Analysis of the geographic pattern of the police reports for domestic violence in Girona (Spain).

BACKGROUND: There are many studies that address the issue of gender-based violence, but few analyse the police-reported cases. It is as important to analyse the temporal and geographic distribution of these incidents as it is the sociodemographic profile of the accuser. To this effect, the present study aims to analyse the sociodemographic profile of the victims of the particular case of domestic violence that report the incident to the police and to evaluate the spatial-temporal distribution of these reports. METHODS: Using the data from a database containing the police-reported incidents of domestic violence in Girona in the period 2012-2018, the risk of a police-reported incident was estimated by adjusting the two-part Hurdle model. RESULTS: The risk of reporting incidents of domestic violence to the police is higher in the less deprived areas of the city, and the spatial distribution of these police reports corroborate this finding. Nevertheless, those areas with the greatest socio-economic deprivation were also the ones where there were less police reports filed. Also the prediction of less police reports in the census tract with the highest percentage of the population with an insufficient educational level coincides with the largest number of police reports made by women with a medium and university level education (56.1%) compared with 9.5% of police reports made by women with insufficient schooling. CONCLUSIONS: These results can be useful for social protection services to design policies specifically aimed at women residing in those areas with the highest risk. Moreover, the use of spatial statistical techniques together with geographic information systems tools is a good strategy to analyse domestic violence and other types of offences because they not only allow to graphically identify the spatial distribution, but it is also a good tool to identify problems related to this type of offence.

Did psychotropic drug consumption increase during the 2008 financial crisis? A cross-sectional population-based study in Spain.

OBJECTIVES AND SETTING: Although psychotropic drugs are used to treat mental health disorders, little evidence analyses the effects the 2008 economic downturn had on psychotropic drug consumption in the case of Spain. We analyse these effects, considering both gender and employment situation. PARTICIPANTS: We used the microdata from the face-to-face cross-sectional population-based Spanish National Health Survey for two periods: 2006-2007 (n=28 954) and 2011-2012 (n=20 509). Our samples included adults (>15 years old). METHODS: The response variables are consumption (or not) of antidepressants or sedatives and the explanatory variables are the year of the survey, gender and employment status. Covariates are mental health problems, mental health index General Health Questionnaire (GHQ-12) and self-reported health outcome variables such as self-rated health, chronic diseases, smoking behaviour, sleeping hours, body mass index, physical activity in the workplace, medical visits during the past year, age, region of residence (autonomous communities), educational level, marital status and social class of the reference person. Finally, we include interactions between time period, gender and employment status. We specify random effects logistic regressions and use Bayesian methods for the inference. RESULTS: The economic crisis did not significantly change the probability of taking antidepressant drugs (OR=0.56, 95% CI 0.18 to 2.56) nor sedatives (OR=1.21, 95% CI 0.26 to 5.49). In general, the probability of consuming antidepressants among men and women decreases, but there are differences depending on employment status. The probability of consuming sedatives also depends on the employment status. CONCLUSIONS: While the year of the financial crisis is not associated with the consumption of antidepressants nor sedatives, it has widened the gap in consumption differences between men and women. Although antidepressant use dropped, the difference in consumption levels between men and women grew significantly among the retired, and in the case of sedatives, risk of women taking sedatives increased in all groups except students.

Incidence and survival of Hodgkin lymphoma patients in Girona (Spain) over three decades: a population-based study.

Hodgkin lymphoma (HL) is characterized by heterogeneous histologic findings, clinical presentation and outcomes. Using the Girona population-based cancer registry data we sought to explore the incidence of HL over three decades in Girona Province (Spain) and examine the relationship between clinical features at diagnosis and survival. From 1985 to 2013, 459 cases were recorded. Patients were stratified by sex, age group, stage at diagnosis, histological subtypes and the presence of B-symptoms. The crude incidence rate (CR) was 2.7 and the corresponding European age-adjusted rate was 2.6, being higher in men than in women (sex ratio=1.6). Incidence remained constant throughout the period of study. Nodular sclerosis was the most frequent histology and showed an increasing incidence over time [estimated annual percentage change=+2.4, 95% confidence interval (CI): 0.8-4.0]. The 5-year observed survival and relative survival of patients diagnosed with HL were 73.1% (95% CI: 69.0-77.5) and 74.6% (95% CI: 70.0-79.4), respectively. No statistical differences in observed survival were observed across the three decades of study (P=0.455). Clinical parameters negatively influencing 5-year relative survival in the multivariate analysis were as follows: age at diagnosis at least 65 years; clinical stage IV; and presence of B-symptoms. These current patterns of presentation and outcomes of HL help delineate key populations in order to explore risk factors for HL and strategies to improve treatment outcomes.

Indicadores contextuales para evaluar los determinantes sociales de la salud y la crisis económica española / Contextual indicators to assess social determinants of health and the Spanish economic recession

Objetivo: Proporcionar indicadores para evaluar, en España y en sus comunidades autónomas, el impacto sobre la salud, sus determinantes sociales y las desigualdades en salud del contexto social y de la crisis económica más reciente. Métodos: Basándonos en el marco conceptual de los determinantes de las desigualdades sociales en salud en España, identificamos indicadores secuencialmente a partir de documentos clave, Web of Science y organismos con estadísticas oficiales. La información recopilada dio lugar a un directorio amplio de indicadores que fue revisado por un panel de expertos. Posteriormente seleccionamos un conjunto de esos indicadores según un criterio geográfico y otro temporal: disponibilidad de datos según comunidades autónomas y al menos desde 2006 hasta 2012. Resultados: Identificamos 203 indicadores contextuales sobre determinantes sociales de la salud y seleccionamos 96 (47%) según los criterios anteriores. De los indicadores identificados, el 16% no cumplieron el criterio geográfico y el 35% no cumplieron el criterio temporal. Se excluyó al menos un 80% de los indicadores relacionados con la dependencia y los servicios de salud. Los indicadores finalmente seleccionados cubrieron todas las áreas de los determinantes sociales de la salud. El 62% de estos no estuvieron disponibles en Internet. Alrededor del 40% de los indicadores se extrajeron de fuentes relacionadas con el Instituto Nacional de Estadística. Conclusiones: Proporcionamos un amplio directorio de indicadores contextuales sobre determinantes sociales de la salud y una base de datos que facilitarán la evaluación, en España y sus comunidades autónomas, del impacto de la crisis económica sobre la salud y las desigualdades en salud (AU)

Objective: To provide indicators to assess the impact on health, its social determinants and health inequalities from a social context and the recent economic recession in Spain and its autonomous regions. Methods: Based on the Spanish conceptual framework for determinants of social inequalities in health, we identified indicators sequentially from key documents, Web of Science, and organizations with official statistics. The information collected resulted in a large directory of indicators which was reviewed by an expert panel. We then selected a set of these indicators according to geographical (availability of data according to autonomous regions) and temporal (from at least 2006 to 2012) criteria. Results: We identified 203 contextual indicators related to social determinants of health and selected 96 (47%) based on the above criteria; 16% of the identified indicators did not satisfy the geographical criteria and 35% did not satisfy the temporal criteria. At least 80% of the indicators related to dependence and healthcare services were excluded. The final selection of indicators covered all areas for social determinants of health, and 62% of these were not available on the Internet. Around 40% of the indicators were extracted from sources related to the Spanish Statistics Institute. Conclusions: We have provided an extensive directory of contextual indicators on social determinants of health and a database to facilitate assessment of the impact of the economic recession on health and health inequalities in Spain and its autonomous regions (AU)

Influence maternal background has on children's mental health.

BACKGROUND: In this paper, we aim to discern how a mother's health and her socioeconomic determinants may influence her children's mental health. In addition to this, we also evaluate the influence of other household characteristics and whether or not the economic downturn has heightened the effect a parent's social gradient has on their children's mental health. METHODS: We use samples comprised of 4-14-year-old minors from the 2006 Spanish National Health Survey (SNHS), undertaken prior to the crisis, and the 2011 SNHS, carried out during the crisis. The participating children's mental health is assessed using the Strengths and Difficulties Questionnaire (SDQ). Mixed models are used to evaluate the influence a mother's health and her socioeconomic status may have on her children's mental health. We also add interactions to observe the effect specific socioeconomic determinants may have had during the economic downturn. RESULTS: The risk of a child suffering from mental health disorders increases when their mother has mental health problems. Socioeconomic determinants also play a role, as a low socioeconomic status (SES) increases the risk of a child exhibiting behavioural problems, being hyperactive or antisocial, whereas when a mother has attained a high level of education, this significantly reduces the probability of a child having mental health problems. 'Homemaker' is the activity status most positively related to children's mental health. The findings show that the Spanish economic downturn has not significantly changed children's mental health problems and the negative effects of low maternal SES are no greater than they were before the crisis. The main difference in 2011, with respect to 2006, is that the risk of children suffering from mental health problems is higher when their parents are (long or short-term) unemployed. CONCLUSIONS: In conclusion, both a mother's health and her socioeconomic status, as well as other household characteristics, are found to be related to her children's mental well-being. Although the crisis has not significantly changed mental health disorders in children or the social gradient of parents in general, at-risk children are the most negatively affected in the Spanish economic downturn.

[Contextual indicators to assess social determinants of health and the Spanish economic recession]. / Indicadores contextuales para evaluar los determinantes sociales de la salud y la crisis económica española.

OBJECTIVE: To provide indicators to assess the impact on health, its social determinants and health inequalities from a social context and the recent economic recession in Spain and its autonomous regions. METHODS: Based on the Spanish conceptual framework for determinants of social inequalities in health, we identified indicators sequentially from key documents, Web of Science, and organisations with official statistics. The information collected resulted in a large directory of indicators which was reviewed by an expert panel. We then selected a set of these indicators according to geographical (availability of data according to autonomous regions) and temporal (from at least 2006 to 2012) criteria. RESULTS: We identified 203 contextual indicators related to social determinants of health and selected 96 (47%) based on the above criteria; 16% of the identified indicators did not satisfy the geographical criteria and 35% did not satisfy the temporal criteria. At least 80% of the indicators related to dependence and healthcare services were excluded. The final selection of indicators covered all areas for social determinants of health, and 62% of these were not available on the Internet. Around 40% of the indicators were extracted from sources related to the Spanish Statistics Institute. CONCLUSIONS: We have provided an extensive directory of contextual indicators on social determinants of health and a database to facilitate assessment of the impact of the economic recession on health and health inequalities in Spain and its autonomous regions.

How the economic recession has changed the likelihood of reporting poor self-rated health in Spain.

BACKGROUND: Between 2006 and 2011 self-rated health (SRH) (the subjective report of an individual's health status) actually improved in Spain despite its being in the grips of a serious economic recession. This study examines whether the likelihood of reporting poor health has changed because of the global financial crisis. It also attempts to estimate the differences between SRH and other self-perceived measures of health among groups before and during the current economic crisis in Spain. METHODS: Cross-sectional population-based surveys were conducted in Spain (ENSE 2006 and ENSE 2011) and in Catalonia (ESCA 2006 and ESCA 2011) in 2006 and again in 2011. In this research work we have used random effects logistic models (dependent variable SRH 1 Poor, 0 Good) and exact matching and propensity score-matching. RESULTS: The results of the ENSE explanatory variables are the same in both 2006 and 2011. In other words, all diseases negatively affect SRH, whereas alcohol habits positively affect SRH and obesity is the only disease unrelated to SRH. ESCA explanatory variables' results show that in 2006 all diseases are significant and have large odds ratio (OR) and consequently those individuals suffering from any of these diseases are more likely to report poor health. In 2011 the same pattern follows with the exception of allergies, obesity, high cholesterol and hypertension, albeit they are not statistically significant. Drinking habits had a positive effect on SRH in 2006 and 2011, whereas smoking is considered as unrelated to SRH. The likelihood of reporting poor health in 2006 is added as a variable in with the logistic regression of 2011 and is not, in either the ENSE data or the ESCA data, significant. Furthermore, neither is it significant when controlling by age, gender, employment status or education. CONCLUSIONS: The results of our analysis show that the financial crisis did not alter the likelihood of reporting poor health in 2011. Therefore, there are no differences between our perceived health in either 2006 or in 2011.

A common error in the ecological regression of cancer incidence on the deprivation index.

OBJECTIVE: To determine if introducing age as another explanatory variable in an ecological regression model relating crude rates of cancer incidence and a deprivation index provides better results than the usual practice of using the standard incidence ratio (SIR) as the response variable, introducing the non-standardized index, and not including age in the model. METHODS: Relative risks associated with the deprivation index for some locations of cancer in Spain's Girona Health Region were estimated using two different models. Model 1 estimated relative risks with the indirect method, using the SIR as the response variable. Model 2 estimated relative risks using age as an explanatory variable and crude cancer rates as the response variable. Two scenarios and two sub-scenarios were simulated to test the properties of the estimators and the goodness of fit of the two models. RESULTS: The results obtained from Model 2's estimates were slightly better (less biased) than those from Model 1. The results of the simulation showed that in all cases (two scenarios and two sub-scenarios) Model 2 had a better fit than Model 1. The probability density for the parameter of interest provided evidence that Model 1 leads to biased estimates. CONCLUSIONS: When attempting to explain the relative risk of incidence of cancer using ecological models that control geographic variability, introducing age as another explanatory variable and crude rates as a response variable provides less biased results.

A common error in the ecological regression of cancer incidence on the deprivation index / Un error frecuente en los modelos de regresión ecológica de la incidencia de cáncer con respecto al índice de carencia

OBJECTIVE: To determine if introducing age as another explanatory variable in an ecological regression model relating crude rates of cancer incidence and a deprivation index provides better results than the usual practice of using the standard incidence ratio (SIR) as the response variable, introducing the non-standardized index, and not including age in the model. METHODS: Relative risks associated with the deprivation index for some locations of cancer in Spain's Girona Health Region were estimated using two different models. Model 1 estimated relative risks with the indirect method, using the SIR as the response variable. Model 2 estimated relative risks using age as an explanatory variable and crude cancer rates as the response variable. Two scenarios and two sub-scenarios were simulated to test the properties of the estimators and the goodness of fit of the two models. RESULTS: The results obtained from Model 2's estimates were slightly better (less biased) than those from Model 1. The results of the simulation showed that in all cases (two scenarios and two sub-scenarios) Model 2 had a better fit than Model 1. The probability density for the parameter of interest provided evidence that Model 1 leads to biased estimates. CONCLUSIONS: When attempting to explain the relative risk of incidence of cancer using ecological models that control geographic variability, introducing age as another explanatory variable and crude rates as a response variable provides less biased results.

OBJETIVO: Determinar si la introducción de la edad como otra variable independiente en un modelo de regresión ecológica que relaciona las tasas brutas de incidencia de cáncer con un índice de carencia, ofrece mejores resultados que la práctica corriente del uso de la razón de incidencia normalizada como criterio de valoración, con introducción del índice sin normalización y sin incluir la edad en el modelo. MÉTODOS:Se calcularon los riesgos relativos asociados con el índice de carencia de algunos tipos de cáncer en la Región Sanitaria de Girona en España, mediante dos modelos diferentes. En el modelo 1 se calcularon los riesgos relativos con el método indirecto, usando la razón de incidencia normalizada como criterio de valoración. En el modelo 2 se calcularon los riesgos relativos introduciendo la edad como una variable independiente y las tasas brutas de cáncer como criterio de valoración. Se simularon dos hipótesis y dos subhipótesis con el fin de verificar las propiedades de los estimadores y la bondad del ajuste de ambos modelos. RESULTADOS: Los resultados obtenidos a partir de las estimaciones con el modelo 2 fueron un poco mejores (menos sesgados) que los resultados obtenidos con el modelo 1. Los resultados de la simulación indicaron que en todos los casos (las dos hipótesis y las dos subhipótesis) el modelo 2 exhibió un mejor ajuste que el modelo 1. La función de densidad del parámetro de interés puso en evidencia que el modelo 1 da lugar a estimaciones sesgadas. CONCLUSIONES: Cuando se intenta explicar el riesgo relativo de incidencia de cáncer mediante modelos de regresión ecológica que tienen en cuenta la variabilidad geográfica, se obtienen resultados menos sesgados cuando se introduce la edad como una de las variables independientes y se utilizan las tasas brutas de incidencia como criterio de valoración.

Effects of deprivation on the geographical variability of larynx cancer incidence in men, Girona (Spain) 1994-2004.

OBJECTIVE: To assess the association between the incidence of larynx cancer and socioeconomic conditions in the province of Girona from a spatial viewpoint. MATERIALS AND METHODS: Incidence cases of larynx cancer (CL) in 1994-2004 were provided by the Girona Cancer Registry. A census tract (CT) was assigned to all patients. Socioeconomic data were extracted from the 2001 Census. A deprivation index for each CT was obtained by principal component analysis, using four socioeconomic indicators. The standardised incidence ratio (SIR) was calculated using the CL incidence rates in the men of the province of Girona assuming a Poisson distribution. Relative risk was obtained applying the Besag, York and Mollié model. The deprivation index was introduced into the model and was categorised in quartiles. RESULTS: Four hundred and seventy-six incident cases in men were registered. CTs in the lowest deprivation index had a lower risk of larynx cancer, with a risk increase in the higher quartiles. In the highest quartile it was 1.91 times greater than in the lowest. This association was significant when the whole province was considered. DISCUSSION: The deprivation index explains only part of the geographical variability of CL incidence. Other risk factors without spatial structure may contribute to this explaination.

Accurately estimating breast cancer survival in Spain: cross-matching local cancer registries with the National Death Index.

OBJECTIVES: To assess the impact of using data from the National Death Index (NDI) of Spain to estimate breast cancer survival rates among residents of Girona and Zaragoza diagnosed in 1995-1999. METHODS: This was an observational, longitudinal epidemiologic study, using two population-based cancer registries. Data collected were of female residents of Girona or Zaragoza who had been diagnosed with breast cancer in 1995-1999. Observed and relative 5-year survival rates were estimated, first using the information available from the Girona and Zaragoza cancer registries, and then with the inclusion of NDI data. The 5-year relative survival rate and corresponding 95% Confidence Intervals were estimated using the Hakulinen method. The Kaplan-Maier method and Log Rank test were used to compare survival curves. RESULTS: No statistically significant difference in survival curves was observed in Girona for the data obtained before and after cross-matching with the NDI. However, there was a significant difference in Zaragoza. A comparison of the relative survival rates of each of the two registries before NDI cross-matching showed differences of 3.9% (5-year) and 16.1% (10-year) between the two, whereas after the cross-match, the difference was only 0.5% (5-year) and 1.2% (10-year). CONCLUSIONS: In Spain it is imperative that there be systematic use of NDI data to supplement cancer registries, so that comparisons of relative survival rates between registries can be improved.

Accurately estimating breast cancer survival in Spain: cross-matching local cancer registries with the National Death Index / Estimación precisa de la supervivencia de cáncer de mama en España: emparejamiento de los registros locales de cáncer con el Índice Nacional de Defunciones

OBJECTIVES: To assess the impact of using data from the National Death Index (NDI) of Spain to estimate breast cancer survival rates among residents of Girona and Zaragoza diagnosed in 1995-1999. METHODS: This was an observational, longitudinal epidemiologic study, using two population- based cancer registries. Data collected were of female residents of Girona or Zaragoza who had been diagnosed with breast cancer in 1995-1999. Observed and relative 5-year survival rates were estimated, first using the information available from the Girona and Zaragoza cancer registries, and then with the inclusion of NDI data. The 5-year relative survival rate and corresponding 95 percent Confidence Intervals were estimated using the Hakulinen method. The Kaplan-Maier method and Log Rank test were used to compare survival curves. RESULTS: No statistically significant difference in survival curves was observed in Girona for the data obtained before and after cross-matching with the NDI. However, there was a significant difference in Zaragoza. A comparison of the relative survival rates of each of the two registries before NDI cross-matching showed differences of 3.9 percent (5-year) and 16.1 percent (10-year) between the two, whereas after the cross-match, the difference was only 0.5 percent (5-year) and 1.2 percent (10-year). CONCLUSIONS: In Spain it is imperative that there be systematic use of NDI data to supplement cancer registries, so that comparisons of relative survival rates between registries can be improved.

OBJETIVO: Evaluar el efecto de utilizar los datos del Índice Nacional de Defunciones (IND) de España para estimar las tasas de supervivencia de cáncer de mama en las mujeres residentes en Girona y Zaragoza que recibieron el diagnóstico de cáncer de mama en 1995-1999. MÉTODOS: Se realizó un estudio epidemiológico observacional y longitudinal basado en el empleo de los registros de cáncer de mujeres residentes en Girona y Zaragoza que habían recibido el diagnóstico de cáncer de mama en 1995-1999. Se estimaron las tasas de supervivencias observada y relativa a 5 años, primero según la información disponible en los registros de cáncer de Girona y Zaragoza y luego con la inclusión de los datos del IND. Se calcularon las tasas de supervivencia relativa a 5 años y sus correspondientes intervalos de confianza de 95 por ciento por el método de Hakulinen. Las curvas de supervivencia se compararon por el método de Kaplan-Maier y la prueba de rangos logarítmicos. RESULTADOS: No se encontraron diferencias estadísticamente significativas entre las curvas de supervivencia de Girona antes y después de emparejar lo datos locales con los del IND; sin embargo, hubo diferencias significativas entre las curvas de Zaragoza. Al comparar las tasas de supervivencia relativa de cada uno de los registros antes de emparejarlos con los datos del IND se encontraron diferencias de 3,9 por ciento (a 5 años) y 16,1 por ciento (a 10 años), mientras que después del emparejamiento, la diferencia entre ellas fue solamente de 0,5 por ciento (a 5 años) y 1,2 por ciento (a 10 años). CONCLUSIONES: En España es imperativo el empleo sistemático de los datos del IND para complementar los registros de cáncer de manera de mejorar las comparaciones de las tasas de supervivencia relativa cuando se utilizan diferentes registros.