[The study of social inequalities in child and adolescent health in Spain].
OBJECTIVE
To identify and describe studies on social inequalities in child and adolescent health conducted in Spain with special emphasis on social determinants.


METHODS
In July 2012, we conducted a systematic review in the PubMed, MEDES, SCOPUS and COCHRANE databases. We included studies on social inequalities in child and adolescent health in Spain published between 2000 and 2012. A total of 2147 abstracts were reviewed by two researchers and 80 manuscripts were fully reviewed by three researchers. Risk of bias was assessed. Seventy-two articles were finally included.


RESULTS
A total of 83% of the studies were cross-sectional and the most frequently studied age group consisted of 13-15-year-olds. More than 20 individual or group determinants were identified. The most frequently analyzed determinants were the most advantaged educational level and occupation of the mother or the father. In 38% of the studies analyzing education and occupation, there was no definition of the determinant. Social inequalities were detected in dental health with all determinants and in all age groups (9% of studies with a high risk of bias). Social inequalities were also detected in obesity, physical activity and mental health with some determinants. Specific data were missing for younger children. No social inequalities were found in the use of health services, excluding dental care. Few studies analyzed immigration and 42% of them had a high risk of bias.


CONCLUSIONS
Wide diversity was found in the measurement of social determinants, with a lack of studies in preschoolers and of studies with longitudinal designs. The results of this study confirm social inequalities in some aspects of health.
Centre for Research in Environmental Epidemiology (CREAL), Barcelona, España; IMIM (Hospital del Mar Medical Research Institute), Barcelona, España; Universitat Pompeu Fabra (UPF), Barcelona, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España. Electronic address: lfont@creal.cat.
Laia
L
Font-Ribera
CIBER de Epidemiología y Salud Pública (CIBERESP), España; Agència de Salut Pública de Barcelona, Barcelona, España.
Xavier
X
García-Continente
Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia, Universidad de Alicante, Alicante, España.
M Carmen
MC
Davó-Blanes
CIBER de Epidemiología y Salud Pública (CIBERESP), España; Agència de Salut Pública de Barcelona, Barcelona, España; Instituto de Investigación Biomédica Sant Pau (IIB Sant Pau), Barcelona, España.
Carles
C
Ariza
CIBER de Epidemiología y Salud Pública (CIBERESP), España; Agència de Salut Pública de Barcelona, Barcelona, España.
Elia
E
Díez
Escuela Andaluza de Salud Pública, Granada, España.
M del Mar
Mdel M
García Calvente
Escuela Andaluza de Salud Pública, Granada, España.
Gracia
G
Maroto
Ministerio de Sanidad, Servicios Sociales e Igualdad, Madrid, España.
Mónica
M
Suárez
IMIM (Hospital del Mar Medical Research Institute), Barcelona, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, España.
Luis
L
Rajmil
D000293:Adolescent; D000294:Adolescent Behavior; D016497:Adolescent Health Services / Q000706:statistics & numerical data*; D015982:Bias; D002648:Child; D002652:Child Behavior; D002662:Child Health Services / Q000706:statistics & numerical data*; D002669:Child Welfare; D002675:Child, Preschool; D003752:Dental Health Services / Q000706:statistics & numerical data*; D004522:Educational Status; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data; D015340:Epidemiologic Research Design; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D007223:Infant; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology; D009043:Motor Activity; D009765:Obesity / Q000453:epidemiology; D009790:Occupations; D011788:Quality of Life; D012120:Respiration Disorders / Q000453:epidemiology; D012959:Socioeconomic Factors; D013030:Spain / Q000453:epidemiology
Adolescent; Adolescente; Child; Desigualdades en el estado de salud; Factores socioeconómicos; Health status disparities; Niño; Preescolar; Preschooler; Review; Revisión; Socioeconomic factors