ABSTRACT
The European Union is currently immersed in policy development to address the effects of climate change around the world. Key plans and processes for facilitating adaptation to high temperatures and for reducing the adverse effects on health are among the most urgent measures. Therefore, it is necessary to understand those factors that influence adaptation. The aim of this study was to provide knowledge related to the social, climate and economic factors that are related to the evolution of minimum mortality temperatures (MMT) in Spain in the rural and urban contexts, during the 1983-2018 time period. For this purpose, local factors were studied regarding their relationship to levels of adaptation to heat. MMT is an indicator that allows for establishing a relationship to between mortality and temperature, and is a valid indicator to assess the capacity of adaptation to heat of a certain population. MMT is obtained through the maximum daily temperature and daily mortality of the study period. The evolution of MMT values for Spain was established in a previous paper. An ecological, longitudinal and retrospective study was carried out. Generalized linear models (GLM) were performed to identify the variables that appeared to be related to adaptation. The adaptation was calculated as the difference in variation in MMT based on the average increase in maximum daily temperatures. In terms of adaptation to heat, urban populations have adapted more than non-urban populations. Seventy-nine percent (n = 11) of urban provinces have adapted to heat, compared to twenty-one percent (n = 3) of rural provinces that have not adapted. In terms of urban zones, income level and habituation to heat (values over the 95th percentile) were variables shown to be related to adaptation. In contrast, among non-urban provinces, a greater number of housing rehabilitation licenses and a greater number of health professionals were variables associated with higher increases in MMT, and therefore, with adaptation. These results highlight the need to carry out studies that allow for identifying the local factors that are most relevant and influential in population adaptation. More studies carried out at a small scale are needed.
Subject(s)
Acclimatization , Hot Temperature , Adaptation, Physiological , Climate Change , Humans , Mortality , Retrospective Studies , Spain/epidemiologyABSTRACT
OBJETIVO: Describir patrones de causa de muerte por género, edad y territorio. Las causas de mortalidad y sus posibles relaciones con las desigualdades en salud en la población rural y urbana en España. MATERIAL Y MÉTODOS: Se realizó un estudio ecológico de los datos de mortalidad de la población española entre 2007 y 2013. Los datos de mortalidad se obtuvieron del Instituto Nacional de Estadística (INE). Para presentar los datos de forma agrupada y simplificada, se codificó la clasificación CIE-10 utilizada por el INE con la clasificación de Carga de Enfermedad definida por Murray y López en 1996, reducida a 21 categorías de enfermedades. Se ha calculado la variable territorio rural/urbano tomando como referencia el corte que establece que poblaciones superiores a 10.000 habitantes son entornos urbanos y los que están por debajo son entornos rurales. Se utilizó el test de χ2 y de la z corregida por Bonferroni para los factores de carácter cualitativo y el contraste de la t de Student para los factores de carácter cuantitativo. RESULTADOS: Las principales causas de muerte fueron las enfermedades cardiovasculares con el 31% (844.010) y los tumores malignos con el 26,7% (724.889), las neuropsiquiátricas con el 8,8% (238.330) y las respiratorias con el 8,7% (235.448). En el entorno rural, para el género masculino se encontró que fallecieron el 52,7% (366.053) mientras que en el entorno urbano fallecieron el 51,3% (995.470). En cuanto al género femenino, los casos de defunciones fueron el 47,3% (329.063) en el entorno rural y el 48,7% (9545.188) en el urbano. Con respecto a la edad, las medias de las edades que se asocian a un fallecimiento más tardío fueron las condiciones nutricionales (media de 85,62 años). En cuanto a las edades más tempranas, obviando las relacionadas con los fallecimientos de recién nacidos, fueron las anomalías congénitas con 25,37 años de media. CONCLUSIONES: Se encontraron diferencias de mortalidad entre los 3 ejes de desigualdad sociales en salud (edad, género y territorio). Por lo tanto, podemos decir que los determinantes sociales condicionan nuestra esperanza de vida
OBJECTIVE: Describe patterns of cause of death by gender, age and territory. The causes of mortality and their possible relationships with health inequalities in the rural and urban population in Spain. MATERIAL AND METHODS: An ecological study of the mortality data of the Spanish population between 2007 and 2013 was carried out. Mortality data were obtained from the National Statistics Institute (INE). To be able to present the data in the grouped and simplified form, the ICD-10 classification detected by the INE was coded with the classification of Disease Load defined by Murray and López (1996), reduced to 21 categories of diseases. The territory variable has been determined: rural / urban, taking as a reference the cut that establishes that populations over 10,000 inhabitants are urban environments and those that are below rural environments. The chi-square test and the Bonferroni-corrected z test for qualitative factors and the Student's t-test for quantitative factors were considered. RESULTS: The results showed than the main causes of death were cardiovascular diseases with 31% (844,010) and malignant tumors with 26.7% (724,889), neuropsychiatric with 8.8% (238,330) and respiratory with 8.7% (235,448). In the rural setting, for the male gender, 52.7% (366,053) died, while 51.3% (995,470) died in the urban environment. Regarding the female gender, the cases of deaths were 47.3% (329,063) in the rural environment and 48.7% (9545.188) in the urban. Related to age, the means of the ages associated with a later death were nutritional conditions with 85.62 years. As for the earliest ages, obviating those related to the deaths of newborns, were the congenital anomalies with 25.37 years of means. CONCLUSIONS: Mortality differences were found between the 3 axes of social inequality in health-age, gender and territory. Therefore, we can say that social determinants condition our life expectancy
