El efecto del estado civil sobre las desigualdades sociales y de género en la mortalidad por diabetes mellitus en Andalucía / The effect of marital status on social and gender inequalities in diabetes mortality in Andalusia

Objetivos: Evaluar el efecto modificador del estado civil sobre las desigualdades sociales y de género en la mortalidad por diabetes mellitus (DM) en Andalucía. Material y métodos: Estudio transversal a partir de la Cohorte Censal 2001 de Andalucía. Se estudiaron defunciones por DM entre 2002 y 2013 según nivel de estudios y estado civil. Se calcularon tasas de mortalidad ajustadas por edad (TA) y razones de tasas de mortalidad (RTM) mediante modelos de regresión de Poisson, controladas por otras variables sociodemográficas. Se evaluó el efecto modificador del estado civil incorporando a los modelos un término de interacción. Todos los análisis se realizaron separadamente para hombres y mujeres. Resultados: Sobre un total de 4.229.791 sujetos se registraron 18.158 muertes por DM (10.635 mujeres y 7.523 hombres). A medida que disminuye el nivel educativo aumenta el riesgo de muerte. El estado civil modifica la desigualdad social en la mortalidad por DM de forma diferente en cada sexo. Las mujeres viudas y separadas/divorciadas con menor nivel de estudios presentan las mayores RTM: 5,1 (IC95%: 3,6-7,3) y 5,6 (IC95%: 3,6-8,5), respectivamente, mientras que los hombres solteros tienen la RTM más elevada: 3,1 (IC95%: 2,7-3,6). Conclusiones: El nivel de estudios es un determinante fundamental de la mortalidad por DM en ambos sexos; su relevancia es mayor entre las mujeres, mientras que en los hombres también el estado civil es un factor clave. Para abordar las desigualdades en la mortalidad nuestros resultados sugieren que el énfasis actual en los factores individuales y el autocuidado debería extenderse hacia intervenciones sobre la familia, la comunidad y los contextos sociales más cercanos a los pacientes (AU)

Objective: To assess the modifying effect of marital status on social and gender inequalities in mortality from diabetes mellitus (DM) in Andalusia. Material and methods: A cross-sectional study was conducted using the Andalusian Longitudinal Population Database. DM deaths between 2002 and 2013 were analyzed by educational level and marital status. Age-adjusted rates (AARs) and mortality rate ratios (MRRs) were calculated using Poisson regression models, controlling for several social and demographic variables. The modifying effect of marital status on the association between educational level and DM mortality was evaluated by introducing an interaction term into the models. All analyses were performed separately for men and women. Results: There were 18,158 DM deaths (10,635 women and 7,523 men) among the 4,229,791 people included in the study. The risk of death increased as the educational level decreased. Marital status modified social inequality in DM mortality in a different way in each sex. Widowed and separated/divorced women with the lowest educational level had the highest MRRs, 5,1 (95%CI: 3,6-7,3) and 5,6 (95% CI:3,6-8,5) respectively, while single men had the highest MRR, 3,1 (95%CI: 2,7-3,6). Conclusions: Educational level is a key determinant of DM mortality in both sexes, and is more relevant in women, while marital status also plays an outstanding role in men. Our results suggest that in order to address inequalities in DM mortality, the current focus on individual factors and self-care should be extended to interventions on the family, the community, and the social contexts closest to patients (AU)

The effect of marital status on social and gender inequalities in diabetes mortality in Andalusia. / El efecto del estado civil sobre las desigualdades sociales y de género en la mortalidad por diabetes mellitus en Andalucía.

OBJECTIVE: To assess the modifying effect of marital status on social and gender inequalities in mortality from diabetes mellitus (DM) in Andalusia. MATERIAL AND METHODS: A cross-sectional study was conducted using the Andalusian Longitudinal Population Database. DM deaths between 2002 and 2013 were analyzed by educational level and marital status. Age-adjusted rates (AARs) and mortality rate ratios (MRRs) were calculated using Poisson regression models, controlling for several social and demographic variables. The modifying effect of marital status on the association between educational level and DM mortality was evaluated by introducing an interaction term into the models. All analyses were performed separately for men and women. RESULTS: There were 18,158 DM deaths (10,635 women and 7,523 men) among the 4,229,791 people included in the study. The risk of death increased as the educational level decreased. Marital status modified social inequality in DM mortality in a different way in each sex. Widowed and separated/divorced women with the lowest educational level had the highest MRRs, 5,1 (95%CI: 3,6-7,3) and 5,6 (95% CI:3,6-8,5) respectively, while single men had the highest MRR, 3,1 (95%CI: 2,7-3,6). CONCLUSIONS: Educational level is a key determinant of DM mortality in both sexes, and is more relevant in women, while marital status also plays an outstanding role in men. Our results suggest that in order to address inequalities in DM mortality, the current focus on individual factors and self-care should be extended to interventions on the family, the community, and the social contexts closest to patients.

[Family, socioeconomic status and health services: Clues to health care in diabetic patients with lower limb amputations in Andalusia. A qualitative study]. / Familia, economía y servicios sanitarios: claves de los cuidados en pacientes con diabetes y amputación de miembros inferiores. Estudio cualitativo en Andalucía.

AIM: To examine the experience of diabetic care in patients undergoing lower limb amputation. DESIGN: A qualitative study using the phenomenological approach. SETTING: Cadiz Health District. PARTICIPANTS: A total of 16 patients (11 men and 5 women) diagnosed with diabetes mellitus type 2 and with non-traumatic lower limb amputation. METHODS: Semi-structured interviews were performed, followed by a content analysis according Graneheim and Lundman. RESULTS: Four categories were identified: 1. The family is the cornerstone for diabetic care. 2. The socio-economic and working conditions determine the quality of self-care. 3. The patient-health professional interaction facilitates patient care. 4. Limitations in the provision of health services. CONCLUSION: Family, economic and working conditions, along with health system-related factors are the most important elements in the care of patients with diabetes and amputations. Social, economic and working conditions determine diabetic complications. In order to enhance health care impact on the prevention of diabetes mellitus complications, health system policy makers must take these facts seriously into consideration and in a more personalised manner.

Evolución de las desigualdades sociales en la mortalidad general de la ciudad de Cádiz (1992-2007) / Trends in socioeconomic inequalities in general mortality in the city of Cadiz, Spain (1992-2007)

Objetivo: Analizar la evolución de la desigualdad socioeconómica en la mortalidad general en la ciudad de Cádiz durante el periodo 1992-2007. Método: Estudio ecológico de tendencias con tres cortes transversales, con la sección censal como unidad de análisis. Defunciones agrupadas en tres periodos (1992-1996, 1997-2001 y 2002-2007), clasificadas según un índice de privación de la sección censal. Se calcularon tasas ajustadas por el método directo y tres medidas de desigualdad social. Resultados: Del total de 18.586 defunciones, se geocodificó la sección censal del 96,7%. El riesgo atribuible poblacional pasó, respectivamente en hombres y mujeres, del 15,4% y el 12,2% en 1992-1996 al 9,3% y el 5,6% en 2002-2007. El índice relativo de desigualdad y el índice de la pendiente de desigualdad descendieron sólo entre las mujeres. Conclusión: A pesar de observar una tendencia decreciente, las desigualdades sociales son un elemento sustantivo en la distribución de la mortalidad general en la ciudad de Cádiz (AU)

Objective: To analyze trends in socioeconomic inequality in mortality in the city of Cadiz (Spain) from 1992 to 2007. Methods: An ecological study was performed of trends over 3 cross-sections, with the census tract as the unit of analysis. Deaths were grouped into three periods: 1992-1996, 1997-2001 and 2002-2007 and were then classified according to a deprivation index of the census tract. We calculated adjusted rates by the direct method and three measures of health inequality. Results: Of 18,586 deaths, 96.7% was geocoded to a census tract. The population-attributable risk decreased in men and women, respectively, from 15.4% and 12.2% in 1992-1996 to 9.3% and 5.6% in 2002-2007. The other measures, slope index and the relative index also showed a decline in inequality but only among women. Conclusions: Despite a decreasing trend, social inequalities are a substantial component in the distribution of overall mortality in the city of Cadiz (AU)

[Trends in socioeconomic inequalities in general mortality in the city of Cadiz, Spain (1992-2007)]. / Evolución de las desigualdades sociales en la mortalidad general de la ciudad de Cádiz (1992-2007).

OBJECTIVE: To analyze trends in socioeconomic inequality in mortality in the city of Cadiz (Spain) from 1992 to 2007. METHODS: An ecological study was performed of trends over 3 cross-sections, with the census tract as the unit of analysis. Deaths were grouped into three periods: 1992-1996, 1997-2001 and 2002-2007 and were then classified according to a deprivation index of the census tract. We calculated adjusted rates by the direct method and three measures of health inequality. RESULTS: Of 18,586 deaths, 96.7% was geocoded to a census tract. The population-attributable risk decreased in men and women, respectively, from 15.4% and 12.2% in 1992-1996 to 9.3% and 5.6% in 2002-2007. The other measures, slope index and the relative index also showed a decline in inequality but only among women. CONCLUSIONS: Despite a decreasing trend, social inequalities are a substantial component in the distribution of overall mortality in the city of Cadiz.