Long-term impact of the 2008 economic crisis in Spain on road traffic collisions mortality by socioeconomic position

We aimed to assess the effect of the 2008 crisis on road traffic collision (RTC) mortality in Spain, by socioeconomic position (SEP) and type of road use. This prospective, country-wide study covered all adults living in Spain and aged ≥30 years in November 2001. The long-term effect of the crisis was assessed by measuring the monthly percentage change (MPC) in RTC mortality between the pre-crisis (2002-2007) and crisis period (2008-2011). During the recession, RTC mortality fell more in people with low compared to high SEP, so MPCs difference between periods were of a higher magnitude in the low compared to high SEP groups, especially among men motorcyclists. RTC mortality trends were favorable following the 2008 crisis, particularly among low-SEP groups. In men motorcyclists, the upward trend of the pre-crisis period reversed course.

Near real-time surveillance of the SARS-CoV-2 epidemic with incomplete data

Designing public health responses to outbreaks requires close monitoring of population-level health indicators in real-time. Thus, an accurate estimation of the epidemic curve is critical. We propose an approach to reconstruct epidemic curves in near real time. We apply this approach to characterize the early SARS-CoV-2 outbreak in two Spanish regions between March and April 2020. We address two data collection problems that affected the reliability of the available real-time epidemiological data, namely, the frequent missing information documenting when a patient first experienced symptoms, and the frequent retrospective revision of historical information (including right censoring). This is done by using a novel back-calculating procedure based on imputing patients' dates of symptom onset from reported cases, according to a dynamically-estimated "backward" reporting delay conditional distribution, and adjusting for right censoring using an existing package, NobBS , to estimate in real time (nowcast) cases by date of symptom onset. This process allows us to obtain an approximation of the time-varying reproduction number ( R t ) in real-time. At each step, we evaluate how different assumptions affect the recovered epidemiological events and compare the proposed approach to the alternative procedure of merely using curves of case counts, by report day, to characterize the time-evolution of the outbreak. Finally, we assess how these real-time estimates compare with subsequently documented epidemiological information that is considered more reliable and complete that became available later in time. Our approach may help improve accuracy, quantify uncertainty, and evaluate frequently unstated assumptions when recovering the epidemic curves from limited data obtained from public health surveillance systems in other locations.

Hospital admissions/mortality ratio: a composite health indicator for monitoring NCD

Background

Our aim was to test the usefulness of a new tool to monitor NCD. We evaluated a composite indicator, the ratio of hospitalizations vs mortality rates (HMR), by assessing its capacity of identifying additional variability among regions. In this communication, we present the analysis corresponding to ischemic heart disease as an example.

Methods

We used the Hospital Morbidity Survey and the Death Statistics for Spain in 2016, both provided by the National Institute of Statistics, to calculate age-adjusted hospitalisation and mortality rates for ischemic heart disease for men and women in all 52 provinces of Spain. Subsequently, we computed HMR, the ratio of the age-adjusted of hospital morbidity and mortality rates. The correlation and linear adjustment between provincial mortality and morbidity rates, as well as mortality and HMR, were also estimated by sex.

Results

The rate of hospital admissions for ischemic heart disease in Spain was 407 per 100,000 in men and 129.4 in women. The mortality rate was 93.1 per 100,000 in men and 40.3 in women. In both sexes, the highest morbidity and mortality rates were observed in the south of Spain. Pearson correlation between morbidity and mortality rates were 0.53 (p < 0.01) in men and 0.75 (p < 0.05) in women. HMR showed a different spatial pattern with important variability. In men the average ratio was 4.3, with a range of 2.8 (Tenerife) to 7.1 (Melilla); in women the average was 3.2 with a range between1.7 (Zamora and Tenerife) and 4.7 (Barcelona), and in both sexes very high ratios were found in Catalonia's provinces. Association between mortality rate and HMR showed a negative correlation in both men (-0.39; p < 0.01) and women (-0.24; p < 0.05).

Conclusions

HMR is a composite indicator that provides complementary information regarding the individual analysis of hospital morbidity and mortality rates. HMR of ischemic heart disease shows an important geographical variability and an inverse association with mortality.

Towards an EU sustainable health information infrastructure. Integrating technical and political views and interest

Background

Health information systems (HIS) play a key role in providing information for decision-making. Europe lacks of an integrated HIS on non-communicable diseases (NCD) and Health Systems Performance (HSP) able to compare health problems across countries. NCDs are the main contributor to the EU-burden of disease, including the highest mortality rates. There is a general agreement among public health policy makers and researchers on the need of an integrated EU health information (HI) infrastructure to monitor risk factors, NCD and HSP. Such infrastructure would provide common inputs for public health and research to prioritize health policies. However, there is no EU-EEA consensus on how to go forward with this initiative.

Methods

The Information for Action (InfAct) project is aimed at establishing a sustainable HI infrastructure on HIS and HSP by cataloging resources, experience, research capacities and expertise into a 'one-stop shop'. Significant political will is needed to support and systematically feed a functional and permanent governance structure. InfAct provides a ground for Member States to discuss and generate consensus through two main boards: 1) Technical Dialogues (TD), composed by national experts, to discuss scientific aspects, feasibility and added value; and 2) Assembly of Members (AoM) where political representatives from Ministries of Health and Research provide the framework of political acceptance and guarantee of implementation and future development.

Results

Both boards reveal different interests and concerns. The AoM rather focused on resources and necessary political decisions based on expected returns. The TD focused on feasibility aspects and new adaptations required from current systems. The feedback provided by both boards is key to develop a sustainable EU-HIS infrastructure.

Conclusions

The TD and the AoM are key forums to provide feedback, guidance and advocacy to build a sustainable EU-HIS infrastructure

Use of non-health EU databases for health surveillance. En-risk application

Background

To combine health information and environmental health determinants is key, for epidemiological monitoring and health risk studies but its integration represents a challenge that requires specific expertise. An example of a potentially useful source of significant environmental data relevant for health is the European Pollutant Release and Transfer Register (E-PRTR), which allows estimating exposure to industrial pollution. Our aim was to develop an easy-to-use tool that allows to perform a screening suggesting the presence/absence of excess risk of a disease linked to residential proximity to industrial pollution.

Methods

En-risk: java interactive tool was developed to merge E-PRTR information and municipal mortality/morbidity data, to perform an exploratory spatial analysis of association between them by type of industrial facility using distance as proxy of exposure. The application needs cartography of the country and a database of the annual observed deaths (mortality) or cases (morbidity) and population broken down by age groups and sex per municipality. With this it calculates the expected number of deaths, the distance from the municipal centroids to the industrial location (classifying municipalities as exposed or not exposed), and perform the statistical analyses. Municipal lung cancer deaths (2005-2009) in Spain provided by the National Institute of Statistics were analyzed with this application as an example.

Results

En-risk gives a table of Relative Risk of mortality/morbidity due to exposure to industrial pollution by industrial sector and sex. The analysis in lung cancer deaths showed an excess of mortality associated to proximity to several industrial sectors.

Conclusions

En-risk facilitates the study of the relationship between industrial pollution and health around Europe. It can be used by public health services to identify health problems.

Suicide mortality trends in Galicia, Spain and their relationship with economic indicators

BACKGROUND

Recent research has shown an association between unemployment and suicide, but the mediating factors in this relationship are still unknown. In this study, we investigated the effect of unemployment and economic recession on suicide rates in the Spanish region of Galicia between 1975 and 2012 Method. We analysed age-standardised suicide rates in men and women and in four age groups: less than 25 years, 25-45 years, 45-65 years and more than 65 years and performed a joinpoint analysis to determine trend changes throughout 1975-2012 period. Also we analysed the association between suicide, recession and unemployment by means of a temporal trend model with a Generalised Additive Model.

RESULTS

Suicide rates increased from 145 suicides in 1975 to a high in 1993, with 377 deaths by suicide, representing 1.38% of all causes of death, and thereafter they tend to decrease to 335 suicides in 2012. Joinpoint analyses revealed that suicide rates changed differently across sex and age groups. For men, the annual percentage of change (APC) between 1975 and 1988 (CI 95% 1986-1994) was 5.45 (CI 95% = 3.5, -7.2) but from 1988 the APC became negative [-0.66 (CI 95% = -1.3, -0.1)]. For women, APC between 1974 and 1990 (CI 95% 1986-1992) was 4.86 (CI 95% = 3.2, -6.4) and -1.46 subsequently (CI 95% = -2.2, -0.5). Women aged 24 years or less showed stable suicide rates while men from 45-65 years showed two incidence peaks. When we studied the independent correlation between unemployment, recession and suicide, we found a significant association between unemployment and suicide, but not between recession and suicide for both sexes together and for men while for women there was no significant correlation between suicide and unemployment or recession. Finally, when we studied the effect of the interaction between unemployment and recession on suicide we found economic recession and unemployment interacted with regards to suicide rates (F = 5.902; df = 4.167; p = 0.00098) and after adjusting by sex, the effect was confirmed among men (F = 4.827; df = 2.823; p = 0.0087), but not among women (F = 0.001; df = 1.000; p = 0.979).

CONCLUSIONS

Although suicide rates in Galicia are gradually decreasing in the last decades, there are important sex and age differences. Unemployment was related with suicide during economic recession periods according to our results.

Contribution of JAK2 mutations to T-cell lymphoblastic lymphoma development

The JAK-STAT pathway has a substantial role in lymphoid precursor cell proliferation, survival and differentiation. Nonetheless, the contribution of JAK2 to T-cell lymphoblastic lymphoma (T-LBL) development remains poorly understood. We have identified one activating TEL-JAK2 translocation and four missense mutations accumulated in 2 out of 16 T-LBL samples. Two of them are novel JAK2 mutations and the other two are reported for the first time in T-LBL. Notably, R683G and I682T might have arisen owing to RNA editing. Mutated samples showed different mutated transcripts suggesting sub-clonal heterogeneity. Functional approaches revealed that two JAK2 mutations (H574R and R683G) constitutively activate JAK-STAT signaling in γ2A cells and can drive the proliferation of BaF3-EpoR cytokine-dependent cell line. In addition, aberrant hypermethylation of SOCS3 might contribute to enhance the activation of JAK-STAT signaling. Of utmost interest is that primary T-LBL samples harboring JAK2 mutations exhibited increased expression of LMO2, suggesting a mechanistic link between JAK2 mutations and the expression of LMO2, which was confirmed for the four missense mutations in transfected γ2A cells. We therefore propose that active JAK2 contribute to T-LBL development by two different mechanisms, and that the use of pan-JAK inhibitors in combination with epigenetic drugs should be considered in future treatments.

The stromal gene encoding the CD274 antigen as a genetic modifier controlling survival of mice with γ-radiation-induced T-cell lymphoblastic lymphomas

Using an inter-specific subcongenic strain, Nested Recombinant Haplotype 3 (NRH3), generated between two mouse strains showing extreme differences in γ-radiation-induced thymic lymphoma susceptibility (SEG/Pas and C57BL/6J), we have identified a critical region on chromosome 19 that regulates survival of mice suffering from T-cell lymphoblastic lymphomas. Mapped on this region, the gene encoding the Cd274 ligand is able to trigger an inhibitory effect that modulates T-cell receptor (TCR) signalling and affects thymocyte maturation. Interestingly, this gene shows differential expression between thymic stromal cells from both strains in early response to a single sublethal γ-ray dose, but is inhibited in T-cell lymphoblastic lymphomas. Furthermore, we have identified several polymorphisms in the complementary DNA sequence of this gene that affect the affinity for its Cd279 receptor and are able to induce a differential rate of thymocyte apoptosis. Taken together, our data are consistent with Cd274 acting as a genetic modifier that influences the survival of γ-radiation-induced T-cell lymphoma-bearing mice. The data similarly support the idea of a co-evolution of tumour cells and associated stromal cells to generate a favourable microenvironment for T-cell lymphoma growth.