Embarazo Adolescente en Chile: Una mirada a la desigualdad sociodemográfica comunal / Teen Pregnancy in Chile: A look to communal sociodemographic inequality

INTRODUCCIÓN Y OBJETIVOS El embarazo adolescente es un problema de salud pública mundial. En Chile no se ha estudiado su asociación a desigualdad y determinantes sociales. Se evaluó la distribución del embarazo adolescente, cuantificó su desigualdad y analizaron los factores socioeconómicos, demográficos y del sistema de salud municipal asociados, por comunas chilenas. Método Se estudió el porcentaje de nacidos vivos de mujeres de 10 a 19 años y la tasa de fertilidad adolescente, por comunas chilenas desde 2008 a 2012. Se midieron los indicadores de desigualdad Gini, Theil, Coeficiente de variación y Razón 90/10. Se evaluó la asociación de la tasa de fertilidad adolescente a características comunales con modelos de datos de panel. Resultados Se observó una disminución en la mediana del embarazo adolescente comunal, con un leve aumento en los indicadores de desigualdad medidos. La fertilidad adolescente se asoció a una mayor dependencia de los recursos municipales a un fondo de redistribución (p<0.01), menor gasto en salud municipal per cápita (p<0.05) y menor tasa de consultas por anticoncepción de emergencia (p<0.05 o p<0.1, dependiendo del modelo). En algunos modelos, se encontró asociación directa a pobreza (p<0.01) y años de vida perdidos (AVPP) (p<0.01), e indirecta a años de escolaridad promedio (p<0.05). Conclusiones Existe una asociación a características socioeconómicas y del sistema de salud municipal que permite proponer una tendencia al alza en la desigualdad en embarazo adolescente, profundizando la desigualdad de oportunidades y la transmisión intergeneracional de la pobreza.

ABSTRACT Introduction and objectives Teen pregnancy is a worldwide public health problem. In Chile, its association to social determinants and inequality has not been well studied. Our objective was to evaluate teen pregnancy distribution, quantify inequality and analyze associated socioeconomic, demographic and municipal health factors, by Chilean communes. Methods We studied the percentage of live births from woman 10 to 19 years old and adolescent fertility rate, from 2008 to 2012, in the 345 communes of Chile. We measured inequality through four indicators: Gini, Theil, Variation coefficient and 90/10 ratio. Using panel data models, we evaluated association of adolescent fertility rate to communes' characteristics. Results We observed a decrease in the communal teen pregnancy median, with a mild raise in inequality indicators. Adolescent fertility was heavily associated to a greater dependence in municipal resources to a redistribution fund (p<0.01), less expense in municipal healthcare per capita (p<0.05) and less emergency contraception consultations rate (p<0.05 or p<0.1, depending on the model built). In some models, we found a direct association to poverty (p<0.01) and years of life lost (YLL) (p<0.01), and indirect to average schooling years (p<0.05). Conclusions Association found to socioeconomic and municipal health characteristics allows proposing that inequality in teen pregnancy by communes in Chile will continue increasing, deepening inequality of opportunity and intergenerational transmission of poverty.

Determinantes sociales de la edad de fallecimiento por causa cardiovascular / Association of socio-demographic factors with the age at death due to cardiovascular diseases

Background: The association of cardiovascular diseases with socio-demographic factors has not been fully explored. Aim: To analyze the association of socio-demographic features with the survival time of individuals who died due to cardiovascular diseases. Material and Methods: The death registries published by the Ministry of Health were analyzed. All deaths due to cardiovascular diseases occurred between 2001 and 2013 in people aged over one year were considered. Using a principal component analysis, the age at death was associated with socio-demographic features such as sex, marital status, residence zone, schooling, work status and medical care prior to death. Results: A total of 293,370 cardiovascular deaths were analyzed. The median age at death was 77 years. Not receiving medical care prior to death, was significantly associated with a lower age at the moment of the decease, mainly between 20 and 80 years of age. Among men, being occupationally active (hazard ratio (HR = 1.5 p < 0.01) and being unemployed (HR = 1.1 p < 0.01) were risks factors for early cardiovascular death. Being married, having higher schooling, residing in urban areas and having prior medical care were associated with a higher age at the moment of decease. Conclusions: Socio-demographic profiles are associated with the age at death due to cardiovascular diseases. The effect of not receiving medical care on the age at death is noteworthy and reflects social inequities in the access to health care.

Perfil sociodemográfico y factores asociados a consultas por anticoncepción de emergencia / Socio-demographic profile and factors associated with emergency contraception consultations

Background: Emergency contraception refers to contraceptive methods that can be used after a sexual intercourse Aim: To analyze the evolution of emergency contraception (EC) consultations on the Chilean public health system, at a communal level, in relation to the legal changes that recently took place, aimed to ease the delivery of the benefit. To analyze its association with socioeconomic, demographic and municipal healthcare system characteristics. Material and Methods: We analyzed data bases of the Ministry of Health to study EC consultation rates on Chilean communes, including consultations on emergency departments and by rape, from 2008 to 2013. We evaluated the association with communal characteristics, obtained from the National Municipal Information System. Results: Both the communal consultation rates and percentage of communes with consultations increased progressively during the period, with an explosive increase between 2009 and 2010. We observed a high dispersion in EC consultations both at a communal and regional level. There was an inverse significant association of the number of consultations with the communal poverty rate. Conclusions: Our results reveal the impact of legal modifications implemented in Chile since 2009 on the communal EC consultation rates. On other hand, our results reveal that although these modifications were oriented to favor the delivery of this benefit, a high dispersion subsists, associated with population's socioeconomic factors, mainly, the communal poverty level.