Lucía Díez-Gañán

Mortalidad atribuible al consumo de tabaco en España en 2006

BACKGROUND AND OBJECTIVE This study estimates smoking-attributable mortality in Spain in 2006. POPULATION AND METHOD Source data included 1) smoking prevalence in Spain; 2) deaths occurred in Spain; and 3) relative risks of mortality by tobacco-caused diseases drawn from the Cancer Prevention Study II. All data corresponded to individuals aged 35 years and older. RESULTS In 2006, 53,155 smoking-attributable deaths were estimated (14.7% of all deaths occurred in individuals≥35 years; 25.1% in men and 3.4% in women). Almost 90% (47,174) of these attributable deaths corresponded to men, and 11.3% (5,981) to women. The most frequent attributable deaths were: cancer (24,058), specially lung cancer (16,482), cardiovascular disease (17,560), specially ischemic heart disease (6,263) and stroke (4,283), and respiratory disease (11,537), specially chronic obstructive lung disease (9,886). Since 2001, a decrease in smoking-attributable mortality was observed in men and an increase in women. CONCLUSIONS About one out of 7 deaths occurring annually in individuals≥35 years in Spain is attributable to smoking (one in 4 in men and one in 29 in women). Despite a decreasing trend in the number of smoking-attributable deaths over time (except in women, where they increase), the toll of estimated attributable deaths is still very high.

Clustering of behavioural risk factors and their association with subjective health

Objetivos: Describir la agregacion de factores de riesgo relacionados con el comportamiento en la poblacion adulta de la Comunidad de Madrid y evaluar la asociacion del grado de agregacion de dichos factores con la salud subjetiva suboptima. Metodos: Los datos proceden del Sistema de Vigilancia de Factores de Riesgo asociados a Enfermedades No Transmisibles (SIVFRENT). Las relaciones entre el consumo de tabaco, el consumo de alcohol de riesgo, el sedentarismo en tiempo libre y la dieta desequilibrada fueron estudiadas en 16.043 personas de 18 a 64 anos, y se compararon las proporciones observadas respecto a las esperadas. Mediante un analisis de regresion logistica se estimo la asociacion entre la agregacion de factores de riesgo y la salud percibida suboptima (regular, mala y muy mala). Resultados: Cerca del 20% de los sujetos presentan 3 o 4 factores de riesgo simultaneamente. La mayoria de combinaciones de 3 factores de riesgo son superiores a las esperadas, destacando la agregacion de los 4 factores con un cociente observado/esperado de 2,15 (IC del 95%, 1,93-2,38) en varones y de 2,96 (IC del 95%, 2,46-3,46) en mujeres. En ambos sexos, el factor individual que mas se asocia al resto de factores de riesgo es el tabaco. La agregacion de factores de riesgo es mas frecuente en varones, en edades jovenes y en el nivel educativo bajo. En comparacion con los que carecen de los 4 factores de riesgo, los que presentan simultaneamente 3 o 4 de ellos tienen con mayor frecuencia una salud percibida suboptima (OR = 2,49; IC del 95%, 1,59-3,90 en varones y OR = 1,96; IC del 95%, 1,29-2,97 en mujeres). Conclusiones: Los factores de riesgo ligados al comportamiento se agregan, y esta acumulacion es superior en varones, en personas jovenes y con bajo nivel de estudios. Un mayor grado de agregacion se asocia a mayor frecuencia de salud percibida suboptima.

Assessment of a blood pressure measurement training programme for lay observers.

This study assessed a training programme attended by 25 observers, intentionally chosen for their lay status, who were invited to participate in a prevalence of hypertension study. The results highlight the fact that the 14 trainee observers finally selected were comparable to professionals in terms of both the estimated validity of the blood pressure measurement [the mean difference (standard deviation) compared with the expert being −0.4 (1.8) mmHg for systolic blood pressure and 0.0 (1.8) mmHg for diastolic blood pressure] and estimated inter-observer variability (100% of the observers complying with the criteria recommended for professional health-care workers), even though the training given to the former was in no way more comprehensive than or distinct from that recommended for professional health-care workers in community studies.

Effectiveness and equity of serum cholesterol and blood pressure testing: a population-based study in Spain

BACKGROUND This study examined the effectiveness and equity of serum cholesterol and blood pressure testing in Spain. METHODS Data were taken from a household survey of 3680 persons of the Basque Country, a region in northern Spain. Analyses were performed using logistic regression, controlling for need, equity, and predisposing factors for serum cholesterol and blood pressure testing. Proxies for need were age, subjective health and cardiovascular risk factors, such as tobacco and alcohol consumption, physical activity at work and at leisure time, and body mass index. Proxies for equity were sex, educational level, and province of residence, and predisposing factors for testing were the marital status and the number of medical visits in the preceding year. RESULTS The percentage of subjects that had their cholesterol measured rose with age and worse subjective health, but showed no association with any cardiovascular risk factor except body mass index, for which a positive association was observed (P for linear trend, 0.0351). The percentage of subjects with serum cholesterol checked also rose with educational level (P for linear trend, 0.0024). Moreover, women were less likely to have their cholesterolemia tested than men (OR, 0.79; 95% CI, 0.67-0.94). Educational and sex differences in cholesterol testing increased after adjustment for the number of medical visits. Similar results were obtained for blood pressure testing. CONCLUSIONS Serum cholesterol and blood pressure testing are not performed according to cardiovascular risk, which compromise its effectiveness. Moreover, there are social inequalities in testing, to which healthcare professionals could be contributing.

Prevalence and correlates of skin cancer risk behaviors in Madrid (Spain)

OBJECTIVE To estimate the prevalence and correlates of skin cancer-related behaviors in a representative sample of the population of the region of Madrid (Spain). METHODS We performed a cross-sectional study based on a telephone survey. A total of 2,007 participants aged 18-64 years completed a questionnaire that included items on knowledge about the risk of skin cancer, sun exposure, the use of ultraviolet (UV) lamps and sunburn during the previous year. Logistic regression models were constructed, adjusted for gender, age, educational level and employment status. RESULTS Sun exposure as a risk factor for skin cancer was identified by 92.3% of participants and artificial tanning by 73.6%. Knowledge of risk factors was greater among university graduates and women (P<.001). A total of 14.6% were usually exposed to the sun in the summer during the hours of maximum UV radiation, while 4.3% had used UV lamps during the previous year; the use of these lamps was more frequent among women (P<.001) and young people (P<.05). The prevalence of sunburn was 13.2% and was lower among women: odds ratio (OR) 0.68 (95% CI: 0.51-0.90); this prevalence declined with greater age (p linear trend <0.001) and was higher among students: OR 1.60 (95% CI: 1.07-2.40). CONCLUSIONS Numerous sociodemographic factors are related to UV radiation exposure and sunburn, with young people at highest risk. UV exposure is more frequent among women, whereas sunburn is more common among men.

Ingesta de alimentos, energía y nutrientes en la población de 5 a 12 años de la Comunidad de Madrid: resultados de la encuesta de nutrición infantil 2001-2002

Fundamento: Para conocer la situacion alimentaria y nutricional en la poblacion infantil, sobre la que no existia informacion actualizada, el Instituto de Salud Publica desarrollo la Encuesta de Nutricion Infantil de la Comunidad de Madrid 2001/2002 (ENICM). En este trabajo se analiza la ENICM para describir y evaluar la ingesta de alimentos, energia y nutrientes en esta poblacion. Metodos: Estudio transversal sobre una muestra representativa de la poblacion de 5-12 anos de la Comunidad de Madrid. La informacion alimentaria se recogio en 2001 y 2002 mediante dos recuerdos de 24 horas. Se ha estudiado la ingesta total diaria de alimentos, energia y nutrientes. Los analisis incluyen los 1.852 ninos con informacion completa en los dos recuerdos (90,8% de las entrevistas realizadas). Resultados: La ingesta media total diaria de alimentos es 1.460,7 gramos/persona/dia. Salvo para los lacteos, huevos y aceites, la ingesta en los grupos alimentarios basicos es inadecuada, particularmente baja en las frutas frescas, verduras y hortalizas. La ingesta media energetica y nutricional resultante es 1.905,9 kcal/persona/dia; 43,6% hidratos de carbono; 17,4% proteinas, 39,0% lipidos (13,3% grasas saturadas, 16,8% monoinsaturadas, 5,0% poliinsaturadas); 363,8 mg de colesterol; 13,6 g de fibra e ingestas por debajo de las recomendadas de zinc, acido folico, vitaminas D y E (ambos sexos) y hierro y vitamina B6 (ninas). Conclusiones: La dieta de la poblacion infantil de la Comunidad de Madrid presenta desequilibrios que es necesario mejorar: ingesta inadecuada de alimentos basicos, exceso de proteinas, grasas saturadas y colesterol y deficit de hidratos de carbono, fibra y algunos micronutrientes.

Agregación de factores de riesgo ligados al comportamiento y su relación con la salud subjetiva

Objectives: To describe the clustering of behavior-related risk factors in the adult population of the Autonomous Community of Madrid (Spain) and evaluate the association between the level of aggregation of these factors and suboptimal subjective health. Methods: Data were drawn from the Non-communicable Disease Risk-Factor Surveillance System (Sistema de Vigilancia de Factores de Riesgo asociados a Enfermedades No Transmisibles [SIVFRENT]). We studied the associations between smoking, high-risk alcohol consumption, leisure-time sedentariness and unbalanced diet in 16,043 persons aged 1864 years and compared the observed against the expected proportions. Logistic regression was used to estimate the association between clustering of risk factors and suboptimal health (fair, poor and very poor). Results: Almost 20% of subjects had 3 or 4 risk factors simultaneously. Most combinations of 3 risk factors exceeded expectations and, in particular, 4 factor clustering yielded observed/expected quotients of 2.15 (95% confidence interval [CI]: 1.93-2.38) in men and 2.96 (95% CI, 2.46-3.46) in women. In both sexes, the individual factor most closely associated with the remaining risk factors was smoking. Aggregation of risk factors was more frequent among men, younger age groups and subjects with low educational level. Compared with persons with none of the 4 risk factors, those that simultaneously had 3 or 4 more frequently reported suboptimal subjective health (OR = 2.49; 95% CI, 1.59-3.90 in men and OR = 1.96; 95% CI, 1.29-2.97 in women). Conclusions: Behavior-related risk factors tend to aggregate, and this accumulation is higher among men, younger age groups, and subjects with a low educational level. A greater level of clustering is associated with a higher frequency of suboptimal perceived health.

Características demográficas, hábitos de vida e historia del consumo de tabaco de los fumadores ocasionales en España

Fundamento: El consumo ocasional de tabaco suele ser un estado de transicion hacia otros patrones de consumo mas intenso o frecuente. Este trabajo describe las caracteristicas sociodemograficas, los habitos de vida relacionados con la salud, y la historia de consumo de tabaco de los fumadores ocasionales en Espana, y examina si estos presentan diferencias con los que consumen tabaco a diario. Metodos: Los datos se tomaron de la Encuesta Nacional de Salud de Espana realizada en 1993 mediante entrevista en los domicilios a una muestra representativa de la poblacion espanola no institucionalizada de 16 y mas anos. Los analisis se realizaron mediante regresion logistica multiple ajustando por variables sociodemograficas, de estado de salud y habitos de vida. Resultados: De los 6.668 fumadores de la encuesta, los fumadores ocasionales representaron el 9,2%, mientras que los fumadores diarios de 5 cigarrillos fueron respectivamente el 9,9% y el 80,9%. En comparacion con los fumadores diarios de >5 cigarrillos, los fumadores ocasionales fueron con mas frecuencia mujeres (odds ratio [0R]): 2,12; IC95%:1,72-2,61), mas jovenes (OR de edad 25-44 frente a 16-24 anos: 0,75; 0,58-0,96), tuvieron menor consumo de alcohol (p de tendencia lineal: 0,0349) e hicieron mas actividad en tiempo libre (p tendencia lineal: 5 cigarrillos. Conclusiones. Los fumadores ocasionales tienen caracteristicas sociodemograficas, habitos de vida e historia de consumo de tabaco diferentes a los que consumen tabaco diariamente. Estas diferencias sugieren que deben realizarse programas de investigacion e intervencion dirigidos de forma especifica a los fumadores ocasionales.

Mortalidad por cáncer en niños y adolescentes de la Comunidad de Madrid, 1977-2001

Introduccion La mortalidad por cancer en ninos y adolescentes ha disminuido de modo desigual en los diferentes paises desarrollados en las ultimas decadas. El objetivo del estudio es conocer el patron y la tendencia de la mortalidad por cancer en menores de 20 anos residentes en la Comunidad de Madrid entre 1977 y 2001. Material y metodos Las defunciones fueron cedidas por el Instituto Nacional de Estadistica y por el Registro de Mortalidad de la Comunidad de Madrid y las poblaciones se tomaron a partir de publicaciones oficiales del Instituto de Estadistica de la Comunidad de Madrid. Las variables estudiadas fueron: sexo, grupo quinquenal de edad, periodo quinquenal de defuncion y causa basica de defuncion. Se describe el patron epidemiologico y se analiza la evolucion temporal de la mortalidad por cancer infantil entre 1977 y 2001 mediante el ajuste de un modelo de Poisson log-lineal. Resultados La mortalidad por cancer infantil ha disminuido un 41 % a lo largo del periodo de estudio. El descenso ha sido desigual para los distintos sexos (varones: 46%; mujeres: 33%) y tipos tumorales (leucemias: 38 %; linfomas no hodgkinianos: 58 %; tumores malignos encefalicos: 45 %; tumores malignos osteoarticulares: 19 %; tumores malignos mal definidos: 78 %). El porcentaje de disminucion anual de la mortalidad ha sido mucho mayor para el ultimo quinquenio (4,7 %) que para el periodo completo (2,2 %). Conclusiones La mortalidad infantil por cancer ha descendido entre 1977 y 2001, acercando la situacion de nuestra region a la de otras regiones europeas y norteamericanas. Seran necesarias futuras evaluaciones que integren indicadores de mortalidad, incidencia y supervivencia para un mejor conocimiento de la epidemiologia del cancer infantil en la Comunidad de Madrid.

Individual and Contextual Factors Associated to Smoking on School Premises

INTRODUCTION Despite regulations, tobacco consumption in schools is still very common. The objective was to evaluate the relationship of personal, family, and school-level contextual factors with smoking on school premises. METHODS A representative survey was undertaken of students in the 4th year of secondary education in the Madrid region (Spain), including 79 schools and 3,622 individuals. The student questionnaire gathered information about personal and family variables. The contextual factors were type of school, perception of compliance with the law, smoking policy, existence of complaints against smoking, and undertaking of educational activities regarding smoking. Analysis was carried out in the smoking population (n = 1,179) using multilevel logistic regression models. RESULTS During the last 30 days, 50.6% of smokers had smoked on school premises. Having a father with a university education (in comparison with fathers who have not attained any educational level) reduces this probability (odds ratio [OR]: 0.43; 95% CI: 0.19-0.96), whereas smoking a larger number of cigarettes (p < .001), illicit drug consumption (p < .001), and low academic achievement (p = .052) increases it. The probability is reduced when there is no parental permission to smoke (OR: 0.66; 95% CI: 0.43-1.01) and is lower both in nonsubsidized private schools (OR: 0.29; 95% CI: 0.12-0.67) and in state subsidized private schools (OR: 0.17; 95% CI: 0.09-0.34) than in public schools. CONCLUSIONS A very low level of educational attainment by the father, smoking a higher number of cigarettes, as well as illicit drug consumption, low academic achievement, having parental permission to smoke, and attending public schools are all related to a higher probability of smoking on school premises.