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Although mortality from ischemic heart disease has declined over the past decades in Argentina, ischemic heart disease remains one of the most frequent causes of death. This study aimed to describe the role of individual and contextual factors on premature ischemic heart disease mortality and to analyze how educational differentials in premature ischemic heart disease mortality changed during economic fluctuations in two provinces of Argentina from 1990 to 2018. To test the relationship between individual (age, sex, and educational level) and contextual (urbanization, poverty, and macroeconomic variations) factors, a multilevel Poisson model was estimated. When controlling for the level of poverty at the departmental level, we observed inequalities in premature ischemic heart disease mortality according to the educational level of individuals, affecting population of low educational level. Moreover, economic expansion was related to an increase in ischemic heart disease mortality, however, expansion years were not associated with increasing educational inequalities in ischemic heart disease mortality. At the departmental level, we found no contextual association beween area-related socioeconomic level and the risk of ischemic heart disease mortality. Despite the continuing decline in ischemic heart disease mortality in Argentina, this study highlighted that social inequalities in mortality risk increased over time. Therefore, prevention policies should be more focused on populations of lower socioeconomic status in Argentina.

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Abstract: Although mortality from ischemic heart disease has declined over the past decades in Argentina, ischemic heart disease remains one of the most frequent causes of death. This study aimed to describe the role of individual and contextual factors on premature ischemic heart disease mortality and to analyze how educational differentials in premature ischemic heart disease mortality changed during economic fluctuations in two provinces of Argentina from 1990 to 2018. To test the relationship between individual (age, sex, and educational level) and contextual (urbanization, poverty, and macroeconomic variations) factors, a multilevel Poisson model was estimated. When controlling for the level of poverty at the departmental level, we observed inequalities in premature ischemic heart disease mortality according to the educational level of individuals, affecting population of low educational level. Moreover, economic expansion was related to an increase in ischemic heart disease mortality, however, expansion years were not associated with increasing educational inequalities in ischemic heart disease mortality. At the departmental level, we found no contextual association beween area-related socioeconomic level and the risk of ischemic heart disease mortality. Despite the continuing decline in ischemic heart disease mortality in Argentina, this study highlighted that social inequalities in mortality risk increased over time. Therefore, prevention policies should be more focused on populations of lower socioeconomic status in Argentina.

Resumen: Si bien la mortalidad por cardiopatía isquémica ha disminuido en las últimas décadas en Argentina, la cardiopatía isquémica sigue siendo una de las causas más frecuentes de muerte. Los objetivos de este estudio fueron describir el papel de los factores individuales y contextuales en la mortalidad prematura por cardiopatía isquémica y analizar cómo estos cambiaron las diferencias educativas en la mortalidad prematura por cardiopatía isquémica durante las variaciones económicas en dos provincias de Argentina durante el periodo 1990-2018. Para probar la relación entre los factores individuales (edad, género y nivel de educación) y contextuales (urbanización, pobreza y variaciones macroeconómicas), se estimó un modelo de Poisson multinivel. Controlando el nivel de pobreza en el ámbito departamental, se observaron desigualdades en la mortalidad prematura por cardiopatía isquémica según el nivel de educación de los individuos, lo que afecta a la población con bajo nivel de educación; la expansión económica se relacionó con el aumento de la mortalidad por cardiopatía isquémica; sin embargo, el periodo de expansión no estuvo asociado a aumentos de las desigualdades educativas en la mortalidad por cardiopatía isquémica. En el ámbito departamental no se detectó asociación entre el nivel socioeconómico de la área y el riesgo de mortalidad por cardiopatía isquémica. A pesar de la disminución continua de la mortalidad por cardiopatía isquémica en Argentina, este estudio destaca que las desigualdades sociales con relación al riesgo de mortalidad tuvieron un aumento con el tiempo. Por lo tanto, las políticas de prevención deberán dirigirse más a las poblaciones de menor nivel socioeconómico en Argentina.

Resumo: Embora a mortalidade por doença isquêmica do coração tenha diminuído nas últimas décadas na Argentina, a doença isquêmica do coração continua sendo uma das causas mais frequentes de morte. Os objetivos deste estudo foram descrever o papel de fatores individuais e contextuais na mortalidade prematura por doença isquêmica do coração e analisar como as diferenças educacionais na mortalidade prematura por doença isquêmica do coração mudaram durante as flutuações econômicas em duas províncias da Argentina durante o período 1990-2018. Para testar a relação entre fatores individuais (idade, sexo e escolaridade) e contextuais (urbanização, pobreza e variações macroeconômicas), estimou-se um modelo de Poisson multinível. Controlando o nível de pobreza no nível departamental, observaram-se desigualdades na mortalidade prematura por doença isquêmica do coração de acordo com o nível educacional dos indivíduos, afetando a população de baixa escolaridade; a expansão econômica esteve relacionada ao aumento da mortalidade por doença isquêmica do coração; no entanto, os anos de expansão não foram associados a aumentos nas desigualdades educacionais na mortalidade por doença isquêmica do coração. No nível departamental, não foi detectada uma associação contextual entre nível socioeconômico da área e risco de mortalidade por doença isquêmica do coração. Apesar do contínuo declínio da mortalidade por doença isquêmica do coração na Argentina, este estudo destaca que as desigualdades sociais em relação ao risco de mortalidade aumentaram ao longo do tempo. Portanto, as políticas de prevenção devem ser mais focadas nas populações de menor nível socioeconômico na Argentina.

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Objective: To analyze the relationship between economic conditions and mortality in cities of Latin America. Methods: We analyzed data from 340 urban areas in ten countries: Argentina, Brazil, Chile, Colombia, Costa Rica, Guatemala, Mexico, Panama, Peru, and El Salvador. We used panel models adjusted for space-invariant and time-invariant factors to examine whether changes in area gross domestic product (GDP) per capita were associated with changes in mortality. Results: We find procyclical oscillations in mortality (i.e., higher mortality with higher GDP per capita) for total mortality, female population, populations of 0-9 and 45+ years, mortality due to cardiovascular diseases, malignant neoplasms, diabetes mellitus, respiratory infections and road traffic injuries. Homicides appear countercyclical, with higher levels at lower GDP per capita. Conclusions: Our results reveal large heterogeneity, but in our sample of cities, for specific population groups and causes of death, mortality oscillates procyclically, increasing when GDP per capita increases. In contrast we find few instances of countercyclical mortality.

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PURPOSE: Little is known about how economic fluctuations affect educational inequalities in mortality in low- or middle-income countries. The objective of this study is to analyze the temporal variations in educational differentials in suicide in four Argentinian provinces. METHODS: Data on suicides for ages 25 years and over and three age groups (25-44, 45-64, and 65 +) in four Argentinian provinces during the period 1999-2013 were linked to population data and information on the educational level of the deceased. Regression models were estimated using age, sex, year, province of residence, educational level, and economic character of the year (expansion or recession) as explanatory variables. RESULTS: The educational gap in suicide mortality widened since the expansion following the crisis of 1999-2002, and then only decreased in 2005 and 2011. For ages 45-64, the confidence intervals of the suicide rate overlapped each year, and the suicide rate of the middle-high education population exceeded the suicide rate of the low-education population in 2 recession years, 1999 and 2002. Considering the years of economic expansion or recession as a dichotomous variable, at ages 45-64 differences in suicide rates by educational level disappeared during years of recession, while they were present in years of expansion. CONCLUSION: Suicides rise during economic downturns but these periods could reduce the educational gaps of suicide mortality by increasing the vulnerability of adults of high educational level to changes in the economy.

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In recent publications it has been suggested that the health of the European population is deteriorating as a consequence of the economic crisis. Such deterioration would be manifested by an increase in mortality, particularly in those countries applying austerity measures. It has also been suggested that as a consequence of these policies, suicides have skyrocketed and the situation could become a public health catastrophe of the kind that occurred in the 1990s in the countries formerly part of the USSR. These affirmations have no basis in the existing data. Statistics indicate that in European countries in general and especially in those most affected by the crisis, general mortality has decreased and the health of the population has improved in 2007-2010. Paradoxically, the crisis has had a beneficial effect on health in these countries. Such findings are in substantial agreement with previous studies that have shown throughout various periods within market economies that recessions are favorable to health while periods of economic expansion are harmful.

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En publicaciones recientes se ha sugerido que por efecto de la crisis económica la salud de la población se está deteriorando en Europa, lo que se manifestaría en aumentos de la mortalidad, particularmente en los países donde se están aplicando políticas de austeridad. Se ha sugerido también que, como consecuencia de esas políticas, los suicidios se han disparado y que la situación podría derivar en una catástrofe sanitaria como la que ocurrió en los antiguos países de la URSS durante los años noventa. Esas afirmaciones no tienen base en los datos disponibles. Las estadísticas indican que, en los países europeos en general y sobre todo en los más afectados por la crisis, las tasas de mortalidad general han disminuido y la salud de la población ha mejorado durante los años 2007-2010. Paradójicamente, la crisis ha tenido un efecto beneficioso para la salud en estos países. Esto supone una confirmación sustancial de investigaciones previas que han mostrado en diversos períodos y economías de mercado que las recesiones son favorables para la salud, mientras que los períodos de expansión económica son perjudiciales.

In recent publications it has been suggested that the health of the European population is deteriorating as a consequence of the economic crisis. Such deterioration would be manifested by an increase in mortality, particularly in those countries applying austerity measures. It has also been suggested that as a consequence of these policies, suicides have skyrocketed and the situation could become a public health catastrophe of the kind that occurred in the 1990s in the countries formerly part of the USSR. These affirmations have no basis in the existing data. Statistics indicate that in European countries in general and especially in those most affected by the crisis, general mortality has decreased and the health of the population has improved in 2007-2010. Paradoxically, the crisis has had a beneficial effect on health in these countries. Such findings are in substantial agreement with previous studies that have shown throughout various periods within market economies that recessions are favorable to health while periods of economic expansion are harmful.

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En publicaciones recientes se ha sugerido que por efecto de la crisis económica la salud de la población se está deteriorando en Europa, lo que se manifestaría en aumentos de la mortalidad, particularmente en los países donde se están aplicando políticas de austeridad. Se ha sugerido también que, como consecuencia de esas políticas, los suicidios se han disparado y que la situación podría derivar en una catástrofe sanitaria como la que ocurrió en los antiguos países de la URSS durante los años noventa. Esas afirmaciones no tienen base en los datos disponibles. Las estadísticas indican que, en los países europeos en general y sobre todo en los más afectados por la crisis, las tasas de mortalidad general han disminuido y la salud de la población ha mejorado durante los años 2007-2010. Paradójicamente, la crisis ha tenido un efecto beneficioso para la salud en estos países. Esto supone una confirmación sustancial de investigaciones previas que han mostrado en diversos períodos y economías de mercado que las recesiones son favorables para la salud, mientras que los períodos de expansión económica son perjudiciales.(AU)

In recent publications it has been suggested that the health of the European population is deteriorating as a consequence of the economic crisis. Such deterioration would be manifested by an increase in mortality, particularly in those countries applying austerity measures. It has also been suggested that as a consequence of these policies, suicides have skyrocketed and the situation could become a public health catastrophe of the kind that occurred in the 1990s in the countries formerly part of the USSR. These affirmations have no basis in the existing data. Statistics indicate that in European countries in general and especially in those most affected by the crisis, general mortality has decreased and the health of the population has improved in 2007-2010. Paradoxically, the crisis has had a beneficial effect on health in these countries. Such findings are in substantial agreement with previous studies that have shown throughout various periods within market economies that recessions are favorable to health while periods of economic expansion are harmful.(AU)

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In recent publications it has been suggested that the health of the European population is deteriorating as a consequence of the economic crisis. Such deterioration would be manifested by an increase in mortality, particularly in those countries applying austerity measures. It has also been suggested that as a consequence of these policies, suicides have skyrocketed and the situation could become a public health catastrophe of the kind that occurred in the 1990s in the countries formerly part of the USSR. These affirmations have no basis in the existing data. Statistics indicate that in European countries in general and especially in those most affected by the crisis, general mortality has decreased and the health of the population has improved in 2007-2010. Paradoxically, the crisis has had a beneficial effect on health in these countries. Such findings are in substantial agreement with previous studies that have shown throughout various periods within market economies that recessions are favorable to health while periods of economic expansion are harmful.

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En este artículo se discute la relación entre la inequidad en salud y el crecimiento económico. Se revisa el significado general de estos y otros conceptos relacionados (desarrollo económico, desigualdades en salud), se presentan algunos estudios que ilustran las diferentes hipótesis sobre la evolución histórica de la inequidad en salud y se analizan tres casos -EE. UU. en 1920-1940 y en años recientes, y Finlandia durante la expansión de los años 80 y la recesión de los 90- para mostrar la evolución de las inequidades en salud durante los periodos de expansión y recesión en economías de mercado sometidas al denominado ciclo económico. Las inequidades en salud entre grupos étnicos y entre clases sociales son frecuentes en sociedades modernas y algunas de estas inequidades parecen estar aumentando. Al parecer, los períodos de expansión económica no son favorables para la disminución de las inequidades en salud. Por el contrario, y en contra de lo que podría intuirse, los datos sugieren que es durante los períodos de recesión cuando tienden a reducir las inequidades en salud entre grupos privilegiados y desfavorecidos.

This essay reviews the relation between health inequities and economic growth. The general meaning of these and ancillary concepts (economic development, health inequalities) is briefly reviewed. Some studies illustrating different hypotheses on the long-run historical evolution of health inequalities are presented, and three case studies -the United States in 1920-1940 and in recent years, Finland during the expansion of the 1980s and the recession of the 1990s- are reviewed to demonstrate the evolution of health inequalities during the periods of expansion and recession in markets economies that conform to the so-called business cycle. Health inequities between ethnic groups and social classes are often found in modern societies, and some of these disparities seem to be widening. Periods of economic expansion do not seem favorable for the lessening of health inequalities. Contrarily, and counter-intuitively, evidence rather suggests that it is during periods of recession that gaps in health between privileged and disadvantaged groups tend to narrow.

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This essay reviews the relation between health inequities and economic growth. The general meaning of these and ancillary concepts (economic development, health inequalities) is briefly reviewed. Some studies illustrating different hypotheses on the long-run historical evolution of health inequalities are presented, and three case studies -the United States in 1920-1940 and in recent years, Finland during the expansion of the 1980s and the recession of the 1990s- are reviewed to demonstrate the evolution of health inequalities during the periods of expansion and recession in markets economies that conform to the so-called business cycle. Health inequities between ethnic groups and social classes are often found in modern societies, and some of these disparities seem to be widening. Periods of economic expansion do not seem favorable for the lessening of health inequalities. Contrarily, and counter-intuitively, evidence rather suggests that it is during periods of recession that gaps in health between privileged and disadvantaged groups tend to narrow.

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Cuba's economic crisis of 1989-2000 resulted in reduced energy intake, increased physical activity, and sustained population-wide weight loss. The authors evaluated the possible association of these factors with mortality trends. Data on per capita daily energy intake, physical activity, weight loss, and smoking were systematically retrieved from national and local surveys. National vital statistics from 1980-2005 were used to assess trends in mortality from diabetes, coronary heart disease, stroke, cancer, and all causes. The crisis reduced per capita daily energy intake from 2,899 calories to 1,863 calories. During the crisis period, the proportion of physically active adults increased from 30% to 67%, and a 1.5-unit shift in the body mass index distribution was observed, along with a change in the distribution of body mass index categories. The prevalence of obesity declined from 14% to 7%, the prevalence of overweight increased 1%, and the prevalence of normal weight increased 4%. During 1997-2002, there were declines in deaths attributed to diabetes (51%), coronary heart disease (35%), stroke (20%), and all causes (18%). An outbreak of neuropathy and a modest increase in the all-cause death rate among the elderly were also observed. These results suggest that population-wide measures designed to reduce energy stores, without affecting nutritional sufficiency, may lead to declines in diabetes and cardiovascular disease prevalence and mortality.

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Se presentan y cuestionan los conceptos sobre sostenibilidad y progreso social de un artículo de Goñi y Goin publicado en Salud Colectiva, se dan alternativas a la visión de dichos autores, se analiza brevemente la relación entre crecimiento económico y progreso en condiciones de salud (medidas según la mortalidad de menores de cinco años) en la Argentina en los años 1960-2003, y se discuten informaciones recientes referentes a las previsiones científicas de efectos del cambio climático y ciertos conflictos políticos suscitados por esas previsiones...(AU)

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Se presentan y cuestionan los conceptos sobre sostenibilidad y progreso social de un artículo de Goñi y Goin publicado en Salud Colectiva, se dan alternativas a la visión de dichos autores, se analiza brevemente la relación entre crecimiento económico y progreso en condiciones de salud (medidas según la mortalidad de menores de cinco años) en la Argentina en los años 1960-2003, y se discuten informaciones recientes referentes a las previsiones científicas de efectos del cambio climático y ciertos conflictos políticos suscitados por esas previsiones...(AU)

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Se presentan y cuestionan los conceptos sobre sostenibilidad y progreso social de un artículo de Goñi y Goin publicado en Salud Colectiva, se dan alternativas a la visión de dichos autores, se analiza brevemente la relación entre crecimiento económico y progreso en condiciones de salud (medidas según la mortalidad de menores de cinco años) en la Argentina en los años 1960-2003, y se discuten informaciones recientes referentes a las previsiones científicas de efectos del cambio climático y ciertos conflictos políticos suscitados por esas previsiones...

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Se presenta el desarrollo histórico, desde el Renacimiento hasta el siglo XX, de las ideas generales sobre la influencia de la economía en la mortalidad. Muchas de esas ideas corresponden a las controversias maltusianas, especulativas hasta comienzos del siglo XX, cuando las estadísticas que mostraban la reducción de la mortalidad en muchos países dieron paso a la discusión de diversas teorías sobre la llamada transición demográfica. Se revisan sucesivamente las contribuciones de los fundadores de la medicina laboral o profesional, la aritmética política de Petty, las ideas sobrecrecimiento de la población y mortalidad de Malthus, las contribuciones demográficas y epidemiológicas de Engels y Marx, el movimiento de la medicina social y de los fundadores de la salud pública a finales del siglo XIX y las ideas modernas sobre la transición demográfica que tuvieron como foco las controversias sobre la tesis de McKeown. Se excluyen específicamentelas controversias del siglo XX sobre el efecto a corto plazo de las fluctuaciones económicas en las tasas de mortalidad...(AU)

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