Evolución de las desigualdades socioeconómicas en la mortalidad prematura en los barrios de Barcelona

El objetivo es analizar la evolución de las desigualdades socioeconómicas en mortalidad en los barrios de Barcelona, considerando los cambios poblacionales ocurridos. Se realizaron 3 estudios. Una revisión del uso del nivel socioeconómico del área, en España, y su relación con la salud y las desigualdades en salud. Un análisis de 20 años de evolución de las desigualdades socioeconómicas en mortalidad prematura en los barrios de Barcelona, teniendo en cuenta la inmigración en los barrios. Un análisis de 10 años de evolución de las desigualdades socioeconómicas en mortalidad prematura en los barrios, en población autóctona y extranjera. En Barcelona, las desigualdades socioeconómicas entre barrios persisten, existe un exceso de mortalidad prematura en los barrios más desfavorecidos. En los últimos años estas desigualdades tienden a disminuir, en parte por la llegada de población inmigrante a los barrios desfavorecidos. La población inmigrante registra menor mortalidad y no presenta desigualdades entre barrios.The objective is to analyze trends in socioeconomic inequalities in mortality in the neighborhoods of Barcelona, taking into account the population changes. We have three studies. A review of the use of area-level socioeconomic indicators in epidemiological research, in Spain, and its association with health and health inequalities. An analysis of twenty years of trends in socioeconomic inequalities in premature mortality in the neighborhoods of Barcelona, accounting for immigration in neighborhoods. An analysis of ten years of trends in socioeconomic inequalities in premature mortality in the neighborhoods of Barcelona, in foreign-born and native population. In Barcelona, socioeconomic inequalities between neighborhoods persist, there is an excess of premature mortality in the most disadvantaged neighborhoods. Last years, these inequalities tend to diminish, related to the arrival of immigrant population. Foreign-born population register lower levels of premature mortality than native population, and without inequalities between neighborhoods

Evolución de las desigualdades socioeconómicas en la mortalidad prematura en los barrios de Barcelona

El objetivo es analizar la evolución de las desigualdades socioeconómicas en mortalidad en los barrios de Barcelona, considerando los cambios poblacionales ocurridos. Se realizaron 3 estudios. Una revisión del uso del nivel socioeconómico del área, en España, y su relación con la salud y las desigualdades en salud. Un análisis de 20 años de evolución de las desigualdades socioeconómicas en mortalidad prematura en los barrios de Barcelona, teniendo en cuenta la inmigración en los barrios. Un análisis de 10 años de evolución de las desigualdades socioeconómicas en mortalidad prematura en los barrios, en población autóctona y extranjera. En Barcelona, las desigualdades socioeconómicas entre barrios persisten, existe un exceso de mortalidad prematura en los barrios más desfavorecidos. En los últimos años estas desigualdades tienden a disminuir, en parte por la llegada de población inmigrante a los barrios desfavorecidos. La población inmigrante registra menor mortalidad y no presenta desigualdades entre barrios.The objective is to analyze trends in socioeconomic inequalities in mortality in the neighborhoods of Barcelona, taking into account the population changes. We have three studies. A review of the use of area-level socioeconomic indicators in epidemiological research, in Spain, and its association with health and health inequalities. An analysis of twenty years of trends in socioeconomic inequalities in premature mortality in the neighborhoods of Barcelona, accounting for immigration in neighborhoods. An analysis of ten years of trends in socioeconomic inequalities in premature mortality in the neighborhoods of Barcelona, in foreign-born and native population. In Barcelona, socioeconomic inequalities between neighborhoods persist, there is an excess of premature mortality in the most disadvantaged neighborhoods. Last years, these inequalities tend to diminish, related to the arrival of immigrant population. Foreign-born population register lower levels of premature mortality than native population, and without inequalities between neighborhoods

El sufrimiento de la población en la crisis económica del Estado español

L'article (The suffering of the population in the economic crisis of the Spanish State) també està disponible en anglès.Este artículo forma parte del proyecto: “Evaluating the impact of structural policies on health inequalities and their social determinants and fostering change (sophie)” financiado por la Comisión Europea (FP7/2007–2013, Grant agreement 278173)

Inequalities in life expectancy by educational level and its decomposition in Barcelona, 2004-2018

Objective: To analyse the gap in life expectancy by educational level in the city of Barcelona from 2004 to 2018 and to decompose this gap by age and causes of death. Method: We computed abridged life tables at the age of 25 years by sex from 2004 to 2018 using standard methods. Educational level was categorised in two groups (lower secondary or less vs. upper secondary or higher education). The life expectancy gap was further decomposed by age and by causes of death based in Arriaga's method in 5-year age blocks up to the age of ≥ 90 years and broad causes of death using ICD-10 codes. Results: The life expectancy gap at 25 years by educational level oscillated without trend at around 3.08 years for men and 1.93 years for women. Decomposition by age showed a favourable significant shift in the contribution to this gap from young to older ages for men, with few changes for women. Decomposition by causes of death showed that the diseases concentrating the largest share of the contribution were neoplasms and respiratory and circulatory disease. There was a significant downward trend in external causes for men and in infectious diseases for both men and women but a significant upward trend for respiratory disease for both sexes. Conclusions: The stability of the life expectancy gap by educational level during the period analysed resulted from a combination of divergent trends by age and causes of death among high and low educational levels

Modified version of the PCAT-A10 tool for the evaluation of primary care

Objetivo: Evaluar las características métricas del índice Primary Care Assessment Tool de 10 ítems, para adultos (PCAT-A10), versión en castellano y catalán, reducida del original Primary Care Assessment Tool-Adult Edition (PCAT-AE), habiendo modificado el ítem de salud mental. Diseño: Estudio observacional transversal. Emplazamiento: Población residente en la ciudad de Barcelona. Participantes: De los 3.496 participantes mayores de 14 años de la muestra aleatoria representativa de la población de Barcelona, de la Encuesta de Salud de Barcelona 2016-17, se seleccionaron los que declararon tener un médico/a de cabecera, que alguna vez en la vida habían realizado una visita a algún especialista y que habían contestado más del 50% de ítems del PCAT-A10 (n = 3.107). Mediciones principales: Descriptiva de los ítems, análisis de consistencia interna y de correlación ítem-total corregida del índice PCAT-A10 modificado y los 10 ítems que lo conforman. Se analizan tres escenarios de tratamiento de las no respuestas: sustitución por 0, por el valor intermedio (2,5) y excluyendo las personas que no contestaron algún ítem. Resultados: El índice PCAT-A10 obtuvo alfa de Cronbach de 0,73, 0,79 y 0,85 en los tres escenarios nombrados, correlaciones ítem-total corregida entre 0,41 y 0,66, y 20,8% de no respuesta al ítem de salud mental. Conclusiones: La nueva versión del PCAT-A10 presenta una alta fiabilidad con una mayor respuesta en el ítem de salud mental respecto a la versión anterior.Objective: To evaluate the measurement characteristics of the Spanish and Catalan versions of the 10-Item Primary Care Assessment Tool for adults (PCAT-A10), shortened from the original Primary Care Assessment Tool (PCAT), with a new mental health item. Design: Cross-sectional observational study. Location: The city of Barcelona. Participants: Of the 3,496 people over 14 years of age from the representative random sample of the Barcelona population, from the 2016-17 Barcelona Health Survey, those who declared they had a family doctor, and had visited a specialist at some time in their lives, and had answered more than 50% of PCAT-A10 items were selected (n=3,107). Main measurements: Item descriptive analysis, analysis of internal consistency, corrected item - total correlation, of the PCAT-A10 index and the 10 items that make it up. Three scenarios for non-response to treatment were analysed: substitution by 0, by the intermediate value, and excluding people who did not answer any item. Results: The PCAT-A10 index obtained Cronbach alphas of 0.73, 0.79, and 0.85 in the three mentioned scenarios, correlation item total corrected between 0.41 and 0.66, and 20.8% non-responses to the mental health item. Conclusions: The new version of PCAT-A10 has a high reliability with a higher response in the mental health item compared to the previous version

Socioeconomic inequalities in suicide mortality in Barcelona during the economic crisis (2006–2016): a time trend study

Objectives: This study aimed to analyse trends in socioeconomic inequalities in suicide mortality in Barcelona before and after the start of the economic crisis that started at the end of 2008, including both individual factors and contextual factors of the deceased's neighbourhood of residence. Design: This is a trend study of three time periods: pre-economic crisis (2006-2008), early crisis (2009-2012) and late crisis (2013-2016). Setting: Total Barcelona residents between 2006 and 2016 (≥25 years of age) and death data derived from the Judicial Mortality Registry of Barcelona. Participants: 996 deaths by suicide between 2006 and 2016 were analysed. Primary and secondary outcome measures: The outcomes were age-standardised suicide mortality rates and the associations (relative and absolute risk) between suicide mortality and individual and contextual characteristics for the three time periods. Results: From 2006 to 2008, men with a lower educational level were more likely to commit suicide than better educated men (relative risk (RR)=1.46; 95% CI 1.11 to 1.91). This difference disappeared after the onset of the crisis. We found no differences among women. From 2013 to 2016, suicide risk increased among men living in neighbourhoods with higher unemployment levels (RR=1.57; 95% CI 1.09 to 2.25) and among women living in neighbourhoods with a higher proportion of elderly people living alone (RR=2.13; 95% CI 1.15 to 3.93). Conclusions: We observed risks for suicide among men living in neighbourhoods of Barcelona with higher unemployment levels and among women living in neighbourhoods with a higher proportion of elderly people living alone. Inequalities in suicide mortality according to educational level tended to disappear during the crisis among men. Thus, it is important to continue to monitor suicide determinants especially in times of economic crisis

Socioeconomic inequalities in COVID-19 in a european urban area: two waves, two patterns

Background: The objective of this paper is to analyze social inequalities in COVID-19 incidence, stratified by age, sex, geographical area, and income in Barcelona during the first two waves of the pandemic. Methods: We collected data on COVID-19 cases confirmed by laboratory tests during the first two waves of the pandemic (1 March to 15 July and 16 July to 30 November, 2020) in Barcelona. For each wave and sex, we calculated smooth cumulative incidence by census tract using a hierarchical Bayesian model. We analyzed income inequalities in the incidence of COVID-19, categorizing the census tracts into quintiles based on the income indicator. Results: During the two waves, women showed higher COVID-19 cumulative incidence under 64 years, while the trend was reversed after that threshold. The incidence of the disease was higher in some poor neighborhoods. The risk ratio (RR) increased in the poorest groups compared to the richest ones, mainly in the second wave, with RR being 1.67 (95% Credible Interval-CI-: 1.41-1.96) in the fifth quintile income group for men and 1.71 (95% CI: 1.44-1.99) for women. Conclusion: Our results indicate the existence of inequalities in the incidence of COVID-19 in an urban area of Southern Europe