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Area-based policies (ABIs) aim to improve the quality of life and health of residents in socio-economically disadvantaged areas of cities. Although health impact evaluations of ABIs have proliferated in the last decade, several weaknesses have been identified in these evaluations. Inspired by the propositions of the fundamental cause theory (FCT), this paper attempts to address some of these weaknesses by investigating the possible impacts of different combinations of ABIs on premature mortality in vulnerable urban areas of Andalusia (Spain). We conducted a quasi-experimental cohort study, based on the longitudinal statistics on survival and longevity of a population aged 40–70 during the period from 2002 to 2016. Hazard ratios for individuals living in targeted areas relative to control areas were estimated using quasi-Poisson regressions, and the impact was evaluated using a difference-in-difference approach. Most of the ABIs studied do not seem to generate a visible impact on premature mortality. However, the combination of ARB and URBAN interventions is associated with a significant decrease in preventable and all-cause mortality in the targeted versus control areas. The flexible resources proposed by FCT can operate at both the contextual and individual levels, since more comprehensive interventions seem to contribute to achieving health impacts on vulnerable populations. Future evaluations should consider the nature of the intervened areas themselves in relation to the dynamics of the city and the degree of comprehensiveness of the policies, to elucidate what may constitute “fundamental interventions” to reduce health disparities between urban places.
Ángel Zapata-Moya; María Martín-Díaz; Francisco Viciana-Fernández. Area-Based Policies and Potential Health Benefits: A Quasi-Experimental Cohort Study in Vulnerable Urban Areas of Andalusia (Spain). Sustainability 2021, 13, 8169 .
AMA StyleÁngel Zapata-Moya, María Martín-Díaz, Francisco Viciana-Fernández. Area-Based Policies and Potential Health Benefits: A Quasi-Experimental Cohort Study in Vulnerable Urban Areas of Andalusia (Spain). Sustainability. 2021; 13 (15):8169.
Chicago/Turabian StyleÁngel Zapata-Moya; María Martín-Díaz; Francisco Viciana-Fernández. 2021. "Area-Based Policies and Potential Health Benefits: A Quasi-Experimental Cohort Study in Vulnerable Urban Areas of Andalusia (Spain)." Sustainability 13, no. 15: 8169.
Analyses of health and mortality disparities between today's urban and rural populations appear to be exclusively focused on vastly urbanising countries. By incorporating environmental data at census tract level and accounting for within‐area homogeneity, this work attempts to extend classic rural–urban comparisons. Geographical information is linked to a register‐based mortality follow up and Spanish census data for the autonomous community of Andalusia. We then apply mixed effects Cox proportional hazards models to estimate individual mortality differences and account for area variations between residential areas. Estimated effects suggest that the shared degree of “urbanicity” does not affect individual hazards of mortality, whereas environmental‐ and population‐based measures influence the relative risk of dying despite controlling for individual‐level risk factors. Although we do not find an impact of physical urban measures, our results reveal persistent that area‐related mortality disparities which can help to explain the mechanisms behind prevalent spatial‐temporal inequalities such as those in Andalusia.
Mathias Voigt; Dariya Ordanovich; Francisco Viciana Fernández; Laura Ann Cilek; Rosa Canovas Balboá; Diego Ramiro Fariñas. Urban environment and mortality differentials in Spain. Population, Space and Place 2019, 25, e2239 .
AMA StyleMathias Voigt, Dariya Ordanovich, Francisco Viciana Fernández, Laura Ann Cilek, Rosa Canovas Balboá, Diego Ramiro Fariñas. Urban environment and mortality differentials in Spain. Population, Space and Place. 2019; 25 (4):e2239.
Chicago/Turabian StyleMathias Voigt; Dariya Ordanovich; Francisco Viciana Fernández; Laura Ann Cilek; Rosa Canovas Balboá; Diego Ramiro Fariñas. 2019. "Urban environment and mortality differentials in Spain." Population, Space and Place 25, no. 4: e2239.
Diego Ramiro-Fariñas; Francisco J. Viciana-Fernández; Víctor Montañés Cobo. Will highly educated women have more children in the future? In Southern Europe, it will largely depend on labour market conditions. Vienna Yearbook of Population Research 2018, 1, 49 -54.
AMA StyleDiego Ramiro-Fariñas, Francisco J. Viciana-Fernández, Víctor Montañés Cobo. Will highly educated women have more children in the future? In Southern Europe, it will largely depend on labour market conditions. Vienna Yearbook of Population Research. 2018; 1 ():49-54.
Chicago/Turabian StyleDiego Ramiro-Fariñas; Francisco J. Viciana-Fernández; Víctor Montañés Cobo. 2018. "Will highly educated women have more children in the future? In Southern Europe, it will largely depend on labour market conditions." Vienna Yearbook of Population Research 1, no. : 49-54.
Reliable estimates of mortality according to socioeconomic status play a crucial role in informing the policy debate about social inequality, social cohesion, and exclusion as well as about the reform of pension systems. Linked mortality data have become a gold standard for monitoring socioeconomic differentials in survival. Several approaches have been proposed to assess the quality of the linkage, in order to avoid the misclassification of deaths according to socioeconomic status. However, the plausibility of mortality estimates has never been scrutinized from a demographic perspective, and the potential problems with the quality of the data on the at-risk populations have been overlooked. Using indirect demographic estimation (i.e., the synthetic extinct generation method), we analyze the plausibility of old-age mortality estimates according to educational attainment in four European data contexts with different quality issues: deterministic and probabilistic linkage of deaths, as well as differences in the methodology of the collection of educational data. We evaluate whether the at-risk population according to educational attainment is misclassified and/or misestimated, correct these biases, and estimate the education-specific linkage rates of deaths. The results confirm a good linkage of death records within different educational strata, even when probabilistic matching is used. The main biases in mortality estimates concern the classification and estimation of the person-years of exposure according to educational attainment. Changes in the census questions about educational attainment led to inconsistent information over time, which misclassified the at-risk population. Sample censuses also misestimated the at-risk populations according to educational attainment. The synthetic extinct generation method can be recommended for quality assessments of linked data because it is capable not only of quantifying linkage precision, but also of tracking problems in the population data. Rather than focusing only on the quality of the linkage, more attention should be directed towards the quality of the self-reported socioeconomic status at censuses, as well as towards the accurate estimation of the at-risk populations.
Mathias Lerch; Adrian Spoerri; Domantas Jasilionis; Francisco Viciana Fernandèz. On the plausibility of socioeconomic mortality estimates derived from linked data: a demographic approach. Population Health Metrics 2017, 15, 26 .
AMA StyleMathias Lerch, Adrian Spoerri, Domantas Jasilionis, Francisco Viciana Fernandèz. On the plausibility of socioeconomic mortality estimates derived from linked data: a demographic approach. Population Health Metrics. 2017; 15 (1):26.
Chicago/Turabian StyleMathias Lerch; Adrian Spoerri; Domantas Jasilionis; Francisco Viciana Fernandèz. 2017. "On the plausibility of socioeconomic mortality estimates derived from linked data: a demographic approach." Population Health Metrics 15, no. 1: 26.
Studies of the effect of macroeconomic fluctuations on mortality in different socioeconomic groups are scarce and have yielded mixed findings. We analyse mortality trends in Spain before and during the Great Recession in different socioeconomic groups, quantifying the change within each group. We did a nationwide prospective study, in which we took data from the 2001 Census. All people living in Spain on Nov 1, 2001, were followed up until Dec 31, 2011. We included 35 951 354 people alive in 2001 who were aged between 10 and 74 years in each one of the four calendar years before the economic crisis (from 2004 to 2007) and in each one of the first four calendar years of the crisis (from 2008 to 2011), and analysed all-cause and cause-specific mortality in those people. We classified individuals by socioeconomic status (low, medium, or high) using two indicators of household wealth: household floor space (104 m2) and number of cars owned by the residents of the household (none, one, and two or more). We used Poisson regression to calculate the annual percentage reduction (APR) in mortality rates during 2004-07 (pre-crisis) and 2008-11 (crisis) in each socioeconomic group, as well as the effect size, measured by the APR difference between the pre-crisis and crisis period. The annual decline in all-cause mortality in the three socioeconomic groups was 1·7% (95% CI 1·2 to 2·1) for the low group, 1·7% (1·3 to 2·1) for the medium group, and 2·0% (1·4 to 2·5) for the high group in 2004-07, and 3·0% (2·5 to 3·5) for the low group, 2·8% (2·5 to 3·2) for the medium group, and 2·1% (1·6 to 2·7) for the high group in 2008-11 when individuals were classified by household floor space. The annual decline in all-cause mortality when people were classified by number of cars owned by the household was 0·3% (-0·1 to 0·8) for the low group, 1·6% (1·2 to 2·0) for the medium group, and 2·2% (1·6 to 2·8) for the high group in 2004-07, and 2·3% (1·8 to 2·8) for the low group, 2·4% (2·0 to 2·7) for the medium group and 2·5% (1·9 to 3·0) for the high group in 2008-11. The low socioeconomic group showed the largest effect size for both wealth indicators. In Spain, probably due to the decrease in exposure to risk factors, all-cause mortality decreased more during the economic crisis than before the economic crisis, especially in low socioeconomic groups. None.
Enrique Regidor; Fernando Vallejo; José A Tapia Granados; Francisco Viciana; Luis De la Fuente; Gregorio Barrio. Mortality decrease according to socioeconomic groups during the economic crisis in Spain: a cohort study of 36 million people. The Lancet 2016, 388, 2642 -2652.
AMA StyleEnrique Regidor, Fernando Vallejo, José A Tapia Granados, Francisco Viciana, Luis De la Fuente, Gregorio Barrio. Mortality decrease according to socioeconomic groups during the economic crisis in Spain: a cohort study of 36 million people. The Lancet. 2016; 388 (10060):2642-2652.
Chicago/Turabian StyleEnrique Regidor; Fernando Vallejo; José A Tapia Granados; Francisco Viciana; Luis De la Fuente; Gregorio Barrio. 2016. "Mortality decrease according to socioeconomic groups during the economic crisis in Spain: a cohort study of 36 million people." The Lancet 388, no. 10060: 2642-2652.
Evidence suggests that educational differences in perinatal outcomes have increased in some countries (Eastern Europe) while remained stable in others (Scandinavian countries). However, less is known about the experience of Southern Europe. This study aims to evaluate the association between maternal education and perinatal outcomes derived from birthweight (low birthweight and macrosomia) and gestational age (pre-term and post-term births) among Spaniards living in the Autonomous Community of Andalusia during the period 2001-2011 (around 19 % of births in Spain); and to evaluate whether the educational differences narrowed or widened during that period, which includes both an economic boom (2001-2008) and the global economic crisis (2009-2011). This study uses the Andalusian Population Longitudinal Database and the Vital Statistics Data provided by the Spanish National Statistics Institute. We study live and singleton births of Spanish mothers who lived in Andalusia at the time of delivery (n = 404,951). ORs with 95 % confidence intervals (crude and adjusted) were estimated using multinomial regression models. A negative educational gradient is observed in all perinatal outcomes studied (i.e., the higher the educational status, the lower the risk of negative perinatal outcomes). However, when disaggregating the sample in two periods, the gradient is only statistically significant for pre-term birth during 2001-2008, while a full gradient is observed in all perinatal indicators in the period 2009-2011 with an increase in the educational inequalities in macrosomia and post-term. Further studies are needed in order to confirm whether there is a causal association between the widening of the educational differences in perinatal outcomes and the onset of the economic crisis in Spain, or the widening can be explained by other factors, such as changes in childbearing patterns and the composition of women accessing motherhood.
Sol Juárez; Barbara Ana Revuelta-Eugercios; Diego Ramiro-Fariñas; Francisco Viciana. Maternal Education and Perinatal Outcomes Among Spanish Women Residing in Southern Spain (2001–2011). Maternal and Child Health Journal 2013, 18, 1814 -1822.
AMA StyleSol Juárez, Barbara Ana Revuelta-Eugercios, Diego Ramiro-Fariñas, Francisco Viciana. Maternal Education and Perinatal Outcomes Among Spanish Women Residing in Southern Spain (2001–2011). Maternal and Child Health Journal. 2013; 18 (8):1814-1822.
Chicago/Turabian StyleSol Juárez; Barbara Ana Revuelta-Eugercios; Diego Ramiro-Fariñas; Francisco Viciana. 2013. "Maternal Education and Perinatal Outcomes Among Spanish Women Residing in Southern Spain (2001–2011)." Maternal and Child Health Journal 18, no. 8: 1814-1822.
We performed a multilevel analysis (including individuals, households, census tracts, municipalities and provinces) on a 10% sample (N = 230,978) from the Longitudinal Database of the Andalusian Population (LDAP). We aimed to investigate place effects on 8-year individual mortality risk. Moreover, besides calculating association (yielding odds ratios, ORs) between area socio-economic circumstances and individual risk, we wanted to estimate variance and clustering using the variance partition coefficient (VPC). We explicitly proclaim the relevance of considering general contextual effects (i.e. the degree to which the context, as a whole, affects individual variance in mortality risk) under at least two circumstances. The first of these concerns the interpretation of specific contextual effects (i.e. the association between a particular area characteristic and individual risk) obtained from multilevel regression analyses. The second involves the interpretation of geographical variance obtained from classic ecological spatial analyses. The so-called “ecological fallacy” apart, the lack of individual-level information renders geographical variance unrelated to the total individual variation and, therefore, difficult to interpret. Finally, we stress the importance of considering the familial household in multilevel analyses. We observed an association between percentage of people with a low educational level in the census tract and individual mortality risk (OR, highest v. lowest quintile = 1.14; 95% confidence interval, CI 1.08–1.20). However, only a minor proportion of the total individual variance in the probability of dying was at the municipality (M) and census tract (CT) levels (VPCM = 0.2% and VPCCT = 0.3%). Conversely, the household (H) level appeared much more relevant (VPCH = 18.6%) than the administrative geographical areas. Without considering general contextual effects, both multilevel analyses of specific contextual effects and ecological studies of small-area variation may provide a misleading picture that overstates the role of administrative areas as contextual determinants of individual differences in mortality.
Juan Merlo; Francisco Viciana; Diego Ramiro-Fariñas. Bringing the individual back to small-area variation studies: A multilevel analysis of all-cause mortality in Andalusia, Spain. Social Science & Medicine 2012, 75, 1477 -1487.
AMA StyleJuan Merlo, Francisco Viciana, Diego Ramiro-Fariñas. Bringing the individual back to small-area variation studies: A multilevel analysis of all-cause mortality in Andalusia, Spain. Social Science & Medicine. 2012; 75 (8):1477-1487.
Chicago/Turabian StyleJuan Merlo; Francisco Viciana; Diego Ramiro-Fariñas. 2012. "Bringing the individual back to small-area variation studies: A multilevel analysis of all-cause mortality in Andalusia, Spain." Social Science & Medicine 75, no. 8: 1477-1487.
The objective of this article is to study the changes that have occurred in the mortality pattern of women of fertile age in Spain throughout the 20th century, the significance of maternal mortality in the development of this pattern, and the other causes of death that have contributed most to such changes. Female mortality has most often been approached from the perspective of the genetic differences from males–particularly from the sexual-biological, basically reproductive, aspect–without considering other possible (social) differences. We have studied the female mortality pattern from the double incline of date of death (period) and of date of birth (cohort). Using the mortality theory of competing risks as our basis, we excluded in turn maternal mortality and mortality due to tuberculosis from overall mortality, and analyzed the transformations produced in the mortality pattern. Our results show that maternal mortality alone cannot be held responsible for the excess female mortality of the 1910s and 1920s, or for the mortality pattern among women of fertile age during the first half of this century. We suggest that the social discrimination against females from infancy has been responsible for most of the differences observed in mortality patterns.
Margarita Cortés-Majó; Carmen García-Gil; Francisco Viciana. The Role of the Social Condition of Women in the Decline of Maternal and Female Mortality. International Journal of Health Services 1990, 20, 315 -328.
AMA StyleMargarita Cortés-Majó, Carmen García-Gil, Francisco Viciana. The Role of the Social Condition of Women in the Decline of Maternal and Female Mortality. International Journal of Health Services. 1990; 20 (2):315-328.
Chicago/Turabian StyleMargarita Cortés-Majó; Carmen García-Gil; Francisco Viciana. 1990. "The Role of the Social Condition of Women in the Decline of Maternal and Female Mortality." International Journal of Health Services 20, no. 2: 315-328.