Deaths in collective dwellings and inequalities in small-area mortality: an ecological study in the Madrid region (Spain).

BACKGROUND: Increasing numbers of elderly persons reside and die in institutions, yet there are few studies that analyse the effect of this on mortality in small areas and its ensuing effect on the association between material deprivation and mortality. METHODS: A cross-sectional, ecological study in the region of Madrid covering 3906 census tracts (median 1000 inhabitants), using mortality data for 1996-2003 and socioeconomic deprivation from the 2001 census. Standardised mortality ratios (SMR) were calculated for each census tract. Using the Besag-York-Mollié model, RR of dying and their 95% CI according to the deprivation index considered (with the fourth quartile, Q, being the most unfavourable situation) were calculated for deaths among: the total population and the population excluding residents who died in institutions. RESULTS: 6% of the deceased had been residing in institutions, which affected 16.5% of census sections (644) and accounted for 17% of the variability in SMR among men and 10% among women, p<0.001. Mortality increased with socioeconomic deprivation, whereas the RR for the total population in Q4 with respect to Q1 was 1.46 among men (95% CI 1.41 to 1.50) and 1.12 among women (95% CI 1.08 to 1.17), these figures rose to 1.48 (95% CI 1.43 to 1.53) and 1.14 (95% CI 1.10 to 1.18), respectively, for the population excluding residents who died in institutions. CONCLUSIONS: Deaths of residents in institutions affect the variation in small-area mortality, and confound the relationship between mortality and socioeconomic deprivation. This variable should be recorded in mortality statistics so that its effect can be controlled for in subsequent analyses.

Chronic liver disease and cirrhosis mortality and social deprivation: a spatial analysis in small areas of Madrid region.

OBJECTIVES: To study census-tract distribution of chronic liver disease and cirrhosis mortality in the Madrid Region and its association with socio-economic deprivation. METHODS: Cross-sectional, ecological (3906 census-tract) study, using mortality data for 1996-2003 and a deprivation index drawn up on the basis of 2001 census data. Standardised mortality ratios were calculated taking Spanish rates for 2001 as reference. Smoothed census-tract relative risks were computed using the Besag-York-Mollie model. Relative risks (RRs) of dying and their 95% credibility intervals (95% CIs) were calculated according to quartiles of the deprivation index (with the fourth quartile -Q- of the indicator being the most unfavourable situation). Maps were plotted depicting the distribution of the posterior probability of RR > 1. RESULTS: Census tracts with a high risk of mortality were detected, mostly located in the centre and on the eastern, south-eastern and south-western fringes of the city of Madrid. Mortality increased with deprivation. RRs of mortality according to quartíles of the deprivation index were: Q2 = 1.5 (CI: 1.3-1.6), Q3 = 1.9 (CI:1.7-2.2) and Q4 = 2.5 (CI:2.2-2.8) for men; and Q2 = 1.3 (CI:1.1-1.5), Q3 = 1.5 (CI:1.3-1.7) and Q4 = 1.6 (CI:1.3-1.8) for women. CONCLUSIONS: This small-area study enabled census tracts with excess mortality eligible for a special public health intervention to be identified, and their association with socio-economic deprivation to be confirmed.

Chronic liver disease and cirrhosis mortality and social deprivation: a spatial analysis in small areas of Madrid region / Mortalidad por cirrosis y otras hepatopatías crónicas y privación social: un análisis espacial por áreas pequeñas de la Comunidad de Madrid

Objectives: To study census-tract distribution of chronic liver disease and cirrhosis mortality in the Madrid Region and its association with socio-economic deprivation. Methods: Cross-sectional, ecological (3906 censustract) study, using mortality data for 1996-2003 and a deprivation index drawn up on the basis of 2001 census data. Standardised mortality ratios were calculated taking Spanish rates for 2001 as reference. Smoothed censustract relative risks were computed using the Besag-York-Mollie model. Relative risks (RRs) of dying and their 95% credibility intervals (95% CIs) were calculated according to quartiles of the deprivation index (with the fourth quartile -Q- of the indicator being the most unfavourable situation). Maps were plotted depicting the distribution of the posterior probability of RR > 1. Results: Census tracts with a high risk of mortality were detected, mostly located in the centre and on the eastern, south-eastern and south-western fringes of the city of Madrid. Mortality increased with deprivation. RRs of mortality according to quartíles of the deprivation index were: Q2 = 1.5 (CI: 1.3-1.6), Q3 = 1.9 (CI:1.7-2.2) and Q4 = 2.5 (CI:2.2-2.8) for men; and Q2 = 1.3 (CI:1.1-1.5), Q3 = 1.5 (CI:1.3-1.7) and Q4 = 1.6 (CI:1.3-1.8) forwomen. Conclusions: This small-area study enabled census tracts with excess mortality eligible for a special public health intervention to be identified, and their association with socio-economic deprivation to be confirmed (AU)

Objetivos: Estudiar la distribución por secciones censales de la mortalidad por cirrosis y hepatopatías crónicas de la Comunidad de Madrid y su asociación con la privación socioeconómica. Métodos: Estudio transversal y ecológico (3.906 secciones censales) utilizando los datos del registro de mortalidad de 1996-2003 y un índice de privación construido a partir de los datos del Censo de 2001. Se calcularon razones de mortalidad estandarizadas tomando como referencia las tasas de España del 2001. Los riesgos relativos suavizados de las secciones censales se calcularon siguiendo el modelo Besag-York-Molife. Se han estimado los riesgos relativos (RR) de morir, y su intervalo de credibilidad al 95% (ICI), según los cuartiles del índice de privación (siendo el cuarto cuartil -Q4- del indicador la situación más desfavorable). Se realizaron mapas representando la distribución de la probabilidad posterior de RR > 1. Resultados: Se han detectado secciones censales con alto riesgo de mortalidad localizadas en su mayoría en el centro y la periferia este, sureste y suroeste de la ciudad de Madrid. La mortalidad se incrementa con la privación social: El RR de mortalidad según cuartiles del índice de privación fue: Q2 = 1,5 (CI: 1,3-1,6); Q3 = 1,9 (CI: 1,7-2,2); Q4 = 2,5 (CI: 2,2-2,8), para los hombres; y Q2 = 1,3 (CI: 1,1-1,5); Q3 = 1,5 (CI: 1,3-1,7); Q4 = 1,6 (CI: 1,3-1,8), para las mujeres. Conclusiones: El estudio de áreas pequeñas ha permitido identificar secciones censales con sobremortalidad subsidiarias de una intervención especial de salud pública, así como confirmar su asociación con la privación socioeconómica (AU)

Census tract socioeconomic and physical environment and cardiovascular mortality in the Region of Madrid (Spain).

BACKGROUND: Features of the area might contribute to differences in cardiovascular mortality. The census tract distribution of ischaemic heart disease (IHD) and cerebrovascular disease mortality in the Region of Madrid and its association with deprivation and environmental variables were examined in this study. METHODS: Cross-sectional, ecological study covering 3906 census tracts (median of around 1000 inhabitants), using mortality data (population aged <75 years) for 1996-2003, as well as socioeconomic deprivation and other environmental indicators (subjective perceptions of pollution, background noise, lack of green spaces and delinquency) drawn from the 2001 census. Standardised mortality ratios were calculated. Smoothed census tract relative risks were calculated using the Besag-York-Mollié model. Relative risks (RRs) of dying and their 95% credibility intervals (95% CI) were calculated according to the indicators considered (with the fourth quartile, Q, being the most unfavourable situation). Maps were plotted depicting the distribution of the posterior probability of RR>1. RESULTS: Census tracts with excess mortality were mostly located in the city of Madrid. Mortality increased with deprivation: RRs of IHD and stroke mortality in Q4 with respect to Q1 were 1.42 (95% CI 1.31 to 1.54) and 1.66 (95% CI 1.45 to 1.88) for men, and 1.54 (95% CI 1.33 to 1.79) and 1.52 (95% CI 1.29 to 1.76) for women respectively. Associations with deprivation decreased only slightly when perceived lack of green spaces and delinquency were included in the model. In men, subjective perceptions of areas remained associated with cardiovascular mortality after adjustment for deprivation. CONCLUSION: Deprivation and subjective perceptions of physical environmental characteristics are ecologically associated with cardiovascular disease mortality.

Waterborne outbreak of tularemia associated with crayfish fishing.

In 1997, an outbreak of human tularemia associated with hare-hunting in central Spain affected 585 patients. We describe the identification of Francisella tularensis biovar palaearctica in a second outbreak of ulceroglandular tularemia associated with crayfish (Procambarus clarkii) fishing in a contaminated freshwater stream distant from the hare-associated outbreak. The second outbreak occurred 1 year after the first.