Area deprivation and trends in inequalities in self-rated health in Spain,1987

Abstract

Aims: This study examined the impact that individual social position and municipal area deprivation levels had on trends in inequalities in self-rated health in Spain, between 1987 and 2001. Methods: The study was based on cross-sectional data of the National Health Surveys of Spain for the years 1987, 1993, 1995, 1997, and 2001 (n=84,567). The indicators used were educational level and occupational class, and deprivation level as the indicator of municipal areas. Multilevel logistic regression models were made, with individuals nested into municipal areas. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated. To evaluate trends, the relative index of inequality was calculated. Results: At the individual level, the likelihood of less-than-good health between those with no formal education as compared to those with graduate-level education increased from OR=2.66 (95% CI: 2.06—3.38) in 1987 to OR=3.62 (95% CI: 2.95—4.63) in 2001 among women. The values for men were OR=2.27 (95% CI: 1.89—2.72) and OR=2.94 (95% CI: 2.36—3.68) respectively. Living in areas with the highest deprivation levels as compared to the lowest systematically increased the likelihood of less-than-good health. The likelihood of reporting less-than-good health among women with no formal education as compared to women with graduate-level education in municipal areas with the highest deprivation levels increased from OR=3.61 (95% CI: 2.39—5.45) in 1987 to 4.85 (95% CI: 3.06—7.69) in 2001. Among men, the corresponding magnitudes were OR=2.07 (95% CI: 1.39—3.08) and OR=4.16 (95% CI: 2.52—6.89). Conclusions: Inequalities in self-rated health increased in Spain in this period. These inequalities may be explained by the social conditions existing throughout the period of reference, and the pattern varies according to gender, municipal area deprivation levels, and the individual indicator of social position used.

Keywords

Deprivation inequalities multilevel analysis self-rated health Spain trends

Get full access to this article

View all access options for this article.

References

Marmot M. , Wilkinson RG Social determinants of health. New York: Oxford University Press; 1999.

Chaix B. , Chauvin P. Tobacco and alcohol consumption, sedentary lifestyle and overweightness in France: a multilevel analysis of individual and area-level determinants . Eur J Epidemiol 2003;18:531-8.

Malmstrom M. , Sundquist J. , Johansson SE Neighborhood environment and self-reported health status: a multilevel analysis . Am J Public Health 1999;89:1181-6.

Stafford M. , Marmot M.

Neighbourhood deprivation and health: does it affect us all equally?

Int J Epidemiol 2003;32:357-66.

Gravelle H. , Sutton M. Income related inequalities in self assessed health in Britain: 1979-1995 . J Epidemiol Community Health 2003;57:125-9.

Heistaro S. , Vartiainen E. , Puska P. Trends in self-rated health in Finland 1972-1992 . Prev Med 1996 ;25:625-32.

Borrell C. , Rue M. , Pasarin MI , Rohlfs I. , Ferrando J. , Fernandez E. Trends in social class inequalities in health status, health-related behaviors, and health services utilization in a Southern European urban area (1983-1994) . Prev Med 2000;31:691-701.

International Labour Office. Indicators on income and economic activity. New York: Statistics Division of the United Secretarial and International Labour Office ; 1998.

Navarro V. , Benach J. , Comisión científica de estudios de las desigualdades sociales en salud en España. Desigualdades sociales en salud en España. Madrid : Ministerio de Sanidad y Consumo; 1996.

10.

Benach J. , Borrell C. , Daponte A. Social and economic policies in Spain with potential impact on reducing health inequalities. In: Mackenbach JP , Bakker M , editors. Reducing inequalities in health: a European perspective. London: Routledge; 2002. p 262-73.

11.

Idler EL , Benyamini Y. Self-rated health and mortality: a review of twenty-seven community studies . J Health Soc Behav 1997;38:21-37.

12.

Fayers PM , Sprangers MA Understanding self-rated health . Lancet 2002;359:187-8.

13.

Ministerio de Sanidad y Consumo. Spanish National Health Survey. Available at: http://www.msc.es/estadEstudios/estadisticas/encuestaNacional/home.htm (accessed 20 September 2007).

14.

Arias A. , Rebagliato M. , Palumbo MA , Bellver R. , Ashton J. , Colomer C. , et al. Health inequalities in Barcelona and Valencia . Med Clin (Barc) 1993;100:281-7.

15.

Phillimore P. , Beattie A. , Townsend P. Widening inequality of health in northern England, 1981-91 . BMJ 1994;308:1125-8.

16.

Instituto Nacional de Estadística. Censo de Población y Viviendas 1991. Madrid: Instituto Nacional de Estadística; 1994.

17.

Dirección General de Tráfico. Parque de turismos de 1991. Madrid: Ministerio del Interior; 1991.

18.

Arber S. Comparing inequalities in women's and men's health: Britain in the 1990s . Soc Sci Med 1997;44:773-87.

19.

Mackenbach JP , Kunst AE Measuring the magnitude of socio-economic inequalities in health: an overview of available measures illustrated with two examples from Europe . Soc Sci Med 1997 ;44:757-7.

20.

Goldstein H. Multilevel statistical models. London: Edward Arnold & Halstead Press; 1995.

21.

Leyland AH , Goldstein H. Multilevel modelling of health statistics. New York: Wiley; 2001.

22.

Duncan C. , Jones K. , Moon G. Context, composition and heterogeneity: using multilevel models in health research . Soc Sci Med 1998;46:97-117.

23.

Venables W. , Ripley BD Modern applied statistics with S Plus. New York : Springer; 2002.

24.

Blakely TA , Lochner K. , Kawachi I. Metropolitan area income inequality and self-rated health - a multi-level study . Soc Sci Med 2002;54:65-77.

25.

Navarro V , editor. The political economy of social inequalities. Consequences for health and quality of life . Amityville, NY: Baywood; 2002.

26.

Tamames R. La economía española, 1975-1995. Madrid: Temas de Hoy; 1995.

27.

Rodríguez-Sanz M. , Borrell C. , Urbanos R. , Pasarín M. , Rico A. , Fraile M. , et al. Power relations and premature mortality in Spain's autonomous communities. In: Navarro V , editor. The political and social context of health. Amytiville, NY: Baywood; 2004. p 165-200.

28.

Ferrie JE , Shipley MJ , Stansfeld SA , Marmot MG Effects of chronic job insecurity and change in job security on self reported health, minor psychiatric morbidity, physiological measures, and health related behaviours in British civil servants: the Whitehall II study . J Epidemiol Community Health 2002 ;56:450-4.

29.

Regidor E. , Gutierrez-Fisac JL , Dominguez V. , Calle ME , Navarro P. Comparing social inequalities in health in Spain: 1987 and 1995/97 . Soc Sci Med 2002;54:1323-32.

30.

Blane D. Commentary: explanations of the difference in mortality risk between different educational groups . Int J Epidemiol 2003;32:355-6.

31.

Santolaria E. , Fernandez A. , Daponte A. , Aguilera I. The productive sector . Gac Sanit 2004;18(Suppl 1):24-30.

32.

Borrell C. , Muntaner C. , Benach J. , Artazcoz L.

Social class and self-reported health status among men and women: what is the role of work organisation, household material standards and household labour?

Soc Sci Med 2004;58:1869-87.

33.

Garcia-Calvente MM , Mateo-Rodriguez I. , Maroto-Navarro G. Impact of caregiving on women's health and quality of life . Gac Sanit 2004;18(Suppl 2):83-92.

34.

Krantz G. , Ostergren PO Double exposure. The combined impact of domestic responsibilities and job strain on common symptoms in employed Swedish women . Eur J Public Health 2001;11:413-19.

35.

Navarro V. La situación social en España. Madrid: Biblioteca Nueva, Fundación Francisco Largo Caballero y Programa en Políticas Públicas y Sociales-UPF; 2005.

36.

Ramos-Díaz J. Empleo precario en España: una asignatura pendiente . In: Navarro V , editor. El estado del bienestar en España. Madrid: Tecnos; 2004. p 97-120.

37.

Centro de Investigaciones Sociológicas. Principales problemas del país. Series Históricas . Boletín Datos Opinión 11. Madrid: Centro de Investigaciones Sociológicas; 1997.

38.

Statistical Office of the European Commission. Social portrait of Europe. Luxembourg : Office for Official Publications of the European Communities; 1998.

39.

Krieger N. , Williams DR , Moss NE Measuring social class in US public health research: concepts, methodologies, and guidelines . Annu Rev Public Health 1997;18:341-78.

40.

Anuario Económico de la Caixa. Available at: http://www.anuarioeco.lacaixa.comunicacions.com/java/X?cgi=caixa.anuari99.util.ChangeLanguage&lang=es (accessed 20 September 2007).

41.

O'Campo P. Invited commentary: advancing theory and methods for multilevel models of residential neighborhoods and health . Am J Epidemiol 2003;157:9-13.

Area deprivation and trends in inequalities in self-rated health in Spain,1987—2001

Abstract

Keywords

Get full access to this article

References