Treatment, outcomes and costs of asthma exacerbations in Chilean children: a prospective multicenter observational study.

OBJECTIVE: To describe potential regional variations in therapies for severe asthma exacerbations in Chilean children and estimate the associated health expenditures. METHODS: Observational prospective cohort study in 14 hospitals over a one-year period. Children five years of age or older were eligible for inclusion. Days with oxygen supply and pharmacological treatments received were recorded from the clinical chart. A basic asthma hospitalization basket was defined in order to estimate the average hospitalization cost for a single patient. Six months after discharge, new visits to the Emergency Room (ER), use of systemic corticosteroids and adherence to the controller treatment were evaluated. RESULTS: 396 patients were enrolled. Patients from the public health system and from the north zone received significantly more days of oxygen, systemic corticosteroids and antibiotics. Great heterogeneity in antibiotic use among the participating hospitals was found, from 0 to 92.3% (ICC 0.34, 95% CI 0.16-0.52). The use of aminophylline, magnesium sulfate and ketamine varied from 0 to 36.4% between the different Pediatric Intensive Care Units (ICC 0.353, 95% CI 0.010-0.608). The average cost per inpatient was of $1910 USD. 290 patients (73.2%) completed the follow-up six months after discharge. 76 patients (26.2%) were not receiving any controller treatment and nearly a fourth had new ER visits and use of systemic corticosteroids due to new asthma exacerbations. CONCLUSIONS: Considerable practice variation in asthma exacerbations treatment was found among the participating hospitals, highlighting the poor outcome of many patients after hospital discharge, with an important health cost.

Total mercury in muscles and liver of Mugil spp. from three coastal lagoons of NW Mexico: concentrations and risk assessment.

Total mercury (Hg) concentrations were determined by atomic absorption spectrophotometry in muscles and liver of composite samples of Mugil cephalus and M. curema collected during November 2013 and in January, April, and July 2014 from the coastal lagoons Altata-Ensenada del Pabellón (AEP), Ceuta (CEU), and Teacapán-Agua Brava (TAG) of Sinaloa State. The mean Hg contents and information on local consumption were used to assess the possible risk caused by fish ingestion. Mean total mercury levels in the muscles ranged from 0.11 to 0.39 µg/g, while the range for liver was 0.12-3.91 µg/g. The mean Hg content of the liver was significantly (p < 0.001) higher than that of the muscles only in samples collected from AEP. Although total Hg levels in the muscles were lower than the official permissible limit, the HQ values for methyl mercury calculated for the younger age classes of one fishing community were >1, indicating a possible risk for some fishing communities of the Mexican Pacific coast.

The oxidative cost of reproduction depends on early development oxidative stress and sex in a bird species.

In the early 2000s, a new component of the cost of reproduction was proposed: oxidative stress. Since then the oxidative cost of reproduction hypothesis has, however, received mixed support. Different arguments have been provided to explain this. Among them, the lack of a life-history perspective on most experimental tests was suggested. We manipulated the levels of a key intracellular antioxidant (glutathione) in captive zebra finches (Taeniopygia guttata) during a short period of early life and subsequently tested the oxidative cost of reproduction. Birds were allowed to mate freely in an outdoor aviary for several months. We repeatedly enlarged or reduced their broods to increase or reduce, respectively, breeding effort. Birds whose glutathione levels were reduced during growth showed higher erythrocyte resistance to free radical-induced haemolysis when forced to rear enlarged broods. This supports the hypothesis predicting the occurrence of developing programmes matching early and adult environmental conditions to improve fitness. Moreover, adult males rearing enlarged broods endured higher plasma levels of lipid oxidative damage than control males, whereas adult females showed the opposite trend. As most previous studies reporting non-significant or opposite results used females only, we also discuss some sex-related particularities that may contribute to explain unexpected results.

Five-year experience of tele-ophthalmology for diabetic retinopathy screening in a rural population. / Análisis de un programa de teleoftalmología para el cribado de retinopatía diabética en área rural tras cinco años.

OBJECTIVE: To identify the prevalence and risk factors of diabetic retinopathy (DR) among rural inhabitants included in a tele-ophthalmology program. To analyse diagnostic accuracy among primary care physicians, concordance with ophthalmologists, and financial savings. MATERIAL AND METHODS: An observational randomised study was conducted on 394 patients included in a tele-ophthalmology program (from January 2010 to January 2015). An analysis was performed on the clinical characteristics, DR findings in retinography images, and correspondence between the request for a second interpretation by an ophthalmologist, and previously established criteria for it: presence of moderate to severe DR, vision loss, poor image quality and/or intraocular pressure >22mmHg. Statistical analysis was performed using the SPSS program (Student t and χ(2) tests). RESULTS: DR prevalence was 12.1%. Patients with glycosylated haemoglobin values >7.68% or those treated with a combination of insulin and oral antidiabetic drugs showed a higher risk of DR (P<.05). 43.3% of patients correctly referred to ophthalmologists showed moderate to severe DR. Unnecessary referrals to specialists were improved from 91.7% in 2010 to 98.6% in 2014. It is estimated that the program has made a total saving of €152,550.45. CONCLUSIONS: Tele-ophthalmology programs are a useful tool in DR screening. Primary care physicians are able to distinguish patients who need specialist care, avoiding unnecessary referrals to ophthalmologists, and saving costs.

Mercury content and their risk assessment in farmed shrimp Litopenaeus vannamei from NW Mexico.

The main objective of this study was to evaluate the total mercury content in hepatopancreas and edible muscle of the whiteleg shrimp Litopenaeus vannamei cultured along the NW coast of Mexico, and to evaluate the potential human health risk due to their consumption. Samples were obtained between May and June 2010 in 26 shrimp farms from the three most important shrimp-producing states of NW Mexico, and total Hg was analyzed after reduction with SnCl2 in a mercury analyzer. The ranges of Hg concentrations of the hepatopancreas were 0.101±0.03-0.184±0.13 µg g(-1) in Sonora, 0.077±0.055-0.813±0.363 µg g(-1) in Sinaloa and 0.139±0.037-0.791±0.33 µg g(-1) in Nayarit. In the muscle, values were from 0.078±0.02 to 0.539±0.09 µg g(-1) in Sonora, 0.154±0.03-0.861±0.423 µg g(-1) in Sinaloa and 0.121±0.041-1.48±0.44 µg g(-1) in Nayarit. Considering the concentrations of Hg in the muscle and the national consumption rate, shrimp farmed in NW Mexico does not represent a risk for human health (HQ<1).

Total mercury content in cultured oysters from NW Mexico: health risk assessment.

The total mercury (Hg) content of the soft tissues of cultured oysters of the genus Crassostrea obtained during the dry and rainy seasons at sampling sites of NW Mexico with different degrees of urbanization, was determined by cold vapor atomic absorption spectrophotometry. Hg levels ranged from 0.05 to 0.37 µg/g (dry weight) and no significant differences (p > 0.05) related to season and sampling site were observed. The values did not exceed the limit of 1.0 µg/g (wet weight) established by Mexican legislation and by the Food and Drug Agency (FDA), and the hazard quotient was between 0.001 and 0.002. The estimated hazard quotient for MeHg ranged approximately from 0.002 to 0.01.

Exclusión social y calidad de vida relacionada con la salud en personas entre 25 y 60 años de la zona nororiental de Medellín - Colombia, 2009 / Social exclusion and quality of life related to health in people from 25 to 60 years old living in the northeast zone, Medellín, 2009

OBJETIVO: identificar la percepción de exclusión social y sus dimensiones demográfica, económica, de participación social y política y su asociación con la calidad de vida relacionada con la salud en las personas de 25 a 60 años de la zona nororiental de Medellín - Colombia, 2009. METODOLOGIA: se condujo un estudio transversal de asociación. El tamaño muestral se calculó con un nivel de confianza de 95%, un error de 4,5% y una proporción de 0,28 derivada de la investigación sobre exclusión social realizada en Medellín en el año 2008, para un total de 404 sujetos. La muestra fue obtenida mediante un muestreo probabilístico, por conglomerados, polietápico, proporcional por sexo sin reemplazo. Los datos se analizaron en el software SPSS v.15.0 y StataSE 10. RESULTADOS: el 22,8% de la población se percibió en situación de exclusión social. En la evaluación de la Calidad de vida relacionada con la salud (CVRS) se encontraron altos puntajes en todos los dominios del cuestionario SF-36, presentándose diferencias significativas en los puntajes del Desempeño Físico (p = 0,000), Desempeño Emocional (p = 0,000) y Salud Mental (p = 0,023), teniendo mayores puntajes en estos dominios las personas no excluidas. Conclusiones: los resultados sugieren que la percepción de exclusión social afecta la CVRS y las condiciones individuales de salud pueden incidir en la percepción de exclusión social. Esto puede deberse a que la salud (enfermedad) en sí es un generador de exclusión social o que la prestación de los servicios de salud en el sistema de salud colombiano, haga que las personas enfermas se sientan excluidas.

OBJECTIVE: to identify the perception of social exclusion and its demographic, economic, and sociopolitical participation dimensions as well as its association with the Health-Related Quality of Life (HRQOL) of people aged 25 to 60 living in the northeastern area of Medellin - Colombia, 2009. METHODOLOGY: a cross-sectional study of association was conducted. The sample size was calculated with a confidence level of 95%, an error of 4.5%, and a ratio of 0.28 derived from a study on social exclusion conducted in Medellín in 2008. The study was conducted with a total of 404 subjects. The sample was obtained through a probability, cluster, and multistage sampling that was proportional by sex and had no replacement. The data was analyzed using the SPSS v.15.0 and Stata 10 software. RESULTS: 22.8% of the population was perceived to be in a situation of social exclusion. The assessment of the Health-Related Quality of Life (hrqol) showed high scores in all the domains of the SF-36 questionnaire. Significant differences were observed in role physical (p = 0.000), role emotional (p = 0.000), and Mental Health (p = 0.023) scores. Non-excluded individuals showed higher scores in these domains. CONCLUSIONS: the results suggest that the perception of social exclusion affects HRQOL and individual health conditions may affect the perception of social exclusion. This may be due to the fact that health (disease) in itself generates social exclusion or that the healthcare services in the Colombian health system cause sick people to feel excluded.

Los estilos de vida en salud: del individuo al contexto / Lifestyles: from the individual to the context

Los estilos de vida han sido estudiados por varias disciplinas como la sociología, la antropología y la epidemiología. El origen del término y los mayores desarrollos conceptuales se han formulado en el campo de las ciencias socioculturales, para las que los estilos de vida son patrones de comportamiento grupales sobre los que la estructura social ejerce una influencia considerable. La epidemiología ha hecho un uso extensivo del concepto de estilos de vida y salud pero con un significado restrictivo, asociándolo a las conductas que los individuos de manera racional asumen y que pueden ser riesgosas para su salud. En este artículo se reflexiona sobre rasgos comunes que caracterizan algunas de las investigaciones en el campo de la epidemiología sobre estilos de vida, en relación con el padecimiento de algunas enfermedades, que han sido publicadas recientemente. Se concluye un viraje hacia consideraciones contextuales que superan la mirada estrictamente individual de los estilos de vida y la salud. Sin embargo, se requiere mayor anclaje en los aportes de otras disciplinas, especialmente de las ciencias sociales y unos referentes conceptuales más claros para vincular las decisiones individuales con las posibilidades o restricciones del contexto.

Lifestyles have been studied by different disciplines such as sociology, anthropology, and epidemiology. Both the term and the greatest developments in this regard stem from the social and cultural sciences, which consider lifestyles as group behavior patterns upon which social structure has remarkable influence. Epidemiology has used the concepts of lifestyle and health extensively, but with a more restricted meaning, associating it with behaviors that people assume in a rational way and that can be hazardous for their health. In this paper we analyze some common traits of recently published studies on lifestyle in regards to the suffering of some diseases. We conclude that a shift toward contextual considerations can be observed. Such considerations overcome the strictly individual perspective regarding lifestyles and health. Nevertheless, additional insight from other disciplines, especially from the social sciences, is required. Likewise, theoretical frameworks linking individual decisions to contextual constraints or possibilities are needed.

Assessment of enzymatic efficiency on protein digestion in the tilapia Oreochromis niloticus.

The present study develops an experimental procedure aimed to estimate the efficiency of protein digestion in fish by measuring both gut transit rate and total amount of the main intestinal proteases (trypsin and chymotrypsin). The selected species was the Nile tilapia (Oreochromis niloticus). Total time for digestion, calculated through the estimation of gut transit rate using differently colored feeds, was 7.15 h. Mean production of trypsin and chymotrypsin was 15.94 and 24.11 mU in the proximal intestine and much lower (2,39, 4.90 mU) in the distal intestine. The enzyme efficiency, calculated from the average enzyme activity and time of residence of the digesta in each intestinal section, points to the major role of proximal intestine in protein digestion for this species. Results are discussed in relation to the main features characterizing digestion in stomachless fish.

Evaluación in vitro de hongos nematófagos para el control biológico de nemátodos gastrointestinales de rumiantes / In vitro assessment of nematophagus fungi for biological control of gastrointestinal nematodes of ruminants

Objetivo. Determinar la actividad depredadora in vitro de cepas de hongos nematófagos autóctonos de Costa Rica. Materiales y métodos. Dieciséis cepas de hongos nematófagos nativos de Costa Rica de los géneros Candelabrella musiformis, Arthrobotrys oligospora y Dactylella sp. Se evaluó in vitro la actividad depredadora de los hongos frente a nematodos gastrointestinales como Haemonchus spp., Oesophagostomum sp. y Trichostrongylus sp aislados de pequeños rumiantes. Resultados. La actividad de los hongos fue muy heterogénea, presentándose resultados que van desde 9.8 a 99.6% de depredación. Conclusiones. El análisis estadístico demostró diferencias significativas en la actividad de los hongos; sin embargo, las cepas de A. oligospora mostraron un mejor desempeño en la captura de nemátodos comparado con las cepas de C. musiformis y Dactylella sp. La heterogeneidad encontrada responde a factores como: origen de las cepas, características intrínsecas de las mismas y especies de larvas utilizadas.

[Assessment of the nutritional value of the menus served in school canteens on the island of Tenerife, Spain]. / Valoración nutricional de los menús escolares de los colegios públicos de la isla de Tenerife.

OBJECTIVE: To study the nutritional characteristics of the menus provided in the state primary schools of Tenerife and to assess whether they are adequate for the different age groups of school children. SCOPE AND METHODS: The study is conducted in 52 school canteens, with a population of 8,411 diners aged between 4 and 12 years old. 27 of the 52 school dinner services were managed directly and 25 were contracted out to catering companies. They were selected through a random sampling that was stratified by the different geographic areas of the island. A full menu was taken from each of them: first course, second course and dessert (in some cases, a dairy product, normally a piece of fruit). The food was recorded by weight. For assessing the nutritional input in the directly managed dining rooms, we took information on the menu, how it was prepared, the ingredients used and the proportion of each of these in each dish, the amount of oil and salt added, etc. Hence we calculate the proportion of each ingredient. We then weigh the different rations offered to the school children. In the case of the menus offered by catering companies, the quantity of the ration is weighed in the school dining room and, as the catering company supplies us with the breakdown of all the ingredients used in the dishes, we can determine the composition of the menus. To convert the food into nutrients, we used the Dietsource V 1.0 programme. The school menu is broken down using the diet, dish and food management plan, to give the proportions of active ingredients used, and the Recommended Inputs for the Spanish population are used as a reference for evaluating the nutritional quality of the diet, taking the average of the recommended value for the different age groups for each of the parameters. RESULTS: The carbohydrates account for 54% of the total energy, lipids 27% and proteins 19%. The mean content and standard error for cholesterol is 77.53 +/- 64.30 mg, so the mean cholesterol input per 1,000 kcal is 109 mg/1,000 kcal. Saturated fatty acids contribute 8.6% of the calorie input, monounsaturated fatty acids 11.7% and polyunsaturated fatty acids 9.7%. The fibre input per 1,000 kcal is 11 g. CONCLUSIONS: The energy value of the school menu is adequate, the percentage content of proteins is slightly high and the lipid and carbohydrate contents are within the limits. The percentage content of fatty acids is adequate, as are the percentage contents of cholesterol and fibre. The vitamin and mineral contents are appropriate, with the exception of iodine, zinc, iron and vitamins D, E and riboflavin, where there is a deficit, especially for the older children.

Cost-effectiveness analysis of enfuvirtide (ENF) added to an optimized therapy compared with an optimized therapy in patients with HIV/AIDS.

BACKGROUND: Fuzeon (enfuvirtide) (ENF) is the first drug among the HIV fusion inhibitors that has shown high efficacy in HIV-1/AIDS patients resistant to conventional antiretroviral agents. PURPOSE: To analyze the cost-effectiveness of ENF plus optimized therapy (OT) in HIV patients. METHOD: A Markov model was used to calculate the cost-effectiveness of ENF in terms of incremental cost per life-year gained. The model has a 10-year horizon, with monthly cycles, and the perspective is the Spanish National Health System. Efficacy rates and transition probabilities were obtained from clinical and epidemiological trials. Resource use data were retrieved from published literature and a panel of clinicians. Unit costs refer to the year 2003. MAIN OUTCOME MEASURE: Incremental cost-effectiveness ratio. RESULTS: Adding ENF to OT increased patient life expectancy by 1.6 years (6.2 years with OT compared with 7.8 years with ENF + OT). Total costs were 160,728 euro for OT and 200,859 euro with ENF + OT, mainly due to increasing life expectancy raising resource use and costs. Incremental cost per life-year gained with ENF was 25,082 euro. CONCLUSION: ENF plus OT increased life expectancy for HIV-1-treated patients and is an efficient treatment option.

[Cost and outcome of hip's arthroplasty nosocomial infection. Case and control study]. / Costo y desenlace de la infección de artroplastía de cadera. Estudio de caso y control.

Case-control study for evaluation of cost and outcome of nosocomial surgical site infection in primary hip arthroplasty during a period of 5 years. Mean hospitalization time in the orthopedic service was 54 days for cases, and 13 days for control (p<0.05). Mean hospitalization time in Intensive Care Unit (ICU) was 1.1 days for cases. There were 0.83 post primary surgery interventions in cases, and a mean of 2.08 bacteriological cultures in each case. Controls didn't have hospitalizations in the ICU surgical reinterventions nor cultures necessary. The mean cost of infected patients was US $: 6,174.8. Mean cost in controls was US $: 2,354.7. The excess of cost due to infections was US $: 2,354.7 on the average. Outcomes in cases were: normal function 30.8%; moderate or serious sequelae 46.2%; death rate 15, 4%. The measured parameters contributed to raise case costs, and they caused an unsatisfactory outcome for two third of the patients.

Costo y desenlace de la infección de artroplastía de cadera: Estudio de caso y control / Cost and outcome of hip's arthroplasty nosocomial infection: Case and control study

Case-control study for evaluation of cost and outcome of nosocomial surgical site infection in primary hip arthroplasty during a period of 5 years. Mean hospitalization time in the orthopedic service was 54 days for cases, and 13 days for control (p < 0.05). Mean hospitalization time in Intensive Care Unit (ICU) was 1.1 days for cases. There were 0.83 post primary surgery interventions in cases, and a mean of 2.08 bacteriological cultures in each case. Controls didn't have hospitalizations in the ICU surgical reinterventions nor cultures necesary. The mean cost of infected patients was US $: 6,174.8. Mean cost in controls was US $: 2,354.7. The excess of cost due to infections was US $: 2,354.7 on the average. Outcomes in cases were: normal function 30.8 percent; moderate or serious sequelea 46.2 percent; death rate 15, 4 percent. The measured parameters contributed to raise case costs, and they caused an unsatisfactory outcome for two third of the patients.

Estudio de casos y controles efectuado para evaluar el costo y desenlace de la infección del sitio quirúrgico en artroplastía primaria de cadera en cinco años. La media de hospitalización en el Servicio de Traumatología fue de 54 días para los casos y 13 días para los controles (p < 0,05). La media de hospitalización en UCI de los casos fue 1,1 días; hubo 0,83 reintervenciones en los casos y una media de 2,08 cultivos por cada caso. Los controles no tenían hospitalización en UCI, reintervenciones, ni cultivos. El costo promedio de los pacientes infectados fue $ 3.241.800 (US $ 6.174,8). El costo promedio de los controles, alcanzó a $1.236.244 (US $ 2.354,7). El exceso promedio de costo por la infección fue de $ 2.005.556 (US $ 3.820,1). El desenlace fue el siguiente: función normal 30,8 por ciento; secuelas medianas y graves 46,2 por ciento; letalidad 15,4 por ciento. Los factores medidos contribuyeron a encarecer los costos de los casos y produjeron un desenlace insatisfactorio para dos tercios de los pacientes.

[Clinical trials on glaucoma: differences according to the medical or surgical nature of the treatment being evaluated]. / Ensayos clínicos sobre glaucoma: diferencias en función de que evalúen tratamientos médicos o quirúrgicos.

PURPOSE: To compare the quality of clinical trials on glaucoma between those evaluating the effectiveness of medical treatments and those evaluating surgical treatments. METHOD: Clinical trials on glaucoma published in seven international journals between January 1980 and December 1999 were selected. The papers were revised by researchers with a background in epidemiology using a standard qualitative questionnaire. Proportions were compared using Fisher's exact test. RESULTS: Sample size was pre-estimated in 19% of medical treatment trials and 2% of surgical trials (p=0.005); masking (72% vs. 9%; p<0.001) and intention-to-treat analysis (17 vs. 0 papers; p<0.001) were also more frequent in medical trials. Only 50% of the trials correctly described the patient flow. CONCLUSIONS: Quality in clinical trials on glaucoma medical treatment was higher than in surgical trials regarding sample size pre-estimation, masking and intention-to-treat analysis. However, both medical and surgical trials should improve in these aspects and in the patient flow description

Prediction of dairy housing construction costs.

Dairy farms in Galicia and elsewhere in Europe are going through a transition phase to adapt to modern dairy technology, improve labor efficiency, and increase in size and scale. Expanding a dairy herd and building housing for more cows can be very expensive. A poor decision during expansion can result in serious financial difficulties even to the point of making the farm economically unviable. Dairy managers must carefully evaluate existing alternatives and must select an optimal strategy. To aid this decision, a computer spreadsheet application has been developed that predicts the cost per cow and cost per unit of area of alternative designs as functions of the number of cows to be housed. The spreadsheet is, in principle, applicable to a wide variety of designs and to housing for livestock other than dairy cattle. However, the current database allows comparison among six of the dairy housing designs that have been used most widely in Galicia in recent years. From projected financial results of the developed model, it was concluded that differing designs were preferred for different farm circumstances. Preferred designs for farms with 60 to 200 cows were either four rows of facing free stalls or four rows of tail-to-tail free stalls, which have virtually the same costs. Whereas for farms with fewer than 60 cows, the preferred design was two rows of tail-to-tail free stalls, designs with three rows of free stalls were generally more costly per cow. Results of design calculations must be integrated with other farm management considerations in choosing a particular design.

La salud en el plan nacional de desarrollo: sin cambios para construir la paz / Health in the National Development Plan: no changes in building peace

El Plan Nacional de Desarrollo 1999-2002, expedido por medio de la Ley 508 de 1999, propone como política de salud para este período la profundización de los mecanismos de funcionamiento del actual sistema de prestación de servicios. No se plantean en él estrategias para superarar los problemas más críticos, como la exclusión del acceso a los servicios que hoy sufre una parte importante de la población, los altos costos generados por la intermediación, la crisis de los hospitales públicos la reducción de los programas de promoción de la salud y la fragmentación de la participación ciudadana. La crisis que hoy atraviesa la salud de los colombianos, requiere al contrario de lo propuesto por la actual administración, cambios estructurales en las metas y estrategias del desarrollo social y económico, para evitar un mayor deterioro de la situación de salud de la población, así como también demanda la constucción democrática de un sistema de prestación de servicios que responda a las necesidades heterogéneas de los grupos sociales y no al desarrollo de un mercado de servicios, cuyas limitaciones son cada vez más evidentes

Age differential mortality in Spain, 1900-1991.

STUDY OBJECTIVE: To analyse the interindividual inequalities in mortality in Spain through the 20th century using the Gini coefficient, widely used as an income concentration index. DESIGN: Age mortality data were obtained from official publications of vital statistics and age and sex compositions were obtained from population census. The Gini coefficient was estimated. It can take values between 0 and 1. Zero represents the situation in which all subjects die at the same age, whereas when all but one subject dies at 25 the index reaches a figure of 1. MAIN RESULTS: In both men and women there was a trend to decrease age differential mortality (from 0.26 to 0.16 for men and from 0.26 to 0.12 for women). Nevertheless, transitory increases were produced in 1918 (influenza epidemic), and in the period of the Civil War of Spain, showing a more important increase in the mortality of young people than that of the elderly. A new increase was observed through the second half of eighties; it resulted from an AIDS epidemic and motor vehicle injuries. CONCLUSION: Inequalities in mortality in Spain have decreased through the 20th century.