17 research outputs found
Effect of the use of heuristics on diagnostic error in Primary Care: Scoping review
Evaluar la evidencia sobre el uso de heurísticos de representatividad, disponibilidad,
anclaje y ajuste y exceso de confianza en la práctica clínica real, específicamente en el ámbito
de la Atención Primaria. Se seleccionaron 48 estudios que analizaban heurísticos de disponibilidad
(26), anclaje y ajuste (9), exceso de confianza (9) y representatividad (8).
Resultados: La población de estudio incluía médicos (35,4%), pacientes (27%), residentes
(20,8%), enfermeros (14,5%) y estudiantes (14,5%). Los estudios realizados en condiciones reales
fueron 17 (35,4%). En 33 de los 48 estudios se observó el empleo del heurístico analizado en
la población estudiada (68,7%). El uso de heurísticos durante el proceso diagnóstico fue analizado
en 27 estudios (54,1%); en 5 de ellos, el estudio se realizó en escenarios reales (18%).
De los 48 estudios, 6 se realizaron en Atención Primaria (12,5%), 3 de los cuales analizaban el
proceso diagnóstico: solo en uno de los 3 se analizó el uso de heurístico en condiciones reales,
sin demostrar la existencia de sesgo. La evidencia empírica disponible sobre la utilización de heurísticos y su papel en
el error diagnóstico en condiciones reales es limitada. En particular, en el caso del proceso de
decisión diagnóstica en Atención Primaria la evidencia es prácticamente inexistente.To assess the use of representativeness, availability, overconfidence, anchoring andadjustment heuristics in clinical practice, specifically in Primary Care setting. A total of 48 studies were selected that analyzed availability heuristics(26), anchoring and adjustment (9), overconfidence (9) and representativeness (8).Results: From the 48 studies selected, 26 analyzed availability heuristics, 9 anchoring andadjustment, 9 overconfidence; and 8 representativeness. The study population included physi-cians (35.4%), patients (27%), trainees (20.8%), nurses (14.5%) and students (14.5%). The studiesconducted in clinical practice setting were 17 (35.4%). In 33 of the 48 studies (68,7%) it wasobserved heuristic use in the population studied. Heuristics use on diagnostic process was foundin 27 studies (54.1%); 5 of them (18%) were carried out in clinical practice setting. Of the 48studies, 6 (12,5%) were performed in Primary Care, 3 of which studied diagnostic process: onlyone of them analyzed the use of heuristics in clinical practice setting, without demonstratingbias as consequence of the use of heuristic. The evidence about heuristic use in diagnostic process on clinical practice settingis limited, especially in Primary Care
Sex Differences of Perceived Health before and During the Economic Crisis (2007 and 2011). Spain
Fundamentos: Diversos estudios muestran la asociación entre las crisis
económicas, el desempleo y la renta con la salud. Sin embargo, se precisa
diferenciar su impacto en función del sexo. El objetivo de este estudio fue
analizar el efecto que la crisis económica, el desempleo y la renta pueden
haber tenido en la salud percibida de hombres y mujeres en España.
Métodos: Se realizó un estudio transversal que combinó las Encuestas
de Condiciones de Vida de 2007 y 2011, incluyendo a 43.900 personas adultas
de hasta 65 años. Se realizó análisis estratificado y regresión logística
multivariante. La variable dependiente fue la salud percibida y las variables
independientes la renta, la situación laboral, la educación, la enfermedad
crónica y el año de la encuesta.
Resultados: La buena salud percibida se incrementó del 75,1 % en 2007
al 83% en 2011. El desempleo se relacionó con mayor probabilidad de mala
salud percibida en hombres: OR de 1,45; IC95%:1,26-1,67, mientras que
en mujeres las diferencias fueron OR=1,20; IC95%:0,99-1,47. La probabilidad
de mala salud percibida fueron mayores para mujeres (OR=1,81;
IC95%:1,56-2,11) que para hombres (OR=1,7; IC95%:1,46-1,97) en el caso
de menor renta. El año 2011 se relacionó con tener menor probabilidad de
mala salud percibida tanto en hombres (OR=0,41; IC95%: 0,37-0,46) como
en mujeres (OR=0,39; CI95%:0,35-0,44).
Conclusiones: La asociación de la crisis económica con la salud percibida
fue similar en hombres y mujeres. El desempleo fue un factor de riesgo
para la mala salud percibida en hombres mientras que la influencia del nivel
de renta, del educativo y la enfermedad crónica fue mayor en mujeres que
hombres.Background: Several studies show the association between economic crisis,
unemployment and health income. However, it is necessary to differentiate
their impact according to gender. The objective of this study was to analyze the
differential effect that the economic crisis, unemployment and income may had
on the perceived health of men and women in Spain.
Methods: A cross-sectional study was conducted combining data from
the 2007 and 2011 Living Conditions Surveys, which collect data from 43,900
adult individuals up to 65 years of age. A multivariate logistic regression analysis
was performed, for the whole population as for each sex. The dependent
variable was perceived health and the independent variables were income level,
employment status, education level, chronic illness, and the year in which the
survey was performed.
Results: Perceived health improved over the period under consideration,
from 75.1% in 2007 to 83%,0 in 2011. Unemployment significantly increased
the chances of reporting perceived bad health in men [OR=1.45; CI95%:1.26-
1.67] but not in women [OR=1.20; CI95%:0.99-1.47]. ORs of perceived bad
health were higher for women than for men in the lower income bracket [OR:
1.81; IC95%1,56-2,11 against 1.70; IC95%:1,46-1,97]. 2011 was related to
a lower probability of poor perceived health in both men [OR=0.41, CI95%:
0.37-0.46] and women [OR=0.39 ; CI95%:0.35-0.44].
Conclusions: The association of the economic crisis with perceived health
was similar in men and women. Unemployment was a risk factor for perceived
bad health in the case of men. Available income, education level, and the presence
of chronic illness had a larger influence as determinants of perceived bad
health for women than they did for men.
Keywords: Unemployment, Sex, Spain, Social health determinants, Economic
recession, Policy, economic, Factors, Economic, Women’s Health, Men,
Sex distribution, Bias, Gender, Sexism, Health surveys.Consejería de Salud. Junta de Andalucía. Código: PI-0682-201
Identification of factors associated with diagnostic error in primary care
Background
Missed, delayed or incorrect diagnoses are considered to be diagnostic errors. The aim of this paper is to describe the methodology of a study to analyse cognitive aspects of the process by which primary care (PC) physicians diagnose dyspnoea. It examines the possible links between the use of heuristics, suboptimal cognitive acts and diagnostic errors, using Reason’s taxonomy of human error (slips, lapses, mistakes and violations). The influence of situational factors (professional experience, perceived overwork and fatigue) is also analysed.Methods
Cohort study of new episodes of dyspnoea in patients receiving care from family physicians and residents at PC centres in Granada (Spain). With an initial expected diagnostic error rate of 20%, and a sampling error of 3%, 384 episodes of dyspnoea are calculated to be required. In addition to filling out the electronic medical record of the patients attended, each physician fills out 2 specially designed questionnaires about the diagnostic process performed in each case of dyspnoea. The first questionnaire includes questions on the physician’s initial diagnostic impression, the 3 most likely diagnoses (in order of likelihood), and the diagnosis reached after the initial medical history and physical examination. It also includes items on the physicians’ perceived overwork and fatigue during patient care. The second questionnaire records the confirmed diagnosis once it is reached. The complete diagnostic process is peer-reviewed to identify and classify the diagnostic errors. The possible use of heuristics of representativeness, availability, and anchoring and adjustment in each diagnostic process is also analysed. Each audit is reviewed with the physician responsible for the diagnostic process. Finally, logistic regression models are used to determine if there are differences in the diagnostic error variables based on the heuristics identified.Discussion
This work sets out a new approach to studying the diagnostic decision-making process in PC, taking advantage of new technologies which allow immediate recording of the decision-making process.The authors gratefully acknowledge funding of this research from the Spanish Research Agency. Ministry of Health (Fondo de Investigaciones Sanitarias) FIS PI10/01468 and the European Regional Development Fund (ERDF)
Use of heuristics during the clinical decision process from family care physicians in real conditions
Health Research Fund of the Ministry of Economy and Competitiveness, Grant/Award Numbers: PI13/01175, PI10/01468; Funding for open access charge: Universidad de Granada/CBUARationale aims and objectives: The available evidence on the use of heuristics and
their relationship with diagnostic error in primary care is very limited. The aim of the
study is to identify the use of unknown thought and specifically the possible use of
Representativeness, Availability and overconfidence heuristics in the clinical practice
of primary care physicians in cases of dyspnoea and to analyse their possible relationship
with diagnostic error.
Methods: A total of 371 patients consulting with new episodes of dyspnoea in
Primary Care centres in Spain were registered. Based on specific operational definitions,
the use of unconscious thinking and the use of heuristics during the diagnostic
process were assessed. Subsequently, the association between their use and diagnostic
error was analysed.
Results: In 49.6% of cases, the confirmatory diagnosis coincided with the first diagnostic
impression, suggesting the use of the representativeness heuristic in the diagnostic
decision process. In 82.3% of the cases, the confirmatory diagnosis was among
the three diagnostic hypotheses that were first identified by the general physicians,
suggesting a possible use of the availability heuristic. In more than 50% of the cases,
the physicians were overconfident in the certainty of their own diagnosis. Finally, a
diagnostic error was identified in 9.9% of the recorded cases and no statistically significant
correlation was found between the use of some unconscious thinking tools
(such as the use of heuristics) and the diagnostic error.
Conclusion: Unconscious thinking manifested through the acceptance of the first
diagnostic impression and the use of heuristics is commonly used by primary care
physicians in the clinical decision process in the face of new episodes of dyspnoea;
however, its influence on diagnostic error is not significant. The proposed explicit
and reproducible methodology may inspire further studies to confirm these results.Health Research Fund of the Ministry of Economy and Competitiveness PI13/01175
PI10/0146
Características de los ingresos hospitalarios de las personas sin hogar en Sevilla
ABSTRACT Background: It is well known from studies in different countries that homeless persons have a higher morbidity and mortality. This fact has not been sufficiently investigated in Spain from the perspective of hospital care. The aim was to determine the characteristics of hospital admissions of homeless persons in Seville. Methods: Observational study of 103,802 hospital admissions of 71,756 patients admitted in the Hospitals "Virgen del Rocío" and "Virgen Macarena" (Seville), in 2013 and 2014. Bivariate analysis were performed using χ2 and t-Student tests and multivariate analysis using binomial logistic regression model. Results: 0.16% (n=163) of admissions were homeless persons and 99.84% (n=103,639) were not. The mean age at admission in homeless patients was 48 years and 76.5% of them were men. Hospital deaths of homeless patients occurred being 23 years younger (p=0.009). 92% of hospital admissions came from emergency departments (p<0.001) and 10.0% of their discharges were against medical advice (p<0.001). The average length of stay was 4.8 days longer in homeless persons (p=0.001) and the most frequent diagnoses on admission were mental (27.0%), infectious (19.6%) and respiratory diseases (18.4%). Mental disorders were present on 83.7% of homeless patients as secondary diagnose and 77.6% referred drugs consumption. Conclusions: Hospital admissions characteristics of homeless persons were particularly different. Homeless patients were hospitalized and died at a younger age than non-homeless patients. The morbidity and mortality of homeless persons reflect their vulnerable health condition.RESUMEN Fundamentos: Las personas sin hogar presentan una mayor morbi-mortalidad que las que sí lo tienen. Este hecho no ha sido investigado suficientemente en España desde la perspectiva de la atención hospitalaria. El objetivo fue conocer las características de las hospitalizaciones de las personas sin hogar en dos hospitales de Sevilla. Métodos: Estudio observacional de 103.802 hospitalizaciones correspondientes a 71.756 personas ingresadas en los Hospitales Virgen del Rocío y Macarena (2013 y 2014) analizadas en función de si las personas ingresadas tenían o no hogar. Se realizó análisis bivariante mediante χ2 y t-Student y análisis multivariante con modelos de regresión logística binomial. Resultados: 163 (0,16%) de las hospitalizaciones correspondieron a personas sin hogar y 103.639 (99,84%) a personas con hogar. La edad media de ingreso de las personas sin hogar fue de 48 años, siendo el 76,5% hombres. La mortalidad intrahospitalaria se produjo a una edad media de 23 años menor que la de las personas con hogar (p=0,009). El 92% de sus ingresos fueron urgentes (p<0,001) y el 10,0% tuvieron altas voluntarias/fugas (p<0,001). La estancia media en las personas sin hogar fue 4,8 días mayor (p=0,001) y sus principales motivos de ingreso fueron enfermedades mentales (27,0%), infecciosas (19,6%) y respiratorias (18,4%). El 83,7% de estas personas presentaron enfermedad mental como comorbilidad y el 77,6% consumía alguna droga, alcohol o tabaco. Conclusiones: Las características de las hospitalizaciones de las personas sin hogar que ingresan en los dos hospitales con mayor actividad asistencial de Sevilla son distintas a las de las personas con hogar. Las personas sin hogar ingresan y fallecen a menor edad. Tanto su patrón de morbilidad como las características de sus hospitalizaciones reflejan su estado vulnerable de salud
Review of published works on Spanish youth health promotion
Comparative Study; English Abstract; Journal Article; Review;The objective of this study is to review the health promotion interventions on spanish youths published in Spanish in the 1995-2000 period and to describe them in accordance with the scope within which they have been carried out, the topics addressed, the methodology, the evaluation design used and the results obtained. Two hundred and fourteen intervention were identified. Illegal drugs were the topic on which the largest number of interventions were focused (29.8%), followed by alcohol (15.9%), the risk-related sexual behaviours (14.6%) and leisure time (12.6%). The activities carried out most often were: participation-based educational methods (30.7%), explanatory education methods (11.5%) and the preparation of educational materials (11%). In 80.8% of the cases, some evaluation of the health promotion activities was found. The type of evaluation employed most often was the process evaluation (73.7%), and the medium-long term results evaluation being those employed the least (2.2%). The evaluation methodologies used most often were questionnaires (28.2%). A combination of qualitative and quantitative methods was employed in 13.2% of the cases. The four interventions in which the medium-long term impact was gauged had the purpose of preventing and reducing cigarette smoking and/or drinking and or marijuana smoking, all of these initiatives achieving a reduction in cigarette smoking. In conclusion, it seems necessary to improve the design of the evaluations of the health promotion initiatives addressed to young people in Spain and to increase the dissemination of the same by way of their publication.YesEl objetivo de este estudio ha sido revisar las intervenciones
de promoción de la salud dirigidas a jóvenes españoles, publicadas
entre los años 1995 y 2000 en español, y describirlas de
acuerdo al ámbito en el que se han desarrollado, los temas a los
que se han dirigido, la metodología y el diseño de evaluación
utilizados y los resultados obtenidos.
Se identificaron 214 intervenciones. Las drogas ilegales
fueron el tema en el que se centraron el mayor número de intervenciones
(29,8%), seguido por el alcohol (15,9%), las conductas
sexuales de riesgo (14,6%) y el ocio (12,6%). Las actividades
realizadas con mayor frecuencia fueron: técnicas educativas
participativas (30,7%), técnicas educativas expositivas
(11,5%) y elaboración de materiales educativos (11%). En el
80,8% de casos había constancia de que se había realizado una
evaluación. De ellas, las más frecuente fueron las evaluaciones
de proceso (73,7%), y las menos frecuente las evaluaciones de
resultados a medio-largo plazo (2,2%). Las metodologías de
evaluación más utilizadas fueron los cuestionarios (28,2%). La
combinación de técnicas cualitativas y cuantitativas fue utilizada
en el 13,2% de los casos. Las 4 intervenciones en las que se
midió el impacto a medio-largo plazo tenían como objetivo la
prevención o reducción del consumo de tabaco y/o alcohol y/o
cánnabis, y todas ellas consiguieron reducir el consumo de tabaco.
En conclusión, parece necesario mejorar el diseño evaluativo
de las intervenciones de promoción de la salud dirigidas a
jóvenes en nuestro país y aumentar la difusión de las mismas
mediante su publicació
Characteristics of Hospitalizations of Homeless Persons in Seville, Spain
Background: It is well known from studies in different countries that
homeless persons have a higher morbidity and mortality. This fact has not
been sufficiently investigated in Spain from the perspective of hospital care.
The aim was to determine the characteristics of hospital admissions of homeless
persons in Seville.
Methods: Observational study of 103,802 hospital admissions of
71,756 patients admitted in the Hospitals “Virgen del Rocío” and “Virgen
Macarena” (Seville), in 2013 and 2014. Bivariate analysis were performed
using χ2
and t-Student tests and multivariate analysis using binomial logistic
regression model.
Results: 0.16% (n=163) of admissions were homeless persons and
99.84% (n=103,639) were not. The mean age at admission in homeless
patients was 48 years and 76.5% of them were men. Hospital deaths of homeless
patients occurred being 23 years younger (p=0.009). 92% of hospital
admissions came from emergency departments (p<0.001) and 10.0% of
their discharges were against medical advice (p<0.001). The average length
of stay was 4.8 days longer in homeless persons (p=0.001) and the most
frequent diagnoses on admission were mental (27.0%), infectious (19.6%)
and respiratory diseases (18.4%). Mental disorders were present on 83.7%
of homeless patients as secondary diagnose and 77.6% referred drugs consumption.
Conclusions: Hospital admissions characteristics of homeless persons
were particularly different. Homeless patients were hospitalized and died at
a younger age than non-homeless patients. The morbidity and mortality of
homeless persons reflect their vulnerable health condition.
Key words: Homeless persons. Hospitals. Mortality. Morbidity. Patient
discharge. Length of stay. Alcohol Drinking. Tobacco use. Psychotropic
drugs. Infection. Tuberculosis. HIV. Spain.YesFundamentos: Las personas sin hogar presentan una mayor morbimortalidad
que las que sí lo tienen. Este hecho no ha sido investigado suficientemente
en España desde la perspectiva de la atención hospitalaria.
El objetivo fue conocer las características de las hospitalizaciones de las
personas sin hogar en dos hospitales de Sevilla.
Métodos: Estudio observacional de 103.802 hospitalizaciones correspondientes
a 71.756 personas ingresadas en los Hospitales Virgen del Rocío
y Macarena (2013 y 2014) analizadas en función de si las personas ingresadas
tenían o no hogar. Se realizó análisis bivariante mediante χ2
y t-Student y
análisis multivariante con modelos de regresión logística binomial.
Resultados: 163 (0,16%) de las hospitalizaciones correspondieron
a personas sin hogar y 103.639 (99,84%) a personas con hogar. La edad
media de ingreso de las personas sin hogar fue de 48 años, siendo el 76,5%
hombres. La mortalidad intrahospitalaria se produjo a una edad media de
23 años menor que la de las personas con hogar (p=0,009). El 92% de sus
ingresos fueron urgentes (p<0,001) y el 10,0% tuvieron altas voluntarias/
fugas (p<0,001). La estancia media en las personas sin hogar fue 4,8 días
mayor (p=0,001) y sus principales motivos de ingreso fueron enfermedades
mentales (27,0%), infecciosas (19,6%) y respiratorias (18,4%). El 83,7%
de estas personas presentaron enfermedad mental como comorbilidad y el
77,6% consumía alguna droga, alcohol o tabaco.
Conclusiones: Las características de las hospitalizaciones de las personas
sin hogar que ingresan en los dos hospitales con mayor actividad asistencial
de Sevilla son distintas a las de las personas con hogar. Las personas
sin hogar ingresan y fallecen a menor edad. Tanto su patrón de morbilidad
como las características de sus hospitalizaciones reflejan su estado vulnerable
de salud.
Palabras clave: Personas sin hogar. Ingresos hospitalarios. Mortalidad.
Morbilidad. Alta hospitalaria. Estancia hospitalaria. Consumo de bebidas
alcohólicas. Uso de tabaco. Psicotrópicos. Infección. Tuberculosis. VIH.
Españ
Rural habitat and risk of death in small areas of Southern Spain
The purpose of this paper is to study the linkage between type of habitat and mortality from all causes in small areas of Southern Spain. An ecological study was conducted on 99,870 people who died between 1985 and 1999. The municipality was taken as the unit of analysis. Data analysis was carried out through hierarchical spatio-temporal bayesian models. Results show a 13.3% reduction in mortality rates among men and 14.1% among women in the most rural areas compared to more urban environments. The study demonstrates the usefulness of socio-demographic indices in small-area geographical analyses.Southern Spain Rural health Mortality Small-area analysis Socioeconomic factors Bayesian analysis
Revisión de los trabajos publicados sobre promoción de la salud en jóvenes españoles
The objective of this study is to review the health promotion
interventions on spanish youths published in Spanish in the
1995-2000 period and to describe them in accordance with the
scope within which they have been carried out, the topics addressed,
the methodology, the evaluation design used and the results
obtained.
Two hundred and fourteen intervention were identified.
Illegal drugs were the topic on which the largest number of interventions
were focused (29.8%), followed by alcohol
(15.9%), the risk-related sexual behaviours (14.6%) and leisure
time (12.6%).
The activities carried out most often were: participation-
based educati onal methods (30.7%), explanatory education
methods (11.5%) and the preparation of educational materials
(11%). In 80.8% of the cases, some evaluation of the
health promotion activities was found. The type of evaluation
employed most often was the process evaluation (73.7%), and
the medium-long term results evaluation being those employed
the least (2.2%). The evaluation methodologies used most
often were questionnaires (28.2%). A combination of qualitative
and quantitative methods was employed in 13.2% of the
cases. The four interventions in which the medium-long term
impact was gauged had the purpose of preventing and reducing
cigarette smoking and/or drinking and or marijuana smoking,
all of these initiatives achieving a reduction in cigarette
smoking.
In conclusion, it seems necessary to improve the design of
the evaluations of the health promotion initiatives addressed to
young people in Spain and to increase the dissemination of the
same by way of their publication.El objetivo de este estudio ha sido revisar las intervenciones
de promoción de la salud dirigidas a jóvenes españoles, publicadas
entre los años 1995 y 2000 en español, y describirlas de
acuerdo al ámbito en el que se han desarrollado, los temas a los
que se han dirigido, la metodología y el diseño de evaluación
utilizados y los resultados obtenidos.
Se identificaron 214 intervenciones. Las drogas ilegales
fueron el tema en el que se centraron el mayor número de intervenciones
(29,8%), seguido por el alcohol (15,9%), las conductas
sexuales de riesgo (14,6%) y el ocio (12,6%). Las actividades
realizadas con mayor frecuencia fueron: técnicas educativas
participativas (30,7%), técnicas educativas expositivas
(11,5%) y elaboración de materiales educativos (11%). En el
80,8% de casos había constancia de que se había realizado una
evaluación. De ellas, las más frecuente fueron las evaluaciones
de proceso (73,7%), y las menos frecuente las evaluaciones de
resultados a medio-largo plazo (2,2%). Las metodologías de
evaluación más utilizadas fueron los cuestionarios (28,2%). La
combinación de técnicas cualitativas y cuantitativas fue utilizada
en el 13,2% de los casos. Las 4 intervenciones en las que se
midió el impacto a medio-largo plazo tenían como objetivo la
prevención o reducción del consumo de tabaco y/o alcohol y/o
cánnabis, y todas ellas consiguieron reducir el consumo de tabaco.
En conclusión, parece necesario mejorar el diseño evaluativo
de las intervenciones de promoción de la salud dirigidas a
jóvenes en nuestro país y aumentar la difusión de las mismas
mediante su publicación
Diferencias por sexo de la salud percibida antes y durante la crisis económica (2007 y 2011)
ABSTRACT Background: Several studies show the association between economic crisis, unemployment and health income. However, it is necessary to differentiate their impact according to gender. The objective of this study was to analyze the differential effect that the economic crisis, unemployment and income may had on the perceived health of men and women in Spain. Methods: A cross-sectional study was conducted combining data from the 2007 and 2011 Living Conditions Surveys, which collect data from 43,900 adult individuals up to 65 years of age. A multivariate logistic regression analysis was performed, for the whole population as for each sex. The dependent variable was perceived health and the independent variables were income level, employment status, education level, chronic illness, and the year in which the survey was performed. Results: Perceived health improved over the period under consideration, from 75.1% in 2007 to 83%,0 in 2011. Unemployment significantly increased the chances of reporting perceived bad health in men [OR=1.45; CI95%:1.26-1.67] but not in women [OR=1.20; CI95%:0.99-1.47]. ORs of perceived bad health were higher for women than for men in the lower income bracket [OR: 1.81; IC95%1,56-2,11 against 1.70; IC95%:1,46-1,97]. 2011 was related to a lower probability of poor perceived health in both men [OR=0.41, CI95%: 0.37-0.46] and women [OR=0.39 ; CI95%:0.35-0.44]. Conclusions: The association of the economic crisis with perceived health was similar in men and women. Unemployment was a risk factor for perceived bad health in the case of men. Available income, education level, and the presence of chronic illness had a larger influence as determinants of perceived bad health for women than they did for men.RESUMEN Fundamentos: Diversos estudios muestran la asociación entre las crisis económicas, el desempleo y la renta con la salud. Sin embargo, se precisa diferenciar su impacto en función del sexo. El objetivo de este estudio fue analizar el efecto que la crisis económica, el desempleo y la renta pueden haber tenido en la salud percibida de hombres y mujeres en España. Métodos: Se realizó un estudio transversal que combinó las Encuestas de Condiciones de Vida de 2007 y 2011, incluyendo a 43.900 personas adultas de hasta 65 años. Se realizó análisis estratificado y regresión logística multivariante. La variable dependiente fue la salud percibida y las variables independientes la renta, la situación laboral, la educación, la enfermedad crónica y el año de la encuesta. Resultados: La buena salud percibida se incrementó del 75,1 % en 2007 al 83% en 2011. El desempleo se relacionó con mayor probabilidad de mala salud percibida en hombres: OR de 1,45; IC95%:1,26-1,67, mientras que en mujeres las diferencias fueron OR=1,20; IC95%:0,99-1,47. La probabilidad de mala salud percibida fueron mayores para mujeres (OR=1,81; IC95%:1,56-2,11) que para hombres (OR=1,7; IC95%:1,46-1,97) en el caso de menor renta. El año 2011 se relacionó con tener menor probabilidad de mala salud percibida tanto en hombres (OR=0,41; IC95%: 0,37-0,46) como en mujeres (OR=0,39; CI95%:0,35-0,44). Conclusiones: La asociación de la crisis económica con la salud percibida fue similar en hombres y mujeres. El desempleo fue un factor de riesgo para la mala salud percibida en hombres mientras que la influencia del nivel de renta, del educativo y la enfermedad crónica fue mayor en mujeres que hombres