Diabetes mellitus mortality in Spanish cities: Trends and geographical inequalities

Prim Care Diabetes. 2017 Oct;11(5):453-460. doi: 10.1016/j.pcd.2017.05.006. Epub 2017 Jun 13.


Aim: To analyze the geographical pattern of diabetes mellitus (DM) mortality and its association with socioeconomic factors in 26 Spanish cities.

Methods: We conducted an ecological study of DM mortality trends with two cross-sectional cuts (1996-2001; 2002-2007) using census tract (CT) as the unit of analysis. Smoothed standardized mortality rates (sSMR) were calculated using Bayesian models, and a socioeconomic deprivation score was calculated for each CT.

Results: In total, 27,757 deaths by DM were recorded, with higher mortality rates observed in men and in the period 1996-2001. For men, a significant association between CT deprivation score and DM mortality was observed in 6 cities in the first study period and in 7 cities in the second period. The highest relative risk was observed in Pamplona (RR, 5.13; 95% credible interval (95%CI), 1.32-15.16). For women, a significant association between CT deprivation score and DM mortality was observed in 13 cities in the first period and 8 in the second. The strongest association was observed in San Sebastián (RR, 3.44; 95%CI, 1.25-7.36). DM mortality remained stable in the majority of cities, although a marked decrease was observed in some cities, including Madrid (RR, 0.67 and 0.64 for men and women, respectively).

Conclusions: Our findings demonstrate clear inequalities in DM mortality in Spain. These inequalities remained constant over time are were more marked in women. Detection of high-risk areas is crucial for the implementation of specific interventions.

Keywords: Diabetes mellitus; Geographical inequalities; Mortality; Urban areas.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Bayes Theorem
  • Cross-Sectional Studies
  • Diabetes Mellitus / diagnosis
  • Diabetes Mellitus / economics
  • Diabetes Mellitus / mortality*
  • Diabetes Mellitus / therapy
  • Female
  • Health Status Disparities*
  • Healthcare Disparities / economics*
  • Humans
  • Male
  • Mortality / trends
  • Risk Factors
  • Sex Factors
  • Socioeconomic Factors*
  • Spain / epidemiology
  • Time Factors
  • Urban Health / trends*