Valentín Hernández Barrera

Trends of adverse drug reactions related-hospitalizations in Spain (2001-2006)

BackgroundAdverse drug reactions (ADR) are a substantial cause of hospital admissions. We conducted a nationwide study to estimate the burden of hospital admissions for ADRs in Spain during a six-year period (2001-2006) along with the associated total health cost.MethodsData were obtained from the national surveillance system for hospital data (Minimum Basic Data Set) maintained by the Ministry of Health and Consumer Affairs, and covering more than 95% of Spanish hospitals. From these admissions we selected all hospitalization that were code as drug-related (ICD-9-CM codes E), but intended forms of overdoses, errors in administration and therapeutics failure were excluded. The average number of hospitalizations per year, annual incidence of hospital admissions, average length of stay in the hospital, and case-fatality rate, were calculated.ResultsDuring the 2001-2006 periods, the total number of hospitalized patients with ADR diagnosis was 350,835 subjects, 1.69% of all acute hospital admissions in Spain. The estimated incidence of admissions due to ADR decreased during the period 2001-2006 (p < 0.05). More than five percent of patients (n = 19,734) died during an ADR-related hospitalization. The drugs most commonly associated with ADR-related hospitalization were antineoplastic and immunosuppressive drugs (n = 75,760), adrenal cortical steroids (n = 47,539), anticoagulants (n = 26,546) and antibiotics (n = 22,144). The costs generated by patients in our study increased by 19.05% between 2001 and 2006.ConclusionsApproximately 1.69% of all acute hospital admissions were associated with ADRs. The rates were much higher for elderly patients. The total cost of ADR-related hospitalization to the Spanish health system is high and has increased between 2001 and 2006. ADRs are an important cause of admission, resulting in considerable use of national health system beds and a significant number of deaths.

Significant differences in the use of healthcare resources of native-born and foreign born in Spain

BackgroundIn the last decade, the number of foreign residents in Spain has doubled and it has become one of the countries in the European Union with the highest number of immigrants There is no doubt that the health of the immigrant population has become a relevant subject from the point of view of public healthcare. Our study aimed at describing the potential inequalities in the use of healthcare resources and in the lifestyles of the resident immigrant population of Spain.MethodsCross-sectional, epidemiological study from the Spanish National Health Survey (NHS) in 2006, from the Ministry of Health and Consumer Affairs. We have worked with individualized secondary data, collected in the Spanish National Health Survey carried out in 2006 and 2007 (SNHS-06), from the Ministry of Health and Consumer Affairs. The format of the SNHS-06 has been adapted to the requirements of the European project for the carrying out of health surveys.ResultsThe economic immigrant population resident in Spain, present diseases that are similar to those of the indigenous population. The immigrant population shows significantly lower values in the consumption of alcohol, tobacco and physical activity (OR = 0.76; CI 95%: 0.65–0.89, they nonetheless perceive their health condition as worse than that reported by the autochthonous population (OR = 1.63, CI 95%: 1.34–1.97). The probability of the immigrant population using emergency services in the last 12 months was significantly greater than that of the autochthonous population (OR = 1.31, CI 95%: 1.12–1.54). This situation repeats itself when analyzing hospitalization data, with values of probability of being hospitalized greater among immigrants (OR = 1.39, CI 95%: 1.07–1.81).ConclusionThe economic immigrants have better parameters in relation to lifestyles, but they have a poor perception of their health. Despite the fact that immigrant population shows higher percentages of emergency attendance and hospitalization than the indigenous population, with respect to the use of healthcare resources, their usage of healthcare resources such as drugs, influenza vaccinations or visits to the dentist is lower.

Health status of Roma women in Spain.

BACKGROUND The objective of the present study is to describe the health status of Roma women in Spain. Population-based health data have become available for this group, and we can now identify differences with non-Roma women. METHODS Cross-sectional, epidemiological study from the 2006 Spanish National Health Survey and the first National Health Survey in the Romany population (2006). We analyzed 527 Spanish Roma women aged 16 years and over and 1054 Spanish non-Roma women, age and region matched. RESULTS Our sample comprised 527 Spanish Roma women and 1054 Spanish non-Roma women. Roma women are more likely to suffer from obesity [odds ratio (OR) 1.91; 95% confidence interval (CI) 1.05-3.50], depression and migraine. Roma women have significantly higher values for alcohol consumption than non-Roma women (OR, 3.77; 95% CI, 2.32-6.13). The percentage of Roma women, who have had a smear test and a mammography, is significantly lower than that of non-Roma women. CONCLUSIONS Our comparison showed that Spanish Roma women have a poorer health profile, worse lifestyles and more inequality in the use of health-care resources than non-Roma women, especially with respect to prevention.

Determinants and predictors of the cost of COPD in primary care: A Spanish perspective

Objectives 1) To estimate the annual cost of patients with stable chronic obstructive pulmonary disease (COPD) followed in primary care in Spain; 2) To analyze the possible cost predictor variables. Patients and methods A multicenter, epidemiological, observational, descriptive study. Sociodemographic data, severity of disease, associated comorbidity, treatment followed by patients, quality of life (SF-12 questionnaire), health care resource utilization in the previous 12 months and duration of working disability due to COPD were collected. Results A total of 10,711 patients (75.6% men; 24.4% women) with a mean age of 67.1 ± 9.66 years were evaluated. The mean forced expiratory volume in one second (FEV1) value was 57.4 ± 13.4%. The total cost per patient per year was €1,922.60 ± 2,306.44. The largest component of this cost was hospitalization (€788.72 ± 1,766.65), followed by cost of drugs (€492.87 ± 412.15) and visits to emergency rooms (€134.32 ± 195.44). Linear regression analysis found associated heart disease, FEV1, physical component of quality of life, number of medical visits (primary care physician, pneumologist and emergency room), hospital admissions (frequency and duration of stay) and duration of working disability to be significant predictors of the total annual cost. Conclusions The total annual cost of a COPD patient followed in primary care in Spain was considered high in this study. The presence of associated heart disease, severity of airflow obstruction, physical component of quality of life, health care resource utilization and duration of work disability were found to be predictor of cost.

Psychiatric Comorbidity in Asthma Patients. Associated Factors

Objective. To study the prevalence of anxiety and depression in patients with asthma and to identify associated factors. Material and methods. The study was based on individual data of subjects aged ≥18 years drawn from the 2006 Spanish National Health Survey. We identified asthmatic individuals through a specific questionnaire. Presence of depression or anxiety was assessed using the following questions: (1) “Have you suffered depression or anxiety over the previous 12 months?” (2) “Has your medical doctor confirmed the diagnosis?” (3) “Have you consumed antidepressants prescribed by your physician over the last 2 weeks?” (4) “Have you consumed anxiolytics prescribed by your physician over the last 2 weeks?” Those who answered yes to questions 1, 2, and 3 or to all questions were considered “Depression sufferers,” those who answered yes to questions 1, 2, and 4 were considered “Anxiety sufferers.” We analyzed sociodemographic characteristics and health-related variables. Results. Of the 28,966 subjects included in the study, 1650 were classified as asthmatic (5.6%). The prevalence of anxiety was 9.7% among people with asthma and 6.6% among those without the disease (p < .01). After multivariate adjustment the probability of a subject suffering anxiety was 1.27 (95% CI 1.08–1.49) higher among those with asthma than among those without. Independent and significantly associated variables with anxiety among asthmatic patients were older age, concomitant comorbidities, and visits to general practitioner in the last 4 weeks. The prevalence of depression was 9% among asthmatics and 5.5% among those without the disease (p < .05). The multivariate adjustment revealed that suffering depression was associated with suffering asthma (adjusted OR 1.39, 95% CI 1.18–1.64). Variables associated with depression among asthmatic patients were female sex, older age, worse self-related health, concomitant comorbidities, abstemious individuals, and the need for attendance on emergency room in the last year. Conclusions. Suffering anxiety or depression is associated with suffering asthma. Associated variables with anxiety or depression among asthmatic patients include older age and concomitant comorbidities.

Medication consumption in the Spanish paediatric population: related factors and time trend, 1993-2003

AIMS To ascertain the prevalence of consumption of medications in the Spanish paediatric population and to identify the factors associated with such consumption. METHODS This was a descriptive, cross-sectional study covering the Spanish adult population, using data drawn from the 1993 and 2003 Spanish National Health Surveys (SNHS). The 1993 and 2003 SNHS include data on 5280 and 6463 children, respectively, age range 0-15 years. The independent variables were sociodemographic and health-related, and the dependent variable was medications use. Using logistic multivariate regression models, we analysed the temporal evolution of medication consumption between 1993 and 2003. RESULTS The 1993 SNHS data revealed that 36.81% of the paediatric population had consumed some type of medication, whereas in 2003 this figure had dropped to 34%. Over the decade of study, there was a significant decrease in use of medications for catarrh, influenza, throat (P < 0.05), and an increase in consumption of pain-relieving drugs and/or fever-lowering, antibiotics and anti-allergy remedies. Multivariate analysis highlighted the association between medication consumption, negative perception of the childs health [odds ratio (OR) 2.84, 95% confidence interval (CI) 2.16, 3.72 in 1993, and OR 3.54, 95% CI 2.74, 4.56 in 2003] and medical visits to the physician across the 2 years (OR 12.09, 95% CI 10.13, 14.42 in 1993, and OR 7.17, 95% CI 6.06, 8.47 in 2003). CONCLUSIONS Although there was a significant decline in overall drug consumption in the Spanish paediatric population from 1993 to 2003, the prevalence of consumption of certain groups, such as analgesics, antipyretics and antibiotics, has risen.

Evolución de las coberturas vacunales antigripales entre 1993-2001 en España: Análisis por Comunidades Autónomas

Fundamento: La gripe es una enfermedad con una elevada morbilidad y que ocasiona un alto coste sanitario, para la que ademas se dispone de una vacuna eficaz. El objetivo de este trabajo es evaluar la evolucion de las coberturas vacunales antigripales en Espana por Comunidades Autonomas entre 1993 y 2001. Metodos: Se han analizado un total de 42.123 registros de la Encuesta Nacional de Salud (ENS) de los anos 1993 (n=21.051) y 2001(n=21.072). Todos ellos corresponden a adultos espanoles mayores de 15 anos no institucionalizados. Ambas encuestas son representativas a nivel de Comunidad Autonoma. Resultados: Para el total de la muestra se estima una cobertura vacunal en 1993 de 17,94% (IC 95% 17,42-18,46) y de 19,30% (18,77-19,83) en 2001. En el modelo de regresion logistica, ajustado por edad, genero y enfermedad cronica asociada, se observan mejoras significativas en las coberturas del grupo de mayores de 64 anos (OR= 1,28 IC 95% 1,10-1,50) para el total de Espana y para cinco de las 17 Comunidades Autonomas entre 1993 y 2001. Sin embargo, no encontramos cambios significativos en las coberturas para el grupo de menores de 65 anos con enfermedad cronica asociada que supone una indicacion para la vacunacion. Conclusiones: Tanto en Espana como en la mayoria de las Comunidades Autonomas entre 1993 y 2001 se observa una ligera pero insuficiente mejoria en las coberturas de vacunacion en los grupos de riesgo estudiados. Las Comunidades Autonomas muestran coberturas dispares entre si. Los sujetos menores de 65 anos con enfermedades cronicas asociadas que incrementan el riesgo de sufrir las complicaciones de la gripe no han mejorado las coberturas de esta vacuna durante el periodo de estudio. La dificultad para mejorar las coberturas en este tipo de pacientes podria hacernos considerar la opcion y el beneficio potencial de rebajar la edad limite de las actuales recomendaciones de indicacion de vacuna antigripal en Espana.

Epidemiology of hospital-treated Salmonella infection; data from a national cohort over a ten-year period.

OBJECTIVE The aim of this study was to describe the clinical and economic burden of hospital admissions related to Salmonella infections amongst the population of Spain over the course of 10 years (1997-2006). METHODS Data provided by the National Epidemiology Surveillance System for Hospital Data (Conjunto Mínimo Básico de Datos; CMBD) were analysed. This database included information about Salmonella infection-related hospital incidence rates, patient demographics, length of stay, mortality, case-fatality rates and associated costs. RESULTS During the period 1997-2006, 65,100 infections due to Salmonella were recorded, indicating an annual incidence rate of 16.18 cases/100,000 people/year (95% confidence interval [CI] 16.05-16.30). The average length of hospital stay for patients with Salmonella infection was of 7.6 days (SD 8.9), and the average patient age was 31 years old (SD 29). The mortality rate was 0.23/100,000 people (95% CI 0.22-0.24 per 100,000 people), and the case-fatality rate was 1.40% (95% CI 1.33-1.51%). The incidence rate was significantly higher in those <14 and >65 years old (maximum of 89.12 cases/100,000 people <4 years old; 95% CI 87.80-90.45 cases/100,000). The mortality and case-fatality rates increased significantly with age, reaching 2.05 deaths per 100,000 people (95% CI 1.70-2.37 cases/100,000) or 7.53% (95% CI 6.34-8.73%) in people >85 years old. The total cost of Salmonella infection was 124 million Euros during the study period, with children up to 4 years of age being the most prominent consumers of resources. CONCLUSIONS Salmonella infection remains an important cause of hospitalization of children up to 4 years old, but the main mortality and case-fatality rates are observed in persons older than 65 years.

Prevalence of anxiety and depression among chronic bronchitis patients and the associated factors

Background and objective:  Patients with COPD, including those with chronic bronchitis (CB), have a high risk of suffering from psychiatric disorders. Although depression has always received greater attention in these patients, most of the published studies have been of poor methodological quality. Anxiety has received less attention than depression among COPD patients. The aim of this study was to assess the prevalence of anxiety and depression among patients with CB and to identify associated factors.

Predictive factors of self-medicated analgesic use in Spanish adults: a cross-sectional national study

BackgroundAnalgesics are among the most commonly consumed drugs by the world populations. Within the broader context of self-medication, pain relief occupies a prominent position. Our study was to ascertain the prevalence of self-medication with analgesics among the Spanish population and to identify predictors of self-medication, including psychological disorders, psychological dysfunction, mental health status, and sociodemographic and health-related variables.MethodsWe used individualized secondary data retrieved from the 2009 European Health Interview Survey (EHIS) for Spain to conduct a nationwide, descriptive, cross-sectional pharmacoepidemiology study on self-medication with analgesics among adults (individuals aged at least 16 years) of both genders living in Spain. A total of 7,606 interviews were analysed. The dichotomous dependent variables chosen were the answers “yes” or “no” to the question In the last 2 weeks have you taken the medicines not prescribed for you by a doctor for joint pain, headache, or low back pain?” Independent variables were sociodemographic, comorbidity, and healthcare resources.ResultsA total of 7,606 individuals reported pain in any of the locations (23.7%). In addition, analgesic consumption was self-prescribed in 23.7% (1,481) of these subjects. Forty percent (40.1%) of patients self-medicated for headache, 15.1% for low back pain, and 6.7% for joint pain. The variables significantly associated with a greater likelihood of self-medication of analgesics, independently of pain location were: age 16–39 years (2.36 < AOR < 3.68), higher educational level (1.80 < AOR <2.21), psychological disorders (1.56 < AOR < 1.98), and excellent/good perception of health status (1.74 < AOR < 2.68). In subjects suffering headache, self-prescription was associated with male gender (AOR 2.13) and absence of other comorbid condition (AOR 4.65).ConclusionsThis pharmacoepidemiology study constitutes an adequate approach to analgesic self-medication use in the Spanish population, based on a representative nationwide sample. Self-prescribed analgesic consumption was higher in young people with higher educational level, higher income, smoker, and with psychological disorders and with a good perception of their health status independently of the location of pain.