Pilar Brugulat-Guiteras

Comparison of the information provided by electronic health records data and a population health survey to estimate prevalence of selected health conditions and multimorbidity

BackgroundHealth surveys (HS) are a well-established methodology for measuring the health status of a population. The relative merit of using information based on HS versus electronic health records (EHR) to measure multimorbidity has not been established. Our study had two objectives: 1) to measure and compare the prevalence and distribution of multimorbidity in HS and EHR data, and 2) to test specific hypotheses about potential differences between HS and EHR reporting of diseases with a symptoms-based diagnosis and those requiring diagnostic testing.MethodsCross-sectional study using data from a periodic HS conducted by the Catalan government and from EHR covering 80% of the Catalan population aged 15 years and older. We determined the prevalence of 27 selected health conditions in both data sources, calculated the prevalence and distribution of multimorbidity (defined as the presence of ≥2 of the selected conditions), and determined multimorbidity patterns. We tested two hypotheses: a) health conditions requiring diagnostic tests for their diagnosis and management would be more prevalent in the EHR; and b) symptoms-based health problems would be more prevalent in the HS data.ResultsWe analysed 15,926 HS interviews and 1,597,258 EHRs. The profile of the EHR sample was 52% women, average age 47 years (standard deviation: 18.8), and 68% having at least one of the selected health conditions, the 3 most prevalent being hypertension (20%), depression or anxiety (16%) and mental disorders (15%). Multimorbidity was higher in HS than in EHR data (60% vs. 43%, respectively, for ages 15-75+, P <0.001, and 91% vs. 83% in participants aged ≥65 years, P <0.001). The most prevalent multimorbidity cluster was cardiovascular. Circulation disorders (other than varicose veins), chronic allergies, neck pain, haemorrhoids, migraine or frequent headaches and chronic constipation were more prevalent in the HS. Most symptomatic conditions (71%) had a higher prevalence in the HS, while less than a third of conditions requiring diagnostic tests were more prevalent in EHR.ConclusionsPrevalence of multimorbidity varies depending on age and the source of information. The prevalence of self-reported multimorbidity was significantly higher in HS data among younger patients; prevalence was similar in both data sources for elderly patients. Self-report appears to be more sensitive to identifying symptoms-based conditions. A comprehensive approach to the study of multimorbidity should take into account the patient perspective.

Características metodológicas de la Encuesta de Salud de Cataluña 2006

The Health Survey of Catalonia (ESCA) gives essential population information for health planning and evaluation. On the edition of 2006, 18,126 non-institutionalized persons were interviewed. The sample design is complex with the aim to guarantee the representatively also in small geographic areas with interest in health and service planning. There are certain novelties in the third edition such as the relevance given to the territory, questionnaires adaptations to the interviewed population and new subject areas studied. This paper describes the useful methodological aspects for the ESCA 2006 users. In the first part we describe the sample design, questioners, field work, interviewers formation, codification and quality micro data control. In the second part compound variables, used tools and their references are shown. And the third part describes the indicators construction since the sample design determines the use of weighing and elevation factors to obtain representative estimation values.

Prevalencia y condicionantes de la obesidad en la población infantojuvenil de Cataluña, 2006-2012

BACKGROUND AND OBJECTIVE To estimate the prevalence of obesity and overweight in children aged 2 to 14 years in Catalonia, its trends between 2006 and 2010-2012, and to evaluate social determinants and lifestyle associated with obesity. MATERIAL AND METHODS A cross-sectional study, using the data from 4,389 surveys from Catalonia Health Surveys of the years 2006 and 2010-2012, was conducted. Obesity and overweight were determined by World Health Organization criteria. Socioeconomic position, parents education, usual diet and activity, and hours of sleep were assessed. RESULTS The prevalence of obesity and overweight were: 15.4 and 20.2% in 2010-2012. The prevalence of obesity was higher in boys (15.5%) compared to girls (12.8%) (P<.05), and higher in children ranging from 2 to 9 years old (17.5%) than children aged 10 to 14 years (7.7%) (P<.05). In 2006, the prevalence of obesity and overweight were similar to the prevalence in 2010-2012. Obesity was more frequent in children with parents with a low socioeconomic position and/or a primary or elementary parents education. CONCLUSIONS During the last 5 years (2006-2012), child obesity and overweight have remained stable in Catalonia, yet they are relatively high in Europe. Public health programmes against obesity must consider conducting an intersectional action taking social determinants and family life styles into account.

Encuestas de salud: luces y sombras

Surveys are relevant tolls to analyze social changes and its methods are appropriate to know about the distribution of perceptions and behaviors of different phenomena related to health and disease. Health surveys (HS) are usually focused on areas like social and demographic characteristics, health related behaviors, health status and health services utilization. They provide with information that is not possible to reach through other systematic data sources and are crucial to assist decision making in health policy. HS provide data from the general population which is complementary of that obtained through other procedures and takes into account the various dimensions and connections of health and health system. They are very important in health planning because of its adaptability different need, circumstances or population groups, and in all cases, when properly used, they provide with new knowledge that can be shared. Among its limitations it must be emphasized its reduced capacity to catch all the complexity of social phenomena, its high cost, and the need of a very strong work to coordinate different expert teams and its poor capacity to offer accurate estimates when little geographic areas or low prevalence phenomena are studied. The areas and opportunities for innovation in the design, data gathering and data analysis of HS are actually various and there is a need to try to optimize all its potentialities to get a better knowledge about populations’ health and social reality.

OriginalPrevalencia y condicionantes de la obesidad en la población infantojuvenil de Cataluña, 2006-2012Prevalence and determinants of obesity in children and young people in Catalonia, Spain, 2006-2012

BACKGROUND AND OBJECTIVE To estimate the prevalence of obesity and overweight in children aged 2 to 14 years in Catalonia, its trends between 2006 and 2010-2012, and to evaluate social determinants and lifestyle associated with obesity. MATERIAL AND METHODS A cross-sectional study, using the data from 4,389 surveys from Catalonia Health Surveys of the years 2006 and 2010-2012, was conducted. Obesity and overweight were determined by World Health Organization criteria. Socioeconomic position, parents education, usual diet and activity, and hours of sleep were assessed. RESULTS The prevalence of obesity and overweight were: 15.4 and 20.2% in 2010-2012. The prevalence of obesity was higher in boys (15.5%) compared to girls (12.8%) (P<.05), and higher in children ranging from 2 to 9 years old (17.5%) than children aged 10 to 14 years (7.7%) (P<.05). In 2006, the prevalence of obesity and overweight were similar to the prevalence in 2010-2012. Obesity was more frequent in children with parents with a low socioeconomic position and/or a primary or elementary parents education. CONCLUSIONS During the last 5 years (2006-2012), child obesity and overweight have remained stable in Catalonia, yet they are relatively high in Europe. Public health programmes against obesity must consider conducting an intersectional action taking social determinants and family life styles into account.

Prevalencia y carga de defectos visuales en Cataluña

The aim of this work is to determine the prevalence of visual impairment in Catalonia and analyze inequalities in vision. Cross sectional study in the population having ≥ 15 years of age (7,881 men and 8,045 women) based on data from the Encuesta de Salud de Cataluna 2006. Logistic regression models were used to calculate the adjusted odds ratio by age, civil state, level of studies, income and working situation with a confidence interval (CI) of 95%. A 4.7% (CI 95% 4.4-5.0) of the population of Catalonia, a 5.3% of female (CI 95% 4.8-5.8), and 4.1% of men (CI 95% 3.7-4.5) state that they have poor vision. The most unfavourable situations of self-reported poor vision by the Catalan population correspond to the elderly and women with lower levels of both studies and income.

Dependencia para la realización de actividades de la vida diaria en las personas mayores de Cataluña

The aim of this article is to estimate the disabilty prevalence for the activities of daily living (ADL), the socioeconomic and demographic characteristics and the use of health services, distinguishing between the population receiving assistance for ADL and not. Cross-sectional study (Encuesta de Salud de Cataluna [ESCA] 2006). We have analyzed 17 ADL. Differences among proportions are estimated with a 95% confidence interval to characterize the analysis groups. Logistic regression describes the explanatory variables about getting help or not. Disabilty prevalence for the ADL: 26.6% men and 48.2% in women. Of these, 79.6% is getting help. There is a socioeconomic gradient in prevalence, not being observed in relation to assistance or not. We must deepen our understanding of the phenomenon and its evolution to which the ESCA is an essential tool.The aim of this article is to estimate the disabilty prevalence for the activities of daily living (ADL), the socioeconomic and demographic characteristics and the use of health services, distinguishing between the population receiving assistance for ADL and not. Cross-sectional study (Encuesta de Salud de Cataluña [ESCA] 2006). We have analyzed 17 ADL. Differences among proportions are estimated with a 95% confidence interval to characterize the analysis groups. Logistic regression describes the explanatory variables about getting help or not. Disabilty prevalence for the ADL: 26.6% men and 48.2% in women. Of these, 79.6% is getting help. There is a socioeconomic gradient in prevalence, not being observed in relation to assistance or not. We must deepen our understanding of the phenomenon and its evolution to which the ESCA is an essential tool.

Impacto de los trastornos crónicos en la esperanza de vida de la población de Cataluña en 1994 y 2006

This paper analyzes the changes in the prevalence of selected chronic conditions and their impact on the life expectancy in the population of Catalonia. The chronic conditions selected are: hypertension, diabetes, stroke, heart diseases, chronic bronchitis, asthma, chronic allergies, musculoskeletal system diseases, and anxiety/depression. The prevalence of these diseases is estimated from data collected by the Health Survey of Catalonia in 1994 and 2006. The most frequently chronic conditions among the Catalan population are the musculoskeletal disorders, the high blood pressure and the depression and/or anxiety. By the analysis of the changes in the life expectancy free of chronic disorders, this study shows the impact of these disorders in the life expectancy. The burden of the chronic morbidity in our community, and its impact on the health systems, requires further studies to increase the knowledge of this phenomenon.

La salud de los hombres y las mujeres en Cataluña. ¿Se están produciendo cambios?

The aim of this work is to show the changes observed in the health profile according to gender in 2006 with respect to 1994 of the population of Catalonia, through the comparison of data obtained in 1994 and 2006 from the Encuesta de Salud de Cataluna. The increase of the level of studies of the population has tended to comparing both sexes. The pattern of the social classes has been invested, so that in 2006 the proportion of women who place themselves in the upper classes and intermediate is superior to that of the men, and the proportion of women belonging to the lower class is inferior to that of the men. The number of women who incorporate into the work and handicapped world has increased those who are declared housewives. The little healthy behaviors continue being more frequent among men but the proportion of smoker and sedentary women increased between 1994 and 2006. Women have a more preventive than men in relation to the taking of blood pressure and measurement of cholesterol levels. People who value their health as positive has increased, but maintains that the percentage of women is lower than in males. The women continue to have more chronic diseases, mental disorders and disabilities. In 2006, and in comparison with 1994, it is observed that in Catalonia the health profile by gender, wherein women have poorer perception of health status, greater number of chronic diseases and disabilities and greater risk of poor mental health than men. Unhealthy habits are still more prevalent among men with the exception of the sedentarism, which is more frequent among women. Women continue practicing preventive activities in greater proportion than men.