Ruth Gil-Prieto

Epidemiology of suicide in Spain, 1981–2008: A spatiotemporal analysis

OBJECTIVEnTo analyse the epidemiology of suicide, and compare its occurrence between the sexes and in various regions in Spain.nnnMETHODnAge-specific analysis and spatiotemporal analysis to analyse death by suicide between 1981 and 2008 in Spain.nnnSTUDY DESIGNnEcological study.nnnRESULTSnDeath by suicide has decreased since the 1990s in Spain, although peaks in suicides correspond with times of economic crisis. Death by suicide was more common among men than among women, although the suicide mortality rate increased over the study period among women aged 35-49 years. Geographical analysis showed that rural populations and areas with historically higher levels of unemployment have higher suicide rates. In contrast, less-populated regions have lower suicide rates.nnnCONCLUSIONnSuicides in Spain exhibit a clear geographic pattern and occur at different rates between the genders. The results suggest an increasing number of suicides among women aged 35-49 years over the study period.

Budget impact analysis of a pneumococcal vaccination programme in the 65-year-old Spanish cohort using a dynamic model

BackgroundThis study aimed to assess the costs and clinical benefits of the 13-valent pneumococcal conjugate vaccine (PCV13) administered annually to the 65-year-old cohort in Spain versus the alternative of not vaccinating patients and treating them only when infected.MethodsCases of pneumococcal disease avoided were calculated through a dynamic model based on the work of Anderson and May (1999). Sixty-six percent of the 65-year-old cohort was assumed to have been vaccinated with one PCV13 dose (304,492 subjects). Base-case estimated vaccine effectiveness and serotype coverage were 58% and 60%, respectively. Disease-related costs were calculated based on published data.ResultsOver the 5-year period, a total of 125,906 cases of pneumococcal disease would be avoided. Net savings of €102 million would be obtained. The cost-saving distribution was not homogeneous, starting in the 2nd year and increasing through the 5th. To demonstrate model robustness, an additional scenario analysis was performed using extreme values of model parameters (vaccination programme coverage, vaccine effectiveness, discount rate and disease costs). Under those scenarios, net savings were always achieved.ConclusionsBased on the assumptions of the model, the 65-year-cohort pneumococcal vaccination campaign appears to be a cost-saving intervention in the Spanish population under different scenarios.

Temporal trends in incidence rates of herpes zoster among patients treated in primary care centers in Madrid (Spain), 2005–2012

OBJECTIVESnThis study aimed to estimate total and age-specific incidence rates of HZ with data from electronic clinical records in primary care (ECRPC) and to analyze trends by sex and age.nnnMETHODSnDescriptive cross-sectional study covering the incident HZ episodes registered in the ECRPC of the Madrid Regional Public Health System in 2005-2012. Annual crude and age-adjusted incidence rates were calculated. Differences by sex and age were assessed by poisson regression. The annual percentage of change (APC) of incidence rates and breakthrough points of the time trends were determined with the Joinpoint Regression Program.nnnRESULTSn211,650 episodes of HZ were identified (60.6% women, 52.2% > 55 years). The incidence rate increased from 363.21 to 481.92 per 100,000 person-year in 2005-2012. Rates were higher among women and increased with age. The APC for the period was 3.59% in men and 3.67% in women (p < 0.05). Age-specific rates increased in patients over 14 years. The APC in the 25-44 age group was 7.4% since 2007. The incidence rate ratio (women/men) was highest in this group.nnnCONCLUSIONSnThe incidence of HZ presents an upward trend in 2005-2012 in adults and the elderly. Monitoring the incidence and age-specific rates, will help to detect changes in trends.

Hospital-acquired rotavirus infections in Spain over a ten-year period (1998-2007)

Background and objectives: To analyze the epidemiology and burden of rotavirus infections amongst hospitalized children up to 5 years of age in Spain over a 10-year period (1998-2007). Patients and methods: Data provided by the National Epidemiology Surveillance System for Hospital Data (Conjunto Mínimo Básico de Datos; CMBD) were analyzed. This database includes clinical information on hospitalizations and associated costs. For the purpose of this study, hospital discharges that mentioned rotavirus disease as a secondary diagnosis (ICD-9CM 008.61) were considered rotavirus hospital-acquired infections. All such cases reported from January 1, 1998 to December 31, 2007 were selected. Results: During the study period (1998-2007), a total of 10,990 cases of rotavirus disease mentioned as a secondary diagnosis were recorded (annual incidence of 59.02 cases per 100,000 people and 0.45 cases per 100 admissions). The average patient age was 9.8 months (SD 9.3), with 71% of the patients younger than 12 months of age. The mortality rate for children hospitalized for other primary causes, with rotavirus gastroenteritis as a secondary diagnosis was 0.16 per 100,000, and the case-fatality rate was 0.27%. The hospitalization rate decreased significantly with age, from 226 cases per 100,000 children 12 months of age or younger to 1.78 cases per 100,000 in children at the age of four. The infection rate amongst hospitalized children also decreased significantly with age, from 0.55% and 0.66% in children under one and two years, respectively, to 0.04% in children at the age of four. Conclusion: Hospital-acquired rotavirus infection morbidity and the associated consumption of health care resources are still important in Spain, especially in the younger groups (24 months of age and younger).

Herpes zoster hospitalizations of patients with chronic illnesses in Spain, 1998-2004

Abstract Herpes zoster affects 10–30% of the population during their lifetime and its incidence and severity increase substantially with age and the presence of some chronic diseases. The objective of this study was to describe the disease burden of patients hospitalised with herpes zoster who presented COPD, cardiovascular disease and/or diabetes. A retrospective study was performed using information obtained from the Minimum Data Set. All hospitalizations from 1998 to 2004 of patients agedxa0≥50 years with herpes zoster who also presented diabetes, COPD and/or chronic cardiovascular disease were selected. A total of 16,022 admissions for herpes zoster were identified in non immunocompromised patients agedxa0≥xa050 years. 69.4% of patients were aged xa0≥xa070 years. Specifically, 60.8% had diabetes and/or COPD and/or chronic cardiovascular disease and had a longer mean hospital stay (13.0 vs. 11.4 days), higher mean cost per patient (3,617€ vs. 3,275€) and a higher fatality rate (4.6% vs. 2.1%) than patients without these pathologies. Herpes zoster is a significant cause of death in people agedxa0≥xa050 years. The higher medical and economic hospital burden generated by the patients with diabetes, COPD and/or cardiovascular disease might indicate that an episode of herpes zoster could further compromise the health of these patients.

Factors involved in health-related transitions after curative resection for pancreatic cancer. 10-Years experience: A multi state model

BACKGROUNDnPancreatic cancer is one of the least common tumours, nevertheless it is one of the most lethal. This lethality is mainly due to the fact that the vast majority of patients are diagnosed in an advanced stage. The purpose of this study was to investigate how different covariates affect the transition to death or discharge with and without complications after pancreatic resection.nnnMETHODSnWe analyse the impact of different factors on transitions after pancreatic resection based on a multi state model.nnnRESULTSnTransitions of interest include the transition to death/discharge with/without complications after pancreatic resection. We consider presence of comorbidities, higher age (>60), gender-male, lower hospital volume (<10 cases per year), type of surgery, localization of tumour and transfusion received as covariates with a potentially negative effect on the transition intensities to death with or without complications.nnnCONCLUSIONSnThe multi-state model allows for a very detailed analysis of the impact of covariates on each transition, since effects of covariates may change depending on the current state of the patient, thus helping surgeons and patients throughout the surgical process and counselling patients if needed.

Hospitalizaciones de mujeres embarazadas en España entre 1997 y 2007

OBJECTIVEnTo study the non-delivery pregnancy associated hospitalizations in Spain during the period 1997-2007.nnnMETHODSnA descriptive epidemiological study was performed using data from the National Epidemiological Surveillance System for hospital data (Minimum Basic Data Set [MBDS]). Records of all pregnant women admitted to hospital with a pregnancy associated complication (excluding delivery) as a principal admitting diagnosis were studied.nnnRESULTSnThere were a total of 4,506,449 deliveries reported in Spain during the study period (1997-2007), with a hospitalization rate of 11.86% deliveries (95% CI, 11.83%-11.89%). The principal admitting diagnoses were abortions (10%), abnormal products of conception and non-viable pregnancies (1.5%). The mortality rate was 2.35 per 100,000 deliveries (95% CI, 1.9%-2.8%) and the case-fatality rate was 0.02% (95% CI, 0.016%-0.024%). Adolescents and women over 45 years had higher hospitalization and mortality rates.nnnCONCLUSIONSnThe main causes for hospitalization in pregnant women in Spain were abortions, abnormal products of conception and non-viable pregnancies. Hospitalization and mortality rates were higher in adolescents and women over 45 years, and did not vary during the study period.

Hospitalizaciones relacionadas con infección gonocócica en la Comunidad de Madrid: 1997–2006

OBJECTIVEnGonorrhoea is one of the most frequent sexually transmitted diseases in the world. It is a serious problem due to its morbidity, complications and associated sequelae. This study aims to estimate the frequency of hospitalisations due to gonococcal infection in Madrid between 1997 and 2006.nnnMETHODnA retrospective epidemiological study was performed using data from the National Epidemiological Surveillance System for hospital data (Minimum Basic Data Set, [MBDS]). All hospitalisations related to gonococcal infection in Madrid were analysed. Information on hospitalisation rates, mortality, fatality and stay were obtained and gathered by year, sex and age.nnnRESULTSnDuring this study period, 113 hospitalisations related to gonococcal infection were recorded (Spanish Version of the International Classification of Diseases, 9th Revision, Clinical Modification: ICD-9-CM codes 098.0 and 098.89, any diagnostic position) representing a hospitalisation rate of 0.21 per 100,000, mortality rate of 0.02 per 100,000 people and case-fatality rate of 9.73%. An increased rate of hospitalisation in children up to 4 years and adults older than 65 years was observed.nnnCONCLUSIONnThe hospitalisation rate in patients with gonococcal infection has decreased in recent years, but it is important to continue with existing public health and control policies and create new ones to reduce these figures.

Epidemiología de las hospitalizaciones causadas por rubéola en la población general en España (1997-2006)

Background. Rubella is benign in children, but in pregnant women it can produce Congenital Rubella Syndrome (CRS) with severe consequences for the foetus. In spite of vaccination coverage in Spain being above 95%, isolated cases and outbreaks continue to occur. The aim of this study is to estimate the incidence of hospitalisations due to rubella in Spain (1997-2006). n nMethods. Utilising the basic minimum dataset (National System of Epidemiological Surveillance) we calculated: rate of hospitalisation, average stay and cost. n nResults. There were 267 hospitalisations, amongst them 144 due to rubella during pregnancy, 1 due to CRS and 8 due to encephalomyelitis. The overall rate of hospitalisation was 0.065 per 105 inhabitants (IC95%=0.0649-0.0654). The average stay was 3 days. The average cost of a hospitalisation was 2,082 €, and if complicated by encephalomyelitis it rose to 8.191 €. n nConclusion. There continue to be hospitalisations due to rubella, basically due to problems in gestation and to complications in the existing susceptible population group.

Discapacidad atribuible al exceso de peso en España

BACKGROUND AND OBJECTIVEnTo estimate the disability attributable to higher than optimal body mass index in the Spanish population in 2006.nnnPOPULATION AND METHODnExcess body weight prevalence data were obtained from the 2006 National Health Survey (NHS), while the prevalence of associated morbidities was extracted from the 2006 NHS and from a national hospital data base. Population attributable fractions were applied and disability attributable was expressed as years life with disability (YLD).nnnRESULTSnIn 2006, in the Spanish population aged 35-79 years, 791.650 YLD were lost due to higher than optimal body mass index (46.7% in males and 53.3% in females). Overweight (body mass index 25-29.9) accounted for 45.7% of total YLD. Males YLD were higher than females under 60. The 35-39 quinquennial group showed a difference for males of 16.6% while in the 74-79 group the difference was 23.8% for women. Osteoarthritis and chronic back pain accounted for 60% of YLD while hypertensive disease and type 2 diabetes mellitus were responsible of 37%.nnnCONCLUSIONSnExcess body weight is a health risk related to the development of various diseases with an important associated disability burden and social and economical cost. YLD analysis is a useful monitor tool for disease control interventions.