Increase in socioeconomic inequalities in mortality in a Southern European region: a small-area ecological study.

BACKGROUND: This study sought to describe the total mortality trend by socioeconomic deprivation (SED) in the Madrid Autonomous Region, by sex and age group. METHODS: Cross-sectional ecological study by census tract, in two periods: 1994-2000 (P1) with SED of 1996 census and 2001-07 (P2) with SED of 2001 census. We calculated the relative risks (RRs) and their 95% credibility intervals (95% CIs) by SED quintile (Q), taking the quintile of least deprivation as reference. Besag-York-Mollié ecological regression models and the Integrated Nested Laplace Approximation procedure were applied. The absolute differences in age-standardized rates were compared by SED quintile. RESULTS: Inequalities decreased in young adults: among men aged 20-39 years, the RR in Q5 versus Q1 ranged from 2.73 (95% CI, 2.51-3.02) in P1 to 1.93 (95% CI, 1.76-2.15) in P2, due to the greater improvement in the most underprivileged groups. In contrast, there was an increase in SED-related mortality in the 40-79 age group. Among men aged 40-59 years, the RR in Q5 versus Q1 rose from 1.88 (95% CI, 1.76-2.02) in P1 to 2.29 (95% CI, 2.17-2.43) in P2; the improvement was greater in the most privileged groups. CONCLUSION: In a context of an economic boom, inequalities were observed to increase among adults by a greater improvement in the most privileged groups.

[Trends and social inequalities in cervical cancer and breast cancer screening in Madrid: Non-Commumicable Disease Risk FactorSurveillance System (SIVFRENT-A) from 1995 to 2010]. / Tendencias y desigualdades sociales en el cribado de cáncer de cérvix y cáncer de mama en la Comunidad de Madrid duranteel periodo 1995-2010 a partir del Sistema de Vigilancia deFactores de Riesgo de enfermedades no transmisibles (SIVFRENT-A).

BACKGROUND: The assessment of preventive programs is necessary to support the decisions made in public health. There are few research studies that evaluate the degree of implementation and equity of cancer screening in Spain. The objective was to describe trends and inequalities in cervical and breast cancer screening according social determinants of health. METHODS: An analysis was carried out on the Behavioral Risk Factor Surveillance System of Community of Madrid data, obtained between 1995 and 2000 from telephone surveys conducted on a population between ages 18 to 65, were analyzed. The years were grouped into four periods: P1 to P4. The trends were estimated with prevalence ratios (PR) with 95% confidence intervals (95% CI), obtained through generalized linear models with binomial family and logarithmic link. The inequalities were estimated with differences of proportions (DP) with 95% CI. RESULTS: An increased in mammograms is seen especially in women with low education (PR P4/P1: 1.93; 95%CI 1.62 to 2.3), this trend more discreet in cytology (PR P4/P1: 1.28; 95%CI 1.11 to 1.47). However mammograms have not increased over in the past 5 years (PR P4/P3: 1.02; 95% CI 0.99 to 1.04). Inequalities get better, but show an increase in the last period. CONCLUSIONS: All groups increase in preventative behaviors and those who did not, had a high prevalence from the start.Itis worth mentioning the stagnation of mammography in disadvantaged women in the period 2007-2010. There was a social gradient for preventive preventative measures, which was lower in the population-basedscreening (mammography) than in the opportunistic one (cytology).