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Arregi A, Vegas O, Lertxundi A, García-Baquero G, Ibarluzea J, Andiarena A, Babarro I, Subiza-Pérez M, Lertxundi N. Hair cortisol determinants in 11-year-old children: Environmental, social and individual factors. Horm Behav 2024; 164:105575. [PMID: 38851169 DOI: 10.1016/j.yhbeh.2024.105575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 05/30/2024] [Accepted: 05/30/2024] [Indexed: 06/10/2024]
Abstract
INTRODUCTION Children's exposure to chronic stress is associated with several health problems. Measuring hair cortisol concentration is particularly useful for studying chronic stress but much is unknown about hair cortisol determinants in children and adolescents, and previous research has often not considered the simultaneous exposure of multiple variables. This research is focused on investigating the relationship between environmental, social and individual factors with hair cortisol concentration in children. METHODS The data used in this study are from the INMA prospective epidemiological cohort study. The assessment of chronic stress was made on the basis of hair samples taken at the age of 11 years in the INMA-Gipuzkoa cohort (n = 346). A metamodel summarizing the hypothesized relationships among environmental, social and individual factors and hair cortisol concentration was constructed based on previous literature. Structural Equation Modelling was performed to examine the relationships among the variables. RESULTS In the general model higher behavioural problems were associated with higher cortisol levels and an inverse relationship between environmental noise and cortisol levels was observed, explaining 5 % of the variance in HCC. Once stratified by sex these associations were only hold in boys, while no significant effect of any of the study variables was related with cortisol levels in girls. Importantly, maternal stress was positively related to behavioural difficulties in children. Finally, higher traffic-related air pollution and lower exposure to neighborhood greenness were related to higher environmental noise. DISCUSSION This study highlights that simultaneous exposure to different environmental, social and individual characteristics may determine the concentration of hair cortisol. More research is needed and future studies should include this complex view to better understanding of hair cortisol determinants in children.
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Affiliation(s)
- Ane Arregi
- Faculty of Psychology, University of the Basque Country (UPV/EHU), 20008 San Sebastian, Spain; Environmental Epidemiology and Child Development Group, Biogipuzkoa Health Research Institute, Paseo Doctor Begiristain s/n, 20014 San Sebastian, Spain.
| | - Oscar Vegas
- Faculty of Psychology, University of the Basque Country (UPV/EHU), 20008 San Sebastian, Spain; Environmental Epidemiology and Child Development Group, Biogipuzkoa Health Research Institute, Paseo Doctor Begiristain s/n, 20014 San Sebastian, Spain
| | - Aitana Lertxundi
- Environmental Epidemiology and Child Development Group, Biogipuzkoa Health Research Institute, Paseo Doctor Begiristain s/n, 20014 San Sebastian, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, C/Monforte de Lemos 3-5, 28029 Madrid, Spain; Department of Preventive Medicine and Public Health, Faculty of Medicine, University of the Basque Country (UPV/EHU), 48940 Leioa, Spain
| | - Gonzalo García-Baquero
- Environmental Epidemiology and Child Development Group, Biogipuzkoa Health Research Institute, Paseo Doctor Begiristain s/n, 20014 San Sebastian, Spain; Faculty of Biology, University of Salamanca, Campus Miguel de Unamuno, Avda Licenciado Méndez Nieto s/n, 37007 Salamanca, Spain
| | - Jesus Ibarluzea
- Faculty of Psychology, University of the Basque Country (UPV/EHU), 20008 San Sebastian, Spain; Environmental Epidemiology and Child Development Group, Biogipuzkoa Health Research Institute, Paseo Doctor Begiristain s/n, 20014 San Sebastian, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, C/Monforte de Lemos 3-5, 28029 Madrid, Spain; Ministry of Health of the Basque Government, Sub-Directorate for Public Health and Addictions of Gipuzkoa, 20013 San Sebastian, Spain
| | - Ainara Andiarena
- Faculty of Psychology, University of the Basque Country (UPV/EHU), 20008 San Sebastian, Spain; Environmental Epidemiology and Child Development Group, Biogipuzkoa Health Research Institute, Paseo Doctor Begiristain s/n, 20014 San Sebastian, Spain
| | - Izaro Babarro
- Environmental Epidemiology and Child Development Group, Biogipuzkoa Health Research Institute, Paseo Doctor Begiristain s/n, 20014 San Sebastian, Spain; Faculty of Medicine and Nursing of the University of the Basque Country (UPV/EHU), 20014 Donostia/San Sebastian, Spain
| | - Mikel Subiza-Pérez
- Faculty of Psychology, University of the Basque Country (UPV/EHU), 20008 San Sebastian, Spain; Environmental Epidemiology and Child Development Group, Biogipuzkoa Health Research Institute, Paseo Doctor Begiristain s/n, 20014 San Sebastian, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, C/Monforte de Lemos 3-5, 28029 Madrid, Spain; Bradford Institute for Health Research, Bradford BD9 6RJ, UK
| | - Nerea Lertxundi
- Faculty of Psychology, University of the Basque Country (UPV/EHU), 20008 San Sebastian, Spain; Environmental Epidemiology and Child Development Group, Biogipuzkoa Health Research Institute, Paseo Doctor Begiristain s/n, 20014 San Sebastian, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, C/Monforte de Lemos 3-5, 28029 Madrid, Spain
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Román Villaizán ML, Seoane Sanz A, Sanz Cuesta T, Rodríguez Barrientos R, Alonso Safont T, Villaizán Pérez C, Praena Crespo M. Poor compliance with clinical practice guidelines in the management of asthma in primary care in the community of Madrid. An Pediatr (Barc) 2024; 101:84-94. [PMID: 39068038 DOI: 10.1016/j.anpede.2024.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 05/15/2024] [Indexed: 07/30/2024] Open
Abstract
INTRODUCTION Asthma is a common chronic disease in the paediatric age group that requires close follow-up. Clinical practice guidelines offer evidence-based recommendations to achieve adequate control of the disease. OBJECTIVE To assess the management of childhood asthma in the primary care setting in the Community of Madrid, and the adherence of health care professionals to guideline recommendations. To analyse the association of asthma management with age, the socioeconomic level of the catchment population and the workload of primary care centres. METHODS retrospective longitudinal study in patients aged 6-14 years newly diagnosed with asthma in primary care centres of the Community of Madrid in 2021. We analysed sociodemographic and clinical variables and the compliance with recommendations at the time of diagnosis and over 1 year of follow-up. The source of data was the electronic health record database of the primary care system. RESULTS We found a proportion of compliance with the recommendations upon diagnosis of the disease of 5.84%, with differences associated to the socioeconomic level of the catchment population (P = .033), and the pressure of care (P = .006). The proportion of compliance with recommendations during follow-up was 12.73%, with differences based on age (P = .01), socioeconomic level (P = 0.006) and centre workloads (P = .002). CONCLUSIONS Compliance with the recommendations of the main childhood asthma management guidelines in the primary care setting was low in the Community of Madrid. Strategies need to be implemented to improve the management of this disease and the adherence of professionals to the protocols developed for this purpose.
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Affiliation(s)
| | | | - Teresa Sanz Cuesta
- Unidad de Investigación, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
| | | | - Tamara Alonso Safont
- Dirección Técnica de Sistemas de Información Sanitaria, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
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Tejera-Vaquerizo A, Boada A, Puig S, Nagore E, Fernández-de-Misa R, Ferrándiz L, Conde-Taboada A, Castro E, Richarz NA, Paradela S, Llambrich Á, Salgüero I, Diago A, Samaniego E, Flórez Á, Segura S, Maldonado-Seral C, Coronel-Pérez IM, Tomás-Velázquez A, Rodríguez-Jiménez P, Mayor A, García-Doval I, Grau-Pérez M. [Translated article] Melanoma Registry of the Spanish Academy of Dermatology and Venereology (REGESMEL): Description and Data in its First Year of Operation. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:T663-T669. [PMID: 38821354 DOI: 10.1016/j.ad.2024.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/24/2024] [Accepted: 02/25/2024] [Indexed: 06/02/2024] Open
Abstract
INTRODUCTION The incidence of melanoma is rising in Spain. The prognostic stages of patients with melanoma are determined by various biological factors, such as tumor thickness, ulceration, or the presence of regional or distant metastases. The Spanish Academy of Dermatology and Venereology (AEDV) has encouraged the creation of a Spanish Melanoma Registry (REGESMEL) to evaluate other individual and health system-related factors that may impact the prognosis of patients with melanoma. The aim of this article is to introduce REGESMEL and provide basic descriptive data for its first year of operation. METHODS REGESMEL is a prospective, multicentre cohort of consecutive patients with invasive cutaneous melanoma that collects demographic and staging data as well as individual and healthcare-related baseline data. It also records the medical and surgical treatment received by patients. RESULTS A total of 450 cases of invasive cutaneous melanoma from 19 participant centres were included, with a predominance of thin melanomas≤1mm thick (54.7%), mainly located on the posterior trunk (35.2%). Selective sentinel lymph node biopsy was performed in 40.7% of cases. Most cases of melanoma were suspected by the patient (30.4%), or his/her dermatologist (29.6%). Patients received care mainly in public health centers (85.2%), with tele-dermatology resources being used in 21.6% of the cases. CONCLUSIONS The distribution of the pathological and demographic variables of melanoma cases is consistent with data from former studies. REGESMEL has already recruited patients from 15 Spanish provinces and given its potential representativeness, it renders the Registry as an important tool to address a wide range of research questions.
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Affiliation(s)
| | - A Boada
- Servicio de Dermatología, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - S Puig
- Servicio de Dermatología, Hospital Clínic de Barcelona, IDIBAPS, Universidad de Barcelona, Barcelona, Spain; Centro de investigación biomédica en red de enfermedades raras, CIBERER, Barcelona, Spain
| | - E Nagore
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, Spain
| | - R Fernández-de-Misa
- Servicio de Dermatología, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - L Ferrándiz
- Unidad de Melanoma, Servicio de Dermatología médico-quirúrgico, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - A Conde-Taboada
- Servicio de Dermatología, Hospital Clínico San Carlos, Madrid, Spain
| | - E Castro
- Servicio de Dermatología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - N A Richarz
- Servicio de Dermatología, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - S Paradela
- Servicio de Dermatología, Complexo Hospitalario A Coruña, A Coruña, Spain
| | - Á Llambrich
- Servicio de Dermatología, Hospital Universitario Son Llàtzer, Palma de Mallorca, Spain
| | - I Salgüero
- Servicio de Dermatología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - A Diago
- Servicio de Dermatología, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - E Samaniego
- Servicio de Dermatología, Complejo Asistencial Universitario de León, León, Spain
| | - Á Flórez
- Servicio de Dermatología, Complejo Hospitalario Universitario de Pontevedra, Grupo de Investigación DIPO, Instituto de Investigación Sanitaria Galicia Sur, SERGAS-UVIGO, Pontevedra, Spain
| | - S Segura
- Servicio de Dermatología, Hospital del Mar de Barcelona, Barcelona, Spain
| | - C Maldonado-Seral
- Servicio de Dermatología, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - I M Coronel-Pérez
- Servicio de Dermatología, Hospital Universitario Virgen de Valme de Sevilla, Sevilla, Spain
| | - A Tomás-Velázquez
- Servicio de Dermatología, Clínica Universidad de Navarra, Madrid, Spain
| | - P Rodríguez-Jiménez
- Servicio de Dermatología, Hospital Universitario La Princesa, Madrid, Spain; Servicio de Dermatología, Hospital Ruber Internacional, Madrid, Spain
| | - A Mayor
- Servicio de Dermatología, Hospital Universitario La Paz, Madrid, Spain
| | - I García-Doval
- Unidad de Investigación, Academia Española de Dermatología y Venereología, Madrid, Spain; Servicio de Dermatología, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - M Grau-Pérez
- Unidad de Investigación, Academia Española de Dermatología y Venereología, Madrid, Spain; Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.
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Tejera-Vaquerizo A, Boada A, Puig S, Nagore E, Fernández-de-Misa R, Ferrándiz L, Conde-Taboada A, Castro E, Richarz NA, Paradela S, Llambrich Á, Salgüero I, Diago A, Samaniego E, Flórez Á, Segura S, Maldonado-Seral C, Coronel-Pérez IM, Tomás-Velázquez A, Rodríguez-Jiménez P, Mayor A, García-Doval I, Grau-Pérez M. Melanoma Registry of the Spanish Academy of Dermatology and Venereology (REGESMEL): Description and Data in its First Year of Operation. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:663-669. [PMID: 38452890 DOI: 10.1016/j.ad.2024.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/24/2024] [Accepted: 02/25/2024] [Indexed: 03/09/2024] Open
Abstract
INTRODUCTION The incidence of melanoma is rising in Spain. The prognostic stages of patients with melanoma are determined by various biological factors, such as tumor thickness, ulceration, or the presence of regional or distant metastases. The Spanish Academy of Dermatology and Venereology (AEDV) has encouraged the creation of a Spanish Melanoma Registry (REGESMEL) to evaluate other individual and health system-related factors that may impact the prognosis of patients with melanoma. The aim of this article is to introduce REGESMEL and provide basic descriptive data for its first year of operation. METHODS REGESMEL is a prospective, multicentre cohort of consecutive patients with invasive cutaneous melanoma that collects demographic and staging data as well as individual and healthcare-related baseline data. It also records the medical and surgical treatment received by patients. RESULTS A total of 450 cases of invasive cutaneous melanoma from 19 participant centres were included, with a predominance of thin melanomas≤1mm thick (54.7%), mainly located on the posterior trunk (35.2%). Selective sentinel lymph node biopsy was performed in 40.7% of cases. Most cases of melanoma were suspected by the patient (30.4%), or his/her dermatologist (29.6%). Patients received care mainly in public health centers (85.2%), with tele-dermatology resources being used in 21.6% of the cases. CONCLUSIONS The distribution of the pathological and demographic variables of melanoma cases is consistent with data from former studies. REGESMEL has already recruited patients from 15 Spanish provinces and given its potential representativeness, it renders the Registry as an important tool to address a wide range of research questions.
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Affiliation(s)
| | - A Boada
- Servicio de Dermatología, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, España
| | - S Puig
- Servicio de Dermatología, Hospital Clínic de Barcelona, IDIBAPS, Universidad de Barcelona, Barcelona, España; Centro de investigación biomédica en red de enfermedades raras, CIBERER, Barcelona, España
| | - E Nagore
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
| | - R Fernández-de-Misa
- Servicio de Dermatología, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, España
| | - L Ferrándiz
- Unidad de Melanoma, Servicio de Dermatología médico-quirúrgico, Hospital Universitario Virgen Macarena, Sevilla, España
| | - A Conde-Taboada
- Servicio de Dermatología, Hospital Clínico San Carlos, Madrid, España
| | - E Castro
- Servicio de Dermatología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, España
| | - N A Richarz
- Servicio de Dermatología, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, España
| | - S Paradela
- Servicio de Dermatología, Complexo Hospitalario A Coruña, A Coruña, España
| | - Á Llambrich
- Servicio de Dermatología, Hospital Universitario Son Llàtzer, Palma de Mallorca, España
| | - I Salgüero
- Servicio de Dermatología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, España
| | - A Diago
- Servicio de Dermatología, Hospital Universitario Miguel Servet, Zaragoza, España
| | - E Samaniego
- Servicio de Dermatología, Complejo Asistencial Universitario de León, León, España
| | - Á Flórez
- Servicio de Dermatología, Complejo Hospitalario Universitario de Pontevedra, Grupo de Investigación DIPO, Instituto de Investigación Sanitaria Galicia Sur, SERGAS-UVIGO, Pontevedra, España
| | - S Segura
- Servicio de Dermatología, Hospital del Mar de Barcelona, Barcelona, España
| | - C Maldonado-Seral
- Servicio de Dermatología, Hospital Universitario Central de Asturias, Oviedo, España
| | - I M Coronel-Pérez
- Servicio de Dermatología, Hospital Universitario Virgen de Valme de Sevilla, Sevilla, España
| | - A Tomás-Velázquez
- Servicio de Dermatología, Clínica Universidad de Navarra, Madrid, España
| | - P Rodríguez-Jiménez
- Servicio de Dermatología, Hospital Universitario La Princesa, Madrid, España; Servicio de Dermatología, Hospital Ruber Internacional, Madrid, España
| | - A Mayor
- Servicio de Dermatología, Hospital Universitario La Paz, Madrid, España
| | - I García-Doval
- Unidad de Investigación, Academia Española de Dermatología y Venereología, Madrid, España; Servicio de Dermatología, Complexo Hospitalario Universitario de Vigo, Vigo, España
| | - M Grau-Pérez
- Unidad de Investigación, Academia Española de Dermatología y Venereología, Madrid, España; Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España.
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Rodoreda-Pallàs B, Torra Escarrer E, Sanahuja Juncadella J, Pampalona Cardona T, Solanas Bacardit N, Vilarrubias Calaf M. [Evaluation of a coding guide on social determinants of health in primary care consultations: A mixed study]. Aten Primaria 2024; 56:102878. [PMID: 38401205 PMCID: PMC10904901 DOI: 10.1016/j.aprim.2024.102878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 01/03/2024] [Indexed: 02/26/2024] Open
Abstract
OBJECTIVE To evaluate a coding guide for social determinants of health in primary care consultations as an effective tool in the professional's daily workflow. DESIGN Mixed sequential explanatory study. Formed by a quantitative part (experimental) and a qualitative part (descriptive-evaluative). LOCATION All the primary care teams of the Central Catalonia Management (32 teams). PARTICIPANTS AND SETTING All nursing, social work and medical professionals working in the 32 primary care teams of the Catalan Institute of Health in Central Catalonia from February 2023 to July 2023. METHODS A social determinants of health coding guide was developed. This guide was created in a multidisciplinary and multicenter manner. Purposive sampling. Quantitatively, the number of diagnoses recorded by the experimental group versus the control group was counted. Qualitatively, a thematic analysis was carried out from a socio-constructivist perspective. RESULTS The results were significant and satisfactory. Using a quantitative methodology, the effectiveness of the use of the guide was assessed. A significant increase in the use of the social determinants was observed in the intervention group vs. the control group, with a percentage of post-intervention use of 19.53% in the control group and 32.26% in the intervention group (P < .001). The number of diagnoses recorded increased from 312 to 1322 in the intervention group, while it remained the same in the control group. The main factors identified through qualitative methodology that may explain the effectiveness of the guideline were: 1) the effectiveness of the guideline among primary care professionals, 2) the appropriateness of the guideline by assessing its usefulness and practicality, 3) feasibility and 4) specific contributions to the improvement of the guideline. CONCLUSIONS The social determinants of health coding guide is effective, appropriate and can be implemented in the workflow of primary health care professionals for good recording of the social determinants of health.
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Affiliation(s)
- Berta Rodoreda-Pallàs
- Grup d'Investigació Promoció de la Salut en l' Àmbit Rural, Gerència d'Atenció Primària i a la Comunitat de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Barcelona, España; Centre d'Atenció Primària de Santpedor,EAP Navarcles/Sant Fruitós/Santpedor, Bages, Gerència d'Atenció Primària i a la Comunitat de la Catalunya Central, Institut Català de la Salut, Barcelona, España.
| | - Eva Torra Escarrer
- Centre d'Atenció Primària de Sant Vicenç de Castellet, EAP Sant Vicenç de Castellet, Bages, Gerència d'Atenció Primària i a la Comunitat de la Catalunya Central, Institut Català de la Salut, Barcelona, España
| | - Jaume Sanahuja Juncadella
- Centre d'Atenció Primària de Plaça Catalunya, EAP Plaça Catalunya, Bages, Gerència d'Atenció Primària i a la Comunitat de la Catalunya Central, Institut Català de la Salut, Barcelona, España
| | - Teresa Pampalona Cardona
- Centre d'Atenció Primària de Cardona, EAP Cardona, Bages, Gerència d'Atenció Primària i a la Comunitat de la Catalunya Central, Institut Català de la Salut, Barcelona, España
| | - Nuria Solanas Bacardit
- Centre d'Atenció Primària de Cardona, EAP Cardona, Bages, Gerència d'Atenció Primària i a la Comunitat de la Catalunya Central, Institut Català de la Salut, Barcelona, España
| | - Montserrat Vilarrubias Calaf
- Centre d'Atenció Primària de Anoia Rural, EAP Anoia Rural, Anoia, Gerència d'Atenció Primària i a la Comunitat de la Catalunya Central, Institut Català de la Salut, Barcelona, España
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Quesada JA, López-Pineda A, Orozco-Beltrán D, Carratalá-Munuera C, Barber-Vallés X, Gil-Guillén VF, Nouni-García R, Carbonell-Soliva Á. Diabetes mellitus as a cause of premature death in small areas of Spain by socioeconomic level from 2016 to 2020: A multiple-cause approach. Prim Care Diabetes 2024; 18:356-361. [PMID: 38514366 DOI: 10.1016/j.pcd.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/12/2024] [Accepted: 03/10/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVE This study aimed to assess premature mortality due to Diabetes in small areas of Spain between 2016 and 2020, and its relationship with socioeconomic level and the immediate cause of death. As a secondary objective, we evaluated the effect of the Covid 19 pandemic. METHODS This was an ecological study of premature mortality due to Diabetes from 2016 to 2020, with a focus on small areas. All deaths in people under 75 years of age due to Diabetes as the underlying cause were included RESULTS: The final sample comprised 7382 premature deaths in 5967 census tracts. Women living in census tracts with an high level of deprivation(RR=2.40) were at a significantly higher risk. Mortality from Diabetes increased with deprivation, especially people aged 0-54(RR=2.40). People with an immediate cause of death related to a circulatory disease, living in census tracts with an high level of deprivation(RR=3.86) was associated with a significantly greater risk of death with underlying Diabetes. When a disease of the circulatory system was recorded as the immediate cause of death, being 65-74 years (RR=71.01) was associated with a significantly higher risk of premature mortality. CONCLUSIONS Living in geographic areas with higher levels of socioeconomic deprivation is associated with a higher risk of premature death from Diabetes in Spain. This relationship has a greater impact on women, people under 54 years, and people at risk of death caused directly by diseases of the circulatory system. Premature mortality due to diabetes saw a modest increase in 2020.
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Affiliation(s)
- José A Quesada
- Clinical Medicine Department, School of Medicine, University of Miguel Hernández de Elche, Ctra. Nacional N-332 s/n, San Juan de Alicante 03550, Spain; Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS), San Juan de Alicante 03550, Spain
| | - Adriana López-Pineda
- Clinical Medicine Department, School of Medicine, University of Miguel Hernández de Elche, Ctra. Nacional N-332 s/n, San Juan de Alicante 03550, Spain; Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS), San Juan de Alicante 03550, Spain
| | - Domingo Orozco-Beltrán
- Clinical Medicine Department, School of Medicine, University of Miguel Hernández de Elche, Ctra. Nacional N-332 s/n, San Juan de Alicante 03550, Spain; Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS), San Juan de Alicante 03550, Spain
| | - Concepción Carratalá-Munuera
- Clinical Medicine Department, School of Medicine, University of Miguel Hernández de Elche, Ctra. Nacional N-332 s/n, San Juan de Alicante 03550, Spain; Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS), San Juan de Alicante 03550, Spain
| | - Xavier Barber-Vallés
- Center for Operations Research, University Miguel Hernández of Elche, Elche, Alicante, Spain
| | - Vicente F Gil-Guillén
- Clinical Medicine Department, School of Medicine, University of Miguel Hernández de Elche, Ctra. Nacional N-332 s/n, San Juan de Alicante 03550, Spain; Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS), San Juan de Alicante 03550, Spain; Primary care research center, Miguel Hernández University, Elche, Alicante, Spain; Institute of Health and Biomedical Research of Alicante, General University Hospital of Alicante. Diagnostic Center, Fifth floor. Pintor Baeza street, 12, Alicante 03110, Spain
| | - Rauf Nouni-García
- Clinical Medicine Department, School of Medicine, University of Miguel Hernández de Elche, Ctra. Nacional N-332 s/n, San Juan de Alicante 03550, Spain; Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS), San Juan de Alicante 03550, Spain; Institute of Health and Biomedical Research of Alicante, General University Hospital of Alicante. Diagnostic Center, Fifth floor. Pintor Baeza street, 12, Alicante 03110, Spain.
| | - Álvaro Carbonell-Soliva
- Clinical Medicine Department, School of Medicine, University of Miguel Hernández de Elche, Ctra. Nacional N-332 s/n, San Juan de Alicante 03550, Spain
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Bermúdez-Tamayo C, Negrín Hernández M, Alguacil J, Cantarero D, Carrasco-Portiño M, Casino G, García Calvente M, Hernán M, Posenato García L, Ruiz Cantero MT, Segura A, García Amez J, Juárez Herrera Y Cairo LA, March JC, Marcos-Marcos J, Mar J, Peiró R, Álvarez-Dardet C. [Gaceta Sanitaria in 2023. The show must go on. Goodbye and thanks]. GACETA SANITARIA 2024; 38:102390. [PMID: 38701664 DOI: 10.1016/j.gaceta.2024.102390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Affiliation(s)
- Clara Bermúdez-Tamayo
- Comité Editorial de Gaceta Sanitaria, España; CIBER de Epidemiología y Salud Pública (CIBERESP) , España; Escuela Andaluza de Salud Pública, Granada, España; Instituto de Investigación Biosanitaria, Granada, España.
| | - Miguel Negrín Hernández
- Comité Editorial de Gaceta Sanitaria, España; Departamento de Métodos Cuantitativos, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España
| | - Juan Alguacil
- Comité Editorial de Gaceta Sanitaria, España; Departamento de Sociología, Trabajo Social y Salud Pública, Universidad de Huelva, Huelva, España
| | - David Cantarero
- Comité Editorial de Gaceta Sanitaria, España; Departamento de Economía, Universidad de Cantabria, Santander, España
| | - Mercedes Carrasco-Portiño
- Comité Editorial de Gaceta Sanitaria, España; Departamento Obstetricia y Puericultura, Universidad de Concepción, Concepción, Chile; Grupo de Investigación en Salud Pública, Universidad de Alicante, Alicante, España
| | - Gonzalo Casino
- Comité Editorial de Gaceta Sanitaria, España; Centro Cochrane Iberoamericano, IR Sant Pau, Barcelona, España; Departamento de Comunicación, Universidad Pompeu Fabra, Barcelona, España
| | - Mar García Calvente
- Comité Editorial de Gaceta Sanitaria, España; Escuela Andaluza de Salud Pública, Granada, España; Instituto de Investigación Biosanitaria, Granada, España
| | - Mariano Hernán
- Comité Editorial de Gaceta Sanitaria, España; Escuela Andaluza de Salud Pública, Granada, España; Instituto de Investigación Biosanitaria, Granada, España
| | - Leila Posenato García
- Comité Editorial de Gaceta Sanitaria, España; Instituto de Pesquisa Econômica Aplicada, Brasilia, Brasil
| | - María Teresa Ruiz Cantero
- Comité Editorial de Gaceta Sanitaria, España; CIBER de Epidemiología y Salud Pública (CIBERESP) , España; Grupo de Investigación en Salud Pública, Universidad de Alicante, Alicante, España
| | - Andreu Segura
- Comité Editorial de Gaceta Sanitaria, España; Comité de Bioética de Cataluña, Barcelona, España
| | - Javier García Amez
- Comité Editorial de Gaceta Sanitaria, España; Departamento de Ciencias Jurídicas Básicas, Universidad de Oviedo, Oviedo, España
| | | | - Joan Carles March
- Comité Editorial de Gaceta Sanitaria, España; Escuela Andaluza de Salud Pública, Granada, España; Instituto de Investigación Biosanitaria, Granada, España
| | - Jorge Marcos-Marcos
- Comité Editorial de Gaceta Sanitaria, España; Departamento de Psicología de la Salud, Universidad de Alicante, Alicante, España
| | - Javier Mar
- SESPAS de Gaceta Sanitaria, España; Hospital Alto Deba, Arrasate (Gipuzkoa), España
| | - Rosana Peiró
- CIBER de Epidemiología y Salud Pública (CIBERESP) , España; Consejo Asesor de Gaceta Sanitaria, España; Dirección General de Salud Pública, Conselleria de Sanidad, Generalitat Valenciana, Valencia, España
| | - Carlos Álvarez-Dardet
- Comité Editorial de Gaceta Sanitaria, España; CIBER de Epidemiología y Salud Pública (CIBERESP) , España; Grupo de Investigación en Salud Pública, Universidad de Alicante, Alicante, España
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Hernáez L, Zoni AC, Domínguez-Berjón MF, Esteban-Vasallo MD, Domínguez-González C, Serrano P. Prevalence of Steinert's Myotonic Dystrophy and Utilization of Healthcare Services: A Population-Based Cross-Sectional Study. Healthcare (Basel) 2024; 12:838. [PMID: 38667600 PMCID: PMC11050373 DOI: 10.3390/healthcare12080838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/01/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
Myotonic dystrophy type I (MDI) is the most common muscular dystrophy in adults. The main objectives of this study were to determine the prevalence of MDI in the Community of Madrid (CM) (Spain) and to analyze the use of public healthcare services; a population-based cross-sectional descriptive study was carried out on patients with MDI in CM and data were obtained from a population-based registry (2010-2017). A total of 1101 patients were studied (49.1% women) with average age of 47.8 years; the prevalence of MDI was 14.4/100,000 inhabitants. In the women lineal regression model for hospital admissions, being in the fourth quartile of the deprivation index, was a risk factor (regression coef (rc): 0.80; 95%CI 0.25-1.37). In the overall multiple lineal regression model for primary health care (PHC) attendance, being a woman increased the probability of having a higher number of consultations (rc: 3.99; 95%CI: 3.95-5.04), as did being in the fourth quartile of the deprivation index (rc: 2.10; 95%CI: 0.58-3.63); having received influenza vaccines was a protective factor (rc: -0.46; 95%CI: -0.66-(-0.25)). The prevalence of MDI in the CM is high compared to other settings. Moreover, having any level of risk stratification of becoming ill (high, medium or low) has a positive association with increased PHC consultations and hospital admissions.
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Affiliation(s)
- Leticia Hernáez
- Nursing Department, Faculty of Medicine, Universidad Autónoma de Madrid, 28040 Madrid, Spain; (L.H.); (P.S.)
| | - Ana Clara Zoni
- Subdirección General de Información Sanitaria, Ministry of Health, 28071 Madrid, Spain
| | - María-Felicitas Domínguez-Berjón
- Technical Unit for Health Status Report and Registries, Subdirección General de Vigilancia en Salud Pública, Dirección General de Salud Pública, 28040 Madrid, Spain; (M.-F.D.-B.); (M.D.E.-V.)
| | - María D. Esteban-Vasallo
- Technical Unit for Health Status Report and Registries, Subdirección General de Vigilancia en Salud Pública, Dirección General de Salud Pública, 28040 Madrid, Spain; (M.-F.D.-B.); (M.D.E.-V.)
| | - Cristina Domínguez-González
- Department of Neurology, Research Institute (imas12), Hospital Universitario 12 de Octubre, 28041 Madrid, Spain;
| | - Pilar Serrano
- Nursing Department, Faculty of Medicine, Universidad Autónoma de Madrid, 28040 Madrid, Spain; (L.H.); (P.S.)
- Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), 28222 Majadahonda, Spain
- Instituro Interuniversitario “Investigación Avanzada sobre Evaluación de la Ciencia y la Universidad” (INAECU), 28903 Madrid, Spain
- Grupo de Investigación UAM “Vulnerabilidad Social, Cuidados y Salud” (GIVulneSCare), 28040 Madrid, Spain
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9
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Scheer C, Plans-Beriso E, Pastor-Barriuso R, Ortolá R, Sotos-Prieto M, Cabañas-Sánchez V, Gullón P, Ojeda Sánchez C, Ramis R, Fernández-Navarro P, Rodríguez-Artalejo F, García-Esquinas E. Exposure to green spaces, cardiovascular risk biomarkers and incident cardiovascular disease in older adults: The Seniors-Enrica II cohort. ENVIRONMENT INTERNATIONAL 2024; 185:108570. [PMID: 38484611 DOI: 10.1016/j.envint.2024.108570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 02/07/2024] [Accepted: 03/07/2024] [Indexed: 03/26/2024]
Abstract
INTRODUCTION The impact of residential green spaces on cardiovascular health in older adults remains uncertain. METHODS Cohort study involving 2114 adults aged ≥ 65 years without cardiovascular disease (CVD), residing in five dense municipalities (Prince et al., 2015) of the Madrid region and with detailed characterization of their socioeconomic background, health behaviors, CVD biological risk factors, and mental, physical, and cognitive health. Greenness exposure was measured using the Normalized Difference Vegetation Index (NDVI) at varying distances from participants' homes. Traffic exposure, neighborhood environment, neighborhood walkability, and socioeconomic deprivation at the census level were also assessed. Serum N-terminal pro-B-type natriuretic peptide (NT-ProBNP), high-sensitivity troponin T (hs-TnT), interleukin 6 (IL-6), and Growth Differentiation Factor 15 (GDF-15) were measured at baseline, and incident CVD events identified through electronic medical records (International Classification of Primary Care-2 codes K74, K75, K77, K90, and K92). RESULTS After adjusting for sex, age, educational attainment, financial hardship and socioeconomic deprivation at the census level, an interquartile range (IQR) increase in NDVI at 250, 500, 750, and 1000 m around participants' homes was associated with mean differences in ProBNP of -5.56 % (95 %CI: -9.77; -1.35), -5.05 % (-9.58; -0.53), -4.24 % (-8.19, -0.19), and -4.16 % (-7.59; -0.74), respectively; and mean differences in hs-TnT among diabetic participants of -8.03 % (95 %CI: -13.30; -2.77), -9.52 % (-16.08; -2.96), -8.05 % (-13.94, -2.16) and -5.56 % (-10.75; -0.54), respectively. Of similar magnitude, although only statistically significant at 250 and 500 m, were the observed lower IL-6 levels with increasing greenness. GDF-15 levels were independent of NDVI. In prospective analyses (median follow-up 6.29 years), an IQR increase in residential greenness at 500, 750, and 1000 m was associated with a lower risk of incident CVD. The variables that contributed most to the apparent beneficial effects of greenness on CVD were lower exposure to traffic, improved cardiovascular risk factors, and enhanced physical performance. Additionally, neighborhood walkability and increased physical activity were notable contributors among individuals with diabetes. CONCLUSION Increased exposure to residential green space was associated with a moderate reduction in CVD risk in older adults residing in densely populated areas.
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Affiliation(s)
- Cara Scheer
- Fulda University of Applied Sciences. Fulda, Germany
| | - Elena Plans-Beriso
- Public Health and Epidemiology Research Group, School of Medicine, Universidad de Alcala, 28871 Madrid, Spain; Department of Chronic Diseases, National Center of Epidemiology, Carlos III Health Institute, Madrid, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Roberto Pastor-Barriuso
- Department of Chronic Diseases, National Center of Epidemiology, Carlos III Health Institute, Madrid, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Rosario Ortolá
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid. Madrid, Spain/ CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Mercedes Sotos-Prieto
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid. Madrid, Spain/ CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA; IMDEA Food Institute. CEI UAM+CSIC, Madrid, Spain
| | - Verónica Cabañas-Sánchez
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid. Madrid, Spain/ CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Pedro Gullón
- Department of Surgery, Social and Medical Sciences. School of Medicine and Health Sciences, Universidad de Alcala. Alcala de Henares, Madrid, Spain; Centre for Urban Research, RMIT University, Melbourne, Australia
| | | | - Rebeca Ramis
- Department of Chronic Diseases, National Center of Epidemiology, Carlos III Health Institute, Madrid, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Pablo Fernández-Navarro
- Department of Chronic Diseases, National Center of Epidemiology, Carlos III Health Institute, Madrid, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Fernando Rodríguez-Artalejo
- Department of Chronic Diseases, National Center of Epidemiology, Carlos III Health Institute, Madrid, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain; IMDEA Food Institute. CEI UAM+CSIC, Madrid, Spain
| | - Esther García-Esquinas
- Department of Chronic Diseases, National Center of Epidemiology, Carlos III Health Institute, Madrid, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.
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10
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Del Río SG, Plans-Beriso E, Ramis R, Ortolá R, Pastor R, Sotos-Prieto M, Castelló A, Requena RO, Moleón JJJ, Félix BMF, Muriel A, Miret M, Mateos JLA, Choi YH, Rodríguez-Artalejo F, Fernández-Navarro P, García-Esquinas E. Exposure to residential traffic and trajectories of unhealthy ageing: results from a nationally-representative cohort of older adults. Environ Health 2024; 23:15. [PMID: 38303067 PMCID: PMC10832178 DOI: 10.1186/s12940-024-01057-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 01/22/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND Traffic exposure has been associated with biomarkers of increased biological ageing, age-related chronic morbidities, and increased respiratory, cardiovascular, and all-cause mortality. Whether it is associated with functional impairments and unhealthy ageing trajectories is unknown. METHODS Nationally representative population-based cohort with 3,126 community-dwelling individuals aged ≥60 years who contributed 8,291 biannual visits over a 10 year period. Unhealthy ageing was estimated with a deficit accumulation index (DAI) based on the number and severity of 52 health deficits, including 22 objectively-measured impairments in physical and cognitive functioning. Differences in DAI at each follow-up across quintiles of residential traffic density (RTD) at 50 and 100 meters, and closest distance to a petrol station, were estimated using flexible marginal structural models with inverse probability of censoring weights. Models were adjusted for sociodemographic and time-varying lifestyle factors, social deprivation index at the census tract and residential exposure to natural spaces. RESULTS At baseline, the mean (SD) age and DAI score of the participants were 69.0 (6.6) years and 17.02 (11.0) %, and 54.0% were women. The median (IQR) RTD at 50 and 100 meters were 77 (31-467) and 509 (182-1802) vehicles/day, and the mean (SD) distance to the nearest petrol station of 962 (1317) meters. The average increase in DAI (95%CI) for participants in quintiles Q2-Q5 (vs Q1) of RTD at 50 meters was of 1.51 (0.50, 2.53), 0.98 (-0.05, 2.01), 2.20 (1.18, 3.21) and 1.98 (0.90, 3.05), respectively. Consistent findings were observed at 100 meters. By domains, most of the deficits accumulated with increased RTD were of a functional nature, although RTD at 50 meters was also associated with worse self-reported health, increased vitality problems and higher incidence of chronic morbidities. Living closer to a petrol station was associated with a higher incidence of functional impairments and chronic morbidities. CONCLUSIONS Exposure to nearby residential traffic is associated with accelerated trajectories of unhealthy ageing. Diminishing traffic pollution should become a priority intervention for adding healthy years to life in the old age.
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Affiliation(s)
- Sergio Gómez Del Río
- Department of Preventive Medicine, Hospital Central de la Cruz Roja San José y Santa Adela, Madrid, Spain
| | - Elena Plans-Beriso
- Department of Chronic Diseases, National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain
| | - Rebeca Ramis
- Department of Chronic Diseases, National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology, Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Madrid, Spain
| | - Rosario Ortolá
- Consortium for Biomedical Research in Epidemiology, Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Madrid, Spain
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Roberto Pastor
- Department of Chronic Diseases, National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology, Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Madrid, Spain
| | - Mercedes Sotos-Prieto
- Consortium for Biomedical Research in Epidemiology, Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Madrid, Spain
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- IMDEA-Food Institute (CEI UAM+CSIC), Madrid, Spain
| | - Adela Castelló
- Department of Chronic Diseases, National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology, Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Madrid, Spain
| | - Rocío Olmedo Requena
- Consortium for Biomedical Research in Epidemiology, Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Madrid, Spain
- Department of Preventive Medicine and Public Health, School of Medicine, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria ibs. GRANADA, Granada, Spain
| | - José Juan Jiménez Moleón
- Consortium for Biomedical Research in Epidemiology, Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Madrid, Spain
- Department of Preventive Medicine and Public Health, School of Medicine, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria ibs. GRANADA, Granada, Spain
| | - Borja María Fernández Félix
- Consortium for Biomedical Research in Epidemiology, Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Madrid, Spain
- Clinical Biostatistics Unit, Hospital Ramón y Cajal (IRYCIS), Madrid, Spain
| | - Alfonso Muriel
- Consortium for Biomedical Research in Epidemiology, Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Madrid, Spain
- Clinical Biostatistics Unit, Hospital Ramón y Cajal (IRYCIS), Madrid, Spain
- Department of Nursery and Physiotherapy, Universidad de Alcalá, Madrid, Spain
| | - Marta Miret
- Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain
- Consortium for Biomedical Research in Mental Health (CIBER en Salud Mental - CIBERSAM), Madrid, Spain
| | - Jose Luis Ayuso Mateos
- Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain
- Consortium for Biomedical Research in Mental Health (CIBER en Salud Mental - CIBERSAM), Madrid, Spain
- Department of Psychiatry, Hospital Universitario de La Princesa, Madrid, Spain
| | - Yoon-Hyeong Choi
- School of Health and Environmental Science, College of Health Science, Korea University, Seoul, Korea
| | - Fernando Rodríguez-Artalejo
- Consortium for Biomedical Research in Epidemiology, Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Madrid, Spain
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- IMDEA-Food Institute (CEI UAM+CSIC), Madrid, Spain
| | - Pablo Fernández-Navarro
- Department of Chronic Diseases, National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain.
- Consortium for Biomedical Research in Epidemiology, Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Madrid, Spain.
| | - Esther García-Esquinas
- Department of Chronic Diseases, National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain.
- Consortium for Biomedical Research in Epidemiology, Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Madrid, Spain.
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11
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Sebastian-Valles F, Martínez-Alfonso J, Arranz Martin JA, Jiménez-Díaz J, Hernando Alday I, Navas-Moreno V, Joya TA, Fandiño García MDM, Román Gómez GL, Garai Hierro J, Lander Lobariñas LE, Martínez de Icaya P, Sampedro-Nuñez MA, Martínez-Vizcaíno V, Marazuela M. Impact of socioeconomic status on chronic control and complications of type 1 diabetes mellitus in users of glucose flash systems: a follow-up study. BMC Med 2024; 22:37. [PMID: 38273326 PMCID: PMC10809494 DOI: 10.1186/s12916-024-03254-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 01/10/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND This study investigates the association between socioeconomic status (SES) and glycemic control in individuals with type 1 diabetes (T1D) using flash glucose monitoring (FGM) devices within a public health system where these technologies are freely available and utilized according to recommended guidelines. METHODS A follow-up study of 1060 adults (mean age 47.4 ± 15.0 years, 49.0% women) with T1D, receiving care at three Spanish university hospitals that regularly employ the FGM system. SES was assessed using the Spanish Deprivation Index and the average annual net income per person. Glycemic data were collected over a 14-day follow-up period, including baseline glycated hemoglobin (HbA1c) levels prior to sensor placement, the last available HbA1c levels, and FGM-derived glucose metrics. Individuals with sensor usage time < 70% were excluded. Chronic micro and macrovascular complications related to diabetes were documented. Regression models, adjusted for clinical variables, were employed to determine the impact of SES on optimal sensor control (defined as time in range (TIR) ≥ 70% with time below range < 4%) and disease complications. RESULTS The average follow-up was of 2 years. The mean TIR and the percentage of individuals with optimal control were higher in individuals in the highest SES quartile (64.9% ± 17.8% and 27.9%, respectively) compared to those in the lowest SES quartile (57.8 ± 17.4% and 12.1%) (p < 0.001). Regression models showed a higher risk of suboptimal control (OR 2.27, p < 0.001) and ischemic heart disease and/or stroke (OR 3.59, p = 0.005) in the lowest SES quartile. No association was observed between SES and the risk of diabetic nephropathy and retinopathy. FGM system improved HbA1c levels across all SES quartiles. Although individuals in the highest SES quartile still achieved a significantly lower value at the end of the follow-up 55 mmol/mol (7.2%) compared to those in the lowest SES quartile 60 mmol/mol (7.6%) (p < 0.001), the significant disparities in this parameter between the various SES groups were significantly reduced after FGM technology use. CONCLUSIONS Socioeconomic status plays a significant role in glycemic control and complications in individuals with T1D, extending beyond access to technology and its proper utilization. The free utilization of FGM technology helps alleviate the impact of social inequalities on glycemic control.
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Affiliation(s)
- Fernando Sebastian-Valles
- Department of Endocrinology and Nutrition, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria de La Princesa, Universidad Autónoma de Madrid, 28006, Madrid, Spain.
| | - Julia Martínez-Alfonso
- Department of Family and Community Medicine, Centro de Salud Daroca, 28006, Madrid, Spain
| | - Jose Alfonso Arranz Martin
- Department of Endocrinology and Nutrition, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria de La Princesa, Universidad Autónoma de Madrid, 28006, Madrid, Spain
| | - Jessica Jiménez-Díaz
- Department of Endocrinology and Nutrition, Hospital Universitario Severo Ochoa, Leganés, 28194, Madrid, Spain
| | - Iñigo Hernando Alday
- Department of Endocrinology and Nutrition, Hospital Universitario Basurto, 48013, Bilbao, Spain
| | - Victor Navas-Moreno
- Department of Endocrinology and Nutrition, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria de La Princesa, Universidad Autónoma de Madrid, 28006, Madrid, Spain
| | - Teresa Armenta Joya
- Department of Endocrinology and Nutrition, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria de La Princesa, Universidad Autónoma de Madrid, 28006, Madrid, Spain
| | | | - Gisela Liz Román Gómez
- Department of Endocrinology and Nutrition, Hospital Universitario Severo Ochoa, Leganés, 28194, Madrid, Spain
| | - Jon Garai Hierro
- Department of Endocrinology and Nutrition, Hospital Universitario Basurto, 48013, Bilbao, Spain
| | | | | | - Miguel Antonio Sampedro-Nuñez
- Department of Endocrinology and Nutrition, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria de La Princesa, Universidad Autónoma de Madrid, 28006, Madrid, Spain
| | - Vicente Martínez-Vizcaíno
- Health and Social Care Research Center, Universidad de Castilla-La Mancha, 16071, Cuenca, Spain
- Facultad de Ciencias de La Salud, Universidad Autónoma de Chile, Talca, Chile
| | - Mónica Marazuela
- Department of Endocrinology and Nutrition, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria de La Princesa, Universidad Autónoma de Madrid, 28006, Madrid, Spain
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12
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Berenguer J, Calvo-Alcántara MJ, Alvaro-Meca A, Estévez JC, Basanta M, Ruiz S, Matáix ÁL, Bienzóbas C, Cosano L, Silva AP, Salas P, Gullón P, Franco M, Arribas JR, Molero JM, Hernán MA. Three Years of the Coronavirus Disease 2019 Pandemic in a European Region: A Population-Based Longitudinal Assessment in Madrid Between 2020 and 2022. Open Forum Infect Dis 2024; 11:ofad635. [PMID: 38173846 PMCID: PMC10763997 DOI: 10.1093/ofid/ofad635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/13/2023] [Indexed: 01/05/2024] Open
Abstract
Background Our objective was to assess the health impact of coronavirus disease 2019 (COVID-19) during 2020-2022 in the Madrid region. Methods We included all individuals registered in the Madrid Health System Registry as of 31 December 2019, and followed them until 31 December 2022. Using a unique personal identifier, we linked the databases of primary care, hospitals, pharmacies, certified laboratories performing diagnostic tests, vaccines, and mortality. Results Of 6 833 423 individuals, 21.4% had a confirmed COVID-19 diagnosis, and 1.5% had a COVID-19 hospitalization (primary diagnosis). Thirty-day mortality was 1.6% for confirmed COVID-19 (from 11.4% in first semester 2020 to 0.4% in first semester 2022). Thirty-day mortality was 10.8% for COVID-19 hospitalizations (from 14.0% in first semester 2020 to 6.0% in second semester 2022). There were 24 073 deaths within 30 days of a confirmed COVID-19 diagnosis. Advanced age, male sex, higher socioeconomic deprivation, and comorbidities were associated with higher mortality. Conclusions By linking administrative and clinical databases, we characterized the burden of the COVID-19 pandemic in Madrid over 3 years. Our analysis proposes a high-level framework for comparisons of the burden of COVID-19 across areas worldwide.
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Affiliation(s)
- Juan Berenguer
- Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
| | | | - Alejandro Alvaro-Meca
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
- Medicina Preventiva y Salud Pública, Universidad Rey Juan Carlos, Madrid, Spain
| | - José C Estévez
- Gerencia Asistencial de Atención Primaria, Madrid, Spain
| | - Miguel Basanta
- Dirección General de Sistemas de Información y Equipamientos Sanitarios, Madrid, Spain
| | - Sergio Ruiz
- Gerencia Asistencial de Atención Primaria, Madrid, Spain
| | - Ángel L Matáix
- Subdirección General de Farmacia y Productos Sanitarios, Madrid, Spain
| | - César Bienzóbas
- Dirección General de Inspección y Ordenación Sanitaria, Madrid, Spain
| | - Lourdes Cosano
- Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Aura P Silva
- Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Pilar Salas
- Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Pedro Gullón
- Departamento de Cirugía, Ciencias Médicas y Sociales, Grupo de Investigación en Epidemiología y Salud Pública, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain
| | - Manuel Franco
- Departamento de Cirugía, Ciencias Médicas y Sociales, Grupo de Investigación en Epidemiología y Salud Pública, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain
| | - José R Arribas
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
- Infectious Diseases, Internal Medicine, Hospital Universitario La Paz, Madrid, Spain
- Instituto de Investigación Hospital Universitario La Paz, Madrid, Spain
- Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Miguel A Hernán
- CAUSALab, Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
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Zamanillo-Campos R, Zaforteza Dezcallar M, Boronat Moreiro MA, Leiva Rus A, Ripoll Amengual J, Konieczna J, Fiol-deRoque MA, Ricci-Cabello I. Non-adherence to non-insulin glucose-lowering drugs: Prevalence, predictors and impact on glycemic control and insulin initiation. A longitudinal cohort study in a large primary care database in Spain. Eur J Gen Pract 2023; 29:2268838. [PMID: 37874585 PMCID: PMC10990259 DOI: 10.1080/13814788.2023.2268838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 10/03/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND A better understanding of patient non-adherence to type 2 diabetes medication is needed to design effective interventions to address this issue. OBJECTIVES (1) To estimate the prevalence of non-adherence to diabetes medication; (2) to examine its impact on glycemic control and insulin initiation; (3) to develop and validate a prediction model of non-adherence. METHODS We conducted a longitudinal cohort study based on data from electronic health records. We included adult patients registered within the Health Service of the Balearic Islands (Spain) starting a new prescription of a non-insulin glucose-lowering drug between January 2016 and December 2018. We calculated non-adherence at 12 months follow-up, defined as medication possession ratio (MPR) ≤ 80%. We fitted multivariable regression models to examine the association between non-adherence and glycemic control and insulin initiation and identified predictors of non-adherence. RESULTS Of 18,119 patients identified, after 12 months follow-up, 5,740 (31.68%) were non-adherent. Compared with non-adherent, adherent patients presented lower HbA1c levels (mean difference = -0.32%; 95%CI = -0.38%; -0.27%) and were less likely to initiate insulin (aOR = 0.77; 95%CI = 0.63; 0.94). A predictive model explained 22.3% of the variation and presented a satisfactory performance (AUC = 0.721; Brier score = 0.177). The most important predictors of non-adherence were: non-Spanish nationality, currently working, low adherence to previous drugs, taking biguanides, smoker and absence of hypertension. CONCLUSION Around one-third of the patients do not adhere to their non-insulin glucose-lowering drugs. More research is needed to optimise the performance of the predicting model before considering its implementation in routine clinical practice.
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Affiliation(s)
- Rocío Zamanillo-Campos
- Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitari Son Espases, Palma, Spain
- Primary Care Research Unit of Mallorca, Balearic Islands Health Service, Palma, Spain
| | | | | | - Alfonso Leiva Rus
- Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitari Son Espases, Palma, Spain
- Primary Care Research Unit of Mallorca, Balearic Islands Health Service, Palma, Spain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS, RD21/0016/0005), Barcelona, Spain
| | - Joana Ripoll Amengual
- Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitari Son Espases, Palma, Spain
- Primary Care Research Unit of Mallorca, Balearic Islands Health Service, Palma, Spain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS, RD21/0016/0005), Barcelona, Spain
| | - Jadwiga Konieczna
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Madrid, Spain
- Research Group on Nutritional Epidemiology & Cardiovascular Physiopathology (NUTRECOR), Health Research Institute of the Balearic Islands (IdISBa), University Hospital Son Espases (HUSE), Palma de Mallorca, Spain
| | - Maria Antonia Fiol-deRoque
- Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitari Son Espases, Palma, Spain
- Primary Care Research Unit of Mallorca, Balearic Islands Health Service, Palma, Spain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS, RD21/0016/0005), Barcelona, Spain
| | - Ignacio Ricci-Cabello
- Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitari Son Espases, Palma, Spain
- Primary Care Research Unit of Mallorca, Balearic Islands Health Service, Palma, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Ijalba Martínez M, Lasheras Carbajo MD, Santos Sanz S, Gómez Barroso D. Acceptance and socioeconomic inequalities in meningococcal B vaccination in the community of Madrid prior to its inclusion in the immunization schedule. An Pediatr (Barc) 2023; 99:393-402. [PMID: 38016859 DOI: 10.1016/j.anpede.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/23/2023] [Indexed: 11/30/2023] Open
Abstract
INTRODUCTION The main preventive measure against invasive meningococcal disease is vaccination. The aim of our study was to evaluate the acceptability of the meningococcal B (MenB) vaccine and socioeconomic inequalities in the access to the vaccine in the Community of Madrid in the period prior to its introduction in the immunization schedule. MATERIALS AND METHODS We conducted an observational and ecological descriptive study in the cohort of children born between 2016 and 2019 using population-based electronic records. We calculated the vaccination coverage and analysed factors associated with vaccination status, determined the spatial distribution of vaccination coverage and the deprivation index (DI) and assessed the association between them by means of spatial regression. RESULTS We observed an increasing trend in primary vaccination coverage, from 44% in the cohort born in 2016 to 68% in the 2019 cohort. We found a statistically significant association between vaccination status and the DI (OR of primary vaccination in areas with DI5 compared to areas with DP1, 0.38; 95% confidence interval, 0.39-0.50; P<.001). The spatial analysis showed an inverse correlation between the DI and vaccination coverage. CONCLUSIONS The rise in the coverages of the MenB vaccine shows acceptance by the population. The association between socioeconomic level and vaccination coverage confirms the existence of health inequality and underlines the importance including this vaccine in the immunization schedule.
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Affiliation(s)
- Marta Ijalba Martínez
- Servicio de Medicina Preventiva, Hospital Universitario de Cruces, Barakaldo, Bizkaia, Spain.
| | - María Dolores Lasheras Carbajo
- Servicio de Prevención de la Enfermedad, Dirección General de Salud Pública, Consejería de Sanidad de Madrid, Madrid, Spain
| | - Sara Santos Sanz
- Servicio de Prevención de la Enfermedad, Dirección General de Salud Pública, Consejería de Sanidad de Madrid, Madrid, Spain
| | - Diana Gómez Barroso
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
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Alvarez-Galvez J, Ortega-Martin E, Ramos-Fiol B, Suarez-Lledo V, Carretero-Bravo J. Epidemiology, mortality, and health service use of local-level multimorbidity patterns in South Spain. Nat Commun 2023; 14:7689. [PMID: 38001107 PMCID: PMC10673852 DOI: 10.1038/s41467-023-43569-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023] Open
Abstract
Multimorbidity -understood as the occurrence of chronic diseases together- represents a major challenge for healthcare systems due to its impact on disability, quality of life, increased use of services and mortality. However, despite the global need to address this health problem, evidence is still needed to advance our understanding of its clinical and social implications. Our study aims to characterise multimorbidity patterns in a dataset of 1,375,068 patients residing in southern Spain. Combining LCA techniques and geographic information, together with service use, mortality, and socioeconomic data, 25 chronicity profiles were identified and subsequently characterised by sex and age. The present study has led us to several findings that take a step forward in this field of knowledge. Specifically, we contribute to the identification of an extensive range of at-risk groups. Moreover, our study reveals that the complexity of multimorbidity patterns escalates at a faster rate and is associated with a poorer prognosis in local areas characterised by lower socioeconomic status. These results emphasize the persistence of social inequalities in multimorbidity, highlighting the need for targeted interventions to mitigate the impact on patients' quality of life, healthcare utilisation, and mortality rates.
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Affiliation(s)
- Javier Alvarez-Galvez
- Department of General Economy (Health Sociology area), Faculty of Nursing and Physiotherapy, University of Cadiz, Cadiz, Spain.
- Computational Social Science DataLab, University Institute for Sustainable Social Development, University of Cádiz, Jerez de la Frontera, Spain.
- Biomedical Research and Innovation Institute of Cadiz (INiBICA), Hospital Puerta del Mar, Cadiz, Spain.
| | - Esther Ortega-Martin
- Department of General Economy (Health Sociology area), Faculty of Nursing and Physiotherapy, University of Cadiz, Cadiz, Spain
- Computational Social Science DataLab, University Institute for Sustainable Social Development, University of Cádiz, Jerez de la Frontera, Spain
| | - Begoña Ramos-Fiol
- Department of General Economy (Health Sociology area), Faculty of Nursing and Physiotherapy, University of Cadiz, Cadiz, Spain
- Computational Social Science DataLab, University Institute for Sustainable Social Development, University of Cádiz, Jerez de la Frontera, Spain
| | - Victor Suarez-Lledo
- Computational Social Science DataLab, University Institute for Sustainable Social Development, University of Cádiz, Jerez de la Frontera, Spain
- Department of Sociology, University of Granada, Granada, Spain
| | - Jesus Carretero-Bravo
- Department of General Economy (Health Sociology area), Faculty of Nursing and Physiotherapy, University of Cadiz, Cadiz, Spain
- Computational Social Science DataLab, University Institute for Sustainable Social Development, University of Cádiz, Jerez de la Frontera, Spain
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16
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Evangelidou S, Cruz A, Osorio Y, Sequeira-Aymar E, Gonçalves AQ, Camps-Vila L, Monclús-González MM, Cuxart-Graell A, Revuelta-Muñoz EM, Busquet-Solé N, Sarriegui-Domínguez S, Casellas A, Dalmau Llorca MR, Aguilar Martín C, Requena-Mendez A. Screening and routine diagnosis of mental disorders among migrants in primary care: A cross-sectional study. J Migr Health 2023; 8:100205. [PMID: 38047139 PMCID: PMC10692454 DOI: 10.1016/j.jmh.2023.100205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/26/2023] [Accepted: 11/04/2023] [Indexed: 12/05/2023] Open
Abstract
Background Migrants in host countries are at risk for the development of mental health conditions. The two aims of the study were to describe routine diagnoses of mental disorders among migrant patients at primary healthcare level and the associated risk factors, and to test the utility of an innovative migrant mental health assessment by evaluating whether the health professionals followed the recommendations proposed by the clinical decision support system (CDSS) tool. Methods A cross-sectional study was carried out in eight primary care centres (PCCs) in four non-randomly selected health regions of Catalonia, Spain from March to December 2018. Routine health data and mental health diagnoses based on the International Classification of Diseases (10th edition), including mental, behavioural and neuro developmental disorders (F01-F99), symptoms and signs involving emotional state (R45), and sleep disorders (G47), were extracted from the electronic health records. The proportion of mental health conditions was estimated and logistic regression models were used to assess any possible association with mental health disorders. The utility of the mental health assessment was assessed with the proportion of questionnaires performed by health professionals for migrants fulfilling the mental health screening criterion (country of origin with an active conflict in 2017) and the diagnoses given to the screened patients. Results Of 14,130 migrants that visited any of the PCCs during the study period, 7,358 (52.1 %) were women with a median age of 38.0 years-old. There were 520/14,130 (3.7 %) migrant patients diagnosed with a mental disorder, being more frequent among women (342/7,358; 4.7 %, p-value < 0.001), migrants from Latin-America (177/3,483; 5.1 %, p < 0.001) and those who recently arrived in Spain (170/3,672; 4.6 %, p < 0.001). A lower proportion of mental disorders were reported in migrants coming from conflicted countries in 2017 (116/3,669, 3.2 %, p = 0.053).Out of the 547 mental health diagnoses reported in 520 patients, 69/14,130 (0.5 %) were mood disorders, 346/14,130 (2.5 %) anxiety disorders and 127/14,130 (0.9 %) sleeping disorders. Mood disorders were more common in migrants from Eastern Europe (25/2,971; 0.8 %, p < 0.001) and anxiety disorders in migrants from Latin-America (126/3,483; 3.6 %, p < 0.001), while both type of disorders were more often reported in women (p < 0.001).In the adjusted model, women (aOR: 1.5, [95 % CI 1.2-1.8, p < 0.001]), migrants with more than one visit to the health center during the study period (aOR: 4.4, [95 %CI 2.8-6.8, p < 0.001]) and who presented an infectious disease (aOR: 2.1, [95 %CI 1.5-3.1, p < 0.001]) had higher odds of having a mental disorder.Lastly, out of the 1,840 migrants coming from a conflicted country in 2017 who were attended in centres where the CDSS tool was implemented, 29 (1.6 %) had a mental health assessment performed and the tool correctly identified one individual. Conclusions Mental health is a condition that may be overlooked in migrants at primary healthcare. Interventions at this level of care must be reinforced and adapted to the needs and circumstances of migrants to ensure equity in health services.
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Affiliation(s)
- Stella Evangelidou
- Barcelona Institute for Global Health (ISGlobal, Hospital Clínic-Universitat de Barcelona). Carrer Roselló 132, 40, 08036 Barcelona, Spain
| | - Angeline Cruz
- Barcelona Institute for Global Health (ISGlobal, Hospital Clínic-Universitat de Barcelona). Carrer Roselló 132, 40, 08036 Barcelona, Spain
| | - Yolanda Osorio
- Parc Sanitari Sant Joan de Deu, Programa Atenció a la Salut Mental de les persones Immigrades i Programa per Persones Sense Llar, Carrer Dr. Antoni Pujadas, 42, 08830 Barcelona, Spain
| | - Ethel Sequeira-Aymar
- Barcelona Institute for Global Health (ISGlobal, Hospital Clínic-Universitat de Barcelona). Carrer Roselló 132, 40, 08036 Barcelona, Spain
- Consorci d'Atenció Primària de Salut Barcelona Esquerra (CAPSBE) Casanova, Carrer Rosselló 161, 08036 Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Carrer Rosselló, 149, Barcelona, Spain
| | - Alessandra Queiroga Gonçalves
- Unitat de Suport a la Recerca Terres de l'Ebre, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 43500 Tortosa, Tarragona, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Spain
| | - Laura Camps-Vila
- Unitat Docent Multiprofessional d'Atenció Familiar i Comunitària Catalunya Central, Institut Català de la Salut, Carrer Pica d'Estats, 13-15, 08272 Sant Fruitós de Bages, Barcelona, Spain
| | - Marta M. Monclús-González
- Centre d'Atencio Primaria Sagrada Família, Consorci Sanitari Integral (CSI), Carrer Còrsega 643, 08025 Barcelona, Spain
| | - Alba Cuxart-Graell
- Barcelona Institute for Global Health (ISGlobal, Hospital Clínic-Universitat de Barcelona). Carrer Roselló 132, 40, 08036 Barcelona, Spain
| | - Elisa M. Revuelta-Muñoz
- Centre d'Atencio Primaria Rambla Ferran, Institut Català de la Salut (ICS), Carrer Rambla Ferran 44, 25007, Lleida, Spain
| | - Núria Busquet-Solé
- Centre d'Atencio Primaria Sagrada Família, Institut Català de la Salut, Carrer St. Cristòfol, 34, 08243 Manresa, Barcelona, Spain
| | - Susana Sarriegui-Domínguez
- Centre d'Atencio Primaria 1 Maig, Institut Català de la Salut (ICS), Carrer De la Mercè, 5, 25003, Lleida, Spain
| | - Aina Casellas
- Barcelona Institute for Global Health (ISGlobal, Hospital Clínic-Universitat de Barcelona). Carrer Roselló 132, 40, 08036 Barcelona, Spain
| | - M. Rosa Dalmau Llorca
- Unitat de Suport a la Recerca Terres de l'Ebre, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 43500 Tortosa, Tarragona, Spain
- Equip d'Atenció Primària Tortosa Oest, Institut Català de la Salut, 43500, Tortosa, Tarragona, Spain
| | - Carina Aguilar Martín
- Unitat de Suport a la Recerca Terres de l'Ebre, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 43500 Tortosa, Tarragona, Spain
- Unitat d'Avaluació, Direcció d'Atenció Primària Terres de l'Ebre, Institut Català de la Salut, Tortosa, 43500 Tarragona, Spain
| | - Ana Requena-Mendez
- Barcelona Institute for Global Health (ISGlobal, Hospital Clínic-Universitat de Barcelona). Carrer Roselló 132, 40, 08036 Barcelona, Spain
- Department of Medicine Solna, Karolinska Institutet, Solnavägen 17177, Solna, Stockholm, Sweden
- CIBERINFEC, ISCIII-CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
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Warkentin S, de Bont J, Abellan A, Pistillo A, Saucy A, Cirach M, Nieuwenhuijsen M, Khalid S, Basagaña X, Duarte-Salles T, Vrijheid M. Changes in air pollution exposure after residential relocation and body mass index in children and adolescents: A natural experiment study. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2023; 334:122217. [PMID: 37467916 DOI: 10.1016/j.envpol.2023.122217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/16/2023] [Accepted: 07/16/2023] [Indexed: 07/21/2023]
Abstract
Air pollution exposure may affect child weight gain, but observational studies provide inconsistent evidence. Residential relocation can be leveraged as a natural experiment by studying changes in health outcomes after a sudden change in exposure within an individual. We aimed to evaluate whether changes in air pollution exposure due to residential relocation are associated with changes in body mass index (BMI) in children and adolescents in a natural experiment study. This population-based study included children and adolescents, between 2 and 17 years, who moved during 2011-2018 and were registered in the primary healthcare in Catalonia, Spain (N = 46,644). Outdoor air pollutants (nitrogen dioxides (NO2), particulate matter <10 μm (PM10) and <2.5 μm (PM2.5)) were estimated at residential census tract level before and after relocation; tertile cut-offs were used to define changes in exposure. Routinely measured weight and height were used to calculate age-sex-specific BMI z-scores. A minimum of 180 days after moving was considered to observe zBMI changes according to changes in exposure using linear fixed effects regression. The majority of participants (60-67% depending on the pollutant) moved to areas with similar levels of air pollution, 15-49% to less polluted, and 14-31% to more polluted areas. Moving to areas with more air pollution was associated with zBMI increases for all air pollutants (β NO2 = 0.10(95%CI 0.09; 0.12), β PM2.5 0.06(0.04; 0.07), β PM10 0.08(0.06; 0.10)). Moving to similar air pollution areas was associated with decreases in zBMI for all pollutants. No associations were found for those moving to less polluted areas. Associations with moving to more polluted areas were stronger in preschool- and primary school-ages. Associations did not differ by area deprivation strata. This large, natural experiment study suggests that increases in outdoor air pollution may be associated with child weight gain, supporting ongoing efforts to lower air pollution levels.
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Affiliation(s)
| | - Jeroen de Bont
- Institute of Environmental Medicine, Karolinska Institutet, Sweden
| | - Alicia Abellan
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Andrea Pistillo
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain
| | | | - Marta Cirach
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Mark Nieuwenhuijsen
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Sara Khalid
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Oxfordshire, UK; Centre for Statistics in Medicine, University of Oxford, Oxford, Oxfordshire, UK
| | - Xavier Basagaña
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Talita Duarte-Salles
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Martine Vrijheid
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
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Fernández-Martínez NF, Rivera-Izquierdo M, Ortiz-González-Serna R, Martínez-Ruiz V, Lardelli-Claret P, Aginagalde-Llorente AH, Valero-Ubierna MDC, Vergara-Díaz MA, Lorusso N. Healthcare-associated infections by multidrug-resistant bacteria in Andalusia, Spain, 2014 to 2021. Euro Surveill 2023; 28:2200805. [PMID: 37768559 PMCID: PMC10540512 DOI: 10.2807/1560-7917.es.2023.28.39.2200805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 03/15/2023] [Indexed: 09/29/2023] Open
Abstract
BackgroundMultidrug-resistant (MDR) bacteria are among chief causes of healthcare-associated infections (HAIs). In Spain, studies addressing multidrug resistance based on epidemiological surveillance systems are lacking.AimIn this observational study, cases of HAIs by MDR bacteria notified to the epidemiological surveillance system of Andalusia, Spain, between 2014-2021, were investigated. Notified cases and their spatiotemporal distribution were described, with a focus on social determinants of health (SDoH).MethodsNew cases during the study period of HAIs caused by extended-spectrum β-lactamase (ESBL)-/carbapenemase-producing Enterobacterales, MDR Acinectobacter baumannii, MDR Pseudomonas aeruginosa or meticillin resistant Staphylococcus aureus were considered. Among others, notification variables included sex and age, while socio-economic variables comprised several SDoH. Cases' spatial distribution across municipalities was assessed. The smooth standardised incidence ratio (sSIR) was obtained using a Bayesian spatial model. Association between municipalities' sSIR level and SDoH was evaluated by bivariate analysis.ResultsIn total, 6,389 cases with a median age of 68 years were notified; 61.4% were men (n = 3,921). The most frequent MDR bacteria were ESBL-producing Enterobacterales (2,812/6,389; 44.0%); the main agent was Klebsiella spp. (2,956/6,389; 46.3%). Between 2014 and 2021 case numbers appeared to increase. Overall, up to 15-fold differences in sSIR between municipalities were observed. In bivariate analysis, there appeared to be an association between municipalities' sSIR level and deprivation (p = 0.003).ConclusionThis study indicates that social factors should be considered when investigating HAIs by MDR bacteria. The case incidence heterogeneity between Andalusian municipalities might be explained by SDoH, but also possibly by under-notification. Automatising reporting may address the latter.
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Affiliation(s)
- Nicolás Francisco Fernández-Martínez
- Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), Cordova, Spain
- Unidad de Gestión Clínica Interniveles de Prevención, Promoción y Vigilancia de La Salud, Hospital Universitario Reina Sofía, Cordova, Spain
| | - Mario Rivera-Izquierdo
- Unidad de Gestión Clínica Interniveles de Prevención, Promoción y Vigilancia de La Salud, Hospital Universitario San Cecilio, Granada, Spain
- Department of Preventive Medicine and Public Health, University of Granada, Avda. de la Investigación n°11, Granada, Spain
| | - Rocío Ortiz-González-Serna
- Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), Cordova, Spain
- Unidad de Gestión Clínica Interniveles de Prevención, Promoción y Vigilancia de La Salud, Hospital Universitario Reina Sofía, Cordova, Spain
| | - Virginia Martínez-Ruiz
- Department of Preventive Medicine and Public Health, University of Granada, Avda. de la Investigación n°11, Granada, Spain
| | - Pablo Lardelli-Claret
- Department of Preventive Medicine and Public Health, University of Granada, Avda. de la Investigación n°11, Granada, Spain
| | - Adrián Hugo Aginagalde-Llorente
- Subdirección de Promoción de la Salud y Prevención, Dirección General de Salud Pública, Ministerio de Sanidad, Madrid, Spain
| | - María Del Carmen Valero-Ubierna
- Unidad de Gestión Clínica Interniveles de Prevención, Promoción y Vigilancia de La Salud, Hospital Universitario San Cecilio, Granada, Spain
- Department of Preventive Medicine and Public Health, University of Granada, Avda. de la Investigación n°11, Granada, Spain
| | - María Auxiliadora Vergara-Díaz
- Dirección General de Salud Pública y Ordenación Farmacéutica, Consejería de Salud y Consumo, Junta de Andalucía, Seville, Spain
| | - Nicola Lorusso
- Dirección General de Salud Pública y Ordenación Farmacéutica, Consejería de Salud y Consumo, Junta de Andalucía, Seville, Spain
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Redondo-Sánchez D, Fernández-Navarro P, Rodríguez-Barranco M, Nuñez O, Petrova D, García-Torrecillas JM, Jiménez-Moleón JJ, Sánchez MJ. Socio-economic inequalities in lung cancer mortality in Spain: a nation-wide study using area-based deprivation. Int J Equity Health 2023; 22:145. [PMID: 37533035 PMCID: PMC10399030 DOI: 10.1186/s12939-023-01970-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 07/19/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Lung cancer is the main cause of cancer mortality worldwide and in Spain. Several previous studies have documented socio-economic inequalities in lung cancer mortality but these have focused on specific provinces or cities. The goal of this study was to describe lung cancer mortality in Spain by sex as a function of socio-economic deprivation. METHODS We analysed all registered deaths from lung cancer during the period 2011-2017 in Spain. Mortality data was obtained from the National Institute of Statistics, and socio-economic level was measured with the small-area deprivation index developed by the Spanish Society of Epidemiology, with the census tract of residence at the time of death as the unit of analysis. We computed crude and age-standardized rates per 100,000 inhabitants by sex, deprivation quintile, and type of municipality (rural, semi-rural, urban) considering the 2013 European standard population (ASR-E). We further calculated ASR-E ratios between the most deprived (Q5) and the least deprived (Q1) areas and mapped census tract smoothed standardized lung cancer mortality ratios by sex. RESULTS We observed 148,425 lung cancer deaths (80.7% in men), with 73.5 deaths per 100,000 men and 17.1 deaths per 100,000 women. Deaths from lung cancer in men were five times more frequent than in women (ASR-E ratio = 5.3). Women residing in the least deprived areas had higher mortality from lung cancer (ASR-E = 22.2), compared to women residing in the most deprived areas (ASR-E = 13.2), with a clear gradient among the quintiles of deprivation. For men, this pattern was reversed, with the highest mortality occurring in areas of lower socio-economic level (ASR-E = 99.0 in Q5 vs. ASR-E = 86.6 in Q1). These socio-economic inequalities remained fairly stable over time and across urban and rural areas. CONCLUSIONS Socio-economic status is strongly related to lung cancer mortality, showing opposite patterns in men and women, such that mortality is highest in women residing in the least deprived areas and men residing in the most deprived areas. Systematic surveillance of lung cancer mortality by socio-economic status may facilitate the assessment of public health interventions aimed at mitigating cancer inequalities in Spain.
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Grants
- PROYE20023SÁNC High Resolution Study of Social Inequalities in Cancer (HiReSIC), Asociación Española Contra el Cáncer (AECC)
- PROYE20023SÁNC High Resolution Study of Social Inequalities in Cancer (HiReSIC), Asociación Española Contra el Cáncer (AECC)
- PROYE20023SÁNC High Resolution Study of Social Inequalities in Cancer (HiReSIC), Asociación Española Contra el Cáncer (AECC)
- PROYE20023SÁNC High Resolution Study of Social Inequalities in Cancer (HiReSIC), Asociación Española Contra el Cáncer (AECC)
- PROYE20023SÁNC High Resolution Study of Social Inequalities in Cancer (HiReSIC), Asociación Española Contra el Cáncer (AECC)
- PROYE20023SÁNC High Resolution Study of Social Inequalities in Cancer (HiReSIC), Asociación Española Contra el Cáncer (AECC)
- PROYE20023SÁNC High Resolution Study of Social Inequalities in Cancer (HiReSIC), Asociación Española Contra el Cáncer (AECC)
- Not applicable Subprograma de Vigilancia Epidemiológica del Cáncer (VICA), del CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII)
- Not applicable Subprograma de Vigilancia Epidemiológica del Cáncer (VICA), del CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII)
- Not applicable Subprograma de Vigilancia Epidemiológica del Cáncer (VICA), del CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII)
- Not applicable Subprograma de Vigilancia Epidemiológica del Cáncer (VICA), del CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII)
- Not applicable Subprograma de Vigilancia Epidemiológica del Cáncer (VICA), del CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII)
- Not applicable Subprograma de Vigilancia Epidemiológica del Cáncer (VICA), del CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII)
- PI18/01593 EU/FEDER Instituto de Salud Carlos III
- PI18/01593 EU/FEDER Instituto de Salud Carlos III
- PI18/01593 EU/FEDER Instituto de Salud Carlos III
- Not applicable Acciones de Movilidad CIBERESP, 2022
- JC2019-039691-I Juan de la Cierva Fellowship from the Ministry of Science and the National Research Agency of Spain
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Affiliation(s)
- Daniel Redondo-Sánchez
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, 18012, Spain.
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, 28029, Spain.
- Escuela Andaluza de Salud Pública, Granada, 18080, Spain.
| | - Pablo Fernández-Navarro
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, 28029, Spain
- Cancer and Environmental Epidemiology Unit, National Center for Epidemiology, Carlos III Institute of Health, Madrid, 28029, Spain
| | - Miguel Rodríguez-Barranco
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, 18012, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, 28029, Spain
- Escuela Andaluza de Salud Pública, Granada, 18080, Spain
| | - Olivier Nuñez
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, 28029, Spain
- Cancer and Environmental Epidemiology Unit, National Center for Epidemiology, Carlos III Institute of Health, Madrid, 28029, Spain
| | - Dafina Petrova
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, 18012, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, 28029, Spain
- Escuela Andaluza de Salud Pública, Granada, 18080, Spain
| | - Juan Manuel García-Torrecillas
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, 18012, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, 28029, Spain
- Emergency and Research Unit, Torrecárdenas University Hospital, Almería, 04009, Spain
| | - Jose Juan Jiménez-Moleón
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, 18012, Spain
- Department of Preventive Medicine and Public Health, University of Granada, Granada, 18071, Spain
| | - María-José Sánchez
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, 18012, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, 28029, Spain
- Escuela Andaluza de Salud Pública, Granada, 18080, Spain
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20
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Negrín Hernández M. [Drop in the impact factor of Gaceta Sanitaria in 2022: Reasons and projection]. GACETA SANITARIA 2023; 37:102319. [PMID: 37494869 DOI: 10.1016/j.gaceta.2023.102319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 07/28/2023]
Affiliation(s)
- Miguel Negrín Hernández
- Comité Editorial de Gaceta Sanitaria; Departamento de Métodos Cuantitativos, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España.
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21
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Gullón P, Fontán-Vela M, Díez J, Nieuwenhuijsen M, Rojas-Rueda D, Escobar F, Franco M. Who benefits from green spaces? Surrounding greenness and incidence of cardiovascular disease in a population-based electronic medical records cohort in Madrid. Int J Hyg Environ Health 2023; 252:114221. [PMID: 37421937 DOI: 10.1016/j.ijheh.2023.114221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 05/06/2023] [Accepted: 07/03/2023] [Indexed: 07/10/2023]
Abstract
The objective was to study the association between surrounding greenness and the incidence of cardiovascular diseases (CVD) with a four years follow-up in almost half a million high CVD-risk women and men, as well as its differential effect by area-level deprivation in Madrid. We analyzed 2015-2018 primary healthcare electronic medical records for 437,513 high CVD risk individuals representing more than 95% of the population of that age range residing in Madrid. The outcome variable was any cardiovascular event. We measured surrounding residence greenness at 200 m, 300 m, 500 m, and 1000 m through the Normalized Difference Vegetation Index (NDVI). We assessed socioeconomic deprivation through a census-based deprivation index. We estimated the 4-year relative risk of CVD by an increase in 0.1 units of NDVI and then stratified the models by quintiles of deprivation (Q5 the most deprived). We found that for every increase in 0.1 units of NDVI at 1000 m there was a 16% decrease in CVD risk (RR = 0.84 95% CI 0.75-0.94). CVD risk for the remaining distance exposures (at 200 m, 300 m, and 500 m) were none statistically significant. In general, the protective effect of green spaces was present in medium-deprivation areas and males, but the associations were inconsistent across deprivation levels. This study highlights the relevance of evaluating the interaction between physical and social urban components to further understand possible population prevention approaches for cardiovascular diseases. Future studies should focus on the mechanisms of context-specific interactions between social inequalities and green spaces' effects on health.
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Affiliation(s)
- Pedro Gullón
- Public Health and Epidemiology Research Group, School of Medicine and Health Sciences, Universidad de Alcala, Alcala de Henares, 28871, Madrid, Spain; Centre for Urban Research, RMIT University, Melbourne, Australia.
| | - Mario Fontán-Vela
- Public Health and Epidemiology Research Group, School of Medicine and Health Sciences, Universidad de Alcala, Alcala de Henares, 28871, Madrid, Spain; Instituto de Lengua, Literatura y Antropología, Centro Superior de Investigaciones Sociológicas, Ministerio de Ciencia e Innovación, Spain
| | - Julia Díez
- Public Health and Epidemiology Research Group, School of Medicine and Health Sciences, Universidad de Alcala, Alcala de Henares, 28871, Madrid, Spain
| | - Mark Nieuwenhuijsen
- ISGlobal, Center for Research in Environmental Epidemiology (CREAL), 08036, Barcelona, Spain; Universitat Pompeu Fabra (UPF), 08002, Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - David Rojas-Rueda
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA; Colorado School of Public Health, Colorado State University, Fort Collins, CO, USA
| | - Francisco Escobar
- Department of Geology, Geography and Environmental Sciences, University of Alcalá, Calle Colegios 2, Alcalá de Henares, 28801, Madrid, Spain
| | - Manuel Franco
- Public Health and Epidemiology Research Group, School of Medicine and Health Sciences, Universidad de Alcala, Alcala de Henares, 28871, Madrid, Spain; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md, 21205-2217, USA
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22
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Santa-Ramírez HA, Otálvaro-Castro GJ, Joost S, Melgar-Quiñonez H, Bilal U, Stringhini S. Small area vulnerability, household food insecurity and child malnutrition in Medellin, Colombia: results from a repeated cross-sectional study. LANCET REGIONAL HEALTH. AMERICAS 2023; 23:100521. [PMID: 37275622 PMCID: PMC10238747 DOI: 10.1016/j.lana.2023.100521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 04/27/2023] [Accepted: 05/11/2023] [Indexed: 06/07/2023]
Abstract
Background Malnutrition and food insecurity might be driven not only by individual factors but also by contextual conditions, such as area-level deprivation or vulnerability. This study aimed to analyze the association between area-level vulnerability and i) household food insecurity and ii) malnutrition in children in Medellin, Colombia, during the years 2017 and 2018. Methods We obtained data from two different sources: the Living Standards Measurement Survey (LSMS) and the nutrition surveillance system of Medellin. The main outcomes were food insecurity in households with children and anthropometric indicators for children under five. The main predictor was area-level vulnerability. Mixed effects Poisson regression with robust standard errors models were conducted to test the association of quintiles of deprivation with each outcome. Findings Households with children living in areas with the highest deprivation had 1.9 times the prevalence of food insecurity as compared to those living in areas with the lowest deprivation (PR 1.91, 95% CI 1.42-2.57). Similar results were observed for underweight/risk of underweight (PR 1.26, 95% CI 1.11-1.42), stunting/risk of stunting (PR 1.36, 95% CI 1.22-1.53) and stunting (PR 1.93 95% CI 1.55-2.39) among children under five. We found no consistent associations with wasting/risk of wasting or excess weight/risk of overweight across quintiles of deprivation. Interpretation This study sheds light on the role of area-level vulnerability on malnutrition in children in Medellin, Colombia, showing a pattern of increasing prevalence of food insecurity, underweight and stunting by quintile of deprivation. Funding Swiss School of Public Health (SSPH+) and Centre for Global Health Inequalities Research (CHAIN).
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Affiliation(s)
- Hugo-Alejandro Santa-Ramírez
- Unit of Population Epidemiology, Division of Primary Care, Geneva University Hospitals, Geneva, Switzerland
- Health Policy and Management Research Group, National Faculty of Public Health, University of Antioquia, Medellin, Colombia
| | - Gabriel-Jaime Otálvaro-Castro
- Health Policy and Management Research Group, National Faculty of Public Health, University of Antioquia, Medellin, Colombia
| | - Stéphane Joost
- Unit of Population Epidemiology, Division of Primary Care, Geneva University Hospitals, Geneva, Switzerland
- Group of Geographic Information Research and Analysis in Population Health (GIRAPH), Geneva, Switzerland
- Laboratory of Geographic Information Systems (LASIG), School of Architecture, Civil and Environmental Engineering (ENAC), École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Hugo Melgar-Quiñonez
- McGill Institute for Global Food Security, School of Human Nutrition, McGill University, Montreal, Canada
| | - Usama Bilal
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, USA
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | - Silvia Stringhini
- Unit of Population Epidemiology, Division of Primary Care, Geneva University Hospitals, Geneva, Switzerland
- Department of Health and Community Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- University Centre for General Medicine and Public Health (UNISANTE), University of Lausanne, Lausanne, Switzerland
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23
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Carrasco-Ribelles LA, Cabrera-Bean M, Danés-Castells M, Zabaleta-Del-Olmo E, Roso-Llorach A, Violán C. Contribution of Frailty to Multimorbidity Patterns and Trajectories: Longitudinal Dynamic Cohort Study of Aging People. JMIR Public Health Surveill 2023; 9:e45848. [PMID: 37368462 PMCID: PMC10365626 DOI: 10.2196/45848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 05/02/2023] [Accepted: 05/25/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Multimorbidity and frailty are characteristics of aging that need individualized evaluation, and there is a 2-way causal relationship between them. Thus, considering frailty in analyses of multimorbidity is important for tailoring social and health care to the specific needs of older people. OBJECTIVE This study aimed to assess how the inclusion of frailty contributes to identifying and characterizing multimorbidity patterns in people aged 65 years or older. METHODS Longitudinal data were drawn from electronic health records through the SIDIAP (Sistema d'Informació pel Desenvolupament de la Investigació a l'Atenció Primària) primary care database for the population aged 65 years or older from 2010 to 2019 in Catalonia, Spain. Frailty and multimorbidity were measured annually using validated tools (eFRAGICAP, a cumulative deficit model; and Swedish National Study of Aging and Care in Kungsholmen [SNAC-K], respectively). Two sets of 11 multimorbidity patterns were obtained using fuzzy c-means. Both considered the chronic conditions of the participants. In addition, one set included age, and the other included frailty. Cox models were used to test their associations with death, nursing home admission, and home care need. Trajectories were defined as the evolution of the patterns over the follow-up period. RESULTS The study included 1,456,052 unique participants (mean follow-up of 7.0 years). Most patterns were similar in both sets in terms of the most prevalent conditions. However, the patterns that considered frailty were better for identifying the population whose main conditions imposed limitations on daily life, with a higher prevalence of frail individuals in patterns like chronic ulcers &peripheral vascular. This set also included a dementia-specific pattern and showed a better fit with the risk of nursing home admission and home care need. On the other hand, the risk of death had a better fit with the set of patterns that did not include frailty. The change in patterns when considering frailty also led to a change in trajectories. On average, participants were in 1.8 patterns during their follow-up, while 45.1% (656,778/1,456,052) remained in the same pattern. CONCLUSIONS Our results suggest that frailty should be considered in addition to chronic diseases when studying multimorbidity patterns in older adults. Multimorbidity patterns and trajectories can help to identify patients with specific needs. The patterns that considered frailty were better for identifying the risk of certain age-related outcomes, such as nursing home admission or home care need, while those considering age were better for identifying the risk of death. Clinical and social intervention guidelines and resource planning can be tailored based on the prevalence of these patterns and trajectories.
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Affiliation(s)
- Lucía A Carrasco-Ribelles
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Barcelona, Spain
- Signal Processing and Communications Group (SPCOM), Department of Signal Theory and Communications, Universitat Politècnica de Catalunya (UPC), Barcelona, Spain
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Mataró, Spain
- Grup de REcerca en Impacte de les Malalties Cròniques i les seves Trajectòries (GRIMTRA) (2021 SGR 01537), Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Barcelona, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS) (RD21/0016/0029), Instituto de Salud Carlos III, Madrid, Spain
| | - Margarita Cabrera-Bean
- Signal Processing and Communications Group (SPCOM), Department of Signal Theory and Communications, Universitat Politècnica de Catalunya (UPC), Barcelona, Spain
| | - Marc Danés-Castells
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Mataró, Spain
| | - Edurne Zabaleta-Del-Olmo
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Barcelona, Spain
- Grup de REcerca en Impacte de les Malalties Cròniques i les seves Trajectòries (GRIMTRA) (2021 SGR 01537), Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Barcelona, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS) (RD21/0016/0029), Instituto de Salud Carlos III, Madrid, Spain
- Gerència Territorial de Barcelona, Institut Català de la Salut, Barcelona, Spain
- Nursing Department, Faculty of Nursing, Universitat de Girona, Girona, Spain
| | - Albert Roso-Llorach
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Barcelona, Spain
- Grup de REcerca en Impacte de les Malalties Cròniques i les seves Trajectòries (GRIMTRA) (2021 SGR 01537), Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Barcelona, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS) (RD21/0016/0029), Instituto de Salud Carlos III, Madrid, Spain
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
| | - Concepción Violán
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Mataró, Spain
- Grup de REcerca en Impacte de les Malalties Cròniques i les seves Trajectòries (GRIMTRA) (2021 SGR 01537), Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Barcelona, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS) (RD21/0016/0029), Instituto de Salud Carlos III, Madrid, Spain
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
- Fundació Institut d'Investigació en ciències de la Salut Germans Trias i Pujol (IGTP), Badalona, Spain
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24
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Salvador C, Gullón P, Franco M, Vicedo-Cabrera AM. Heat-related first cardiovascular event incidence in the city of Madrid (Spain): Vulnerability assessment by demographic, socioeconomic, and health indicators. ENVIRONMENTAL RESEARCH 2023; 226:115698. [PMID: 36931379 DOI: 10.1016/j.envres.2023.115698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/07/2023] [Accepted: 03/14/2023] [Indexed: 06/18/2023]
Abstract
While climate change and population ageing are expected to increase the exposure and vulnerability to extreme heat events, there is emerging evidence suggesting that social inequalities would additionally magnify the projected health impacts. However, limited evidence exists on how social determinants modify heat-related cardiovascular morbidity. This study aims to explore the association between heat and the incidence of first acute cardiovascular event (CVE) in adults in Madrid between 2015 and 2018, and to assess how social context and other individual characteristics modify the estimated association. We performed a case-crossover study using the individual information collected from electronic medical records of 6514 adults aged 40-75 living in Madrid city that suffered a first CVE during summer (June-September) between 2015 and 2018. We applied conditional logistic regression with a distributed lag non-linear model to analyse the heat-CVE association. Estimates were expressed as Odds Ratio (OR) for extreme heat (at 97.5th percentile of daily maximum temperature distribution), compared to the minimum risk temperature. We performed stratified analyses by specific diagnosis, sex, age (40-64, 65-75), country of origin, area-level deprivation, and presence of comorbidities. Overall, the risk of suffering CVE increased by 15.3% (OR: 1.153 [95%CI 1.010-1.317]) during extreme heat. Males were particularly more affected (1.248, [1.059-1.471]), vs 1.039 [0.810-1.331] in females), and non-Spanish population (1.869 [1.28-2.728]), vs 1.084 [0.940-1.250] in Spanish). Similar estimates were found by age groups. We observed a dose-response pattern across deprivation levels, with larger risks in populations with higher deprivation (1.228 [1.031-1.462]) and almost null association in the lowest deprivation group (1.062 [0.836-1.349]). No clear patterns of larger vulnerability were found by presence of comorbidity. We found that heat unequally increased the risk of suffering CVE in adults in Madrid, affecting mainly males and deprived populations. Local measures should pay special attention to vulnerable populations.
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Affiliation(s)
- Coral Salvador
- Centro de Investigación Mariña, Universidade de Vigo, Environmental Physics Laboratory (EPhysLab), Ourense, Spain; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Oeschger Center for Climate Change Research, University of Bern, Bern, Switzerland
| | - Pedro Gullón
- Universidad de Alcalá, Grupo de Investigación en Epidemiología y Salud Pública Facultad de Medicina y Ciencias de La Salud, Alcalá de Henares, Madrid, Spain; Centre for Urban Research, RMIT University, Melbourne, Australia
| | - Manuel Franco
- Universidad de Alcalá, Grupo de Investigación en Epidemiología y Salud Pública Facultad de Medicina y Ciencias de La Salud, Alcalá de Henares, Madrid, Spain; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md, 21205-2217, USA.
| | - Ana M Vicedo-Cabrera
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Oeschger Center for Climate Change Research, University of Bern, Bern, Switzerland
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25
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Santiago-Pérez MI, López-Vizcaíno E, Pérez-Ríos M, Guerra-Tort C, Rey-Brandariz J, Varela-Lema L, Martín-Gisbert L, Ruano-Ravina A, Schiaffino A, Galán I, Candal-Pedreira C, Montes A, Ahluwalia J. Small-area models to assess the geographical distribution of tobacco consumption by sex and age in Spain. Tob Induc Dis 2023; 21:63. [PMID: 37215189 PMCID: PMC10194049 DOI: 10.18332/tid/162379] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/31/2023] [Accepted: 03/19/2023] [Indexed: 05/24/2023] Open
Abstract
INTRODUCTION Complete and accurate data on smoking prevalence at a local level would enable health authorities to plan context-dependent smoking interventions. However, national health surveys do not generally provide direct estimates of smoking prevalence by sex and age groups at the subnational level. This study uses a small-area model-based methodology to obtain precise estimations of smoking prevalence by sex, age group and region, from a population-based survey. METHODS The areas targeted for analysis consisted of 180 groups based on a combination of sex, age group (15-34, 35-54, 55-64, 65-74, and ≥75 years), and Autonomous Region. Data on tobacco use came from the 2017 Spanish National Health Survey (2017 SNHS). In each of the 180 groups, we estimated the prevalence of smokers (S), ex-smokers (ExS) and never smokers (NS), as well as their coefficients of variation (CV), using a weighted ratio estimator (direct estimator) and a multinomial logistic model with random area effects. RESULTS When smoking prevalence was estimated using the small-area model, the precision of direct estimates improved; the CV of S and ExS decreased on average by 26%, and those of NS by 25%. The range of S prevalence was 11-46% in men and 4-37% in women, excluding the group aged ≥75 years. CONCLUSIONS This study proposes a methodology for obtaining reliable estimates of smoking prevalence in groups or areas not covered in the survey design. The model applied is a good alternative for enhancing the precision of estimates at a detailed level, at a much lower cost than that involved in conducting large-scale surveys. This method could be easily integrated into routine data processing of population health surveys. Having such estimates directly after completing a health survey would help characterize the tobacco epidemic and/or any other risk factor more precisely.
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Affiliation(s)
- María I. Santiago-Pérez
- Epidemiology Department, Directorate-General of Public Health, Galician Regional Health Authority, Santiago de Compostela, Spain
| | - Esther López-Vizcaíno
- Diffusion and Information Service, Galician Institute of Statistics, Santiago de Compostela, Spain
| | - Mónica Pérez-Ríos
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública/CIBERESP), Santiago de Compostela, Spain
- Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela - IDIS), Santiago de Compostela, Spain
| | - Carla Guerra-Tort
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Julia Rey-Brandariz
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Leonor Varela-Lema
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública/CIBERESP), Santiago de Compostela, Spain
- Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela - IDIS), Santiago de Compostela, Spain
| | - Lucía Martín-Gisbert
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Alberto Ruano-Ravina
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública/CIBERESP), Santiago de Compostela, Spain
- Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela - IDIS), Santiago de Compostela, Spain
| | - Anna Schiaffino
- Directorate-General of Health Planning, Health Department, Catalonian Regional Authority, Barcelona, Spain
| | - Iñaki Galán
- National Centre for Epidemiology, Carlos III Institute of Health, Madrid, Spain
- Department of Preventive Medicine and Public Health, Autonomous University of Madrid/IdiPAZ, Madrid, Spain
| | - Cristina Candal-Pedreira
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Agustín Montes
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública/CIBERESP), Santiago de Compostela, Spain
- Health Research Institute of Santiago de Compostela (Instituto de Investigación Sanitaria de Santiago de Compostela - IDIS), Santiago de Compostela, Spain
| | - Jasjit Ahluwalia
- Department of Medicine, Alpert School of Medicine, Brown University, Providence, United States
- Department of Behavioral and Social Science, School of Public Health, Brown University, Providence, United States
- Legoretta Cancer Center, Division of Biology and Medicine, Brown University, Providence, United States
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Kogevinas M, Karachaliou M, Espinosa A, Aguilar R, Castaño-Vinyals G, Garcia-Aymerich J, Carreras A, Cortés B, Pleguezuelos V, Papantoniou K, Rubio R, Jiménez A, Vidal M, Serra P, Parras D, Santamaría P, Izquierdo L, Cirach M, Nieuwenhuijsen M, Dadvand P, Straif K, Moncunill G, de Cid R, Dobaño C, Tonne C. Long-Term Exposure to Air Pollution and COVID-19 Vaccine Antibody Response in a General Population Cohort (COVICAT Study, Catalonia). ENVIRONMENTAL HEALTH PERSPECTIVES 2023; 131:47001. [PMID: 37017430 PMCID: PMC10075082 DOI: 10.1289/ehp11989] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 02/05/2023] [Accepted: 02/22/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Ambient air pollution has been associated with COVID-19 disease severity and antibody response induced by infection. OBJECTIVES We examined the association between long-term exposure to air pollution and vaccine-induced antibody response. METHODS This study was nested in an ongoing population-based cohort, COVICAT, the GCAT-Genomes for Life cohort, in Catalonia, Spain, with multiple follow-ups. We drew blood samples in 2021 from 1,090 participants of 2,404 who provided samples in 2020, and we included 927 participants in this analysis. We measured immunoglobulin M (IgM), IgG, and IgA antibodies against five viral-target antigens, including receptor-binding domain (RBD), spike-protein (S), and segment spike-protein (S2) triggered by vaccines available in Spain. We estimated prepandemic (2018-2019) exposure to fine particulate matter [PM ≤2.5μm in aerodynamic diameter (PM2.5)], nitrogen dioxide (NO2), black carbon (BC), and ozone (O3) using Effects of Low-Level Air Pollution: A Study in Europe (ELAPSE) models. We adjusted estimates for individual- and area-level covariates, time since vaccination, and vaccine doses and type and stratified by infection status. We used generalized additive models to explore the relationship between air pollution and antibodies according to days since vaccination. RESULTS Among vaccinated persons not infected by SARS-CoV-2 (n=632), higher prepandemic air pollution levels were associated with a lower vaccine antibody response for IgM (1 month post vaccination) and IgG. Percentage change in geometric mean IgG levels per interquartile range of PM2.5 (1.7 μg/m3) were -8.1 (95% CI: -15.9, 0.4) for RBD, -9.9 (-16.2, -3.1) for S, and -8.4 (-13.5, -3.0) for S2. We observed a similar pattern for NO2 and BC and an inverse pattern for O3. Differences in IgG levels by air pollution levels persisted with time since vaccination. We did not observe an association of air pollution with vaccine antibody response among participants with prior infection (n=295). DISCUSSION Exposure to air pollution was associated with lower COVID-19 vaccine antibody response. The implications of this association on the risk of breakthrough infections require further investigation. https://doi.org/10.1289/EHP11989.
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Affiliation(s)
- Manolis Kogevinas
- Barcelona Institute for Global Health, Barcelona, Spain
- CIBER Epidemiologia y Salud Pública, Madrid, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- Hospital del Mar Medical Research Institute, Barcelona, Spain
| | | | - Ana Espinosa
- Barcelona Institute for Global Health, Barcelona, Spain
- CIBER Epidemiologia y Salud Pública, Madrid, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Ruth Aguilar
- Barcelona Institute for Global Health, Barcelona, Spain
| | - Gemma Castaño-Vinyals
- Barcelona Institute for Global Health, Barcelona, Spain
- CIBER Epidemiologia y Salud Pública, Madrid, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Judith Garcia-Aymerich
- Barcelona Institute for Global Health, Barcelona, Spain
- CIBER Epidemiologia y Salud Pública, Madrid, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
| | - Anna Carreras
- Genomes for Life-GCAT lab Group, Germans Trias i Pujol Research Institute, Badalona, Spain
| | - Beatriz Cortés
- Genomes for Life-GCAT lab Group, Germans Trias i Pujol Research Institute, Badalona, Spain
| | | | - Kyriaki Papantoniou
- Department of Epidemiology, Center of Public Health, Medical University of Vienna, Vienna, Austria
| | - Rocío Rubio
- Barcelona Institute for Global Health, Barcelona, Spain
| | - Alfons Jiménez
- Barcelona Institute for Global Health, Barcelona, Spain
- CIBER Epidemiologia y Salud Pública, Madrid, Spain
| | - Marta Vidal
- Barcelona Institute for Global Health, Barcelona, Spain
| | - Pau Serra
- Institut d’Investigacions Biomèdiques August Pi Sunyer, Barcelona, Spain
| | - Daniel Parras
- Institut d’Investigacions Biomèdiques August Pi Sunyer, Barcelona, Spain
| | - Pere Santamaría
- Institut d’Investigacions Biomèdiques August Pi Sunyer, Barcelona, Spain
- Department of Microbiology, Immunology and Infectious Diseases, Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Luis Izquierdo
- Barcelona Institute for Global Health, Barcelona, Spain
- CIBER Enfermedades Infecciosas, Barcelona, Spain
| | - Marta Cirach
- Barcelona Institute for Global Health, Barcelona, Spain
| | - Mark Nieuwenhuijsen
- Barcelona Institute for Global Health, Barcelona, Spain
- CIBER Epidemiologia y Salud Pública, Madrid, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
| | - Payam Dadvand
- Barcelona Institute for Global Health, Barcelona, Spain
- CIBER Epidemiologia y Salud Pública, Madrid, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
| | - Kurt Straif
- Barcelona Institute for Global Health, Barcelona, Spain
| | - Gemma Moncunill
- Barcelona Institute for Global Health, Barcelona, Spain
- CIBER Enfermedades Infecciosas, Barcelona, Spain
| | - Rafael de Cid
- Genomes for Life-GCAT lab Group, Germans Trias i Pujol Research Institute, Badalona, Spain
| | - Carlota Dobaño
- Barcelona Institute for Global Health, Barcelona, Spain
- CIBER Enfermedades Infecciosas, Barcelona, Spain
| | - Cathryn Tonne
- Barcelona Institute for Global Health, Barcelona, Spain
- CIBER Epidemiologia y Salud Pública, Madrid, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
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Borrell C. [Health inequalities in Gaceta Sanitaria, from 1988 to 2022]. GACETA SANITARIA 2023; 37:102291. [PMID: 36806941 DOI: 10.1016/j.gaceta.2023.102291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 12/09/2022] [Indexed: 02/19/2023]
Affiliation(s)
- Carme Borrell
- Agència de Salut Pública de Barcelona, Barcelona, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; Institut de Recerca Biomèdica Sant Pau, Barcelona, España; Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, Barcelona, España.
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Ruiz‐Pérez M, Moragues A, Seguí‐Pons JM, Muncunill J, Pou Goyanes A, Colom Fernández A. Geographical Distribution and Social Justice of the COVID-19 Pandemic: The Case of Palma (Balearic Islands). GEOHEALTH 2023; 7:e2022GH000733. [PMID: 36819934 PMCID: PMC9930193 DOI: 10.1029/2022gh000733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 01/17/2023] [Accepted: 01/17/2023] [Indexed: 06/18/2023]
Abstract
The spatial distribution of the COVID-19 infection rate in the city of Palma (Balearic Islands) is analyzed from the geolocation of positive cases by census tract and its relationship with socioeconomic variables is evaluated. Data on infections have been provided by the Health Service of the Ministry of Health and Consumption of the Government of the Balearic Islands. The study combines several methods of analysis: spatial autocorrelation, calculation of the Gini index and least squares regression, and weighted geographical regression. The results show that the pandemic comprised five waves in the March 2020-March 2022 period, corresponding to the months of April 2020, August 2020, December 2020, July 2021, and January 2022. Each wave shows a particular geographical distribution pattern, however, the second and third waves show higher levels of spatial concentration. In this sense, the second wave, affecting the peripheral neighborhoods of the eastern part of the city. The Gini index confirms geographical imbalances in the distribution of infections in the first waves of the pandemic. In addition, the regression models indicate that the most significant socioeconomic variables in the prediction of COVID-19 infection are average income, percentage of children under 18 years of age, average size of the household, and percentage of single-person households. The study shows that economic imbalances in the city have had a clear influence on the spatial pattern of pandemic distribution. It shows the need to implement spatial justice policies in income distribution to balance the effects of the pandemic.
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Affiliation(s)
- Maurici Ruiz‐Pérez
- Servei de SIG i TeledeteccióUniversitat de les Illes BalearsPalmaSpain
- Institut d’Investigació Sanitària de les Illes BallearsPalmaSpain
- Departament de GeografiaUniversitat de les Illes BalearsPalmaSpain
| | | | | | - Josep Muncunill
- Institut d’Investigació Sanitària de les Illes BallearsPalmaSpain
| | | | - Antoni Colom Fernández
- Institut d’Investigació Sanitària de les Illes BallearsPalmaSpain
- Departament de GeografiaUniversitat de les Illes BalearsPalmaSpain
- EpiPHAAN Research GroupSchool of Health SciencesUniversity of MálagaInstituto de Investigación Biomédica en Málaga (IBIMA)MálagaSpain
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Parker LA, Moreno-Garijo A, Chilet-Rosell E, Lorente F, Lumbreras B. Gender Differences in the Impact of Recommendations on Diagnostic Imaging Tests: A Retrospective Study 2007-2021. Life (Basel) 2023; 13:life13020289. [PMID: 36836646 PMCID: PMC9965980 DOI: 10.3390/life13020289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 01/22/2023] Open
Abstract
(1) Background: The frequency of imaging tests grew exponentially in recent years. This increase may differ according to a patient's sex, age, or socioeconomic status. We aim to analyze the impact of the Council Directive 2013/59/Euratom to control exposure to radiation for men and women and explore the impact of patients' age and socioeconomic status; (2) Methods: The retrospective observational study that includes a catchment population of 234,424. We included data of CT, mammography, radiography (conventional radiography and fluoroscopy) and nuclear medicine between 2007-2021. We estimated the associated radiation effective dose per test according using previously published evidence. We calculated a deprivation index according to the postcode of their residence. We divided the study in 2007-2013, 2014-2019 and 2020-2021 (the pandemic period). (3) Results: There was an increase in the number of imaging tests received by men and women after 2013 (p < 0.001), and this increase was higher in women than in men. The frequency of imaging tests decreased during the pandemic period (2020-2021), but the frequency of CT and nuclear medicine tests increased even during these years (p < 0.001) and thus, the overall effective mean dose. Women and men living in the least deprived areas had a higher frequency of imaging test than those living in the most deprived areas. (4) Conclusions: The largest increase in the number of imaging tests is due to CTs, which account for the higher amount of effective dose. The difference in the increase of imaging tests carried out in men and women and according to the socioeconomic status could reflect different management strategies and barriers to access in clinical practice. Given the low impact of the available recommendations on the population exposure to radiation and the performance of high-dose procedures such as CT, deserve special attention when it comes to justification and optimization, especially in women.
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Affiliation(s)
- Lucy A. Parker
- Department of Public Health, University Miguel Hernández de Elche, 03550 Alicante, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Andrea Moreno-Garijo
- Faculty of Pharmacy, University Miguel Hernández de Elche, 03550 Alicante, Spain
| | - Elisa Chilet-Rosell
- Department of Public Health, University Miguel Hernández de Elche, 03550 Alicante, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Fermina Lorente
- Radiology Department, University Hospital of San Juan de Alicante, Sant Joan d’Alacant, 03550 Alicante, Spain
| | - Blanca Lumbreras
- Department of Public Health, University Miguel Hernández de Elche, 03550 Alicante, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-965-919510
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Díaz-García RS, Sánchez-Gómez A, López-Zambrano MA, Esteban-Vasallo MD, Cañellas Llabrés S, Gutiérrez Rodríguez MÁ, Lasheras Carbajo MD. Vaccination against influenza: Coverage and adherence in children under 15 years with high-risk medical conditions in the Community of Madrid. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2023; 98:3-11. [PMID: 36496313 DOI: 10.1016/j.anpede.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 07/18/2022] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Vaccination against influenza is indicated in children at risk of complications or severe disease. The objective of this study was to describe the percentage of children aged less than 15 years with risk conditions vaccinated against influenza in the Community of Madrid, and to analyze the factors associated with adherence to vaccination throughout 3 vaccination campaigns. MATERIALS AND METHODS Population-based cross-sectional observational study of children aged 6 months to 14 years with conditions that indicated influenza vaccination at the beginning of the 2018-2019 campaign. Electronic population registers were used. We described the percentage of children vaccinated in 3 consecutive campaigns, and assessed the association of adherence to vaccination with demographic and socioeconomic variables and risk conditions using bivariate and multivariate analysis. RESULTS The vaccination coverage was 15.6% in the 2018-2019 campaign. The adherence to vaccination was 65.9%. The variables associated with greater adherence were age greater than 2 years, especially in the 6-10 years group (aOR = 1.63; 95% CI, 1.43-1.85) and presenting more than one risk condition, especially 3 or more diseases (aOR = 1.80; 95% CI, 1.00-3.26). Diabetes mellitus was the disease associated most strongly with adherence (aOR = 2.15; 95% CI, 1.74-2.65). Adherence was lower in the immigrant population (aOR = 0.43; 95% CI, 0.36-0.51). We found no association between vaccination adherence and sex or socioeconomic status. CONCLUSIONS Vaccination coverage and adherence were suboptimal. Adherence to vaccination against influenza is associated with demographic and clinical conditions. Strategies need to be established to increase vaccination in children, with greater involvement of professionals and education of parents.
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Affiliation(s)
- Rosa S Díaz-García
- Servicio de Prevención de la Enfermedad, Subdirección General de Prevención y Promoción de la Salud, Dirección General de Salud Pública, Consejería de Sanidad, Comunidad de Madrid, Madrid, Spain; Servicio de Medicina Preventiva y Gestión de Calidad, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Amaya Sánchez-Gómez
- Servicio de Prevención de la Enfermedad, Subdirección General de Prevención y Promoción de la Salud, Dirección General de Salud Pública, Consejería de Sanidad, Comunidad de Madrid, Madrid, Spain
| | - María Alejandra López-Zambrano
- Servicio de Prevención de la Enfermedad, Subdirección General de Prevención y Promoción de la Salud, Dirección General de Salud Pública, Consejería de Sanidad, Comunidad de Madrid, Madrid, Spain
| | - María Dolores Esteban-Vasallo
- Servicio de Informes de Salud y Estudios, Subdirección General de Vigilancia en Salud Pública, Dirección General de Salud Pública, Consejería de Sanidad, Comunidad de Madrid, Madrid, Spain
| | - Soledad Cañellas Llabrés
- Servicio de Prevención de la Enfermedad, Subdirección General de Prevención y Promoción de la Salud, Dirección General de Salud Pública, Consejería de Sanidad, Comunidad de Madrid, Madrid, Spain
| | - María Ángeles Gutiérrez Rodríguez
- Servicio de Prevención de la Enfermedad, Subdirección General de Prevención y Promoción de la Salud, Dirección General de Salud Pública, Consejería de Sanidad, Comunidad de Madrid, Madrid, Spain
| | - María Dolores Lasheras Carbajo
- Servicio de Prevención de la Enfermedad, Subdirección General de Prevención y Promoción de la Salud, Dirección General de Salud Pública, Consejería de Sanidad, Comunidad de Madrid, Madrid, Spain
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Portuondo-Jiménez J, Gascón M, García J, Legarreta MJ, Villanueva A, Larrea N, García-Gutiérrez S, Munitiz E, Quintana JM. Influencia del índice de privación social en resultados durante la pandemia de COVID-19. GACETA SANITARIA 2023; 37:102301. [PMID: 37028280 PMCID: PMC10075210 DOI: 10.1016/j.gaceta.2023.102301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 02/17/2023] [Accepted: 02/17/2023] [Indexed: 04/08/2023]
Abstract
Objetivo Determinar la relación del índice de privación de la población con la utilización del sistema sanitario, la mala evolución y la mortalidad durante la pandemia de COVID-19. Método Estudio de cohorte retrospectivo de personas con infección por SARS-CoV-2 del 1 de marzo de 2020 al 9 de enero de 2022. Se recopilaron datos sociodemográficos, comorbilidad y tratamientos basales prescritos, otros datos basales y el índice de privación, estimado por sección censal. Se realizaron modelos multivariable de regresión logística multinivel para cada variable de resultado: fallecimiento, mala evolución (definida como fallecimiento o ingreso en la unidad de cuidados intensivos), ingreso y visitas a urgencias. Resultados La cohorte se compone de 371.237 personas con infección por SARS-CoV-2. En los modelos multivariable se observó un mayor riesgo de fallecimiento, de mala evolución, de ingreso hospitalario o de visita a urgencias en los quintiles de mayor privación en comparación con el quintil de menor privación. Para el riesgo de ser hospitalizado o de acudir a urgencias, en términos generales hubo diferencias entre todos los quintiles. También se observó que estas diferencias se daban en el primer y el tercer periodos de la pandemia para la mortalidad y la mala evolución, y en todos para el riesgo de ser ingresado o de acudir a urgencias. Conclusiones Los colectivos con mayor nivel de privación han tenido mayores tasas de mortalidad y de ingreso en comparación con los colectivos con unas tasas de privación más bajas. Es necesario realizar intervenciones que minimicen estas desigualdades.
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Affiliation(s)
- Janire Portuondo-Jiménez
- Osakidetza Servicio Vasco de Salud, Subdirección de Coordinación de Atención Primaria, Vitoria-Gasteiz, España; Instituto de Investigación Sanitaria Biocruces Bizkaia, Grupo de Investigación en Ciencias de la Diseminación e Implementación en Servicios de Salud, Barakaldo, Bizkaia, España; Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), España.
| | - María Gascón
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), España; Osakidetza Servicio Vasco de Salud, Hospital Universitario Galdakao-Usansolo, Unidad de Investigación, Galdakao, Bizkaia, España; Red de Investigación de Servicios de Salud en Enfermedades Crónicas (REDISSEC), España; Instituto Kronikgune de Investigación en Servicios Sanitarios, Barakaldo, Bizkaia, España
| | - Julia García
- Departamento de Salud del Gobierno Vasco, Oficina de Planificación, Organización y Evaluación Sanitaria, País Vasco, España
| | - María-José Legarreta
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), España; Osakidetza Servicio Vasco de Salud, Hospital Universitario Galdakao-Usansolo, Unidad de Investigación, Galdakao, Bizkaia, España; Red de Investigación de Servicios de Salud en Enfermedades Crónicas (REDISSEC), España; Instituto Kronikgune de Investigación en Servicios Sanitarios, Barakaldo, Bizkaia, España
| | - Ane Villanueva
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), España; Osakidetza Servicio Vasco de Salud, Hospital Universitario Galdakao-Usansolo, Unidad de Investigación, Galdakao, Bizkaia, España; Red de Investigación de Servicios de Salud en Enfermedades Crónicas (REDISSEC), España; Instituto Kronikgune de Investigación en Servicios Sanitarios, Barakaldo, Bizkaia, España
| | - Nere Larrea
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), España; Osakidetza Servicio Vasco de Salud, Hospital Universitario Galdakao-Usansolo, Unidad de Investigación, Galdakao, Bizkaia, España; Red de Investigación de Servicios de Salud en Enfermedades Crónicas (REDISSEC), España; Instituto Kronikgune de Investigación en Servicios Sanitarios, Barakaldo, Bizkaia, España
| | - Susana García-Gutiérrez
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), España; Osakidetza Servicio Vasco de Salud, Hospital Universitario Galdakao-Usansolo, Unidad de Investigación, Galdakao, Bizkaia, España; Red de Investigación de Servicios de Salud en Enfermedades Crónicas (REDISSEC), España; Instituto Kronikgune de Investigación en Servicios Sanitarios, Barakaldo, Bizkaia, España
| | - Endika Munitiz
- Instituto de Investigación Sanitaria Biocruces Bizkaia, Grupo de Investigación en Ciencias de la Diseminación e Implementación en Servicios de Salud, Barakaldo, Bizkaia, España
| | - José M Quintana
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), España; Osakidetza Servicio Vasco de Salud, Hospital Universitario Galdakao-Usansolo, Unidad de Investigación, Galdakao, Bizkaia, España; Red de Investigación de Servicios de Salud en Enfermedades Crónicas (REDISSEC), España; Instituto Kronikgune de Investigación en Servicios Sanitarios, Barakaldo, Bizkaia, España
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Martínez-Alfonso J, Mesas AE, Jimenez-Olivas N, Cabrera-Majada A, Martínez-Vizcaíno V, Díaz-Olalla JM. Economic Migrants and Clinical Course of SARS-CoV-2 Infection: A Follow-Up Study. Int J Public Health 2022; 67:1605481. [PMID: 36589473 PMCID: PMC9800286 DOI: 10.3389/ijph.2022.1605481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022] Open
Abstract
Objective: To analyze whether social deprivation and economic migrant (EM) status influence the risk of being hospitalized with COVID-19. Methods: This was a retrospective follow-up study including all patients older than 18 years attending the Daroca Health Center in Madrid, Spain, diagnosed with COVID-19 during September 2020. Data on EM status and other sociodemographic, lifestyle and comorbidities that could affect the clinical course of the infection were obtained from electronic medical records. Results: Of the 796 patients positive for COVID-19, 44 (5.53%) were hospitalized. No significant differences were observed between those who were hospitalized and those who were not in the mean of social deprivation index or socioeconomic status, but EM status was associated with the risk of being hospitalized (p = 0.028). Logistic regression models showed that years of age (OR = 1.07; 95% CI: 1.04-1.10), EM status (OR = 5.72; 95% CI: 2.56-12.63) and hypertension (OR = 2.22; 95% CI: 1.01-4.85) were the only predictors of hospitalization. Conclusion: Our data support that EM status, rather than economic deprivation, is the socioeconomic factor associated with the probability of hospital admission for COVID-19 in Madrid, Spain.
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Affiliation(s)
| | - Arthur Eumann Mesas
- Universidad de Castilla-La Mancha, Cuenca, Spain
- Postgraduate Program in Public Health, Universidade Estadual de Londrina, Londrina, Brazil
| | | | | | - Vicente Martínez-Vizcaíno
- Universidad de Castilla-La Mancha, Cuenca, Spain
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
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Couso-Viana S, Bentué-Martínez C, Delgado-Martín MV, Cabeza-Irigoyen E, León-Latre M, Concheiro-Guisán A, Rodríguez-Álvarez MX, Román-Rodríguez M, Roca-Pardiñas J, Zúñiga-Antón M, García-Flaquer A, Pericàs-Pulido P, Sánchez-Recio R, González-Álvarez B, Rodríguez-Pastoriza S, Gómez-Gómez I, Motrico E, Jiménez-Murillo JL, Rabanaque I, Clavería A. Analysis of the impact of social determinants and primary care morbidity on population health outcomes by combining big data: A research protocol. Front Med (Lausanne) 2022; 9:1012437. [PMID: 36590942 PMCID: PMC9800778 DOI: 10.3389/fmed.2022.1012437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022] Open
Abstract
Background In recent years, different tools have been developed to facilitate analysis of social determinants of health (SDH) and apply this to health policy. The possibility of generating predictive models of health outcomes which combine a wide range of socioeconomic indicators with health problems is an approach that is receiving increasing attention. Our objectives are twofold: (1) to predict population health outcomes measured as hospital morbidity, taking primary care (PC) morbidity adjusted for SDH as predictors; and (2) to analyze the geographic variability of the impact of SDH-adjusted PC morbidity on hospital morbidity, by combining data sourced from electronic health records and selected operations of the National Statistics Institute (Instituto Nacional de Estadística/INE). Methods The following will be conducted: a qualitative study to select socio-health indicators using RAND methodology in accordance with SDH frameworks, based on indicators published by the INE in selected operations; and a quantitative study combining two large databases drawn from different Spain's Autonomous Regions (ARs) to enable hospital morbidity to be ascertained, i.e., PC electronic health records and the minimum basic data set (MBDS) for hospital discharges. These will be linked to socioeconomic indicators, previously selected by geographic unit. The outcome variable will be hospital morbidity, and the independent variables will be age, sex, PC morbidity, geographic unit, and socioeconomic indicators. Analysis To achieve the first objective, predictive models will be used, with a test-and-training technique, fitting multiple logistic regression models. In the analysis of geographic variability, penalized mixed models will be used, with geographic units considered as random effects and independent predictors as fixed effects. Discussion This study seeks to show the relationship between SDH and population health, and the geographic differences determined by such determinants. The main limitations are posed by the collection of data for healthcare as opposed to research purposes, and the time lag between collection and publication of data, sampling errors and missing data in registries and surveys. The main strength lies in the project's multidisciplinary nature (family medicine, pediatrics, public health, nursing, psychology, engineering, geography).
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Affiliation(s)
- Sabela Couso-Viana
- I-Saúde Group, South Galicia Health Research Institute (Instituto de Investigación Sanitaria Galicia Sur), SERGAS-UVIGO, Vigo, Spain
| | - Carmen Bentué-Martínez
- Department of Geography, Aragon University Environmental Sciences Research Institute (Instituto Universitario de Investigación en Ciencias Ambientales de Aragón/IUCA), University of Zaragoza, Zaragoza, Spain
| | - María Victoria Delgado-Martín
- I-Saúde Group, South Galicia Health Research Institute (Instituto de Investigación Sanitaria Galicia Sur), SERGAS-UVIGO, Vigo, Spain,Moaña Health Center, Vigo Area, SERGAS, Vigo, Spain,*Correspondence: María Victoria Delgado-Martín,
| | - Elena Cabeza-Irigoyen
- Health Promotion Service, Ministry of Health and Consumer Affairs, Public Health Research Group (Grup d’Investigació en Salud Pública/GISPIB), Balearic Islands Health Research Institute (IdISBa), Balearic Islands, Spain
| | | | - Ana Concheiro-Guisán
- Department of Pediatrics, Álvaro Cunqueiro Hospital, SERGAS, Vigo, Spain,Rare Diseases and Pediatric Medicine Group, South Galicia Health Research Institute (Instituto de Investigación Sanitaria Galicia Sur), SERGAS-UVIGO, Vigo, Spain
| | - María Xosé Rodríguez-Álvarez
- Department of Statistics and Operations Research, Biomedical Research Center (Centro de Investigacións Biomédicas/CINBIO), University of Vigo, Vigo, Spain,Galician Research and Mathematical Technology Center (Centro de Investigación e Tecnoloxía Matemática de Galicia/CITMAga), Vigo, Spain
| | - Miguel Román-Rodríguez
- Primary Care Management of Mallorca, Balearic Islands Health Research Institute, Balearic Islands, Spain
| | - Javier Roca-Pardiñas
- Galician Research and Mathematical Technology Center (Centro de Investigación e Tecnoloxía Matemática de Galicia/CITMAga), Vigo, Spain,Department of Statistics and Operations Research, University of Vigo, Vigo, Spain,Network for Research on Chronicity, Primary Care and Health Promotion (Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud/RICAPPS), Galicia, Spain
| | - María Zúñiga-Antón
- Department of Geography, Aragon University Environmental Sciences Research Institute (Instituto Universitario de Investigación en Ciencias Ambientales de Aragón/IUCA), University of Zaragoza, Zaragoza, Spain
| | - Ana García-Flaquer
- Balearic Islands Health Research Platform (Plataforma de Investigación en Información en Salud de Las Islas Baleares/PRISIB), Balearic Islands, Spain
| | - Pau Pericàs-Pulido
- Balearic Islands Health Research Platform (Plataforma de Investigación en Información en Salud de Las Islas Baleares/PRISIB), Balearic Islands, Spain
| | - Raquel Sánchez-Recio
- Aragon Health Services Research Group (Grupo de Investigación en Servicios Sanitarios de Aragón/GRISSA), Aragon, Spain,Aragonese Institute of Health, Aragon, Spain
| | | | - Sara Rodríguez-Pastoriza
- I-Saúde Group, South Galicia Health Research Institute (Instituto de Investigación Sanitaria Galicia Sur), SERGAS-UVIGO, Vigo, Spain
| | - Irene Gómez-Gómez
- Network for Research on Chronicity, Primary Care and Health Promotion (Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud/RICAPPS), Galicia, Spain,Department of Psychology, Loyola University Andalusia, Seville, Spain
| | - Emma Motrico
- Network for Research on Chronicity, Primary Care and Health Promotion (Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud/RICAPPS), Galicia, Spain,Department of Psychology, Loyola University Andalusia, Seville, Spain
| | | | - Isabel Rabanaque
- Department of Geography, Aragon University Environmental Sciences Research Institute (Instituto Universitario de Investigación en Ciencias Ambientales de Aragón/IUCA), University of Zaragoza, Zaragoza, Spain
| | - Ana Clavería
- I-Saúde Group, South Galicia Health Research Institute (Instituto de Investigación Sanitaria Galicia Sur), SERGAS-UVIGO, Vigo, Spain,Network for Research on Chronicity, Primary Care and Health Promotion (Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud/RICAPPS), Galicia, Spain
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López-Bueno JA, Navas-Martín MA, Díaz J, Mirón IJ, Luna MY, Sánchez-Martínez G, Culqui D, Linares C. Population vulnerability to extreme cold days in rural and urban municipalities in ten provinces in Spain. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 852:158165. [PMID: 35988600 DOI: 10.1016/j.scitotenv.2022.158165] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 07/29/2022] [Accepted: 08/16/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The objective was to analyze whether there are differences in vulnerability to Extreme Cold Days (ECD) between rural and urban populations in Spain. METHODOLOGY Time series analysis carried out from January 1, 2000, through December 31, 2013. Municipalities with over 10,000 inhabitants were included from 10 Spanish provinces, classified into 42 groups by isoclimate and urban/rural character as defined by Eurostat criteria. The statistical strategy was carried out in two phases. First: It was analyzed the relationship between minimum daily temperature (Tmin) (source: AEMET) and the rate of daily winter mortality due to natural causes -CIE-10: A00 - R99- (source: National Statistics Institute). Then, It was determinated the threshold of Tmin that defines the ECD and its percentile in the series of winter Tmin (Pthreshold), which is a measure of vulnerability to ECD so that the higher the percentile, the higher the vulnerability. Second: possible explanatory variables of vulnerability were explored using Mixed Generalized Models, using 13 independent variables related to meteorology, environment, socioeconomics, demographics and housing quality. RESULTS The average Pthreshold was 18 %. The final model indicated that for each percentage point increase in unemployment, the vulnerability to ECD increased by 0.4 (0.2, 0.6) points. Also, with each point increase in rurality index, this vulnerability decreased by -6.1 (-2.1, -10.0) points. Although less determinant, other factors that could contribute to explaining vulnerability at the province level included minimum winter daily temperatures and the percentage of housing with poor insulation. CONCLUSIONS The vulnerability to ECD was greater in urban zones than in rural zones. Socioeconomic status is a key to understanding how this vulnerability is distributed. These results suggest the need to implement public health prevention plans to address ECD at the state level. These plans should be based on threshold temperatures determined at the smallest scale possible.
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Affiliation(s)
- J A López-Bueno
- Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain.
| | - M A Navas-Martín
- Escuela Nacional de Salud, Instituto de Salud Carlos III, Madrid, Spain
| | - J Díaz
- Escuela Nacional de Salud, Instituto de Salud Carlos III, Madrid, Spain
| | - I J Mirón
- Consejería de Sanidad, Junta de Comunidades de Castilla la Mancha, Toledo, Spain
| | - M Y Luna
- Agencia Estatal de Meteorología, Madrid, Spain
| | | | - D Culqui
- Escuela Nacional de Salud, Instituto de Salud Carlos III, Madrid, Spain
| | - C Linares
- Escuela Nacional de Salud, Instituto de Salud Carlos III, Madrid, Spain
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Arregi A, Lertxundi A, Vegas O, García-Baquero G, Ibarluzea J, Anabitarte A, Barroeta Z, Jimeno-Romero A, Subiza-Pérez M, Lertxundi N. Environmental Noise Exposure and Sleep Habits among Children in a Cohort from Northern Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16321. [PMID: 36498392 PMCID: PMC9738338 DOI: 10.3390/ijerph192316321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 11/23/2022] [Accepted: 12/02/2022] [Indexed: 06/17/2023]
Abstract
Environmental noise is considered the second most serious environmental risk factor in Europe. However, little evidence exists regarding its impact on health and sleep in children, and the results are inconclusive. In this study, we aim to analyse the effect of environmental noise exposure on 11-year-old children's sleep habits. Data were collected from 377 participants in the INMA-Gipuzkoa (INfancia y Medio Ambiente) cohort project using both parent-reported and actigraphic sleep measures. The results revealed that 60% of children have a day-evening-night environmental noise exposure (Lden) of above 55 dB, which is defined as a "high noise level". No differences in noise exposure were observed between different socioeconomic groups. However, no effect of environmental noise was found on sleep variables. The paper highlights the importance of studying how environmental noise may affect children's sleep.
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Affiliation(s)
- Ane Arregi
- Faculty of Psychology, University of the Basque Country (UPV/EHU), 20008 San Sebastian, Spain
- Environmental Epidemiology and Child Development Group, Biodonostia Health Research Institute, Paseo Doctor Begiristain s/n, 20014 San Sebastian, Spain
| | - Aitana Lertxundi
- Environmental Epidemiology and Child Development Group, Biodonostia Health Research Institute, Paseo Doctor Begiristain s/n, 20014 San Sebastian, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, C/Monforte de Lemos 3-5, 28029 Madrid, Spain
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of the Basque Country (UPV/EHU), 48940 Leioa, Spain
| | - Oscar Vegas
- Faculty of Psychology, University of the Basque Country (UPV/EHU), 20008 San Sebastian, Spain
- Environmental Epidemiology and Child Development Group, Biodonostia Health Research Institute, Paseo Doctor Begiristain s/n, 20014 San Sebastian, Spain
| | - Gonzalo García-Baquero
- Environmental Epidemiology and Child Development Group, Biodonostia Health Research Institute, Paseo Doctor Begiristain s/n, 20014 San Sebastian, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, C/Monforte de Lemos 3-5, 28029 Madrid, Spain
| | - Jesus Ibarluzea
- Faculty of Psychology, University of the Basque Country (UPV/EHU), 20008 San Sebastian, Spain
- Environmental Epidemiology and Child Development Group, Biodonostia Health Research Institute, Paseo Doctor Begiristain s/n, 20014 San Sebastian, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, C/Monforte de Lemos 3-5, 28029 Madrid, Spain
- Ministry of Health of the Basque Government, Sub-Directorate for Public Health and Addictions of Gipuzkoa, 20013 San Sebastian, Spain
| | - Asier Anabitarte
- Environmental Epidemiology and Child Development Group, Biodonostia Health Research Institute, Paseo Doctor Begiristain s/n, 20014 San Sebastian, Spain
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of the Basque Country (UPV/EHU), 48940 Leioa, Spain
| | - Ziortza Barroeta
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of the Basque Country (UPV/EHU), 48940 Leioa, Spain
| | - Alba Jimeno-Romero
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of the Basque Country (UPV/EHU), 48940 Leioa, Spain
| | - Mikel Subiza-Pérez
- Faculty of Psychology, University of the Basque Country (UPV/EHU), 20008 San Sebastian, Spain
- Environmental Epidemiology and Child Development Group, Biodonostia Health Research Institute, Paseo Doctor Begiristain s/n, 20014 San Sebastian, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, C/Monforte de Lemos 3-5, 28029 Madrid, Spain
- Bradford Institute for Health Research, Bradford BD9 6RJ, UK
| | - Nerea Lertxundi
- Faculty of Psychology, University of the Basque Country (UPV/EHU), 20008 San Sebastian, Spain
- Environmental Epidemiology and Child Development Group, Biodonostia Health Research Institute, Paseo Doctor Begiristain s/n, 20014 San Sebastian, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, C/Monforte de Lemos 3-5, 28029 Madrid, Spain
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Sánchez-Valdivia N, Pérez-del-Pulgar C, de Bont J, Anguelovski I, López-Gay A, Pistillo A, Triguero-Mas M, Duarte-Salles T. Residential Proximity to Urban Play Spaces and Childhood Overweight and Obesity in Barcelona, Spain: A Population-Based Longitudinal Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13676. [PMID: 36294256 PMCID: PMC9603004 DOI: 10.3390/ijerph192013676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 06/16/2023]
Abstract
Findings on the relationship between play spaces and childhood overweight and obesity are mixed and scarce. This study aimed to investigate the associations between residential proximity to play spaces and the risk of childhood overweight or obesity and potential effect modifiers. This longitudinal study included children living in the city of Barcelona identified in an electronic primary healthcare record database between 2011 and 2018 (N = 75,608). Overweight and obesity were defined according to the WHO standards and we used 300 m network buffers to assess residential proximity to play spaces. We calculated the risk of developing overweight or obesity using Cox proportional hazard models. A share of 29.4% of the study population developed overweight or obesity, but we did not find consistent associations between play space indicators and overweight or obesity. We did not find any consistent sign of effect modification by sex, and only some indications of the modifying role of area socioeconomic status and level of exposure. Although it is not possible to draw clear conclusions from our study, we call for cities to continue increasing and improving urban play spaces with an equitable, healthy, and child-friendly perspective.
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Affiliation(s)
- Nacho Sánchez-Valdivia
- Barcelona Lab for Urban Environmental Justice and Sustainability, Institute of Environmental Science and Technology (ICTA), Universitat Autònoma de Barcelona (UAB), 08003 Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), Carrer Doctor Aiguader, 88, 08003 Barcelona, Spain
| | - Carmen Pérez-del-Pulgar
- Barcelona Lab for Urban Environmental Justice and Sustainability, Institute of Environmental Science and Technology (ICTA), Universitat Autònoma de Barcelona (UAB), 08003 Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), Carrer Doctor Aiguader, 88, 08003 Barcelona, Spain
- Helmholtz Centre for Environmental Research—UFZ Department Environmental Politics, 04318 Leipzig, Germany
- Department for Political Science, Friedrich-Schiller-University, 07737 Jena, Germany
| | - Jeroen de Bont
- Institute of Environmental Medicine, Karolinska Institute, 171 77 Stockholm, Sweden
| | - Isabelle Anguelovski
- Barcelona Lab for Urban Environmental Justice and Sustainability, Institute of Environmental Science and Technology (ICTA), Universitat Autònoma de Barcelona (UAB), 08003 Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), Carrer Doctor Aiguader, 88, 08003 Barcelona, Spain
- ICREA (Institució Catalana de Recerca i Estudis Avançats), 08010 Barcelona, Spain
| | - Antonio López-Gay
- Department of Geography, Universitat Autònoma de Barcelona (UAB), 08193 Barcelona, Spain
- Center for Demographic Studies, 08193 Bellaterra, Spain
| | - Andrea Pistillo
- Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain
| | - Margarita Triguero-Mas
- Barcelona Lab for Urban Environmental Justice and Sustainability, Institute of Environmental Science and Technology (ICTA), Universitat Autònoma de Barcelona (UAB), 08003 Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), Carrer Doctor Aiguader, 88, 08003 Barcelona, Spain
- Mariana Arcaya’s Research Lab, Department of Urban Studies and Planning, Massachusetts Institute of Technology, 77 Massachusetts Ave, Cambridge, MA 02139, USA
| | - Talita Duarte-Salles
- Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain
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Mostaza JM, Salinero-Fort MA, Cardenas-Valladolid J, Rodríguez-Artalejo F, Díaz-Almirón M, Vich-Pérez P, San Andrés-Rebollo FJ, Vicente I, Lahoz C. Factores asociados con la mortalidad por SARS-CoV-2 en la población mayor de 75 años de la Comunidad de Madrid. Rev Clin Esp 2022; 222:468-478. [PMID: 35720162 PMCID: PMC9193184 DOI: 10.1016/j.rce.2022.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 06/04/2022] [Indexed: 11/17/2022]
Abstract
Objetivo Pacientes y métodos Resultados Conclusión
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Affiliation(s)
- J M Mostaza
- Unidad de Lípidos y Riesgo Vascular, Servicio de Medicina Interna, Hospital La Paz-Carlos III, Madrid, España
| | - M A Salinero-Fort
- Fundación de Investigación Biosanitaria y de Innovación de Atención Primaria (FIIBAP), Instituto de Investigación del Hospital La Paz (IdIPAZ); Red de Investigación en pacientes crónicos (REDISSEC); Subdirección general de Investigación en Salud, Ministerio de Sanidad, Madrid, España
| | - J Cardenas-Valladolid
- Dirección Técnica de Sistemas de Información Sanitaria, Gerencia Adjunta de Procesos Asistenciales, Gerencia Asistencial de Atención Primaria, Madrid, España
| | - F Rodríguez-Artalejo
- Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid-IdIPAZ, CIBER de Epidemiología y Salud Pública (CIBERESP) e IMDEA-Alimentación, CEI UAM + CSIC, Madrid, España
| | - M Díaz-Almirón
- Unidad de Investigación, Instituto de Investigación Hospital La Paz, IdiPAZ, Madrid, España
| | - P Vich-Pérez
- Fundación de Investigación Biosanitaria y de Innovación de Atención Primaria (FIIBAP), Centro de Salud Los Alpes, Madrid, España
| | - F J San Andrés-Rebollo
- Fundación de Investigación Biosanitaria y de Innovación de Atención Primaria (FIIBAP), Centro de Salud Las Calesas, Madrid, España
| | - I Vicente
- Centro de Salud Monovar, Madrid, España
| | - C Lahoz
- Unidad de Lípidos y Riesgo Vascular, Servicio de Medicina Interna, Hospital La Paz-Carlos III, Madrid, España
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Carrasco-Ribelles LA, Roso-Llorach A, Cabrera-Bean M, Costa-Garrido A, Zabaleta-del-Olmo E, Toran-Monserrat P, Orfila Pernas F, Violán C. Dynamics of multimorbidity and frailty, and their contribution to mortality, nursing home and home care need: A primary care cohort of 1 456 052 ageing people. EClinicalMedicine 2022; 52:101610. [PMID: 36034409 PMCID: PMC9399153 DOI: 10.1016/j.eclinm.2022.101610] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/21/2022] [Accepted: 07/21/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Prevalence of both multimorbidity and frailty increases with age, but more evidence is needed to elucidate their relationship and their association with other health-related outcomes. We analysed the dynamics of both conditions as people age and calculate the associated risk of death, nursing home admission, and need for home care. METHODS Data were drawn from the primary care electronic health records of a longitudinal cohort of people aged 65 or older in Catalonia in 2010-2019. Frailty and multimorbidity were measured using validated instruments (eFRAGICAP, a cumulative deficit model; and SNAC-K, respectively), and their longitudinal evolution was described. Cox regression models accounted for the competing risk of death and adjusted by sex, socioeconomical status, and time-varying age, alcohol and smoking. FINDINGS We included 1 456 052 patients. Prevalence of multimorbidity was consistently high regardless of age, while frailty almost quadrupled from 65 to 99 years. Frailty worsened and also changed with age: up to 84 years, it was more related to concurrent diseases, and afterwards, to frailty-related deficits. While concurrent diseases contributed more to mortality, frailty-related deficits increased the risk of institutionalisation and the need for home care. INTERPRETATION The nature of people's multimorbidity and frailty vary with age, as does their impact on health status. People become frailer as they age, and their frailty is more characterised by disability and other symptoms than by diseases. Mortality is most associated with the number of comorbidities, whereas frailty-related deficits are associated with needing specialised care. FUNDING Instituto de Salud Carlos III through PI19/00535, and the PFIS Grant FI20/00040 (Co-funded by European Regional Development Fund/European Social Fund).
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Affiliation(s)
- Lucía A. Carrasco-Ribelles
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Barcelona, Spain
- Department of Signal Theory and Communications, Universitat Politécnica de Catalunya (UPC), Barcelona, Spain
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Mataró, Spain
| | - Albert Roso-Llorach
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Barcelona, Spain
- Departament de Pediatria, d’Obstetrícia i Ginecologia i de Medicina Preventiva, Universitat Autónoma de Barcelona, Bellaterra, Spain
| | - Margarita Cabrera-Bean
- Department of Signal Theory and Communications, Universitat Politécnica de Catalunya (UPC), Barcelona, Spain
| | - Anna Costa-Garrido
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Mataró, Spain
| | - Edurne Zabaleta-del-Olmo
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Barcelona, Spain
- Geréncia Territorial de Barcelona, Institut Català de la Salut, Barcelona, Spain
- Nursing Department, Faculty of Nursing, Universitat de Girona, Girona, Spain
| | - Pere Toran-Monserrat
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Mataró, Spain
- Fundació Institut d’Investigació en ciéncies de la salut Germans Trias i Pujol (IGTP), Badalona, Spain
- Medicine Department, Faculty of Medicine, Universitat de Girona, Girona, Spain
| | - Francesc Orfila Pernas
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Barcelona, Spain
- Geréncia Territorial de Barcelona, Institut Català de la Salut, Barcelona, Spain
| | - Concepción Violán
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Mataró, Spain
- Fundació Institut d’Investigació en ciéncies de la salut Germans Trias i Pujol (IGTP), Badalona, Spain
- Direcció d’Atenció Primària, Metropolitana Nord Institut Català de Salut, Badalona, Spain
- Universitat Autónoma de Barcelona, Cerdanyola del Vallés, Spain
- Corresponding author.
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Association of socioeconomic deprivation with life expectancy and all-cause mortality in Spain, 2011–2013. Sci Rep 2022; 12:15554. [PMID: 36114247 PMCID: PMC9481591 DOI: 10.1038/s41598-022-19859-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 09/06/2022] [Indexed: 11/08/2022] Open
Abstract
AbstractLife tables summarise a population’s mortality experience during a time period. Sex- and age-specific life tables are needed to compute various cancer survival measures. However, mortality rates vary according to socioeconomic status. We present sex- and age-specific life tables based on socioeconomic status at the census tract level in Spain during 2011–2013 that will allow estimating cancer relative survival estimates and life expectancy measures by socioeconomic status. Population and mortality data were obtained from the Spanish Statistical Office. Socioeconomic level was measured using the Spanish Deprivation Index by census tract. We produced sex- and age-specific life expectancies at birth by quintiles of deprivation, and life tables by census tract and province. Life expectancy at birth was higher among women than among men. Women and men in the most deprived census tracts in Spain lived 3.2 and 3.8 years less than their counterparts in the least deprived areas. A higher life expectancy in the northern regions of Spain was discovered. Life expectancy was higher in provincial capitals than in rural areas. We found a significant life expectancy gap and geographical variation by sex and socioeconomic status in Spain. The gap was more pronounced among men than among women. Understanding the association between life expectancy and socioeconomic status could help in developing appropriate public health programs. Furthermore, the life tables we produced are needed to estimate cancer specific survival measures by socioeconomic status. Therefore, they are important for cancer control in Spain.
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Ayuso-Álvarez A, Ortiz C, López-Cuadrado T, Rodríguez-Blázquez C, Fernández-Navarro P, González-Palacios J, Damián J, Galán I. Rural-urban gradients and all-cause, cardiovascular and cancer mortality in Spain using individual data. SSM Popul Health 2022; 19:101232. [PMID: 36188419 PMCID: PMC9516441 DOI: 10.1016/j.ssmph.2022.101232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/13/2022] [Accepted: 09/13/2022] [Indexed: 11/30/2022] Open
Abstract
The literature reporting on rural-urban health status disparities remains inconclusive. We analyzed data from a longitudinal population-based study using individual observations. Our results show that the risks of all-cause and cancer mortality are greater in large cities than in other municipalities, with no clear urban-rural gradient. Not differences were found among territories in cardiovascular mortality.
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Affiliation(s)
- Ana Ayuso-Álvarez
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain.,Sociology Department, Faculty of Economic and Business Sciences, Autonomous University of Madrid, Spain
| | - Cristina Ortiz
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain
| | - Teresa López-Cuadrado
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain.,Department of Preventive Medicine and Public Health, Autonomous University of Madrid/IdiPAZ, Madrid, Spain
| | | | - Pablo Fernández-Navarro
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain.,Bioinformatics and Data Management Group (BIODAMA), National Centre for Epidemiology, Carlos III Institute of Health, Madrid, Spain
| | - Javier González-Palacios
- Bioinformatics and Data Management Group (BIODAMA), National Centre for Epidemiology, Carlos III Institute of Health, Madrid, Spain
| | - Javier Damián
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain
| | - Iñaki Galán
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain.,Department of Preventive Medicine and Public Health, Autonomous University of Madrid/IdiPAZ, Madrid, Spain
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Díaz-García RS, Sánchez-Gómez A, López-Zambrano MA, Esteban-Vasallo MD, Cañellas Llabrés S, Gutiérrez Rodríguez MÁ, Lasheras Carbajo MD. Cobertura y adherencia a la vacunación frente a la gripe en menores de 15 años con condiciones de riesgo en la Comunidad de Madrid. An Pediatr (Barc) 2022. [DOI: 10.1016/j.anpedi.2022.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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Zelenina A, Shalnova S, Maksimov S, Drapkina O. Classification of Deprivation Indices That Applied to Detect Health Inequality: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10063. [PMID: 36011694 PMCID: PMC9408665 DOI: 10.3390/ijerph191610063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/10/2022] [Accepted: 08/12/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Many studies around the world are undertaken to establish the association between deprivation and public health indicators. Both separate indicators (e.g., income, education, occupation, public security and social support) and complex models (indices) include several indicators. Deprivation indices are actively used in public health since the mid 1980s. There is currently no clear classification of indices. METHODS In the current review, data related to deprivation indices are combined and analyzed in order to create a taxonomy of indices based on the results obtained. The search was carried out using two bibliographic databases. After conducting a full-text review of the articles and searching and adding relevant articles from the bibliography, and articles that were already known to the authors, sixty studies describing the use of sixty deprivation indices in seventeen countries were included in the narrative synthesis, resulting in development of a taxonomy of indices. When creating the taxonomy, an integrative approach was used that allows integrating new classes and sub-classes in the event that new information appears. RESULTS In the review, 68% (41/60) of indices were classified as socio-economic, 7% (4/60) of indices as material deprivation, 5% (3/60) of indices as environmental deprivation and 20% (12/60) as multidimensional indices. CONCLUSIONS The data stimulates the use of a competent approach, and will help researchers and public health specialist in resolving conflicts or inconsistencies that arise during the construction and use of indices.
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Affiliation(s)
- Anastasia Zelenina
- National Medical Research Center for Preventive Medicine of the Ministry of Healthcare of the Russian Federation, Petroverigskiy per. 10, 101990 Moscow, Russia
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Mostaza JM, Salinero-Fort MA, Cardenas-Valladolid J, Rodríguez-Artalejo F, Díaz-Almirón M, Vich-Pérez P, San Andrés-Rebollo FJ, Vicente I, Lahoz C. Factors associated with mortality due to SARS-CoV-2 in the population over 75 years of age in the Community of Madrid. Rev Clin Esp 2022; 222:468-478. [PMID: 35970758 PMCID: PMC9372797 DOI: 10.1016/j.rceng.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 06/04/2022] [Indexed: 11/30/2022]
Abstract
Objective Various studies have identified factors associated with risk of mortality in patients with SARS-CoV-2 infection. However, their sample size has often been limited and their results partially contradictory. This study evaluated factors associated with COVID-19 mortality in the population of Madrid over 75 years of age, in infected patients, and in hospitalized patients up to January 2021. Patients and Methods This population-based cohort study analyzed all residents of the Community of Madrid born before January 1, 1945 who were alive as of December 31, 2019. Demographic and clinical data were obtained from primary care electronic medical records (PC-Madrid), data on hospital admissions from the Conjunto Mínimo Básico de Datos (CMBD, Minimum Data Set), and data on mortality from the Índice Nacional de Defunciones (INDEF, National Death Index). Data on SARS-CoV-2 infection, hospitalization, and death were collected from March 1, 2020 to January 31, 2021. Results A total of 587,603 subjects were included in the cohort. Of them, 41,603 (7.1%) had confirmed SARS-CoV-2 infection, of which 22,362 (53.7% of the infected individuals) were hospitalized and 11,251 (27%) died. Male sex and age were the factors most closely associated with mortality, though many comorbidities also had an influence. The associations were stronger in the analysis of the total population than in the analysis of infected or hospitalized patients. Mortality among hospitalized patients was lower during the second wave (33.4%) than during the first wave (41.2%) of the pandemic. Conclusion Age, sex, and numerous comorbidities are associated with risk of death due to COVID-19. Mortality in hospitalized patients declined notably after the first wave of the pandemic.
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Affiliation(s)
- J M Mostaza
- Unidad de Lípidos y Riesgo Vascular, Servicio de Medicina Interna. Hospital La Paz-Carlos III, Madrid, Spain.
| | - M A Salinero-Fort
- Fundación de Investigación Biosanitaria y de Innovación de Atención Primaria (FIIBAP), Instituto de Investigación del Hospital La Paz (IdIPAZ), Red de Investigación en pacientes crónicos (REDISSEC), Subdirección general de Investigación en Salud, Ministerios de Sanidad, Madrid, Spain
| | - J Cardenas-Valladolid
- Dirección Técnica de Sistemas de Información Sanitaria, Gerencia Adjunta de Procesos Asistenciales, Gerencia Asistencial de Atención Primaria, Madrid. Spain
| | - F Rodríguez-Artalejo
- Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid-IdIPAZ, CIBER de Epidemiología y Salud Pública (CIBERESP) e IMDEA-Alimentación, CEI UAM + CSIC, Madrid, Spain
| | - M Díaz-Almirón
- Unidad de Investigación, Instituto de Investigación Hospital La Paz, IdiPAZ, Madrid, Spain
| | - P Vich-Pérez
- Fundación de Investigación Biosanitaria y de Innovación de Atención Primaria (FIIBAP), Centro de Salud Los Alpes, Madrid, Spain
| | - F J San Andrés-Rebollo
- Fundación de Investigación Biosanitaria y de Innovación de Atención Primaria (FIIBAP), Centro de Salud Las Calesas, Madrid, Spain
| | - I Vicente
- Centro de Salud Monovar, Madrid, Spain
| | - C Lahoz
- Unidad de Lípidos y Riesgo Vascular, Servicio de Medicina Interna. Hospital La Paz-Carlos III, Madrid, Spain
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Culqui DR, Díaz J, Blanco A, Lopez JA, Navas MA, Sánchez-Martínez G, Luna MY, Hervella B, Belda F, Linares C. Short-term influence of environmental factors and social variables COVID-19 disease in Spain during first wave (Feb-May 2020). ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:50392-50406. [PMID: 35230631 PMCID: PMC8886199 DOI: 10.1007/s11356-022-19232-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 02/10/2022] [Indexed: 06/14/2023]
Abstract
This study aims to identify the combined role of environmental pollutants and atmospheric variables at short term on the rate of incidence (TIC) and on the hospital admission rate (TIHC) due to COVID-19 disease in Spain. This study used information from 41 of the 52 provinces of Spain (from Feb. 1, 2021 to May 31, 2021). Using TIC and TIHC as dependent variables, and average daily concentrations of PM10 and NO2 as independent variables. Meteorological variables included maximum daily temperature (Tmax) and average daily absolute humidity (HA). Generalized linear models (GLM) with Poisson link were carried out for each provinces The GLM model controlled for trend, seasonalities, and the autoregressive character of the series. Days with lags were established. The relative risk (RR) was calculated by increases of 10 μg/m3 in PM10 and NO2 and by 1 °C in the case of Tmax and 1 g/m3 in the case of HA. Later, a linear regression was carried out that included the social determinants of health. Statistically significant associations were found between PM10, NO2, and the rate of COVID-19 incidence. NO2 was the variable that showed greater association, both for TIC as well as for TIHC in the majority of provinces. Temperature and HA do not seem to have played an important role. The geographic distribution of RR in the studied provinces was very much heterogeneous. Some of the health determinants considered, including income per capita, presence of airports, average number of diesel cars per inhabitant, average number of nursing personnel, and homes under 30 m2 could explain the differential geographic behavior. As findings indicates, environmental factors only could modulate the incidence and severity of COVID-19. Moreover, the social determinants and public health measures could explain some patterns of geographically distribution founded.
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Affiliation(s)
- Dante R. Culqui
- Reference Unit on Climate Change, Health and Urban Environment National School of Health, Carlos III Health Institute, Monforte de Lemos, 5 (Aveniu), 28029, Madrid, Spain
| | - Julio Díaz
- Reference Unit on Climate Change, Health and Urban Environment National School of Health, Carlos III Health Institute, Monforte de Lemos, 5 (Aveniu), 28029, Madrid, Spain
| | - Alejandro Blanco
- Reference Unit on Climate Change, Health and Urban Environment National School of Health, Carlos III Health Institute, Monforte de Lemos, 5 (Aveniu), 28029, Madrid, Spain
| | - José A. Lopez
- Reference Unit on Climate Change, Health and Urban Environment National School of Health, Carlos III Health Institute, Monforte de Lemos, 5 (Aveniu), 28029, Madrid, Spain
| | - Miguel A. Navas
- Reference Unit on Climate Change, Health and Urban Environment National School of Health, Carlos III Health Institute, Monforte de Lemos, 5 (Aveniu), 28029, Madrid, Spain
| | | | | | | | | | - Cristina Linares
- Reference Unit on Climate Change, Health and Urban Environment National School of Health, Carlos III Health Institute, Monforte de Lemos, 5 (Aveniu), 28029, Madrid, Spain
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Gullón P, Cuesta-Lozano D, Cuevas-Castillo C, Fontán-Vela M, Franco M. Temporal trends in within-city inequities in COVID-19 incidence rate by area-level deprivation in Madrid, Spain. Health Place 2022; 76:102830. [PMID: 35636072 PMCID: PMC9127049 DOI: 10.1016/j.healthplace.2022.102830] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 05/10/2022] [Accepted: 05/17/2022] [Indexed: 01/26/2023]
Abstract
Patterns of exposure and policies aiming at reducing physical contact might have changed the social distribution of COVID-19 incidence over the course of the pandemic. Thus, we studied the temporal trends in the association between area-level deprivation and COVID-19 incidence rate by Basic Health Zone (minimum administration division for health service provision) in Madrid, Spain, from March 2020 to September 2021. We found an overall association between deprivation and COVID-19 incidence. This association varied over time; areas with higher deprivation showed higher COVID-19 incidence rates from July to November 2020 and August-September 2021, while, by contrast, higher deprivation areas showed lower COVID-19 incidence rates in December 2020 and July 2021.
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Affiliation(s)
- Pedro Gullón
- Universidad de Alcalá, Facultad de Medicina y Ciencias de La Salud, Departamento de Cirugía, Ciencias Médicas y Sociales, Grupo de Investigación en Epidemiología y Salud Pública, Alcalá de Henares, Madrid, Spain; Centre for Urban Research, RMIT University, Melbourne, Australia.
| | - Daniel Cuesta-Lozano
- Universidad de Alcalá, Facultad de Medicina y Ciencias de La Salud, Departamento de Enfermería y Fisioterapia, Alcalá de Henares, Madrid, Spain
| | - Carmen Cuevas-Castillo
- Universidad de Alcalá, Facultad de Medicina y Ciencias de La Salud, Departamento de Cirugía, Ciencias Médicas y Sociales, Grupo de Investigación en Epidemiología y Salud Pública, Alcalá de Henares, Madrid, Spain
| | - Mario Fontán-Vela
- Universidad de Alcalá, Facultad de Medicina y Ciencias de La Salud, Departamento de Cirugía, Ciencias Médicas y Sociales, Grupo de Investigación en Epidemiología y Salud Pública, Alcalá de Henares, Madrid, Spain; Instituto de Lengua, Literatura y Antropología, Consejo Superior de Investigaciones Científicas, Madrid, Spain
| | - Manuel Franco
- Universidad de Alcalá, Facultad de Medicina y Ciencias de La Salud, Departamento de Cirugía, Ciencias Médicas y Sociales, Grupo de Investigación en Epidemiología y Salud Pública, Alcalá de Henares, Madrid, Spain; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md, 21205-2217, USA
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Navas-Martín M, López-Bueno JA, Díaz J, Follos F, Vellón J, Mirón I, Luna M, Sánchez-Martínez G, Culqui D, Linares C. Effects of local factors on adaptation to heat in Spain (1983-2018). ENVIRONMENTAL RESEARCH 2022; 209:112784. [PMID: 35090871 DOI: 10.1016/j.envres.2022.112784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 01/11/2022] [Accepted: 01/19/2022] [Indexed: 05/16/2023]
Abstract
The European Union is currently immersed in policy development to address the effects of climate change around the world. Key plans and processes for facilitating adaptation to high temperatures and for reducing the adverse effects on health are among the most urgent measures. Therefore, it is necessary to understand those factors that influence adaptation. The aim of this study was to provide knowledge related to the social, climate and economic factors that are related to the evolution of minimum mortality temperatures (MMT) in Spain in the rural and urban contexts, during the 1983-2018 time period. For this purpose, local factors were studied regarding their relationship to levels of adaptation to heat. MMT is an indicator that allows for establishing a relationship to between mortality and temperature, and is a valid indicator to assess the capacity of adaptation to heat of a certain population. MMT is obtained through the maximum daily temperature and daily mortality of the study period. The evolution of MMT values for Spain was established in a previous paper. An ecological, longitudinal and retrospective study was carried out. Generalized linear models (GLM) were performed to identify the variables that appeared to be related to adaptation. The adaptation was calculated as the difference in variation in MMT based on the average increase in maximum daily temperatures. In terms of adaptation to heat, urban populations have adapted more than non-urban populations. Seventy-nine percent (n = 11) of urban provinces have adapted to heat, compared to twenty-one percent (n = 3) of rural provinces that have not adapted. In terms of urban zones, income level and habituation to heat (values over the 95th percentile) were variables shown to be related to adaptation. In contrast, among non-urban provinces, a greater number of housing rehabilitation licenses and a greater number of health professionals were variables associated with higher increases in MMT, and therefore, with adaptation. These results highlight the need to carry out studies that allow for identifying the local factors that are most relevant and influential in population adaptation. More studies carried out at a small scale are needed.
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Affiliation(s)
- Má Navas-Martín
- Doctorate Program in Biomedical Sciences and Public Health, National University of Distance Education, Madrid, Spain; National School of Public Health, Carlos III Institute of Health, Madrid, Spain.
| | - J A López-Bueno
- National School of Public Health, Carlos III Institute of Health, Madrid, Spain
| | - J Díaz
- National School of Public Health, Carlos III Institute of Health, Madrid, Spain
| | - F Follos
- Tdot Soluciones Sostenibles, SL. Ferrol. A Coruña, Spain
| | - Jm Vellón
- Tdot Soluciones Sostenibles, SL. Ferrol. A Coruña, Spain
| | - Ij Mirón
- Regional Health Authority of Castile La Mancha, Toledo, Spain
| | - My Luna
- State Meteorological Agency, Madrid, Spain
| | | | - D Culqui
- National School of Public Health, Carlos III Institute of Health, Madrid, Spain
| | - C Linares
- National School of Public Health, Carlos III Institute of Health, Madrid, Spain
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López-Bueno JA, Navas-Martín MA, Díaz J, Mirón IJ, Luna MY, Sánchez-Martínez G, Culqui D, Linares C. Analysis of vulnerability to heat in rural and urban areas in Spain: What factors explain Heat's geographic behavior? ENVIRONMENTAL RESEARCH 2022; 207:112213. [PMID: 34666017 DOI: 10.1016/j.envres.2021.112213] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/21/2021] [Accepted: 10/11/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION There is currently little knowledge and few published works on the subject of vulnerability to heat in rural environments at the country level. Therefore, the objective of this study was to determine whether rural areas are more vulnerable to extreme heat than urban areas in Spain. This study aimed to analyze whether a pattern of vulnerability depends on contextual, environmental, demographic, economic and housing variables. METHODS An ecological, longitudinal and retrospective study was carried out based on time series data between January 01, 2000 and December 31, 2013 in 42 geographic areas in 10 provinces in Spain. We first analyzed the functional relationship between the mortality rate per million inhabitants and maximum daily temperature (Tmax). We then determined the summer temperature threshold (Pthreshold) (June-September) at which increases in mortality are produced that are attributable to heat. In a second phase, based on Pthreshold, a vulnerability variable was calculated, and its distribution was analyzed using mixed linear models from the Poisson family (link = log). In these models, the dependent variable was vulnerability, and the independent variables were exposure to high temperatures, aridity of the climate, deprivation index, percentage of people over age 65, rurality index, percentage of housing built prior to 1980 and condition of dwellings. RESULTS Rurality was a protective factor, and vulnerability in urban areas was six times greater. In contrast, risk factors included aridity (RR = 5.89 (2.26 15.36)), living in cool summer zones (2.69 (1.23, 5.91)), poverty (4.05 (1.91 8.59)) and the percentage of dysfunctional housing (1.13 (1.04 1.24)). CONCLUSIONS Rural areas are less vulnerable to extreme heat than the urban areas analyzed. Also, population groups with worse working conditions and higher percentages of dwellings in poor conditions are more vulnerable.
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Affiliation(s)
- J A López-Bueno
- Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Madrid, Spain.
| | - M A Navas-Martín
- Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Madrid, Spain
| | - J Díaz
- Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Madrid, Spain
| | - I J Mirón
- Consejería de Sanidad, Junta de Comunidades de Castilla la Mancha, Toledo, Spain
| | - M Y Luna
- Agencia Estatal de Meteorología, Madrid, Spain
| | | | - D Culqui
- Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Madrid, Spain
| | - C Linares
- Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Madrid, Spain
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Lara-Morales A, Gandarillas-Grande A, Díaz-Holgado A, Serrano-Gallardo P. Psychosocial factors in adherence to pharmacological treatment and diabetes mellitus control in patients over 65. Aten Primaria 2022; 54:102302. [PMID: 35430460 PMCID: PMC9036116 DOI: 10.1016/j.aprim.2022.102302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/26/2021] [Accepted: 01/13/2022] [Indexed: 11/02/2022] Open
Abstract
Aim Design Setting and participants Main measurements Results Conclusions
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Recalde M, Rodríguez C, Burn E, Far M, García D, Carrere-Molina J, Benítez M, Moleras A, Pistillo A, Bolíbar B, Aragón M, Duarte-Salles T. Data Resource Profile: The Information System for Research in Primary Care (SIDIAP). Int J Epidemiol 2022; 51:e324-e336. [PMID: 35415748 PMCID: PMC9749711 DOI: 10.1093/ije/dyac068] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 03/29/2022] [Indexed: 01/21/2023] Open
Affiliation(s)
| | | | - Edward Burn
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain,Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK
| | - Marc Far
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Darío García
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Jordi Carrere-Molina
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Mencia Benítez
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Anna Moleras
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Andrea Pistillo
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Bonaventura Bolíbar
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain,Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - María Aragón
- Corresponding author. Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Gran Via Corts Catalanes, 587 àtic, 08007 Barcelona, Spain. E-mail:
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Avellaneda-Gómez C, Vivanco-Hidalgo RM, Olmos S, Lazcano U, Valentin A, Milà C, Ambrós A, Roquer J, Tonne C. Air pollution and surrounding greenness in relation to ischemic stroke: A population-based cohort study. ENVIRONMENT INTERNATIONAL 2022; 161:107147. [PMID: 35180670 DOI: 10.1016/j.envint.2022.107147] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/28/2022] [Accepted: 02/08/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Evidence for the association between environmental exposures and ischemic stroke (IS) is limited and inconsistent. We aimed to assess the relationship between exposure to air pollutants, residential surrounding greenness, and incident IS, and to identify population subgroups particularly sensitive to these exposures. METHODS We used data from administrative health registries of the public healthcare system in Catalonia, Spain to construct a cohort of individuals aged 18 years and older without a previous stroke diagnosis at 1st January 2016 (n = 3 521 274). We collected data on sociodemographic characteristics and cerebrovascular risk factors, and derived exposure at the participant's residence to ambient levels of fine particulate matter (PM2.5), black carbon (BC), nitrogen dioxide (NO2), and Normalized Difference Vegetation Index (NDVI) in a 300 m buffer as an indicator of greenness. The primary outcome was IS diagnosis at any point during the follow-up. We used Cox proportional hazards models to estimate associations between environmental exposures and incident IS and stratified analyses to investigate effect modification. RESULTS Between 1st January 2016 and 31st December 2017, 10 865 individuals were admitted to public hospitals with an IS diagnosis. Median exposure levels were: 17 µg/m3 PM2.5, 35 µg/m3 NO2, 2.28 µg/m3 BC and 0.27 NDVI. Individuals with higher residential exposure to air pollution were at greater risk of IS: HR 1·04 (95% CI:0·99-1·10) per 5 µg/m3 of PM2.5; HR 1.05 (95% CI:1·00-1·10) per 1 µg/m3 of BC; HR 1·04 (95% CI:1·03-1·06) per 10 µg/m3 of NO2. Conversely, individuals with higher residential surrounding green space, had lower risk of IS (HR 0·84; CI 95%:0·7-1.0). There was no evidence of effect modification by individual characteristics. CONCLUSIONS Higher incidence of IS was observed in relation to long-term exposures to air pollution, particularly NO2, in a region that meets European health-based air quality standards. Residential surrounding greenness was associated with lower incidence of IS.
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Affiliation(s)
- C Avellaneda-Gómez
- Neurology Department, IMIM-Hospital del Mar, Barcelona, Spain; Universitat Autònoma de Barcelona (UAB), Barcelona, Spain; Complex Hospitalari Moisès Broggi, Consorci Sanitari Integral, Barcelona, Spain.
| | - R M Vivanco-Hidalgo
- Neurology Department, IMIM-Hospital del Mar, Barcelona, Spain; Agency for Health Quality and Assessment of Catalonia (AQuAS), Barcelona, Spain.
| | - S Olmos
- ISGlobal, Barcelona, Spain; CIBER epidemiología y salud pública (CIBERESP), Madrid, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain.
| | - U Lazcano
- Agency for Health Quality and Assessment of Catalonia (AQuAS), Barcelona, Spain.
| | - A Valentin
- ISGlobal, Barcelona, Spain; CIBER epidemiología y salud pública (CIBERESP), Madrid, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain.
| | - C Milà
- ISGlobal, Barcelona, Spain; CIBER epidemiología y salud pública (CIBERESP), Madrid, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain.
| | - A Ambrós
- ISGlobal, Barcelona, Spain; CIBER epidemiología y salud pública (CIBERESP), Madrid, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain.
| | - J Roquer
- Neurology Department, IMIM-Hospital del Mar, Barcelona, Spain; Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
| | - C Tonne
- ISGlobal, Barcelona, Spain; CIBER epidemiología y salud pública (CIBERESP), Madrid, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain.
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