Factors explaining the geographical differences in Disability Free Life Expectancy in Spain

OBJECTIVE—To study the geographical variations in Disability Free Life Expectancy (DFLE) at birth (DFLEb) and at 65 years (DFLE65) in Spain and to identify the main factors that explain these variations.
DESIGN—Ecological study with the 50 provinces of Spain as the units of analysis. Sullivan's method is used to calculate DFLE for each province based on information from the death registry and the survey on disabilities, impairments and handicaps. Information on the independent variables—socioeconomic level, factors related with the health system and risk factors—was taken from various sources.
MAIN OUTCOME MEASURE—Simple correlation coefficients were obtained between each dependent variable (DFLEb and DLFE65) and the independent variables. Two multiple linear regression models were fit to obtain the best set of factors that explain the geographical distribution of DFLEb and DLFE65.
RESULTS—Both DFLEb and DLFE65 vary widely among provinces. The multiple linear regression analysis shows that the illiteracy rate, the percentage of the unemployed and the percentage of smokers in the population were the main factors associated with the geographical variation of DFLE. The models explained approximately 40% of the variance for DFLEb and 30% for DLFE65.
CONCLUSIONS—The results obtained show the influence of education, the unemployment rate and smoking on the geographical differences of DFLE. The DFLE indicators are shown to be valid for use in health policy.


Keywords: Disability Free Life Expectancy; geographical difference

Social inequalities in health related behaviours in Barcelona

OBJECTIVE—This study describes social class inequalities in health related behaviours (tobacco and alcohol consumption, physical activity) among a sample of general population over 14 years old in Barcelona.
DESIGN—Cross sectional study (Barcelona Health Interview Survey).
SETTING—Barcelona city (Spain).
PARTICIPANTS—A representative stratified sample of the non-institutionalised population resident in Barcelona was obtained. This study refers to the 4171 respondents aged over 14.
DATA—Social class was obtained from a Spanish adaptation of the British Registrar General classification. In addition, sociodemographic variables such as family structure and employment status were used. As health related behaviours tobacco consumption, alcohol consumption, usual physical activity and leisure time physical activity were analysed. Age adjusted percentages were compared by social class. Multivariate analysis was performed using logistic regression models.
MAIN RESULTS—Women in the upper social classes were more likely to smoke, the adjusted odds ratio (OR) for social class V in reference to social class I was 0.36 (95% confidence intervals (95%CI): 0.19, 0.67), while the opposite occurred among men although it was not statistically significant in multivariate analysis. Smoking cessation was more likely among men in the higher classes (OR for class V 0.41, 95%CI: 0.18, 0.90). Excessive alcohol consumption among men showed no differences between classes, while among women it was greater in the upper classes. Engaging in usual physical activity classified as "light or none" in men decreased with lowering social class (OR class IVa: 0.55 and OR class IVb: 0.47). Women of social classes IV and V were less likely to have two or more health risk behaviours (OR for class V 0.33, 95% CI: 0.18, 0.62).
CONCLUSION—Health damaging behaviours are differentially distributed among social classes in Barcelona. Health policies should take into account these inequalities.


Keywords: health related behaviours; social class; health surve