Agència de Qualitat I Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, Spain.
Department of Medicine and Life Sciences (MELIS-UPF), Pompeu Fabra University, Barcelona, Spain.
Int J Equity Health. 2024 Apr 17;23(1):76. doi: 10.1186/s12939-024-02169-5.
Since 2008, children in Catalonia (Spain) have suffered a period of great economic deprivation. This situation has generated broad-ranging health inequalities in a variety of diseases. It is not known how these inequalities have changed over time. The aim of the present study is to determine trends in inequalities over this period in ten relevant diseases in children according to sex and age.
A retrospective cross-sectional population-based study of all children under 15 years old resident in Catalonia during the 2014-2021 period (over 1.2 million children/year) and of their diagnoses registered by the Catalan Health System. Health inequalities were estimated by calculating the relative index of inequality and time trends using logistic regression models. Interaction terms were added to test for the effects of sex on time trends.
Increasing significant temporal trends in inequalities were shown for both sexes in almost all the diseases or adverse events studied (asthma, injuries, poisoning, congenital anomalies, overweight and obesity), in mood disorders in boys, and in adverse birth outcomes in girls. Adjustment and anxiety and mood disorders in girls showed a decreasing temporal trend in inequalities. More than half of the diseases and adverse events studied experienced significant annual increases in inequality. Poisoning stood out with an average annual increase of 8.65% [4.30, 13.00], p ≤ 0.001 in boys and 8.64% [5.76, 11.52], p ≤ 0.001) in girls, followed by obesity with increases of 5.52% [4.15, 6.90], p = < 0.001 in boys and 4.89% [4.26, 5.51], p ≤ 0.001) in girls.
Our results suggest that inequalities persist and have increased since 2014. Policy makers should turn their attention to how interventions to reduce Health inequalities are designed, and who benefits from them.
自 2008 年以来，加泰罗尼亚（西班牙）的儿童经历了一段严重的经济贫困时期。这种情况在各种疾病中产生了广泛的健康不平等。目前尚不清楚这些不平等现象随时间发生了怎样的变化。本研究旨在根据性别和年龄，确定这一时期 10 种相关疾病中不平等现象的变化趋势。
这是一项回顾性的、基于人群的、基于横断面的研究，研究对象为 2014 年至 2021 年期间居住在加泰罗尼亚的所有 15 岁以下儿童（每年超过 120 万儿童）及其由加泰罗尼亚卫生系统登记的诊断。通过计算相对不平等指数和使用逻辑回归模型来估计健康不平等，然后用时间趋势来表示。添加交互项来检验性别对时间趋势的影响。
在几乎所有研究的疾病或不良事件中（哮喘、伤害、中毒、先天畸形、超重和肥胖），男孩的情绪障碍，女孩的不良出生结局，都显示出两性的时间趋势不平等呈显著增加。调整后，女孩的焦虑和情绪障碍呈下降趋势。所研究的一半以上的疾病和不良事件经历了不平等程度的显著年度增加。男孩中毒的平均年增长率为 8.65%[4.30，13.00]，p≤0.001，女孩为 8.64%[5.76，11.52]，p≤0.001，肥胖的增长率为 5.52%[4.15，6.90]，p<0.001，女孩为 4.89%[4.26，5.51]，p≤0.001）。
我们的研究结果表明，自 2014 年以来，不平等现象持续存在且有所增加。政策制定者应关注如何设计减少健康不平等的干预措施，以及谁从中受益。
