Effect of COVID-19 prevention as part of an urban renewal programme.

OBJECTIVES: To address existing inequalities, the Barcelona City Council launched a Neighbourhood Plan in 2016-2020. During the first wave of the COVID-19 pandemic, the Neighbourhood Plan interventions were intensified. This study aimed to assess the effect of the plan on the incidence of COVID-19 during the first wave of the pandemic in Barcelona. STUDY DESIGN: We used a quasi-experimental design with 16 intervention neighbourhoods and 17 neighbourhoods in the comparison group with similar socioeconomic characteristics. METHODS: We calculated the cumulative incidence rate (CIR) of COVID-19 per 100,000 inhabitants by sex, age groups, and neighbourhood of residence. Poisson regression models were fitted to estimate the crude relative risk and relative risk adjusted by socioeconomic status (cRR and aRR) and their 95% confidence intervals (CIs). RESULTS: The CIR of COVID-19 was lower in the intervention neighbourhoods (CIR: 841 per 100,000 inhabitants) than in the comparison group (CIR: 973 per 100,000 inhabitants). On multivariate analysis, the aRR was 0.77 (CI: 0.70-0.83) for men and 0.89 (CI: 0.83-0.96) for women. Among men older than 75 years (aRR = 0.73; CI: 0.62-0.86), statistically significant differences were found in the intervention neighbourhoods compared to the comparison group. This pattern was not observed in women older than 75 years (aRR = 1.13; CI: 0.99-1.30). CONCLUSION: This research finds positive short-term effect in the intervention neighbourhoods. We conclude that the COVID-19 control and prevention interventions are likely to explain the better performance in the neighbourhoods included in the Neighbourhood Plan.

Social determinants of self-perceived discrimination in Spain.

OBJECTIVES: To analyse the association between self-perceived discrimination and social determinants (social class, gender, country of origin) in Spain, and further to describe contextual factors which contribute to self-perceived discrimination. METHODS: Cross-sectional design using data from the Spanish National Health Survey (2006). The dependent variable was self-perceived discrimination, and independent and stratifying variables were sociodemographic characteristics (e.g. sex, social class, country of origin, educational level). Logistic regression was used. RESULTS: The prevalence of self-perceived discrimination was 4.2% for men and 6.3% for women. The likelihood of self-perceived discrimination was higher in people who originated from low-income countries: men, odds ratio (OR) 5.59 [95% confidence interval (CI) 4.55-6.87]; women, OR 4.06 (95% CI 3.42-4.83). Women were more likely to report self-perceived discrimination by their partner at home than men [OR 8.35 (95% CI 4.70-14.84)]. The likelihood of self-perceived discrimination when seeking work was higher among people who originated from low-income countries than their Spanish counterparts: men, OR 13.65 (95% CI 9.62-19.35); women, OR 10.64 (95% CI 8.31-13.62). In comparison with Spaniards, male white-collar workers who originated from low-income countries [OR 11.93 (95% CI 8.26-17.23)] and female blue-collar workers who originated from low-income countries (OR 1.6 (95% CI 1.08-2.39)] reported higher levels of self-perceived discrimination. CONCLUSIONS: Self-perceived discrimination is distributed unevenly in Spain and interacts with social inequalities. This particularly affects women and immigrants.

Evolution of socio-economic inequalities in mortality in small geographical areas of the two largest cities in Spain (Barcelona and Madrid), 1996-2007.

OBJECTIVES: To describe the evolution of socio-economic inequalities in mortality in small areas of two Spanish cities (Barcelona and Madrid) from 1996 to 2001 and from 2002 to 2007. STUDY DESIGN: A small-area ecological study of trends was performed, in which the units of analysis were census tracts. METHODS: The association between mortality and socio-economic deprivation was assessed through Poisson regression analysis. Models were stratified by sex, age group and period of study. The trend in inequalities in mortality was assessed by introducing an interaction term between deprivation and the period of study. RESULTS: Mortality in the most-deprived areas was significantly higher than mortality in the less-deprived areas in both periods and most age groups. However, inequalities seemed to diminish in young people and elderly women, especially in Barcelona. CONCLUSIONS: There is a need to monitor inequalities in mortality in the near future because the current financial crisis could change this situation.

Bibliometric analysis in paediatric dental journals listed in journal citation reports. Current trends.

AIM: The aim of this study was to analyse articles published in paediatric dental journals included in Journal Citation Reports (JCR), to determine current trends in paediatric publishing. METHODS: Articles included in paediatric dentistry journals in 2020 JCR were selected, published during the period 2008-2020. After applying inclusion criteria, author-based parameters (article title, first author's name, institution, sex and number of authors, number of affiliations, first/last author's origin and geographic origin), and article-based parameters (article type, main topic, research design) were registered for each article. CONCLUSION: International Journal of Paediatric Dentistry, Journal of Clinical Pediatric Dentistry, European Journal of Paediatric Dentistry and Pediatric Dentistry were the four main journals in terms of production volume, USA being the most productive country. The most recurrent topic was dental surgery, and the most common design was observational studies. Study design, geographic origin of the articles, article type and main subject of the article might predict citation.

Socioeconomic inequalities in lung cancer mortality in 16 European populations.

OBJECTIVES: This paper aims to describe socioeconomic inequalities in lung cancer mortality in Europe and to get further insight into socioeconomic inequalities in lung cancer mortality in different European populations by relating these to socioeconomic inequalities in overall mortality and smoking within the same or reference populations. Particular attention is paid to inequalities in Eastern European and Baltic countries. METHODS: Data were obtained from mortality registers, population censuses and health interview surveys in 16 European populations. Educational inequalities in lung cancer and total mortality were assessed by direct standardization and calculation of two indices of inequality: the Relative Index of Inequality (RII) and the Slope Index of Inequality (SII). SIIs were used to calculate the contribution of inequalities in lung cancer mortality to inequalities in total mortality. Indices of inequality in lung cancer mortality in the age group 40-59 years were compared with indices of inequalities in smoking taking into account a time lag of 20 years. RESULTS: The pattern of inequalities in Eastern European and Baltic countries is more or less similar as the one observed in the Northern countries. Among men educational inequalities are largest in the Eastern European and Baltic countries. Among women they are largest in Northern European countries. Whereas among Southern European women lung cancer mortality rates are still higher among the high educated, we observe a negative association between smoking and education among young female adults. The contribution of lung cancer mortality inequalities to total mortality inequalities is in most male populations more than 10%. Important smoking inequalities are observed among young adults in all populations. In Sweden, Hungary and the Czech Republic smoking inequalities among young adult women are larger than lung cancer mortality inequalities among women aged 20 years older. CONCLUSIONS: Important socioeconomic inequalities exist in lung cancer mortality in Europe. They are consistent with the geographical spread of the smoking epidemic. In the next decades socioeconomic inequalities in lung cancer mortality are likely to persist and even increase among women. In Southern European countries we may expect a reversal from a positive to a negative association between socioeconomic status and lung cancer mortality. Continuous efforts are necessary to tackle socioeconomic inequalities in lung cancer mortality in all European countries.

Substance use among road traffic casualties admitted to emergency departments.

OBJECTIVE: To describe the prevalence of recent psychoactive substance use and associated factors among road traffic casualties admitted to emergency departments. METHODS: A cross-sectional study was carried out, including adults injured in road traffic crashes admitted to the emergency department (ED) of eight hospitals in Catalonia (Spain), during three cross-sections, each of 4 days duration (2005-2006). Information sources were an interview, an oral fluid specimen and the patient's clinical record. Dependent variables were presence of alcohol, cannabis, cocaine, ecstasy, opiates or benzodiazepines. Independent variables were socioeconomic characteristics and circumstances of the injuries and admission. Prevalence and exact 95% confidence intervals were estimated for men and women. Bivariate analyses and multivariate binomial regression modelling were carried out to study factors associated with substance use in male drivers and pedestrians. RESULTS: The prevalence of substance use was higher in men (n = 226) than in women (n = 161) for any substance (34.4% and 16.2%), any illegal substance (19.3% and 7.6%), alcohol (18.5% and 9.2%) and cannabis (17.0% and 3.8%), respectively. In male drivers and pedestrians, alcohol use was associated with being in the 25-30-year age group, being injured at night and the weekend, and arriving at the ED by ambulance; cannabis use was only associated with being in the 18-30-year age group. CONCLUSIONS: A high prevalence of recent psychoactive substance use, especially alcohol, cannabis and cocaine, was observed in all age groups. The results indicate the need to screen for substance use and to give simple advice to casualties at EDs.

Applying an equity lens to tobacco-control policies and their uptake in six Western-European countries.

We identified policies that may be effective in reducing smoking among socioeconomically disadvantaged groups, and examined trends in their level of application between 1985 and 2000 in six western-European countries (Sweden, Finland, the United Kingdom, the Netherlands, Germany, and Spain). We located studies from literature searches in major databases, and acquired policy data from international data banks and questionnaires distributed to tobacco policy organisations/researchers. Advertising bans, smoking bans in workplaces, removing barriers to smoking cessation therapies, and increasing the cost of cigarettes have the potential to reduce socioeconomic inequalities in smoking. Between 1985 and 2000, tobacco control policies in most countries have become more targeted to decrease the smoking behaviour of low-socioeconomic groups. Despite this, many national tobacco-control strategies in western-European countries still fall short of a comprehensive policy approach to addressing smoking inequalities.

Diabetes mellitus mortality in Spanish cities: Trends and geographical inequalities.

AIM: To analyze the geographical pattern of diabetes mellitus (DM) mortality and its association with socioeconomic factors in 26 Spanish cities. METHODS: We conducted an ecological study of DM mortality trends with two cross-sectional cuts (1996-2001; 2002-2007) using census tract (CT) as the unit of analysis. Smoothed standardized mortality rates (sSMR) were calculated using Bayesian models, and a socioeconomic deprivation score was calculated for each CT. RESULTS: In total, 27,757 deaths by DM were recorded, with higher mortality rates observed in men and in the period 1996-2001. For men, a significant association between CT deprivation score and DM mortality was observed in 6 cities in the first study period and in 7 cities in the second period. The highest relative risk was observed in Pamplona (RR, 5.13; 95% credible interval (95%CI), 1.32-15.16). For women, a significant association between CT deprivation score and DM mortality was observed in 13 cities in the first period and 8 in the second. The strongest association was observed in San Sebastián (RR, 3.44; 95%CI, 1.25-7.36). DM mortality remained stable in the majority of cities, although a marked decrease was observed in some cities, including Madrid (RR, 0.67 and 0.64 for men and women, respectively). CONCLUSIONS: Our findings demonstrate clear inequalities in DM mortality in Spain. These inequalities remained constant over time are were more marked in women. Detection of high-risk areas is crucial for the implementation of specific interventions.

Comparability between ICD-9 and ICD-10 for the leading causes of death in Spain.

BACKGROUND: Implementation of a new Revision of the International Classification of Diseases can create discontinuity in mortality statistics. Revisions are nevertheless essential to ensure international comparability of health statistics. The purpose of this work was to describe the effects of the 10th Revision on mortality statistics by sex and age for leading causes of death in Spain. METHODS: A cross-sectional study of leading causes of death was carried out when the underlying cause of death was coded using both the 9th and 10th Revisions of the International Classification of Diseases in 88,044 death certificates completed in five Autonomous Communities of Spain (Andalusia, Cantabria, Murcia, Navarra, the Basque Country), and the city of Barcelona during the year 1999. Changes introduced by the 10th Revision were described by simple correspondence, percentage of change, Kappa index and comparability ratios between the 10th and the 9th Revision along with their 95% confidence intervals by sex and five-year age group, for the leading causes of death. RESULTS: Under the 10th Revision, AIDS deaths rose by 3.6% (comparability ratio (CR): 1.036; 95% confidence interval (CI):1.015-1.058), arteriosclerosis by 7.1% (CR: 1.071; 95% CI: 1.052-1.090), and drug overdose by 5.2% (CR: 1.052; 95% CI: 0.964-1.140). Mortality due to vascular and senile dementia and non specific dementia declined by 3.2% under the 10th (CR: 0.969; 95% CI: 0.950-0.988). In all the other causes of death the percentage of change regardless of direction was less than 2%. CONCLUSION: The present study found good agreement between ICD-9 and ICD-10 on the leading causes of death and premature mortality in Spain. Causes of death which present differences between Revisions were AIDS, arteriosclerosis, drug overdose and senile dementia. For these causes, the comparability ratios must be taken into account when interpreting mortality statistics.

AIDS-related knowledge and behaviors in Mozambique.

BACKGROUND: The objective of this study was to describe attitudes and knowledge about AIDS among the population aged 15 to 49 in Chókwè (Mozambique) during the period from March to May 2004, and to study associated factors. METHODS: Cross-sectional study conducted by interviewing 1,055 people aged 15 to 49, of both sexes, residents in Chókwè (68,698 inhabitants). The questionnaires employed are known as the Behavior Surveillance Survey. Dependent variables were: knowledge about transmission routes and preventive methods, use of condoms and having had sexual relations with an irregular partner during the past 12 months. Odds ratios were calculated for the association between these variables and age, sex, educational level, neighborhood of residence, number of relations in the last 30 days, and whether AIDS tested, by fitting Logistic Regression models (bivariate and multivariate). RESULTS: Over 99% of the sexually active population of Chókwè knew about AIDS and condoms. More than half of the population of Chókwè has a good knowledge of preventive methods and of transmission routes. 72.9% of men and 91.3% of women did not use the condom when having sexual relationships. It was observed that a low educational level implied a lower degree of knowledge about preventive methods (OR=2.48, 95% CI: 1.60-3.84) and about transmission routes (OR=2.49, 95% CI: 1.37-4.52), less condom use and less relations with irregular or sporadic partners. The probability of not using condoms was higher among females, among people living in less privileged districts, with no education (OR=3.79; 95% CI: 1.80-7.99), with regular partners (OR=4.36; 95% CI: 1.93-9.84) and among people who have not had an AIDS test. CONCLUSION: Knowledge of preventive methods and transmission routes is good in more than half of the population of Chókwè. The majority of men and women do not use the condom when having sexual intercourse. Moreover, inequalities may be observed as a function of educational level and district socioeconomic level. Knowledge of preventive practices, mainly among socio-economically disadvantaged groups, must be improved and strategies designed to broaden access to use of condoms by everyone should be implemented.

Process-generated nanoparticles from ceramic tile sintering: Emissions, exposure and environmental release.

The ceramic industry is an industrial sector in need of significant process changes, which may benefit from innovative technologies such as laser sintering of ceramic tiles. Such innovations result in a considerable research gap within exposure assessment studies for process-generated ultrafine and nanoparticles. This study addresses this issue aiming to characterise particle formation, release mechanisms and their impact on personal exposure during a tile sintering activity in an industrial-scale pilot plant, as a follow-up of a previous study in a laboratory-scale plant. In addition, possible particle transformations in the exhaust system, the potential for particle release to the outdoor environment, and the effectiveness of the filtration system were also assessed. For this purpose, a tiered measurement strategy was conducted. The main findings evidence that nanoparticle emission patterns were strongly linked to temperature and tile chemical composition, and mainly independent of the laser treatment. Also, new particle formation (from gaseous precursors) events were detected, with nanoparticles <30nm in diameter being formed during the thermal treatment. In addition, ultrafine and nano-sized airborne particles were generated and emitted into workplace air during sintering process on a statistically significant level. These results evidence the risk of occupational exposure to ultrafine and nanoparticles during tile sintering activity since workers would be exposed to concentrations above the nano reference value (NRV; 4×10(4)cm(-3)), with 8-hour time weighted average concentrations in the range of 1.4×10(5)cm(-3) and 5.3×10(5)cm(-3). A potential risk for nanoparticle and ultrafine particle release to the environment was also identified, despite the fact that the efficiency of the filtration system was successfully tested and evidenced a >87% efficiency in particle number concentrations removal.

Socioeconomic differences in the prevalence of common chronic diseases: an overview of eight European countries.

BACKGROUND: Few studies have compared socioeconomic inequalities in the prevalence of both fatal and non-fatal diseases. This paper aims to give the first international overview for several common chronic diseases. METHODS: Micro-level data were pooled from non-standardized national health surveys conducted in eight European countries in the 1990s. Surveys ranged in size from 3700 to 41 200 participants. The prevalence of 17 chronic disease groups were analysed in relation to education. Standardized prevalence rates and age-adjusted odds ratios (ORs) were calculated. RESULTS: Most diseases showed higher prevalence among the lower education group. Stroke, diseases of the nervous system, diabetes, and arthritis displayed relatively large inequalities (OR > 1.50). No socioeconomic differences were evident for cancer, kidney diseases, and skin diseases. Allergy was more common in the higher education group. Relative socioeconomic differences were often smaller among the 60-79 age group as compared with the 25-59 age group. Cancer was more prevalent among the lower educated in the 25-59 age group, but among the higher educated in the 60-79 age group. For diabetes, hypertension, and heart disease, socioeconomic differences were larger among women as compared with men. Inequalities in heart disease were larger in northern European countries as compared with southern European countries. CONCLUSION: There are large variations between chronic diseases in the size and pattern of socioeconomic differences in their prevalence. The large inequalities that are found for some specific fatal diseases (e.g. stroke) and non-fatal diseases (e.g. arthritis) require special attention in equity-oriented research and policies.

Trends in smoking behaviour between 1985 and 2000 in nine European countries by education.

OBJECTIVE: To examine whether trends in smoking behaviour in Western Europe between 1985 and 2000 differed by education group. DESIGN: Data of smoking behaviour and education level were obtained from national cross sectional surveys conducted between 1985 and 2000 (a period characterised by intense tobacco control policies) and analysed for countries combined and each country separately. Annual trends in smoking prevalence and the quantity of cigarettes consumed by smokers were summarised for each education level. Education inequalities in smoking were examined at four time points. SETTING: Data were obtained from nine European countries: Norway, Sweden, Denmark, Finland, the United Kingdom, the Netherlands, Germany, Italy, and Spain. PARTICIPANTS: 451 386 non-institutionalised men and women 25-79 years old. MAIN OUTCOME MEASURES: Smoking status, daily quantity of cigarettes consumed by smokers. RESULTS: Combined country analyses showed greater declines in smoking and tobacco consumption among tertiary educated men and women compared with their less educated counterparts. In country specific analyses, elementary educated British men and women, and elementary educated Italian men showed greater declines in smoking than their more educated counterparts. Among Swedish, Finnish, Danish, German, Italian, and Spanish women, greater declines were seen among more educated groups. CONCLUSIONS: Widening education inequalities in smoking related diseases may be seen in several European countries in the future. More insight into effective strategies specifically targeting the smoking behaviour of low educated groups may be gained from examining the tobacco control policies of the UK and Italy over this period.

Physical activity assessment in population surveys: can it really be simplified?

BACKGROUND: Several studies have used a simplified approach for the assessment of physical activity such as the frequency of exercise-induced sweating. In this study leisure-time physical activity has been assessed using this and another more detailed measure. SUBJECTS AND METHODS: A sample of 4171 adults answered the Health Interview Survey of Barcelona in 1992. The respondents were classified into categories depending on participation in moderate and/or intense physical activity (> or =20 min) and also according to the frequency of exercise-induced sweating: 0, 1-2 and > or =3 times/week. Agreement between the two measures was calculated using the weighted Kappa (Kw) statistic with 95% confidence intervals (95% CI). Stratified analyses were performed. RESULTS: Prevalence of physical activity > or =3 times/week was lower with the sweat question (12.5%) than with the questions about the frequency of performance of selected activities (19.6%). The physical activity patterns by age, gender and overweight were similar for the two measures, but differed by month of the year. Agreement was lower among the older age categories and was higher among males (Kw = 0.59, 95% CI: 0.57-0.62) than among females (Kw = 0.48, 95% CI: 0.46-0.50). Overall, the agreement was higher in the hotter months (Kw = 0.72 among males and 0.58 among females). CONCLUSIONS: In the assessment of physical activity in the population by means of the sweat question there can be interference from other variables, apart from the intensity of the activity, which influence sweating during the exercise. Further assessments of the validity of exercise-induced sweating in representative samples of the general population would be useful.

Inequalities in mortality according to educational level in two large Southern European cities.

BACKGROUND: In Spain, studies on social inequalities in mortality based on individuals are few due to the poor quality of information on occupation in death certificates. This study looks at the differences in mortality according to educational level, using individual information obtained through the linkage between the Death Register and the Municipal Census, in the cities of Madrid and Barcelona, Spain. METHODS: The study populations were residents of Madrid and Barcelona aged >24 years, who died in 1993 and 1994. Indicators obtained for each city and educational level were: age- and sex-specific mortality rates, and life expectancy at 25 years. Poisson regression models were fitted to obtain the relative risk (RR) of death for each educational level with respect to the reference level (higher education completed), adjusted for age. RESULTS: The mortality rate was lower among individuals with higher educational levels, while life expectancy at 25 years was higher. In both cities men and women with no education showed the highest mortality in all age groups, with very high RR in the youngest age group (RR for men aged 25-34 years = 7.08 in Madrid and 6.02 in Barcelona, whereas in women these RR were 6.33 and 5.63 respectively). In Barcelona the greater part of the overall mortality difference for the group aged 25-34 years was due to AIDS (acquired deficiency syndrome, 33.4% in men and 59.3% in women). CONCLUSION: The present study has found higher mortality (mainly from AIDS) among individuals with no academic qualifications thus drawing attention to the need to implement policies aimed at reducing these inequalities.

Migration within Spain, level of education, and cervical cancer screening.

Migration has been related to the utilization of preventive care services. We analysed the relation between cervical cancer screening and migration within the same country and socioeconomic status in a context in which there is no organized screening. The health survey of Barcelona (Spain) was the data source. Barcelona, a city in north eastern Spain, has experienced important migration from the south and other regions of Spain. Variables studied were the migrant women's year of arrival, age at arrival, educational attainment and Pap smear test uptake. Multivariate logistic regression analysis was performed to examine the correlations among the variables of interest. Just over 30% of the women had never had a Pap smear test. Uptake was higher among younger, educated women born either in Barcelona or abroad. After adjusting for age, migrant women were at higher risk for not participating in screening tests (odds ratio: 1.23; 1.09-1.39); but after adjusting for educational attainment and age, the odds ratio was no longer significant. This study shows that migrants within Spain have less access to preventive services, such as cervical cancer screening in an opportunistic setting. However, this association is almost completely explained by socioeconomic status. Migration could be seen as a social factor that puts people at risk of falling into lower socioeconomic status associated with poor access to screening.

Socioeconomic factors and mortality in urban settings: the case of Barcelona, Spain.

STUDY OBJECTIVE: This study aimed to describe the relationship between health and socioeconomic indicators in the 38 neighbourhoods of the city of Barcelona, Spain. DESIGN: Mortality data for 1983-89 and socioeconomic data for each of the 38 neighbourhoods of Barcelona were used. Mortality indicators used were the comparative mortality figure, the ratio of potential years of life lost, and life expectancy at birth. Socioeconomic indicators were the percentage of unemployed, the percentage of illiteracy, monthly telephone usage, the average power and age of cars, and the average rateable value of buildings and of land. The statistical correlation between socioeconomic indicators and mortality indicators was studied by Spearman's rank correlation coefficient. SETTING: The 38 neighbourhoods of Barcelona, Spain. MEASUREMENTS AND MAIN RESULTS: The comparative mortality figure ranged from 87.41-152.43 and the ratio of potential years of life lost from 74.94-237.31 in both sexes. Both the absolute difference and the ratio of the value for the neighbourhood with lowest mortality and that with highest mortality were larger when premature mortality was examined. Life expectancy at birth ranged from 64.77-75.32 years in men and 75.04-81.51 in women. All correlations between mortality and socioeconomic indicators were high and statistically significant: the higher the unemployment and illiteracy levels and the older the cars, the greater the comparative mortality figure and ratio of potential years of life lost, and the lower the life expectancy (negative correlations). Conversely, the higher the telephone use, the more powerful the cars, and the greater the rateable value, the lower the mortality (negative correlations) and the greater the life expectancy. These correlations were greater in males than in females. The highest correlations were with illiteracy. CONCLUSIONS: This study has detected significant differences in mortality in a large town in the Mediterranean region of Europe.

Gender inequalities in health among workers: the relation with family demands.

OBJECTIVES: To analyse whether there are gender inequalities in health among male and female workers who are married or cohabiting and to assess whether there are gender differences in the relation between family demands and health. Additionally, for both objectives it will be examined whether these gender patterns are similar for manual and non-manual workers. DESIGN AND SETTING: The data have been taken from the 1994 Catalonian Health Survey (CHS), a cross sectional survey based on a representative sample of the non-institutionalised population of Catalonia, a region in the north east of Spain that has about 6 million inhabitants. The dependent variables were four ill health indicators (self perceived health status, limiting longstanding illness, having at least one chronic condition and mental health) and two health related behaviours closely related to having time for oneself (no leisure time physical activity and sleeping six hours or less a day). Family demands were measured with three variables: household size, living with children under 15 years and living with adults older than 65 years. The analysis was separated for gender and social class (manual and non-manual workers) and additionally adjusted for age. Gender differences for all dependent and independent variables were first tested at the bivariate level using the chi(2) test for categorical variables and the t test for age. Secondly, multivariate logistic regression models were fitted. PARTICIPANTS: Persons who were employed, married or cohabiting, aged 25 to 64 years (2148 men and 1185 women). RESULTS: A female excess for all the ill health indicators was found, while there were no gender differences in the health related behaviours analysed. Family demands had a greater impact on health and health related behaviours of female manual workers. In this group household size was positively related to four dependent variables. The adjusted odds ratios (ORs) to living in family units of more than four persons versus living only with the spouse were 2.74 (95%CI=1.22, 6.17) for poor self perceived health status, 3.16 (95%CI=0.98, 10.15) for limiting long standing illness, 3.28 (95%CI=1.45, 7.44) for having at least one chronic condition, and 2.60 (95%CI=1.12, 6.00) for sleeping six hours or less a day. Among female manual workers living with children under 15 years was positively associated with no leisure time physical activity (adjusted OR=2.37; 95% CI=1.43, 3.92) and with sleeping six hours or less a day (adjusted OR=1.91; 95% CI=1.13, 3.32). Living with adults older than 65 years had an unexpected negative relation with poor self perceived health status (adjusted OR=0.33; 95%CI=0.16, 0.66), and with chronic conditions (adjusted OR=0.45; 95%CI=0.24, 0.87) in female manual workers. Among male manual workers living with children under 15 years was positively associated with longstanding limiting illness (adjusted OR=2.44; 95%CI=1.36, 4.38). CONCLUSION: When gender differences in health are analysed, both the paid and the non-paid work should be considered as well as the interaction between these two dimensions, gender and social class. In Catalonia, as probably in Spain and in other countries, private changes such as sharing domestic responsibilities, as well as active public policies for facilitating family care are needed in order to reduce gender health inequalities attributable to the unequal distribution of family demands.

Widening social inequalities in mortality: the case of Barcelona, a southern European city.

OBJECTIVE: To analyse trends in mortality inequalities in Barcelona between 1983 and 1994 by comparing rates in those electoral wards with a low socioeconomic level and rates in the remaining wards. DESIGN: Mortality trends study. SETTING: The city of Barcelona (Spain). SUBJECTS: The study included all deaths among residents of the two groups of city wards. Details were obtained from death certificates. MAIN OUTCOME MEASURES: Age standardised mortality rates, age standardised rates of years of potential life lost, and age specific mortality rates in relation to cause of death, sex, and year were computed as well as the comparative mortality figure and the ratio of standardised rates of years of potential life lost. RESULTS: Rates of premature mortality increased from 5691.2 years of potential life lost per 100,000 inhabitants aged 1 to 70 years in 1983 to 7606.2 in 1994 in the low socioeconomic level wards, and from 3731.2 to 4236.9 in the other wards, showing an increase in inequalities over the 12 years, mostly due to AIDS and drug overdose as causes of death. Conversely, cerebrovascular disease showed a reduction in inequality over the same period. Overall mortality in the 15-44 age group widened the gap between both groups of wards. CONCLUSION: AIDS and drug overdose are emerging as the causes of death that are contributing to a substantial increase in social inequality in terms of premature mortality, an unreported observation in European urban areas.

Material deprivation and leading causes of death by gender: evidence from a nationwide small area study.

STUDY OBJECTIVE: To investigate the association between material deprivation and 10 leading causes of death by gender. DESIGN: Small area cross sectional ecological study using two dimensions of material deprivation (Index 1 and Index 2) drawn from 1991 census and cause specific mortality data aggregated for 1987-1995. SETTING: 2218 small areas in Spain. MAIN RESULTS: Strong detrimental associations of two deprivation indices were found with top six leading causes of death for men and top seven leading causes of death for women, except breast cancer. For men, the highest percentages of excess mortality (between 40% and 60%) were found for smoking and alcohol related causes of death such as lung cancer, chronic obstructive pulmonary diseases, and cirrhosis while for women the highest percentages of excess mortality (between 40% and 60%) were found for diet related causes such as diabetes and ischaemic heart disease. CONCLUSIONS: Health inequality is a widespread phenomenon in the majority of the top leading causes of deaths of the nation. Increasing levels of deprivation indices are associated with mortality risk differently by both cause and gender. Results suggest that deprivation effects mainly captured by Index 2 may manifest largely as unfavourable health behaviours leading to gender specific sets of causes of deaths. Findings of this study are consistent with the idea that material deprivation determines health inequality through both an increase of general susceptibility to ill health, leading to excess mortality in a wide range of causes, and a set of specific factors, resulting in an increased risk of death from a specific set of causes in each gender.