Power relations and premature mortality in Spain's autonomous communities.
This trends ecological study analyzes, across 17 autonomous communities of Spain from 1989 to 1998, the relationship between mortality (total and by main causes of death) and power relations (type of government: social democratic (SDP), conservative (CDP), and others), labor market variables, welfare state variables, income inequality, absolute income, poverty, and number of civil associations. The authors conducted a descriptive analysis; a bivariate analysis (Pearson correlation coefficients) between mortality and each of the independent variables; and a multivariate analysis, adjusting multilevel linear regression models. All dimensions of the conceptual power relations model were related to premature mortality in the direction hypothesized. The cross-pooled multilevel regression models show that total premature mortality in males, male and female cerebrovascular mortality, male and female cirrhosis mortality, and male lung cancer mortality decreased somewhat more in communities where primary health care reform was implemented more quickly. Premature mortality decreased somewhat more in SDP than in CDP communities for male and female total premature mortality, cerebrovascular mortality, and cirrhosis mortality, and male lung cancer mortality. These results are in accord with earlier studies that found a relationship among health indicators and variables related to labor market, welfare state, income inequalities, civil associations, and power relations.
Rodríguez-Sanz
Maica
M
Health Information Service, Agency of Public Health of Barcelona, Spain. mrodri@imsb.bcn.es
Borrell
Carme
C
Urbanos
Rosa
R
Pasarín
M Isabel
MI
Rico
Ana
A
Fraile
Marta
M
Ramos
Xavier
X
Navarro
Vicente
V
D000293:Adolescent; D000328:Adult; D000368:Aged; D002561:Cerebrovascular Disorders / Q000191:economics / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D018672:Community Health Planning; D005260:Female; D018166:Health Care Reform; D006801:Humans; D007223:Infant; D008103:Liver Cirrhosis / Q000191:economics / Q000401:mortality; D008175:Lung Neoplasms / Q000191:economics / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009026:Mortality; D017202:Myocardial Ischemia / Q000191:economics / Q000401:mortality; D011057:Politics; D011203:Poverty / Q000706:statistics & numerical data; D011209:Power, Psychological; D011320:Primary Health Care; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D013030:Spain / Q000453:epidemiology