Implementación de un programa de educación maternal en medio acuático / Implementation of a maternal education program in an aquatic environment

Objetivo: evaluar la efectividad de una intervención de educación maternal en medio acuático guiado por matronas en mujeres gestantes en seguimiento en Atención Primaria.Método: estudio cuasi-experimental, longitudinal y prospectivo. Participarán las mujeres gestantes pertenecientes a los centros de salud adscritos al programa de educación maternal que hayan realizado el seguimiento completo del embarazo en los centros de salud ubicados en el distrito de Usera (Madrid), y cuyo parto haya tenido lugar en el hospital de referencia. El programa de educación maternal consta de seis sesiones de 50 minutos de duración, que incluye ejercicios acuáticos dirigidos por las matronas del centro de salud. La variable principal será el porcentaje de partos eutócicos. Entre las variables secundarias se analizará el control del dolor y el traumatismo perineal. Se llevará a cabo análisis descriptivo. Para la comparación entre grupos se usarán los test estadísticos adecuados al tipo de variables.Conclusión: con la implementación del programa se pretende disminuir la tasa de cesáreas.(AU)

Objective: to evaluate the effectiveness of a maternal education intervention in an aquatic environment and guided by midwives for pregnant women under follow-up by Primary Care.Method: a quasi-experimental, longitudinal and prospective study, which will include pregnant women from the Primary Care centres affiliated with the Maternal Education Program, who have received complete follow-up for their pregnancy in the health centres at the Usera district (Madrid), and with delivery taking place in their hospital of reference. The Maternal Education program consists of six 50-minute sessions, and includes aquatic exercises guided by the Primary Care centre midwives. The primary endpoint will be the proportion of normal deliveries. The secondary endpoints will include the analysis of pain management and perineal trauma. Descriptive analysis will be conducted. The statistical tests adequate for this type of endpoints will be used for comparison between arms.Conclusion: the implementation of the program intends to reduce the rate of Caesarean deliveries.(AU)

¿Refleja la historia clínica electrónica los determinantes sociales de la salud desde Atención Primaria? / Does the Electronic Health Record reflect the social determinants of health from Primary Health Care?

OBJETIVO: Analizar si la utilización de códigos Z en la historia clínica electrónica (HCE) se correlaciona con la realidad socioeconómica de la población atendida en Atención Primaria (AP). DISEÑO: Estudio observacional, descriptivo, transversal, de tipo ecológico. Emplazamiento: 90 centros de salud de dos Direcciones Asistenciales de AP, Comunidad de Madrid. PARTICIPANTES: El total de pacientes atendidos durante el año 2016 fue de 1.920.124 (54,33% mujeres, 45,67% hombres). El 7,15% recibió algún código Z (67,29% mujeres, 32,71% hombres). Mediciones principales: Como variable dependiente se estableció la proporción de pacientes con registros de códigos Z en su HCE. Como variables independientes se seleccionaron dos indicadores socioeconómicos que reflejan de forma objetiva las diferencias entre zonas básicas de salud: renta media disponible per cápita y proporción de inmigrantes económicos. Para evaluar la correlación entre variable dependiente e independientes se recurrió a análisis multivariante de correlación-regresión. RESULTADOS: Se observó que a mayor renta disponible, menor proporción de registros de episodios Z en las HCE (coeficiente de correlación de Pearson: -0,56). Sin embargo, existe una gran variabilidad de registro de códigos Z y la codificación no consigue visibilizar las realidades socioeconómicas de las poblaciones atendidas (odds ratio diagnóstica: 0,12 [IC: 0,05-0,32]). CONCLUSIONES: Resulta relevante para una orientación comunitaria de la AP la utilización de distintas herramientas que faciliten visibilizar el impacto en la salud de las desigualdades sociales, así como su evaluación a través de diversas metodologías de investigación. Los códigos Z no visibilizan en la zona estudiada los determinantes sociales de la salud de la población atendida

OBJECTIVE: Analyze whether the use of Z codes in the Electronic Health Record (EHR) correlates with the socioeconomic reality of the population attended. DESIGN: Observational, descriptive, cross-sectional, ecological study. LOCATION: 90 health centres of two Primary Health Care (PHC) Departments of the Community of Madrid. PARTICIPANTS: The total number of patients treated during 2016: 1,920,124 (54.33% women, 45.67% men). The 7.15% received some Z code (67.29% women, 32.71% men). MAIN MEASUREMENTS: As a dependent variable, the proportion of patients with Z code records in their EHRs was established. As independent variable, two socioeconomic indicators were selected that objectively reflect the differences between Basic Health Areas: Average Income Available per capita and Proportion of Economic Immigrants. To evaluate the correlation between dependent and independent variables, a multivariate correlation-regression analysis was used. RESULTS: It was observed that the higher the disposable income, the lower the proportion of Z code records in the EHRs (Pearson correlation coefficient: -0.56). However, there is a great variability in the registration of Z codes and the coding fails to make visible the socio-economic realities of the populations covered (Diagnostic Odds Ratio: 0.12. CI: 0.05-0.32). CONCLUSIONS: The use of different tools that facilitate the visualization of the health impact of social inequalities, as well as their evaluation through various research methodologies, is relevant for a community orientation of the PHC. The Z codes do not make visible in the studied area the social determinants of health of the population attended

[Does the Electronic Health Record reflect the social determinants of health from Primary Health Care?] / ¿Refleja la historia clínica electrónica los determinantes sociales de la salud desde Atención Primaria?

OBJECTIVE: Analyze whether the use of Z codes in the Electronic Health Record (EHR) correlates with the socioeconomic reality of the population attended. DESIGN: Observational, descriptive, cross-sectional, ecological study. LOCATION: 90 health centres of two Primary Health Care (PHC) Departments of the Community of Madrid. PARTICIPANTS: The total number of patients treated during 2016: 1,920,124 (54.33% women, 45.67% men). The 7.15% received some Z code (67.29% women, 32.71% men). MAIN MEASUREMENTS: As a dependent variable, the proportion of patients with Z code records in their EHRs was established. As independent variable, two socioeconomic indicators were selected that objectively reflect the differences between Basic Health Areas: Average Income Available per capita and Proportion of Economic Immigrants. To evaluate the correlation between dependent and independent variables, a multivariate correlation-regression analysis was used. RESULTS: It was observed that the higher the disposable income, the lower the proportion of Z code records in the EHRs (Pearson correlation coefficient: -0.56). However, there is a great variability in the registration of Z codes and the coding fails to make visible the socio-economic realities of the populations covered (Diagnostic Odds Ratio: 0.12. CI: 0.05-0.32). CONCLUSIONS: The use of different tools that facilitate the visualization of the health impact of social inequalities, as well as their evaluation through various research methodologies, is relevant for a community orientation of the PHC. The Z codes do not make visible in the studied area the social determinants of health of the population attended.

¿Son efectivas las intervenciones psicológicas para mejorar el control de la Diabetes Mellitus tipo 2 en adultos?: una revisión sistemática y metaanálisis / Psychological interventions for patients with type 2 diabetes mellitus. A systematic review and meta-analysis

Background Affordable interventions to improve metabolic control of Type 2-Diabetes Mellitus are increasingly necessary. Aim To review systematically the existing literature on the effects of psychological interventions on Type-2 Diabetes Mellitus compensation. Material and Methods We performed a systematic literature review and meta-analysis on the effectiveness of psychological interventions implemented for Type-2 Diabetes Mellitus patients. Research included the following electronic databases: PubMed, Bireme, Web of Science, SciELO, Embase, EBSCOhost, SCOPUS, Psychology Database. Results Most studies showed a decrease in the level of glycated hemoglobin after interventions, which applied different initiatives complementary to standard medical treatment. Mainly, these interventions encompassed training for self-monitoring and control of diabetes based on cognitive behavioral psychology, counseling, self-assessment and physical-spiritual work based on transpersonal psychology. Conclusions Psychological tools could be an adjunct to the standard medical treatment for patients with Type-2 Diabetes Mellitus, reducing glycated hemoglobin levels and improving self-regulation, disease awareness and adherence from the self-efficacy perception perspective.

Functional analysis of new variants at the low-density lipoprotein receptor associated with familial hypercholesterolemia.

Familial hypercholesterolemia is an autosomal dominant disease of lipid metabolism caused by defects in the genes LDLR, APOB, and PCSK9. The prevalence of heterozygous familial hypercholesterolemia (HeFH) is estimated between 1/200 and 1/250. Early detection of patients with FH allows initiation of treatment, thus reducing the risk of coronary heart disease. In this study, we performed in vitro characterization of new LDLR variants found in our patients. Genetic analysis was performed by Next Generation Sequencing using a customized panel of 198 genes in DNA samples of 516 subjects with a clinical diagnosis of probable or definitive FH. All new LDLR variants found in our patients were functionally validated in CHO-ldlA7 cells. The LDLR activity was measured by flow cytometry and LDLR expression was detected by immunofluorescence. Seven new variants at LDLR were tested: c.518 G>C;p.(Cys173Ser), c.[684 G>T;694 G>T];p.[Glu228Asp;Ala232Ser], c.926C>A;p.(Pro309His), c.1261A>G;p.(Ser421Gly), c.1594T>A;p.(Tyr532Asn), and c.2138delC;p.(Thr713Lysfs*17). We classified all variants as pathogenic except p.(Ser421Gly) and p.(Ala232Ser). The functional in vitro characterization of rare variants at the LDLR is a useful tool to classify the new variants. This approach allows us to confirm the genetic diagnosis of FH, avoiding the classification as "uncertain significant variants", and therefore, carry out cascade family screening.

Efectividad de intervenciones basadas en Mindfulness para mejorar el control de la Diabetes Mellitus tipo 2: una revisión sistemática e integración metanalitica preliminar / Effectiveness of Mindfulness-based interventions to improve control of type 2 diabetes mellitus: a systematic review and preliminary meta-analytic integration

Resumen El propósito de este trabajo fue estudiar la efectividad de intervenciones basadas en Mindfulness sobre el nivel de hemoglobina glicada —HbA1c— en pacientes con diabetes mellitus tipo 2 —DM2—. Se realizó una revisión sistemática e integración metanalítica preliminar. La búsqueda de los estudios se realizó en las siguientes bases: PubMed, Bireme, Web of Science, SciELO, Embase, EBSCOhost, SCOPUS, Psychology Database. Se identificaron 10 artículos: cuatro fueron llevados a cabo en Estados Unidos, dos en Irán, uno en Alemania, uno en Australia, uno en Tailandia y uno en Inglaterra. Se observó una reducción en los niveles de la HbA1c utilizando Mindfulness en comparación a los grupos controles (p < 0,02). Además, se observó un efecto diferenciado al analizar según número de participantes, sexo y tiempo de seguimiento. Se concluyó que el uso de intervenciones basadas en Mindfulness tendría un efecto indirecto sobre la reducción de la hemoglobina glicada.

Abstract The purpose of this paper was to study the effectiveness of Mindfulness-based interventions on the level of glycated hemoglobin —HbA1c— in patients with type 2 diabetes mellitus —DM2—. A systematic review and preliminary meta-analytic integration was performed. The search of the studies was carried out in the following bases: PubMed, Bireme, Web of Science, SciELO, Embase, EBSCOhost, SCOPUS, Psychology Database. Ten articles were identified: four were published in the United States, two in Iran, one in Germany, one in Australia, one in Thailand and one in England. A reduction in HbA1c levels was observed using Mindfulness compared to control groups (p <0,02). In addition, according to the number of participants, sex and time of follow-up a differentiated effect was found. It was concluded that the use of interventions based on Mindfulness would have an indirect effect on the reduction of glycated hemoglobin (HbA1c).

[Psychological interventions for patients with type 2 diabetes mellitus. A systematic review and meta-analysis]. / ¿Son efectivas las intervenciones psicológicas para mejorar el control de la Diabetes Mellitus tipo 2 en adultos?: una revisión sistemática y metaanálisis.

Background Affordable interventions to improve metabolic control of Type 2-Diabetes Mellitus are increasingly necessary. Aim To review systematically the existing literature on the effects of psychological interventions on Type-2 Diabetes Mellitus compensation. Material and Methods We performed a systematic literature review and meta-analysis on the effectiveness of psychological interventions implemented for Type-2 Diabetes Mellitus patients. Research included the following electronic databases: PubMed, Bireme, Web of Science, SciELO, Embase, EBSCOhost, SCOPUS, Psychology Database. Results Most studies showed a decrease in the level of glycated hemoglobin after interventions, which applied different initiatives complementary to standard medical treatment. Mainly, these interventions encompassed training for self-monitoring and control of diabetes based on cognitive behavioral psychology, counseling, self-assessment and physical-spiritual work based on transpersonal psychology. Conclusions Psychological tools could be an adjunct to the standard medical treatment for patients with Type-2 Diabetes Mellitus, reducing glycated hemoglobin levels and improving self-regulation, disease awareness and adherence from the self-efficacy perception perspective.

Variabilidad en la utilización de servicios sanitarios por las personas mayores relacionada con el cupo médico al que pertenecen / Variability in the use of health services by the elderly related to the medical list to which they belong

No disponible

Enfermera familiar o de pediatría: ¿qué modelo de trabajo es más efectivo en Atención Primaria? / Family or Paediatric Nurse, which model of work is more effective in Primary Care?

Objetivo: comparar la efectividad de dos modelos organizativos de atención enfermera, el de Enfermería de Familia (MEF) y el de atención diferenciada de adultos/pediatría (MEA/MEP). Método: estudio observacional transversal. Se estudió la cobertura alcanzada de indicadores procedentes de la Cartera de Servicios y del Contrato Programa de 2014, en todos los Centros de Salud de la Dirección Asistencial Centro de Madrid. Se compararon los resultados entre los centros de salud que trabajaban con cada modelo: MEF vs. MEA/MEP. Resultados: se estudiaron los 49 centros de salud que conforman la Dirección Asistencial Centro de la Comunidad de Madrid, el 43% tenía el modelo de atención MEF y el 57%, el modelo MEA/MEP. Se registraron diferencias de cobertura estadísticamente significativas en 14 de los 15 indicadores, que muestran las desigualdades en los servicios de atención según el modelo MEF o MEA/MEP. Las mayores diferencias se constataron en los indicadores «Pacientes con resultados en planes de cuidados por CIAS de Enfermería», siendo la cobertura superior en el modelo MEF con una RC= 1,68 (IC95% 1,65-1,71) y «Promoción de hábitos saludables en la adolescencia» (201), con resultados de cobertura mayores en el modelo MEA/MEP con RC= 0,63 (IC95% 0,58-0,69). Los coeficientes de variación son excesivos en la práctica totalidad de los indicadores estudiados. Conclusiones: no se puede demostrar que alguno de los dos modelos de organización del trabajo enfermero en Atención Primaria sea claramente más efectivo que el otro. Se detectó una gran variabilidad de resultados entre los centros de salud, independientemente del modelo organizativo (AU)

Objective: to compare the effectiveness of two organization models for nursing care: the Family Nurse Model (FNM) and the Model for Differentiated Care for Adults / Paediatrics (ANM / PNM). Method: an observational transversal study on the coverage reached by the indicators from the Portfolio of Services and the 2014 Contract Program, in all Health Centres from the Healthcare Management for Central Madrid. There was a comparison of the outcomes between the health centres working with each model: FNM vs. ANM/PNM. Results: the study included the 49 health centres within the Healthcare Management for Central Madrid; 43% of them had the FNM Model of Care, and 57% had the ANM/PNM Model. There were statistically significant differences of coverage in 14 of the 15 indicators, showing the disparities in healthcare services according to the FNM or the ANM/PNM model. The highest differences were found in the indicators «Patients with results in healthcare plans by Nursing CIAS (Health Area Identification Codes): coverage was superior in the FNM Model with CR= 1.68 (CI 95% 1.65-1.71) and «Promotion of Healthy Habits in Adolescence» (201), with higher coverage results in the ANM/PNM Model with CR= 0.63 (CI95% 0.58-0.69). Variation coefficients are excessive in practically all the indicators studied. Conclusions: it cannot be demonstrated that any of the two models for the organization of nursing work in Primary Care is clearly more effective than the other. A great variability of results was found between health centres, regardless of their organization model (AU)

Análisis de la influencia del proceso asistencial de la atención primaria de salud sobre la ocurrencia de hospitalizaciones evitables por insuficiencia cardíaca / Analysis of the influence of the process of care in primary health care on avoidable hospitalizations for heart failure

Objetivo: Comprobar si el proceso asistencial en Atención Primaria de Salud (APS), definido por 7 criterios de correcta atención, influye en el riesgo de hospitalizaciones evitables por Ambulatory Care Sensitive Conditions (ACSH) por insuficiencia cardíaca (IC). Diseño: Estudio de casos y controles que analizó el riesgo de hospitalización por IC. Factor de exposición: proceso asistencial de APS. Emplazamiento: Área sanitaria de la Comunidad de Madrid (n = 466.901). Participantes: Pacientes mayores de 14 años con el registro del diagnóstico de IC en la historia clínica electrónica de APS (n = 3.277) antes del 1 de enero de 2007. Los casos fueron pacientes que ingresaron en el hospital de referencia por IC durante 2007. Los controles no requirieron ingreso. Mediciones principales: Riesgo de ACSH por IC relacionado con el proceso asistencial considerado tanto de forma conjunta como por cada uno de los criterios. Diferencias en complejidad clínica mediante Adjusted Clinical Group(ACG). Resultados: Doscientos veintisiete ingresos por IC frente a un grupo control de 3.050 pacientes. El peso medio de ACG fue mayor en los casos. Los controles tuvieron mayor cumplimentación de criterios, pero ninguno cumplió los 7. Solo en 2 de los criterios se observó menor riesgo de ACSH. A medida que no se cumplimentaba progresivamente cada criterio, el riesgo de ingresar aumentó (OR = 1,33; IC 95%: 1,19-1,49). Conclusión: La calidad del proceso asistencial en APS influyó en el riesgo de ingreso por IC (AU)

Objective: To determine if the process of care in primary health, affects the risk of avoidable hospitalizations for ambulatory care sensitive conditions (ACSH) for heart failure (HF). Design: Case-control study analyzing the risk of hospitalization for HF. The exposure factor was the process of care for HF in primary health. Location: Health area of the region of Madrid (n=466.901). Participants: There were included all adult patients (14 years or older) with a documented diagnosis of HF in the electronic medical record of primary health (n = 3.277). The cases were patients who were hospitalized for HF while the controls did not require admission, during 2007. Main measurements: risk of ACSH for HF related to the process of care considered both overall and for each separate standard of appropiate care. Differences in clinical complexity of the groups were measured using the Adjusted Clinical Group (ACG) classification system. Results: 227 cases and 3.050 controls. Clinical complexity was greater in cases. The standards of appropriate care were met to a greater degree in the control group, but none of the two groups met all the standards that would define a process of care as fully appropriate. A significantly lower risk of ACSH was seen for only two standards of appropriate care. For each additional standard of appropriate care not met, the probability of admission was significantly greater (OR: 1,33, 95% CI: 1,19-1,49). Conclusion: Higher quality in the process of care in primary health was associated with a lower risk of hospitalization for HF (AU)

[Analysis of the influence of the process of care in primary health care on avoidable hospitalizations for heart failure]. / Análisis de la influencia del proceso asistencial de la atención primaria de salud sobre la ocurrencia de hospitalizaciones evitables por insuficiencia cardíaca.

OBJECTIVE: To determine if the process of care in primary health, affects the risk of avoidable hospitalizations for ambulatory care sensitive conditions (ACSH) for heart failure (HF). DESIGN: Case-control study analyzing the risk of hospitalization for HF. The exposure factor was the process of care for HF in primary health. LOCATION: Health area of the region of Madrid (n=466.901). PARTICIPANTS: There were included all adult patients (14 years or older) with a documented diagnosis of HF in the electronic medical record of primary health (n=3.277). The cases were patients who were hospitalized for HF while the controls did not require admission, during 2007. MAIN MEASUREMENTS: risk of ACSH for HF related to the process of care considered both overall and for each separate standard of appropiate care. Differences in clinical complexity of the groups were measured using the Adjusted Clinical Group (ACG) classification system. RESULTS: 227 cases and 3.050 controls. Clinical complexity was greater in cases. The standards of appropriate care were met to a greater degree in the control group, but none of the two groups met all the standards that would define a process of care as fully appropriate. A significantly lower risk of ACSH was seen for only two standards of appropriate care. For each additional standard of appropriate care not met, the probability of admission was significantly greater (OR: 1,33, 95% CI: 1,19-1,49). CONCLUSION: Higher quality in the process of care in primary health was associated with a lower risk of hospitalization for HF.

Frequency of hypoglycemia and its impact on length of stay, mortality, and short-term readmission in patients with diabetes hospitalized in internal medicine wards.

OBJECTIVE: To evaluate whether hypoglycemia is associated with increases in length of stay (LOS), inpatient mortality, and readmission among patients with diabetes hospitalized in internal medicine wards. METHODS: A retrospective cohort study was carried out using the Basic Minimum Data Set registry of the Spanish National Health System, which contains clinical and administrative information for every patient discharged from system hospitals. The analysis included patients discharged between January 2005 and December 2010 and had a primary (i.e., reason for the admission) or secondary diagnosis of diabetes and a secondary diagnosis of hypoglycemia. The associations between hypoglycemia and the study outcomes (mortality, readmission, and LOS) were evaluated using multivariate and multilinear regression models that included age, sex, and the Charlson index as covariates. RESULTS: During the study period, 3,361,104 patients were admitted to internal medicine wards in the National Health System. Of these, 921,306 (27.4%) had diagnoses of diabetes, and among these patients, 46,408 (5%) had secondary hypoglycemia. A total of 4,754 (10.2%) patients with secondary hypoglycemia died during their hospital stays, compared with 83,508 (9.5%) patients without hypoglycemia. The multivariate/multilinear regression models demonstrated significant associations between the presence of secondary hypoglycemia and greater inpatient mortality (odds ratio [OR] 1.24, 95% confidence interval [CI] 1.20-1.28), a greater likelihood of readmission (OR 1.20, 95% CI 1.17-1.23), and an increased LOS (ß 1.24, 95% CI 1.15-1.35). CONCLUSION: Hypoglycemia in patients with diabetes hospitalized in internal medicine wards is associated with increases in the LOS, inpatient mortality, and early readmission.

Professional quality of life and organizational changes: a five-year observational study in Primary Care.

BACKGROUND: The satisfaction and the quality of life perceived by professionals have implications for the performance of health organizations. We have assessed the variations in professional quality of life (PQL) and their explanatory factors during a services management decentralization process. METHODS: It was designed as a longitudinal analytical observational study in a Health Area in Madrid, Spain. Three surveys were sent out during an ongoing management decentralization process between 2001 and 2005. The professionals surveyed were divided into three groups: Group I (97.3% physicians), group II (92.5% nurses) and group III (auxiliary personnel). Analysis of the tendency and elaboration of an explanatory multivariate model was made. The PQL -35 questionnaire, based on Karasek's demand-control theory, was used to measure PQL. This questionnaire recognizes three PQL dimensions: management support (MS), workload (WL) and intrinsic motivation (IM). RESULTS: 1444 responses were analyzed. PQL increased 0.16 (CI 95% 0.04-0.28) points in each survey. Group II presents over time a higher PQL score than group I of 0.38 (IC 95% 0.18-0.59) points. There is no difference between groups I and III.For each point that MS increases, PQL increases between 0.44 and 0.59 points. PQL decreases an average of between 0.35 and 0.49 point, for each point that WL increases. Age appears to have a marginal association with PQL (CI 95% 0.00-0.02), as it occurs with being single or not having a stable relationship (CI 95% 0.01-0.41). Performing management tasks currently or in the past is related to poorer PQL perception (CI 95% -0.45 - -0.06), and the same occurs with working other than morning shifts (CI 95% -0.03 - -0.40 points).PQL is not related to sex, location of the centre (rural/urban), time spent working in the organization or contractual situation. CONCLUSION: With the improvement in work control and avoiding increases in workloads, PQL perception can be maintained despite deep organizational changes at the macro-management level. Different professional groups experience different perceptions depending on how the changes impact their position in the organization.

[Differences in mortality in the over-65s in a health area of the community of Madrid]. / Diferencias en la mortalidad de la población mayor de 65 años en un área sanitaria de la Comunidad de Madrid.

OBJECTIVE: To detect the possible differences in risk of mortality of the population aged 65 and over in Health Area 11 of the Community of Madrid and to explore their relationship with economic factors. DESIGN: Observational, retrospective, and ecological-style study. SETTING: Districts and boroughs in Health Area 11 of the Community of Madrid, Spain. PARTICIPANTS: People aged 65 and over. MAIN MEASUREMENTS: The analysed variable was the total deaths occurring in the study population during the period 1996-2001. The standardized mortality rate (SMR) was calculated. As a social/economic indicator, mean available income, stratified in 3 groups, was used. The statistical method used was Poisson regression. RESULTS: The mortality rates oscillated between 37.33 and 91.54 deaths for every thousand inhabitants (SMR ratio, 2.47). In urban areas, in men with level 2 income, mortality was 16% less (P=.0406) than the reference group, whereas in high-income men it was 20% less (P=.0042). In women the rate was about 8% less, though this did not attain statistical significance (P=.3039). The relationship in semi-rural areas was not demonstrated. CONCLUSIONS: The existence of inequalities in the mortality of the population aged 65 or over was demonstrated. There was an inverse relationship between mean available income and mortality in urban areas.

Diferencias en la mortalidad de la población mayor de 65 años en un área sanitaria de la Comunidad de Madrid / Differences in mortality in the over-65s in a health area of the Community of Madrid

Objetivo. Detectar las posibles desigualdades en la mortalidad de la población >= 65 años incluida en el Área Sanitaria 11 de la Comunidad de Madrid (CM) y explorar su relación con factores económicos. Diseño. Observacional, retrospectivo, de tipo ecológico. Emplazamiento. Barrios y municipios del Área Sanitaria 11 de la CM. Participantes. Personas >= 65 años. Mediciones principales. La variable analizada ha sido el total de defunciones acaecidas para la población de estudio durante el período 1996-2001. Se ha calculado la tasa de mortalidad estandarizada (TEM). Como indicador socioeconómico se ha utilizado la renta media disponible (RMD), que se ha estratificado en 3 grupos. Como método estadístico se ha utilizado el análisis de regresión de Poisson. Resultados. Las tasas de mortalidad oscilan entre 37,33 y 91,54 defunciones por cada 1.000 habitantes (razón de TEM = 2,47). En el medio urbano, entre los varones con nivel de renta 2, la mortalidad disminuye el 16% (intervalo de confianza [IC] del 95%, 1-29), mientras que entre los de mayor renta la mortalidad disminuye el 20% (IC del 95%, 7-31) respecto al grupo de referencia; en las mujeres, esta disminución es del 8%, sin alcanzar la significación estadística. No se demuestra relación en el medio semirrural. Conclusiones. Se demuestra que hay desigualdades en la mortalidad de la población >= 65 años y una relación inversa entre el nivel de RMD y la mortalidad en el ámbito urbano

Objective. To detect the possible differences in risk of mortality of the population aged 65 and over in Health Area 11 of the Community of Madrid and to explore their relationship with economic factors. Design. Observational, retrospective, and ecological-style study. Setting. Districts and boroughs in Health Area 11 of the Community of Madrid, Spain. Participants. People aged 65 and over. Main measurements. The analysed variable was the total deaths occurring in the study population during the period 1996-2001. The standardized mortality rate (SMR) was calculated. As a social/economic indicator, mean available income, stratified in 3 groups, was used. The statistical method used was Poisson regression. Results. The mortality rates oscillated between 37.33 and 91.54 deaths for every thousand inhabitants (SMR ratio, 2.47). In urban areas, in men with level 2 income, mortality was 16% less (P=.0406) than the reference group, whereas in high-income men it was 20% less (P=.0042). In women the rate was about 8% less, though this did not attain statistical significance (P=.3039). The relationship in semi-rural areas was not demonstrated. Conclusions. The existence of inequalities in the mortality of the population aged 65 or over was demonstrated. There was an inverse relationship between mean available income and mortality in urban areas