[Inequalities in Total Mortality and by Cause of Death According to the Level of Education in Navarra: findings from a Longitudinal Study from 2001 to 2008]. / Desigualdades en mortalidad total y por causa de muerte según el nivel de estudios en Navarra: hallazgos de un estudio longitudinal 2001-2008.

BACKGROUND: Due to the lack of evidence, the objective was to show the inequalities in mortality by educational level in Navarra and the contribution of the main causes of death to the magnitude of inequalities in mortality from all causes of death. METHODS: All citizens aged 25 years and older residing in Spain in 2001 were followed during 7 years to determine their vital status. Level of education was used as socioeconomic status indicator. It was estimated the age-adjusted total mortality rate and mortality rate from cause-specific mortality by educational level. Then it was calculated the relative difference (ratio) and the absolute difference in rates between the lowest and highest levels of education and the contribution of the main causes of death to the absolute difference. RESULTS: The rate ratio for all causes of death was 1.37 in men and 1.23 in women. The human immunodeficiency virus (HIV) (25.84) and unintentional injuries (3.78) are the causes of death with higher rate ratio in men and diabetes (4.92) and HIV (4.38) in women. Cardiovascular diseases were the leading causes of death that contribute most to the absolute difference in mortality: 26% in men and 48% women. CONCLUSIONS: The mortality rate in the Navarre population shows an inverse gradient with educational level, except in some cancer sites. Cardiovascular disease is the leading cause of death that contributes most to the absolute inequalities in mortality, while other causes of death that show significant relative inequalities, contribute little to the absolute inequalities.

STRAIGHT-A STUDENTS DISLIKE PHYSICAL EDUCATION IN ADOLESCENCE: MYTH OR TRUTH? THE AVENA, AFINOS AND UP&DOWN STUDIES.

OBJECTIVE: to examine if those adolescents who dislike physical education classes get better results on academic and cognitive performance than their peers. METHODS: participants included 4 226 adolescents from the AVENA, AFINOS and UP&DOWN studies. Physical education enjoyment was assessed with a 7-point Likert scale. Cognitive performance in the AVENA study was assessed using the Spanish version of the SRA Test of Educational Ability. Academic performance in the AFINOS and UP&DOWN studies was assessed through Mathematics and Language grades and the average of both subjects. RESULTS: in the AVENA study we found differences in verbal ability among girls who dislike physical education and their peers (P = 0.033). In the AFINOS study, boys who dislike physical education had higher scores in Language than their peers (P = 0.024). In the UP&DOWN study girls who disliked physical education had higher scores in Language and in the average of Language and Mathematics than their peers (P < 0.001). CONCLUSION: in the AVENA and AFINOS studies adolescents who disliked physical education had similar results in cognitive and academic performance than their peers, but in the UP&DOWN study girls who disliked physical education showed higher results in academic performance than their peers.

Objetivo: conocer si a aquellos adolescentes que no les gusta la educación física obtienen mejores resultados en rendimiento académico y cognitivo que sus compañeros. Métodos: los participantes incluyen 4.226 adolescentes de los estudios AVENA, AFINOS y UP&DOWN. El gusto por la educación física se valoró con una escala Likert de 7 puntos. El rendimiento cognitivo se valoró en el estudio AVENA usando la versión española del SRA Test of Educational Ability. El rendimiento académico se valoró en los estudios AFINOS y UP&DOWN con las notas de Matemáticas, Lengua y la media de Lengua y Matemáticas. Resultados: en el estudio AVENA encontramos diferencias en la habilidad verbal entre las chicas a las que no les gustaba la educación física y sus compañeros (P = 0,033). En el estudio AFINOS los chicos a los que no les gustaba la educación física tenían mejores notas en Lengua que sus compañeros (P = 0,024). En el estudio UP&DOWN las chicas a las que no les gustaba la educación física obtuvieron mejores resultados en Lengua y en la media de Lengua y Matemáticas (P < 0,001). CONCLUSION: en los estudios AVENA y AFINOS los adolescentes a los que no les gusta la educación física obtuvieron resultados similares a los que sus compañeros, mientras que en el estudio UP&DOWN las chicas a las que no les gustaba la educación física obtuvieron mejores resultados en rendimiento académico que sus compañeros.

Straight-A students dislike physical education in adolescence: myth or truth? The AVENA, AFINOS and UP&DOWN studies / A los mejores estudiantes no les gusta la educación física durante la adolescencia ¿mito o realidad? Los estudios AVENA, AFINOS y UP&DOWN

Objective: to examine if those adolescents who dislike physical education classes get better results on academic and cognitive performance than their peers. Methods: participants included 4 226 adolescents from the AVENA, AFINOS and UP&DOWN studies. Physical education enjoyment was assessed with a 7-point Likert scale. Cognitive performance in the AVENA study was assessed using the Spanish version of the SRA Test of Educational Ability. Academic performance in the AFINOS and UP&DOWN studies was assessed through Mathematics and Language grades and the average of both subjects. Results: in the AVENA study we found differences in verbal ability among girls who dislike physical education and their peers (P=0.033). In the AFINOS study, boys who dislike physical education had higher scores in Language than their peers (P=0.024). In the UP&DOWN study girls who disliked physical education had higher scores in Language and in the average of Language and Mathematics than their peers (P<0.001). Conclusion: in the AVENA and AFINOS studies adolescents who disliked physical education had similar results in cognitive and academic performance than their peers, but in the UP&DOWN study girls who disliked physical education showed higher results in academic performance than their peers (AU)

Objetivo: conocer si a aquellos adolescentes que no les gusta la educación física obtienen mejores resultados en rendimiento académico y cognitivo que sus compañeros. Métodos: los participantes incluyen 4.226 adolescentes de los estudios AVENA, AFINOS y UP&DOWN. El gusto por la educación física se valoró con una escala Likert de 7 puntos. El rendimiento cognitivo se valoró en el estudio AVENA usando la versión española del SRA Test of Educational Ability. El rendimiento académico se valoró en los estudios AFINOS y UP&DOWN con las notas de Matemáticas, Lengua y la media de Lengua y Matemá- ticas. Resultados: en el estudio AVENA encontramos diferencias en la habilidad verbal entre las chicas a las que no les gustaba la educación física y sus compañeros (P=0,033). En el estudio AFINOS los chicos a los que no les gustaba la educación física tenían mejores notas en Lengua que sus compañeros (P=0,024). En el estudio UP&DOWN las chicas a las que no les gustaba la educación física obtuvieron mejores resultados en Lengua y en la media de Lengua y Matemáticas (P<0,001). Conclusion: en los estudios AVENA y AFINOS los adolescentes a los que no les gusta la educación física obtuvieron resultados similares a los que sus compañeros, mientras que en el estudio UP&DOWN las chicas a las que no les gustaba la educación física obtuvieron mejores resultados en rendimiento académico que sus compañeros (AU)

Desigualdades en mortalidad total y por causa de muerte según el nivel de estudios en navarra: hallazgos de un estudio longitudinal 2001-2008 / Inequalities in Total Mortality and by Cause of Death According to the Level of Education in Navarra: Findings from a Longitudinal Study from 2001 to 2008

Fundamentos: Dada la ausencia de evidencia científica, el objetivo fue mostrar las desigualdades en mortalidad según el nivel de estudios en Navarra y la contribución de las principales causas de defunción a la magnitud de desigualdades en la mortalidad por todas las causas de muerte. Métodos: Todos los ciudadanos de 25 años y mayores residentes en Navarra en 2001 fueron seguidos durante 7 años para conocer su estado vital. El indicador de posición socioeconómica utilizado fue el nivel de estudios. Se estimaron las tasas de mortalidad general y por causa de muerte ajustadas por edad según la educación. Posteriormente, se calcularon la diferencia relativa (razón) y la diferencia absoluta de tasas entre las categorías más baja y más alta de nivel de estudios y la contribución de las principales causas de muerte a la diferencia absoluta. Resultados: La razón de tasas por todas las causas de muerte fue 1,37 en hombres y 1,23 en mujeres. El virus de la inmunodeficiencia humana (VIH) (25,84) y los accidentes no intencionales (3,78) presentaron las razones de tasas más altas en los hombres y la diabetes mellitus (4,92) y el VIH (4,38) en las mujeres. Las enfermedades cardiovasculares constituyeron la causa de muerte que más contribuyó a la diferencia absoluta en mortalidad: 26% en hombres y 48% en mujeres. Conclusiones: La tasa de mortalidad en la población navarra muestra un gradiente inverso con el nivel educativo, a excepción de algunas localizaciones de cáncer. Las enfermedades cardiovasculares son la causa de muerte que más contribuye a las desigualdades absolutas en mortalidad, mientras que otras causas de muerte que muestran importantes desigualdades relativas contribuyen poco a las desigualdades absolutas (AU)

Background: Due to the lack of evidence, the objective was to show the inequalities in mortality by educational level in Navarra and the contribution of the main causes of death to the magnitude of inequalities in mortality from all causes of death. Methods: All citizens aged 25 years and older residing in Spain in 2001 were followed during 7 years to determine their vital status. Level of education was used as socioeconomic status indicator. It was estimated the age-adjusted total mortality rate and mortality rate from cause-specific mortality by educational level. Then it was calculated the relative difference (ratio) and the absolute difference in rates between the lowest and highest levels of education and the contribution of the main causes of death to the absolute difference. Results: The rate ratio for all causes of death was 1.37 in men and 1.23 in women. The human immunodeficiency virus (HIV) (25.84) and unintentional injuries (3.78) are the causes of death with higher rate ratio in men and diabetes (4.92) and HIV (4.38) in women. Cardiovascular diseases were the leading causes of death that contribute most to the absolute difference in mortality: 26% in men and 48% women. Conclusions: The mortality rate in the Navarre population shows an inverse gradient with educational level, except in some cancer sites. Cardiovascular disease is the leading cause of death that contributes most to the absolute inequalities in mortality, while other causes of death that show significant relative inequalities, contribute little to the absolute inequalities (AU)

The role of population change in the increased economic differences in mortality: a study of premature death from all causes and major groups of causes of death in Spain, 1980-2010.

BACKGROUND: An increase has been observed in differences in mortality between the richest and poorest areas of rich countries. This study assesses whether one of the proposed explanations, i.e., population change, might be responsible for this increase in Spain. METHODS: Observational study based on average income, population change and mortality at provincial level. The premature mortality rate (ages 0-74 years) was estimated for all causes and for cancer, cardiovascular disease and external causes across the period 1980-2010. In the years analysed, provinces were grouped into tertiles based on provincial income, with the mortality rate ratio (MMR) being estimated by taking the tertile of highest-income provinces as reference. Population change was then controlled for to ascertain whether it would modify the rate ratio. RESULTS: In all-cause mortality, the magnitude of the MRR for provinces in the poorest versus the richest tertile was 1.01 in 1980 and 1.12 in 2010; in cardiovascular mortality, the MMRs for these same years were 1.08 and 1.31 respectively; and in the case of cancer and external-cause mortality, MMR magnitude was similar in 1980 and 2010. The magnitude of the MMR remained unchanged in response to adjustment for population change, with the single exception of 1980, when it increased in all-cause and cardiovascular mortality. CONCLUSION: The increase in the difference in premature mortality between the richest and poorest areas in Spain is due to the increased difference in cardiovascular mortality. This increase is not accounted for by population change. In rich countries, more empirical evidence is thus needed to test other alternative explanations for the increase in economic differences in mortality.

Length of residence and risk of eating disorders in immigrant adolescents living in madrid. The AFINOS study.

OBJECTIVES: This study was designed to compare the risk of having an eating disorder (ED) among immigrant and native adolescents living in Madrid and to determine the possible influence of length of residence (LOR) on the risk of the immigrants. METHODS: A cross-sectional survey was conducted from november 2007 to february 2008 in a representative sample of adolescents aged 13 to 17 years (n = 2,077, 1,052 girls) living in the Madrid region. Data were collected using the Spanish version of the SCOFF Eating Disorders Questionnaire. Further factors considered were country of birth, LOR and several biological, sociodemographic, lifestyle and health-related variables. RESULTS: According to the three logistic regression models constructed, female immigrant adolescents on the whole showed a greater ED risk (OR = 1.95; 95% CI 1.29- 2.95; p = 0.001) than native adolescents. Moreover, the likelihood of ED was higher among female immigrants living in Spain for <6 years than for Spanish native females (OR = 2.44; 95% CI 1.42-4.18; p = 0.001), while no significant differences were found when female natives were compared with female immigrants living in this country for ≥ 6 years. Similarly, no differences were observed in the ED risk recorded for male native and immigrant adolescents, both as a whole and by length of residence in Spain. CONCLUSIONS: The immigrant status and the length of Spanish residence are relevant factors in regard to the ED risk in adolescents living in Madrid.

Objetivos: Este estudio fue diseñado para comparar el riesgo de trastornos de conducta alimentaria (TCA) entre adolescentes nativos e inmigrantes residentes en Madrid, así como para determinar la posible influencia del tiempo de residencia en el riesgo de los inmigrantes. Métodos: Se llevó a cabo un estudio transversal durante el periodo comprendido entre noviembre 2007 y febrero 2008 sobre una muestra representativa de adolescentes residentes en Madrid, con edades de entre 13 y 17 años (n = 2.077, 1.052 mujeres). Los datos se recogieron usando la versión española del cuestionario SCOFF para la detección de trastornos alimentarios. Otros factores considerados fueron el país de nacimiento, el tiempo de residencia y diversas variables biológicas, socio-demográficas, relativas a estilo de vida y la salud. Resultados: Según los tres modelos de regresión logística construidos, las mujeres adolescentes inmigrantes en conjunto mostraron un mayor riesgo de TCA (OR = 1,95; 95%CI 1,29-2,95; p = 0,001) que las nativas. Además, la probabilidad de sufrir TCA fue mayor entre las adolescentes inmigrantes con una residencia en España < 6 años que en las nativas (OR = 2,44; 95%CI 1,42-4,18; p = 0,001), mientras que no se encontraron diferencias entre las adolescentes nativas y las inmigrantes con un tiempo de residencia ≥6 años. No se observaron diferencias en el riesgo de TCA entre los adolescentes varones nativos y los inmigrantes, tanto en conjunto como según tiempo de residencia. Conclusiones: La condición de inmigrante y el tiempo de residencia son factores relevantes a la hora de considerar el riesgo de TCA en adolescentes residentes en Madrid.

Decreasing income inequality and emergence of the association between income and premature mortality: Spain, 1970-2010.

This study evaluates the relationship between income and mortality in Spain over a long period of declining in income inequality. The ratio between income in the richest and poorest provinces was 2.74 in 1970 and 2.10 in 2010. Pearson correlation coefficients for the association between provincial income and the measures of mortality were estimated, as well as absolute and relative differences between the mortality rates of the poorest and richest provinces. The correlation coefficient between income and infant mortality decreased from -0.59 in 1970 to -0.17 in 2010, and lost significance from 1995 onwards. The coefficient for premature all-cause mortality increased from -0.04 in 1970 to -0.40 in 2010, and acquired significance beginning in 2005. The coefficient also increased in mortality from cardiovascular, respiratory and digestive diseases. No association was found between provincial income and cancer mortality or mortality from injuries. The findings on premature mortality do not support the theory that decreasing income inequality will lead to reduced inequalities in mortality.

Influence of health behaviours on the incidence of infection and allergy in adolescents: the AFINOS cross-sectional study.

BACKGROUND: Some health behaviours are liable to affect the incidence of allergies and/or common infections in young people; however, the extent and ways in which these might occur are mostly unknown. This study examines the association of health behaviours related to physical activity, sedentariness, diet and sleep with allergy and infection symptoms in adolescents, and also with biological markers that might mediate disease incidence. METHODS: The study comprised a total of 2054 adolescents (50.7% girls) from the Madrid region of Spain. The incidence of infection and allergy symptoms three months prior to the study was obtained from a self-administered questionnaire. Physical and sedentary activities, height and weight, food habits and sleep duration were also self-reported and their influence on infection and allergy incidence was assessed by logistic regression analysis. Blood biomarkers (IgE, eosinophil percentage, leptin, interleukin (IL)-2, IL-4, IL-5 and IL-10) were evaluated in a subsample of 198 subjects. RESULTS: Adequate sleep duration (OR = 0.79, 95%CI: 0.64 to 0.97) and unhealthy weight status (overweight/obesity) (OR = 1.35, 95%CI: 1.04-1.74) were independently associated with decreased and increased allergy incidence, respectively. No significant association was observed with infection incidence. IgE and leptin differed between adolescents with and without allergy symptoms. In regression models IgE was significantly associated with inadequate sleep duration and leptin with weight status. CONCLUSION: Excess weight and inadequate sleep duration are independently associated with the incidence of allergy symptoms in adolescents. Adequate sleep duration and weight during adolescence might be relevant for a decreased risk of suffering allergy symptoms.

Sports facilities in Madrid explain the relationship between neighbourhood economic context and physical inactivity in older people, but not in younger adults: a case study.

BACKGROUND: Neighbourhood characteristics may contribute to differences in physical inactivity. PURPOSE: To evaluate whether the availability of sports facilities helps explain the differences in physical inactivity according to the economic context of the neighbourhood. METHODS: 6607 participants representative of the population aged 16-74 years, resident in Madrid (Spain) in 2005, were analysed. Using ORs calculated by multilevel logistic regression, the association between per capita income of the neighbourhood of residence and physical inactivity was estimated, after adjusting for age, population density, individual socioeconomic characteristics and the availability of green spaces. The analysis was repeated after further adjustment for the availability of sports facilities to determine if this reduced the magnitude of the association. RESULTS: Residents in the neighbourhoods with the lowest per capita income had the highest OR for the prevalence of physical inactivity. In participants aged 16-49 years, after adjusting for the availability of sports facilities, the magnitude of the OR in the poorest neighbourhoods with respect to the richest neighbourhoods increased in men (from 2.22 to 2.35) and declined by 13% in women (from 2.13 to 1.98). In contrast, in the population aged 50-74 years, this adjustment reduced the magnitude of the OR by 21% in men (from 2.00 to 1.80) and by 53% in women (from 2.03 to 1.48). CONCLUSIONS: The poorest neighbourhoods show the highest prevalence of physical inactivity. The availability of sports facilities explains an important part of this excess prevalence in participants aged 50-74 years, but not in younger individuals.

The role of political and welfare state characteristics in infant mortality: a comparative study in wealthy countries since the late 19th century.

BACKGROUND: A close examination of the literature suggests that the consistent relation between political and welfare state characteristics and infant mortality in the second half of the 20th century in wealthy countries may not be causal. METHODS: The evolution of infant mortality since the late 19th century was studied in 17 wealthy countries classified according to political traditions, family policy model and period of infant mortality transition. The relation of public health expenditure and income inequality to infant mortality from 1980 to 2005 was also evaluated. RESULTS: The Social Democratic and Scandinavian countries, and those with the earliest transition in infant mortality, had the lowest infant mortality rates until the early 21st century, whereas the late democracies, the Southern European countries, and those in which the transition in infant mortality took place later, had the highest rates until the late 20th century. By the early 21st century, the differences in infant mortality were negligible. Three of the four Scandinavian countries were the first to achieve infant mortality transition, whereas the Southern European countries were the last. The relation between public health expenditure and infant mortality varied depending on the time period in which the analysis was made, and increased income inequality was associated with higher infant mortality. CONCLUSIONS: The relation between political and welfare state characteristics and infant mortality in previous studies probably reflects the historical moment in which the transition in infant mortality took place in each country. Methodological limitations do not allow inference of causality in the associations found between welfare state characteristics and infant mortality.

Heterogeneity in the association between socioeconomic position in early life and adult self-rated health in two birth cohorts of Spanish adults.

BACKGROUND: The purpose of this work was to evaluate the association between socioeconomic circumstances in early life and poor self-rated health in adulthood, and to determine whether this association varies depending on birth cohort. METHODS: Using data from the 2005 Living Conditions Survey carried out in a Spanish population sample, separate analyses were made for persons born between 1941 and 1959 who lived their childhood and adolescence in a period marked by absence of economic growth in Spain, and those born between 1960 and 1980. The authors estimated of the relation of financial difficulties in adolescence, occupation of father, education of father and education of mother with poor self-reported health, adjusted for the measures of socioeconomic position in adulthood. Also evaluated was the possibility of interaction between early and adult socioeconomic position and the cumulative effect of low socioeconomic position across the life course. RESULTS: In the two cohorts, the presence of financial difficulties in adolescence showed an association with an increased risk of poor self-rated health; in contrast, the relation of occupation and education of parents with poor self-rated health varied depending on the birth cohort and gender of the study subjects. The effect of family financial situation was shown to accumulate over the life course, whereas the effect of socioeconomic position across the life course was heterogeneous when occupation and education of parents were used. CONCLUSION: The importance of financial difficulties in the household has probably not varied over time; in contrast, the heterogeneity of the findings regarding occupation and education of parents suggests that the importance of these indicators and, consequently, their aetiological pathways may differ depending on the gender and birth cohort of the study subjects.

Behavioural correlates of active commuting to school in Spanish adolescents: the AFINOS (Physical Activity as a Preventive Measure Against Overweight, Obesity, Infections, Allergies, and Cardiovascular Disease Risk Factors in Adolescents) study.

OBJECTIVE: To examine the associations between lifestyle factors and active commuting to school in Spanish adolescents. DESIGN: Cross-sectional study. Lifestyle factors (overall/extracurricular physical activity, television viewing, reading as a hobby, sleep duration, breakfast/fruit intake, smoking and alcohol intake) as well as mode and duration of commuting to school were self-reported. Active commuters were defined as those adolescents who walked or cycled to school. SETTING: Secondary schools in Madrid, Spain. SUBJECTS: Adolescents (n 2029) aged 13 to 17 years. RESULTS: Similar percentages of adolescent boys (57·6 %) and girls (56·1 %) were classified as active commuters to school (P = 0·491). The analysis showed that only adequate sleep duration (OR = 1·35, 95 % CI 1·11, 1·66; P = 0·003) and breakfast consumption (OR = 0·66, 95 % CI 0·49, 0·87; P = 0·004) were independently associated with active commuting to school. CONCLUSIONS: Only those behaviours that occur immediately before commuting to school (sleep and breakfast) are associated with active commuting in Spanish adolescents.

Physical activity as a preventive measure against overweight, obesity, infections, allergies and cardiovascular disease risk factors in adolescents: AFINOS Study protocol.

BACKGROUND: Prior studies addressing the impacts of regular physical activity or sedentary habits on the immune system have been conducted in adults and laboratory settings. Thus, it is practically unknown how a healthy active lifestyle could affect low-grade inflammation processes, infections or allergies in young persons. The AFINOS Study was designed to determine the relationship between the regular physical activity levels of adolescents and overweight, infection, and allergies along with the presence of metabolic and immunological biomarkers of a deteriorated health status. A further objective of the AFINOS Study is to assess the health status and lifestyle habits of an adolescent population in an effort to identify any protective factors that could be used as preventive measures, since many chronic diseases and their associated co-morbidities often persist from adolescence into adulthood. METHODS/DESIGN: This study was conducted as three separate sub-studies in three different populations as follows: (a) Study 1 was performed on a population sample of adolescents; (b) Study 2 on the adolescents' parents; and (c) Study 3 on a subset of the adolescents from Study 1. Study 1 assessed health and lifestyle indicators through a questionnaire administered to a representative sample of adolescents from the Madrid Region (n = 2400) aged 13 to 16 years. In Study 2, the parents of the teenagers participating in Study 1 were required to fill out a questionnaire. Finally in Study 3, body composition, physical activity, health-related physical fitness, and blood measurements were determined in a subset (n = 200) of the individuals included in Study 1. DISCUSSION: This paper describes the rationale, design, and methodologies used in the AFINOS Study. This multidisciplinary, multicenter study seeks to evaluate several aspects of existing relationships between routine physical activity/sedentary behaviour and several health status markers, specifically those related to the immune system. The results of this cross-sectional study will serve for comparisons with the available data obtained in laboratory settings and in adults. In addition, knowledge regarding the health status and lifestyle habits of Spanish adolescents and their parents will be useful for designing preventive measures.

Socioeconomic patterns in the use of public and private health services and equity in health care.

BACKGROUND: Several studies in wealthy countries suggest that utilization of GP and hospital services, after adjusting for health care need, is equitable or pro-poor, whereas specialist care tends to favour the better off. Horizontal equity in these studies has not been evaluated appropriately, since the use of healthcare services is analysed without distinguishing between public and private services. The purpose of this study is to estimate the relation between socioeconomic position and health services use to determine whether the findings are compatible with the attainment of horizontal equity: equal use of public healthcare services for equal need. METHODS: Data from a sample of 18,837 Spanish subjects were analysed to calculate the percentage of use of public and private general practitioner (GP), specialist and hospital care according to three indicators of socioeconomic position: educational level, social class and income. The percentage ratio was used to estimate the magnitude of the relation between each measure of socioeconomic position and the use of each health service. RESULTS: After adjusting for age, sex and number of chronic diseases, a gradient was observed in the magnitude of the percentage ratio for public GP visits and hospitalisation: persons in the lowest socioeconomic position were 61-88% more likely to visit public GPs and 39-57% more likely to use public hospitalisation than those in the highest socioeconomic position. In general, the percentage ratio did not show significant socioeconomic differences in the use of public sector specialists. The magnitude of the percentage ratio in the use of the three private services also showed a socioeconomic gradient, but in exactly the opposite direction of the gradient observed in the public services. CONCLUSION: These findings show inequity in GP visits and hospitalisations, favouring the lower socioeconomic groups, and equity in the use of the specialist physician. These inequities could represent an overuse of public healthcare services or could be due to the fact that persons in high socioeconomic positions choose to use private health services.

Trends of socioeconomic inequalities and socioeconomic inequalities in self-perceived health in Spain.

OBJECTIVE: To study the trends of socioeconomic inequalities and socioeconomic inequalities in self-perceived health in Spain between 1987 and 2001. METHODS: We estimated the distribution of educational level and per capita provincial income, and the differences in less-than-good self-perceived health by educational level and per capita provincial income in each period. RESULTS: The percentage of the population that had completed secondary or higher education was larger and inequality in per capita provincial income was smaller in 2001 than in 1987. In general, the differences in less-than-good self-perceived health by educational level and provincial income were greater in 2001 than in 1987, in both absolute and relative terms. However, when the effect of residual correlation within provinces was taken into account, the differences by per capita provincial income were smaller in 1987 than in 2001. CONCLUSIONS: The redistribution of socioeconomic resources achieves greater social justice, but probably does not lead to reduced health inequalities in all cases.

Trends of socioeconomic inequalities and socioeconomic inequalities in self-perceived health in Spain

Objetivo: Estudiar la evolución de las desigualdades socioeconómicas y las desigualdades socioeconómicas en la percepción subjetiva de la salud en España entre 1987 y 2001. Métodos: Se han estimado la distribución del nivel de estudios y de la renta per cápita provincial, así como las diferencias en la percepción de la salud según el nivel de estudios y según la renta per cápita provincial en cada período. Resultados: El porcentaje de población que había completado estudios de segundo grado o superiores fue mayor, y la desigualdad en la renta per cápita provincial fue menor en el año 2001 que en 1987. En líneas generales, las diferencias en la percepción negativa de la salud como según el nivel de estudios y la renta per cápita provincial fueron mayores en 2001 que en 1987, en términos relativos y absolutos. En cambio, cuando se tuvo en cuenta el efecto de la correlación residual dentro de las provincias en el resultado, las diferencias según la renta per cápita provincial fueron menores en 2001 que en 1987. Conclusión: La redistribución de los recursos socioeconómicos básicos consigue una mayor justicia social, pero probablemente no siempre consigan reducir las desigualdades en salud

Objective: To study the trends of socioeconomic inequalities and socioeconomic inequalities in self-perceived health in Spain between 1987 and 2001. Methods: We estimated the distribution of educational level and per capita provincial income, and the differences in less-than-good self-perceived health by educational level and per capita provincial income in each period. Results: The percentage of the population that had completed secondary or higher education was larger and inequality in per capita provincial income was smaller in 2001 than in 1987. In general, the differences in less-than-good self-perceived health by educational level and provincial income were larger in 2001 than in 1987, in both absolute and relative terms. However, when the effect of residual correlation within provinces was taken into account, the differences by per capita provincial income were smaller in 2001 than in 1987. Conclusions: The redistribution of socioeconomic resources achieves greater social justice, but probably does not lead to reduced health inequalities in all cases

Evolución de las desigualdades socioeconómicas y las desigualdades en la percepción de la salud en España / Trends in socioeconomic inequalities and self-perceived health in Spain

Objetivo: Estudiar la evolución de las desigualdades socioeconómicas y las desigualdades socioeconómicas en la percepción subjetiva de la salud en España entre 1987 y 2001. Métodos: Se han estimado la distribución del nivel de estudios y de la renta per cápita provincial, así como las diferencias en la percepción de la salud según el nivel de estudios y según la renta per cápita provincial en cada período. Resultados: El porcentaje de población que había completado estudios de segundo grado o superiores fue mayor, y la desigualdad en la renta per cápita provincial fue menor en el año 2001 que en 1987. En líneas generales, las diferencias en la percepción de la salud como según el nivel de estudios y la renta per cápita provincial fueron mayores en 2001que en 1987, en términos relativos y absolutos. En cambio, cuando se tuvo en cuenta el efecto de la correlación residual dentro de las provincias en el resultado, las diferencias según la renta per cápita provincial fueron menores en 2001 que en 1987. Conclusión: La redistribución de los recursos socioeconómicos básicos consigue una mayor justicia social, pero probablemente no siempre consigan reducir las desigualdades en salud

Objective: To study the evolution of sociaoeconomic inequalities and socioeconomic inequalities in self-perceived health in Spain between from 1987 to 2001. Methods: We estimated the distributions of educational level and per capita provincial income and the differences of less-than-good self-assessed health according education level and per capita provincial in both periods. Results: The percentage of the population that had completed secondary education was greater, and inequality in per capita provincial income was lower, in 2001 than in 1987. In general terms, the differences in suboptimal (less-than-good) self-perceived health by education and by provincial income were greater in 2001 than in 1987, in both absolute and relative terms. However, when the potential within-province correlation in outcomes was taken into account, the differences according provincial income were lower in 1987 than in 2001. Conclusions: The redistribution of socioeconomic resources achieves greater social justice, but probably does not lead to reduced health inequalities in all cases

Bienestar material de la provincia de residencia e inactividad física / Material well-being of the province of residence and leisure-time physical inactivity

Objetivo: Estimar la asociación entre el bienestar material de la provincia de residencia y la inactividad física durante el tiempo libre en la población española mayor de 15 años. Métodos: Los datos proceden de la encuesta de Discapacidades, Deficiencias y Estado de Salud, realizada por el Instituto Nacional de Estadística en 1999. Se analizaron los datos de 24.561 mujeres y 21.133 varones. Se consideró un sujeto inactivo cuando declaraba no realizar ningún tipo de actividad física durante el tiempo libre. La medida de bienestar material fue la renta per cápita de la provincia agrupada en cuartiles. La medida de asociación entre la renta per cápita y la inactividad física fue la odds ratio (OR) estimada mediante modelos logit multinivel. Resultados: En los individuos ≥ 45 años de edad se encontró una asociación entre la renta per cápita y la inactividad física. Las provincias con mayor renta per cápita presentaron la menor prevalencia de inactividad física. No obstante, la OR de mayor magnitud se encontró en el cuartil 2 de renta per cápita, no observándose diferencias estadísticamente significativas entre el cuartil más rico y el cuartil más pobre. Al ajustar por características socioeconómicas y otras variables individuales, esa asociación persistió en las mujeres y desapareció en los varones. En las mujeres la asociación fue mayor en el grupo de ingresos personales más bajos. Conclusiones: Los resultados sugieren que en las mujeres mayores de 45 años la inactividad física podría estar relacionada no sólo con las características individuales, sino también con el contexto socioeconómico del área de residencia

Objective: To estimate the association between material wellbeing of the province of residence and leisure-time physical inactivity in the Spanish population aged 16 years and older.Methods: We used data from the Survey on Disabilities, Impairments and Health Status carried out by the Statistical National Institute in 1999. We analyse 24,561 women and 21,133 men. Respondents were classified as inactive if they reported no leisure-time physical activity. The measure of material wellbeing was the per capita income of the province of residence grouped in quartiles. The measure of the association between per capita income and physical inactivity was the odds ratio (OR) estimated from logit multilevel models. Results: Association between per capita income and physical inactivity was observed in people aged 45 years and older. The lower prevalence of physical inactivity was observed in provinces with the higher per capita income. However the higher OR was found in quartile 2 of per capita income, because no significant difference was observed between quartile 4 (richest) and quartile 1 (poorest). After adjusting for socioeconomic characteristics and other individual variables, association remained significant in women and disappeared in men. In women, association between per capita income and physical inactivity was higher in the population group with lower personal income. Conclusions: Results suggest that physical inactivity in women aged 45 years and older could be related not only with individual characteristics but with the socioeconomic context of the area of residence

[Material well-being of the province of residence and leisure-time physical inactivity]. / Bienestar material de la provincia de residencia e inactividad física.

OBJECTIVE: To estimate the association between material wellbeing of the province of residence and leisure-time physical inactivity in the Spanish population aged 16 years and older. METHODS: We used data from the Survey on Disabilities, Impairments and Health Status carried out by the Statistical National Institute in 1999. We analyse 24,561 women and 21,133 men. Respondents were classified as inactive if they reported no leisure-time physical activity. The measure of material wellbeing was the per capita income of the province of residence grouped in quartiles. The measure of the association between per capita income and physical inactivity was the odds ratio (OR) estimated from logit multilevel models. RESULTS: Association between per capita income and physical inactivity was observed in people aged 45 years and older. The lower prevalence of physical inactivity was observed in provinces with the higher per capita income. However the higher OR was found in quartile 2 of per capita income, because no significant difference was observed between quartile 4 (richest) and quartile 1 (poorest). After adjusting for socioeconomic characteristics and other individual variables, association remained significant in women and disappeared in men. In women, association between per capita income and physical inactivity was higher in the population group with lower personal income. CONCLUSIONS: Results suggest that physical inactivity in women aged 45 years and older could be related not only with individual characteristics but with the socioeconomic context of the area of residence.