El efecto del estado civil sobre las desigualdades sociales y de género en la mortalidad por diabetes mellitus en Andalucía / The effect of marital status on social and gender inequalities in diabetes mortality in Andalusia

Objetivos: Evaluar el efecto modificador del estado civil sobre las desigualdades sociales y de género en la mortalidad por diabetes mellitus (DM) en Andalucía. Material y métodos: Estudio transversal a partir de la Cohorte Censal 2001 de Andalucía. Se estudiaron defunciones por DM entre 2002 y 2013 según nivel de estudios y estado civil. Se calcularon tasas de mortalidad ajustadas por edad (TA) y razones de tasas de mortalidad (RTM) mediante modelos de regresión de Poisson, controladas por otras variables sociodemográficas. Se evaluó el efecto modificador del estado civil incorporando a los modelos un término de interacción. Todos los análisis se realizaron separadamente para hombres y mujeres. Resultados: Sobre un total de 4.229.791 sujetos se registraron 18.158 muertes por DM (10.635 mujeres y 7.523 hombres). A medida que disminuye el nivel educativo aumenta el riesgo de muerte. El estado civil modifica la desigualdad social en la mortalidad por DM de forma diferente en cada sexo. Las mujeres viudas y separadas/divorciadas con menor nivel de estudios presentan las mayores RTM: 5,1 (IC95%: 3,6-7,3) y 5,6 (IC95%: 3,6-8,5), respectivamente, mientras que los hombres solteros tienen la RTM más elevada: 3,1 (IC95%: 2,7-3,6). Conclusiones: El nivel de estudios es un determinante fundamental de la mortalidad por DM en ambos sexos; su relevancia es mayor entre las mujeres, mientras que en los hombres también el estado civil es un factor clave. Para abordar las desigualdades en la mortalidad nuestros resultados sugieren que el énfasis actual en los factores individuales y el autocuidado debería extenderse hacia intervenciones sobre la familia, la comunidad y los contextos sociales más cercanos a los pacientes (AU)

Objective: To assess the modifying effect of marital status on social and gender inequalities in mortality from diabetes mellitus (DM) in Andalusia. Material and methods: A cross-sectional study was conducted using the Andalusian Longitudinal Population Database. DM deaths between 2002 and 2013 were analyzed by educational level and marital status. Age-adjusted rates (AARs) and mortality rate ratios (MRRs) were calculated using Poisson regression models, controlling for several social and demographic variables. The modifying effect of marital status on the association between educational level and DM mortality was evaluated by introducing an interaction term into the models. All analyses were performed separately for men and women. Results: There were 18,158 DM deaths (10,635 women and 7,523 men) among the 4,229,791 people included in the study. The risk of death increased as the educational level decreased. Marital status modified social inequality in DM mortality in a different way in each sex. Widowed and separated/divorced women with the lowest educational level had the highest MRRs, 5,1 (95%CI: 3,6-7,3) and 5,6 (95% CI:3,6-8,5) respectively, while single men had the highest MRR, 3,1 (95%CI: 2,7-3,6). Conclusions: Educational level is a key determinant of DM mortality in both sexes, and is more relevant in women, while marital status also plays an outstanding role in men. Our results suggest that in order to address inequalities in DM mortality, the current focus on individual factors and self-care should be extended to interventions on the family, the community, and the social contexts closest to patients (AU)

The effect of marital status on social and gender inequalities in diabetes mortality in Andalusia. / El efecto del estado civil sobre las desigualdades sociales y de género en la mortalidad por diabetes mellitus en Andalucía.

OBJECTIVE: To assess the modifying effect of marital status on social and gender inequalities in mortality from diabetes mellitus (DM) in Andalusia. MATERIAL AND METHODS: A cross-sectional study was conducted using the Andalusian Longitudinal Population Database. DM deaths between 2002 and 2013 were analyzed by educational level and marital status. Age-adjusted rates (AARs) and mortality rate ratios (MRRs) were calculated using Poisson regression models, controlling for several social and demographic variables. The modifying effect of marital status on the association between educational level and DM mortality was evaluated by introducing an interaction term into the models. All analyses were performed separately for men and women. RESULTS: There were 18,158 DM deaths (10,635 women and 7,523 men) among the 4,229,791 people included in the study. The risk of death increased as the educational level decreased. Marital status modified social inequality in DM mortality in a different way in each sex. Widowed and separated/divorced women with the lowest educational level had the highest MRRs, 5,1 (95%CI: 3,6-7,3) and 5,6 (95% CI:3,6-8,5) respectively, while single men had the highest MRR, 3,1 (95%CI: 2,7-3,6). CONCLUSIONS: Educational level is a key determinant of DM mortality in both sexes, and is more relevant in women, while marital status also plays an outstanding role in men. Our results suggest that in order to address inequalities in DM mortality, the current focus on individual factors and self-care should be extended to interventions on the family, the community, and the social contexts closest to patients.