Patrones geográficos de la mortalidad y de las desigualdades socioeconómicas en mortalidad en España

Fundamentos: Las estimaciones sobre desigualdades socioeconómicas en mortalidad a partir de registros individuales de defunciones y población son escasas y proceden únicamente de la la ciudad de Barcelona, la Comunidad de Madrid y el País Vasco. El objetivo del presente estudio fue mostrar el patrón geográfico de mortalidad en diferentes grupos socioeconómicos, así como el de las desigualdades en mortalidad en el conjunto del territorio español. Métodos: Se realizó el seguimiento de todos los individuos mayores de 25 años del censo de población 2001 durante siete años y dos meses para conocer su estado vital (196.470.401 personas-año a riesgo y 2.379.558 defunciones). Se calculó la tasa de mortalidad ajustada por edad en hombres y mujeres por provincia y nivel de estudios. Las desigualdades en mortalidad provinciales se estimaron mediante la razón de tasas de mortalidad en los sujetos con nivel de estudios primarios o inferiores respecto a los sujetos con estudios universitarios. Resultados: En mujeres, las razones de tasas más bajas –entre 1,06 y 1,16- se observaron Palencia, Segovia, Guadalajara y Ávila. Las más altas –entre 1,53 y 1,75- en Málaga, Las Palmas, Ceuta, Toledo y Melilla. En hombres, las razones de tasas más bajas –entre 1,00 y 1,12- se observan en Guadalajara, Teruel, Cuenca, La Rioja y Ávila y las más altas –entre 1,47 y 1,73- en Las Palmas, Cantabria, Murcia, Melilla y Ceuta. Conclusiones: El patrón geográfico de las tasas de mortalidad en España varía según el nivel educativo. Las desigualdades en mortalidad muestran menor magnitud en las provincias del centro peninsular.Background: Estimates of socioeconomic inequalities in mortality coming from individual data sources were only available from Madrid, the Basque Country and the city of Barcelona. The aim of this study was to show the geographical pattern of mortality in different socio-economic groups, as well as that of inequalities in mortality in the whole Spanish territory. Methods: All people aged 25 and older in the 2001 census were followed for seven years and two months to determine their vital status (196 470 401 person-years at risk and 2,379,558 deaths). The socioeconomic variable was educational level. Age-adjusted mortality rate was estimated for women and men in every province and in each category of educational level. Inequalities in mortality in each province have been estimated by the ratio of mortality in subjects with primary or lower level of education compared to subjects with university education. Results: In women, the lowest rate ratios –between 1.06 and 1.16- are observed in Palencia, Segovia, Guadalajara, Avila and Castellon and the highest -between 1.53 and 1,75- in Malaga, Las Palmas, Ceuta, Melilla and Toledo. In men, the lowest rate ratios -between 1.00 and 1.12 – are observed in Guadalajara, Teruel, Cuenca, La Rioja and Ávila and the highest -between 1.47 and 1,73- in Las Palmas, Cantabria, Murcia, Melilla and Ceuta. Conclusions: The geographical pattern of mortality rates in Spain varies by educational level. Inequalities in mortality by education have the lowest magnitude in central peninsular provinces

Inequalities in total mortality and by cause of death according to the level of education in Navarra: findings from a longitudinal study from 2001 to 2008

Fundamentos: Dada la ausencia de evidencia científica, el objetivo fue mostrar las desigualdades en mortalidad según el nivel de estudios en Navarra y la contribución de las principales causas de defunción a la magnitud de desigualdades en la mortalidad por todas las causas de muerte. Métodos: Todos los ciudadanos de 25 años y mayores residentes en Navarra en 2001 fueron seguidos durante 7 años para conocer su estado vital. El indicador de posición socioeconómica utilizado fue el nivel de estudios. Se estimaron las tasas de mortalidad general y por causa de muerte ajustadas por edad según la educación. Posteriormente, se calcularon la diferencia relativa (razón) y la diferencia absoluta de tasas entre las categorías más baja y más alta de nivel de estudios y la contribución de las principales causas de muerte a la diferencia absoluta. Resultados: La razón de tasas por todas las causas de muerte fue 1,37 en hombres y 1,23 en mujeres. El virus de la inmunodeficiencia humana (VIH) (25,84) y los accidentes no intencionales (3,78) presentaron las razones de tasas más altas en los hombres y la diabetes mellitus (4,92) y el VIH (4,38) en las mujeres. Las enfermedades cardiovasculares constituyeron la causa de muerte que más contribuyó a la diferencia absoluta en mortalidad: 26% en hombres y 48% en mujeres. Conclusiones: La tasa de mortalidad en la población navarra muestra un gradiente inverso con el nivel educativo, a excepción de algunas localizaciones de cáncer. Las enfermedades cardiovasculares son la causa de muerte que más contribuye a las desigualdades absolutas en mortalidad, mientras que otras causas de muerte que muestran importantes desigualdades relativas contribuyen poco a las desigualdades absolutas.Background: Due to the lack of evidence, the objective was to show the inequalities in mortality by educational level in Navarra and the contribution of the main causes of death to the magnitude of inequalities in mortality from all causes of death. Methods: All citizens aged 25 years and older residing in Spain in 2001 were followed during 7 years to determine their vital status. Level of education was used as socioeconomic status indicator. It was estimated the age-adjusted total mortality rate and mortality rate from cause-specific mortality by educational level. Then it was calculated the relative difference (ratio) and the absolute difference in rates between the lowest and highest levels of education and the contribution of the main causes of death to the absolute difference. Results: The rate ratio for all causes of death was 1.37 in men and 1.23 in women. The human immunodeficiency virus (HIV) (25.84) and unintentional injuries (3.78) are the causes of death with higher rate ratio in men and diabetes (4.92) and HIV (4.38) in women. Cardiovascular diseases were the leading causes of death that contribute most to the absolute difference in mortality: 26% in men and 48% women. Conclusions: The mortality rate in the Navarre population shows an inverse gradient with educational level, except in some cancer sites. Cardiovascular disease is the leading cause of death that contributes most to the absolute inequalities in mortality, while other causes of death that show significant relative inequalities, contribute little to the absolute inequalities.Fundación Caja Navarr

The association of geographic coordinates with mortality in people with lower and higher education and with mortality inequalities in Spain

Objective. Geographic patterns in total mortality and in mortality by cause of death are widely known to exist in many countries. However, the geographic pattern of inequalities in mortality within these countries is unknown. This study shows mathematically and graphically the geographic pattern of mortality inequalities by education in Spain. Methods. Data are from a nation-wide prospective study covering all persons living in Spain's 50 provinces in 2001. Individuals were classified in a cohort of subjects with low education and in another cohort of subjects with high education. Age- and sex-adjusted mortality rate from all causes and from leading causes of death in each cohort and mortality rate ratios in the low versus high education cohort were estimated by geographic coordinates and province. Results. Latitude but not longitude was related to mortality. In subjects with low education, latitude had a U-shaped relation to mortality. In those with high education, mortality from all causes, and from cardiovascular, respiratory and digestive diseases decreased with increasing latitude, whereas cancer mortality increased. The mortality-rate ratio for all-cause death was 1.27 in the southern latitudes, 1.14 in the intermediate latitudes, and 1.20 in the northern latitudes. The mortality rate ratios for the leading causes of death were also higher in the lower and upper latitudes than in the intermediate latitudes. The geographic pattern of the mortality rate ratios is similar to that of the mortality rate in the low-education cohort: the highest magnitude is observed in the southern provinces, intermediate magnitudes in the provinces of the north and those of the Mediterranean east coast, and the lowest magnitude in the central provinces and those in the south of the Western Pyrenees. Conclusion. Mortality inequalities by education in Spain are higher in the south and north of the country and lower in the large region making up the central plateau. This geographic pattern is similar to that observed in mortality in the low-education cohort.This study was funded by UCM-Banco de Santander (GR3/14)

Avaliação das propriedades físicas e mecânicas de blocos de solo-cimento formulados com coprodutos siderúrgicos

RESUMO Este trabalho tem por objetivo caracterizar o desempenho de resistência mecânica e absorção de água de blocos solo-cimento para alvenaria, após 28 dias de cura, com a incorporação limite dos seguintes coprodutos siderúrgicos em substituição parcial ao solo: adições de até 20 % em massa do pó de balão coletado em alto-forno, até 10 % de poeiras de despoeiramento de aciaria elétrica, e até 20 % de escória granulada de forno elétrico a arco. As formulações propostas incluem adições simultâneas de pós obtidos do descarte da produção de blocos solo-cimento, onde a substituição parcial ao solo foi de até 20 % em massa. Os resultados obtidos sugerem a potencialidade de uso dos resíduos siderúrgicos em blocos intertravados de solo-cimento para alvenaria sustentável, como alternativa de aplicação para esses resíduos. Verificou-se a possibilidade de bons resultados confrontando os valores exigidos por norma (absorção de água < 20% e resistência mecânica > 2,0 MPa) com destaque quando se utilizou 20% pó de balão juntamente com 10% de reuso do bloco solo-cimento; 10% de escória de aciaria ou 20% de escória de aciaria juntamente com 10% de reuso do bloco solo-cimento; e 2,5% de pó de despoeiramento juntamente com 20% de reuso do bloco solo-cimento