miR-10b and miR-223-3p in serum microvesicles signal progression from prediabetes to type 2 diabetes.

PURPOSE: Type 2 diabetes frequently remains undiagnosed for years, whereas early detection of affected individuals would facilitate the implementation of timely and cost-effective therapies, hence decreasing morbidity. With the intention of identifying novel diagnostic biomarkers, we characterized the miRNA profile of microvesicles isolated from retroactive serum samples of normoglycemic individuals and two groups of subjects with prediabetes that in the following 4 years either progressed to overt diabetes or remained stable. METHODS: We profiled miRNAs in serum microvesicles of a selected group of control and prediabetic individuals participating in the PREDAPS cohort study. Half of the subjects with prediabetes were diagnosed with diabetes during the 4 years of follow-up, while the glycemic status of the other half remained unchanged. RESULTS: We identified two miRNAs, miR-10b and miR-223-3p, which target components of the insulin signaling pathway and whose ratio discriminates between these two subgroups of prediabetic individuals at a stage at which other features, including glycemia, are less proficient at separating them. In global, the profile of miRNAs in microvesicles of prediabetic subjects primed to progress to overt diabetes was more similar to that of diabetic patients than the profile of prediabetic subjects who did not progress. CONCLUSION: We have identified a miRNA signature in serum microvesicles that can be used as a new screening biomarker to identify subjects with prediabetes at high risk of developing diabetes, hence allowing the implementation of earlier, and probably more effective, therapeutic interventions.

The turn of the gradient? Educational differences in breast cancer mortality in 18 European populations during the 2000s.

This study aims to investigate the association between educational level and breast cancer mortality in Europe in the 2000s. Unlike most other causes of death, breast cancer mortality tends to be positively related to education, with higher educated women showing higher mortality rates. Research has however shown that the association is changing from being positive over non-existent to negative in some countries. To investigate these patterns, data from national mortality registers and censuses were collected and harmonized for 18 European populations. The study population included all women aged 30-74. Age-standardized mortality rates, mortality rate ratios, and slope and relative indexes of inequality were computed by education. The population was stratified according to age (women aged 30-49 and women aged 50-74). The relation between educational level and breast cancer mortality was predominantly negative in women aged 30-49, mortality rates being lower among highly educated women and higher among low educated women, although few outcomes were statistically significant. Among women aged 50-74, the association was mostly positive and statistically significant in some populations. A comparison with earlier research in the 1990s revealed a changing pattern of breast cancer mortality. Positive educational differences that used to be significant in the 1990s were no longer significant in the 2000s, indicating that inequalities have decreased or disappeared. This evolution is in line with the "fundamental causes" theory which stipulates that whenever medical insights and treatment become available to combat a disease, a negative association with socio-economic position will arise, independently of the underlying risk factors.

Explaining educational differences in leisure-time physical activity in Europe: the contribution of work-related factors.

Although educational differences in leisure-time physical activity (LTPA) exist across Europe, the independent effect of educational level on leisure-time physical activity has rarely been explored. This study examines the relative contribution of occupational class, employment status, and educational level to LTPA across 12 European countries. The data were obtained from 12 European health surveys conducted at the turn of the century and identified in the EUROTHINE project. All information was self-reported. Logistic regression was applied and relative inequality index (RII) was calculated. Analyses were limited to those in the prime working-age (age 30-59; total N=137,646) men and women. In all 12 European countries, LTPA was more common in the high-educated than in the low-educated. The association between education and LTPA remained mostly unchanged after adjusting for marital status, urbanization, and self-rated health. After further adjusting for occupational class and employment status, the educational differences in LTPA were only slightly attenuated. An inverse association was found between educational level and LTPA across almost all 12 European countries. Occupational class and employment status had only a modest effect on educational differences in LTPA in most of the examined countries, suggesting that education remains an important predictor of LTPA.

No effect of the Penalty Point System on road traffic accident mortality among men with a high socioeconomic status in Spain.

The purpose of this study was to assess the effect of the Penalty Point System (PPS) on road traffic accident mortality by gender and socioeconomic status. We conducted a nationwide prospective study covering adult people living in Spain on November 2001. They were followed up until 30 Nov 2007 to determine vital status and cause of death. An interrupted time-series analysis was used to assess whether PPS (explanatory variable) had both immediate and long-term effect on the rates of road traffic accident mortality (RTAMs) separately by gender. Subjects were classified by socioeconomic status (low and high) using two indicators: educational attainment (up to lower secondary education; upper secondary education or more) and occupation (manual and non-manual workers). We performed several segmented Poisson regression models, controlling for trend, seasonality, 2004 road safety measures and fuel consumption as proxy for traffic exposure. Among men, we found a decrease on the RTAMs immediately after PPS in those with low educational level (16.2 %, IC95 %: 6.1 %-25.2 %) and manual workers (16.3 %, IC95 %: 2.8 %-27.8 %), and a non-significant increase among those with high education level and non-manual workers (6.2 % and 1.8 %). Among women, there were no significant differences in the immediate effect of PPS by socioeconomic status. We did not identify significant trend changes between pre-PPS and post-PPS periods in any socioeconomic group. In a context of downward trend of traffic mortality, the PPS implementation led to an immediate reduction on death rates only among men with a low socioeconomic status.

Long-term impact of the 2008 economic crisis in Spain on road traffic collisions mortality by socioeconomic position.

We aimed to assess the effect of the 2008 crisis on road traffic collision (RTC) mortality in Spain, by socioeconomic position (SEP) and type of road use. This prospective, country-wide study covered all adults living in Spain and aged ≥30 years in November 2001. The long-term effect of the crisis was assessed by measuring the monthly percentage change (MPC) in RTC mortality between the pre-crisis (2002-2007) and crisis period (2008-2011). During the recession, RTC mortality fell more in people with low compared to high SEP, so MPCs difference between periods were of a higher magnitude in the low compared to high SEP groups, especially among men motorcyclists. RTC mortality trends were favorable following the 2008 crisis, particularly among low-SEP groups. In men motorcyclists, the upward trend of the pre-crisis period reversed course.

Trends in principal cancer risk factors in Spain.

Using data furnished by successive national health surveys, this article describes trends in the prevalence of smoking, physical inactivity, obesity, consumption of fruit and vegetables, and excessive alcohol consumption in Spain. For most of these factors, trends are shown since the end of the 1980s, and in the case of smoking, since the end of the 1970s. The findings indicate decreases in smoking--except among women aged 45-64 years--physical inactivity and high-risk alcohol consumption, and increases in consumption of fruit and vegetables, and obesity. The inclusion of these risk factors in cancer prevention strategies continues to be a matter of priority, in some cases because they display high prevalences despite their downward trend, as occurs with smoking among men and physical inactivity in the overall population, and in others because they display an upward trend, e.g. smoking among women aged 45-64 years and obesity in the overall population.

[Frequency of medical consultations in the adult population in Spain, before and after the restriction of access to undocumented immigrants]. / Frecuencia de consultas al médico en población adulta en España, antes y después de la restricción de acceso a los inmigrantes indocumentados.

OBJECTIVE: To study the frequency of medical consultations in autochthonous and immigrant populations in Spain, before and after a government measure of 2012 that restricted the use of public health services to undocumented immigrants. MATERIAL AND METHODS: The data were taken from the European Health Surveys in Spain in 2009 and 2014. An analysis was made of the consultations with the family doctor and the consultations with the medical specialist in autochthonous and immigrant populations from 18 to 64 years. Percentage increases were calculated in the frequency of people who consulted in 2014 with respect to 2009, and, in each year, the percentage ratio (PR) of consultation in immigrants with respect autochthonous, with 95% confidence intervals (95% CI). RESULTS: The frequency of consultations increased in 2014 compared to 2009, with the exception of family doctor's consultation with the autochthonous women. The highest increases occurred in visits to medical specialists in immigrants (39.9%), in autochthonous (21.6%), and in visits by the family doctor to immigrant women. After adjusting for age and socioeconomic variables and indicators of need for assistance, there were no significant differences in both years between immigrants and autochthonous in the 2types of consultations. CONCLUSIONS: The frequency of consultations to the family doctor or medical specialist did not decrease in Spain between 2009 and 2014 in the immigrant population.

Effect of nationwide tobacco control policies on smoking cessation in high and low educated groups in 18 European countries.

BACKGROUND: Recently a scale was introduced to quantify the implementation of tobacco control policies at country level. Our study used this scale to examine the potential impact of these policies on quit ratios in European countries. Special attention was given to smoking cessation among lower educational groups. METHODS: Cross-sectional data were derived from national health surveys from 18 European countries. In the analyses we distinguished between country, sex, two age groups (25-39 and 40-59 years) and educational level. Age-standardised quit ratios were calculated as total former-smokers divided by total ever-smokers. In regression analyses we explored the correlation between national quit ratios and the national score on the Tobacco Control Scale (TCS). RESULTS: Quit ratios were especially high (>45%) in Sweden, England, The Netherlands, Belgium and France and relatively low (<30%) in Lithuania and Latvia. Higher educated smokers were more likely to have quit smoking than lower educated smokers in all age-sex groups in all countries. National score on the tobacco control scale was positively associated with quit ratios in all age-sex groups. The association of quit ratios with score on TCS did not show consistent differences between high and low education. Of all tobacco control policies of which the TCS is constructed, price policies showed the strongest association with quit ratios, followed by an advertising ban. CONCLUSION: Countries with more developed tobacco control policies have higher quit ratios than countries with less developed tobacco control policies. High and low educated smokers benefit about equally from the nationwide tobacco control policies.

Influence of childhood socioeconomic circumstances, height, and obesity on pulse pressure and systolic and diastolic blood pressure in older people.

This study assesses the association of childhood socioeconomic circumstances, height, and obesity with components of blood pressure. We selected 4009 people representative of the Spanish population aged 60 years and older, and estimated systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure (PP) according to childhood social class, height, and obesity. No association was found between childhood social class and blood pressure. SBP showed an inverse gradient and DBP a direct gradient with height, although an independent association between height and DBP was found only in women. Stature was independently associated with increased DBP in women with central obesity, but there was no association between height and DBP in women without central obesity. Short stature was independently associated with increased PP. Body mass index and waist-to-hip ratio were independently associated with increased DBP in women, and waist-to-hip ratio was independently associated with increased PP in men, while waist circumference was independently associated with increased DBP and increased PP in women. These results do not support the assumed effect of socioeconomic circumstances in early life on blood pressure, which may depend on the context and/or study population. The relations observed between height and blood pressure support the hypothesis that PP could be a mediator of the association between short stature and increased cardiovascular risk. The relationship between obesity measures and components of blood pressure reinforces the recommendation to reduce body weight in order to reduce blood pressure.

[Inequalities in premature mortality by indicators of material welfare in Navarre. Population monitoring study 2001-2008]. / Desigualdades en mortalidad prematura según indicadores de bienestarmaterial en Navarra. Estudio poblacional de seguimiento 2001-2008.

BACKGROUND: To show the inequalities in premature mortality according to indicators of material welfare in Navarre. METHODS: All citizens under 75 years of age living in Navarre in 2001 were monitored for seven years to determine their vital status. House size and number of household vehicles was used as the socioeconomic status indicator. The age-adjusted total mortality rate and mortality rate from cause-specific mortality were estimated by these indicators. RESULTS: The rate ratio for all causes of death in the lower categories depending on house size is 1.14 (IC 95%: 1.05-1.24) and 1.25 (IC 95%: 1.18-1.32) in women and men respectively and 1.46 (IC 95%: 1.36-1.57) and 1.97 (IC 95%: 1.89-2.05) depending on the number of vehicles. AIDS is the leading cause of death having a greater difference in mortality rates among people with lower and higher material welfare. Other causes of death with a high difference in mortality rates are digestive diseases and diabetes mellitus in women and digestive diseases and respiratory diseases in men. CONCLUSIONS: The mortality rate in the Navarre population shows an inverse gradient to material welfare,except for some cancer sites. This gradient is higher among men than among women.

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.

Neighbourhood unemployment and all cause mortality: a comparison of six countries.

STUDY OBJECTIVE: Studies have shown that living in more deprived neighbourhoods is related to higher mortality rates, independent of individual socioeconomic characteristics. One approach that contributes to understanding the processes underlying this association is to examine whether the relation is modified by the country context. In this study, the size of the association between neighbourhood unemployment rates and all cause mortality was compared across samples from six countries (United States, Netherlands, England, Finland, Italy, and Spain). DESIGN: Data from three prospective cohort studies (ARIC (US), GLOBE (Netherlands), and Whitehall II (England)) and three population based register studies (Helsinki, Turin, Madrid) were analysed. In each study, neighbourhood unemployment rates were derived from census, register based data. Cox proportional hazard models, taking into account the possible correlation of outcomes among people of the same neighbourhood, were used to assess the associations between neighbourhood unemployment and all cause mortality, adjusted for education and occupation at the individual level. RESULTS: In men, after adjustment for age, education, and occupation, living in the quartile of neighbourhoods with the highest compared with the lowest unemployment rates was associated with increased hazards of mortality (14%-46%), although for the Whitehall II study associations were not statistically significant. Similar patterns were found in women, but associations were not statistically significant in two of the five studies that included women. CONCLUSIONS: Living in more deprived neighbourhoods is associated with increased all cause mortality in the US and five European countries, independent of individual socioeconomic characteristics. There is no evidence that country substantially modified this association.

Trends in obesity differences by educational level in Spain.

Our objective was to study the trend in differences in the frequency of obesity by educational level in the general population 20 to 64 years of age. We used data from two cross-sectional health surveys carried out in 1987 and 1993 in representative samples of the Spanish population. We investigated the relation between obesity and educational level during the periods 1987 and 1993, taking into account the main factors confounding the relation. We used, as setting, the National Health Interview Surveys representative of the whole Spanish population. In both men and women, the highest odds ratios (ORs) for obesity were observed at lower educational levels. These differences increased in women between 1987 and 1993, while they decreased in men during the same period. Evidence of increased educational differences in the frequency of obesity indicates that future studies should focus on the evaluation and monitoring of this trend in the population.

Occupational accidents and alcohol consumption in Spain.

The real impact that alcohol consumption has on occupational accidents is unknown. We estimate the percentage of occupational accidents related to the regular consumption of alcohol in the population through the population attributable proportion (PAP). Spanish National Health Survey data were used to calculate the odds ratio (OR) and prevalence of alcohol consumption. The study restricted the selection of individuals by age and sex, using only interviews of men aged between 16 and 64 years. The results obtained show that approximately 17% of all occupational accidents can be attributable to alcohol consumption; 19% aged 16-24 years, 21% in those aged 25-44, and 9% in those aged 45-64. Although this methodology has some limitations, the advantages of this kind of study are important in public health because the magnitude of the problem, the potential impact of different strategies and the population groups most susceptible to intervention are addressed.

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.

Standardisation or modelling of mortality rates.

STUDY OBJECTIVE: To compare the results obtained when estimating a standardised rate using the conventional technique of stratified analysis and using Poisson regression, and to evaluate the speed of the two techniques in making the calculation. DESIGN: Cross sectional study. SETTING AND PARTICIPANTS: The trend in motor vehicle accident mortality in males from 1985 to 1992 in Spain was compared using stratified analysis and Poisson regression. In the stratified analysis the calculations were made using a specially designed spreadsheet while in the Poisson regression the statistical program used was EGRET. RESULTS: The stratified analysis took two hours and the Poisson regression 15 minutes to complete. In the stratified analysis a single estimate for each year was obtained, whereas the model of Poisson regression that best fitted the data included an interaction term between age and year. CONCLUSION: Poisson regression can be considered a serious alternative to stratified analysis when the objective is to compare mortality rates standardised by one or two variables.

Low birth weight in Spain associated with sociodemographic factors.

STUDY OBJECTIVE: To describe the effect of different social and demographic characteristics on low birth weight (LBW) (less than 2500 g) in Spain, in both preterm (less than 37 weeks' gestation) and term infants (between 37 and 42 weeks' gestation). DESIGN: The study used data obtained from the Spanish birth registry. SETTING: The study was based on those live born infants registered in 1988 from provinces where the birthweight details were completed in at least 99.5% of the birth registration records. PARTICIPANTS: A total of 1332 preterm LBW infants, 1292 term LBW infants, and 38,967 controls were included in the study. MEASUREMENTS AND MAIN RESULTS: The odds ratio (OR) calculated by logistic regression was used as the measure of association between LBW and the sociodemographic variables. The highest ORs of preterm LBW were found in mothers younger than 20 years (1.32; 95% CI 0.98, 1.77) and older than 34 years (1.28; 95% CI 1.04, 1.59), in unmarried mothers (1.68; 95% CI 1.36, 2.07), and in fathers with manual occupations (1.26; 95% CI 1.08, 1.46). In term, live born infants the highest ORs were found in adolescent mothers (1.63; 95% CI 1.25, 2.14), in first born live born infants (1.38; 95% CI 1.09, 1.74) or the fourth born or more (1.28; 95% CI 0.91, 1.80), in unmarried mothers (1.55; 95% CI 1.27, 1.90), in housewives (1.13; 95% CI 0.99, 1.29), and in fathers with manual occupations (1.21; 95% CI 1.04, 1.42). CONCLUSIONS: The results have allowed documentation of the risk of preterm and term LBW in various age and social groups in Spain.

The magnitude of differences in perceived general health associated with educational level in the regions of Spain.

STUDY OBJECTIVE: To examine and compare the relation between inequalities in perceived general health and education in the 17 regions of Spain. DESIGN AND METHODS: Data were taken from the 1993 Spanish Health Interview Survey. For each region we calculated the magnitude of inequality in perceived general health in association with educational level by a measure of association or effect and by a relative index of inequality. Both measures are odds ratios and were estimated by logistic regression. The first is an odds ratio associated with one year less education, while the second represents the inequality in perceived general health between those at the bottom and those at the top of the educational hierarchy. MAIN RESULTS: The six regions with the highest relative indices of inequality also have the highest odds ratios associated with one year less education, and five of the six regions with the lowest relative indices of inequality have the lowest odds ratios associated with one year less education. Pearson's correlation coefficient between the odds ratio and the relative index of inequality is 0.94. CONCLUSIONS: Regional differences in levels of inequality in perceived general health are attributable exclusively to the effect of education on health and not to the distribution of the population among the different educational levels. It is not known why the magnitude of this effect of education on health varies from one area to another.

The size of obesity differences associated with educational level in Spain, 1987 and 1995/97.

OBJECTIVE: To determine the size of obesity differences associated with educational level in the adult population in Spain. DESIGN: Three cross sectional studies representative of the adult population in Spain were carried out in 1987, 1995, and 1997. SETTING: The general population in Spain. PARTICIPANTS: 11 461 men and 10 219 women aged 25 to 64 years. MAIN RESULTS: For both men and women the obesity prevalence was highest in those with elementary education. In 1987 the obesity prevalence proportion associated with less than third level education (PA) was 24.5% (95% CI 6.0 to 42.8) and 47.9% (15.7 to 71.8) in men and women, respectively. The PAs in 1995/97 were 19.8% (0.2 to 40.2) and 55.1% (21.3 to 72.8). CONCLUSIONS: In 1995/97 the burden of obesity associated with less than third level education was 20% in men and 55% in women aged 25 to 64 years. Between 1987 and 1997 the obesity prevalence proportion associated with less than third level education increased in women and decreased in men.

Association between educational level and health related quality of life in Spanish adults.

OBJECTIVE: To analyse differences in health by educational level in Spanish adults by comparing the health dimensions of the SF-36 Heath Survey. DESIGN: Data were taken from the National Survey on Drug Use carried out in February 1996. The information was collected by home personal interview. In addition to measuring the use of legal and illegal drugs and their associated health risks, the health status of the Spanish population was analysed using the Spanish version of the SF-36 Health Survey. MAIN OUTCOME MEASURE: Absolute and standardised differences between mean score on each dimension of the SF-36 Health Survey in each educational group with respect to the group with the highest educational level. RESULTS: Perceived health status declines with decreasing educational level, except in women with second level education who have a higher mean rating than women with third level education on various health dimensions. The absolute differences in perceived health between the different categories of educational level and the reference category become larger with increasing age. The greatest differences by educational level in both men and women were found in mental health and general health among persons 25 to 44 years of age, and in physical function and general health among those 45 to 64 years. In persons aged 65 or older, the greatest differences are seen in physical function and vitality in men, and in bodily pain and emotional role in women. CONCLUSIONS: The influence of educational level on the different dimensions of perceived health may vary by sex.