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Anthropogenic greenhouse gas emissions have increased summer temperatures in Spain by nearly one degree Celsius on average between 1980 and 2015. However, little is known about the extent to which the association between heat and human mortality has been modified. We here investigate whether the observed warming has been associated with an upward trend in excess mortality attributable to heat or, on the contrary, a decrease in the vulnerability to heat has contributed to a reduction of the mortality burden. We analysed a dataset from 47 major cities in Spain for the summer months between 1980 and 2015, which included daily temperatures and 554,491 deaths from circulatory and respiratory causes, by sex. We applied standard quasi-Poisson regression models, controlling for seasonality and long-term trends, and estimated the temporal variation in heat-related mortality with time-varying distributed lag nonlinear models (DLNMs). Results pointed to a reduction in the relative risks of cause-specific and cause-sex mortality across the whole range of summer temperatures. These reductions in turn explained the observed downward trends in heat-attributable deaths, with the only exceptions of respiratory diseases for women and both sexes together. The heat-attributable deaths were consistently higher in women than in men for both circulatory and respiratory causes. The main limitation of our study is that we were not able to account for air pollution in the models because of data unavailability. Despite the summer warming observed in Spain between 1980 and 2015, the decline in the vulnerability of the population has contributed to a general downward trend in overall heat-attributable mortality. This reduction occurred in parallel with a decline in the vulnerability difference between men and women for circulatory and cardiorespiratory mortality. Despite these advances, the risk of death remained high for respiratory diseases, and particularly in women.

A growing number of epidemiological studies have recently assessed temporal variations in vulnerability and/or mortality attributable to hot and cold temperatures. However, the eventual changes in the seasonal distribution of temperature-attributable mortality remain unexplored. Here, we analyse countrywide daily time-series of temperature and mortality counts from respiratory diseases by sex, age group and province of residence during the period 1980–2016 in Spain. We show the complete reversal of the seasonality of temperature-attributable mortality, with a significant shift of the maximum monthly incidence from winter to summer, and the minimum monthly incidence from early and late summer to winter. The reversal in the seasonal distribution of the attributable deaths is not driven by the observed warming in both winter and summer temperatures, but rather by the very large decrease in the risk of death due to cold temperatures and the relatively much smaller reduction due to hot temperatures. We conclude that the projected decrease in the number of moderate and extreme cold days due to climate warming will not contribute to a further reduction of cold-attributable respiratory deaths. Potential changes in the seasonality of temperature-attributable mortality due to climate warming have been poorly investigated. Here, the authors show that the projected decrease in the number of moderate and extreme cold days will not contribute to a further reduction of cold-attributable deaths.

We study the health trajectories of the population aged over 60, comparing between one European and two Latin American countries (Spain, Chile and Costa Rica) which have similar longevity patterns. Our focus is on functional limitation and mortality risks, considering differences by gender, education and social participation. Data come from national panel surveys (EPS, CRELES, SHARE). Multistate modelling is used to estimate transition probabilities between two health states: healthy to unhealthy, unhealthy to healthy as well as the transition to death from healthy or unhealthy states, to estimate the duration of stay in a specific state (computing healthy and unhealthy life expectancies) and the effect of the selected covariates. Results show that older Costa Ricans have the smallest gender gap in life expectancy but women have a lower healthy life expectancy compared to those in Chile and Spain. Participation in social activities leads to higher healthy life expectancy among the elderly in Costa Rica and Spain, whilst there were no relevant educational differences observed in longevity in the analysed countries. To conclude: despite the different patterns observed in health transitions and survival across the three countries, social participation is associated with greater health and longevity among people of old age, with little effect coming from educational attainment. Public policies should therefore be aimed at reducing unhealthy life years and dependency at advanced ages by promoting more engagement in social activities, especially among vulnerable groups who are more likely to experience impairment from a younger age.

[This corrects the article DOI: 10.1371/journal.pmed.1002617.].

The objective of this article is to investigate the variation of fertility across Spain’s geographic areas between 1981 and 2018, to highlight spatial change over three decades of major fertility transformations. During the last decades, Spanish fertility decreased considerably to below replacement levels. Although total fertility remains below replacement level in Spain, there are important differences in subnational trends that seem to concentrate around certain areas. Starting from the assumption that there is fertility diversity across the country, which persists over time and such variation is not random but rather spatially driven, we aim to describe the divergence from national trends and analyse the dynamics of spatial patterns of fertility over time with spatial analysis tools. Using from Spanish municipality data, we use 910 territorial units that ensure spatial contiguity and construct yearly fertility indicators derived from census and register data, encompassing fertility by age, birth order, and age at childbirth. We investigate the spatial patterns of fertility and their changes over time, by means of spatial and correlogram analysis, exploring the effects of neighborhood definitions. Results confirm the presence of spatial autocorrelation for all variables throughout the considered timeframe, both at global and local scale. The considered time frame depicts substantial changes in the distribution of low and high fertility clusters, reshaping the geographical distribution of fertility in Spain, with big metropolitan areas as leaders in high fertility, as childbearing is deeply impacted by labor market covariates. The fertility decline in Spain has driven total fertility to below replacement levels in a short period of time, shifting the classical North-South divide of low-high fertility into an East-West clustering, with economic centres such as cities becoming the new focal points of higher fertility. The descriptive and econometric spatial approaches adopted in this article, together with the detailed data available for this study, make it possible to appreciate the scale of fertility changes across the country, its heterogeneity across regions, and the evolution of fertility determinants over time.  

Changes in population and family structures are altering the provision of care for dependent older people. In Southern European countries like Spain, such care is still largely provided by family, typically spouses and adult daughters. However, an increasing proportion of women have entered the labour force, thereby affecting their availability. To study the demand and supply balance of informal care and to quantify the need for formal care when there is a deficit, we have developed a mixed microsimulation–agent-based model (ABM). Based on nuptiality, fertility and mortality levels of cohorts born at ten-year intervals between 1908 and 1968, the model starts with a microsimulation of the lifecycle of individuals and their close relatives until death. The ABM then determines the amount of time available or needed to care for family members, starting from age 50. Estimates are derived from Spanish survey data on employment, disability and time of care received. Surprisingly, results show that the family care deficit was greater in the older cohorts due to higher mortality and thus a greater impact of widowhood. However, for future elderly persons, we foresee that persistent below-replacement fertility and, paradoxically, the prolongation of the lifespan of couples will increase the demand for formal care as there will be more couples with both members incapacitated but without children to take care of them.

The distinction between renewable and non-renewable events is a central component of demographic analysis. When studying renewable events, age-specific rates (events per person) are summed to obtain the mean number of events occurring over the life course. For fertility, this corresponds to total fertility, including births of all orders. If an order is attributed to each birth, successive births can be analysed as a succession of non-renewable events. It then becomes possible to calculate the probability of transition from one parity to the next and to describe more precisely the occurrence of successive events. In this article, Daniel Devolder establishes a relationship between these two methods. Using historical Spanish fertility data, he provides a graphic representation of total fertility and of parity progression ratios on a comparable scale, along with a decomposition of fertility trends into their components by birth order. This new approach offers original solutions to the practical problems encountered in fertility analysis.

This article analyses the general relationships between general fertility indices and parity progression ratios by birth order. The former refer to the entire population whereas the latter concern persons who have had the same number of children. We establish a relationship between these two types of indicators by defining a mean parity progression ratio (PPR). This allows us to obtain a unified scale to represent these two types of indicators in a single graph. This mean probability can also be used to calculate fertility with small samples. Applications to different types of data, by cohort and by year, are presented. A decomposition of variations in general fertility indices as a function of variations in PPRs, including mean PPR, is also proposed. These relationships and methods are applied to the fertility of Spanish cohorts born between 1898 and 1970. Cet article analyse les relations entre indices de fécondité générale et probabilités d'agrandissement par rang de naissance. Les premiers se réfèrent à toute la population, tandis que les seconds concernent les personnes qui ont eu le même nombre d'enfants. La relation entre ces deux types d'indices est établie en définissant une probabilité d'agrandissement moyenne. Ceci nous permet d'obtenir une échelle unifiée utile pour représenter ces deux types d'indices sur un même graphique. Cette probabilité moyenne peut aussi être utile pour les calculs de fécondité sur des effectifs réduits. Des applications à différents types de données par génération et par année sont présentées. Une décomposition des variations des indices de fécondité générale en fonction de la variation des probabilités, y compris la probabilité moyenne est également proposée. Ces relations et ces méthodes sont appliquées à la fécondité des générations espagnoles nées entre 1898 et 1970. Este artículo analiza las relaciones generales entre los índices de fecundidad general y las probabilidades de crecimiento de las familias por rango de nacimiento. Los primeros se refieren a toda la población mientras que los segundos conciernen las personas que han tenido el mismo número de hijos. En este artículo establecemos una relación entre estos dos tipos de índices definiendo una probabilidad de crecimiento media. Ello nos permite obtener una escala unificada útil para representar estos dos tipos de índice en un mismo gráfico. Esta probabilidad media puede también ser útil para los cálculos de fecundidad sobre pequeños efectivos. Aplicaciones a diferentes tipos de datos, por generación y por año son presentadas. Se propone también una descomposición de las variaciones de los índices de fecundidad general en función de la variación de las probabilidades, incluida la probabilidad media. Estas relaciones y estos métodos son aplicados a las generaciones españolas nacidas entre 1898 y 1970.

Cet article analyse les relations entre indices de fécondité générale et probabilités d’agrandissement par rang de naissance. Les premiers se réfèrent à toute la population, tandis que les seconds concernent les personnes qui ont eu le même nombre d’enfants. La relation entre ces deux types d’indices est établie en définissant une probabilité d’agrandissement moyenne. Ceci nous permet d’obtenir une échelle unifiée utile pour représenter ces deux types d’indices sur un même graphique. Cette probabilité moyenne peut aussi être utile pour les calculs de fécondité sur des effectifs réduits. Des applications à différents types de données par génération et par année sont présentées. Une décomposition des variations des indices de fécondité générale en fonction de la variation des probabilités, y compris la probabilité moyenne est également proposée. Ces relations et ces méthodes sont appliquées à la fécondité des générations espagnoles nées entre 1898 et 1970. This article analyses the general relationships between general fertility indices and parity progression ratios by birth order. The former refer to the entire population whereas the latter concern persons who have had the same number of children. We establish a relationship between these two types of indicators by defining a mean parity progression ratio (PPR). This allows us to obtain a unified scale to represent these two types of indicators in a single graph. This mean probability can also be used to calculate fertility with small samples. Applications to different types of data, by cohort and by year, are presented. A decomposition of variations in general fertility indices as a function of variations in PPRs, including mean PPR, is also proposed. These relationships and methods are applied to the fertility of Spanish cohorts born between 1898 and 1970.