Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
International Journal for Equity in Health
Published in: International Journal for Equity in Health 1/2015

Open Access 01-12-2015 | Research

Trends in socioeconomic inequalities in preventable mortality in urban areas of 33 Spanish cities, 1996–2007 (MEDEA project)

Authors: Andreu Nolasco, Joaquin Moncho, Jose Antonio Quesada, Inmaculada Melchor, Pamela Pereyra-Zamora, Nayara Tamayo-Fonseca, Miguel Angel Martínez-Beneito, Oscar Zurriaga, Mónica Ballesta, Antonio Daponte, Ana Gandarillas, Mª Felicitas Domínguez-Berjón, Marc Marí-Dell’Olmo, Mercè Gotsens, Natividad Izco, Mª Concepción Moreno, Marc Sáez, Carmen Martos, Pablo Sánchez-Villegas, Carme Borrell

Published in: International Journal for Equity in Health | Issue 1/2015

Login to get access

Abstract

Background

Preventable mortality is a good indicator of possible problems to be investigated in the primary prevention chain, making it also a useful tool with which to evaluate health policies particularly public health policies. This study describes inequalities in preventable avoidable mortality in relation to socioeconomic status in small urban areas of thirty three Spanish cities, and analyses their evolution over the course of the periods 1996–2001 and 2002–2007.

Methods

We analysed census tracts and all deaths occurring in the population residing in these cities from 1996 to 2007 were taken into account. The causes included in the study were lung cancer, cirrhosis, AIDS/HIV, motor vehicle traffic accidents injuries, suicide and homicide. The census tracts were classified into three groups, according their socioeconomic level. To analyse inequalities in mortality risks between the highest and lowest socioeconomic levels and over different periods, for each city and separating by sex, Poisson regression were used.

Results

Preventable avoidable mortality made a significant contribution to general mortality (around 7.5%, higher among men), having decreased over time in men (12.7 in 1996–2001 and 10.9 in 2002–2007), though not so clearly among women (3.3% in 1996–2001 and 2.9% in 2002–2007). It has been observed in men that the risks of death are higher in areas of greater deprivation, and that these excesses have not modified over time. The result in women is different and differences in mortality risks by socioeconomic level could not be established in many cities.

Conclusions

Preventable mortality decreased between the 1996–2001 and 2002–2007 periods, more markedly in men than in women. There were socioeconomic inequalities in mortality in most cities analysed, associating a higher risk of death with higher levels of deprivation. Inequalities have remained over the two periods analysed. This study makes it possible to identify those areas where excess preventable mortality was associated with more deprived zones. It is in these deprived zones where actions to reduce and monitor health inequalities should be put into place. Primary healthcare may play an important role in this process.
Literature
1.
Rutstein DD, Berenberg W, Chalmers TC, Child III CG, Fishman AP, Perrin EB. Measuring the quality of medical care. A clinical method. N Engl J Med. 1976;294:582–8.CrossRefPubMed
2.
Charlton JR, Hartley RM, Silver R, Holland WW. Geographical variation in mortality from conditions amenable to medical intervention in England and Wales. Lancet. 1983;1:691–6.CrossRefPubMed
3.
Holland WW. European community atlas of avoidable death - report No 3. Brussels: Oxford University Press; 1988.
4.
Mackenbach JP, Kunst AE, Looman CW, Habbema JD, van der Maas PJ. Regional differences in mortality from conditions amenable to medical intervention in The Netherlands: a comparison of four time periods. J Epidemiol Community Health. 1988;42:325–32.CrossRefPubMedCentralPubMed
5.
Nolte E, McKee M. Does Health Care save lives? Avoidable mortality revisited. London: The Nuffield Trust; 2004.
6.
Gispert R, Bares MA, Puigdefabregas A. Avoidable mortality: a consensus list of causes to update the indicator in Spain. Gac Sanit. 2006;20:184–93.CrossRefPubMed
7.
Nolte E, McKee CM. Measuring the health of nations: updating an earlier analysis. Health Aff (Millwood ). 2008;27:58–71.CrossRef
8.
Tobias M, Yeh LC. How much does health care contribute to health inequality in New Zealand? Aust N Z J Public Health. 2007;31:207–10.CrossRefPubMed
9.
Hoffmann R, Plug I, Khoshaba B, McKee M, Mackenbach JP. Amenable mortality revisited: the AMIEHS study. Gac Sanit. 2013;27:199–206.CrossRefPubMed
10.
Holland WW. European community atlas of avoidable death - report No 6. Brussels: Oxford University Press; 1991.
11.
World Health Organization. The world health report 2000 - health systems: improving performance. Geneva: World Health Organization; 2000.
12.
Stevens G, Mathers C. Avoidable mortality–a tool for policy evaluation in developing countries? Eur J Public Health. 2010;20:241–2.CrossRefPubMed
13.
James PD, Wilkins R, Detsky AS, Tugwell P, Manuel DG. Avoidable mortality by neighbourhood income in Canada: 25 years after the establishment of universal health insurance. J Epidemiol Community Health. 2007;61:287–96.CrossRefPubMedCentralPubMed
14.
Mackenbach JP, Stirbu I, Roskam AJ, Schaap MM, Menvielle G, Leinsalu M, et al. Socioeconomic inequalities in health in 22 European countries. N Engl J Med. 2008;358:2468–81.CrossRefPubMed
15.
Cano-Serral G, Azlor E, Rodriguez-Sanz M, Pasarin MI, Martinez JM, Puigpinos R, et al. Socioeconomic inequalities in mortality in Barcelona: a study based on census tracts (MEDEA Project). Health Place. 2009;15:186–92.CrossRefPubMed
16.
Stirbu I, Kunst AE, Bopp M, Leinsalu M, Regidor E, Esnaola S, et al. Educational inequalities in avoidable mortality in Europe. J Epidemiol Community Health. 2010;64:913–20.CrossRefPubMed
17.
Baburin A, Aareleid T, Padrik P, Valvere V, Innos K. Time trends in population-based breast cancer survival in Estonia: analysis by age and stage. Acta Oncol. 2014;53:226–34.CrossRefPubMed
18.
Regidor E, de la Fuente L, Calle ME, Navarro P, Dominguez V. Unusually strong association between education and mortality in young adults in a community with a high rate of injection-drug users. Eur J Public Health. 2003;13:334–9.CrossRefPubMed
19.
Borrell C, Rodriguez-Sanz M, Pasarin MI, Brugal MT, Garcia-de-Olalla P, Mari-Dell’olmo M, et al. AIDS mortality before and after the introduction of highly active antiretroviral therapy: does it vary with socioeconomic group in a country with a National Health System? Eur J Public Health. 2006;16:601–8.CrossRefPubMed
20.
Mari-Dell’olmo M, Rodriguez-Sanz M, Garcia-Olalla P, Pasarin MI, Brugal MT, Cayla JA, et al. Individual and community-level effects in the socioeconomic inequalities of AIDS-related mortality in an urban area of southern Europe. J Epidemiol Community Health. 2007;61:232–40.CrossRefPubMedCentralPubMed
21.
Borrell C, Azlor E, Rodriguez-Sanz M, Puigpinos R, Cano-Serral G, Pasarin MI, et al. Trends in socioeconomic mortality inequalities in a southern European urban setting at the turn of the 21st century. J Epidemiol Community Health. 2008;62:258–66.CrossRefPubMed
22.
Nolasco A, Melchor I, Pina JA, Pereyra-Zamora P, Moncho J, Tamayo N, et al. Preventable avoidable mortality: evolution of socioeconomic inequalities in urban areas in Spain, 1996–2003. Health Place. 2009;15:702–11.CrossRefPubMed
23.
Dalmau-Bueno A, Garcia-Altes A, Mari-Dell’olmo M, Perez K, Espelt A, Kunst AE, et al. Trends in socioeconomic inequalities in cirrhosis mortality in an urban area of Southern Europe: a multilevel approach. J Epidemiol Community Health. 2010;64:720–7.CrossRefPubMed
24.
Regidor E, Sanchez E, de la Fuente L, Santos JM, Martinez D. A proposal of measures for monitoring social disparities in health using AIDS and liver disease mortality before and after HAART. Eur J Public Health. 2011;21:116–21.CrossRefPubMed
25.
Aguilar I, Feja C, Compés ML, Rabanaque MJ, Esteban M, Alcalá T, et al. Men inequalities and liver cirrhosis mortality (Zaragoza, Spain, 1996–2003). Gac Sanit. 2011;25(2):139–45.CrossRefPubMed
26.
Gotsens M, Mari-Dell’olmo M, Perez K, Palencia L, Martinez-Beneito MA, Rodriguez-Sanz M, et al. Socioeconomic inequalities in injury mortality in small areas of 15 European cities. Health Place. 2013;24:165–72.CrossRefPubMed
27.
Gotsens M, Mari-Dell’olmo M, Perez K, Palencia L, Borrell C. Trends in socio-economic inequalities in injury mortality among men in small areas of 26 Spanish cities, 1996–2007. Accid Anal Prev. 2013;51:120–8.CrossRefPubMed
28.
Rodriguez-Sanz M, Carrillo P, Borrell C. Desigualdades sociales en la salud, los estilos de vida y la utilización de servicios sanitarios en las CC.AA., 1993–2003. Observatorio de la Mujer, Secretaria General de Sanidad, Ministerio de Sanidad y Consumo; 2006.
29.
Barés MA, Gispert R, Puig X, Puigfàbregas A, Treserras R. Geographical distribution and time trends of suicide mortality in Catalonia and Spain (1986–2002). Gac Sanit. 2005;19:315.
30.
31.
Gispert R, Serra I, Bares MA, Puig X, Puigdefabregas A, Freitas A. The impact of avoidable mortality on life expectancy at birth in Spain: changes between three periods, from 1987 to 2001. J Epidemiol Community Health. 2008;62:783–9.CrossRefPubMedCentralPubMed
32.
Cayuela A, Rodríguez-Domínguez S, López-Campos JL, Virgil E, Otero R. Lung cancer mortality trends in Spain between 1980 and 2005. Arch Bronconeumol. 2008;44:70–4.CrossRefPubMed
33.
Grabauskas V, Gaizauskiene A, Sauliune S, Miseikyte R. Trends in avoidable mortality in Lithuania during 2001–2008 and their impact on life expectancy. Medicina (Kaunas ). 2011;47:504–11.
34.
Leyland AH, Dundas R, McLoone P, Boddy FA. Cause-specific inequalities in mortality in Scotland: two decades of change. A population-based study. BMC Public Health. 2007;7:172.CrossRefPubMedCentralPubMed
35.
Weisz D, Gusmano MK, Rodwin VG, Neuberg LG. Population health and the health system: a comparative analysis of avoidable mortality in three nations and their world cities. Eur J Public Health. 2008;18:166–72.CrossRefPubMed
36.
Korda RJ, Butler JR, Clements MS, Kunitz SJ. Differential impacts of health care in Australia: trend analysis of socioeconomic inequalities in avoidable mortality. Int J Epidemiol. 2007;36:157–65.CrossRefPubMed
37.
Lumme S, Sund R, Leyland AH, Keskimaki I. Socioeconomic equity in amenable mortality in Finland 1992–2008. Soc Sci Med. 2012;75:905–13.CrossRefPubMed
38.
Mackenbach JP, Kulhanova I, Menvielle G, Bopp M, Borrell C, Costa G, et al. Trends in inequalities in premature mortality: a study of 3.2 million deaths in 13 European countries. J Epidemiol Community Health. 2014;69(3):207–17.CrossRefPubMed
39.
Vergara M, Benach J, Martinez JM, Buxó M, Yasui Y. Avoidable and nonavoidable mortality: geographical distribution in small areas in Spain (1990–2001). Gac Sanit. 2007;23:16–22.CrossRef
40.
Sundmacher L, Kimmerle J, Latzitis N, Busse R. Amenable mortality in Germany: spatial distribution and regional concentrations. Gesundheitswesen. 2011;73:229–37.CrossRefPubMed
41.
Hoffmann R, Borsboom G, Saez M, Mari DM, Burstrom B, Corman D, et al. Social differences in avoidable mortality between small areas of 15 European cities: an ecological study. Int J Health Geogr. 2014;13:8.CrossRefPubMedCentralPubMed
42.
Tang KK, Petrie D, Rao DS. Measuring health inequalities between genders and age groups with realization of potential life years (RePLY). Bull World Health Organ. 2007;85:681–7.CrossRefPubMedCentralPubMed
43.
Mackenbach JP, Hoffmann R, Khoshaba B, Plug I, Rey G, Westerling R, et al. Using ‘amenable mortality’ as indicator of healthcare effectiveness in international comparisons: results of a validation study. J Epidemiol Community Health. 2013;67:139–46.CrossRefPubMed
44.
Quercioli C, Messina G, Basu S, McKee M, Nante N, Stuckler D. The effect of healthcare delivery privatisation on avoidable mortality: longitudinal cross-regional results from Italy, 1993–2003. J Epidemiol Community Health. 2013;67:132–8.CrossRefPubMed
45.
46.
Melchor I, Nolasco A, Garcia-Senchermes C, Pereyra-Zamora P, Pina JA, Moncho J, et al. Avoidable mortality. Changes in the new century? Gac Sanit. 2008;22:200–9.CrossRefPubMed
47.
Varnik A, Sisask M, Varnik P, Wu J, Kolves K, Arensman E, et al. Drug suicide: a sex-equal cause of death in 16 European countries. BMC Public Health. 2011;11:61.CrossRefPubMedCentralPubMed
48.
Dominguez-Berjon MF, Borrell C, Cano-Serral G, Esnaola S, Nolasco A, Pasarin MI, et al. Constructing a deprivation index based on census data in large Spanish cities (the MEDEA project). Gac Sanit. 2008;22:179–87.CrossRefPubMed
49.
Huisman M, Read S, Towriss CA, Deeg DJ, Grundy E. Socioeconomic Inequalities in Mortality Rates in Old Age in the World Health Organization Europe Region. Epidemiol Rev. 2013;85(1):84–97.CrossRef
50.
Martínez MA, Morales J. Generalized linear models. Elche (Alicante): Universidad Miguel Hernandez; 2001.
51.
Didkowska J, Manczuk M, McNeill A, Powles J, Zatonski W. Lung cancer mortality at ages 35–54 in the European Union: ecological study of evolving tobacco epidemics. BMJ. 2005;331:189–91.CrossRefPubMedCentralPubMed
52.
Windenberger F, Rican S, Jougla E, Rey G. Spatiotemporal association between deprivation and mortality: trends in France during the nineties. Eur J Public Health. 2012;22:347–53.CrossRefPubMedCentralPubMed
53.
Najman JM, Williams GM, Room R. Increasing socioeconomic inequalities in male cirrhosis of the liver mortality: Australia 1981–2002. Drug Alcohol Rev. 2007;26:273–8.CrossRefPubMed
54.
Burrows S, Auger N, Roy M, Alix C. Socio-economic inequalities in suicide attempts and suicide mortality in Québec, Canada, 1990–2005. Public Health. 2010;124:425.CrossRef
55.
Kim MH, Jung-Choi K, Jun HJ, Kawachi I. Socioeconomic inequalities in suicidal ideation, parasuicides, and completed suicides in South Korea. Soc Sci Med. 2010;70:1254–61.CrossRefPubMed
56.
Martinez-Beneito MA, Zurriaga O, Botella-Rocamora P, Mari-Dell’olmo M, Nolasco A, Moncho J, et al. Do socioeconomic inequalities in mortality vary between different Spanish cities? a pooled cross-sectional analysis. BMC Public Health. 2013;13:480.CrossRefPubMedCentralPubMed
57.
Cano-Serral G, Perez G, Borrell C. Comparability between ICD-9 and ICD-10 for the leading causes of death in Spain. Rev Epidemiol Sante Publique. 2006;54:355–65.CrossRefPubMed
58.
Cirera Suárez L, Rodriguez Barranco M, Madrigal de Torez E, Carrillo Prieto J, Hasiak Santo A, Augusto Beker R, et al. Correspondences from 10th to 9th Revision of the International Classification of diseases in the causes of death lists of the National Institute of Statistics and the Regional Health Authority of Murcia in Spain. Rev Esp Salud Publica. 2006;80:157–75.CrossRefPubMed
59.
Hernández-Aguado I, Santaolaya CM, Campos EP. Social inequalities in health and primary care. SESPAS Report 2012. Gac Sanit. 2012;26 Suppl 1:6–13.CrossRefPubMed
Metadata
Title
Trends in socioeconomic inequalities in preventable mortality in urban areas of 33 Spanish cities, 1996–2007 (MEDEA project)
Authors
Andreu Nolasco
Joaquin Moncho
Jose Antonio Quesada
Inmaculada Melchor
Pamela Pereyra-Zamora
Nayara Tamayo-Fonseca
Miguel Angel Martínez-Beneito
Oscar Zurriaga
Mónica Ballesta
Antonio Daponte
Ana Gandarillas
Mª Felicitas Domínguez-Berjón
Marc Marí-Dell’Olmo
Mercè Gotsens
Natividad Izco
Mª Concepción Moreno
Marc Sáez
Carmen Martos
Pablo Sánchez-Villegas
Carme Borrell
Publication date
01-12-2015
Publisher
BioMed Central
Published in
International Journal for Equity in Health / Issue 1/2015
Electronic ISSN: 1475-9276
DOI
https://doi.org/10.1186/s12939-015-0164-0

Other articles of this Issue 1/2015

International Journal for Equity in Health 1/2015 Go to the issue

Research

Paving the way for universal family planning coverage in Ethiopia: an analysis of wealth related inequality

Research

Using decision trees for measuring gender equity in the timing of angiography in patients with acute coronary syndrome: a novel approach to equity analysis

Research

How the government intervention affects the distribution of physicians in Turkey between 1965 and 2000

Research

How the economic recession has changed the likelihood of reporting poor self-rated health in Spain

Research

Ensuring equity of access to primary health care in rural and remote Australia - what core services should be locally available?

Research

The public health impact of economic fluctuations in a Latin American country: mortality and the business cycle in Colombia in the period 1980–2010