Open Access
Cardiovascular mortality and risk behaviours by degree of urbanization before, during and after the economic crisis in Spain
(BioMed Central, 2019) Moreno Lostao, Almudena; Guerras, Juan M.; Lostao Unzu, Lourdes; Fuente, Luis de la; Martínez, David; Rodríguez Artalejo, Fernando; Regidor Poyatos, Enrique; Sociología y Trabajo Social; Soziologia eta Gizarte Lana
Background: To estimate the relationship of the degree of urbanization to cardiovascular mortality and to risk behaviours before, during and after the 2008 economic crisis in Spain. Methods: In three areas of residence - large urban areas, small urban areas and rural areas - we calculated the rate of premature mortality (0-74 years) from cardiovascular diseases before the crisis (2005-2007), during the crisis (2008-2010 and 2011-2013) and after the crisis (2014-2016), and the prevalence of risk behaviours in 2006, 2011 and 2016. In each period we estimated the mortality rate ratio (MRR) and the prevalence ratio, taking large urban areas as the reference. Results: In men, no significant differences were observed in mortality between the two urban areas, while the MRR in rural areas went from 0.92 [95% confidence interval, 0.90-0.94) in 2005-2007 to 0.94 (0.92-0.96) in 2014-2016. In women, no significant differences were observed in mortality between the rural and large urban areas, whereas the MRR in small urban areas decreased from 1.11 (1.08-1.14) in 2005-2007 to 1.06 (1.02-1.09) in 2014-2016. The rural areas had the lowest prevalence of smoking, obesity and physical inactivity in men, and of obesity in women. No significant differences were observed in smoking or physical inactivity by area of residence in women. Conclusion: The pattern of cardiovascular mortality by degree of urbanization was similar before and after the crisis, although in women the excess mortality in small urban areas with respect to large urban areas was smaller after the crisis. The different pattern of risk behaviours in men and women, according to area of residence, could explain these findings.
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 in grip strength: age, period, and cohort effects on grip strength in older adults from Germany, Sweden, and Spain
(Elsevier, 2019) Beller, Johannes; Miething, Alexander; Regidor Poyatos, Enrique; Lostao Unzu, Lourdes; Epping, Jelena; Geyer, Siegfried; Sociología y Trabajo Social; Soziologia eta Gizarte Lana
Grip strength is seen as an objective indicator of morbidity and disability. However, empirical knowledge about trends in grip strength remains incomplete. As trends can occur due to effects of aging, time periods and birth cohorts, we used hierarchical age-period-cohort models to estimate and disentangle putative changes in grip strength. To do this, we used population-based data of older adults, aged 50 years and older, from Germany, Sweden, and Spain from the SHARE study (N = 22500) that encompassed multiple waves of first-time respondents. We found that there were contrasting changes for different age groups: Grip strength improved over time periods for the oldest old, whereas it stagnated or even decreased in younger older adults. Importantly, we found strong birth cohort effects on grip strength: In German older adults, birth cohorts in the wake of the Second World War exhibited increasingly reduced grip strength, and in Spanish older adults, the last birth cohort born after 1960 experienced a sharp drop in grip strength. Therefore, while grip strength increased in the oldest old aged 80 years and older, grip strength stagnated or decreased in comparatively younger cohorts, who might thus be at risk to experience more morbidity and disability in the future than previous generations. Future studies should investigate factors that contribute to this trend, the robustness of the observed birth cohort effects, and the generalizability of our results to other indicators of functional health.
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.
Open Access
Use of health services according to income before and after elimination of copayment in Germany and restriction of universal health coverage in Spain
(BioMed Central, 2018) Lostao Unzu, Lourdes; Geyer, Siegfried; Albaladejo, Romana; Moreno Lostao, Almudena; Ronda, Elena; Regidor Poyatos, Enrique; Sociología; Soziologia
Background: In Germany copayment for medical consultation was eliminated in 2013, and in Spain universal health coverage was partly restricted in 2012. This study shows the relationship between income and the use of health services before and after these measures in each country. Methods: Data were taken from the 2009 and 2014 Socio-Economic Panel conducted in Germany, and from the 2009 and 2014 European Health Surveys in Spain. The health services investigated were physician consultations and hospital admissions, and the measure of socioeconomic position used was household income. The magnitude of the relationship between socioeconomic position and the use of each health service in people from 16 to 74 years old was estimated by calculating the percentage ratio using binary regression. Results: In Germany, after adjusting for age, sex, and need for care, in the model comparing the two lower income categories to the two higher categories, the percentage ratio for physician consultation was 0.97 (95% CI 0.96–0.99) in 2009 and 0.98 (95% CI 0.97–0.99) in 2014, and the percentage ratio for hospitalization was 1.01 (95% CI 0.93–1.10) in 2009 and 1.16 (95% CI 1.08–1.25) in 2014. In Spain, after adjusting for age, sex, and self-rated health, the percentage ratio for physician consultation was 0.99 (95% CI 0.94–1.05) in 2009 and 1.08 (95% CI 1.03–1.14) in 2014, and the percentage ratio for hospitalization was 1.04 (95% CI 0.92–1.18) in 2009 and 0.99 (95% CI 0.87–1.14) in 2014. Conclusion: The results suggest that elimination of the copayment in Germany did not change the frequency of physician consultations, whereas after the restriction of universal health coverage in Spain, subjects with lower incomes had a higher frequency of physician consultations.
Open Access
Socioeconomic position and health services use in Germany and Spain during the Great Recession
(Public Library of Science, 2017) Lostao Unzu, Lourdes; Geyer, Siegfried; Albaladejo, Romana; Moreno Lostao, Almudena; Santos, Juana M.; Regidor Poyatos, Enrique; Sociología; Soziologia
Objective: The relationship of socioeconomic position with the use of health services may have changed with the emergence of the economic crisis. This study shows that relationship before and during the economic crisis, in Germany and in Spain. Methods: Data from the 2006 and 2011 Socio-Economic Panel carried out in Germany, and from the 2006 and 2011 National Health Surveys carried out in Spain were used. The health services investigated were physician consultations and hospitalization. The measures of socioeconomic position used were education and household income. The magnitude of the relationship between socioeconomic position and the use of each health services was estimated by calculating the percentage ratio by binary regression. Results: In Germany, in both periods, after adjusting for age, sex, type of health insurance and need for care, subjects belonging to the lower educational categories had a lower frequency of physician consultations, while those belonging to the lower income categories had a higher frequency of hospitalization. In the model comparing the two lower socioeconomic categories to the two higher categories, the percentage ratio for physician consultation by education was 0.97 (95%CI 0.96–0.98) in 2006 and 0.96 (95%CI 0.95–0.97) in 2011, and the percentage ratio for hospitalization by income was 1.14 (95%CI 1.05–1.25) in 2006 and 1.12 (95%CI 1.03–1.21) in 2011. In Spain, no significant socioeconomic differences were observed in either period in the frequency of use of these health services in the fully adjusted model. Conclusion: The results suggest that the economic crisis did not alter accessibility to the health system in either country, given that the socioeconomic pattern in the use of these health services was similar before and during the crisis in both countries.
Open Access
Trends in activity limitations from an international perspective: differential changes between age groups across 30 countries
(SAGE, 2022) Beller, Johannes; Luy, Marc; Giarelli, Guido; Regidor Poyatos, Enrique; Lostao Unzu, Lourdes; Tetzlaff, Juliane; Geyer, Siegfried; Sociología y Trabajo Social; Soziologia eta Gizarte Lana
Objectives: Examine trends in limitations among young (15–39), middle-aged (40–64) and older age-groups (>=65) and their socioeconomic differences. Methods: Population-based European Social Survey data (N = 396,853) were used, covering 30 mostly European countries and spanning the time-period 2002–2018. Limitations were measured using a global activity limitations indicator. Results: Age-differential trends in limitations were found. Activity limitations generally decreased in older adults, whereas trends varied among younger and middle-aged participants, with decreasing limitations in some countries but increasing limitations in others. These age-differential trends were replicated across limitation severity and socioeconomic groups; however, stronger limitation increases occurred regarding less-severe limitations. Discussion: Functional health has improved in older adults. Contrarily, the increasing limitations in younger and middle-aged individuals seem concerning, which were mostly observed in Western and Northern European countries. Given its public health importance, future studies should investigate the reasons for this declining functional health in the young and middle-aged.
Open Access
Patrón socioeconómico en la alimentación no saludable en niños y adolescentes en España
(Elsevier España, 2014) Miqueleiz Autor, Estrella; Lostao Unzu, Lourdes; Ortega, Paloma; Santos, Juana M.; Astasio, Paloma; Regidor Poyatos, Enrique; Sociología; Soziologia
Objetivo: Investigar la posible asociación de patrones alimentarios relacionados con la obesidad y la posición socioeconómica en la población infantil y adolescente española. Diseño: Estudio descriptivo transversal. Participantes: Los datos proceden de la Encuesta Nacional de Salud de 2007, realizada a una muestra representativa española de 0 a 15 años. En este estudio se han analizado 6.143 sujetos de 5 a 15 años. Mediciones principales: Se ha estimado la prevalencia de omisión de desayuno, la prevalencia de bajo consumo de fruta y verdura y la prevalencia de alto consumo de comida rápida, snacks y bebidas azucaradas. Los indicadores de posición socioeconómica han sido el nivel de estudios y la clase social de la persona que aportaba más ingresos económicos al hogar. En cada consumo de alimentos se han estimado las diferencias socioeconómicas mediante la razón de prevalencia, tomando como referencia la categoría socioeconómica más alta. Resultados: Tanto en la infancia como en la adolescencia la magnitud de la razón de prevalencia muestra un gradiente socioeconómico inverso en todos los consumos de alimentos investigados: la menor y la mayor razón de prevalencia se observa en los sujetos de familias de posición socioeconómica más alta y más baja, respectivamente. Conclusión: En la población infantil y adolescente española la alimentación no saludable relacionada con la obesidad muestra un patrón socioeconómico claro.
Open Access
Evolución de las diferencias socioeconómicas en la utilización y accesibilidad de los serivicios sanitarios en España entre 1987 y 1995/97
(Ministerio de Sanidad y Consumo, 2001) Lostao Unzu, Lourdes; Regidor Poyatos, Enrique; Calle, María Elisa; Navarro, Pedro; Domínguez, Vicente; Sociología; Soziologia
Fundamento: el objetivo del presente trabajo es evaluar la evolución de la utilización y accesibilidad de los servicios sanitarios en España, entre 1987 y 1995/1997, en grupos con diferentes características socioeconómicas. Métodos: los datos utilizados proceden de las Encuestas Nacionales de Salud realizadas por el Ministerio de Sanidad y Consumo a la población adulta en los años 1987, y 1995/1997. Se ha agregado la información de 1995 y 1997 debido al diferente tamaño muestral, de forma que las estimaciones así obtenidas son una media de ambas. La población analizada ha sido la de los individuos mayores de 24 años de edad. Se han estudiado la consulta médica, la hospitalización, la consulta al dentista y la consulta al ginecólogo, el tiempo invertido en llegar a la consulta, el tiempo de espera en la misma y el tiempo de espera para un ingreso hospitalario ordinario. Las características socioeconómicas utilizadas han sido el nivel de estudios y el grupo socioeconómico de los entrevistados. La medida de la asociación estimada entre la utilización de servicios y las características socioeconómicas fue la razón de porcentajes, mediante regresión binomial. Igualmente, se estimó el índice relativo de desigualdad como medida resumen de la desigualdad. Resultados: la consulta médica fue más frecuente en los individuos sin estudios y en los grupos socioeconómicos bajos, en uno y en otro período, mientras que la consulta al dentista y la consulta al ginecólogo fueron más frecuentes en los individuos con estudios superiores y en los grupos socioeconómicos altos en ambos periodos. No se encontraron diferencias socioeconómicas estadísticamente significativas en la frecuencia de hospitalización en ambos períodos. Tanto en 1987 como en 1995/1997 no se hallaron diferencias estadísticamente significativas entre los distintos grupos socioeconómicos en el tiempo de llegada a la consulta (p>0,05), pero sí en el tiempo de espera en la consulta (p<0,05). En el segundo periodo desaparecieron las diferencias socioeconómicas en el tiempo de espera para ingreso hospitalario ordinario que se observaron en el primer periodo. Conclusiones: en la segunda mitad de los años noventa se observa el mismo perfil socioeconómico en la utilización de los servicios sanitarios y en los tiempos de espera para acceder a los mismos que en la segunda mitad de los años ochenta, con la excepción del tiempo de espera para ingreso hospitalario ordinario en el segundo periodo.