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Prim Care Diabetes. 2017 Oct;11(5):453-460. doi: 10.1016/j.pcd.2017.05.006. Epub 2017 Jun 13.

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

Author information

1
Departamento de Microbiología, Medicina Preventiva y Salud Pública, Universidad de Zaragoza, Zaragoza, Spain; Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Spain. Electronic address: iaguilar@unizar.es.
2
Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO-Salud Pública), Valencia, Spain; Ciber de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
3
Departamento de Microbiología, Medicina Preventiva y Salud Pública, Universidad de Zaragoza, Zaragoza, Spain; Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Spain.
4
Ciber de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Agència de Salut Pública de Barcelona, Barcelona, Spain.
5
Ciber de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Servicio de Epidemiología, Consejería de Sanidad, IMIB - Arrrixaca, Murcia, Spain.
6
Ciber de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Observatorio de Salud y Medio Ambiente de Andalucía (OSMAN), Escuela Andaluza de Salud Pública, Consejería de Salud, Junta de Andalucía, Granada, Spain.
7
Subdirección de Promoción de la Salud y Prevención, Consejería de Sanidad, Comunidad de Madrid, Madrid, Spain.
8
Dirección General de Salud Pública, Servicio Canario de Salud, Spain.
9
Unidad de Investigación en Análisis de la Mortalidad y Estadísticas Sanitarias, Universidad de Alicante, Alicante, Spain.
10
Ciber de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Grupo de Investigación en Estadística, Econometría y Salud (GRECS), Universidad de Girona, Girona, Spain.
11
Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Spain; Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO-Salud Pública), Valencia, Spain; Ciber de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.

Abstract

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.

KEYWORDS:

Diabetes mellitus; Geographical inequalities; Mortality; Urban areas

PMID:
28623082
DOI:
10.1016/j.pcd.2017.05.006
[Indexed for MEDLINE]

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