Mortality by cause of death and risk behaviors in farmers versus non-farmers: the importance of avoiding the healthy worker effect.

OBJECTIVES: To compare mortality by cancer sites and by other specific causes of death, and the prevalence of risk behaviors in farmers and non-farmers in Spain. METHODS: Mortality by cause of death was calculated based on a longitudinal study with 10-years follow-up of 9.5 million men and 6 million women aged 20-64 years who were employed in 2001. The prevalence of risk behaviors was calculated from the 2001 National Health Survey in the 6464 employed men and 5573 employed women aged 20-64. The study subjects were grouped as farmers and non-farmers. For each cause of death, we estimated the ratio of age-standardized mortality rates, and for each risk behavior we estimated the age-standardized prevalence ratio in farmers versus non-farmers. RESULTS: In men, the mortality rate for most cancer sites did not differ significantly between farmers and non-farmers, except for cancers of the lip, oral cavity, stomach, larynx and skin epidermoid carcinoma-which was higher in farmers-and cancers of the liver, pancreas and mesothelioma-which was lower in farmers. In contrast, farmers had a higher rate of mortality from most other diseases and from external causes of death. In women, farmers showed lower mortality from lung cancer, breast cancer and chronic lower respiratory disease, and higher mortality from external causes. The prevalence of smoking, excessive alcohol consumption, physical inactivity and obesity was higher in farmers than in non-farmers, except smoking and excessive alcohol consumption in women where prevalence was lower in farmers. CONCLUSIONS: Findings are different from those found in other studies. In men, greater exposure to the sun and the higher prevalence of risk behaviors in farmers could explain their excess mortality from some cancer sites and the other causes of death. However, other factors may be behind this excess risk of mortality from these causes, given that farmers did not show higher mortality from some cancers related to smoking. In women, no differences were observed in mortality rate for majority of causes of death between farmers and non-farmers.

Influencia de la mortalidad en las personas con bajo nivel educativo en la variación de las desigualdades de mortalidad en las comunidades autónomas / Variation in mortality inequalities in the Autonomous Communities of Spain: the influence of mortality in people with less education

Fundamento. Dada la importancia de las tasas de mortalidad en cada grupo socioeconómico, como explicación de la variación en las desigualdades de mortalidad entre las poblaciones, el objetivo del presente estudio es evaluar si la variación regional en las desigualdades de mortalidad en España está relacionado con las tasas de mortalidad en diferentes grupos socioeconómicos. Métodos. El estudio incluyó a todas las personas de 30-74 años que vivían en España en 2001 y a las que se realizó un seguimiento para conocer su estado vital más de 7 años. En cada una de las 17 comunidades autónomas se han estimado las tasas de mortalidad en personas con bajo y con alto nivel educativo, así como dos medidas de desigualdad de la mortalidad de acuerdo a la educación: diferencia de tasas de mortalidad y razón de tasas de mortalidad. Se calculó el valor de la mediana de las desigualdades de mortalidad en las comunidades autónomas con las tasas de mortalidad más altas y bajas y en aquellas con las tasas de mortalidad intermedias. Y se estimó el coeficiente de correlación de Pearson para evaluar la relación entre las tasas de mortalidad y las medidas de desigualdad en mortalidad. Resultados. Los coeficientes de correlación de la tasa de mortalidad en personas con bajo nivel educativo con la diferencia de tasa de mortalidad y con la razón de tasas de mortalidad fueron 0,87 y 0,78 en mujeres y 0,81 y 0,73 en los hombres, respectivamente. Los coeficientes de correlación de la tasa de mortalidad en personas con alto nivel educativo con la diferencia de tasa de mortalidad y con la razón de tasas de mortalidad fueron -0,07 y -0,24 en mujeres y 0,10 y -0,06 en los hombres, respectivamente. Conclusión. Las comunidades autónomas con las tasas de mortalidad más bajas y más altas en las personas con bajo nivel educativo generalmente tienen las menores y las mayores desigualdades en mortalidad. La variación en la magnitud de las desigualdades en mortalidad de un lugar a otro puede ser explicada por la variación en la tasa de la mortalidad en las personas con bajo nivel educativo.No se observó relación entre la tasa de mortalidad en personas con alto nivel educativo y las desigualdades de la mortalidad. (AU)

Background. Given the importance of mortality rates in each socioeconomic group, as explanation for the variation in mortality inequalities across populations, the objective of the present study is to evaluate whether regional variation in mortality inequalities in Spain is related to the mortality rates in different socioeconomic groups. Methods. The study included all persons aged 30-74 years living in Spain in 2001 and followed up for mortality over 7 years. In each of the 17 autonomous communities of Spain mortality rates were estimated for those with low and high education, as well as two measures of mortality inequality according to education: mortality rate difference and mortality rate ratio. Median value of mortality inequalities was calculated for the regions with the highest and lowest mortality rates and for those with intermediate mortality rates. And the Pearson correlation coefficient was used to estimate the relation between mortality rates and the measures of mortality inequality. Results. The correlation coefficients between mortality rate in low education and mortality rate difference and mortality rate ratio were 0.87 and 0.78 in women and 0.81 and 0.73 in men, respectively. The correlation coefficients between mortality rate in high education and mortality rate difference and mortality rate ratio were -0.07 and -0.24 in women and 0.10 and -0.06 in men, respectively. Conclusion. Regions with the lowest and highest mortality rates in low education people generally had the lowest and highest inequalities in mortality. The variation in the magnitude of inequalities in mortality from one place to another can be explained by the variation in mortality in low education people. No relation was observed between mortality rate in high education and mortality inequality (AU)

Area-level socioeconomic context, total mortality and cause-specific mortality in Spain: Heterogeneous findings depending on the level of geographic aggregation.

The objective of this study was to estimate the association between area-level socioeconomic context and mortality in Spain, using two different geographic aggregations. Nation-wide prospective study covering all persons living in Spain in 2001. Mortality was analysed in Spanish citizens by province of residence and in citizens of Madrid by neighbourhood of residence. Provinces and neighbourhoods were grouped into quartiles according to two socioeconomic indicators: percentage of the population with university education and unemployment rate. The measure of association was the rate ratio for total mortality and cause-specific mortality, by each socioeconomic indicator in two age groups, 25-64 years (adult population) and 65 years and over (elderly population). After adjustment for all individual socioeconomic variables, the rate ratio for total mortality among residents in the provinces with the worst versus best socioeconomic context was 0.92 (95% CI 0.88-0.97) when the indicator was percentage of university population and 0.89 (0.85-0.93) when it was unemployment rate in the adult population, and 1.05 (1.00-1.11) and 1.08 (1.03-1.13), respectively, in the elderly population. No significant differences in mortality were observed between adults residing in neighbourhoods with the worst versus best socioeconomic context, but in the elderly population the mortality rate ratios for the two socioeconomic indicators were 1.04 (1.01-1.07) and 1.06 (1.03-1.09), respectively. Residents in provinces with the worst socioeconomic context had the lowest mortality from cancer and external causes and the highest mortality from cardiovascular diseases, while residents in neighbourhoods with the worst socioeconomic context had the highest mortality from respiratory and digestive diseases. Further research should find out the reasons for the lower total mortality in adult population residing in the Spanish provinces with the most adverse socioeconomic context and the reasons for excess mortality from digestive diseases and respiratory diseases among residents in neighbourhoods with the worst socioeconomic context.

[Variation in mortality inequalities in the autonomous communities of Spain: a matter of mortality in people with less education].

BACKGROUND: Given the importance of mortality rates in each socioeconomic group, as explanation for the variation in mortality inequalities across populations, the objective of the present study is to evaluate whether regional variation in mortality inequalities in Spain is related to the mortality rates in different socioeconomic groups. METHODS: The study included all persons aged 30-74 years living in Spain in 2001 and followed up for mortality over 7 years. In each of the 17 autonomous communities of Spain mortality rates were estimated for those with low and high education, as well as two measures of mortality inequality according to education: mortality rate difference and mortality rate ratio. Median value of mortality inequalities was calculated for the regions with the highest and lowest mortality rates and for those with intermediate mortality rates. And the Pearson correlation coefficient was used to estimate the relation between mortality rates and the measures of mortality inequality. RESULTS: The correlation coefficients between mortality rate in low education and mortality rate difference and mortality rate ratio were 0.87 and 0.78 in women and 0.81 and 0.73 in men, respectively. The correlation coefficients between mortality rate in high education and mortality rate difference and mortality rate ratio were -0.07 and -0.24 in women and 0.10 and -0.06 in men, respectively. CONCLUSION: Regions with the lowest and highest mortality rates in low education people generally had the lowest and highest inequalities in mortality. The variation in the magnitude of inequalities in mortality from one place to another can be explained by the variation in mortality in low education people. No relation was observed between mortality rate in high education and mortality inequality.