Faustino Tomás Alonso

Alarming weight gain in women of a post-transitional country

OBJECTIVE In post-transitional countries, obesity disproportionally affects women. Longitudinal studies can detect high-risk groups in whom to target actions. We investigated the magnitude and velocity of BMI changes in Chilean women of reproductive age and evaluated whether these trends vary in specific groups. DESIGN Longitudinal study. We measured weight and height in 2007 (baseline) and again in 2010 (follow-up); we estimated change in BMI (weight/height2) within the 3-year period and assessed its relationship with age, years of education and parity, collected at baseline and follow-up using a questionnaire. SETTING Population-based cohort of low- to middle-income Chilean women. SUBJECTS Seven hundred and sixty-one women of reproductive age (mean 32·0 (sd 7·0) years), mothers of children who participate in the Growth and Obesity Cohort Study (GOCS). RESULTS At baseline, 61 % of women had BMI ≥ 25·0 kg/m2. After 3 years, women gained on average 2·6 kg and obesity (BMI ≥ 30·0 kg/m2) increased by 23 % (12 % new obesity cases). Women with normal nutritional status gained more BMI than obese women (1·4 v. 0·6 kg/m2, P < 0·001). An increase in parity was positively associated with BMI change, independently of age, nutritional status and education (P < 0·05). Age and education were not associated with BMI change after controlling for other factors (P > 0·05). CONCLUSIONS In Chile, a post-transitional country, we observed an alarming increase in obesity among women of reproductive age. Our results indicate that in this population actions need to be targeted at all women irrespective of their nutritional status. A key component of these policies should be avoiding excessive weight gain during pregnancy.

Increased Skin Cancer Mortality in Chile Beyond the Effect of Ageing: Temporal Analysis 1990 to 2005

Chile has a medium-to-high skin cancer mortality rate. Previous studies have shown an increasing rate of skin cancer mortality. We evaluated skin cancer mortality characteristics and their temporal evolution in Chile from 1990 to 2005 in a mixed ecological study using death certificate databases. Age, sex, year and region of residence were obtained for melanoma and non-melanoma deaths. Crude and age-sex-adjusted rates were calculated using the national projections and WHO 2000 standard population data. Descriptive and temporal analyses, using a Prais-Winsten regression, were computed. A total of 3588 deaths were registered, of which 55% were melanoma and 54% occurred in men (median age 71 years; women were older). The adjusted rate was 1.75 deaths per 100,000 inhabitants (2.22 in men vs. 1.39 in women). Melanoma skin cancer and non-melanoma skin cancer mortality had a tendency to increase. In conclusion, skin cancer mortality is rising beyond the rate predicted by ageing. An increased incidence due to changes in modifiable factors, such as exposure to ultraviolet radiation and arsenic, might explain the increase in skin cancer mortality.

Análisis de la tendencia de la mortalidad por cirrosis hepática en Chile: Años 1990 a 2007

BACKGROUND There is a worldwide tendency towards a reduction in the rates of deaths due to cirrhosis. In Chile, a decrease in the number of hospital admissions due to this disease has been recorded. AIM To assess general characteristics and temporal evolution of liver cirrhosis mortality in Chile between 1990 and 2007. MATERIAL AND METHODS National death records and population databases were reviewed. Crude and age-adjusted mortality rates for alcoholic and non-alcoholic cirrhosis were calculated, evaluating their evolution in the study period and the relative risk by gender. RESULTS In the study period, 44,894 deaths caused by cirrhosis were recorded. Mortality rate was 16.6 deaths per 100,000 inhabitants. 54% of deaths were attributed to non-alcoholic cirrhosis. There was a reduction in mortality rates for both types of cirrhosis. Males accounted for 83 and 65% of deaths caused by alcoholic and non-alcoholic cirrhosis, respectively. The figures for relative risk of death were 5 and 1.9, respectively. CONCLUSIONS Alcoholic cirrhosis was the preponderant cause among liver cirrhosis deaths. A decrease in mortality rates was observed in the study period. Improvements in disease treatment and control could possibly explain this trend.

Younger women have a higher risk of in-hospital mortality due to acute myocardial infarction in Chile.

INTRODUCTION AND OBJECTIVES Coronary heart disease is the second cause of death in Chilean women, with higher mortality among women, especially at younger ages. The objective was to analyze in-hospital case-fatality by sex and age in patients with acute myocardial infarction in Chile and to evaluate associated factors. METHODS From the nationwide hospital admissions database and the GEMI registry (a multicenter registry), we selected all cases of acute myocardial infarction (code: I.21) that occurred between 2001 and 2007 in Chile. We estimated odds ratios for in-hospital case-fatality in women by age (crude and adjusted for clinical characteristics and treatment). RESULTS In total, 49,287 cases of acute myocardial infarction were hospitalized, 31.3% of them women; 9278 patients were incorporated in the GEMI registry (27.1% women). In-hospital case-fatality was higher (P<.001) in women than men (national database, 20.4% vs 11.3%; GEMI, 14.2% vs 7.3%, irrespective of age. In-hospital case-fatality risk was higher in women aged<45 years: national odds ratio=2.3 (95% confidence interval, 1.5-3.3) and GEMI, odds ratio=2.7 (1.1-6.8). The estimated risk was lower in women aged 75 or more years in both databases, 1.3 (1.2-2.4) and 1.5 (1.2-1.9), respectively. Younger women less often received statins, odds ratio=0.7 (0.6-0.8); acetylsalicylic acid, odds ratio=0.4 (0.2-0.6); betablockers, odds ratio=0.8 (0.6-0.9), and thrombolytics, odds ratio=0.6 (0.5-0.8). An interaction was found between Killip class and sex. After adjusting for covariates, women aged<55 years with ST-segment elevation myocardial infarction and Killip class I-II, had the highest risk, odds ratio=4.3 (2.1-8.9). CONCLUSIONS In the context of a Latin American country, women aged<55 years with ST-segment elevation myocardial infarction and Killip class I-II had a higher risk of death. Known risk factors do not completely explain this excess of risk.

Incidencia y letalidad por infarto agudo del miocardio en Chile: 2001-2007

Acute myocardial infarction (AMI) causes 73.6% of coronary heart disease (CHD) deaths in Chile. Aim: To estimate the incidence and case fatality of AMI and analyze their trends between 2001-2007. Material and Methods: A time–series study analyzing all cases of AMI (according to the International Classification of Diseases (ICD)-10, I21 code), registered in the National Hospitalizations and Death databases. Annual incidence rates and case fatality by sex and age groups were calculated. The direct method was used to standardize rates by age, using the World Health Organization 2000 Population. Prais-Winsten regression models were used to evaluate trends, expressed as relative change. Results: Between 2001 and 2007, we estimated that 83,754 cases of AMI occurred. Standardized annual incidence rate was 74.4 per 100,000 inhabitants (98.0 in men and 51.0 in women). Incidence rates increased by 34% in individuals < 45 years of age and 9.2% in the group 55-64 years (p < 0.001, both). Total case fatality was 49.5% (45.4% in men and 57.2% in women; p < 0.001), and its trend analysis showed a significant annual reduction of 1.2% in men and 0.81% in women. In-hospital case fatality was 14.2% (11.3 and 20.4% in men and women, respectively; p < 0.001). There was a significant annual reduction of mortality (0.57 and 1.01% in men and women, respectively (p < 0.05). Conclusions: The incidence of AMI was stable in the whole population, but increased in younger age groups. Total and in-hospital case-fatality decreased. Despite the greater reduction of case fatality in women, they still have a higher risk of dying while in hospital

Endocarditis infecciosa: características clínicas, complicaciones y mortalidad en 506 pacientes y factores pronósticos de sobrevida a 10 años (1998-2008). Estudio cooperativo nacional en endocarditis infecciosa en Chile (ECNEI-2)

BACKGROUND Rates of morbidity and mortality in Infective Endocarditis (IE) remain high and prognosis in this disease is still difficult and uncertain. AIM To study IE in Chile in its active phase during inpatient hospital stay and long term survival rates. MATERIAL AND METHODS Observational prospective national cohort study of 506 consecutive patients included between June 1,1998 and July 31, 2008, from 37 Chilean hospitals (secondary and tertiary centers) nationwide. RESULTS The main findings were the presence of Rheumatic valve disease in 22.1 % of patients, a history of intravenous drug abuse (IVDA) only in 0.7%, the presence of Staphylococcus aureus in 29.2% of blood cultures, negative blood cultures in 33.2%, heart failure in 51.7% and native valve involvement in 86% of patients. Echocardiographic diagnosis was achieved in 94% of patients. Hospital mortality was 26.1% and its prognostics factors were persisting infection (Odds ratio (OR) 6.43, Confidence Interval (CI) 1.45-28.33%), failure of medical treatment and no surgical intervention (OR 48.8; CI 6.67-349.9). Five and 10 years survival rates were 75.6 and 48.6%, respectively. The significant prognostic factors for long term mortality, determined by multivariate analysis were the presence of diabetes, Staphylococcus aureus infection, sepsis, heart failure, renal failure and lack of surgical treatment during the IE episode. CONCLUSIONS The microbiologic diagnosis of IE must be urgently improved in Chile. Mortality rates are still high (26.1%) partly because of a high incidence of negative blood cultures and the need for more surgical valve interventions during in-hospital period. Long term prognostic factors for mortality should be identified early to improve outcome.

Mortalidad por cardiopatía isquémica en Chile: quiénes, cuántos y dónde

OBJETIVO: Describir las caracteristicas de la mortalidad por cardiopatia isquemica en Chile y su evolucion temporal, e identificar los factores asociados a mortalidad extrahospitalaria por esta patologia entre 1997 y 2007. METODOS. Estudio de serie temporal que utiliza las bases de defunciones del Departamento de Estadisticas e Informacion en Salud entre 1997 y 2007. De un total de 917 029 muertes notificadas, se seleccionaron aquellas cuya causa primaria fue cardiopatia isquemica (codigos I20 a I25 de la CIE-10). Se calcularon tasas crudas y ajustadas por edad y sexo para analizar la tendencia. Se analizaron las caracteristicas de la mortalidad segun el lugar de defuncion, evaluando posibles factores asociados a mortalidad extrahospitalaria (casa/habitacion u otro lugar), incluidos edad, ruralidad, estado civil, educacion y sexo, asi como el efecto de la incorporacion del infarto agudo al miocardio a la ley de garantias en salud (GES), con regresion binomial. RESULTADOS: Durante el periodo estudiado se notificaron 87 342 muertes por cardiopatia isquemica, de las cuales 57,7% eran hombres y 59,5% ocurrieron fuera del hospital. La tasa de mortalidad ajustada por edad disminuyo de 52,9 a 40,4 por 100 000 habitantes. Los factores asociados a mortalidad extrahospitalaria en hombres fueron ruralidad, riesgo relativo (RR) 1,24 (1,21-1,27); edad mayor a 70 anos, RR 1,03 (1,01-1,05); estado civil soltero, RR 1,10 (1,08-1,12), mientras que en las mujeres los valores correspondientes fueron 1,13 (1,10-1,18); 1,31 (1,27-1,36) y 1,07 (1,04-1,09). La adopcion de la GES se asocio con un aumento en el porcentaje de muertes intrahospitalarias en mujeres, RR 0,95 (0,92-0,97). CONCLUSIONES: †La mortalidad por cardiopatia isquemica en Chile ha disminuido. El mayor porcentaje de las muertes ocurren fuera de hospitales o clinicas. Los factores asociados a mortalidad extrahospitalaria en ambos sexos fueron edad avanzada, estado civil soltero y ruralidad.

[Analysis of mortality due to laryngeal cancer in Chile (1994-2004)].

INTRODUCTION AND OBJECTIVES Laryngeal cancer is the second most common respiratory cancer worldwide. In Chile, national registries of cancer incidence do not exist, only mortality statistics are available. The aim of this study is to analyze the trends in mortality rates from laryngeal cancer in Chile, during the period between 1990 and 2004, and its distribution by sex and age. MATERIAL AND METHOD The totalities of the deaths caused by laryngeal cancer were selected from the official mortality databases (1990-2004), and the projections of population elaborated by the National Statistics Institute were used for the calculation of age- and sex-adjusted mortality rates. RESULTS In Chile, during the period studied a total of 1842 deaths caused by laryngeal cancer occurred, of which 85.78 % corresponded to men and 14.22 % to women. The crude and adjusted incidence rates were 0.90 and 0.82 per 100 000 inhabitants, respectively. They were greater in men, increased progressively with age, and diminished over time throughout the period studied. CONCLUSION Laryngeal cancer in Chile presented a constant decline over the period studied. Sex- and age-distributions were similar to international data. A substantial part of this decline could be explained by the increase in mortality from other causes and by therapeutic and diagnostic improvements.

Análisis de la mortalidad por cáncer laríngeo en Chile (1990-2004)

Introduccion y objetivos El cancer de laringe es el Segundo tumor maligno del aparato respiratorio mas frecuente en el mundo. En Chile no existen registros nacionales de la incidencia de cancer, solo se dispone de cifras oficiales de mortalidad. El objetivo de este trabajo es analizar la tendencia de las tasas de mortalidad por cancer laringeo en Chile, durante el periodo comprendido entre los anos 1990 y 2004, y su distribucion por sexo y edad. Material y metodo Se selecciono la totalidad de las muertes por cancer laringeo registradas en la base de datos oficiales de mortalidad (1990-2004). Se utilizaron las proyecciones de poblacion elaboradas por el Instituto Nacional de Estadistica para el calculo de tasas de mortalidad bruta y ajustada por sexo y edad. Resultados En Chile, durante el periodo estudiado hubo 1.842 defunciones por cancer laringeo, de las que el 85,78% correspondio al sexo masculino y el 14,22 %, al sexo femenino. Las tasas de mortalidad especificas para cancer laringeo brutas y ajustadas por sexo y edad fueron, respectivamente, 0,90 y 0,82/100.000 habitantes, mayores entre los varones, aumentando progresivamente con la edad y disminuyendo durante el periodo estudiado. Conclusiones El cancer laringeo en Chile presento una disminucion constante en el periodo estudiado. La distribucion por sexo y edad fue similar a lo comunicado internacionalmente. Parte sustancial de esta reduccion podria atribuirse al aumento de la mortalidad por otras causas y la mejora de los metodos diagnosticos y terapeuticos.

Tendencia en la sobrevida de pacientes hospitalizados por infarto agudo de miocardio según nivel socioeconómico: Chile, 2002-2012

BACKGROUND A low socioeconomic status is associated with higher overall mortality rates. AIM To assess the effect of socioeconomic inequalities on survival of patients hospitalized with a first myocardial infarction. MATERIAL AND METHODS Analysis of hospital discharge and mortality databases of the Ministry of Health. Patients aged over 15 years discharged between 2002 and 2011 with a first myocardial infarction (code I-21, ICD-10) were identified. Their survival was verified with the mortality registry. Survival from 0 to 28 and from 29 to 365 days was analyzed. Socioeconomic status was determined using the type of health insurance, stratified as public insurance (low and medium status) and private insurance (high status). Prais-Winsten trend (P-W) and Cox survival analyses were done. RESULTS We analyzed 59,557 patients (69% males). Sixty three percent were of low socioeconomic status, 19% medium and 18% high. Between 2002 and 2011 the increase in survival was higher among patients of low socioeconomic status, mainly in women (P-W coefficients 0.58:0.31-0.86 in men and 1.12:0.84-1.41 in women for 0-28 days survival and 0.24:0.09-0.39 in men and 0.48:0.37-0.60 in women for 29-365 days survival, respectively). However, age and year of hospitalization adjusted analysis showed a higher mortality risk among patients of low socioeconomic status at 0-28 days (HR 1.67:1.53-1.83 for men and 1.49:1.34-1.66 for women) and at 29-365 days (HR 2.30:1.75-2.71 for men and 1.90:1.56-1.85 for women). CONCLUSIONS Survival after a myocardial infarction improved in the last decade especially in patients of low socioeconomic status. However, subjects of this stratum continue to have a higher mortality.