Arias A, Rebagliato M, Palumbo M A, Bellver R, Ashton J, Colomer C, Costa J, Flynn P, Alvarez-Dardet C
Instituto Municipal de la Salud, Barcelona.
Med Clin (Barc). 1993 Feb 27;100(8):281-7.
Inequalities in health have been internationally recognized as an important public health problem with a reduction of 25% being the first target of WHO--Europe for the year 2000. It is, therefore, important to describe and monitor the same.
An ecological study was performed using secondary data from the statistics of mortality (years 1985-1988) and the municipal censuses from the year 1986 to describe and compare inequalities in health in the cities of Valencia and Barcelona with neighborhoods being the unit of observation and analysis.
Although the rates of mortality in Barcelona city are slightly inferior and those of Valencia slightly higher to those of Spain, both cities demonstrate important inequalities in regard to mortality in their neighborhoods with respect to standardized mortality which ranged from 78 to 182 in Barcelona and from 63 to 147 in Valencia. The privileged zones in Barcelona are those of Pedralbes and Sant Gervasi and in Valencia in the neighborhoods of Sant Pau and Jaume Roig with the most unfavorable neighborhoods being District I in Barcelona (Gothic Quarter, City Park, Barceloneta and Raval) and the Na Rovella and Fuensanta neighborhoods of Valencia. The level of inequality in both cities is very similar. Statistically significant associations have been found in both cities between the state of health and the level of poverty in the neighborhoods according to an approximation to the Townsend et al indexes.
The description of important inequalities in two large Spanish cities suggests the possibility of its existence in other cities and established the urgent need for a study using comparable methodologies. With the use of routine and presently available data sources it is possible to describe and posteriorly monitor the level of inequality in large cities in Spain. The development of policies to diminish the inequalities in the large cities would provide considerable gains in terms of human lives. The present results support the hypothesis that material conditions in everyday life play an important role as a condition for public health inequality.
健康不平等已被国际公认为一个重要的公共卫生问题，将其减少25%是世界卫生组织欧洲办事处2000年的首要目标。因此，对其进行描述和监测很重要。
开展了一项生态研究，使用了1985 - 1988年死亡率统计数据以及1986年市政人口普查的二手数据，以街区作为观察和分析单位，描述和比较瓦伦西亚市和巴塞罗那市的健康不平等情况。
尽管巴塞罗那市的死亡率略低于西班牙，瓦伦西亚市的死亡率略高于西班牙，但两市在街区死亡率方面均表现出显著的不平等，巴塞罗那的标准化死亡率在78至182之间，瓦伦西亚在63至147之间。巴塞罗那的特权区域是佩德拉尔贝斯和圣热尔瓦西区，瓦伦西亚的特权区域是圣保罗和豪梅·罗伊格街区，最不利的街区在巴塞罗那是第一区（哥特区、城市公园、巴塞罗那海滩和拉瓦尔区），在瓦伦西亚是纳罗韦拉和富恩桑塔街区。两市的不平等程度非常相似。根据与汤森等人的指数近似值，在两市均发现健康状况与街区贫困水平之间存在统计学上的显著关联。
对西班牙两个大城市重要不平等现象的描述表明，其他城市也可能存在这种情况，并确立了使用可比方法进行研究的迫切需求。利用常规和现有数据源可以描述并随后监测西班牙大城市的不平等程度。制定减少大城市不平等的政策将在挽救生命方面带来可观收益。目前的结果支持这样的假设，即日常生活中的物质条件作为公共卫生不平等的一个条件发挥着重要作用。
