[Cleft lip/palate and flour fortification with folic acid in Chile]. / Fisuras labio-palatinas y fortificación de la harina con ácido fólico en Chile: An exploratory study.

BACKGROUND: The effect of food fortification with folic acid on the incidence of lip-palate fissures (FLP) is under discussion. AIM: To calculate the rate of hospital discharges due to cleft lip and palate (CLP) and explore whether they decreased after the start of folic acid fortification in Chile. MATERIAL AND METHODS: The hospital discharge databases published by the Chilean Ministry of Health were analyzed. The trends of discharge rates due to CLP of children of less than one year of life (ICD-10 Q350-379 code) and live births (lb) were calculated from 1986 to 2012. Variables such as incidence of rubella, poverty rate, obesity in pregnant women, and percentage of women who smoked or drank alcohol in the last month were included. The relative risk (RR) of CLP pre-fortification (1986-1999) and post-fortification (2000-2010) was calculated. Mixed and Prais-Winsten models were used to adjust other variables. RESULTS: The hospital discharge rate due to CLP decreased from 1.88 x 1,000 lb during 1986-1996 to 1.68 x 1,000 lb (RR = 1.09 (95% CI 1.05-1.14, p < 0.001). Prais-Winsten and Mixed models, determined that folic acid fortification is the variable explaining this decrease. During 2004-2011, hospital discharge rates for cleft lip decreased but there was an increase in the figures for cleft lip and palate. CONCLUSIONS: The 9% decrease in hospital discharge rates for CLP is concomitant with wheat folic acid fortification.

[Indoor air pollution by fine particulate matter in the homes of newborns]. / Contaminación intradomiciliaria por material particulado fino (MP2,5) en hogares de recién nacidos.

INTRODUCTION: Air pollution by particulate matter (PM) is a major public health problem. In Chile, the study has focused on outdoor air and PM10, rather than indoor air and PM2.5. Because newborns and infants spend most of their time at home, it is necessary to evaluate the exposure to indoor air pollution in this susceptible population. OBJECTIVE: To determine concentration of PM2.5 in the homes of newborns and identify the emission sources of the pollutants. PATIENTS AND METHOD: The PM2.5 concentration ([PM2.5]) was collected over a 24hour period in 207 households. Baseline sociodemographic information and environmental factors (heating, ventilation, smoking and house cleaning), were collected. RESULTS: The median [PM2.5] was 107.5µg/m3. Family history of asthma was associated with lower [PM2.5] (P=.0495). Homes without heating showed a lower median [PM2.5], 58.6µg/m3, while those using firewood, kerosene, and electricity ranged between 112.5 and 114.9, and coal users' homes reached 162.9µg/m3. Wood using homes had significant differences (P=.0164) in median [PM2.5] whether the stove had complete combustion (98.2µg/m3) vs. incomplete (112.6µg/m3), or a salamander stove (140.6µg/m3). Cigarette smoking was reported in 8.7% of the households, but was not associated with the [PM2.5]. Ventilation was associated with a higher median [PM2.5] (120.6 vs. 99.1µg/m3, P=.0039). CONCLUSION: We found homes with high [PM2.5]. Residential wood consumption was almost universal, and it is associated with the [PM2.5]. Natural ventilation increased MP2.5, probably due to infiltration from outside.

Alcohol-attributable mortality and years of potential life lost in Chile in 2009.

AIMS: The aim of the study was to estimate mortality and years of potential life lost (YPLL) attributable to alcohol consumption in 2009 in Chile. METHODS: The population considered for this study included those 15 years and over. Exposure to alcohol in the population was estimated by triangulating the records of alcohol per capita consumption in Chile with information from the Eighth National Study of Drugs in the General Population (2008). The effect of alcohol consumption on each cause of death (relative risk) was extracted from previously published meta-analyses. With this information we estimated the alcohol-attributable fraction (AAF) and deaths and YPLL due to alcohol consumption. The confidence intervals for the AAF were estimated with Monte Carlo sampling using the estimated variances of the exposure prevalence and relative effect. RESULTS: The estimated total number of deaths attributable to alcohol consumption was 8753 (95% CI: 6257, 11,584) corresponding to 9.8% (95% CI: 7.01%, 12.98%) of all deaths in Chile in 2009. The total estimated YPLL attributable to alcohol were 195,475 (95% CI: 164,287, 227,726), corresponding to 21.5% (95% CI: 18.1%, 25.0%) of total YPLL for that year in Chile. CONCLUSION: Alcohol consumption is a major risk factor and accounts for nearly one of ten deaths in Chile. These results may be used to guide the design of public health policies and evaluations.

The Bangor Gambling Task: Computerized replication and reappraisal of an emotion-based decision task.

Emotion-based decision making (EBDM) is the capacity to make decisions based on prior emotional consequences of actions. Several neuropsychological tasks, using different gambling paradigms and with different levels of complexity, have been designed to assess EBDM. The Bangor Gambling Task (BGT) was created as a brief and simple card gambling-task to assess EBDM. BGT contains a single-card deck and requires participants to decide whether to gamble or not, which can result in wins or losses. Unknown to the participant, the winning probabilities decrease throughout the task (from 0.75 in the first block to 0.25 in the fifth block), requiring participants to reduce their gambling probability to avoid long-term losses. A few studies have offered evidence regarding the BGT convergent validity. However, there are no computerized versions of BGT available, thus slowing the process of gathering information to explore the EBDM mechanisms behind the task, its validity, and clinical usefulness. In this article, we present a computerized version of the BGT using the Matlab environment and make all our code available. We explore BGT's replicability and analyze its probabilistic structure, providing trial-level and block-level analyses. Eighty-one participants performed the computerized version, which followed the same structure as the original version. It took participants 8.5 ± 3.3 minutes to complete the task, which is faster than the paper version. Replicating previous studies, participants diminished their gambling probability throughout the task, learning to inhibit the initially rewarded gambling behavior. This change in gambling probability could be considered a proxy for EBDM. Our analyses suggest that the last blocks are especially sensitive to capturing deficits in EBDM, and we propose some modifications to BGT's original version to enhance the initial exploratory and learning phase. Our results show that the BGT constitutes a quick and simple task to evaluate EBDM capacities.

[Eccema herpético en una paciente con dermatitis atópica].

Background: Eczema herpeticum is an infection caused by herpes simplex virus in patients with atopic dermatitis, among its complications we can find meningitis, encephalitis, acute liver failure, and Staphylococcus aureus infection. Case report: We report the case of a female patient of 5 years of age, with a history of atopic dermatitis complicated by eczema herpeticum, who was treated initially without relief. Her hospital stay was complicated with cross infections, which prolonged her course. Dermatology diagnosed eczema herpeticum. Immediately after the start of treatment, the patient showed improvement. Conclusions: Eczema herpeticum is a rare complication of atopic dermatitis, it must be suspected based on patient history and physical examination. Therefore, early recognition and diagnosis are of clinical importance. Without an appropriate approach, these patients can present shock, sepsis, and death.

Antecedentes: El eccema herpético es una infección causada por el virus del herpes simple, que afecta a pacientes con dermatitis atópica. Las principales complicaciones son meningitis, encefalitis, insuficiencia hepática aguda e infección por Staphylococcus aureus. Reporte de caso: Paciente pediátrica de 5 años, con antecedente de dermatitis atópica complicada con eccema herpético, que recibió tratamiento sin reacción satisfactoria. Durante la hospitalización tuvo infecciones nosocomiales que prolongaron su estancia. Luego de la evaluación por personal del servicio de Dermatología se estableció el diagnóstico de eccema herpético, con adecuado tratamiento, seguimiento y egreso sin complicaciones. Conclusiones: El eccema herpético es una complicación rara de la dermatitis atópica, que debe diagnosticarse con base en los antecedentes personales patológicos y la exploración física adecuada. La atención oportuna es de relevancia clínica, pues los pacientes pueden tener complicación serias (choque, sepsis, incluso la muerte). Palabras clave: Eccema herpético; dermatitis atópica; infección nosocomial; Staphylococcus aureus.

Urinary Arsenic Concentration and Its Relationship with Bronchial Asthma in Children from Arica, Chile.

In the city of Arica, northern Chile, the population has been involuntarily exposed to arsenic of natural and anthropogenic origin. This study aims to evaluate the association between urinary arsenic concentration and bronchial asthma diagnosis in the children of Arica. A cross-sectional analysis of a database of 1892 subjects under 18 years of age enrolled in the Environmental Health Centre between 2009 and 2021 was carried out. Arsenic exposure was obtained from a urine sample and bronchial asthma diagnosis from the database of the system for the management of explicit health guarantees. Logistic regression models were used to assess the association between inorganic arsenic and asthma. The median inorganic arsenic was 15 µg/L, and the prevalence of asthma was 7.4%. After adjusting for sex, age, ethnicity, and urinary creatinine, children with the highest tertile of urinary arsenic concentration (≥21.4 µg/L) had a greater chance of developing asthma (odds ratio (OR) 1.90; 95% confidence interval (CI) [1.13-3.18]). When exploring the modifying effect of ethnicity, the association increased among children belonging to any ethnic group (OR 3.51, 95%CI [1.43-8.65]). These findings suggest a relationship between arsenic exposure and bronchial asthma in children. While further studies are needed to assess the impact of arsenic on respiratory health, mitigation efforts to reduce arsenic exposure should be maintained.

Exposure to lead from a storage site associated with intellectual impairment in Chilean children living nearby.

This study assesses the degree of impairment of children's IQ scores due to exposure to lead from a storage site. In 2005, we studied 192 children in Antofagasta, Chile, age 7-16 years who had been exposed to a lead storage site from birth until its removal in 1998. We used past (1998) and current (2005) blood lead levels as explanatory variables for IQ, which was measured once in 2005 using the WISC-r test. Multilevel mixed-effects linear regression models were constructed, adjusting for potential confounders. Current blood lead level (BPb, 2005) was associated with a significant decrease in full-scale IQ (P value = 0.03), whereas blood lead level measured in 1998 (BPb, 1998) showed an inverse but not significant association with full-scale IQ (P value = 0.35). The findings provide evidence that exposure to an open source of environmental lead can exert an effect on IQ. Policy efforts should be targeted to prevent lead exposure to avoid children's intellectual impairment.

Effect of periodontal treatment in patients with periodontitis and diabetes: systematic review and meta-analysis.

OBJECTIVE: The evidence is inconclusive regarding the effect of periodontal treatment on glycemic control and systemic inflammation in patients with type 2 diabetes (T2D) and periodontitis. To evaluate the effect of scaling and root planing (SRP) on the metabolic control and systemic inflammation of patients with type 2 diabetes (T2D). METHODOLOGY: A literature search was conducted using the MEDLINE database via PubMed and the Cochrane Central Register of Controlled Trials, from their oldest records up to July 2018. Only randomized clinical trials (RCT) were considered eligible for evaluating the effect of periodontal treatment on markers of metabolic control [glycated hemoglobin (HbA1C)] and systemic inflammation [C-reactive protein (CRP)] in patients with T2D. The quality of the studies was evaluated using the Cochrane Collaboration risk assessment tool. Meta-analyses were performed for HbA1c and CRP using random effects models. The size of the overall intervention effect was estimated by calculating the weighted average of the differences in means (DM) between the groups in each study. Heterogeneity was assessed using the Q-statistic method (x2 and I²). The level of significance was established at p<0.05. RESULTS: Nine RCT were included. SRP was effective in reducing HbA1c [DM=0.56 (0.36-0.75); p<0.01] and CRP [DM=1.89 (1.70-2.08); p<0.01]. No heterogeneity was detected (I2=0%, p>0.05). CONCLUSIONS: SRP has an impact on metabolic control and reduction of systemic inflammation of patients with T2D.

Higher infant blood lead levels with longer duration of breastfeeding.

OBJECTIVE: To determine whether longer breastfeeding is associated with higher infant lead concentrations. STUDY DESIGN: Data were analyzed from 3 studies of developmental effects of iron deficiency in infancy: Costa Rica (1981-1984), Chile (1991-1996), and Detroit (2002-2003). The relation between duration of breastfeeding and lead levels was assessed with Pearson product-moment or partial correlation coefficients. RESULTS: More than 93% of the Costa Rica and Chile samples was breastfed (179 and 323 breastfed infants, respectively; mean weaning age, 8-10 months), as was 35.6% of the Detroit sample (53 breastfed infants; mean weaning age, 4.5 months). Lead concentrations averaged 10.8 microg/dL (Costa Rica, 12-23 months), 7.8 microg/dL (Chile, 12 months), and 2.5 microg/dL (Detroit, 9-10 months). Duration of breastfeeding as sole milk source and total breastfeeding correlated with lead concentration in all samples (r values = 0.14-0.57; P values = .06-<.0001). CONCLUSIONS: Longer breastfeeding was associated with higher infant lead concentration in 3 countries, in 3 different decades, in settings differing in breastfeeding patterns, environmental lead sources, and infant lead levels. The results suggest that monitoring lead concentrations in breastfed infants be considered.

Structural Equation Modelling in the exploration and analysis of intrauterine environmental exposures with infant health effects.

INTRODUCTION: In epidemiology, generalized linear models are the main statistical methods used to explore associations. However, the use of other methods such as Structural Equation Modelling (SEM) is gradually increasing. OBJECTIVE: The aim of the study was to illustrate the use of SEM in the assessment of salivary cortisol concentration in infants as a biomarker of perinatal exposure to inorganic arsenic. MATERIAL AND METHODS: This was a cohort study of pregnant women recruited from public health care centres in Arica, Chile, in 2013. Socio-demographic information and urine samples to assess inorganic arsenic were collected during the second trimester of pregnancy. Saliva samples were collected to assess cortisol in infants between 18-24 months of age. Four linear regression models (LRMs) and two SEMs were run to estimate the effect of prenatal exposure to inorganic arsenic on cortisol concentration in infants. RESULTS: According to LRMs and SEMs, prenatal exposure to inorganic arsenic and salivary cortisol were not associated. However, the association between maternal cortisol and cortisol in infants was statistically significant in all models; for each increase in standard deviation of the covariate Ln(maternal cortisol), the outcome Ln(cortisol in infant) increased by 0.49 units of variance in both SEMs. CONCLUSIONS: LRMs and SEMs were useful to assess the effect of prenatal exposure to inorganic arsenic on cortisol in infants. However, SEM allowed the adjustment of estimations by an estimated latent that obtained the information about income, occupation, education and ethnicity in a more comprehensive way than achieved by LRM.

Is prenatal arsenic exposure associated with salivary cortisol in infants in Arica, Chile? An exploratory cohort study.

INTRODUCTION: In animal models, gestational exposure to inorganic arsenic has been associated with higher corticosterone concentration and consequent impairment of stress control in offspring. An equivalent association relating cortisol, a glucocorticoid hormone, in humans has not been previously studied. OBJECTIVE: The aim of the study was to explore the association between prenatal inorganic arsenic exposure and salivary cortisol in infants from Arica, Chile. MATERIAL AND METHODS: A cohort study of 168 mother-child dyads was recruited. In the 2nd trimester of pregnancy, urinary inorganic arsenic was assessed; 18-24 months after delivery, salivary cortisol was measured in the children. Maternal cortisol, maternal depression, stress, and socio-economic status were also evaluated. RESULTS: The adjusted association was estimated with multiple linear regression after evaluating confounding through a directed acyclic graph. Median urinary inorganic arsenic in pregnant women was 14.1 µg/L (IQR: 10.4-21.7) while salivary cortisol in the children was 0.17 µg/L (IQR: 0.11-0.38). Among children from the highest income families (> 614 USD/month), arsenic exposure was associated with salivary cortisol. Children in the third quartile of arsenic exposure had -0.769 units of the logarithm of salivary cortiso, compared with those in the first quartile (p = 0.045). CONCLUSIONS: In this sample, prenatal exposure to arsenic was associated with salivary cortisol (third quartile of inorganic arsenic), only in infants belonging the highest income strata (> 614 USD). More studies are needed to confirm these preliminary results.

Multi-level modeling of social factors and preterm delivery in Santiago de Chile.

BACKGROUND: Birth before the 37th week of gestation (preterm birth) is an important cause of infant and neonatal mortality, but has been little studied outside of wealthy nations. Chile is an urbanized Latin American nation classified as "middle-income" based on its annual income per capita of about $6000. METHODS: We studied the relations between maternal social status and neighborhood social status on risk of preterm delivery in this setting using multilevel regression analyses of vital statistics data linked to geocoded decennial census data. The analytic data set included 56,970 births from 2004 in the metropolitan region of Santiago, which constitutes about 70% of all births in the study area and about 25% of all births in Chile that year. Dimensionality of census data was reduced using principal components analysis, with regression scoring to create a single index of community socioeconomic advantage. This was modeled along with years of maternal education in order to predict preterm birth and preterm low birthweight. RESULTS: Births in Santiago displayed an advantaged pattern of preterm risk, with only 6.4% of births delivering before 37 weeks. Associations were observed between risk of outcomes and individual and neighborhood factors, but the magnitudes of these associations were much more modest than reported in North America. CONCLUSION: While several potential explanations for this relatively flat social gradient might be considered, one possibility is that Chile's egalitarian approach to universal prenatal care may have reduced social inequalities in these reproductive outcomes.

Urinary Inorganic Arsenic Concentration and Gestational Diabetes Mellitus in Pregnant Women from Arica, Chile.

Introduction: The association of total arsenic exposure with impaired glucose tolerance and gestational diabetes has been shown; however, evidence regarding urinary inorganic arsenic in pregnant women is still limited. Our aim was to evaluate the association between urinary inorganic arsenic concentration and gestational diabetes among pregnant women living in Arica, Chile. Methods: Cross-sectional study of pregnant women receiving care at primary health centers in urban Arica. The exposure was urinary inorganic arsenic concentration, while gestational diabetes was the outcome. The association was evaluated using multiple logistic regression models adjusted by age, education level, ethnicity, and pre-pregnancy body mass index. Results: 244 pregnant women were surveyed. The median urinary inorganic arsenic was 14.95 μg/L, and the prevalence of gestational diabetes was 8.6%. After adjusting, we did not find a significant association between gestational diabetes and inorganic arsenic exposure tertiles (Odds ratio (OR) 2.98, 95% CI = 0.87⁻10.18), (OR 1.07, 95% CI = 0.26⁻4.33). Conclusion: This study did not provide evidence on the relationship between urinary inorganic arsenic concentration and gestational diabetes. Further research is needed to elucidate the factors underlying this association.

Breast-feeding and mental and motor development at 51/2 years.

OBJECTIVE: Breast-feeding is associated with better child development outcomes, but uncertainty remains primarily due to the close relationship between breast-feeding and socioeconomic status. This study assesses the issue in a low socioeconomic status sample where breast-feeding was close to universal. METHODS: Seven hundred eighty-four Chilean children were followed longitudinally from infancy. All but four were initially breastfed, 40% nursed beyond 12 months, and infant growth was normal. Child development was assessed at 5(1/2) years by a cognitive, language, and motor test battery. The duration of breast-feeding as the sole milk source was analyzed as a continuous variable, adjusting for a comprehensive set of background factors. RESULTS: The relationship between breast-feeding and most 5(1/2)-year developmental outcomes was nonlinear, with poorer outcome for periods of breast-feeding as the sole milk source for <2 months or >8 months--statistically significant for language, motor, and one comprehensive cognitive test, with a suggestive trend for IQ. CONCLUSIONS: The observed nonlinear relationships showed that breast-feeding as the sole milk source for <2 months or >8 months, compared with 2-8 months, was associated with poorer development in this sample. The latter finding requires replication in other samples where long breast-feeding is common and socioeconomic status is relatively homogeneous.

Geographical distribution of alcohol-attributable mortality in Chile: a Bayesian spatial analysis.

OBJECTIVE: To describe the distribution of alcohol-attributable mortality (AAM) at the local level (345 municipalities) in Chile, including fully and partially attributable causes in 2009. METHODS: AAM was estimated for the population 15years of age and older using per capita alcohol consumption combined with survey estimates. The effect of alcohol on each cause of death was extracted from the published scientific literature. We used Bayesian hierarchical models to smooth the Standardized Mortality Ratio for each municipality for six groups of causes related to alcohol consumption (total, neuro-psychiatric, cardiovascular, cancer, injuries and other causes). RESULTS: The percentage of municipalities with high risk for any group of causes in each region ranges from 0% to 87.0%. Municipalities with high risk were concentrated in south-central and southern Chile for all groups of causes related to alcohol. CONCLUSIONS: AAM risk shows marked geographic concentrations, mainly in south-central and southern regions of Chile. This combination of methods for small-area estimates of AAM is a powerful tool to identify high risk regions and associated factors, and may be used to inform local policies and programs.

Effect of periodontal treatment in patients with periodontitis and diabetes: systematic review and meta-analysis

Abstract The evidence is inconclusive regarding the effect of periodontal treatment on glycemic control and systemic inflammation in patients with type 2 diabetes (T2D) and periodontitis Objective: To evaluate the effect of scaling and root planing (SRP) on the metabolic control and systemic inflammation of patients with type 2 diabetes (T2D). Methodology: A literature search was conducted using the MEDLINE database via PubMed and the Cochrane Central Register of Controlled Trials, from their oldest records up to July 2018. Only randomized clinical trials (RCT) were considered eligible for evaluating the effect of periodontal treatment on markers of metabolic control [glycated hemoglobin (HbA1C)] and systemic inflammation [C-reactive protein (CRP)] in patients with T2D. The quality of the studies was evaluated using the Cochrane Collaboration risk assessment tool. Meta-analyses were performed for HbA1c and CRP using random effects models. The size of the overall intervention effect was estimated by calculating the weighted average of the differences in means (DM) between the groups in each study. Heterogeneity was assessed using the Q-statistic method (x2 and I²). The level of significance was established at p<0.05. Results: Nine RCT were included. SRP was effective in reducing HbA1c [DM=0.56 (0.36-0.75); p<0.01] and CRP [DM=1.89 (1.70-2.08); p<0.01]. No heterogeneity was detected (I2=0%, p>0.05). Conclusions: SRP has an impact on metabolic control and reduction of systemic inflammation of patients with T2D.

Chile Confronts its Environmental Health Future After 25 Years of Accelerated Growth.

BACKGROUND: Chile has recently been reclassified by the World Bank from an upper-middle-income country to a high-income country. There has been great progress in the last 20 to 30 years in relation to air and water pollution in Chile. Yet after 25 years of unrestrained growth, there remain clear challenges posed by air and water pollution, as well as climate change. OBJECTIVE: The aim of this study was to review environmental health in Chile. METHODS: In late 2013, a 3-day workshop on environmental health was held in Santiago, Chile, bringing together researchers and government policymakers. As a follow-up to that workshop, here we review the progress made in environmental health in the past 20 to 30 years and discuss the challenges of the future. We focus on air and water pollution and climate change, which we believe are among the most important areas of environmental health in Chile. RESULTS: Air pollution in some cities remains among the highest in the continent. Potable water is generally available, but weak state supervision has led to serious outbreaks of infectious disease and ongoing issues with arsenic exposure in some regions. Climate change modeling in Chile is quite sophisticated, and a number of the impacts of climate change can be reasonably predicted in terms of which areas of the country are most likely to be affected by increased temperature and decreased availability of water, as well as expansion of vector territory. Some health effects, including changes in vector-borne diseases and excess heat mortality, can be predicted. However, there has yet to be an integration of such research with government planning. CONCLUSIONS: Although great progress has been made, currently there are a number of problems. We suspect that the Chilean experience in environmental health may be of some use for other Latin American countries with rapid economic development.

Rapid drop in infant blood lead levels during the transition to unleaded gasoline use in Santiago, Chile.

This study was conducted to relate blood lead levels in infants to changes in lead emissions in Santiago, Chile, a heavily polluted setting where leaded gasoline began to be replaced with unleaded gasoline in 1993. Over an 18-mo period, 422 infants had blood lead levels, cotinine, and iron status determined at 12 mo. Blood lead levels fell at an average rate of 0.5 microg/dl every 2 mo, from 8.3 to 5.9 microg/dl, as the city experienced a net fall of 30% in the quantity of leaded gasoline sold. Time progression, car ownership, serum cotinine, and type of housing were significantly associated with a blood lead level > or = 10 microg/dl. In this study, the authors demonstrated that infant blood lead levels, even if relatively low, can drop very rapidly in conjunction with decreases in environmental lead exposure.

Small area associations between social context and alcohol-attributable mortality in a middle income country.

BACKGROUND: Little is known about the association between alcohol-attributable mortality and small area socioeconomic variables when considering causes both wholly and partially attributable to alcohol. METHODS: An ecological study was conducted of the entire Chilean population aged 15 and older in 345 municipalities nationwide between 2004 and 2009. Deaths were attributed to alcohol consumption either wholly or partially, along with the estimated attributable fractions for each specified cause. Each municipality was characterized according to its average income and educational attainment. Estimates of the ecological associations were produced using a hierarchical Bayesian model, separating out deaths caused by alcohol and dividing them into seven groups of causes. RESULTS: Alcohol-attributable mortality risk showed an inverse association with income and education at the ecological level. A one-quintile increase in income was associated with an average decrease in risk of 10% (CI 95%: 10-20%) for cardiovascular deaths, 8% (6-10%) for intentional injuries and 7% (3-11%) for unintentional injuries. No associations were found between deaths due to cancers and other causes with income and education. CONCLUSIONS: Municipalities with lower income and education have higher risk of alcohol-attributable mortality in Chile.