Influence of Place of Birth on Adult Mortality: The Case of Spain.

We use a unique data set from Spain and we estimate life expectancy at age 50 for males and females by place of residence and place of birth. We show that, consistent with expectations regarding the influence of early conditions on adult health and mortality, the effects of place of birth on adult mortality are very strong, irrespective of place of residence. Furthermore, we find that mortality levels observed in a place are strongly influenced by the composition of migrants by place of birth. This is reflected in a new measure of heritability of early childhood conditions that attains a value in the range 0.42-0.43, implying that as much as 43 percent of the variance in Spain's life expectancy at age 50 is explained by place of birth. Finally, we find evidence of the healthy migrant effect, that is, positive health selection of migrants, at a regional level.

Educational Differences in Cohort Fertility Across Sub-national Regions in Europe.

Educational differences in female cohort fertility vary strongly across high-income countries and over time, but knowledge about how educational fertility differentials play out at the sub-national regional level is limited. Examining these sub-national regional patterns might improve our understanding of national patterns, as regionally varying contextual conditions may affect fertility. This study provides for the first time for a large number of European countries a comprehensive account of educational differences in the cohort fertility rate (CFR) at the sub-national regional level. We harmonise data from population registers, censuses, and large-sample surveys for 15 countries to measure women's completed fertility by educational level and region of residence at the end of the reproductive lifespan. In order to explore associations between educational differences in CFRs and levels of economic development, we link our data to regional GDP per capita. Empirical Bayesian estimation is used to reduce uncertainty in the regional fertility estimates. We document an overall negative gradient between the CFR and level of education, and notable regional variation in the gradient. The steepness of the gradient is inversely related to the economic development level. It is steepest in the least developed regions and close to zero in the most developed regions. This tendency is observed within countries as well as across all regions of all countries. Our findings underline the variability of educational gradients in women's fertility, suggest that higher levels of development may be associated with less negative gradients, and call for more in-depth sub-national-level fertility analyses by education.

Geographical variations in cancer mortality and social inequalities in southern Spain (Andalusia). 2002-2013.

INTRODUCTION: Geographical variations in cancer mortality can be explained, in part, by their association with social inequalities. The objective of our study was to analyse the spatial pattern of mortality in relation to the most common causes of cancer in the Spanish autonomous community of Andalusia and its possible association with social inequalities. MATERIALS AND METHODS: A small area cross-sectional study in Andalusia, with census tracts as units of spatial analysis, for the period 2002-2013. Cases and person-years, sex and age group came from the Longitudinal Population Database of Andalusia. Standardized mortality rates and smoothed risk ratios were calculated using the Besag, York and Mollié model for lung, colorectal, breast, prostate, bladder and stomach cancer. In order to evaluate the association with social inequalities we included the deprivation index of the census tract as a covariate. RESULTS: The results show an East-West mortality pattern with higher risk in the west for lung and bladder cancer among men, and breast cancer among women. For all of Andalusia, the association between deprivation index of the census tract and mortality relative risks is positive and significant for lung, stomach and bladder cancers in men, while in women we observed a negative association for lung cancer and a positive for stomach cancer. CONCLUSIONS: Knowledge regarding the spatial distribution of cancer mortality and the socioeconomic inequalities related should contribute to the design of specific health and social policies-aimed at tackling cancer mortality and social inequalities in areas of high mortality and/or levels of deprivation.

[Differences in disability-free life expectancy by gender and autonomous regions in Spain]. / Diferencias en la esperanza de vida libre de discapacidad por sexo y comunidades autónomas en España.

BACKGROUND: Improvement of population health is the main aim and an important challenge for the health system. To monitor the population health indicators like disability-free life expectancy (DFLE) have been implemented. The purpose of this paper was to analyze the geographical distribution of DFLE according to autonomous regions in Spain. METHODS: Data of mortality, population and disability for the year 1999, provided by the National Institute of Statistics (INE), were used. To calculate DFLE by gender and region we used the Sullivan method that weights the expected time to live according to the status of disablement of the population. The standard error of DFLE, the expectation of disability and the proportion of time lived free of disability have also been estimated. RESULTS: In 1999 the DFLE at birth in Spain was 68.5 year for men and 72.2 years in women. Men lived proportionally more time free of disability than women (91% versus 87.7%) with an expectation of disability of 6.8 and 10.1 years respectively. Variability among regions was higher in DFLE than in life expectancy (LE). The regions with highest LE are not always those with the highest proportion of time lived without disability. CONCLUSIONS: Highest life expectancy does not always mean best health as it has been assumed currently. The DFLE indicator is a useful tool to show health status differences among the Spanish population.

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

[Keys to demographic changes in the new millennium]. / Claves de la evolución demográfica en el cambio de milenio.

This article describes the main features of the dynamics of demographic change in the population of Spain during the twentieth century, emphasizing the most recent developments: population ageing, the establishment of a very low fertility regime and the increasing importance of foreign immigration as well as the impact which all these have on the composition of households. Those aspects most directly related to the provision of health and social services is discussed, such as the impact of increased life expectancy on the incidence of illness and handicap in the population, the role of foreign immigration in providing personal services within the family and the health implications of the new model of delayed fertility. Finally, the health implications of population projections for the next 50 years are discussed.

Claves de la evolución demográfica en el cambio de milenio / Keys to demographic changes in the new millennium

Este trabajo describe las grandes líneas que han marcado la dinámica demográfica de la población española en el siglo XX y subraya las tendencias demográficas más recientes: el envejecimiento de la población, la implantación de un régimen de muy baja fecundidad, la creciente importancia de la inmigración y el impacto que todo ello tiene sobre las estructuras de los hogares. Se discuten algunos de los aspectos más fuertemente conectados con la provisión de servicios sociales y de salud, como las mejoras de la longevidad en la evolución de la carga de enfermedad y discapacidad, el papel de la inmigración en la provisión de servicios de cuidados personales en el seno de las familias y las implicaciones sanitarias de un nuevo modelo de fecundidad retrasada. Por último, se muestran las implicaciones sanitarias de las proyecciones de población para los próximos 50 años. (AU)

[Inequalities in mortality in Seville [Spain]]. / Desigualdades en mortalidad en la ciudad de Sevilla.

OBJECTIVES: To describe social inequalities in mortality in Seville from 1994 to 1998 according to socioeconomic status. METHODS: Life expectancy, crude and age-adjusted rates of total mortality as well as mortality by causes and potential years of life lost were estimated using the number of deaths and the population of Seville, aggregated by Basic Health Areas (BHA). BHA were divided in three levels according to the unemployment rate among men. The relative risks of total mortality and mortality by causes were estimated for men and women in each of these levels, using Poisson regression. The unemployment rate of each of the BHA was related to total mortality and to some of its causes. RESULTS: Differences in life expectancy of up to 7.9 years for men and 4.6 years for women were found among BHA. Concerning potential years of life lost, the areas with the highest mortality showed 4.1 times greater mortality in men and 2.6 times greater mortality in women than those with the lowest mortality. Total mortality increased with unemployment rate: the BHA with the highest unemployment rate showed a 15% increase in mortality in men and a 6% increase in that in women than those with the lowest unemployment rate. Among causes of mortality, AIDS showed the greatest inequalities in both men and women. CONCLUSIONS: From 1994 to 1998, Seville presented inequalities in total mortality and premature mortality, as well as in mortality by causes per BHA. Inequalities were present in men and women, although they were greater in men. There was a clear association between socioeconomic variables and mortality.

Desigualdades en mortalidad en la ciudad de Sevilla / Inequalities in mortality in Seville [Spain]

Objetivos: Describir las desigualdades sociales respecto a la mortalidad en la ciudad de Sevilla en el período 1994-1998, según el nivel socioeconómico. Métodos: Con las defunciones y las poblaciones de Sevilla agregadas por zonas básicas de salud (ZBS), se ha calculado la esperanza de vida, las tasas brutas y ajustadas por edad de la mortalidad general y por causas, y de años potenciales de vida perdidos; con los porcentajes de desempleo en varones, se han dividido las ZBS en 3 niveles, y mediante modelos de regresión de Poisson se han estimado los riesgos relativos (RR) de mortalidad general y por causas en cada uno de los niveles para varones y mujeres; asimismo, se han relacionado los porcentajes de desempleo de cada una de las ZBS con la mortalidad general y algunas causas de muerte. Resultados: Existían unas diferencias de 7,9 y 4,6 años, para varones y mujeres respectivamente, en la esperanza de vida al nacer entre las ZBS de menor y mayor mortalidad. En años potenciales de vida perdidos, las zonas de mayor mortalidad presentaron 4,1 veces más mortalidad en los varones y 2,6 veces en las mujeres que las de menor mortalidad. La mortalidad general aumentaba a medida que se incrementaban los porcentajes de desempleo: las ZBS con porcentajes de desempleo más elevados tuvieron un 15 por ciento más de mortalidad que las de menor desempleo en los varones y un 6 por ciento en las mujeres. Por causas, el sida fue la enfermedad que mayores desigualdades presentó en mortalidad, tanto en varones como en mujeres. Conclusiones: La ciudad de Sevilla en el período 1994-1998 presenta importantes desigualdades por ZBS en la mortalidad general, la mortalidad prematura y por causas. Las desigualdades se dan tanto en los varones como en las mujeres, aunque su magnitud es mayor en los varones. Existe una clara asociación entre los niveles socioeconómicos y la mortalidad (AU)