Do socioeconomic inequalities in mortality vary between different Spanish cities? a pooled cross-sectional analysis

Background: The relationship between deprivation and mortality in urban settings is well established. This relationship has been found for several causes of death in Spanish cities in independent analyses (the MEDEA project). However, no joint analysis which pools the strength of this relationship across several cities has ever been undertaken. Such an analysis would determine, if appropriate, a joint relationship by linking the associations found. Methods: A pooled cross-sectional analysis of the data from the MEDEA project has been carried out for each of the causes of death studied. Specifically, a meta-analysis has been carried out to pool the relative risks in eleven Spanish cities. Different deprivation-mortality relationships across the cities are considered in the analysis (fixed and random effects models). The size of the cities is also considered as a possible factor explaining differences between cities. Results: Twenty studies have been carried out for different combinations of sex and causes of death. For nine of them (men: prostate cancer, diabetes, mental illnesses, Alzheimer’s disease, cerebrovascular disease; women: diabetes, mental illnesses, respiratory diseases, cirrhosis) no differences were found between cities in the effect of deprivation on mortality; in four cases (men: respiratory diseases, all causes of mortality; women: breast cancer, Alzheimer’s disease) differences not associated with the size of the city have been determined; in two cases (men: cirrhosis; women: lung cancer) differences strictly linked to the size of the city have been determined, and in five cases (men: lung cancer, ischaemic heart disease; women: ischaemic heart disease, cerebrovascular diseases, all causes of mortality) both kinds of differences have been found. Except for lung cancer in women, every significant relationship between deprivation and mortality goes in the same direction: deprivation increases mortality. Variability in the relative risks across cities was found for general mortality for both sexes. Conclusions: This study provides a general overview of the relationship between deprivation and mortality for a sample of large Spanish cities combined. This joint study allows the exploration of and, if appropriate, the quantification of the variability in that relationship for the set of cities considered.

Evaluación participativa de los impactos sociales del turismo residencial y meta-análisis de resultados: un caso de estudio en Pipa (Rio Grande do Norte, Brasil)

Este artículo presenta una propuesta metodológica para la evaluación participativa de impactos sociales. Se ejemplifica mediante la descripción del proceso y resultados de una investigación realizada en la comunidad turística de Pipa (Rio Grande do Norte, Brasil) en la que se desarrolló un proceso de participación orientado a discutir el modelo de turismo residencial implantado en este territorio mediante el identificación y evaluación de sus impactos sociales. La novedad de esta propuesta reside en que se añade, a los beneficios y utilidades de la evaluación participativa de impactos sociales, un meta-análisis realizado sobre los resultados del proceso de participación. Este meta-análisis hace uso de las herramientas informáticas propias del Análisis de Redes Sociales aplicadas al estudio de los mapas causa-efecto elaborados por los participantes. Los resultados de este análisis cuantitativo se completan e interpretan con la información obtenida a través de entrevistas en profundidad y revisión documental, permitiendo: 1) identificar las causas últimas de los impactos sociales derivados del turismo residencial a escala local y 2) una mejor comprensión de la complejidad causal de estos impactos. El meta-análisis ha identificado que la primacía de los intereses de las empresas inmobiliarias internacionales sobre el interés general local se sustenta sobre su capacidad ilusoria de controlar la demanda mediante agresivas campañas de marketing. Esta información permite la deconstrucción del discurso desarrollista del turismo y posibilita la demarcación de nuevas áreas de acción estratégica orientadas a la maximización del beneficio colectivo.