title: Trends in socioeconomic inequalities in amenable mortality in urban areas of Spanish cities, 1996-2007.
abstract: BACKGROUND
  While research continues into indicators such as preventable and amenable mortality in order to evaluate quality, access, and equity in the healthcare, it is also necessary to continue identifying the areas of greatest risk owing to these causes of death in urban areas of large cities, where a large part of the population is concentrated, in order to carry out specific actions and reduce inequalities in mortality. This study describes inequalities in amenable mortality in relation to socioeconomic status in small urban areas, and analyses their evolution over the course of the periods 1996-99, 2000-2003 and 2004-2007 in three major cities in the Spanish Mediterranean coast (Alicante, Castellón, and Valencia).
  
  
  METHODS
  All deaths attributed to amenable causes were analysed among non-institutionalised residents in the three cities studied over the course of the study periods. Census tracts for the cities were grouped into 3 socioeconomic status levels, from higher to lower levels of deprivation, using 5 indicators obtained from the 2001 Spanish Population Census. For each city, the relative risks of death were estimated between socioeconomic status levels using Poisson's Regression models, adjusted for age and study period, and distinguishing between genders.
  
  
  RESULTS
  Amenable mortality contributes significantly to general mortality (around 10%, higher among men), having decreased over time in the three cities studied for men and women. In the three cities studied, with a high degree of consistency, it has been seen that the risks of mortality are greater in areas of higher deprivation, and that these excesses have not significantly modified over time.
  
  
  CONCLUSIONS
  Although amenable mortality decreases over the time period studied, the socioeconomic inequalities observed are maintained in the three cities. Areas have been identified that display excesses in amenable mortality, potentially attributable to differences in the healthcare system, associated with areas of greater deprivation. Action must be taken in these areas of greater inequality in order to reduce the health inequalities detected. The causes behind socioeconomic inequalities in amenable mortality must be studied in depth.
authors.affiliation: Unidad de Investigación de Análisis de la Mortalidad y Estadísticas Sanitarias, Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia, Universidad de Alicante Campus de San Vicente del Raspeig s/n, Apartado 99, 03080 Alicante, España. nolasco@ua.es.
authors.forename: Andreu
authors.initials: A
authors.lastname: Nolasco
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Quesada
authors.forename: Joaquín
authors.initials: J
authors.lastname: Moncho
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Melchor
authors.forename: Pamela
authors.initials: P
authors.lastname: Pereyra-Zamora
authors.forename: Nayara
authors.initials: N
authors.lastname: Tamayo-Fonseca
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Martínez-Beneito
authors.forename: Oscar
authors.initials: O
authors.lastname: Zurriaga
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002423:Cause of Death / Q000639:trends*; D019352:Censuses; D002947:Cities; D004522:Educational Status; D004651:Employment / Q000145:classification / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D012306:Risk; D012923:Social Class; D013030:Spain / Q000453:epidemiology; D014504:Urban Health / Q000191:economics* / Q000706:statistics & numerical data*; D055815:Young Adult