[Use of area-level socioeconomic indicators in epidemiological research: experience in Spain and advancement opportunities]

Abstract

Objective: To determine the use of area-level socioeconomic indicators in epidemiological studies in Spain.

Methods: We included studies analyzing the association of area-level socioeconomic indicators and health indicators in Spain published in peer-reviewed journals. An electronic search was conducted in PubMed-Medline, SCI-Expanded, SSCI, Embase, and the Spanish Medical Index (until December 31, 2012). A manual search was also conducted of the references of the selected studies. Each of the articles initially selected on the basis of the title and abstract was reviewed by two investigators. Information was obtained on the publication and methodology (design and study areas, information sources, health and socioeconomic indicators, and statistical analysis).

Results: We included 142 studies published since 1988 (58.4% since 2005). More than half (59.9%) were in English. The level of analysis was ecological in 73.2% and multilevel in 19.0%. The areas most frequently analyzed were census tracts (35 studies), especially within cities or autonomous regions, followed by the provinces (30 studies), mostly concerning Spain overall. The dependent variable most frequently analyzed was mortality and the socioeconomic dimension most commonly used was employment (71.1%).

Conclusions: In the last decade in Spain, there has been an increase in the number of studies examining the association of area-level socioeconomic and health indicators, as well as in the complexity of design and analysis.

Keywords: Areas; Desigualdades; Epidemiología/salud; España; Factores socioeconómicos; Health/epidemiology; Indicadores; Indicators; Inequalities; Socioeconomic factors; Spain; Áreas.