Status In Spain Research Articles

Socioeconomic mortality differences during the Great Influenza in Spain

Despite being one of the deadliest viruses in history, there is limited information on the socioeconomic factors that affected mortality rates during the Great Influenza Pandemic. In this study, we use occupation-province level data to investigate the relationship between influenza excess mortality rates and occupation-related status in Spain. We obtain three main results. Firstly, individuals in low-income occupations experienced the highest excess mortality, pointing to a notable income gradient. Secondly, professions that involved more social interaction were associated with a higher excess of mortality, regardless of income. Finally, we observe a substantial rural mortality penalty, even after controlling for income-related occupational groups. Based on this evidence, it seems that the high number of deaths was caused by not self-isolating. Some individuals did not quarantine themselves because they could not afford to miss work. In rural areas, home confinement was likely more limited because their inhabitants did not have immediate access to information about the pandemic or fully understand its impact due to their limited experience handling influenza outbreaks.

Bureaucratic Violence in the Residency Application Process: Findings from a Mixed Methods Cross-Sectional Survey of Migrant Women in Spain

Bureaucratic violence linked to immigration systems and residency applications, such as confusing and cumbersome administrative processes, discriminatory practices and a lack of accountability, act as significant post-migration stressors in destination countries that can impact migrant wellbeing. The behavior of public officials within these systems, referred to as ‘street-level bureaucrats’, can amplify stress through the use of discretion in interpreting legal requirements. The experiences of migrant women in attempting to obtain resident status in Spain have not been well documented. This article makes a novel contribution to the literature by aiming to understand the barriers faced by migrant women when applying for residency in Spain, and how experiences differ by socio-demographic subgroups. The study analysed mixed-methods data collected via an online survey of migrant women living in Valencia, Spain. A lack of information, communication barriers and difficulty meeting the stringent requirements of visa applications emerged as some of the main barriers to residency, with women from Africa, Asia or the Middle East being most likely to encounter barriers. Policy makers should seek to enhance transparency, standardize processes and improve communication for migrants interacting with the immigration system in order to reduce barriers and create more accessible pathways to residency in Spain.

Socioeconomic and gender inequalities in childhood obesity in Spain

IntroductionChildhood obesity is inversely associated with household socioeconomic status in high-income countries. Our aim was to explore the association between childhood weight status and household socioeconomic status in Spain in relation to family characteristics, perceptions and lifestyle habits and the school environment. MethodsWe performed a descriptive analysis of child weight status according to family socioeconomic factors and mediating variables based on data from the ALADINO 2019 study in a sample of 16,665 schoolchildren representative of the population aged 6–9 years in Spain. ResultsThe prevalence of childhood obesity in households with low socioeconomic status (26.8% boys; 20.4% girls) was, in both sexes, twice as high as in those with higher socioeconomic status (12.1% boys; 8.7% girls). Unhealthy eating habits, sedentary lifestyles (mainly in girls) and the presence of screens in the bedroom (more prevalent in boys) were more frequent in school-aged children from low-income households. On the other hand, in the most disadvantaged households, a history of breastfeeding and physical activity (especially in girls) were less frequent. Similarly, schools attended by children from low-income households were less likely to have their own kitchens and indoor gymnasiums or offer sports activities. ConclusionA lower household socioeconomic status was associated with poorer dietary and physical activity habits and certain characteristics of the family and school environments that mediate the inverse association between household socioeconomic status and the prevalence of childhood obesity. Girls were less physically active and reported more sedentary lifestyles, while boys had greater access to screens. Interventions to combat childhood obesity should address the identified inequalities.

Desigualdades socioeconómicas y de género en la obesidad infantil en España

IntroductionChildhood obesity is inversely associated with household socioeconomic status in high-income countries. Our aim was to explore the association between childhood weight status and household socioeconomic status in Spain in relation to family characteristics, perceptions and lifestyle habits and the school environment. MethodsWe performed a descriptive analysis of child weight status according to family socioeconomic factors and mediating variables based on data from the ALADINO 2019 study in a sample of 16 665 schoolchildren representative of the population aged 6–9 years in Spain. ResultsThe prevalence of childhood obesity in households with low socioeconomic status (26.8% boys; 20.4% girls) was, in both sexes, twice as high as in those with higher socioeconomic status (12.1% boys; 8.7% girls). Unhealthy eating habits, sedentary lifestyles (mainly in girls) and the presence of screens in the bedroom (more prevalent in boys) were more frequent in school-aged children from low-income households. On the other hand, in the most disadvantaged households, a history of breastfeeding and physical activity (especially in girls) were less frequent. Similarly, schools attended by children from low-income households were less likely to have their own kitchens and indoor gymnasiums or offer sports activities. ConclusionsA lower household socioeconomic status was associated with poorer dietary and physical activity habits and certain characteristics of the family and school environments that mediate the inverse association between household socioeconomic status and the prevalence of childhood obesity. Girls were less physically active and reported more sedentary lifestyles, while boys had greater access to screens. Interventions to combat childhood obesity should address the identified inequalities.

Constitutional and Administrative Aspects of Foreigners’ Status in Spain

Spain, like all of Europe, is struggling with a migration crisis in the 21st century. Although Spanish law regulates the legal and administrative situation of foreigners in quite detail, some of the norms no longer match the current geopolitical situation. The article mainly discusses the legal status of a foreigner through the prism of his fundamental rights contained in the Constitution and the Law on Foreigners, as well as problems related to the bureaucracy of the Spanish public administration system in the field of subjective rights of foreigners.

Social and ideological determinants of COVID-19 vaccination status in Spain

ObjectivesThis study analysed the association between social and ideological determinants with COVID-19 vaccine accessibility and hesitancy in the Spanish adult population. Study designThis was a repeated cross-sectional study. MethodsThe data analysed are based on monthly surveys conducted by the Centre for Sociological Research between May 2021 and February 2022. Individuals were classified according to their COVID-19 vaccination status into (1) vaccinated (reference group); (2) willing to vaccinate but not vaccinated, proxy of lack of vaccine accessibility; and (3) hesitant, proxy of vaccine hesitancy. Independent variables included social (educational attainment, gender) and ideological determinants (voting in the last elections, importance attached to the health vs the economic impact of the pandemic, and political self-placement). We estimated odds ratio (OR) and 95% confidence interval (CI) conducting one age-adjusted multinomial logistic regression model for each determinant and then stratified them by gender. ResultsBoth social and ideological determinants had a weak association with the lack of vaccine accessibility. Individuals with medium educational attainment had higher odds of vaccine hesitancy (OR = 1.44, CI 1.08–1.93) compared with those with high educational attainment. People self-identified as conservative (OR = 2.90; CI 2.02–4.15) and those who prioritised the economic impact (OR = 3.80; CI 2.62–5.49) and voted for parties opposed to the Government (OR = 2.00; CI 1.54–2.60) showed higher vaccine hesitancy. The stratified analysis showed a similar pattern for both men and women. ConclusionsConsidering the determinants of vaccine uptake and hesitancy could help to design strategies that increase immunisation at the population level and minimise health inequities.

Фактор Канарского архипелага в контекстах пацификации франкистской Испании и гегемонистской конкуренции (1940–1942)

This article is devoted to highlighting the international problems of the initial period of World War II that arose around the status of Gibraltar and the Canary Islands. Spain maintained military-political neutrality in the war. The countries participating in the armed conflict (USA, Great Britain, Nazi Germany) tried to use the territories belonging to Spain to their advantage. In 1941–1942 the British leadership developed several options for subordinating the Canary Islands to the UK. The article deals with operations Bugler, Chatney, Puma and Pilgrim. The author analyzes the features of these projects and the reasons that did not allow them to be implemented. The attention is focused on the different positions of the USA and Great Britain on the status of Spain and the Canaries. The contradictions between the allied powers allowed Spain to save the Canary archipelago. The article concludes that the British strategy was flawed because it diverted large forces needed on other fronts of the world confrontation.

ODs with a positive TPR conclusion, not subject to a conditional approval, and approved without requiring a PASS would be more likely to be reimbursed in Spain

BackgroundThe present study aims to assess clinical and regulatory variables that would influence pricing and reimbursement (P&R) decisions for Orphan Drugs (ODs) in Spain. ODs approved by the European Commission (EC) between 2006 and 2021 were classified according to their P&R status in Spain: approved, undergoing decision and rejected. A statistical analysis was carried out to assess the potential association between clinical and regulatory variables and P&R decision of ODs in Spain: therapeutic area, rarity of disease, existence of alternative therapies, availability of survival-related outcomes, safety profile, type of population, conditional approval status granted by the European Medicines Agency (EMA) and a positive Therapeutic Positioning Report (TPR) opinion.Results111 ODs have been approved by the EC and have obtained marketing authorisation in Spain between 2006 and 2021. Out of the 111 ODs, 57 (51.4%) were reimbursed, 24 (21.6%) were undergoing decision and 30 (27%) were rejected. According to the statistical analysis, ODs with a positive TPR conclusion (p-value < 0.01), not subject to a conditional approval by the EMA (p-value < 0.05) and approved without the obligation to conduct a post-authorisation safety study (PASS) (p-value < 0.05), were statistically significant, and therefore, would be more likely to obtain P&R approval in Spain.ConclusionsThis study shows that the TPR plays a key role in the P&R process in Spain and highlights that traditional evaluation tools, such us safety and efficacy, were the main drivers of P&R decisions for ODs. A positive conclusion of the TPR, non-conditional approval by the EMA and no obligation for a PASS seems to favourably affect P&R decisions in Spain.

Sex-related disparities in the incidence and outcomes of infective endocarditis according to type 2 diabetes mellitus status in Spain, 2016–2020

BackgroundWe performed a study to assess sex-differences in incidence (2016–2020), clinical characteristics, use of therapeutic procedures, and in-hospital outcomes in patients with infective endocarditis (IE) according to T2DM status.MethodsOurs was a retrospective cohort study using data from the Spanish National Hospital Discharge Database. We estimated the incidence of hospitalizations for IE in men and women aged ≥ 40 years with and without T2DM. Propensity score matching (PSM) and multivariable logistic regression were used to compare subgroups according to sex and the presence of T2DM.ResultsFrom 2016 to 2020, IE was coded in 9,958 patients (66.79% men). T2DM was diagnosed in 2,668 (26.79%). The incidence of IE increased significantly from 15.29 cases per 100,000 persons with T2DM in 2016 to 17.69 in 2020 (p < 0.001). However, this increment was significant only among men with T2DM (19.47 cases per 100,000 in 2016 vs. 22.84 in 2020; p = 0.003). The age-adjusted incidence of IE was significantly higher in people with T2DM (both sexes) than in those without T2DM (IRR, 2.86; 95% CI, 2.74–2.99). The incidence of IE was higher in men with T2DM than in women with T2DM (adjusted IRR, 1.85; 95% CI, 1.54–3.31). After PSM, in-hospital mortality (IHM) was higher among T2DM women than matched T2DM men (22.65% vs. 18.0%; p = 0.018).The presence of T2DM was not associated with IHM in men or women.ConclusionsT2DM is associated with a higher incidence of hospitalization for IE. Findings for T2DM patients who had experienced IE differed by sex, with higher incidence rates and lower IHM in men than in women. T2DM was not associated to IHM in IE in men or in women.

Association of socioeconomic deprivation with life expectancy and all-cause mortality in Spain, 2011–2013

Life tables summarise a population’s mortality experience during a time period. Sex- and age-specific life tables are needed to compute various cancer survival measures. However, mortality rates vary according to socioeconomic status. We present sex- and age-specific life tables based on socioeconomic status at the census tract level in Spain during 2011–2013 that will allow estimating cancer relative survival estimates and life expectancy measures by socioeconomic status. Population and mortality data were obtained from the Spanish Statistical Office. Socioeconomic level was measured using the Spanish Deprivation Index by census tract. We produced sex- and age-specific life expectancies at birth by quintiles of deprivation, and life tables by census tract and province. Life expectancy at birth was higher among women than among men. Women and men in the most deprived census tracts in Spain lived 3.2 and 3.8 years less than their counterparts in the least deprived areas. A higher life expectancy in the northern regions of Spain was discovered. Life expectancy was higher in provincial capitals than in rural areas. We found a significant life expectancy gap and geographical variation by sex and socioeconomic status in Spain. The gap was more pronounced among men than among women. Understanding the association between life expectancy and socioeconomic status could help in developing appropriate public health programs. Furthermore, the life tables we produced are needed to estimate cancer specific survival measures by socioeconomic status. Therefore, they are important for cancer control in Spain.

Growing taller unequally? Adult height and socioeconomic status in Spain (Cohorts 1940–1994)

Socioeconomic inequalities and their evolution in different historical contexts have been widely studied. However, some of their dimensions remain relatively unexplored, such as the role played by socioeconomic status in the trajectory of biological living standards, especially net nutritional status. The main objective of this article is to analyze whether the power of socioeconomic status (SES) to explain differences in the biological dimensions of human well-being (in this case, adult height, a reliable metric for health and nutritional status) has increased or diminished over time. Educational attainment and occupational category have been used as two different proxies for the SES of Spanish men and women born between 1940 and 1994, thus covering a historical period in Spain characterized by remarkable socioeconomic development and a marked increase in mean adult height. Our data is drawn from nine waves of the Spanish National Health Survey and the Spanish sample of two waves of the European Health Interview Survey (ENSE) for the period 1987 to 2017 (N = 73,699 citizens aged 23–47). A multivariate regression analysis has been conducted, showing that, as a whole, height differentials by educational attainment have diminished over time, whereas differences by occupational category of household heads have largely persisted. These results indicate the need for further qualification when describing the process of convergence in biological well-being indicators across social groups. For instance, the progressive enrollment of a greater proportion of the population into higher educational levels may lead us to underestimate the real differences between socioeconomic groups, while other proxies of SES still point to the persistence of such differences.

Lung, Breast and Colorectal Cancer Incidence by Socioeconomic Status in Spain: A Population-Based Multilevel Study.

Simple SummaryDespite political efforts across the world and Europe, social inequalities in cancer incidence are persistent. We studied the association between socioeconomic status (SES) and cancer incidence in nine Spanish provinces. Lower SES was associated with an increased risk of lung cancer among males. Higher SES was associated with an increased risk of breast cancer among females in Spain. Understanding the reasons behind the association between cancer incidence and SES could help develop appropriate public health programs to promote health and reduce socioeconomic inequalities in cancer incidence in Spain.Socioeconomic inequalities in cancer incidence are not well documented in southern Europe. We aim to study the association between socioeconomic status (SES) and colorectal, lung, and breast cancer incidence in Spain. We conducted a multilevel study using data from Spanish population-based cancer registries, including incident cases diagnosed for the period 2010–2013 in nine Spanish provinces. We used Poisson mixed-effects models, including the census tract as a random intercept, to derive cancer incidence rate ratios by SES, adjusted for age and calendar year. Male adults with the lowest SES, compared to those with the highest SES, showed weak evidence of being at increased risk of lung cancer (risk ratio (RR): 1.18, 95% CI: 0.94–1.46) but showed moderate evidence of being at reduced risk of colorectal cancer (RR: 0.84, 95% CI: 0.74–0.97). Female adults with the lowest SES, compared to those with the highest SES, showed strong evidence of lower breast cancer incidence with 24% decreased risk (RR: 0.76, 95% CI: 0.68–0.85). Among females, we did not find evidence of an association between SES and lung or colorectal cancer. The associations found between SES and cancer incidence in Spain are consistent with those obtained in other European countries.

No effect of the Penalty Point System on road traffic accident mortality among men with a high socioeconomic status in Spain

The purpose of this study was to assess the effect of the Penalty Point System (PPS) on road traffic accident mortality by gender and socioeconomic status. We conducted a nationwide prospective study covering adult people living in Spain on November 2001. They were followed up until 30 Nov 2007 to determine vital status and cause of death. An interrupted time-series analysis was used to assess whether PPS (explanatory variable) had both immediate and long-term effect on the rates of road traffic accident mortality (RTAMs) separately by gender. Subjects were classified by socioeconomic status (low and high) using two indicators: educational attainment (up to lower secondary education; upper secondary education or more) and occupation (manual and non-manual workers). We performed several segmented Poisson regression models, controlling for trend, seasonality, 2004 road safety measures and fuel consumption as proxy for traffic exposure. Among men, we found a decrease on the RTAMs immediately after PPS in those with low educational level (16.2 %, IC95 %: 6.1 %–25.2 %) and manual workers (16.3 %, IC95 %: 2.8 %–27.8 %), and a non-significant increase among those with high education level and non-manual workers (6.2 % and 1.8 %). Among women, there were no significant differences in the immediate effect of PPS by socioeconomic status. We did not identify significant trend changes between pre-PPS and post-PPS periods in any socioeconomic group. In a context of downward trend of traffic mortality, the PPS implementation led to an immediate reduction on death rates only among men with a low socioeconomic status.

Демократизация католической церкви в Испании в 1976–1978 годах

The article considers the changes in the position of the Catholic Church in Spanish society caused by the democratic transition. The beginning of the reign of Juan Carlos I was marked by the rethinking of the dialogue between the state and the Catholic Church. The king introduced the initiative to revise the provisions of the Concordat, thereby limiting the power position of the Spanish Catholic diocese. This decision looks like an intention to divide the history of Spain into Franco and democratic periods in the political and public consciousness. But the full-fledged democratization of society would have been impossible without the modernization of the church institution. The Constitution of 1978, being the main law of the country, reflects the state&amp;#x27;s attitude to religious issues, emphasizing the secular status of Spain and the pluralism of religion of the Spaniards. Despite the restrictions imposed on the Catholic Church, caused by the transition to democracy, the position of the religious institution remains high due to the pressure of the historical memory of Spain, in which Catholicism is a nation forming factor. As a result, the democratization of the Catholic Church was successful, and the church institution took a harmonious position in the conditions of democratic Spain.

Is Spain becoming a militant democracy? Empirical evidence from Freedom House Reports

Militant democracy can be seen as a useful theoretical category. Its main objective is to preserve the regime by eliminating its opponents through the legal means. They may affect fundamental civil rights and freedoms including freedom of the press. There are two objectives of the article. The first is to determine the differences between the declaratory level, based on national legislation and legal acts adopted between 2008-2017, and actual level of freedom of the press in Spain, based on press freedom status presented in reports of Freedom House. This comparison will provide an answer to the question if Spain is becoming a militant democracy or not. The second objective is to explain the reasons for these differences as well as to formulate conclusions related to the adoption of the attributes of militant democracies by Spain with special reference to freedom of the press. The main hypothesis reads as follows: legislative changes referring to the functioning of the media in the form of national legislation affected the indicator value of the press freedom status in Spain presented by Freedom House. This dynamic proves that elements of militant democracy are being implemented into the Spanish political system.

Horizon scanning to identify invasion risk of ornamental plants marketed in Spain

Horticulture is one of the main pathways of deliberate introduction of non-native plants, some of which might become invasive. Of the 914 commercial ornamental outdoor plant species sold in Spain, 700 (77%) are non-native (archaeophytes excluded) marketed species. We classified these into six different lists based on their invasion status in Spain and elsewhere, their climatic suitability in Spain and their potential environmental and socioeconomic impacts. We found sufficient information for 270 species. We provide a Priority List of eight regulated invasive species that were still available on the market. We also established an Attention List with 68 non-regulated invasive and potentially invasive species that might cause various impacts. To prioritise the species within the Attention List, we further assessed the risk of invasion of these species by using an adaptation of the Australian WRA protocol and the level of societal interest estimated from values of the Google Trends tool. We also propose a Green List of seven species with probably no potential to become invasive, a Watch List with 27 potentially invasive species with few potential impacts and an Uncertainty List with 161 species of known status but with insufficient information to include them in any of the previous lists. We did not find sufficient information for 430 (61%) of the marketed non-native plant species, which were compiled into a Data Deficient List. Our findings of prohibited species for sale highlight the need for stronger enforcement of the regulations on invasive plant species in Spain. In addition, our results highlight the need for additional information on potential impacts and climate suitability of horticultural plants being sold in Spain, as insufficient information could be found to assess the invasion risk for most species.

The Role of Knowledge in Constructing the Quality of Olive Oil in Spain

The sustainability of a large proportion of Spanish olive oil-producing territories depends to a great extent on their capacity to fit into a specific model of food quality. The strategies used in the different territories differ with respect to their adherence to the objectifiable conception of quality, based on scientific-technical knowledge, or subjectivating conception of quality, based on tacit and practical knowledge. In this paper, we analyse the route taken by two territories with olive oil protected designation of origin (PDO) status in Spain to construct their quality model, the type of knowledge that has been applied and how knowledge processes affect the construction of sustainable quality models. This study applies a qualitative methodology based on participative observation and semi-structured interviews with key actors of the territories. The results indicate that processes of production, reproduction and dissemination of knowledge are basic pillars for the construction of sustainable quality projects. The degree of understanding of the objectifiable and subjectivating conception of quality in olive-producing territories and the interaction between them depend on the specific characteristics of the territory, the objectives set in connection to the olive oil quality method, the importance given to the different types of knowledge, and its standing on the issue of territorial sustainability.

Secular trends in stillbirth by maternal socioeconomic status in Spain 2007-15: a population-based study of 4 million births.

IntroductionStillbirth, one of the urgent concerns of preventable perinatal deaths, has wide-reaching consequences for society. We studied secular stillbirth trends by maternal socioeconomic status (SES) in Spain.MethodsWe developed a population-based observational study, including 4 083 919 births during 2007–15. We estimate stillbirth rates and secular trends by maternal SES. We also evaluated the joint effect of maternal educational attainment and the Human Development Index (HDI) of women’s country of origin on the risk of stillbirth. The data and statistical analysis can be accessed for reproducibility in a GitHub repository: https://github.com/migariane/StillbirthResultsWe found a consistent pattern of socioeconomic inequalities in the risk of delivering a stillborn, mainly characterized by a persistently higher risk, over time, among women with lower SES. Overall, women from countries with low HDIs and low educational attainments had approximately a four times higher risk of stillbirth (RR: 4.44; 95%CI: 3.71–5.32). Furthermore, we found a paradoxical reduction of the stillbirth gap over time between the highest and the lowest SESs, which is mostly due to the significant and increasing trend of stillbirth risk among highly educated women of advanced maternal age.ConclusionOur findings highlight no improvement in stillbirth rates among women of lower SES and an increasing trend among highly educated women of advanced maternal age over recent years. Public health policies developing preventive programmes to reduce stillbirth rates among women with lower SES are needed as well as the necessity of further study to understand the growing trend of age-related stillbirths among highly educated women in Spain.

Prevalencia de personas mayores confinadas en su hogar en España

ObjectiveThe number of older people with functional or other problems that prevent them from going out of doors is unknown. The objective of this study was to estimate the prevalence of homebound status in Spain and to determine their main characteristics. Material and methodsThe Classification of Functioning, Disability and Health was used. Homebound status was defined according to the declared difficulty with regard to mobility outside the home: completely homebound (not able to leave home), semi-homebound (have serious difficulties but can leave with help), and the individuals without problems that were not homebound. Capacity and performance qualifiers were used to assess the final impact of technical or personal help. Prevalences were calculated, and sociodemographic and health characteristics were compared for the different groups. ResultsOut of a total of 2,146,362 older people with disabilities, 8.1% (95% CI: 8.1-8.2) and 16.0% (95% CI: 15.9-16.0) were (complete) homebound, and semi-homebound, respectively. The homebound elderly were mostly women, had a higher mean age and low education level. They also declared they had more difficulty for the environmental barriers, had worse perceived health, a greater number of disabilities, chronic health conditions, and more functional problems. ConclusionsThe prevalence of older disabled people with a homebound status was 24.1%. The social, health, and functional characteristics suggest situations of vulnerability. The information on homebound individuals could contribute to enhance social and health plans, and to raise the visibility of this problem.

Is iodine nutrition in the Spanish pediatric population adequate? Historical review and current situation

Iodine is an essential component of thyroid hormones, and iodine deficit is the leading cause of preventable mental retardation worldwide. Spain was considered iodine-deficient until 2003. Although iodine urinary levels have been in the optimal range in Spain since 2004, the WHO recognizes that our country does not meet the necessary requirements to ensure that the whole population is not at risk of an iodine deficiency disorder. The aim of this article is to review the current iodine status in Spain. Data from several studies emphasize the low consumption of iodized salt at home. Despite the progress made in recent decades, Spanish children are not exempt from suffering an iodine deficiency disorder. Policies that allow for controlling iodine nutrition and promote universal consumption of iodized salt should therefore be implemented.