Diabetes mellitus mortality in Spanish cities: Trends and geographical inequalities.

AIM: To analyze the geographical pattern of diabetes mellitus (DM) mortality and its association with socioeconomic factors in 26 Spanish cities. METHODS: We conducted an ecological study of DM mortality trends with two cross-sectional cuts (1996-2001; 2002-2007) using census tract (CT) as the unit of analysis. Smoothed standardized mortality rates (sSMR) were calculated using Bayesian models, and a socioeconomic deprivation score was calculated for each CT. RESULTS: In total, 27,757 deaths by DM were recorded, with higher mortality rates observed in men and in the period 1996-2001. For men, a significant association between CT deprivation score and DM mortality was observed in 6 cities in the first study period and in 7 cities in the second period. The highest relative risk was observed in Pamplona (RR, 5.13; 95% credible interval (95%CI), 1.32-15.16). For women, a significant association between CT deprivation score and DM mortality was observed in 13 cities in the first period and 8 in the second. The strongest association was observed in San Sebastián (RR, 3.44; 95%CI, 1.25-7.36). DM mortality remained stable in the majority of cities, although a marked decrease was observed in some cities, including Madrid (RR, 0.67 and 0.64 for men and women, respectively). CONCLUSIONS: Our findings demonstrate clear inequalities in DM mortality in Spain. These inequalities remained constant over time are were more marked in women. Detection of high-risk areas is crucial for the implementation of specific interventions.

[Evolution of mortality attributable to tobacco in the Canary Islands (1975-1994)]. / Evolución de la mortalidad atribuible al tabaco en las Islas Canarias (1975-1994).

BACKGROUND: The objective of this study is that of describing the death rate attributable to tobacco on the Canary Islands throughout the 1975-1994 period. METHOD: Deaths by age, sex and cause from 1975 to 1994 were obtained from the Spanish National Institute of Statistics (Natural Movement of Population). Based on the Spanish and Canary Island Health Surveys, the percentages of those who had never smoked, smokers and ex-smokers for the Canary Island population were taken by age and sex. The relative risks of death were taken from the Cancer Prevention Study II carried out in the United States. The percentages of deaths attributable to smoking were calculated for each year, sex and age group based on the attributable fraction of the population. Likewise, the trend in the death rate attributable for the time period in question was calculated and given in the form of the annual mean percentage change in the age-adjusted death rates by way of a log-linear model. RESULTS: During the 1975-1994 period, the number of deaths attributed to smoking rose by 64%. For major causes, a 108% increase in neoplasias, a 32% drop in cardiovascular diseases and a 15.5% increase in respiratory diseases were found for the period under study. The number of deaths was also found to increase with age, the 65 and over age group having been found to be that in which the most deaths caused by smoking occurred. CONCLUSIONS: On the Canary Islands, over 20% of all deaths in 1994 can be attributed to smoking. This suggests that the measures implemented to control the smoking habit are insufficient.