title: Low mortality in the poorest areas of Spain: adults residing in provinces with lower per capita income have the lowest mortality.
abstract: The objective of this study is to ascertain whether income inequality and per capita income of area of residence show a relationship with mortality in Spain. Data are from a nation-wide prospective study with a 7-year mortality follow-up covering all persons living in Spain's 50 provinces in 2001. In total 28,944,854 subjects aged 25 years or over at baseline were studied. Rate ratio for total mortality and cause-specific mortality, according to provincial income inequality and per capita income in two age groups, 25-64 years (adult population) and 65 years and over (elderly population). Provincial income inequality was not related to total mortality or cause-specific mortality. Total mortality rate ratios among residents of the poorest versus the richest provinces were 0.89 (95% CI 0.95-0.93) in men and 0.91 (0.87-0.96) in women, among the adult population; and 1.02 (0.97-1.08) in men and 1.08 (1.02-1.16) in women, among the elderly population. With the exception of cardiovascular-disease mortality for which no association with per capita income was observed, adult residents of the poorest provinces registered the lowest mortality rate ratio for other causes of death. Elderly residents of the poorest provinces registered the highest mortality rate ratio for cardiovascular disease and the lowest mortality rate ratio for cancer and external causes. Aside from cardiovascular-disease mortality, the lowest mortality for most causes of death was registered by residents of the poorest provinces. Nevertheless, these findings need to be confirmed by similar studies using smaller areas as the unit of analysis.
authors.affiliation: Department of Preventive Medicine and Public Health, Faculty of Medicine, Universidad Complutense de Madrid, Ciudad Universitaria, 28040, Madrid, Spain. enriqueregidor@hotmail.com.|CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain. enriqueregidor@hotmail.com.|Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain. enriqueregidor@hotmail.com.
authors.forename: Enrique
authors.initials: E
authors.lastname: Regidor
authors.affiliation: CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.|National Epidemiology Center, Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Vallejo
authors.affiliation: Department of Preventive Medicine and Public Health, Faculty of Medicine, Universidad Complutense de Madrid, Ciudad Universitaria, 28040, Madrid, Spain.|Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
authors.forename: Carolina
authors.initials: C
authors.lastname: Giráldez-García
authors.affiliation: Department of Preventive Medicine and Public Health, Faculty of Medicine, Universidad Complutense de Madrid, Ciudad Universitaria, 28040, Madrid, Spain.|Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
authors.forename: Paloma
authors.initials: P
authors.lastname: Ortega
authors.affiliation: Department of Preventive Medicine and Public Health, Faculty of Medicine, Universidad Complutense de Madrid, Ciudad Universitaria, 28040, Madrid, Spain.|Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
authors.forename: Juana M
authors.initials: JM
authors.lastname: Santos
authors.affiliation: Department of Preventive Medicine and Public Health, Faculty of Medicine, Universidad Complutense de Madrid, Ciudad Universitaria, 28040, Madrid, Spain.|Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
authors.forename: Paloma
authors.initials: P
authors.lastname: Astasio
authors.affiliation: CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.|National Epidemiology Center, Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: de la Fuente
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality; D002423:Cause of Death; D005260:Female; D006304:Health Status; D006801:Humans; D007182:Income / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009369:Neoplasms / Q000401:mortality; D011204:Poverty Areas; D011446:Prospective Studies; D012111:Residence Characteristics; D012959:Socioeconomic Factors; D013030:Spain / Q000453:epidemiology
keywords: Income inequality; Leading causes of death; Mortality; Multilevel study; National prospective study; Per capita income; Spain