Las muertes con intervención judicial y medicolegal y su impacto en la estadística de causas de muerte en Cataluña / Deaths with medicolegal intervention and its impact on the cause-of-death statistics in Catalonia, Spain

Introducción. Los boletines estadísticos correspondientes a las defunciones que requieren intervención judicial (DIJ) y actuación forense contienen un número elevado de causas de muerte mal definidas. El objetivo es presentar los resultados de la recuperación de datos a partir de las autopsias judiciales del año 2013 en Cataluña y analizar el impacto de esta información sobre la estadística de causas de muerte. Material y métodos. Se seleccionaron del Registro de Mortalidad de Cataluña las defunciones con intervención judicial que tenían como causa de muerte unas determinadas afecciones mal definidas, según criterios de codificación de la OMS. Se recuperó la información de los registros de autopsia de los centros de Patología Forense del Instituto de Medicina Legal y Ciencias Forenses de Cataluña (IMLCFC). Resultados. Las DIJ representan el 6% de la mortalidad total de Cataluña, el 42,9% de las causas externas y el 77% de las mal definidas. De los 3.639 casos de DIJ del año 2013 se revisó un 43,4% (n=1.578) y se obtuvo información que mejoró la causa de muerte del 78,4% de los revisados. La información recuperada aumentó un 61,3% las intoxicaciones accidentales, un 32,6% los suicidios, un 28,9% los homicidios, un 27,4% las caídas, un 22,7% los accidentes de tráfico y un 5,2% la cardiopatía isquémica, con el equivalente aumento de las tasas de mortalidad por estas causas. Conclusiones. La información de las autopsias judiciales tiene un gran impacto en las estadísticas de causa de muerte, especialmente en las causas externas y la cardiopatía isquémica. Un informe forense sobre la causa y las circunstancias de la muerte, de manera que permita fácilmente su codificación posterior, así como la transmisión directa de estos datos a la oficina estadística serían la mejor solución para evitar la pérdida de información que se produce actualmente (AU)

Introduction. The statistical forms corresponding to deaths that require judicial and forensic interventions contain a very high number of ill-defined causes of death. The objective is to show the results of data recovery from the forensic autopsies and to analyse the impact of this information on the cause-of-death statistics for the year 2013 in Catalonia (Spain). Material and methods. Deaths with judicial intervention with an ill-defined cause of death according to the WHO coding standards were selected from the Catalan Mortality Registry. Information was recovered from the autopsy registers of the Forensic Pathology centres of the Institute of Legal Medicine and Forensic Science of Catalonia (IMLCFC). Results. Deaths with judicial intervention represent 6% of total mortality in Catalonia, 42.9% due to external causes and 77% pertaining to ill-defined causes-of-death. There were 3,639 cases of death with judicial intervention, of which 43.4% (n=1,578) were reviewed, resulting in information that improved the cause of death in 78.4% of cases. The information retrieved increased accidental poisoning by 61.3%, suicides by 32.6%, homicides by 28.9%, falls by 27.4%, traffic accidents by 22.7% and ischaemic heart disease by 5.2%, with the equivalent increase in the mortality rates from these causes. Conclusions. The forensic autopsy information has a significant impact on cause-of-death statistics, especially external causes and ischemic heart disease. A forensic report concerning the cause and circumstances of death, structured to facilitate further coding and the direct transmission of data to the statistical office, would be the best solution to prevent the loss of information currently experienced (AU)

Evolución de la mortalidad por cáncer de mama y diseminación de la mamografía de cribado en Cataluña. Un análisis por regiones sanitarias / The evolution of breast cancer mortality and the dissemination of mammography in Catalonia. An analysis by health region

Fundamento: El descenso de las tasas de mortalidad por cáncer de mama (CM) se ha atribuido a la implantación de programas de cribado y a avances terapéuticos. El objetivo de este trabajo es comparar la evolución de su mortalidad en las regiones sanitarias de Cataluña en el periodo 1993-2007. Paralelamente, se ha analizado la diseminación de la mamografía periódica en las regiones sanitarias. Métodos: Se analizaron los datos del registro de mortalidad y encuestas de salud. Se utilizaron regresiones de Poisson y «joinpoint» para comparar las tasas de mortalidad por CM y analizar su evolución temporal. Se utilizaron modelos de efectos mixtos para comparar el nivel y la evolución de la mortalidad por regiones. Resultados. La tasa de mortalidad por CM descendió un 3% anual en Cataluña. Entre 1993 y 2007, la tasa estandarizada varió de 34,8 a 23,3 por 100.000 mujeres. Barcelona ciutat presentó unas tasas de mortalidad más elevadas que las regiones Centre (ratio de tasas (RT)=0,87), Costa de Ponent (RT=0,89), Tarragona (RT=0,9) y Lleida (RT=0,915), pero estas diferencias tendieron a desaparecer. No se observaron cambios de tendencia en la evolución de la mortalidad de las regiones, excepto en la región Centre. Durante los años 1990 Barcelona ciutat presentó unos porcentajes de utilización de mamografía periódica del 36,1% de las mujeres de 40-74 años, en la encuesta de 1994, la región Centre (23,7%) y Costa de Ponent (25,2%). Conclusiones: La progresiva utilización de mamografía periódica y la disminución de la mortalidad por CM fueron similares en las regiones sanitarias de Cataluña(AU)

Background: The decrease of breast cancer (BC) mortality rates has been attributed to early detection programs and therapeutic advances. The objective is to compare BC mortality trend in health regions of Catalonia during the period 1993-2007. In parallel, dissemination of periodic mammography in the health regions has been analyzed. Methods: Mortality and health surveys data were used. Poisson and «joinpoint» regression analyses were used to compare regional BC mortality rates and quantify their temporal evolution. Mixed effects models were used to compare the rates and their evolution by region. Results: The BC mortality rate decreased 3% annually in Cataluña. Between 1993 and 2007, the standard mortality rate changed from 34.8 to 23.3 per 100,000 women. Barcelona ciutat showed higher mortality rates than the Centre (rate ratio (RR)=0.873), Costa de Ponent (RR=0.885), Tarragona (RR=0.9) and Lleida regions (RR=0.915), but these differences tend to disappear over time. There were no observed trend changes in the evolution of the regional mortality rates, except in the Centre region. The use of periodic mammography was similar across health regions. During the 90s, Barcelona ciutat had a 36.1% utilization of periodic mammography in women aged 40-74, in the 1994 survey, the Centre 23.7 and Costa de Ponent 25.2%. Conclusions: The progressive increase in the use of periodic mammography and the decrease of BC mortality were similar in the eight health regions of Catalonia(AU)

[The evolution of breast cancer mortality and the dissemination of mammography in Catalonia: an analysis by health region]. / Evolución de la mortalidad por cáncer de mama y diseminación de la mamografía de cribado en Cataluña: Un análisis por regiones sanitarias.

BACKGROUND: The decrease of breast cancer (BC) mortality rates has been attributed to early detection programs and therapeutic advances. The objective is to compare BC mortality trend in health regions of Catalonia during the period 1993-2007. In parallel, dissemination of periodic mammography in the health regions has been analyzed. METHODS: Mortality and health surveys data were used. Poisson and «joinpoint¼ regression analyses were used to compare regional BC mortality rates and quantify their temporal evolution. Mixed effects models were used to compare the rates and their evolution by region. RESULTS: The BC mortality rate decreased 3% annually in Cataluña. Between 1993 and 2007, the standard mortality rate changed from 34.8 to 23.3 per 100,000 women. Barcelona ciutat showed higher mortality rates than the Centre (rate ratio (RR)=0.873), Costa de Ponent (RR=0.885), Tarragona (RR=0.9) and Lleida regions (RR=0.915), but these differences tend to disappear over time. There were no observed trend changes in the evolution of the regional mortality rates, except in the Centre region. The use of periodic mammography was similar across health regions. During the 90s, Barcelona ciutat had a 36.1% utilization of periodic mammography in women aged 40-74, in the 1994 survey, the Centre 23.7 and Costa de Ponent 25.2%. CONCLUSIONS: The progressive increase in the use of periodic mammography and the decrease of BC mortality were similar in the eight health regions of Catalonia.

Prevalencia de la discapacidad en España por Comunidades Autónomas: el papel de los factores individuales y del entorno geográfico en su variabilidad / Prevalence of the disability in Spain for autonomous communities: the paper of the individual factors and the geographical environment in the variability

Fundamento: La prevalencia de discapacidad en la poblacióngeneral presenta una gran variabilidad geográfica, de manera queidentificar aquellos factores que pudieran explicarla será importantepara la planificación de políticas sociales. En este trabajo se analizala variabilidad de la discapacidad por comunidades autónomasdesde una doble vertiente, los factores individuales y del entorno.Métodos: Los datos proceden principalmente de la Encuestade Discapacidad, Deficiencias y Estado de Salud de 1999 y delInebase, ambas del Instituto Nacional de Estadística (INE). Secalculó la prevalencia de discapacidad simple y ajustada por edadde las CCAA. Se analizan los factores individuales asociados a ladiscapacidad mediante una regresión logística y los factores individualesy de la comunidad autónoma conjuntamente con unaregresión logística de dos niveles.Resultados: La prevalencia de discapacidad muestra una diferenciamáxima de 5,75 puntos entre las comunidades autónomas.En la regresión logística la comunidad de residencia fue estadísticamentesignificativa (OR: 3,35 en la de mayor prevalencia respectoa la de menor) junto con otras variables individuales: edad (ORde 40-64= 1,78 OR de 65-79= 1,87 y OR de >79= 3,34), sexo (ORmujer= 0,66), situación laboral (OR sin trabajo=2,25 OR amascasa/estudiante=1,39 y OR otros=2,03), estado de salud (OR regular=1,69 OR malo/muy malo= 2,05) y enfermedades crónicas (OR1-3=1,56 OR4-6=1,82 OR>6=2,59). En la regresión de dos niveleslas variables individuales explican poca varianza (s=0,261) y ningunade las variables relativas a las CCAA mejora el modelo.Conclusiones: Las características individuales no explicansuficientemente la variabilidad de la discapacidad entre CCAA yno se han identificado variables del entorno que sean significativas(AU)

Background: The prevalence of disability shows a highgeographical variability and the identification of factors that couldexplain these variations can be usuful to the heath and socialwelfare planning. Here the analysis of disability variations amongautonomous regions in Spain is made taking into accountindividual and geographical setting factors together.Methods: Data come from the Spanish Disability,Impairment and Health Status survey of 1999 and from Inebaseboth of the National Institute for Statistics. The prevalence ofdisability crude and adjusted by age was calculated for eachautonomous region. Individual factors related to disability areidentified by means of a logistic regression. The analysisaccounting for both, individual and geographical setting factorswas performed by means of a logistic regression of two levels.Results: Disability prevalence showed a maximum differenceof 5.75 points among regions. In a logistic regression the region ofresidence was statistically significant (OR: 3.35 in the highestrated region related to the lowest) beside several individual factors:age (OR 40-64= 1,78 OR 65-79= 1,87 and OR >79= 3,34), sex(OR women= 0,66), working status (OR unemployment=2,25 ORhousewife/student=1,39 y OR other=2,03), health status (ORregular= 1,69 OR bad/very bad= 2,05) and chronic diseases (OR1-3=1,56 OR 4-6=1,82 OR >6=2,59). Individual factors accountedfor a very few variance at the two levels regression model(s=0,261) and none of the regional variables improved the model.Conclusions: Individual factors do not explain enough theobserved disability variations among the regions and none factorrelated to the geographical setting has been identified asstatistically significant(AU)

Hacia una mayor adecuación y equidad del programa de ayudas a personas con dependencia / No disponible

No disponible

Ten-year experience with acenocoumarol treatment in an ambulatory cohort of Spanish patients.

OBJECTIVE: To analyse incidence of hemorrhagic and thrombotic events in a series of ambulatory patients receiving acenocoumarol in a rural area of Spain (1997-2007). RESULTS: Out of 1,544 patients, 1,086 are receiving acenocoumarol at present (2% of our region's population). The total follow-up was 5,462 patients-years. Median age was 74 years. INR therapeutic range was 2.0-3.0 in 82.5%. Atrial fibrillation (AF) was the most frequent indication (73%). Incidence of hemorrhagic and thrombotic events was 2.27 and 0.2/100 patients-year, respectively. Gastrointestinal tract was the most frequent site of bleeding. In multivariate analysis, patients with AF and prosthetic heart valves (PHV) had increased risk of bleeding (OR 2.1 and 4.8, respectively). Age and therapeutic ranges of INR were not associated with increased risk of bleeding. CONCLUSIONS: 2% of our population is receiving acenocoumarol. Incidence of hemorrhagic and thrombotic events was low. Patients with AF and PHV had increased risk of bleeding.

[Differences in reproductive patterns between autochthonous and immigrant women living in Catalonia, Spain]. / Diferencias en el perfil reproductivo de mujeres autóctonas e inmigrantes residentes en Cataluña.

OBJECTIVE: To describe differences in reproductive patterns between autochthonous and immigrant women living in Catalonia (Spain). METHODS: Data on legal abortions were obtained from the abortions register in the Regional Ministry of Health, while data on births and the population were drawn from the Institute of Statistics of Catalonia. Depending on the source, the variables <> or <> were used to compose the groups. Rates of fertility and abortion by age were computed for 2005 and the women's sociodemographic characteristics were analyzed. RESULTS: A total of 20.8% of the 79,504 births and 37.8% of the 16,798 abortions involved immigrant women, while 14.2% of pregnancies in autochthonous women and 27.7% of those in immigrant women terminated in abortion. Crude fertility and abortion rates were 1.4 and 3 times higher, respectively, in immigrant women. CONCLUSIONS: There are important differences in abortion and fertility rates, as well as in social and demographic patterns, between autochthonous and immigrant women.

Diferencias en el perfil reproductivo de mujeres autóctonas e inmigrantes residentes en Cataluña / Differences in reproductive patterns between autochthonous and immigrant women living in Catalonia, Spain

Objetivo: Describir el perfil reproductivo en las mujeres autóctonase inmigrantes residentes en Cataluña.Métodos: Los abortos proceden del Registro de interrupciónvoluntaria del embarazo (IVE) del Departament de Salut, y losnacimientos y la población del Institut d’Estadística de Catalunya.Se han usado las variables ®país de nacimiento» o ®nacionalidad», según la fuente, para agrupar. Se analizan lastasas de fecundidad y aborto por edad, y las característicassociodemográficas de las mujeres para el año 2005.Resultados: El 20,8% de los 79.504 nacimientos y el 37,8%de las 16.798 IVE fueron de mujeres inmigrantes. El14,2% de los embarazos de mujeres autóctonas y el 27,7%de los de mujeres inmigrantes terminan en aborto. Las tasabruta de fecundidad y aborto es 1,4 y 3 veces superior, respectivamente,en las mujeres inmigrantes.Conclusiones: Hay importantes diferencias en las tasas y enlas características sociodemográficas entre las mujeres autóctonasy las inmigrantes(AU)

Objective: To describe differences in reproductive patternsbetween autochthonous and immigrant women living in Catalonia(Spain).Methods: Data on legal abortions were obtained from theabortions register in the Regional Ministry of Health, while dataon births and the population were drawn from the Institute ofStatistics of Catalonia. Depending on the source, the variables®country of birth» or ®nationality» were used to composethe groups. Rates of fertility and abortion by age were computedfor 2005 and the women’s sociodemographiccharacteristics were analyzed.Results: A total of 20.8% of the 79,504 births and 37.8% ofthe 16,798 abortions involved immigrant women, while 14.2%of pregnancies in autochthonous women and 27.7% of thosein immigrant women terminated in abortion. Crude fertility andabortion rates were 1.4 and 3 times higher, respectively, in immigrantwomen.Conclusions: There are important differences in abortion andfertility rates, as well as in social and demographic patterns,between autochthonous and immigrant women(AU)

[Dependence profile in Spain: an analysis from the disability survey of 1999]. / El perfil de la dependencia en España: un análisis de la encuesta de discapacidades de 1999.

BACKGROUND: In the next future an important demographical ageing will imply a rise in the levels of co morbidity, disability and dependence of the population. The objective if this work was to estimate the dependences profile by means of assessing the levels of severity of the disability in the Spanish general population. METHODS: Data come from the disease, disability and health status survey of 1999 of the Spanish Institute for Statistics, which includes 36 limitations with an score of severity (from 0= absence to 4= unable). These limitations were grouped in five kinds of disability, the mean score of severity was computed for each one, and grouped in five levels of dependence. To check the relationship between limitations and severity an analysis of correspondence was performed. To identify the pattern of dependence a multiple correspondence and a clusters analysis were computed using the variables of age, sex, kind of disability and level of dependence. RESULTS: There is a relationship between severity and some limitations (being the limitation on daily activities associated to the highest severity). Five groups of dependent people were identified. Those with lower dependence were middle aged, men and having sensorial disabilities and those with higher dependence were mainly women, older than 80 and with disabilities on mobility and on the activities of daily living. CONCLUSIONS: There are five groups of dependent population and this study allows estimating its frequency among the general population what will be very useful to evaluate the amount of resources necessary to take care of them.

[Individual and ecological factors related to the geographical variability of psychological distress among small areas: a multilevel analysis in Catalonia, Spain]. / Factores individuales y del entorno asociados a la variabilidad geográfica de los trastornos psicológicos entre areas pequeñas: un análisis multinivel.

BACKGROUND: To know the geographic distribution of the prevalence of psychological distress is important for mental health services planning. This study is aimed at identifying the individual factors and those related to the area of residence which may explain the geographic variability of psychological distress (by healthcare districts) in Catalonia. METHODS: The data was taken from the 1994 Catalonian Health Survey and from the 1996 Catalonia population statistics. The prevalence of psychological distress is estimated by age and sex and by healthcare district. In a two-level logic regression model, a study is made of the relationship between the individual variables (first level: health survey n = 12,455) and those of the area of residence (second level: the healthcare district, n = 46) to the geographic distribution of the prevalence of psychological distress. RESULTS: The significant variables at individual level are in men: age (45-64 years OR: 0.63 y > 64 years OR: 0.22), working status (no work OR: 1.60), number of chronic diseases (CD) (CD = 1 OR: 1.75 CD = 2 OR: 2.06 CD = 3-5 OR: 3.36 and CD > 5 OR: 8.9). In women: age (25-44 years OR: 0.63 45-64 years OR: 0.45 and > 64 years OR: 0.32), working status (no work OR: 1.30), number of chronic diseases (CD = 1 OR: 1.75 CD = 2 OR: 2.44 CD = 3-5 OR: 4.09 and CD > 5 OR: 11.14), and also the kind of parental household in women (single-parental OR: 1.42). The variables at the level of the area of residence are in migration (men OR: 1.55 and women OR: 1.68) and unemployment (men OR: 1.07 and women OR: 1.06). CONCLUSIONS: The individual factors do not suffice to explain the geographical variability of the prevalence of psychological distress, but the characteristics of the area of residence are also important.

[Health system interventions assessment in Spain: an approach through the analysis of the time trends and the geographical variability of avoidable mortality between 1986 -2001]. / Medida del resultado de las intervenciones sanitarias en España: una aproximación mediante el análisis temporal y espacial de la mortalidad evitable entre 1986-2001.

BACKGROUND: Many studies have proposed Avoidable Mortality (ME) to monitor the performance of health services although its usefulness is limited by the multiplicity of the avoidable mortality lists being used. Time trends from 1986-2001 and the geographical distribution of avoidable mortality by provinces, are presented for Spain. METHODS: An Avoidable Mortality consensus list is being used. It includes avoidable mortality through the intervention of health services (ISAS in Spanish) and through health policy interventions (IPSI in Spanish). Time trends are analyzed adjusting Poisson or Joinpoint regression models and the annual percentages of change (APC) are estimated. Changes in geographical distribution between the first half of the analysed period and the second are tested by means of standard mortality ratios (SMR) and comparative mortality rates (CMR) for each province. RESULTS: Between 1986 and 2001 avoidable mortality decreased (APC: -1.68; CI: -1.99 and -1.38) slightly more than non-avoidable mortality (APC: -1.28; CI: -1.40 and -1.17). Higher reduction was observed for ISAS mortality (APC: -2.77; CI: -2.89 and -2.65) and an irregular trend for IPSI (between 1986-1990 increase APC: 4.86; CI: 3.32 and 6.41, between 1990-95 stabilization APC: -0.03; CI: -2.32 and 2.31 and finally 1995-2001 decrease APC: -3.57; CI: -4.72 and -2.40). CONCLUSIONS: Avoidable mortality decreased more than non avoidable mortality and important geographical variability can be observed among provinces which should be monitored in order to identify the health services weaknesses. The higher ISAS mortality was observed in southern provinces and the higher IPSI mortality in some areas on the coast. The pattern is somewhat similar for both analyzed periods.

Factores individuales y del entorno asociados a la variabilidad geográfica de los trastornos psicológicos entre áreas pequeñas: un análisis multinivel / Individual and ecological factors related to the geographical variability of psychological distress among small areas: a multilevel analysis in Catalonia, Spain

Fundamento: Para planificar las necesidades de servicios sanitarioses fundamental conocer la distribución de la morbilidad portrastornos psicológicos en el territorio así como los factores que ladeterminan. El objetivo es identificar los factores que pueden explicarla variabilidad geográfica de estos trastornos en Cataluña.Métodos: Los datos proceden de la Encuesta de Salud de l994 yde la estadística de población de l996 para Cataluña. Se estima la prevalenciade trastornos psicológicos por edad y sexo y por sector sanitario.En un modelo de regresión logística a dos niveles se estudia laasociación entre las variables individuales (primer nivel: Encuestade Salud n=12.455) y las de la zona de residencia (segundo nivel: elsector sanitario, n= 46) con la prevalencia de trastornos psicológicos.Resultados: Las variables individuales que influyen en las diferenciasentre sectores son: la edad (45-64 años OR:0,63 y >64 años:OR:0,22), la situación laboral (no trabaja OR:1,60) y el número detrastornos crónicos (TC) (TC=1 OR: 1,75 TC=2 OR: 2,06 TC=3-5OR:3,36 y TC>5 OR: 8,9) en hombres. En las mujeres, además deestas variables (edad 25-44 años OR: 0,63 45-64 años OR:0,45 y >64años OR: 0,32 la situación laboral no trabaja OR:1,30 y el número detrastornos crónicos (TC) TC=1 OR: 1,75 TC=2 OR: 2,44 TC=3-5OR:4,09 y TC>5 OR: 11,14), influye el tipo de hogar (monoparentalOR: 1,42). Las variables a nivel de la zona de residencia son la proporciónde inmigración (hombres OR:1,55 y mujeres OR:1,68) y dedesempleo (hombres OR:1,07 y mujeres OR:1,06).Conclusiones: Los factores individuales no son suficientes paraexplicar la variabilidad geográfica de la prevalencia de los trastornospsicológicos, ya que también influyen las características de la zonade residencia

Background: To know the geographic distribution of the prevalenceof psychological distress is important for mental healthservices planning. This study is aimed at identifying the individualfactors and those related to the area of residence which may explainthe geographic variability of psychological distress (by healthcaredistricts) in Catalonia.Methods: The data was taken from the 1994 Catalonian HealthSurvey and from the 1996 Catalonia population statistics. The prevalenceof psychological distress is estimated by age and sex and byhealthcare district. In a two-level logic regression model, a study ismade of the relationship between the individual variables (first level:health survey n=12,455) and those of the area of residence (secondlevel: the healthcare district, n=46) to the geographic distribution ofthe prevalence of psychological distress.Results: The significant variables at individual level are in men:age (45-64 years OR:0,63 y >64 years OR: 0,22), working status (nowork OR:1,60) , number of chronic diseases (CD) (CD=1 OR: 1,75CD=2 OR: 2,06 CD=3-5 OR:3,36 and CD>5 OR: 8,9). In women:age (25-44 years OR: 0,63 45-64 years OR:0,45 and >64 years OR:0,32), working status (no work OR:1,30), number of chronic diseases(CD=1 OR: 1,75 CD=2 OR: 2,44 CD=3-5 OR:4,09 and CD>5OR: 11,14), and also the kind of parental household in women (single-parental OR: 1,42). The variables at the level of the area of residenceare inmigration (men OR:1,55 and women OR:1,68) andunemployment (men OR:1,07 and women OR:1,06).Conclusions: The individual factors do not suffice to explain thegeographical variability of the prevalence of psychological distress,but the characteristics of the area of residence are also important

Medida del resultado de las intervenciones sanitarias en España: una aproximación mediante el análisis temporal y espacial de la mortalidad evitable entre 1986-2001 / Health system interventions assessment in Spain: an approach through the analysis of the time trends and the geographical variability of avoidable mortality between 1986 -2001

Fundamento: Muchos estudios proponen la mortalidad evitable(ME) como indicador para monitorizar los servicios de salud aunquesu generalización está limitada por el gran número de listas de causasutilizadas. El objetivo es analizar la evolución temporal del período1986-2001 y la distribución geográfica de la mortalidad evitable utilizandouna lista de causas consensuada.Métodos: Se analiza la mortalidad evitable global (ME) y agrupadaen causas ISAS (intervenciones de los servicios sanitarios) ycausas IPSI (políticas intersectoriales). Se analiza la evolución temporalajustando una recta de regresión de Poisson o un modelo deregresión de Joinpoint, según el caso, y se estima el porcentaje decambio anual (PCA). Para la distribución geográfica se calculan losíndices de mortalidad estandarizada (IME) por provincia y la razónde mortalidad comparativa (RMC) de cada provincia entre la primeray la segunda parte del periodo temporal.Resultados: Entre 1986-2001 la mortalidad evitable se redujo(PCA -1,68; IC:-1,99 a -1,38) algo más que la no-evitable (PCA -1,28; IC:-1,40 a -1,17). La mayor disminución se observó en la mortalidadpor causas ISAS (PCA del -2,77; IC: -2,89, -2,65) mientrasque la mortalidad por causas IPSI aumentó entre 1986-1990 (PCAdel 4,86; IC: 3,32 y 6,41), se mantiene constante de 1990-1995 (PCAdel -0,03; IC: -2,32 y 2,31) y disminuyó de 1995-2001 (PCA del -3,57; IC: -4,72 y -2,40). Conclusiones: Durante el período estudiado la mortalidad evitableha tenido una reducción mayor que la no evitable y se observandiferencias importantes entre provincias que sería necesario monitorizarpara tratar de identificar posibles disfunciones en los serviciossanitarios. La mortalidad es superior por causas ISAS en la zona surde España y por causas IPSI en algunas provincias costeras y estepatrón no varió mucho en el período analizado

Background: Many studies have proposed Avoidable Mortality(ME) to monitor the performance of health services although itsusefulness is limited by the multiplicity of the avoidable mortalitylists being used. Time trends from 1986-2001 and the geographicaldistribution of avoidable mortality by provinces, are presented forSpain.Methods: An Avoidable Mortality consensus list is being used.It includes avoidable mortality through the intervention of healthservices (ISAS in Spanish) and through health policy interventions(IPSI in Spanish). Time trends are analyzed adjusting Poisson orJoinpoint regression models and the annual percentages of change(APC) are estimated. Changes in geographical distribution betweenthe first half of the analysed period and the second are tested bymeans of standard mortality ratios (SMR) and comparative mortalityrates (CMR) for each province.Results: Between 1986 and 2001 avoidable mortality decreased(APC: -1.68; CI: -1.99 and -1.38) slightly more than non-avoidablemortality (APC: -1.28; CI: -1.40 and -1.17). Higher reduction wasobserved for ISAS mortality (APC: -2.77; CI: -2.89 and -2.65) andan irregular trend for IPSI (between 1986-1990 increase APC: 4.86;CI: 3.32 and 6.41, between 1990-95 stabilization APC: -0.03; CI: -2.32 and 2.31 and finally 1995-2001 decrease APC: -3.57; CI: -4.72and -2.40). Conclusions: Avoidable mortality decreased more than nonavoidable mortality and important geographical variability can beobserved among provinces which should be monitored in order toidentify the health services weaknesses. The higher ISAS mortalitywas observed in southern provinces and the higher IPSI mortality insome areas on the coast. The pattern is somewhat similar for bothanalyzed periods