitzat variables relatives a les dimensions de recursos i a les cobertures, als trets bàsics i a les condicions d’accés, amb la finalitat de conèixer les característiques, el desenvolupament recent i la capacitat de resposta d’aquests programes respecte de la crisi. Els resultats mostren que, si bé els programes d’RMI en conjunt experimenten una certa millora, persisteixen grans diferències autonòmiques, certes desigualtats socials en l’accés a aquestes i un impacte encara limitat com a eina per pal·liar la pobresa i l’exclusió social

COVID-19 y género: certezas e incertidumbres en la monitorización de la pandemia

Fundamentos: Visibilizar las desigualdades de género durante la pandemia y su relación con otros ejes de desigualdad social resultará decisivo para su adecuada monitorización. El objetivo de este estudio fue analizar las diferencias entre hombres y mujeres en las principales medidas de contagio, complicaciones y mortalidad por la COVID-19 teniendo en cuenta la evolución temporal de las mismas a lo largo de la pandemia en el estado español, visibilizando las aportaciones y carencias entre fuentes de información. Métodos: Análisis transversal en base a los casos COVID notificados por la Red Nacional de Vigilancia Epidemiológica (RENAVE); las estimaciones de mortalidad del Instituto Nacional de Estadística (INE) y las estimaciones de exceso de mortalidad del INE y los microdatos del Sistema de Monitorización de la Mortalidad diaria (MoMo). Se calcularon tasas, prevalencias y ra- tios por sexo de cada indicador. Se calculó el porcentaje de exceso de mortalidad sin diagnóstico COVID-19 en cada sexo. Se calcu- laron, así mismo, las ratios hombres/mujeres para los síntomas y factores de riesgo de la COVID-19 recogidos. Resultados: La tasa de infección por la COVID-19 fue superior en mujeres en las tres olas de la pandemia, llegando a constituir un 65% de las infecciones durante abril y mayo de 2020. Las complicaciones por coronavirus fueron entre 1,5 y 2,5 veces mayores en hombres de manera constante especialmente en las admisiones en UCI que llegaron a ser 2,5 veces más frecuentes que en mujeres. Si bien las tasas de mortalidad y el exceso de mortalidad fueron también superiores en hombres (en torno a 1,8 veces), el porcentaje de exceso de mortalidad sin diagnóstico COVID-19 fue superior en mujeres (44% en hombres frente a 52% en mujeres en la primera ola). Con respecto a los síntomas de la COVID-19, la fiebre, la tos y la disnea fueron más frecuentes en hombres (un 20%, 10% y 19% más, respectivamente) frente al dolor de garganta, vómitos o diarrea que se presentó más en mujeres (90%, 40% y 10% más, respectivamente). Conclusiones: El análisis desagregado por sexo ha permitido identificar diferencias entre hombres y mujeres en el diagnóstico, presentación y gravedad de la COVID-19 que ayudarán a un mejor abordaje clínico y epidemiológico de la enfermedad. Sin embargo, las fuentes oficiales presentan importantes lagunas a la hora de presentar la información desagregada por sexo. Es por ello necesario avanzar en la inclusión de la perspectiva de género en la estadística sobre el COVID-19, empezando por una condición necesaria, pero no suficiente, como la desagregación por sexo de los datos.Background: Highlighting gender inequalities during the pandemic and its relationship with other axes of social inequality will be decisive for its adequate monitoring. The aim of this study was to assess the differences between men and women in the main measures of infection and mortality by COVID-19, considering its temporal evolution, raising awareness about the weaknesses and contradictions between sources of information. Methods: Cross-sectional analysis based on the micro- data on COVID cases notified by the National Epidemiological Surveillance Network (RENAVE), the Death Statistics of the National Statistical Institute (INE) and the estimates of excess mortality from the INE and the Daily Mortality Monitoring System (MoMo) microdata. Standardized rates, prevalences and and ratios by sex were calculated for each indicator. The percen- tage of excess mortality without COVID-19 diagnosis in each sex was calculated. Male/female ratios for symptoms and risk factors of COVID-19 were also calculated. Results: The rate of infection by COVID-19 was higher in women in the three waves of the pandemic, reaching 65% of infections during April and May 2020. Complications were between 1.5 and 2.5 times higher in men, especially in ICU admissions, which were 2.5 times more frequent than in women. Although mortality rates and excess mortality were also higher in men (around 1.8 times), the percentage of excess mortality without COVID-19 diagnosis was higher in women (44% in men vs. 52% in women the first wave). With regard to the symptoms of COVID-19, fever, cough, and dyspnoea were more frequent in men (20%, 10% and 19% more, respectively) compared to sore throat, vomiting or diarrhea that were more prevalent in women (90%, 40% and 10% more, respectively). Conclusions: The analysis disaggregated by sex has made it possible to identify differences between men and women in the diagnosis, presentation and severity of the COVID-19 that can help a better clinical and epidemiological approach to the disease. However, official sources present important gaps when presenting information disaggregated by sex. It is therefore necessary to advance in the inclusion of a gender perspective in the statistics on COVID-19, starting with a necessary but not sufficient condition such as the disaggregation by sex of the data

Social inequalities in a population based colorectal cancer screening programme in the Basque Country

Background: While it is known that a variety of factors (biological, behavioural and interventional) play a major role in the health of individuals and populations, the importance of the role of social determinants is less clear. The effect of social inequality on population-based screening for colorectal cancer (CRC) could limit the value of such programmes. The present study aims to determine whether such inequalities exist. Methods: Data was obtained from the population-based screening programme administered in the Autonomous Community of the Basque Country, Spain, with a target population aged 50 to 69, first invited to participate between 2009 and 2011. The magnitude of inequality was analysed using the odds ratio (taking the least disadvantaged socioeconomic quintile as the reference population), the population attributable risk and the relative index of inequality, based on the regression, which is the ratio of the rates in the most and least disadvantaged socioeconomic groups. Results: The target population comprised 242,394 people, with the test kit successfully sent to 95.1 % (230,510). The overall response rate was 64.3 % (67.1 in women and 61.4 % men). Among women, the highest participation was in the third quintile (71.5 %) and the lowest in the first - the least disadvantaged (65.7 %). The lowest and highest rates of people with identified lesions were in the second and fourth quintiles (14.7/1000 and 17.0/1000 respectively). Among men, the response rate was lowest in the fifth - most disadvantaged - quintile (60.2 %). The highest rate of identified lesions was in the fifth quintile; 38 % higher than the first (55.7/1000 compared to 41.0/1000). Conclusions: Sex and socioeconomic group influence the rate of participation in the CRC programme and the rate of lesions found in the participants. Any public health programme is morally and ethically obliged to strive for equity and effectiveness. Improving participation of men and socially disadvantaged groups should be taken in account

Why does Spain have smaller inequalities in mortality?

Background: While educational inequalities in mortality are substantial in most European countries, they are relatively small in Spain. A better understanding of the causes of these smaller inequalities in Spain may help to develop policies to reduce inequalities in mortality elsewhere. The aim of the present study was therefore to identify the specific causes of death and determinants contributing to these smaller inequalities. Methods: Data on mortality by education were obtained from longitudinal mortality studies in three Spanish populations (Barcelona, Madrid, the Basque Country), and six other Western European populations. Data on determinants by education were obtained from health interview surveys. Results: The Spanish populations have considerably smaller absolute inequalities in mortality than other Western European populations. This is due mainly to smaller inequalities in mortality from cardiovascular disease (men) and cancer (women). Inequalities in mortality from most other causes are not smaller in Spain than elsewhere. Spain also has smaller inequalities in smoking and sedentary lifestyle and this is due to more smoking and physical inactivity in higher educated groups. Conclusion: Overall, the situation with regard to health inequalities does not appear to be more favourable in Spain than in other Western European populations. Smaller inequalities in mortality from cardiovascular disease and cancer in Spain are likely to be related to its later socio-economic modernization. Although these smaller inequalities in mortality seem to be a historical coincidence rather than the outcome of deliberate policies, the Spanish example does suggest that large inequalities in total mortality are

Urban regeneration as population health intervention: a health impact assessment in the Bay of Pasaia (Spain)

Background: An important health issue in urban areas is how changes arising from the regeneration of city-areas affect social determinants of health and equity. This paper examines the impacts attributable to a new fish market and to delays in the regeneration of a port area in a deteriorated region of the Bay of Pasaia (Spain). Potential differential impacts on local residents and socially vulnerable groups were evaluated to determine health inequalities. Methods: An in-depth, prospective and concurrent Health-Impact-Assessment (HIA) focused on equity was conducted by the regional Public Health Department, following the Merseyside guidelines. Data from different sources was triangulated and impacts were identified using qualitative and quantitative methods. Results: The intervention area is characterised by poor social, environmental, and health indicators. The distinctness of the two projects generates contrasting health and inequality impacts: generally positive for the new fish market and negative for the port area. The former creates recreational spaces and improves urban quality and social cohesion. By contrast, inaction and stagnation of the project in the port area perpetuates deterioration, a lack of safety, and poor health, as well as increased social frustration. Conclusions: In addition to assessing the health impacts of both projects this HIA promoted intersectoral partnerships, boosted a holistic and positive view of health and incorporated health and equity into the political discourse. Community-level participatory action enabled public health institutions to respond to new urban planning challenges and responsibilities in a more democratic manner.This research was funded by the Basque Government's Department of Health (Ref. n. 2011111051)