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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">El exceso de peso infantil se ha convertido en un problema de salud p&#250;blica<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">1</span></a>&#46; En Espa&#241;a&#44; la prevalencia de exceso de peso en la infancia se sit&#250;a en torno al 33&#37; entre los 5 y 19 a&#241;os&#44; y alrededor del 40&#37; entre los menores de 6-9 a&#241;os<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">2&#44;3</span></a>&#46; Estas cifras tan elevadas suponen un alto riesgo&#44; debido a la comorbilidad asociada no solo a la obesidad sino tambi&#233;n al sobrepeso durante la infancia&#44; que incluso comienza a manifestarse de forma prematura<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">4&#44;5</span></a>&#46; Ante este creciente problema toma relevancia el an&#225;lisis de las pr&#225;cticas relacionadas con la alimentaci&#243;n&#44; el sedentarismo y la actividad f&#237;sica que conforman los estilos de vida&#46; Estos han sido analizados tradicionalmente como manifestaciones de elecciones motivadas por sistemas de creencias individuales en materia de salud<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">6&#44;7</span></a>&#46; Sin embargo&#44; esta perspectiva suele ignorar que las creencias y las decisiones individuales est&#225;n fuertemente estructuradas por el entorno cultural&#44; social e institucional donde tienen lugar&#46; Frente a esta perspectiva&#44; existen otras aproximaciones que destacan la importancia de la dimensi&#243;n colectiva de los estilos de vida saludables<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">8&#8211;10</span></a>&#46; Los estilos de vida se conciben como patrones y formas de vida expresados en el marco de contextos espec&#237;ficos y&#44; en consecuencia&#44; estos deben analizarse contemplando las influencias sociales&#44; las expresiones colectivas y las intervenciones institucionales que contribuyen a moldear la estructura de oportunidades que facilita o dificulta la incorporaci&#243;n de pr&#225;cticas relacionadas con la salud&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Sabemos que el sobrepeso y la obesidad no afectan por igual a todos los grupos sociales&#46; En los pa&#237;ses desarrollados se ha documentado un claro gradiente socioecon&#243;mico en la prevalencia de la obesidad<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">11</span></a>&#46; Sin embargo&#44; no existen estudios que documenten el posible impacto de los esfuerzos preventivos de las comunidades aut&#243;nomas sobre los distintos grupos sociales&#46; En el a&#241;o 2005&#44; el Ministerio de Sanidad y Consumo&#44; siguiendo las recomendaciones de los organismos internacionales&#44; impuls&#243; la &#171;Estrategia NAOS&#187;&#44; cuyas l&#237;neas de actuaci&#243;n se centran en la nutrici&#243;n&#44; la actividad f&#237;sica y la prevenci&#243;n de la obesidad&#46; Esta estrategia es coordinada por el Ministerio&#44; las Consejer&#237;as de Salud de las Comunidades Aut&#243;nomas y diversos entes p&#250;blicos y privados cuya finalidad es desarrollar iniciativas conjuntas&#44; las cuales pueden ser aplicadas por las comunidades aut&#243;nomas&#44; en un nivel meso&#44; o por los ayuntamientos&#44; en un nivel micro<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">12</span></a>&#46; Desde entonces&#44; las comunidades aut&#243;nomas vienen aprobando planes y programas en estas materias&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Esta investigaci&#243;n pretende explorar si los beneficios del esfuerzo preventivo desarrollado por las comunidades aut&#243;nomas en el &#225;mbito de la obesidad se distribuyen de forma equitativa entre la poblaci&#243;n infantil espa&#241;ola&#46; El presente estudio se fundamenta en las proposiciones de la teor&#237;a de las causas fundamentales<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">13</span></a>&#44; que sostiene que la desigualdad en salud se reproduce a medida que las sociedades ganan capacidad preventiva&#44; ya que emergen nuevos mecanismos que vendr&#237;an a sustituir &#40;o a sumar su efecto&#41; a los ya existentes<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">14</span></a>&#46; A partir de ello se plantean las siguientes hip&#243;tesis&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0015" class="elsevierStylePara elsevierViewall">H1&#58; existe un gradiente social en la probabilidad de que la poblaci&#243;n infantil padezca sobrepeso u obesidad&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0020" class="elsevierStylePara elsevierViewall">H2&#58; las pol&#237;ticas implementadas por las comunidades aut&#243;nomas pueden influir en la evoluci&#243;n de la prevalencia de la obesidad infantil&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0025" class="elsevierStylePara elsevierViewall">H3&#58; los beneficios del esfuerzo preventivo realizado por las comunidades aut&#243;nomas no se distribuyen equitativamente entre los grupos socioecon&#243;micos&#46;</p></li></ul></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">M&#233;todo</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Datos</span><p id="par0030" class="elsevierStylePara elsevierViewall">Se trata de una serie de estudios transversales multinivel a partir de la informaci&#243;n ofrecida por distintas olas de la Encuesta Nacional de Salud&#44; espec&#237;ficamente las de 2003&#44; 2006&#44; 2011 y 2017&#46; Estas encuestas ofrecen informaci&#243;n de muestras representativas de la poblaci&#243;n espa&#241;ola y de cada comunidad aut&#243;noma&#46; Para el presente estudio se emple&#243; la muestra de menores con edades comprendidas entre 2 y 15 a&#241;os residentes en las 17 comunidades aut&#243;nomas&#46; Se cuenta con una muestra efectiva &#40;tras eliminar los casos perdidos&#41; de 19567 menores &#40;N<span class="elsevierStyleInf">2003</span>&#61;5287&#44; N<span class="elsevierStyleInf">2006</span>&#61;5924&#44; N<span class="elsevierStyleInf">2011</span>&#61;3669 y N<span class="elsevierStyleInf">2017</span>&#61;4687&#41;&#46; La obtenci&#243;n de informaci&#243;n en el cuestionario infantil se realiz&#243; mediante entrevistas indirectas al padre&#44; la madre o la persona tutora&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Variables</span><p id="par0035" class="elsevierStylePara elsevierViewall">Las variables dependientes fueron el sobrepeso y la obesidad&#44; ambas derivadas del &#237;ndice de masa corporal &#40;IMC&#41;&#44; el cual fue calculado a partir de las preguntas que se realizan en el cuestionario infantil sobre el peso y la altura&#46; Seg&#250;n el IMC se determin&#243; si los&#47;las menores presentaban o no sobrepeso u obesidad &#40;0<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>no y 1<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>s&#237;&#41; de acuerdo con los criterios internacionales establecidos para la poblaci&#243;n infantil en funci&#243;n del sexo y la edad<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">15</span></a>&#46; Con la finalidad de poder medir el esfuerzo planificador realizado por las comunidades aut&#243;nomas en pol&#237;ticas que pueden contribuir a la prevenci&#243;n de la obesidad infantil&#44; se construy&#243; un &#237;ndice sint&#233;tico a partir de la codificaci&#243;n de distintos planes y programas en el &#225;rea de la alimentaci&#243;n saludable y el ejercicio f&#237;sico aprobados por los gobiernos auton&#243;micos en cuatro periodos temporales&#58; anterior a 2005&#44; entre 2005 y 2009&#44; entre 2010 y 2014&#44; y de 2015 en adelante &#40;v&#233;ase <a class="elsevierStyleCrossRef" href="#sec0100">Ap&#233;ndice <span class="elsevierStyleItalic">on-line</span></a>&#41;&#46; Se utilizaron dos variables independientes derivadas de dicho &#237;ndice sint&#233;tico&#58; en primer lugar&#44; la media aritm&#233;tica de los cuatro periodos con el fin de aproximar el esfuerzo medio que realizan las comunidades aut&#243;nomas en pol&#237;ticas contra la obesidad&#44; y en segundo lugar el valor del &#237;ndice en cada uno de los periodos centrado sobre dicha media para aproximar el cambio o la evoluci&#243;n en el esfuerzo de cada comunidad aut&#243;noma a lo largo del tiempo que abarca el estudio &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46; Adem&#225;s&#44; se consideraron las siguientes variables&#58; edad en a&#241;os&#44; sexo&#44; IMC de la persona adulta entrevistada en el hogar y clase social de la persona referente del hogar&#46; Para ello se realiz&#243; una agrupaci&#243;n en tres categor&#237;as a partir de los seis grupos establecidos en la clasificaci&#243;n del Grupo de Trabajo de Determinantes Sociales de la Sociedad Espa&#241;ola de Epidemiolog&#237;a<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">16</span></a>&#46; Con la finalidad de caracterizar el contexto de las comunidades aut&#243;nomas&#44; adem&#225;s de las variables relacionadas con las pol&#237;ticas de prevenci&#243;n de la obesidad infantil&#44; tambi&#233;n se consideraron como variables independientes el porcentaje medio de gasto en salud p&#250;blica sobre el gasto sanitario total de cada comunidad aut&#243;noma en el periodo 2002-2018 y la media del competente de renta del nuevo &#237;ndice de desarrollo humano &#40;NIDH&#41; para el periodo 2003-2010<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">17</span></a>&#46; En cada periodo se consider&#243; como variable independiente el a&#241;o de cada una de las encuestas como variable categ&#243;rica&#44; permitiendo la no linealidad &#40;2003 ref&#46;&#44; 2006&#44; 2011 y 2017&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">An&#225;lisis</span><p id="par0040" class="elsevierStylePara elsevierViewall">Siguiendo la propuesta de Fairbrother<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">18</span></a>&#44; se calcularon modelos de regresi&#243;n log&#237;stica jer&#225;rquica&#44; en los que los&#47;las 19&#46;567 menores se encontraban anidados&#47;as en 68 unidades espaciotemporales &#40;17 comunidades aut&#243;nomas<span class="elsevierStyleHsp" style=""></span>&#215; 4 periodos<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>68&#41; y 17 contextos regionales&#46; Esta estrategia de an&#225;lisis permiti&#243; la modelizaci&#243;n de las diferencias transversales entre las comunidades aut&#243;nomas en la obesidad o sobrepeso&#44; as&#237; como la influencia de las variaciones durante el periodo analizado&#46; Se realizaron los an&#225;lisis de forma segregada por sexo&#44; sin observar diferencias en los resultados&#46; Dado el tama&#241;o de las muestras&#44; se decidi&#243; presentar los an&#225;lisis de forma conjunta incluyendo la variable sexo como control para no perder potencia estad&#237;stica&#46; Se incluyeron interacciones del sexo y los indicadores de las pol&#237;ticas en los distintos modelos para detectar posibles influencias diferenciales seg&#250;n el sexo&#59; al no ser ninguna de ellas significativa&#44; estas fueron excluidas de los modelos finales&#46; Tambi&#233;n se calcularon modelos de coeficientes aleatorios en el nivel de comunidades aut&#243;nomas y periodo para las tres variables explicativas principales &#40;clase social&#44; media pol&#237;ticas obesidad y cambio pol&#237;ticas de obesidad&#41;&#44; resultando todos ellos no significativos&#46; Por esta raz&#243;n&#44; y debido al limitado n&#250;mero de unidades de an&#225;lisis en el nivel 2&#44; se decidi&#243; mantener solo los modelos con los efectos aleatorios del t&#233;rmino independiente para los distintos niveles de an&#225;lisis&#46; Se calcularon las <span class="elsevierStyleItalic">odds ratios</span> &#40;OR&#41; ajustadas para facilitar la interpretaci&#243;n de los resultados&#46; Los an&#225;lisis se realizaron con el paquete estad&#237;stico MLwiN 2&#46;32&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Resultados</span><p id="par0045" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0025">tabla 2</a> se detallan las caracter&#237;sticas de las muestras&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">En las <a class="elsevierStyleCrossRefs" href="#tbl0030">tablas 3 y 4</a> se presentan los an&#225;lisis log&#237;sticos jer&#225;rquicos de la obesidad y el sobrepeso&#44; respectivamente&#46; En el modelo 1 no se observa una diferencia significativa en la obesidad con respecto al sexo&#44; pero s&#237; en el sobrepeso&#44; siendo aparentemente menor entre la poblaci&#243;n femenina &#40;OR&#58; 0&#44;92&#59; intervalo de confianza del 95&#37; &#91;IC95&#37;&#93;&#58; 0&#44;86-0&#44;99&#41;&#46; Con respecto al IMC de la persona adulta entrevistada&#44; se observa que la probabilidad de que el&#47;la menor presente obesidad o sobrepeso se incrementa considerablemente cuando la persona adulta tiene obesidad &#40;OR&#58; 1&#44;81&#44; IC95&#37;&#58; 1&#44;56-2&#44;09&#44; y OR&#58; 1&#44;99&#44; IC95&#37;&#58; 1&#44;87-2&#44;13&#44; respectivamente&#41;&#46; De igual forma sucede&#44; aunque la asociaci&#243;n es m&#225;s moderada&#44; si la persona adulta presenta sobrepeso &#40;OR&#58; 1&#44;30&#44; IC95&#37;&#58; 1&#44;19-1&#44;41&#44; y OR&#58; 1&#44;34&#44; IC95&#37;&#58;1&#44;28-1&#44;40&#41;&#46; Los resultados muestran la existencia de un claro gradiente social en la obesidad&#44; ya que la prevalencia de obesidad disminuye proporcionalmente a medida que aumenta la clase social &#40;alta&#44; OR&#58; 0&#44;50&#44; IC95&#37;&#58; 0&#44;43-0&#44;57&#59; media&#44; OR&#58; 0&#44;71&#44; IC95&#37;&#58; 0&#44;66-0&#44;77&#41;&#44; replic&#225;ndose dicha asociaci&#243;n tambi&#233;n en el sobrepeso &#40;alta&#44; OR&#58; 0&#44;65&#44; IC95&#37;&#58; 0&#44;58-0&#44;71&#59; media&#44; OR&#58; 0&#44;79&#44; IC95&#37;&#58; 0&#44;71-0&#44;87&#41;&#46;</p><elsevierMultimedia ident="tbl0030"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Los hallazgos del modelo 2 sugieren que el gasto medio en salud p&#250;blica se asocia con una disminuci&#243;n de la prevalencia de sobrepeso y obesidad &#40;OR&#58; 0&#44;82&#44; IC95&#37;&#58; 0&#44;68-0&#44;98&#59; y OR&#58; 0&#44;86&#44; IC95&#37;&#58; 0&#44;77-0&#44;97&#41;&#46; Del mismo modo&#44; el &#237;ndice de renta medio tambi&#233;n parece desempe&#241;ar un papel importante en la reducci&#243;n de la probabilidad de que la poblaci&#243;n infantil presente obesidad &#40;OR&#58; 0&#44;77&#44; IC95&#37;&#58; 0&#44;66-0&#44;89&#41; o sobrepeso &#40;OR&#58; 0&#44;17&#44; IC95&#37;&#58; 0&#44;05-0&#44;54&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">En cuanto a las pol&#237;ticas&#44; el esfuerzo medio realizado por las comunidades aut&#243;nomas y los cambios en dicho esfuerzo no parecen asociarse con reducciones del sobrepeso o de la obesidad para el conjunto de la poblaci&#243;n infantil &#40;modelo 2&#41;&#46; Sin embargo&#44; al considerar el efecto interactivo del cambio en las pol&#237;ticas y la clase social &#40;modelo 3&#41;&#44; los resultados muestran que la poblaci&#243;n infantil de las clases medias y altas tiene menor probabilidad de desarrollar sobrepeso u obesidad a medida que las comunidades aut&#243;nomas aumentan su esfuerzo en pol&#237;ticas preventivas en el tiempo &#40;cambio pol&#237;ticas&#42;clase alta&#44; OR&#58; 0&#44;89&#44; IC95&#37;&#58; 0&#44;82-0&#44;96 y OR&#58; 0&#44;91&#44; IC95&#37;&#58; 0&#44;85-0&#44;96&#59; cambio pol&#237;ticas&#42;clase media&#58; OR&#58; 0&#44;93&#44; IC95&#37;&#58; 0&#44;88-0&#44;97 y OR&#58; 0&#44;93&#44; IC95&#37;&#58; 0&#44;89-0&#44;95&#41;&#46; Ello sugiere que la efectividad de estas pol&#237;ticas es condicional a la clase social&#46; La <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a> muestra que&#44; cuando las autonom&#237;as acumulan mayor esfuerzo en el dise&#241;o y la implementaci&#243;n de este tipo de planes y programas&#44; parece disminuir la prevalencia de sobrepeso y obesidad entre la poblaci&#243;n infantil de clase media y alta&#44; a la vez que aumenta en la de clase baja&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discusi&#243;n</span><p id="par0065" class="elsevierStylePara elsevierViewall">En el presente estudio&#44; realizado con muestras representativas de la poblaci&#243;n infantil de &#225;mbito nacional y auton&#243;mico en distintos periodos de tiempo&#44; los resultados confirman la existencia de una clara relaci&#243;n inversa entre la clase social y el sobrepeso o la obesidad infantil &#40;hip&#243;tesis 1&#41;&#46; Ello est&#225; en sinton&#237;a con la observaci&#243;n de que en Espa&#241;a existe mayor prevalencia de obesidad grave seg&#250;n el nivel educativo de la madre<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">19</span></a> y apunta en la misma direcci&#243;n de investigaciones previas que constatan importantes desigualdades en el sobrepeso y la obesidad en nuestro pa&#237;s<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">20&#44;21</span></a>&#46; Cabe mencionar la asociaci&#243;n positiva entre el sobrepeso o la obesidad en las personas adultas y la probabilidad de que los&#47;las menores tengan exceso de peso&#46; En l&#237;nea con la teor&#237;a sobre estilos de vida saludable<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">8</span></a>&#44; esta relaci&#243;n sugiere la importancia del contexto del hogar en la estructuraci&#243;n social de las pr&#225;cticas relacionadas con la alimentaci&#243;n y el sedentarismo&#44; y por tanto su potencial contribuci&#243;n a la reproducci&#243;n de este tipo de desigualdades en salud&#46; La ausencia de efectos claros de periodo concuerda con la evidencia previa sobre la estabilizaci&#243;n de la prevalencia del exceso de peso en Espa&#241;a durante los &#250;ltimos a&#241;os<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">2&#44;3</span></a>&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Los resultados indican que las pol&#237;ticas implementadas por las comunidades aut&#243;nomas no estar&#237;an consiguiendo los efectos deseados sobre la reducci&#243;n de la prevalencia de sobrepeso y obesidad para el conjunto de la poblaci&#243;n infantil &#40;hip&#243;tesis 2&#41;&#46; Sin embargo&#44; parecen existir influencias contextuales que apuntan a que existe menos obesidad y sobrepeso infantil en aquellas comunidades aut&#243;nomas que m&#225;s recursos destinan a financiar actuaciones de salud p&#250;blica&#46; Este resultado coincide con los argumentos que sostienen que el gasto en salud p&#250;blica es efectivo para mejorar la salud de la poblaci&#243;n<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">22</span></a>&#44; as&#237; como con quienes recomiendan reenfocar la prevenci&#243;n de la obesidad infantil hacia la formulaci&#243;n de pol&#237;ticas que trasciendan al sector sanitario<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">23</span></a>&#46; Los resultados indican una relaci&#243;n inversa entre el &#237;ndice de renta medio &#40;NIDH&#41; de las comunidades aut&#243;nomas y el aumento de peso durante la ni&#241;ez&#46; Este resultado se puede interpretar en l&#237;nea con otros estudios que se&#241;alan que en los contextos de mayor renta las clases socioecon&#243;micas m&#225;s altas estar&#237;an modificando sus h&#225;bitos hacia patrones m&#225;s saludables<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">24</span></a>&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Los resultados de este estudio sustentan la hip&#243;tesis derivada de la teor&#237;a de las causas fundamentales&#44; que sostiene que los beneficios preventivos no se distribuyen equitativamente &#40;hip&#243;tesis 3&#41;&#46; De hecho&#44; cuando las comunidades aut&#243;nomas aumentan su esfuerzo en pol&#237;ticas de prevenci&#243;n del sobrepeso y la obesidad infantil&#44; sus retornos positivos parecen circunscribirse exclusivamente a los grupos de clases medias y altas&#46; Una explicaci&#243;n posible resultar&#237;a de la confluencia de la teor&#237;a de las causas fundamentales y la teor&#237;a de la difusi&#243;n de la innovaci&#243;n preventiva&#46; Las proposiciones de ambas teor&#237;as sugieren que las innovaciones preventivas son incorporadas por los individuos siguiendo un proceso jer&#225;rquico seg&#250;n la clase social&#44; es decir&#44; que las personas que se benefician del nuevo conocimiento preventivo en etapas tempranas suelen tener un estatus socioecon&#243;mico m&#225;s alto y mejores conexiones sociales que quienes las acaban adoptando m&#225;s tard&#237;amente&#44; lo cual contribuir&#237;a a reproducir sistem&#225;ticamente las desigualdades en salud<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">14</span></a>&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Desde un punto de vista pr&#225;ctico&#44; este resultado implica que los distintos gobiernos deber&#237;an tomar en consideraci&#243;n que las pol&#237;ticas preventivas y de promoci&#243;n de la salud&#44; por s&#237; mismas&#44; no tienen por qu&#233; tener retornos equitativos&#44; m&#225;s a&#250;n&#44; si dichas pol&#237;ticas ignoran el concepto de &#171;poblaciones vulnerables&#187; y asumen impl&#237;citamente que todos los grupos se beneficiar&#225;n por igual de las intervenciones poblacionales<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">25</span></a>&#46; En el &#225;mbito de la obesidad&#44; existen evidencias de que ciertas pol&#237;ticas pueden causar efectos no deseados sobre las clases sociales m&#225;s desfavorecidas&#44; aumentando incluso la desigualdad<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">26</span></a>&#46; Tomarse en serio el reto de la equidad implica&#44; al menos&#44; que los distintos gobiernos analicen sistem&#225;ticamente cu&#225;les son los mecanismos que fundamentan las acciones preventivas y eval&#250;en c&#243;mo estas pueden impactar de forma diferencial en las pr&#225;cticas de los distintos grupos socioecon&#243;micos y en distintos contextos sociales<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">27</span></a>&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Entre las fortalezas del estudio cabe destacar que es uno de los primeros an&#225;lisis emp&#237;ricos que trata de aproximar la influencia de las pol&#237;ticas auton&#243;micas de prevenci&#243;n de la obesidad infantil en nuestro pa&#237;s&#46; Aunque los datos transversales limitan el alcance de las inferencias causales&#44; la estrategia de modelado seguida ha sido validada mediante simulaciones que demuestran su utilidad para aproximarse al estudio de influencias contextuales y tendencias de cambio temporal no sesgadas mediante el uso de una serie de encuestas transversales<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">18</span></a>&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Una de las principales limitaciones del estudio podr&#237;a ser el uso del IMC declarado por los progenitores o tutores de los menores&#44; ya que podr&#237;a introducir la posibilidad de un sesgo de informaci&#243;n&#46; A pesar de sus limitaciones&#44; las mediciones subjetivas del IMC generalmente son aceptadas como v&#225;lidas<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">28&#8211;30</span></a>&#44; ya que han demostrado una utilidad razonable para clasificar a los&#47;las menores y adolescentes con obesidad o sobrepeso en los estudios epidemiol&#243;gicos que utilizan muestras representativas de la poblaci&#243;n<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">31</span></a>&#46; Con la fuente de informaci&#243;n utilizada no fue posible obtener una medici&#243;n objetiva que permitiera validar directamente la informaci&#243;n declarada&#46; Sin embargo&#44; se desarroll&#243; una comparaci&#243;n externa con la finalidad de evaluar la posible desviaci&#243;n de estas medidas declaradas&#46; En concreto&#44; se realiz&#243; una comparaci&#243;n entre las estimaciones de la prevalencia de obesidad y sobrepeso con datos de medidas directas de la Organizaci&#243;n Mundial de la Salud &#40;poblaci&#243;n de 5-19 a&#241;os&#41; en Espa&#241;a en periodos cercanos a los analizados&#46; Esta comparaci&#243;n no muestra la existencia de diferencias significativas con las estimaciones de las distintas encuestas si se tienen en cuenta los IC95&#37; &#40;v&#233;ase el <a class="elsevierStyleCrossRef" href="#sec0100">Ap&#233;ndice <span class="elsevierStyleItalic">on-line</span></a>&#41;&#46; Para la obesidad parece existir una ligera sobreestimaci&#243;n seg&#250;n los datos de la Encuesta Nacional de Salud&#44; que ir&#237;a desde<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>1&#44;2&#37; a<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>0&#44;8&#37;&#44; y una infraestimaci&#243;n en el caso del sobrepeso&#44; que var&#237;a entre &#8211;1&#44;3&#37; y &#8211;4&#44;2&#37;&#44; aunque es preciso tener en cuenta que estas diferencias no significativas tambi&#233;n podr&#237;an estar motivadas por el hecho de que los grupos de poblaci&#243;n no son exactamente similares para ambas estimaciones&#46; Teniendo presente que el principal objetivo de este estudio es estimar la posible influencia del esfuerzo realizado por las comunidades aut&#243;nomas sobre las tendencias seguidas por la obesidad y el sobrepeso&#44; de existir cierto sesgo de informaci&#243;n en las mediciones subjetivas&#44; nada hace pensar que este no sea constante a lo largo del tiempo&#44; lo cual minimizar&#237;a su impacto sobre las tendencias estudiadas&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Otra de las posibles limitaciones del indicador utilizado para aproximar el esfuerzo realizado por las comunidades aut&#243;nomas es que pueden existir intervenciones menos estructuradas que&#44; no formando parte de planes institucionales&#44; puedan escapar a dicho indicador&#46; Sin embargo&#44; se decidi&#243; priorizar la identificaci&#243;n de planes y programas&#44; ya que se consider&#243; la forma m&#225;s sistem&#225;tica de garantizar la comparabilidad de los esfuerzos de las comunidades aut&#243;nomas a lo largo de los periodos analizados&#46; El objetivo fue contar con un indicador <span class="elsevierStyleItalic">proxi</span> de la importancia que adquiere esta problem&#225;tica en la agenda de los gobiernos&#44; a la vez que permitiera observar la evoluci&#243;n en el tiempo de dicho esfuerzo planificador&#46; Aunque en este estudio no se ha evaluado el contenido de los planes&#44; creemos que ser&#237;a pertinente que en futuras investigaciones se analicen sus enfoques de intervenci&#243;n con especial atenci&#243;n a los objetivos de equidad&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conclusiones</span><p id="par0100" class="elsevierStylePara elsevierViewall">El efecto conjunto de las pol&#237;ticas implementadas por las comunidades aut&#243;nomas presenta limitaciones para lograr reducir la obesidad y el sobrepeso infantil&#46; Se necesitar&#237;a mejorar los procesos de formulaci&#243;n&#44; implementaci&#243;n y evaluaci&#243;n de las pol&#237;ticas que puedan influir en su prevenci&#243;n&#46; En este sentido&#44; una tarea imprescindible ser&#237;a poder contar con fuentes de informaci&#243;n estandarizadas que faciliten su evaluaci&#243;n&#44; a la vez que permitan desentra&#241;ar la efectividad de los diferentes mecanismos de intervenci&#243;n sobre los estratos socioecon&#243;micos&#46; Esto es particularmente relevante ya que&#44; si las desigualdades documentadas en este trabajo no se abordan en etapas tempranas&#44; es muy posible que se traduzcan en mayores desigualdades en la morbimortalidad en un futuro y contribuyan a su reproducci&#243;n intergeneracional&#46;<elsevierMultimedia ident="tb0005"></elsevierMultimedia></p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Editor responsable del art&#237;culo</span><p id="par0125" class="elsevierStylePara elsevierViewall">Gonzalo Casino&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Declaraci&#243;n de transparencia</span><p id="par0130" class="elsevierStylePara elsevierViewall">El autor principal &#40;garante responsable del manuscrito&#41; afirma que este manuscrito es un reporte honesto&#44; preciso y transparente del estudio que se remite a <span class="elsevierStyleSmallCaps">Gaceta Sanitaria&#44;</span> que no se han omitido aspectos importantes del estudio&#44; y que las discrepancias del estudio seg&#250;n lo previsto &#40;y&#44; si son relevantes&#44; registradas&#41; se han explicado&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Contribuciones de autor&#237;a</span><p id="par0135" class="elsevierStylePara elsevierViewall">Ambos autores han contribuido por igual a la realizaci&#243;n del trabajo&#46; El dise&#241;o del estudio surgi&#243; del proceso de tutorizaci&#243;n desarrollado por A&#46;R&#46; Zapata Moya durante el Trabajo de Fin de Grado de L&#46; Carmona Rosado&#44; quien se ha encargado de la recopilaci&#243;n de la informaci&#243;n necesaria para poder codificar las pol&#237;ticas auton&#243;micas de prevenci&#243;n de la obesidad infantil&#44; y ha contribuido sustancialmente a la redacci&#243;n del marco te&#243;rico y la discusi&#243;n de los resultados&#46; Por su parte&#44; A&#46;R&#46; Zapata Moya ha contribuido principalmente en la parte metodol&#243;gica del estudio&#44; mediante la creaci&#243;n de las bases de datos y el desarrollo de los modelos de an&#225;lisis multinivel&#46; Ambos autores han contribuido a la formulaci&#243;n de las hip&#243;tesis te&#243;ricamente informadas y la interpretaci&#243;n y discusi&#243;n de los resultados&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Registro</span><p id="par0140" class="elsevierStylePara elsevierViewall">Se ha procedido a dar registro al estudio observacional a trav&#233;s de la plataforma OSF&#46; En dicho registro&#44; adem&#225;s de los objetivos y la metodolog&#237;a del estudio&#44; se aporta el siguiente material complementario&#58;</p><p id="par0145" class="elsevierStylePara elsevierViewall">&#8226; Datos para la creaci&#243;n del indicador de pol&#237;ticas y el cambio en dicho indicador en los periodos utilizados&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">&#8226; Resultados completos de los modelos estad&#237;sticos&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">&#8226; Notaciones de los modelos multinivel&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">&#8226; Datos empleados para el an&#225;lisis &#40;formato MLwin&#41;&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">&#8226; Enlace anonimizado del registro&#58; <a href="https://osf.io/8pru7/?view_only=db10379942df4b5f846d9eb1e7a8aebb">https&#58;&#47;&#47;osf&#46;io&#47;8pru7&#47;&#63;view&#95;only&#61;db10379942df4b5f846d9eb1e7a8aebb</a></p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Financiaci&#243;n</span><p id="par0170" class="elsevierStylePara elsevierViewall">Este estudio se ha realizado en el marco del proyecto &#171;<span class="elsevierStyleItalic">Healthy-scenes&#58;</span> el car&#225;cter simb&#243;lico del contexto cultural y los estilos de vida saludables&#187; &#40;PID2019-103853RA-I00&#41;&#44; financiado por el Ministerio de Ciencia e Innovaci&#243;n &#40;ref&#58; 10&#46;13039&#47;501100011033&#41;&#46;</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Conflicto de intereses</span><p id="par0175" class="elsevierStylePara elsevierViewall">Ambos autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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          "titulo" => "Conflicto de intereses"
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        15 => array:1 [
          "titulo" => "Bibliograf&#237;a"
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    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2021-03-18"
    "fechaAceptado" => "2021-08-05"
    "PalabrasClave" => array:2 [
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        0 => array:4 [
          "clase" => "keyword"
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          "identificador" => "xpalclavsec1548477"
          "palabras" => array:4 [
            0 => "Obesidad"
            1 => "Sobrepeso infantil"
            2 => "Pol&#237;ticas p&#250;blicas"
            3 => "Desigualdades en salud"
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            0 => "Obesity"
            1 => "Childhood overweight"
            2 => "Public policies"
            3 => "Health inequalities"
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    "resumen" => array:2 [
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Explorar las tendencias del sobrepeso y la obesidad infantil seg&#250;n la posici&#243;n socioecon&#243;mica y en relaci&#243;n con el esfuerzo preventivo desarrollado por las comunidades aut&#243;nomas&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se trata de una serie de estudios transversales multinivel a partir de la informaci&#243;n ofrecida por distintas olas de la Encuesta Nacional de Salud&#44; espec&#237;ficamente las de 2003&#44; 2006&#44; 2011 y 2017&#46; Se estimaron modelos de regresi&#243;n log&#237;stica jer&#225;rquica&#44; con los individuos &#40;nivel 1&#41; anidados en la comunidad aut&#243;noma-periodo de estudio &#40;nivel 2&#41; y estos&#44; a su vez&#44; en las comunidades aut&#243;nomas &#40;nivel 3&#41;&#46; Las principales variables independientes fueron el esfuerzo medio realizado por las comunidades aut&#243;nomas en pol&#237;ticas de prevenci&#243;n del sobrepeso&#47;obesidad infantil y el cambio en el esfuerzo en dichas pol&#237;ticas a lo largo de los periodos estudiados&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">La probabilidad de obesidad o sobrepeso infantil se incrementa sustancialmente si el adulto entrevistado en el hogar tambi&#233;n presenta obesidad o sobrepeso&#46; El efecto conjunto de las pol&#237;ticas implementadas por las comunidades aut&#243;nomas se asocia con una disminuci&#243;n significativa de la prevalencia solo para la poblaci&#243;n infantil que pertenece a clases sociales altas y medias &#40;<span class="elsevierStyleItalic">odds ratio</span> &#91;OR&#93;&#58; 0&#44;89&#44; intervalo de confianza del 95&#37; &#91;IC95&#37;&#93;&#58; 0&#44;82-0&#44;96&#44; y OR&#58; 0&#44;93&#44; IC95&#37;&#58; 0&#44;88-0&#44;97&#44; respectivamente&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Las pol&#237;ticas implementadas por las comunidades aut&#243;nomas parecen tener una capacidad limitada para conseguir reducciones significativas de la prevalencia de sobrepeso y de obesidad infantil&#46; Los resultados sugieren que ser&#237;an los grupos de clase media y alta los que parecen obtener mayores beneficios de estas pol&#237;ticas&#44; lo cual podr&#237;a contribuir indirectamente a aumentar las desigualdades en la obesidad infantil&#46;</p></span>"
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          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objetivo"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "M&#233;todo"
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          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Resultados"
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          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusiones"
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      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To explore trends in childhood overweight&#47;obesity according to socio-economic status and in relation to the preventive effort developed by the Spanish autonomous regions&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Method</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A series of multilevel cross-sectional studies were conducted using data from different waves of the Spanish National Health Survey&#44; namely 2003&#44; 2006&#44; 2011 and 2017&#46; Hierarchical logistic regression models were estimated&#44; with individuals &#40;level 1&#41; nested within the region&#8211;period of study &#40;level 2&#41; and these&#44; in turn&#44; within the region &#40;level 3&#41;&#46; The main independent variables were the average effort made by the Spanish autonomous regions in child overweight&#8211;obesity prevention policies and the change in the effort made in these policies over the periods studied&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The likelihood of obesity and&#47;or overweight increases substantially if the adult respondent in the household is also obese or overweight&#46; The joint effect of the policies implemented by the autonomous regions is associated with a significant decrease in prevalence only for children belonging to high and middle social classes &#40;odds ratio &#91;OR&#93;&#58; 0&#46;89&#44; 95&#37; confidence interval &#91;95&#37;<span class="elsevierStyleSmallCaps">C</span>I&#93;&#58; 0&#46;82&#8211;0&#46;96&#44; and OR&#58; 0&#46;93&#44; 95&#37;CI&#58; 0&#46;88&#8211;0&#46;97&#44; respectively&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The policies implemented by the Spanish autonomous regions seem to have a limited capacity to achieve significant reductions in the prevalence of childhood overweight and obesity&#46; The results suggest that it is the middle and upper-middle class groups that seem to benefit most from these policies&#44; which could indirectly contribute to increasing inequalities in childhood obesity&#46;</p></span>"
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            "apendice" => "<p id="par0185" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>"
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            "titulo" => "Material adicional"
            "identificador" => "sec0100"
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        "descripcion" => array:1 [
          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Probabilidades predichas de obesidad y sobrepeso seg&#250;n la clase social y el cambio en el indicador de pol&#237;ticas de prevenci&#243;n&#46;</p>"
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          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">NIDH&#58; nuevo &#237;ndice de desarrollo humano&#46;</p><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">&#42; Este indicador es la mediar aritm&#233;tica del &#237;ndice sint&#233;tico sobre el esfuerzo en este tipo de pol&#237;ticas en los cuatro periodos analizados&#44; cuya informaci&#243;n puede consultarse en el ap&#233;ndice on-line&#46;</p><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">&#42;&#42; Este indicador es el resultado de restar al valor del &#237;ndice sint&#233;tico en cada uno de los periodos la media aritm&#233;tica de los cuatro periodos&#58; Cambio &#61; &#237;ndice sint&#233;tico en periodo X - media aritm&#233;tica de los cuatro periodos&#46;</p>"
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                  <table border="0" frame="\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col">NIDH&#58; &#237;ndice de renta&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col">Gasto medio en salud p&#250;blica &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col">Esfuerzo medio en pol&#237;ticas contra la obesidad&#42;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Media 2003-2010&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2002-2018&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Hasta 2005&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2005-2009&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2010-2014&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2015-2017&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Andaluc&#237;a&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;33&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8722;3&#44;19&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8722;1&#44;19&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;81&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;56&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Arag&#243;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;47&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8722;2&#44;13&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8722;1&#44;13&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;87&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Asturias &#40;Principado de&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;88&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8722;0&#44;88&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8722;0&#44;88&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Balears &#40;Illes&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#44;75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#44;75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Canarias&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;1&#44;31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#44;31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;94&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cantabria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;1&#44;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;1&#44;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;87&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Castilla y Le&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#44;56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#44;56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Castilla-La Mancha&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;1&#44;63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#44;63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;87&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Catalu&#241;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;1&#44;88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Comunitat Valenciana&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#44;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#44;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#44;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Extremadura&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;1&#44;63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;87&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Galicia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;1&#44;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;1&#44;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;94&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Madrid &#40;Comunidad de&#41;&nbsp;\t\t\t\t\t\t\n
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                  """
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No consta&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">A&#241;o de la encuesta</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2006&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2017&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Obesidad&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Modelo nulo</th><th class="td" title="\n
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                  \t\t\t\t  " colspan="4" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Modelo 1</th><th class="td" title="\n
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                  \t\t\t\t  " colspan="4" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Modelo 2</th><th class="td" title="\n
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                  \t\t\t\t  " colspan="4" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Modelo 3</th></tr><tr title="table-row"><th class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Efectos fijos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">OR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">IC95&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">OR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">IC95&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">OR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">IC95&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">OR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">IC95&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;09&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;12&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;11&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;11&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;09&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;14&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Edad</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;83&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;83&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;84&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">&#205;ndice de masa corporal de persona adulta &#40;ref&#46; normopeso&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Gasto medio en salud p&#250;blica &#40;2002-2018&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">NIDH&#58; &#237;ndice de renta medio &#40;2003-2010&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Coeficiente de partici&#243;n de la varianza</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Comunidades aut&#243;nomas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Periodo&#42;comunidad aut&#243;noma&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">97&#44;10&#37;</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">17</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">17</td><td class="td" title="\n
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                  \t\t\t\t  " colspan="5" align="left" valign="\n
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                  \t\t\t\t">17</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Periodo&#42;comunidad aut&#243;noma&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Individuos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">OR&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">IC95&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">OR&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">IC95&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">OR&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">IC95&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">OR&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">IC95&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;41&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;37&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;39&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;51&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">&#205;ndice de masa corporal persona adulta &#40;ref&#46; normopeso&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">A&#241;o de la encuesta &#40;ref&#46; 2003&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2017&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Gasto medio en salud p&#250;blica &#40;2002-2018&#41;</span>&nbsp;\t\t\t\t\t\t\n
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