María José Medrano

Several factors influenced attrition in a population-based elderly cohort: neurological disorders in Central Spain study.

OBJECTIVE We studied attrition (i.e., participant dropout) 3 years after the baseline interview in a population-based Spanish cohort. STUDY DESIGN AND SETTING The Neurological Disorders in Central Spain study is a longitudinal, population-based survey of chronic neurologic conditions in persons aged > or = 65 years. Multivariate logistic regression analysis was used to examine baseline differences between participants who took part in the 3-year follow-up evaluation vs. those who did not. RESULTS Of the 5,278 participants evaluated at baseline (1994-1995), 1,482 (28.1%) were lost to the follow-up (1997-1998). Factors that were associated with dropout due to refusal were as follows: living in a rural area and being single. Contact failure was associated with older age and being unmarried and widowed. Unreachable participants were less likely to take three or more medications or live in a professional neighborhood. Predictors of dropout due to death were male gender, older age, having impaired activities of daily living, taking more medications, poor self-perceived health, dementia, and smoking. CONCLUSIONS These findings on participants who are at high risk of dropout may be useful in the planning phase of future prospective studies. Of the possible reasons for attrition, refusal is the most important because it is amenable to change.

Riesgo coronario atribuible a los factores de riesgo cardiovascular en población española

Introduccion y objetivos La carga de enfermedad coronaria atribuible a los factores de riesgo cardiovascular en Espana ha sido extrapolada tradicionalmente de otras poblaciones. Este estudio pretende estimar el riesgo coronario atribuible al tabaquismo, la hipercolesterolemia, la hipertension, la diabetes y el sobrepeso, utilizando datos procedentes de poblaciones Espanolas. Metodos Las prevalencias de los factores de riesgo en la poblacion general se obtuvieron de un metaanalisis de 48 estudios transversales realizados en Espana, y las prevalencias en enfermos coronarios se tomaron de los registros hospitalarios multicentricos PRIAMHO II y PREVESE II. Los riesgos relativos brutos y ajustados de enfermedad coronaria se obtuvieron del seguimiento durante 5 anos de una cohorte de atencion primaria de 6.124 personas adultas libres de enfermedad cardiovascular. Las fracciones atribuibles brutas y ajustadas se calcularon para ambos sexos y para varones y mujeres por separado. Resultados En los varones, el 42,5% (intervalo de confianza [IC] del 95%, 6,8%-59,6%) de la incidencia ajustada de enfermedad coronaria se atribuyo al sobrepeso; el 33,9% (IC del 95%, 22,6%-41%), al tabaquismo, el 19,4% (IC del 95%, 8,2%-26,5%), a la hipercolesterolemia, y el 15,5% (IC del 95%, 1,6%-24,6%), a la hipertension. En las mujeres, el 36,5% (IC del 95%, –8%-56,3%) de los casos de cardiopatia isquemica se atribuyeron al sobrepeso, el 24,8% (IC del 95%, 12%-31,9%), a la diabetes y el 20,1% (IC del 95%, 6,1%-28,6%), a la hipercolesterolemia. Conclusiones El sobrepeso y el tabaquismo en varones son los factores de riesgo cardiovascular a los que cabe atribuir un mayor impacto poblacional en la enfermedad coronaria.

Mortality from Parkinson's Disease: A Population-Based Prospective Study (NEDICES)

Most studies of mortality in Parkinsons disease have been clinical studies, yielding results that are not representative of the general population. We assessed the risk of mortality from Parkinsons disease in the Neurological Disorders in Central Spain (NEDICES) study, a prospective population‐based study in which Parkinsons disease patients who were not ascertained through medical practitioners were also included. The cohort consisted of 5262 elderly subjects (mean baseline age, 73.0 years), including 81 with Parkinsons disease at baseline (1994–1995). Thirteen‐year mortality was assessed. Two thousand seven hundred and one of 5262 subjects (51.3%) died over a median follow‐up of 12.0 years (range, 0.04–14.8 years), including 66 of 81 subjects (81.5%) with Parkinsons disease at baseline and 2635 of 5181 subjects (50.8%) without Parkinsons disease at baseline. In an unadjusted Cox model, the hazard ratio of mortality was increased in subjects with Parkinsons disease (hazard ratio, 2.29; 95% confidence interval, 1.80–2.93; P < .001) versus subjects without Parkinsons disease (reference group). In a Cox model that adjusted for a variety of demographic factors and comorbidities, the risk of mortality remained elevated in subjects with Parkinsons disease (hazard ratio, 1.75; 95% CI, 1.32–2.31, P < .001). In additional Cox models, Parkinsons disease patients with dementia had particularly high risks of mortality (adjusted hazard ratio, 2.62; 95% CI, 1.40–4.90; P < .001). In this prospective population‐based study, Parkinsons disease was an independent predictor of mortality in the elderly. Parkinsons disease patients with dementia had particularly high risks of mortality.

Risk of ischaemic heart disease and acute myocardial infarction in a Spanish population: observational prospective study in a primary-care setting

BackgroundIschaemic heart disease is a global priority of health-care policy, because of its social repercussions and its impact on the health-care system. Yet there is little information on coronary morbidity in Spain and on the effect of the principal risk factors on risk of coronary heart disease. The objective of this study is to describe the epidemiology of coronary disease (incidence, mortality and its association with cardiovascular risk factors) using the information gathered by primary care practitioners on cardiovascular health of their population.MethodsA prospective study was designed. Eight primary-care centres participated, each contributing to the constitution of the cohort with the entire population covered by the centre. A total of 6124 men and women aged over 25 years and free of cardiovascular disease agreed to participate and were thus enrolled and followed-up, with all fatal and non-fatal coronary disease episodes being registered during a 5-year period. Repeated measurements were collected on smoking, blood pressure, weight and height, serum total cholesterol, high-density and low-density lipoproteins and fasting glucose. Rates were calculated for acute myocardial infarction and ischaemic heart disease. Associations between cardiovascular risk factors and coronary disease-free survival were evaluated using Kaplan-Meier and Cox regression analyses.ResultsMean age at recruitment was 51.6 ± 15, with 24% of patients being over 65. At baseline, 74% of patients were overweight, serum cholesterol over 240 was present in 35% of patients, arterial hypertension in 37%, and basal glucose over 126 in 11%. Thirty-four percent of men and 13% of women were current smokers. During follow-up, 155 first episodes of coronary disease were detected, which yielded age-adjusted rates of 362 and 191 per 100,000 person-years in men and women respectively. Disease-free survival was associated with all risk factors in univariate analyses. After multivariate adjustments, age, male gender, smoking, high total cholesterol, high HDL/LDL ratio, diabetes and overweight remained strongly associated with risk. Relative risks for hypertension in women and for diabetes in men did not reach statistical significance.ConclusionDespite high prevalence of vascular risk factors, incidence rates were lower than those reported for other countries and other periods, but similar to those reported in the few population-based studies in Spain. Effect measures of vascular risk factors were mainly as reported worldwide and support the hypothesis that protective factors not considered in this study must exist as to explain low rates. This study shows the feasibility of conducting epidemiological cohort studies in primary-care settings.

Physical activity and self-reported health status among adolescents: A cross-sectional population-based study

Objectives Little is known about the dose–response relationship between physical activity and health benefits among young people. Our objective was to analyse the association between the frequency of undertaking moderate-to-vigorous physical activity (MVPA) and the self-reported health status of the adolescent population. Design Cross-sectional study. Setting All regions of Spain. Participants Students aged 11–18 years participating in the Spanish Health Behaviour in School-aged Children survey 2006. A total of 375 schools and 21 188 students were selected. Main outcomes The frequency of undertaking MVPA was measured by a questionnaire, with the following four health indicators: self-rated health, health complaints, satisfaction with life and health-related quality of life. Linear and logistic regression models were used to analyse the association, adjusting for potential confounding variables and the modelling of the dose–response relationship. Results As the frequency of MVPA increased, the association with health benefits was stronger. A linear trend (p<0.05) was found for self-rated health and health complaints in males and females and for satisfaction with life among females; for health-related quality of life this relationship was quadratic for both sexes (p<0.05). For self-reported health and health complaints, the effect was found to be of greater magnitude in males than in females and, in all scales, the benefits were observed from the lowest frequencies of MVPA, especially in males. Conclusions A protective effect of MVPA was found in both sexes for the four health indicators studied, and this activity had a gradient effect. Among males, health benefits were detected from very low levels of physical activity and the magnitude of the relationship was greater than that for females.

Polypharmacy in the Elderly: A Marker of Increased Risk of Mortality in a Population-Based Prospective Study (NEDICES).

Background: Little information is available on the potential association between polypharmacy and risk of mortality. Objective: To determine in a population-based study whether polypharmacy is associated with increased risk of mortality in elderly persons. Methods: In this population-based, prospective study of 5,052 people aged 65 years and older (Neurological Disorders in Central Spain), current medications were recorded. Cox proportional hazards models, adjusted for sociodemographics and comorbidity factors, were used to assess the risk of death up to 13.3 years later, comparing the polypharmacy group (≥6 drugs) to those who were taking 1-5 drugs and those in a nonmedicated group (0 drugs). Results: Out of 5,052 participants, 2,550 (50.5%) died over a median follow-up of 6.5 years, including 361 (28.8%) deaths among 931 nonmedicated participants, 1,946 (51.4%) deaths among 3,787 participants taking 1-5 drugs daily, and 243 (72.8%) among 334 participants on polypharmacy. In an unadjusted Cox model, risk of mortality was increased in participants on polypharmacy [hazard ratio (HR) = 2.78, 95% confidence interval [CI]: 2.36-3.27, p < 0.001) and in those taking between 1 and 5 drugs (HR = 1.47, 95% CI: 1.31-1.64, p < 0.001) versus those who were nonmedicated (reference group). In a Cox model that adjusted for a variety of demographic factors and comorbidities, HR remained increased in participants on polypharmacy (HR = 1.83, 95% CI: 1.51-2.21, p < 0.001). Conclusion: This study provides evidence that polypharmacy is associated with increased risk of mortality in elderly people. The extent to which polypharmacy is the proximate cause rather than a marker of this increase risk remains to be determined.

Derivation and validation of a set of 10-year cardiovascular risk predictive functions in Spain: The FRESCO Study

OBJECTIVE To derive and validate a set of functions to predict coronary heart disease (CHD) and stroke, and validate the Framingham-REGICOR function. METHOD Pooled analysis of 11 population-based Spanish cohorts (1992-2005) with 50,408 eligible participants. Baseline smoking, diabetes, systolic blood pressure (SBP), lipid profile, and body mass index were recorded. A ten-year follow-up included re-examinations/telephone contact and cross-linkage with mortality registries. For each sex, two models were fitted for CHD, stroke, and both end-points combined: model A was adjusted for age, smoking, and body mass index and model B for age, smoking, diabetes, SBP, total and HDL cholesterol, and for hypertension treatment by SBP, and age by smoking and by SBP interactions. RESULTS The 9.3-year median follow-up accumulated 2973 cardiovascular events. The C-statistic improved from model A to model B for CHD (0.66 to 0.71 for men; 0.70 to 0.74 for women) and the combined CHD-stroke end-points (0.68 to 0.71; 0.72 to 0.75, respectively), but not for stroke alone. Framingham-REGICOR had similar C-statistics but overestimated CHD risk. CONCLUSIONS The new functions accurately estimate 10-year stroke and CHD risk in the adult population of a typical southern European country. The Framingham-REGICOR function provided similar CHD prediction but overestimated risk.

Low morale is associated with increased risk of mortality in the elderly: a population-based prospective study (NEDICES)

OBJECTIVE the study aimed to assess the association between morale and mortality. DESIGN we used data from the Neurological Disorders in Central Spain (NEDICES), a population-based study. SUBJECTS 2,516 older persons (mean age 75.7 years) participated in the study. METHODS Cox models were used to estimate risk of mortality. Morale was assessed using the Philadelphia Geriatric Center Morale Scale. RESULTS 489 (21.8%) participants died over a median follow-up of 5.9 years (range 0.1-7.7 years), including 253 (21.8%) deaths among 1,163 participants with low morale scores, 168 (19.3%) among 870 participants with moderate scores and 68 (14.1%) among participants with high scores. In an unadjusted Cox model, relative risk (RR) of mortality in participants with low morale scores = 1.69 (P < 0.001) and RR in participants with moderate scores = 1.47 (P < 0.01) were compared to the reference group (participants with high scores). In a Cox model that adjusted for a variety of demographic factors and co-morbidities, RR of mortality in participants with low morale scores = 1.35 (P <0.05) and moderate scores = 1.16 (not significant) were compared to the reference group. CONCLUSION low morale may be an independent predictor of mortality in the elderly. By assessing morale, practitioners might be better positioned to identify patients with poorer prognoses.

Effect of Age, Birth Cohort, and Period of Death on Cerebrovascular Mortality in Spain, 1952 Through 1991

BACKGROUND AND PURPOSE The continued decrease in cerebrovascular disease in Spain remains unexplained. Age-period-cohort analysis enables description of birth cohort and period-of-death components. This study sought to describe these effects on the decline of stroke mortality in Spain. METHODS Deaths due to cerebrovascular diseases in the period from 1952 through 1991 and the corresponding population figures were grouped into 11 age groups and 8 5-year periods, from which age-specific mortality rates for 18 birth cohorts were then computed. These were plotted for graphical presentation purposes and fitted to Poisson regression models to assess age, period, and cohort effects. RESULTS An exponential age effect was present for both sexes regardless of cohort or period. A definite downward period effect was observable from 1962 to 1991, except for a sharp fall and peak in the periods 1967 to 1971 and 1972 to 1976, respectively, which was possibly ascribable to changes in diagnostic and coding practices. Age- and period-adjusted stroke mortality increased for earlier cohorts and decreased for generations born between 1892 and 1940. For post-1940 generations, there was an increasing risk of stroke mortality. CONCLUSIONS The results suggest that a decrease in incidence coupled with an increase in survival may account for the observed decline in stroke mortality, but further studies on the Spanish population are needed to assess these findings. Although not yet definitive, there are signs of an increase in incidence among the more recent generations. If the decreasing period effect fails to offset this increase, future years may see a deceleration in the current decline in stroke mortality.

The association of dietary folate, B6, and B12 with cardiovascular mortality in Spain: an ecological analysis.

OBJECTIVES This study assessed the association of dietary folate, vitamin B6, and vitamin B12 with cardiovascular mortality. METHODS Poisson regression analyses assessed coronary/cerebrovascular mortality rates via nutrient data obtained from the National Nutrition Survey, which recorded 7-day food intakes from a national sample of 21,155 households. RESULTS In regard to coronary mortality, male and female rate ratios (highest vs lowest quintile) were 0.83 (95% confidence interval [CI] = 0.77, 0.91) and 0.95 (95% CI = 0.86, 1.05), respectively, for folate and 0.74 (95% CI = 0.65, 0.84) and 0.86 (95% CI = 0.73, 0.99), respectively, for B12. Intake of folate and B6 (but not B12) was significantly associated with cerebrovascular mortality. CONCLUSIONS B vitamins are associated with cardiovascular mortality in the general population.