Diferencias en la esperanza de vida libre de discapacidad por sexo y Comunidades Autónomas en España / Differences in disability-free life expectancy by gender and autonomous regions in Spain

Fundamentos: La mejora de la salud de la población esel principal objetivo y el mayor reto del sistema sanitario ypara monitorizarla se dispone de indicadores como la esperanzade vida libre de discapacidad (EVLD). El objetivo esanalizar la distribución de este indicador por comunidadesautónomas (CCAA) en España.Métodos: Los datos de mortalidad, de población y de discapacidadpara el año 1999 proceden del INE. La EVLD seha calculado por el método de Sullivan, que pondera la tablade vida en función del estado de discapacidad, por sexo yCCAA. También se ha estimado el error estándar de laEVLD, la expectativa de discapacidad y la proporción deltiempo vivido libre de discapacidad.Resultados: En 1999 la EVLD al nacer fue de 68,5 años enhombres y de 72,2 años en mujeres. El tiempo vivido sin discapacidadesfue superior en hombres (91%) que en mujeres(87,7%) y la expectativa de discapacidad de 6,8 años y de 10,1años respectivamente. La diversidad entre comunidades es superioren la EVLD que en la esperanza de vida (EV). Las CCAAcon mayor esperanza de vida no coinciden siempre con las quetienen una mayor proporción de tiempo vivido sin discapacidad.Conclusiones: Una mayor EV no significa necesariamenteuna mejor salud, tal como se asume tradicionalmente.La EVLD es útil para evidenciar diferencias del estado desalud en la población española

Background: Improvement of population health is themain aim and an important challenge for the health system. Tomonitor the population health indicators like disability-freelife expectancy (DFLE) have been implemented. The purposeof this paper was to analyze the geographical distribution ofDFLE according to autonomous regions in Spain.Methods: Data of mortality, population and disability forthe year 1999, provided by the National Institute of Statistics(INE), were used. To calculate DFLE by gender and region weused the Sullivan method that weights the expected time to liveaccording to the status of disablement of the population. Thestandard error of DFLE, the expectation of disability and theproportion of time lived free of disability have also beenestimated.Results: In 1999 the DFLE at birth in Spain was 68.5 yearfor men and 72.2 years in women. Men lived proportionallymore time free of disability than women (91% versus 87.7%)with an expectation of disability of 6.8 and 10.1 yearsrespectively. Variability among regions was higher in DFLEthan in life expectancy (LE). The regions with highest LE arenot always those with the highest proportion of time livedwithout disability.Conclusions: Highest life expectancy does not alwaysmean best health as it has been assumed currently. The DFLEindicator is a useful tool to show health status differencesamong the Spanish population

[Geographical distribution and time trends in avoidable mortality in Catalonia, Spain (1986-2001)]. / Distribución geográfica y evolución temporal de la mortalidad evitable en Cataluña (1986-2001).

OBJECTIVES: To analyze time trends and geographical variation in avoidable mortality by health areas in Catalonia. MATERIAL AND METHODS: Avoidable mortality was analyzed according to the classification used by the Health Department of the Regional Government of Catalonia from 1986-2001 for health areas and causes were grouped as treatable and preventable. Standardized mortality rates were calculated by the direct and indirect method and the comparative mortality figures were calculated for the treatable and preventable groups and for the 46 health areas. The mean annual change adjusted for age was also calculated using a Poisson regression of avoidable and general mortality. RESULTS: The total number of avoidable deaths was 61,261 (7.3% of overall deaths). 10,623 cases (17.34%) were classified as treatable and 50,638 (82.65%) as preventable. The mean annual change for avoidable causes was -2.43% (95% CI, -2.60 to -2.26), higher than the -1.57% (95% CI, -1.61 to -1.52) change for general mortality. The rates were higher for preventable causes than for treatable causes, although mortality decreased in both groups. The health area of Segrià was notable for its significantly higher mortality from both treatable and preventable causes in both periods. Four health areas showed a significant increase in mortality from preventable causes but none showed an increase in mortality from treatable causes. CONCLUSIONS: In Catalonia, the decrease in avoidable mortality was greater than that in general mortality from 1986 to 2001. The geographical distribution shows wide dispersion but allows areas requiring preventive interventions to be identified.

Exactitud de las estadísticas de mortalidad por causas externas y naturales con intervención médico-legal en Cataluña, 1996 / Accuracy of mortality statistics for external and natural causes of death with forensic intervention in Catalonia [Spain], 1996

Objetivo: Las muertes por causas externas y naturales con intervención judicial requieren autopsia médico-legal. Para formar parte de las estadísticas de mortalidad, los resultados de las autopsias se declaran en el documento estadístico MNP52. La exactitud de las causas de muerte declaradas en este documento podría depender de la persona que lo cumplimenta (médico-forense y personal del juzgado), del momento en que se hace (después de la muerte o de la autopsia) y de la estructura del mismo. El objetivo es conocer con qué exactitud se notifican las causas de muerte en las defunciones con intervención judicial de Cataluña en 1996. Métodos: Se realizaron dos muestreos: uno para causas naturales y otro para causas externas; se estratificó por sexo y partido judicial. Las fuentes de información fueron el Registro de Mortalidad de Cataluña para los documentos estadísticos y los Juzgados de Instrucción para los informes de autopsia médico-legal, de toxicología y de anatomía patológica. Se calculó la concordancia global simple, la sensibilidad o tasa de detección (TD) y el valor predictivo positivo o tasa de confirmación (TC) con sus respectivos intervalos de confianza. Resultados: La concordancia global simple fue de 72,3 por ciento (IC 95 por ciento: 68,7-75,9). Para los grupos de causas externas la TD fue de 65,9 por ciento (60,6-71,2) y la TC de 69 por ciento (63,6-71,2). Para los grupos de causas naturales la TD resultó 79,4 por ciento (74,7-84,2) y la TC 75,5 por ciento (70,7-80,5). Conclusiones: En las defunciones con intervención judicial, los documentos estadísticos oficiales carecen de exactitud en la notificación de las causas externas; en las causas naturales se aproximan al grado de exactitud que se considera aceptable. Estos resultados son debidos principalmente a déficits en la cumplimentación e incorrecta certificación de causas de muerte en los documentos estadísticos oficiales (AU)

[Exactness of mortality statistics by external and natural causes of death with medico-legal intervention in Catalonia, 1996]. / Exactitud de las estadísticas de mortalidad por causas externas y naturales con intervención médico-legal en Cataluña, 1996.

OBJECTIVE: Deaths due to external and natural causes with forensic intervention require medical-legal autopsy. In order to be included in the mortality statistics the results are reported in the statistical document MNP52. The accuracy of cause of death depends on the characteristics of the document, the point at which it is completed (after the death or after the autopsy) and the person that completes it. The objective is to determine the accuracy of external and natural causes of death with forensic intervention, reported in the official statistical documents by a medical-legal autopsy report of these deaths occurred in Catalonia in 1996. METHODS: Two samplings were undertaken--one for natural causes and another for external causes--that were stratified by sex and judicial district. The information sources were the Mortality Register of Catalonia for the statistical documents and the criminal courts for the medical-legal autopsy, toxicological and pathological reports. We calculated the index of agreement, the sensitivity or detection rate (DR) and the positive predictive value of confirmation rate (CR), and their respective 95% confidence intervals. RESULTS: The index of agreement was 72.3% (IC 95%: 68.7-75.9). The DR for external causes groups was 65.9% (60.6-71.2) and the CR was 69% (63.6-71.2). For natural causes the DR was 79.4% (74.7-84.2) and the CR was 75.5% (70.7-80.5). CONCLUSION: In deaths with forensic intervention, the official statistical documents do not correctly report external causes of death, and statistics for natural causes of death approach acceptable levels of accuracy. The results are mainly due to deficits in reporting and certifying these causes in the official statistics.