Desiguales ante la muerte. Un estudio de caso en el Sur de España (1850-1950)

El presente trabajo analiza las diferencias sociales en la mortalidad, poniendo en relación el desarrollo económico y las condiciones de vida de la población a partir del estudio de un caso: Vera, una localidad del sudeste español. La mayor parte de los datos se han extraído de censos de población y libros de defunciones parroquiales. La relación entre las tasas de mortalidad estandarizadas de cada uno de los grupos socioeconómicos ha sido el principal indicador utilizado para observar las diferencias en las condiciones de vida entre categorías ocupacionales. Los resultados muestran una progresiva reducción de la desigualdad social ante la muerte entre la población adulta desde el año 1860, momento en el que comienza nuestro análisis, hasta los años 30 del siglo XX. Este proceso de convergencia se trunca dramáticamente en los años de la posguerra. El comportamiento de la mortalidad desagregado por categorías socioeconómicas parece estar en línea con la evolución de los factores nutricionales y los relacionados con los avances higiénicos y en la salud públic

Inequality in mortality in pre-industrial Southern Europe during an epidemic episode : socio-economic determinants (eighteenth - nineteenth centuries Spain)

The objective of this study is to gain more comprehensive knowledge about social inequality in mortality in pre-industrial periods. With this aim, we have reconstructed the life courses of the inhabitants of the town of Vera in south-east Spain for the period 1797-1812 in order to estimate the influence of socio-economic status on ordinary and extraordinary mortality, given that, during this period, the town suffered from several epidemic outbreaks of yellow fever. As a result of these outbreaks, around a quarter of the town's population died. The results obtained indicate social inequality in mortality at least from the end of the eighteenth century. Although the differences are higher in mortality caused by non-infectious diseases or ill-defined causes, the coefficients also show a certain social gradient in mortality derived from infectious diseases. However, with respect to this latter type of mortality, the place of residence - seems to have a greater influence on the chances of survival than socio-economic status

Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

The persistence of social inequality in adult mortality in rural Spain, death cohorts 1546-2010

This paper analyses social inequality in adult mortality over the last 500 years in rural Aragon (Spain). It uses individual-level microdata corresponding to more than 20,000 individuals whose socioeconomic status, age at death and other family, cultural and environmental variables are known. Using advanced statistical techniques (mainly event history analysis), it follows all individuals who died after the age of seven years in 17 villages throughout their lives. This study is focused on observing the evolution of inequality in mortality by SES over a period of 500 years, deepening and relating it to the debates present in the historiography. As it is a pioneer study in connecting adult mortality with SES for almost five centuries, it enables us to verify the persistence of social inequality in death in rural Spain, which contrasts with the results obtained in northern European countries where these differences only emerged from the late nineteenth or early twentieth century onwards

Life and death under son preference: Economic stress, fertility and early-life mortality in rural Spain, 1800-1910

Relying on longitudinal micro data from 13 Spanish rural villages between 1800 and 1910, this paper assesses whether discriminatory practices affected fertility and sex-specific mortality during infancy and childhood during economic crises in an area with a strong preference for sons. Our contribution is twofold. On the one hand, there is a connection between shortterm economic stress, fertility, and sex ratios at baptism: high-price years were followed by a decline in the number of registered baptisms and by an increase of the sex ratios at baptism. These results therefore suggest that families mortally neglected a significant fraction of their female babies during economic crises. On the other hand, there is a connection between shortterm economic stress, mortality, and sex ratios at death. Using death registers further supports this interpretation, since our evidence shows that the female biological advantage was not visible after an economic shock. In addition, gender discriminatory practices against girls during bad years seem to have compensated the male vulnerability at older ages as well

I Informe del Observatorio de Desigualdad de Andalucía: resumen

El documento es un resumen el I Informe del Observatorio de la Desigualdad en Andalucía, en el que participaron varios profesores de la Universidad Loyola (Mª Carmen López Martín, Ana Hernández, Pedro Caldentey y Ricarldo Molero)Observatorio de la Desigualdad de AndalucíaAgencia Andaluza de Cooperación Internacional para el Desarroll

Role of age and comorbidities in mortality of patients with infective endocarditis.

The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups: A total of 3120 patients with IE (1327  There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in th

Prosthetic Valve Candida spp. Endocarditis: New Insights Into Long-term Prognosis—The ESCAPE Study

International audienceBackground: Prosthetic valve endocarditis caused by Candida spp. (PVE-C) is rare and devastating, with international guidelines based on expert recommendations supporting the combination of surgery and subsequent azole treatment.Methods: We retrospectively analyzed PVE-C cases collected in Spain and France between 2001 and 2015, with a focus on management and outcome.Results: Forty-six cases were followed up for a median of 9 months. Twenty-two patients (48%) had a history of endocarditis, 30 cases (65%) were nosocomial or healthcare related, and 9 (20%) patients were intravenous drug users. "Induction" therapy consisted mainly of liposomal amphotericin B (L-amB)-based (n = 21) or echinocandin-based therapy (n = 13). Overall, 19 patients (41%) were operated on. Patients <66 years old and without cardiac failure were more likely to undergo cardiac surgery (adjusted odds ratios [aORs], 6.80 [95% confidence interval [CI], 1.59-29.13] and 10.92 [1.15-104.06], respectively). Surgery was not associated with better survival rates at 6 months. Patients who received L-amB alone had a better 6-month survival rate than those who received an echinocandin alone (aOR, 13.52; 95% CI, 1.03-838.10). "Maintenance" fluconazole therapy, prescribed in 21 patients for a median duration of 13 months (range, 2-84 months), led to minor adverse effects.Conclusion: L-amB induction treatment improves survival in patients with PVE-C. Medical treatment followed by long-term maintenance fluconazole may be the best treatment option for frail patients