Trends in socioeconomic inequalities in preventable mortality in urban areas of 33 Spanish cities, 1996–2007 (MEDEA project)

Background: Preventable mortality is a good indicator of possible problems to be investigated in the primary prevention chain, making it also a useful tool with which to evaluate health policies particularly public health policies. This study describes inequalities in preventable avoidable mortality in relation to socioeconomic status in small urban areas of thirty three Spanish cities, and analyses their evolution over the course of the periods 1996–2001 and 2002–2007. Methods: We analysed census tracts and all deaths occurring in the population residing in these cities from 1996 to 2007 were taken into account. The causes included in the study were lung cancer, cirrhosis, AIDS/HIV, motor vehicle traffic accidents injuries, suicide and homicide. The census tracts were classified into three groups, according their socioeconomic level. To analyse inequalities in mortality risks between the highest and lowest socioeconomic levels and over different periods, for each city and separating by sex, Poisson regression were used. Results: Preventable avoidable mortality made a significant contribution to general mortality (around 7.5%, higher among men), having decreased over time in men (12.7 in 1996–2001 and 10.9 in 2002–2007), though not so clearly among women (3.3% in 1996–2001 and 2.9% in 2002–2007). It has been observed in men that the risks of death are higher in areas of greater deprivation, and that these excesses have not modified over time. The result in women is different and differences in mortality risks by socioeconomic level could not be established in many cities. Conclusions: Preventable mortality decreased between the 1996–2001 and 2002–2007 periods, more markedly in men than in women. There were socioeconomic inequalities in mortality in most cities analysed, associating a higher risk of death with higher levels of deprivation. Inequalities have remained over the two periods analysed. This study makes it possible to identify those areas where excess preventable mortality was associated with more deprived zones. It is in these deprived zones where actions to reduce and monitor health inequalities should be put into place. Primary healthcare may play an important role in this process.

Indicators of obesity and the educational attainment of the Czech female population

The aim of this paper was to evaluate the relationship between selected indicators of obesity and the highest completed level of education in the adult female population of the Czech republic. As basic indicators of obesity, these following parameters were selected and measured via the bioimpedance method on the device InBody 720: BMI, WHR (waist-to-hip ratio), % body fat, % skeletal muscle mass, fitness score. The educational attainment of the tested women was inquired by a questionnaire. Based on the responses, we subsequently divided our sample into four categories according to the level of education: primary education, secondary education-apprenticeship, secondary education-graduate diploma, and university. The research was realized within the project CZ.1.07/2.3.00/20.0044. The measurements on the device InBody 720 and the accompanying survey were conducted between 2011-2013 in different regions of the Czech Republic. The sample consisted of 754 women divided into 3 age groups (18-39, 40-59, 60+ years). Based on the results (p<0.05), we can say that average values of the indicators obesity (BMI: 22.76, 24.88, 26.49 kg/m2, WHR: 0.85, 0.88, 0.90 and % body fat: 25.76, 30.23, 34.62%) increase with the increasing age of examined women. The average values of the fitness score (75.53, 73.86, 70.04 points) and % skeletal muscle mass (40.78, 38.15, 33.95%) decrease with increasing age. With regard to the educational attainment, women with secondary education-apprenticeship achieved the worst results. In contrast, the values in university educated women were the best in most indicators of obesity.