Open Access
Excess mortality during 2020 in Spain: the most affected population, age, and educational group by the Covid-19 pandemic
(Cambridge University Press, 2024-02-19) Pulido, José; Barrio, Gregorio; Donat, Marta; Politi, Julieta; Moreno Lostao, Almudena; Cea-Soriano, Lucía; Guerras, Juan M.; Huertas, Lidia; Mateo-Urdiales, Alberto; Ronda, Elena; Martínez, David; Lostao Unzu, Lourdes; Belza, María José; Regidor Poyatos, Enrique; Sociología y Trabajo Social; Soziologia eta Gizarte Lana; Institute for Advanced Social Research - ICOMMUNITAS; Universidad Pública de Navarra / Nafarroako Unibertsitate Publikoa.
Objective: The objective of this work was to study mortality increase in Spain during the first and second academic semesters of 2020, coinciding with the first 2 waves of the Covid-19 pandemic; by sex, age, and education. Methods: An observational study was carried out, using linked populations and deaths' data from 2017 to 2020. The mortality rates from all causes and leading causes other than Covid-19 during each semester of 2020, compared to the 2017-2019 averages for the same semester, was also estimated. Mortality rate ratios (MRR) and differences were used for comparison. Results: All-cause mortality rates increased in 2020 compared to pre-covid, except among working-age, (25-64 years) highly-educated women. Such increases were larger in lower-educated people between the working age range, in both 2020 semesters, but not at other ages. In the elderly, the MMR in the first semester in women and men were respectively, 1.14, and 1.25 among lower-educated people, and 1.28 and 1.23 among highly-educated people. In the second semester, the MMR were 1.12 in both sexes among lower-educated people and 1.13 in women and 1.16 in men among highly-educated people. Conclusion: Lower-educated people within working age and highly-educated people at older ages showed the greatest increase in all-cause mortality in 2020, compared to the pre-pandemic period.
Open Access
Trends and equity in the use of health services in Spain and Germany around austerity in Europe
(BMC, 2021) Moreno Lostao, Almudena; Lostao Unzu, Lourdes; Beller, Johannes; Sperlich, Stefanie; Ronda, Elena; Geyer, Siegfried; Pulido, José; Regidor Poyatos, Enrique; Soziologia eta Gizarte Lana; Institute for Advanced Social Research - ICOMMUNITAS; Sociología y Trabajo Social
Background: following the 2008 economic crisis many countries implemented austerity policies, including reducing public spending on health services. This paper evaluates the trends and equity in the use of health services during and after that period in Spain - a country with austerity policies - and in Germany - a country without restriction on healthcare spending. Methods: data from several National Surveys in Spain and several waves of the Socio-Economic Panel in Germany, carried out between 2009 and 2017, were used. The dependent variables were number of doctor's consultations and whether or not a hospital admission occurred. The measure of socioeconomic position was education. In each year, the estimates were made for people with and without pre-existing health problems. First, the average number of doctor's consultations and the percentage of respondents who had had been hospitalized were calculated. Second, the relationship between education and use of those health services was estimated by calculating the difference in consultations using covariance analysis - in the case of number of consultations - and by calculating the percentage ratio using binomial regression - in the case of hospitalization. Results: the annual mean number of consultations went down in both countries. In Spain the average was 14.2 in 2009 and 10.4 in 2017 for patients with chronic conditions; 16.6 and 13.5 for those with a mental illness; and 6.4 and 5.9 for those without a defined illness. In Germany, the averages were 13.8 (2009) and 12.9 (2017) for the chronic group; 21.1 and 17.0 for mental illness; and 8.7 and 7.5 with no defined illness. The hospitalization frequency also decreased in both countries. The majority of the analyses presented no significant differences in relation to education. Conclusion: in both Spain and Germany, service use decreased between 2009 and 2017. In the first few years, this reduction coincided with a period of austerity in Spain. In general, we did not find socioeconomic differences in health service use.
Open Access
Rural-urban disparities in the reduction of avoidable mortality and mortality from all other causes of death in Spain, 2003-2019
(Springer, 2023) Moreno Lostao, Almudena; Pulido, José; Cea-Soriano, Lucía; Guerras, Juan M.; Ronda, Elena; Lostao Unzu, Lourdes; Regidor Poyatos, Enrique; Sociología y Trabajo Social; Soziologia eta Gizarte Lana; Institute for Advanced Social Research - ICOMMUNITAS; Universidad Pública de Navarra / Nafarroako Unibertsitate Publikoa
Aim: This study aims to evaluate the trend of avoidable mortality and of mortality from all other causes of death in urban and rural areas in Spain, throughout the first 2 decades of the twenty-first century. Methods: Data deaths and population by age and sex, according to the area of residence, were obtained from the National Institute of Statistics. Avoidable mortality refers to premature deaths (≤ 75 years old) for which there is reasonable scientific consensus that they should not occur in the presence of timely health care. In large urban, small urban, and rural areas, annual age-standardized mortality rates from avoidable causes and from all other causes of death were calculated from 2003 to 2019. The annual percentage change (APC) in the mortality rate in each area was estimated using linear regression models and taking age-standardized mortality rates as dependent variable. Results: Mortality rates decreased between the beginning and the end of the period analysed. Large urban areas and rural areas showed the largest and smallest reduction in mortality rate respectively. The APC in avoidable mortality was -3.5% in men and -3.0% in women in large urban areas, and -2.7% in men and -2.6% in women in rural areas. The APC in the mortality rate from all other causes of death was -2.4% in men and -1.2% in women in large urban areas, and -1.4% in men and -1.0% in women in rural areas. Conclusion: In Spain, avoidable mortality and mortality from other causes of death in rural and urban areas show similar trends, which suggests the presence of a common factor responsible for such findings.

Lostao Unzu, Lourdes

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