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Biomedical subjects

Enrique Regidor

Publications and source records attributed to Enrique Regidor.

At least 19 recordsLinked to original sources
PubMed2006

Association of adult socioeconomic position with hypertension in older people.

OBJECTIVE: To determine the role of obesity, adult behavioural risk factors, and markers of specific childhood exposures in the association between adult socioeconomic position and hypertension in a cohort of people aged 60 years and older. DESIGN: Cross sectional study. SETTING: Spain. PARTICIPANTS: 4009 subjects representative of the Spanish non-institutionalised population aged 60 years and older. MAIN OUTCOME MEASURE: Prevalence of hyperteMarinhonsion according to education and social class, and proportion of excess difference in hypertension prevalence in lower socioeconomic groups explained by different risk factors for hypertension. RESULTS: The highest prevalence of hypertension was seen in subjects with less education and in those belonging to a low social class. In men, the hypertension risk factors analysed did not explain the difference in prevalence by education, but they explained almost half of the difference by social class. In women, these risk factors explained the differences in hypertension prevalence by education and a substantial part of the differences by social class. Central and general obesity, and physical inactivity were the risk factors that were the most important in this association in women. CONCLUSIONS: In women, socioeconomic position has no direct effect on hypertension in the case of education and only a small effect in the case of social class. In contrast, most of the effect of education and half of the effect of social class on hypertension in men is direct or, at least, is not explained by the risk factors analysed. The mechanisms that can explain the association between socioeconomic position and hypertension in older men remain to be established.

Aged↗
PubMed2006

Social determinants of health: a veil that hides socioeconomic position and its relation with health.

The emergence of theoretical models of social determinants of health has added conceptual ambiguity to the understanding of social inequalities in health, as it is often not possible to clearly distinguish between socioeconomic position and these determinants. Whether the existence of social inequalities in health is based on differences in health or on differences in social determinants of health that are systematically associated with socioeconomic position, policymakers should be clearly informed of the importance of socioeconomic position for health. Thus, the following three basic requirements are proposed: to reach a consensus about the dimensions that reflect socioeconomic position; to agree about what are to be considered the social determinants of health and whether or not these determinants are a construct that can be distinguished from socioeconomic position; and finally, to establish which dimensions and measures of socioeconomic position are most appropriate for the evaluation of interventions that aim to reduce these inequalities.

Health Policy↗
PubMed2006

Social inequalities in suicide mortality: Spain and France, 1980-1982 and 1988-1990.

In this study we analyzed the socioeconomic differences in mortality from suicide in the economically active male population aged 25-64 years in Spain and France in 1980-1982 and 1988-1990; in the case of Spain the data came from the Eight Provinces Study (Regidor, Gutierrez-Fisac, & Rodríguez, 1995). Individuals were grouped into four categories: professional/managerial, clerical/sales/ service, agricultural, and manual workers. For 1980-1982, among those aged 25-44, professionals and managers had the lowest risk of mortality in Spain, and clerical/sales/service workers in France. These socioeconomic differences in mortality increased in 1988-1990. In 1980-1982, among those aged 45-64, clerical/ sales/service workers had the lowest risk of mortality from suicide relative to the other occupational groups in both countries, but this difference was not maintained in 1988-1990. Thus, differences in suicide mortality for men by occupational status depended in the present study upon both the nation studied and the time period chosen for study.

Adult↗
PubMed2005

Decreasing socioeconomic inequalities and increasing health inequalities in Spain: a case study.

OBJECTIVES: We examined the evolution of income inequalities and health inequalities in Spain from the time of the country's entry into the European Union. METHODS: We estimated distributions of provincial income and household income, relations of provincial income with mortality and disability, and relations of household income with disability in 1984-1986 and 1999-2001. RESULTS: Inequalities in average provincial income and household income were lower in 2000 than in 1985. Differences in mortality and disability according to income were greater in 2000 than in 1985, in both absolute and relative terms, except for differences in mortality among individuals aged 25 to 44 years. In most cases, differences in mortality from leading causes of death and differences in major types of disabilities were also greater in 2000. CONCLUSIONS: Our results show that redistribution of income might achieve greater social justice but probably does not lead to reduced health inequalities, despite observed improvements in material circumstances as well as in most health indicators among disadvantaged population groups.

Adult↗
PubMed2005

[Factors associated with acute myocardial infarction in-hospital mortality. Results of an observational study].

BACKGROUND AND OBJECTIVE: Myocardial infarction is one of the leading causes of death in Spain. This study assesses in-hospital mortality and associated factors. PATIENTS AND METHOD: Mortality of episodes of initial attention of myocardial infarction attended in hospitals was analyzed using the 2001 Minimum Basic Group of Data corresponding to the Community of Madrid in relation with sociodemographic, hospitals, procedures, risk factors and comorbidities. Statistical descriptive techniques and logistic regression analyses were employed to analyze the data. RESULTS: 5,306 cases of myocardial infarction were studied. 71% were men and the mean age was 68 year. 73% were admitted in high technology hospitals, 49% received coronary angiography and 29% received a stent. Mortality rate was 10.8%. Multivariable analysis showed that increase in age, presence of arrhythmias, congestive heart failure, renal failure, cardiogenic shock and cerebrovascular disease were associated with in-hospital mortality, while admission in centers attending between 100 and 300 myocardial infarction cases, use of coronary angiography and stent, and previous history of arterial hypertension, smoking and high lipid levels, appeared to be protective factors. CONCLUSIONS: Mortality estimated with an administrative data-base is similar than the mortality estimated in studies based on clinical data sets. Mortality is associated with several variables; although some of them have been previously reported, others need further investigations to confirm their relevance.

Aged↗
PubMed2005

Occupational social class and mortality in a population of men economically active: the contribution of education and employment situation.

This study examines how education and employment situation contribute to the association between a classification of occupational class based on skill assets and mortality from different causes of death. Data were obtained by linking records from the 1996 population census for Spanish men aged 35-64 residing in Madrid with 1996 and 1997 mortality records. The risk of mortality was higher in skilled, semi-skilled and unskilled workers than in higher and lower managerial and professional workers. Adjusting for educational level substantially decreased the magnitude of the gradient. The decrease in the gradient after adjusting for employment situation was much smaller. Except in the case of mortality from respiratory diseases, the mortality gradient disappeared after adjusting for both variables. These results show that education and, to a much lesser degree, employment situation explain part of the social gradient observed in mortality from all causes and from broad causes of death, except from respiratory diseases.

Adult↗
PubMed2005

Income in large residential areas and premature mortality in six countries of the European Union.

We study the relation between per capita income and mortality within six countries of the European Union - Finland, the Netherlands, Belgium, France, Italy and Spain - in 1981-1985 and 1996-2000. We obtained information on gross domestic product per capita (GDPpc) and mortality in large residential areas. The areas in each country were grouped in quintiles as a function of GDPpc. In 1996-2000, a negative gradient was seen in premature mortality from all causes in men and women in accordance with the GDPpc quintile, except in the Netherlands and in women in Finland. In Belgium, France, Italy and Spain, the impact of GDPpc on premature mortality was stronger in 1996-2000 than in 1981-1985. All six countries showed a negative gradient in premature mortality from cardiovascular disease by GDPpc. The pathways by which residential area with lower wealth is associated with higher mortality are probably related with investment in economic and social resources over time, although for some causes of death, this association is not seen in some countries due to specific historic and cultural circumstances.

Aged↗
PubMed2005

Association between congenital anomalies and paternal exposure to agricultural pesticides depending on mother's employment status.

OBJECTIVE: We analyzed the association between fetal death from congenital anomalies and paternal agricultural occupation in mothers who were employed and in housewives. MATERIALS AND METHODS: The data consist of individual records from the Spanish Birth Register (1995-1999). RESULTS: The adjusted relative risk of fetal death in agricultural workers compared with nonagricultural was 1.24 (95% confidence interval = 0.38- 4.02) in mothers who were employed and 1.68 (95% confidence interval = 1.03-2.73) in housewives. CONCLUSION: The risk of fetal death in the offspring of agricultural workers exposed to pesticides around the time of conception was higher than in the offspring of nonagricultural workers in mothers who were housewives but not in mothers who worked outside the home.

Adult↗
PubMed2004

[Estimating mortality attributed to illegal drug use in Spain].

BACKGROUND AND OBJECTIVE: The impact of illegal drug consumption on general mortality in Spain is unknown. We aimed to quantify this impact for the period 1994-2000. SUBJECTS AND METHOD: Number of directly drug-related deaths from HIV among injecting drug users as well as others -- both taken from the General Mortality Register (GMR). Next, corrections were made, multiplying the aforementioned figures by the percentage of injecting drug users in the AIDS register in the first case, and by the underestimation index in the second. This index was calculated comparing the GMR with the specific drug-related register in certain areas. RESULTS: In Spain, mortality from illegal drug use fell from 22.7 per 100,000 inhabitants, aged 15-49 years (16.4% of all deaths) in 1996 to 8.9/100,000 in 2000 (7.8% of all deaths), meaning a 58% decrease in general mortality. In 2000, drug-related deaths surpassed AIDS mortality in the group of men aged 15-49 years. CONCLUSIONS: Illegal drug use continues to be an important cause of death among young people in Spain. Overdose is the most likely primary cause of death in drug consumers.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Trends in socioeconomic inequalities in self-assessed health in 10 European countries.

BACKGROUND: Changes over time in inequalities in self-reported health are studied for increasingly more countries, but a comprehensive overview encompassing several countries is still lacking. The general aim of this article is to determine whether inequalities in self-assessed health in 10 European countries showed a general tendency either to increase or to decrease between the 1980s and the 1990s and whether trends varied among countries. METHODS: Data were obtained from nationally representative interview surveys held in Finland, Sweden, Norway, Denmark, England, The Netherlands, West Germany, Austria, Italy, and Spain. The proportion of respondents with self-assessed health less than 'good' was measured in relation to educational level and income level. Inequalities were measured by means of age-standardized prevalence rates and odds ratios (ORs). RESULTS: Socioeconomic inequalities in self-assessed health showed a high degree of stability in European countries. For all countries together, the ORs comparing low with high educational levels remained stable for men (2.61 in the 1980s and 2.54 in the 1990s) but increased slightly for women (from 2.48 to 2.70). The ORs comparing extreme income quintiles increased from 3.13 to 3.37 for men and from 2.43 to 2.86 for women. Increases could be demonstrated most clearly for Italian and Spanish men and women, and for Dutch women, whereas inequalities in health in the Nordic countries showed no tendency to increase. CONCLUSIONS: The results underscore the persistent nature of socioeconomic inequalities in health in modern societies. The relatively favourable trends in the Nordic countries suggest that these countries' welfare states were able to buffer many of the adverse effects of economic crises on the health of disadvantaged groups.

Educational Status↗
PubMed2004

Socioeconomic position in childhood and cardiovascular risk factors in older Spanish people.

OBJECTIVE: To investigate the association between childhood social class and the prevalence of cardiovascular risk factors in the elderly. METHODS: Cross-sectional study of 4009 subjects representative of the Spanish non-institutionalized population aged >or =60 years, for whom information was available on father's occupation. We estimated the prevalence of hypertension, obesity, diabetes mellitus, physical inactivity, smoking, and alcohol intake. RESULTS: Belonging to a working social class in childhood is associated with increased hypertension, having ever smoked, and heavy alcohol intake, independent of adult social class in men. No association was found between social class in childhood and the other cardiovascular risk factors in men. Belonging to a working social class in childhood is associated with increased general obesity, abdominal obesity, diabetes mellitus, and physical inactivity in women, but the size of the association for abdominal obesity and diabetes mellitus decreases and the statistical significance disappears after adjusting for adult social class. The highest smoking prevalence was observed in women who were in social class I in childhood and the lowest in women who were in social class IV. CONCLUSIONS: The results of this study show increased prevalence of some cardiovascular risk factors in men who belong to a working social class in childhood, but they do not support the existing evidence about an association between adverse social circumstances in childhood and increased prevalence of cardiovascular risk factors in later life in women.

Aged↗
PubMed2004

Educational level and stroke mortality: a comparison of 10 European populations during the 1990s.

BACKGROUND AND PURPOSE: Variations between countries in occupational differences in stroke mortality were observed among men during the 1980s. This study estimates the magnitude of differences in stroke mortality by educational level among men and women aged >or=30 years in 10 European populations during the 1990s. METHODS: Longitudinal data from mortality registries were obtained for 10 European populations, namely Finland, Norway, Denmark, England/Wales, Belgium, Switzerland, Austria, Turin (Italy), Barcelona (Spain), and Madrid (Spain). Rate ratios (RRs) were calculated to assess the association between educational level and stroke mortality. The life table method was used to estimate the impact of stroke mortality on educational differences in life expectancy. RESULTS: Differences in stroke mortality according to educational level were of a similar magnitude in most populations. However, larger educational differences were observed in Austria. Overall, educational differences in stroke mortality were of similar size among men (RR, 1.27; 95% CI, 1.24 to 1.30) and women (RR, 1.29; 95% CI, 1.27 to 1.32). Educational differences in stroke mortality persisted at all ages in all populations, although they generally decreased with age. Eliminating these differences would on average reduce educational differences in life expectancy by 7% among men and 14% among women. CONCLUSIONS: Educational differences in stroke mortality were observed across Europe during the 1990s. Risk factors such as hypertension and smoking may explain part of these differences in several countries. Other factors, such as socioeconomic differences in healthcare utilization and childhood socioeconomic conditions, may have contributed to educational differences in stroke mortality across Europe.

Adult↗
PubMed2004

Inequalities in lung cancer mortality by the educational level in 10 European populations.

Previous studies have shown that due to differences in the progression of the smoking epidemic European countries differ in the direction and size of socioeconomic variations in smoking prevalence. We studied differences in the direction and size of inequalities in lung cancer mortality by the educational level of subjects in 10 European populations during the 1990's. We obtained longitudinal mortality data by cause of death, age, sex and educational level for 4 Northern European populations (England/Wales, Norway, Denmark, Finland), 3 continental European populations (Belgium, Switzerland, Austria), and 3 Southern European populations (Barcelona, Madrid, Turin). Age- and sex-specific mortality rates by educational level were calculated, as well as the age- and sex-specific mortality rate ratios. Patterns of educational inequalities in lung cancer mortality suggest that England/Wales, Norway, Denmark, Finland and Belgium are the farthest advanced in terms of the progression of the smoking epidemic: these populations have consistently higher lung cancer mortality rates among the less educated in all age-groups in men, including the oldest men, and in all age-groups in women up to those aged 60-69 years. Madrid appears to be less advanced, with less educated men in the oldest age-group and less educated women in all age-groups still benefiting from lower lung cancer mortality rates. Switzerland, Austria, Turin and Barcelona occupy intermediate positions. The lung cancer mortality data suggest that inequalities in smoking contribute substantially to the educational differences in total mortality among men in all populations, except Madrid. Among women, these contributions are probably substantial in the Northern European countries and in Belgium, but only small in Switzerland, Austria, Turin and Barcelona, and negative in Madrid. In many European countries, policies and interventions that reduce smoking in less educated groups should be one of the main priorities to tackle socioeconomic inequalities in mortality. In some countries, particularly in Southern Europe, it may not be too late to prevent women in less educated groups from taking up the smoking habit, thereby avoiding large inequalities in mortality in the future in these countries.

Adult↗
PubMed2004

The use of personal data from medical records and biological materials: ethical perspectives and the basis for legal restrictions in health research.

This paper discusses the moral justification for using personal data without informed consent, from both medical records and biological materials, in research where subjects are not physically present in the study and will never have any contact with the study investigators. Although the idea of waiving the requirement for informed consent in certain investigations has been mentioned in several ethical guidelines formulated by epidemiologists and physicians since the late 1980s, these guidelines are now of limited use due to legal restrictions on the use of personal data in most western countries. Several misconceptions that form the basis for legal restriction of health research are discussed: lack of knowledge of the need to link personal information from health services with personal information produced outside the health system in many biomedical investigations; the assumption of a deterministic model of disease causation in which the prediction of disease occurrence is based on a genetic association despite the fact that most genotypes for common diseases are incompletely penetrant; the lack of a logical rationale for the recommendation in the Declaration of Helsinki that only research that offers some benefit to study subjects is justified; the great lack of knowledge about research methodology revealed in some alternatives proposed to avoid using personal data; and the lack of a debate about the ethical double standard of institutions and investigators in countries that prohibit the use of personal data but finance and carry out studies in other countries where it is permitted.

Biomedical Research↗