1
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Cayuela A, Cayuela L, Ortega Belmonte MJ, Rodríguez-Domínguez S, Escudero-Martínez I, González A. Has stroke mortality stopped declining in Spain? Neurologia 2022; 37:550-556. [PMID: 31780318 DOI: 10.1016/j.nrl.2019.06.001] [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: 05/02/2018] [Revised: 05/06/2019] [Accepted: 06/20/2019] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES To analyse the changes in stroke mortality trends in Spain by autonomous community and by sex during the period 1980-2016, using joinpoint regression models. METHODS Mortality data were obtained from the Spanish National Statistics Institute. Crude and standardised rates were calculated for each Spanish autonomous community, and for each sex. Joinpoint analysis was used to identify the best-fitting points showing a statistically significant change in the trend. RESULTS Joinpoint analysis enabled us to differentiate between communities in which mortality rates showed a continuous decline throughout the study period in both sexes (Asturias, Cantabria, Castile and Leon, Ceuta, and Melilla) or in men only (Extremadura). In men, in all those communities in which changes in the trend were observed (all but Aragon, the Balearic Islands, and Murcia, where rates remained stable), we observed an initial period of decline (ranging from -3.4% in Catalonia and Extremadura, to -6.0% in Madrid) and a final period where the trends diverged: mortality rates continued to fall in Andalusia, Aragon, the Balearic Islands, and Madrid, but began to stabilise in Castile-La Mancha and Murcia and to increase in the Canary Islands. In women, in those communities where changes were observed (all but Aragon, Murcia, and the Basque Country, where rates remained stable), we observed an initial period of decline (ranging from -3.1% in Catalonia to -6.4% in Navarre) and a final period where divergent trends were observed: rates continued to decline in Andalusia, Aragon, Catalonia, Galicia, Madrid, and the Basque Country, but began to stabilise in Extremadura and Murcia and to increase in the Canary Islands. CONCLUSIONS Current data show that stroke mortality rates have decreased (in women in Andalusia), stabilised (in both sexes in Murcia, in men in Castile-La Mancha, and in women in Extremadura), and have even reversed (in both sexes in the Canary Islands). Further study is needed to identify the causes of these trends.
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Affiliation(s)
- A Cayuela
- Unidad de Gestión Clínica de Salud Pública, Prevención y Promoción de la Salud, Hospital de Valme, Área de Gestión Sanitaria Sur de Sevilla, Sevilla, España.
| | - L Cayuela
- Departamento de Medicina Interna, Hospital Severo Ochoa, Leganés, Madrid, España
| | - M J Ortega Belmonte
- Unidad de Gestión Clínica de Salud Pública, Prevención y Promoción de la Salud, Hospital de Valme, Área de Gestión Sanitaria Sur de Sevilla, Sevilla, España
| | | | - I Escudero-Martínez
- Unidad de Ictus, Unidad de Gestión Clínica de Neurociencias, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - A González
- Servicio de Neurorradiología Intervencionista, Hospital Universitario Virgen del Rocío, Sevilla, España
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2
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Pellico-López A, Fernández-Feito A, Cantarero D, Herrero-Montes M, Cayón-de Las Cuevas J, Parás-Bravo P, Paz-Zulueta M. Cost of stay and characteristics of patients with stroke and delayed discharge for non-clinical reasons. Sci Rep 2022; 12:10854. [PMID: 35760829 PMCID: PMC9237047 DOI: 10.1038/s41598-022-14502-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 06/08/2022] [Indexed: 12/04/2022] Open
Abstract
Delayed discharge for non-clinical reasons (bed-blocking) is characteristic of pathologies associated with ageing, loss of functional capacity and dependence such as stroke. The aims of this study were to describe the costs and characteristics of cases of patients with stroke and delayed discharge for non-clinical reasons (bed-blocking) compared with cases of bed-blocking (BB) for other reasons and to assess the relationship between the length of total stay (LOS) with patient characteristics and the context of care. A descriptive cross-sectional study was conducted at a high complexity public hospital in Northern Spain (2007–2015). 443 stroke patients presented with BB. Delayed discharge increased LOS by approximately one week. The median age was 79.7 years, significantly higher than in cases of BB for other reasons. Patients with stroke and BB are usually older patients, however, when younger patients are affected, their length of stay is longer in relation to the sudden onset of the problem and the lack of adequate functional recovery resources or residential facilities for intermediate care.
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Affiliation(s)
- Amada Pellico-López
- Cantabria Health Service, Avda. Derechos de la Infancia, 31. C.P., 39340, Suances, Cantabria, Spain.,Departamento de Enfermería, Universidad de Cantabria, Avda. Valdecilla s/n. C.P., 39008, Santander, Cantabria, Spain
| | - Ana Fernández-Feito
- Departamento de Medicina, Facultad de Medicina y Ciencias de la Salud, Universidad de Oviedo, Avda. Julián Clavería s/n C.P., 33006, Oviedo, Principado de Asturias, Spain. .,Área de Investigación en Cuidados, Grupo de Procesos Asistenciales de Enfermería, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Avda del Hospital Universitario, s/n. C.P., 33011, Oviedo, Principado de Asturias, Spain.
| | - David Cantarero
- Departamento de Economía, Universidad de Cantabria, Avda. de los Castros s/n C.P., 39005, Santander, Cantabria, Spain.,IDIVAL, Research Group of Health Economics and Health Services Management-Research Institute Marqués de Valdecilla C/ Cardenal Herrera Oria s/n., 39011, Santander, Cantabria, Spain
| | - Manuel Herrero-Montes
- Departamento de Enfermería, Universidad de Cantabria, Avda. Valdecilla s/n. C.P., 39008, Santander, Cantabria, Spain.,IDIVAL, Grupo de Investigación en Enfermería, C/ Cardenal Herrera Oria s/n. C.P., 39011, Santander, Cantabria, Spain
| | - Joaquín Cayón-de Las Cuevas
- Departamento de Derecho Privado, Universidad de Cantabria, Avda. de los Castros s/n. C.P.,, 39005, Santander, Cantabria, Spain.,IDIVAL, Grupo de Investigación en Derecho Sanitario y Bioética, GRIDES, C/ Cardenal Herrera Oria s/n. C.P., 39011, Santander, Cantabria,, Spain
| | - Paula Parás-Bravo
- Departamento de Enfermería, Universidad de Cantabria, Avda. Valdecilla s/n. C.P., 39008, Santander, Cantabria, Spain.,IDIVAL, Grupo de Investigación en Enfermería, C/ Cardenal Herrera Oria s/n. C.P., 39011, Santander, Cantabria, Spain
| | - María Paz-Zulueta
- Departamento de Enfermería, Universidad de Cantabria, Avda. Valdecilla s/n. C.P., 39008, Santander, Cantabria, Spain.,IDIVAL, Grupo de Investigación en Derecho Sanitario y Bioética, GRIDES, C/ Cardenal Herrera Oria s/n. C.P., 39011, Santander, Cantabria,, Spain
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3
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Cayuela A, Cayuela L, Ortega Belmonte MJ, Rodríguez-Domínguez S, Escudero-Martínez I, González A. Has stroke mortality stopped declining in Spain? NEUROLOGÍA (ENGLISH EDITION) 2021; 37:550-556. [PMID: 34521606 DOI: 10.1016/j.nrleng.2019.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 06/20/2019] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES To analyse the changes in stroke mortality trends in Spain by autonomous community and by sex during the period 1980-2016, using joinpoint regression models. METHODS Mortality data were obtained from the Spanish National Statistics Institute. Crude and standardised rates were calculated for each Spanish autonomous community, and for each sex. Joinpoint analysis was used to identify the best-fitting points showing a statistically significant change in the trend. RESULTS Joinpoint analysis enabled us to differentiate between communities in which mortality rates showed a continuous decline throughout the study period in both sexes (Asturias, Cantabria, Castile and Leon, Ceuta, and Melilla) or in men only (Extremadura). In men, in all those communities in which changes in the trend were observed (all but Aragon, the Balearic Islands, and Murcia, where rates remained stable), we observed an initial period of decline (ranging from -3.4% in Catalonia and Extremadura, to -6.0% in Madrid) and a final period where the trends diverged: mortality rates continued to fall in Andalusia, Aragon, the Balearic Islands, and Madrid, but began to stabilise in Castile-La Mancha and Murcia and to increase in the Canary Islands. In women, in those communities where changes were observed (all but Aragon, Murcia, and the Basque Country, where rates remained stable), we observed an initial period of decline (ranging from -3.1% in Catalonia to -6.4% in Navarre) and a final period where divergent trends were observed: rates continued to decline in Andalusia, Aragon, Catalonia, Galicia, Madrid, and the Basque Country, but began to stabilise in Extremadura and Murcia and to increase in the Canary Islands. CONCLUSIONS Current data show that stroke mortality rates have decreased (in women in Andalusia), stabilised (in both sexes in Murcia, in men in Castile-La Mancha, and in women in Extremadura), and have even reversed (in both sexes in the Canary Islands). Further study is needed to identify the causes of these trends.
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Affiliation(s)
- A Cayuela
- Unidad de Gestión Clínica de Salud Pública, Prevención y Promoción de la Salud, Hospital de Valme, Área de Gestión Sanitaria Sur de Sevilla, Sevilla, Spain.
| | - L Cayuela
- Departamento de Medicina Interna, Hospital Severo Ochoa, Leganés, Madrid, Spain
| | - M J Ortega Belmonte
- Unidad de Gestión Clínica de Salud Pública, Prevención y Promoción de la Salud, Hospital de Valme, Área de Gestión Sanitaria Sur de Sevilla, Sevilla, Spain
| | | | - I Escudero-Martínez
- Unidad de Ictus, Unidad de Gestión Clínica de Neurociencias, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - A González
- Servicio de Neurorradiología Intervencionista, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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4
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García-Feijoo P, Isla A, Díez-Tejedor E, Mansilla B, Palpan Flores A, Sáez-Alegre M, Vivancos C. Decompressive craniectomy in malignant middle cerebral artery infarction: family perception, outcome and prognostic factors. Neurocirugia (Astur) 2019; 31:7-13. [PMID: 31445797 DOI: 10.1016/j.neucir.2019.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 05/27/2019] [Accepted: 07/07/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The prognosis of one hemisphere malignant infarction creates doubt among neurosurgeons about decompressive hemicraniectomy indication. What results are achieved in the short to medium term? Are families satisfied with the surgery once the patient is at home? In the present study, we analyze our experience in this matter during the last thirteen years. MATERIAL AND METHODS In our review, twenty-one patients were included from 2004 to 2017, according to the protocol for the management of ischaemic stroke that is implemented in our institution. The relatives were interviewed by telephone. The functional outcome at discharge, 3 months, 1 year, and at present was measured using the modified Rankin scale (mRS). RESULTS Patient age was shown to be directly related to the mRS (r=0.56; p=0.035) and 37.5% achieved a good outcome (mRS≤3); 78.9% of the interviewed relatives would repeat the surgical decision. CONCLUSIONS We present a 21 patients group where the best outcome was achieved in patients ≤60 years old. The severe neurological sequelae in patients with malignant infarction subjected to decompressive hemicraniectomy are tolerated and accepted by most families to the benefit of survival. We must not let this family satisfaction hide the prognosis, having to contextualize it within the real ambulatory situation of the patients.
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Affiliation(s)
| | - Alberto Isla
- Servicio de Neurocirugía, Hospital Universitario La Paz, Madrid, España
| | | | - Beatriz Mansilla
- Servicio de Neurocirugía, Hospital Universitario La Paz, Madrid, España
| | | | | | - Catalina Vivancos
- Servicio de Neurocirugía, Hospital Universitario La Paz, Madrid, España
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5
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Soriano JB, Rojas-Rueda D, Alonso J, Antó JM, Cardona PJ, Fernández E, Garcia-Basteiro AL, Benavides FG, Glenn SD, Krish V, Lazarus JV, Martínez-Raga J, Masana MF, Nieuwenhuijsen MJ, Ortiz A, Sánchez-Niño MD, Serrano-Blanco A, Tortajada-Girbés M, Tyrovolas S, Haro JM, Naghavi M, Murray CJL. The burden of disease in Spain: Results from the Global Burden of Disease 2016. Med Clin (Barc) 2018; 151:171-190. [PMID: 30037695 DOI: 10.1016/j.medcle.2018.05.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 04/27/2018] [Accepted: 05/03/2018] [Indexed: 05/27/2023]
Abstract
BACKGROUND AND OBJECTIVES The global burden of disease (GBD) project measures the health of populations worldwide on an annual basis, and results are available by country. We used the estimates of the GBD to summarise the state of health in Spain in 2016 and report trends in mortality and morbidity from 1990 to 2016. MATERIAL AND METHODS GBD 2016 estimated disease burden due to 333 diseases and injuries, and 84 risk factors. The GBD list of causes is hierarchical and includes 3 top level categories, namely: 1) communicable, maternal, neonatal, and nutritional diseases; 2) non-communicable diseases (NCDs), and 3) injuries. Mortality and disability-adjusted life-years (DALYs), risk factors, and progress towards the sustainable development goals (SDGs) are presented based on the GBD 2016 data in Spain. RESULTS There were 418,516 deaths in Spain in 2016, from a total population of 46.5 million, and 80.5% of them occurred in those aged 70 years and older. Overall, NCDs were the main cause of death: 388,617 (95% uncertainty interval 374,959-402,486), corresponding to 92.8% of all deaths. They were followed by 3.6% due to injuries with 15,052 (13,902-17,107) deaths, and 3.5% communicable diseases with 14,847 (13,208-16,482) deaths. The 5 leading specific causes of death were ischaemic heart disease (IHD, 14.6% of all deaths), Alzheimer disease and other dementias (13.6%), stroke (7.1%), chronic obstructive pulmonary disease (6.9%), and lung cancer (5.0%). Remarkable increases in mortality from 1990 to 2016 were observed in other cancers, lower respiratory infections, chronic kidney disease, and other cardiovascular disease, among others. On the contrary, road injuries moved down from 8th to 32nd position, and diabetes from 6th to 10th. Low back and neck pain became the number one cause of DALYs in Spain in 2016, just surpassing IHD, while Alzheimer disease moved from 9th to 3rd position. The greatest changes in DALYs were observed for road injuries dropping from 4th to 16th position, and congenital disorders from 17th to 35th; conversely, oral disorders rose from 25th to 17th. Overall, smoking is by far the most relevant risk factor in Spain, followed by high blood pressure, high body mass index, alcohol use, and high fasting plasma glucose. Finally, Spain scored 74.3 of 100 points in the SDG index classification in 2016, and the main national drivers of detrimental health in SDGs were alcohol consumption, smoking and child obesity. An increase to 80.3 points is projected in 2030. CONCLUSION Low back and neck pain was the most important contributor of disability in Spain in 2016. There has seen a remarkable increase in the burden due to Alzheimer disease and other dementias. Tobacco remains the most important health issue to address in Spain.
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Affiliation(s)
- Joan B Soriano
- Instituto de Investigación Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Madrid, España; SEPAR, Barcelona, España.
| | - David Rojas-Rueda
- Instituto de Salud Global de Barcelona, Barcelona, España; IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, España; Universitat Pompeu Fabra (UPF), Barcelona, España; Biomedical Research Networking Center in Epidemiology & Public (CIBERESP), Barcelona, España; Centre for Research in Environmental Epidemiology (CREAL), Barcelona, España
| | - Jordi Alonso
- IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, España; Universitat Pompeu Fabra (UPF), Barcelona, España; Biomedical Research Networking Center in Epidemiology & Public (CIBERESP), Barcelona, España
| | - Josep M Antó
- Instituto de Salud Global de Barcelona, Barcelona, España; IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, España; Universitat Pompeu Fabra (UPF), Barcelona, España; Biomedical Research Networking Center in Epidemiology & Public (CIBERESP), Barcelona, España; Centre for Research in Environmental Epidemiology (CREAL), Barcelona, España
| | - Pere-Joan Cardona
- Institut Germans Trias i Pujol, Badalona, Barcelona, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, España; Universitat Autònoma de Barcelona, Barcelona, España
| | - Esteve Fernández
- Institut Català d'Oncologia (ICO)-Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, España; Facultat de Medicina, Universitat de Barcelona, Barcelona, España
| | - Alberto L Garcia-Basteiro
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; Amsterdam Institute for Global Health and Development (AIGHD), Amsterdam, Países Bajos; Instituto de Salud Global de Barcelona, Barcelona, España; Facultat de Medicina, Universitat de Barcelona, Barcelona, España
| | - Fernando G Benavides
- Center for Research in Occupational Health, Universitat Pompeu Fabra (UPF), Barcelona, España; Universitat Pompeu Fabra (UPF), Barcelona, España; Biomedical Research Networking Center in Epidemiology & Public (CIBERESP), Barcelona, España
| | - Scott D Glenn
- Institute of Health Metrics and Evaluation, University of Washington, Seattle, WA, Estados Unidos
| | - Varsha Krish
- Institute of Health Metrics and Evaluation, University of Washington, Seattle, WA, Estados Unidos
| | - Jeffrey V Lazarus
- Instituto de Salud Global de Barcelona, Barcelona, España; Facultat de Medicina, Universitat de Barcelona, Barcelona, España
| | - José Martínez-Raga
- Hospital Universitario Doctor Peset, Valencia, España; Universitat de Valencia, Valencia, España; University Cardenal Herrera CEU, Valencia, España
| | - Maria F Masana
- Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, España; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, España; Facultat de Medicina, Universitat de Barcelona, Barcelona, España
| | - Mark J Nieuwenhuijsen
- Instituto de Salud Global de Barcelona, Barcelona, España; IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, España; Universitat Pompeu Fabra (UPF), Barcelona, España; Biomedical Research Networking Center in Epidemiology & Public (CIBERESP), Barcelona, España; Centre for Research in Environmental Epidemiology (CREAL), Barcelona, España
| | - Alberto Ortiz
- IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, España
| | | | - Antoni Serrano-Blanco
- Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, España; Biomedical Research Networking Center in Epidemiology & Public (CIBERESP), Barcelona, España
| | - Miguel Tortajada-Girbés
- Hospital Universitario Doctor Peset, Valencia, España; Departamento de Pediatría, Obstetricia y Ginecología, Universidad de Valencia, Valencia, España
| | - Stefanos Tyrovolas
- Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, España; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, España; Institute of Health Metrics and Evaluation, University of Washington, Seattle, WA, Estados Unidos
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, España; Facultat de Medicina, Universitat de Barcelona, Barcelona, España; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, España
| | - Mohsen Naghavi
- Institute of Health Metrics and Evaluation, University of Washington, Seattle, WA, Estados Unidos
| | - Christopher J L Murray
- Institute of Health Metrics and Evaluation, University of Washington, Seattle, WA, Estados Unidos
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6
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Soriano JB, Rojas-Rueda D, Alonso J, Antó JM, Cardona PJ, Fernández E, Garcia-Basteiro AL, Benavides FG, Glenn SD, Krish V, Lazarus JV, Martínez-Raga J, Masana MF, Nieuwenhuijsen MJ, Ortiz A, Sánchez-Niño MD, Serrano-Blanco A, Tortajada-Girbés M, Tyrovolas S, Haro JM, Naghavi M, Murray CJL. The burden of disease in Spain: Results from the Global Burden of Disease 2016. Med Clin (Barc) 2018; 151:171-190. [PMID: 30037695 DOI: 10.1016/j.medcli.2018.05.011] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 04/27/2018] [Accepted: 05/03/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND OBJECTIVES The global burden of disease (GBD) project measures the health of populations worldwide on an annual basis, and results are available by country. We used the estimates of the GBD to summarise the state of health in Spain in 2016 and report trends in mortality and morbidity from 1990 to 2016. MATERIAL AND METHODS GBD 2016 estimated disease burden due to 333 diseases and injuries, and 84 risk factors. The GBD list of causes is hierarchical and includes 3 top level categories, namely: 1) communicable, maternal, neonatal, and nutritional diseases; 2) non-communicable diseases (NCDs), and 3) injuries. Mortality and disability-adjusted life-years (DALYs), risk factors, and progress towards the sustainable development goals (SDGs) are presented based on the GBD 2016 data in Spain. RESULTS There were 418,516 deaths in Spain in 2016, from a total population of 46.5 million, and 80.5% of them occurred in those aged 70 years and older. Overall, NCDs were the main cause of death: 388,617 (95% uncertainty interval 374,959-402,486), corresponding to 92.8% of all deaths. They were followed by 3.6% due to injuries with 15,052 (13,902-17,107) deaths, and 3.5% communicable diseases with 14,847 (13,208-16,482) deaths. The 5 leading specific causes of death were ischaemic heart disease (IHD, 14.6% of all deaths), Alzheimer disease and other dementias (13.6%), stroke (7.1%), chronic obstructive pulmonary disease (6.9%), and lung cancer (5.0%). Remarkable increases in mortality from 1990 to 2016 were observed in other cancers, lower respiratory infections, chronic kidney disease, and other cardiovascular disease, among others. On the contrary, road injuries moved down from 8th to 32nd position, and diabetes from 6th to 10th. Low back and neck pain became the number one cause of DALYs in Spain in 2016, just surpassing IHD, while Alzheimer disease moved from 9th to 3rd position. The greatest changes in DALYs were observed for road injuries dropping from 4th to 16th position, and congenital disorders from 17th to 35th; conversely, oral disorders rose from 25th to 17th. Overall, smoking is by far the most relevant risk factor in Spain, followed by high blood pressure, high body mass index, alcohol use, and high fasting plasma glucose. Finally, Spain scored 74.3 of 100 points in the SDG index classification in 2016, and the main national drivers of detrimental health in SDGs were alcohol consumption, smoking and child obesity. An increase to 80.3 points is projected in 2030. CONCLUSION Low back and neck pain was the most important contributor of disability in Spain in 2016. There has seen a remarkable increase in the burden due to Alzheimer disease and other dementias. Tobacco remains the most important health issue to address in Spain.
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Affiliation(s)
- Joan B Soriano
- Instituto de Investigación Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Madrid, España; SEPAR, Barcelona, España.
| | - David Rojas-Rueda
- Instituto de Salud Global de Barcelona, Barcelona, España; IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, España; Universitat Pompeu Fabra (UPF), Barcelona, España; Biomedical Research Networking Center in Epidemiology & Public (CIBERESP), Barcelona, España; Centre for Research in Environmental Epidemiology (CREAL), Barcelona, España
| | - Jordi Alonso
- IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, España; Universitat Pompeu Fabra (UPF), Barcelona, España; Biomedical Research Networking Center in Epidemiology & Public (CIBERESP), Barcelona, España
| | - Josep M Antó
- Instituto de Salud Global de Barcelona, Barcelona, España; IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, España; Universitat Pompeu Fabra (UPF), Barcelona, España; Biomedical Research Networking Center in Epidemiology & Public (CIBERESP), Barcelona, España; Centre for Research in Environmental Epidemiology (CREAL), Barcelona, España
| | - Pere-Joan Cardona
- Institut Germans Trias i Pujol, Badalona, Barcelona, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, España; Universitat Autònoma de Barcelona, Barcelona, España
| | - Esteve Fernández
- Institut Català d'Oncologia (ICO)-Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, España; Facultat de Medicina, Universitat de Barcelona, Barcelona, España
| | - Alberto L Garcia-Basteiro
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; Amsterdam Institute for Global Health and Development (AIGHD), Amsterdam, Países Bajos; Instituto de Salud Global de Barcelona, Barcelona, España; Facultat de Medicina, Universitat de Barcelona, Barcelona, España
| | - Fernando G Benavides
- Center for Research in Occupational Health, Universitat Pompeu Fabra (UPF), Barcelona, España; Universitat Pompeu Fabra (UPF), Barcelona, España; Biomedical Research Networking Center in Epidemiology & Public (CIBERESP), Barcelona, España
| | - Scott D Glenn
- Institute of Health Metrics and Evaluation, University of Washington, Seattle, WA, Estados Unidos
| | - Varsha Krish
- Institute of Health Metrics and Evaluation, University of Washington, Seattle, WA, Estados Unidos
| | - Jeffrey V Lazarus
- Instituto de Salud Global de Barcelona, Barcelona, España; Facultat de Medicina, Universitat de Barcelona, Barcelona, España
| | - José Martínez-Raga
- Hospital Universitario Doctor Peset, Valencia, España; Universitat de Valencia, Valencia, España; University Cardenal Herrera CEU, Valencia, España
| | - Maria F Masana
- Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, España; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, España; Facultat de Medicina, Universitat de Barcelona, Barcelona, España
| | - Mark J Nieuwenhuijsen
- Instituto de Salud Global de Barcelona, Barcelona, España; IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, España; Universitat Pompeu Fabra (UPF), Barcelona, España; Biomedical Research Networking Center in Epidemiology & Public (CIBERESP), Barcelona, España; Centre for Research in Environmental Epidemiology (CREAL), Barcelona, España
| | - Alberto Ortiz
- IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, España
| | | | - Antoni Serrano-Blanco
- Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, España; Biomedical Research Networking Center in Epidemiology & Public (CIBERESP), Barcelona, España
| | - Miguel Tortajada-Girbés
- Hospital Universitario Doctor Peset, Valencia, España; Departamento de Pediatría, Obstetricia y Ginecología, Universidad de Valencia, Valencia, España
| | - Stefanos Tyrovolas
- Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, España; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, España; Institute of Health Metrics and Evaluation, University of Washington, Seattle, WA, Estados Unidos
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, España; Facultat de Medicina, Universitat de Barcelona, Barcelona, España; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, España
| | - Mohsen Naghavi
- Institute of Health Metrics and Evaluation, University of Washington, Seattle, WA, Estados Unidos
| | - Christopher J L Murray
- Institute of Health Metrics and Evaluation, University of Washington, Seattle, WA, Estados Unidos
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Santurtún A, Ruiz PB, López-Delgado L, Sanchez-Lorenzo A, Riancho J, Zarrabeitia MT. Stroke: Temporal Trends and Association with Atmospheric Variables and Air Pollutants in Northern Spain. Cardiovasc Toxicol 2018; 17:360-367. [PMID: 27990617 DOI: 10.1007/s12012-016-9395-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Stroke, the second cause of death and the most frequent cause of severe disability among adults in developed countries, is related to a large variety of risk factors. This paper assesses the temporal patterns in stroke episodes in a city in Northern Spain during a 12-year period and analyzes the possible effects that atmospheric pollutants and meteorological variables may have on stroke on a daily scale. Our results show that there is an increase in stroke admissions (r = 0.818, p = 0.001) especially in patients over 85 years old. On a weekly scale, the number of hospital admissions due to stroke remains stable from Monday to Friday, whereas it abruptly decreases during the weekends, reaching its minimum values on Sunday (p < 0.005); however, mortality in patients admitted to the hospital is higher on Sundays than on other days of the week. Finally, a statistically significant positive correlation between the number of stroke hospital admissions and NO2 levels (p = 0.012) and an inverse correlation with relative humidity (p = 0.032) were found. The analysis of the relationship between ischemic strokes and atmospheric circulation shows a higher frequency of the former in Santander with enhanced negative air pressure anomalies over western Spain; the fact that under these conditions the region studied registers very low values of relative humidity is in line with the aforementioned inverse correlation, which has not been described elsewhere in the literature. This study could be a first step for implementing stroke alert protocols depending on air pollution levels and circulation patterns forecasts.
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Affiliation(s)
- Ana Santurtún
- Unit of Legal Medicine, Department of Physiology and Pharmacology, University of Cantabria, Av Cardenal Herrera Oria s/n, 39011, Santander, Spain.
| | - Patricia Bolivar Ruiz
- Unit of Legal Medicine, Department of Physiology and Pharmacology, University of Cantabria, Av Cardenal Herrera Oria s/n, 39011, Santander, Spain
| | - Laura López-Delgado
- Service of Internal Medicine, University Hospital Marqués de Valdecilla, Santander, Spain
| | - Arturo Sanchez-Lorenzo
- Instituto Pirenaico de Ecología, Consejo Superior de Investigaciones Científicas (IPE-CSIC), Saragossa, Spain
| | - Javier Riancho
- Service of Neurology, University Hospital Marqués de Valdecilla - IDIVAL (CIBERNED), Santander, Spain
| | - María T Zarrabeitia
- Unit of Legal Medicine, Department of Physiology and Pharmacology, University of Cantabria, Av Cardenal Herrera Oria s/n, 39011, Santander, Spain
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Chaker L, Falla A, van der Lee SJ, Muka T, Imo D, Jaspers L, Colpani V, Mendis S, Chowdhury R, Bramer WM, Pazoki R, Franco OH. The global impact of non-communicable diseases on macro-economic productivity: a systematic review. Eur J Epidemiol 2015; 30:357-95. [PMID: 25837965 PMCID: PMC4457808 DOI: 10.1007/s10654-015-0026-5] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 03/24/2015] [Indexed: 12/23/2022]
Abstract
Non-communicable diseases (NCDs) have large economic impact at multiple levels. To systematically review the literature investigating the economic impact of NCDs [including coronary heart disease (CHD), stroke, type 2 diabetes mellitus (DM), cancer (lung, colon, cervical and breast), chronic obstructive pulmonary disease (COPD) and chronic kidney disease (CKD)] on macro-economic productivity. Systematic search, up to November 6th 2014, of medical databases (Medline, Embase and Google Scholar) without language restrictions. To identify additional publications, we searched the reference lists of retrieved studies and contacted authors in the field. Randomized controlled trials, cohort, case-control, cross-sectional, ecological studies and modelling studies carried out in adults (>18 years old) were included. Two independent reviewers performed all abstract and full text selection. Disagreements were resolved through consensus or consulting a third reviewer. Two independent reviewers extracted data using a predesigned data collection form. Main outcome measure was the impact of the selected NCDs on productivity, measured in DALYs, productivity costs, and labor market participation, including unemployment, return to work and sick leave. From 4542 references, 126 studies met the inclusion criteria, many of which focused on the impact of more than one NCD on productivity. Breast cancer was the most common (n = 45), followed by stroke (n = 31), COPD (n = 24), colon cancer (n = 24), DM (n = 22), lung cancer (n = 16), CVD (n = 15), cervical cancer (n = 7) and CKD (n = 2). Four studies were from the WHO African Region, 52 from the European Region, 53 from the Region of the Americas and 16 from the Western Pacific Region, one from the Eastern Mediterranean Region and none from South East Asia. We found large regional differences in DALYs attributable to NCDs but especially for cervical and lung cancer. Productivity losses in the USA ranged from 88 million US dollars (USD) for COPD to 20.9 billion USD for colon cancer. CHD costs the Australian economy 13.2 billion USD per year. People with DM, COPD and survivors of breast and especially lung cancer are at a higher risk of reduced labor market participation. Overall NCDs generate a large impact on macro-economic productivity in most WHO regions irrespective of continent and income. The absolute global impact in terms of dollars and DALYs remains an elusive challenge due to the wide heterogeneity in the included studies as well as limited information from low- and middle-income countries.
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Affiliation(s)
- Layal Chaker
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Office NA29-16, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
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