Identifying the impact of the business cycle on drug-related harms in European countries.

BACKGROUND: The evidence resulting from the analysis of the association between economic fluctuations and their impact on the substance use is mixed and inconclusive. Effects can be pro-cyclical (drug-related harms are predicted to rise when economic conditions improve), counter-cyclical (drug-related harms are predicted to rise in bad economic times) or unrelated to business cycle conditions as different transmission mechanisms could operate simultaneously. METHODS: The main aim of this study is to assess, from a macroeconomic perspective, the impact of economic cycles on illegal drug-related harms in European countries over the 2000-2020 period. To this end, the regime-dependent relationship between drug-related harm, proxied by unemployment, and the business cycle, proxied by overdose deaths will be identified. Applying a time dynamic linear analysis, within the framework of threshold panel data models, structural-breaks will also be tested. RESULTS: The relationship between economic cycles (proxied by unemployment) and drug-related harms (proxied by overdose deaths) is negative, and therefore found to be pro-cyclical. One percentage point in the country unemployment rate is predicted to reduce the overdose death rate by a statistically significant percentage of 2.42. A counter-cyclical component was identified during the 2008 economic recession. The threshold model captures two effects: when unemployment rates are lower than the estimated thresholds, ranging from 3.92% to 4.12%, drug-related harms and unemployment have a pro-cyclical relationship. However, when unemployment rates are higher than this threshold, this relationship becomes counter-cyclical. CONCLUSIONS: The relationship between economic cycles and drug-related harms is pro-cyclical. However, in situations of economic downturns, a counter-cyclical effect is detected, as identified during the 2008 economic recession.

Evidence of the adverse effects of air pollution on the population's health in Spain: analysis of the economic costs of premature deaths.

Exposure to ambient air pollution increases mortality and morbidity, leading disabilities, and premature deaths. Air pollution has been identified as a leading cause of global disease burden, especially in low- and middle-income countries in 2015 (Global Burden of Diseases, Injuries and Risk Factors Study, 2015). This study explores the relation between mortality rates and particulate matter (PM) concentrations in the 50 Spanish regions for the period 2002-2017. Moreover, we estimated the premature deaths due to PM in Spain according to welfare and production losses in 2017. Random-effects models were developed to evaluate the relation between mortality rates and PM concentrations. The economic cost of premature deaths was assessed using the Willingness to Pay approach to quantify welfare losses and the Human Capital method to estimate production losses. PM10 concentrations are positively related to mortality due to respiratory diseases and stroke. Based on 10,342 premature deaths in 2017, losses in welfare amount to EUR 36,227 million (3.1% of Spanish GDP). The economic value of current and future production losses reached EUR 229 million (0.02% of GDP). From a social perspective, air pollution is a public health concern that greatly impacts health and quality of life. Results highlight the need to implement or strengthen regulatory, fiscal, and health public policies to substantially benefit the population's health by reducing their exposure to air pollution.

Evidence of the adverse effects of air pollution on the population's health in Spain: analysis of the economic costs of premature deaths / Evidencias sobre los efectos adversos de la contaminación atmosférica en la salud de la población de España: análisis de los costes económicos de las muertes prematuras / Evidências sobre os efeitos adversos da poluição do ar sobre a saúde da população na Espanha: análise dos custos econômicos das mortes prematuras

Abstract: Exposure to ambient air pollution increases mortality and morbidity, leading disabilities, and premature deaths. Air pollution has been identified as a leading cause of global disease burden, especially in low- and middle-income countries in 2015 (Global Burden of Diseases, Injuries and Risk Factors Study, 2015). This study explores the relation between mortality rates and particulate matter (PM) concentrations in the 50 Spanish regions for the period 2002-2017. Moreover, we estimated the premature deaths due to PM in Spain according to welfare and production losses in 2017. Random-effects models were developed to evaluate the relation between mortality rates and PM concentrations. The economic cost of premature deaths was assessed using the Willingness to Pay approach to quantify welfare losses and the Human Capital method to estimate production losses. PM10 concentrations are positively related to mortality due to respiratory diseases and stroke. Based on 10,342 premature deaths in 2017, losses in welfare amount to EUR 36,227 million (3.1% of Spanish GDP). The economic value of current and future production losses reached EUR 229 million (0.02% of GDP). From a social perspective, air pollution is a public health concern that greatly impacts health and quality of life. Results highlight the need to implement or strengthen regulatory, fiscal, and health public policies to substantially benefit the population's health by reducing their exposure to air pollution.

Resumen: La exposición a la contaminación atmosférica aumenta la mortalidad y la morbilidad, lo que conduce a la discapacidad y a la muerte prematura. La contaminación del aire se identificó como una de las principales causas de la carga mundial de enfermedades, sobre todo en países de ingresos bajos y medianos en el 2015 (Global Burden of Diseases, Injuries and Risk Factors Study, 2015). Este artículo explora la relación entre las tasas de mortalidad y la concentración de material particulado (PM) en las 50 regiones españolas desde el 2002 hasta el 2017. Además, se realizó una estimación de las muertes prematuras provocadas por PM en España en términos de bienestar y pérdidas de producción en el 2017. Se desarrollaron modelos de efectos aleatorios para estudiar la relación entre las tasas de mortalidad y las concentraciones de PM. El costo económico de las muertes prematuras se evaluó usando el enfoque "disposición a pagar" para monetizar las pérdidas de bienestar y el método del capital humano para estimar las pérdidas de producción. Las concentraciones de PM10 están positivamente asociadas con la mortalidad por enfermedades respiratorias y accidente cerebrovascular. Con base en 10.342 muertes prematuras en el 2017, las pérdidas en el bienestar social ascendieron a EUR 36.227 millones (3,1% del PIB español). El valor económico de las pérdidas de producción presentes y futuras llegó a EUR 229 millones (0,02% del PIB). Desde un punto de vista social, la contaminación del aire es un problema de salud pública que tiene un gran impacto en la salud y en la calidad de vida. Los resultados ponen de manifiesto la necesidad de implementar o de fortalecer políticas públicas regulatorias, fiscales y de salud para obtener beneficios sustanciales para la salud con la reducción de la exposición.

Resumo: A exposição à poluição do ar ambiente aumenta a mortalidade e a morbidade, levando a incapacidades e mortes prematuras. A poluição do ar foi identificada como uma das principais causas da carga global de doenças, principalmente em países de baixa e média renda em 2015 (Global Burden of Diseases, Injuries and Risk Factors Study, 2015). Este artigo explora a relação entre as taxas de mortalidade e a concentração de material particulado (PM) nas 50 regiões espanholas de 2002 a 2017. Além disso, foi realizada uma estimativa das mortes prematuras causadas por PM na Espanha em termos de bem-estar e perdas de produção em 2017. Modelos de efeitos aleatórios foram desenvolvidos para estudar a relação entre as taxas de mortalidade e as concentrações de PMP. O custo econômico das mortes prematuras foi avaliado usando a abordagem "disposição a pagar" para monetizar as perdas de bem-estar e o método do capital humano para estimar as perdas de produção. As concentrações de PM10 estão positivamente associadas à mortalidade por doenças respiratórias e acidente vascular cerebral. Com base em 10.342 mortes prematuras em 2017, as perdas no bem-estar social subiram para EUR 36,227 bilhões (3,1% do PIB espanhol). O valor econômico das perdas de produção presentes e futuras atingiu os EUR 229 milhões (0,02% do PIB). Do ponto de vista social, a poluição do ar é um problema de saúde pública que tem grande impacto na saúde e na qualidade de vida. Os resultados evidenciam a necessidade de implementar ou fortalecer políticas públicas regulatórias, fiscais e de saúde para obter benefícios substanciais à saúde com a redução da exposição.

Early-life disease environment and adult height in historical populations.

Nutrition and the incidence of diseases during early life are considered environmental factors that determine people's height when they become adults. While there is extensive literature focusing on the relationship between physical growth, general mortality and infant mortality rates, few studies analyse the impact of certain disease groups on the final height of historical populations. Using regional mortality rates by causes of death, the main objective of this study is to determine the onset of the disease environment during early life for populations born in Spain between 1916 and 1930, and its relationship with the stature reached at 21 years of age. A population-averaged model is performed on epidemic-infectious, gastrointestinal, and congenital diseases during the gestation period and first year of life. The disease burden in early life had a statistically significant negative effect on adult stature. These results support the premise that an improvement in the disease environment could lead to a greater number of short children surviving and therefore a decrease in the average height.

Measuring health-related quality of life in patients treated for substance dependence: differences among instruments and methods of eliciting preferences.

BACKGROUND: Measuring the health-related quality of life is an essential estimation in cost-utility studies. In this research, we provide new evidence about comparing utility scores - in the field of substance dependence. Although the main objective is to compare the EQ-5D-5L and SF-6D with paired gamble, evidence about the SF-6D with standard gamble is also provided. METHODS: Ninety-four patients with substance dependence were recruited; the SF-6D and the EQ-5D-5L were administered at the beginning of treatment and 6 months thereafter. Differences in treatment effect were estimated by comparing utility gains. All analyses were reproduced for two subgroups of severity. RESULTS: Both the baseline scores and the treatment effect are sensitive to the instrument used. For severe states, the SF-6D with paired gamble (SF-6D with standard gamble) estimates the lowest (highest) utility. With regard to the impact of treatment, the EQ-5D-5L and SF-6D with paired gamble estimate strongly similar effects for severe states (and both estimate greater effects than does the SF-6D with standard gamble). CONCLUSIONS: These findings have implications for cost-utility analyses. The incremental cost-utility ratio of treatments intended for severe states is barely sensitive to the choice of EQ-5D-5L or SF-6D with paired gamble.

Measuring intangible cost-of-morbidity due to substance dependence: implications of using alternative preference-based instruments.

OBJECTIVE: Drug and/or alcohol dependence (DAD) generates substantial costs to society. One of the main consequences of DAD is its negative impact on health-related quality of life (HRQoL). The main objective of this study is to analyse the impact of using EQ-5D-5L, SF-6DSG (SF-6D using standard-gamble as the preference-eliciting method) and SF-6DPG (SF-6D using a paired-gamble method), to estimate the HRQoL burden, attributable to DAD, within the cost-of-illness framework. METHODS: A convenience sample of 109 patients with a diagnosis of substance use disorder was recruited. SF-6D and EQ-5D-5L were administered and then the utility scores were computed. The impact of employing different instruments to estimate the HRQoL burden was assessed by comparing the utility scores of patients and general population after controlling for sex and age through regression analysis. The analysis was reproduced for two subgroups of severity. RESULTS: All instruments detect that DAD significantly affects the HRQoL. However, the estimated impact changes, according to the instrument used, whose pattern varies by severity group. Nonetheless, regardless of severity, SF-6DPG always estimates a higher or equal DAD burden than the other instruments considered. These results are compatible with the presence of the floor effect in SF-6DSG, the ceiling effect in EQ-ED-5L, and a smaller presence of both biases in SF-6DPG. CONCLUSIONS: The SF-6DPG instrument emerges as a good candidate to avoid under-estimating intangible costs within the cost-of-illness framework. However, further research is needed to assess the validity of our results in the context of other health problems.

Socioeconomic status, health inequalities and non-communicable diseases: a systematic review.

AIM: A comprehensive approach to health highlights its close relationship with the social and economic conditions, physical environment and individual lifestyles. However, this relationship is not exempt from methodological problems that may bias the establishment of direct effects between the variables studied. Thus, further research is necessary to investigate the role of socioeconomic variables, their composition and distribution according to health status, particularly on non-communicable diseases. SUBJECTS AND METHODS: To shed light on this field, here a systematic review is performed using PubMed, the Cochrane Library and Web of Science. A 7-year retrospective horizon was considered until 21 July 2017. RESULTS: Twenty-six papers were obtained from the database search. Additionally, results from "hand searching" were also included, where a wider horizon was considered. Five of the 26 studies analyzed used aggregated data compared to 21 using individual data. Eleven considered income as a study variable, while 17 analyzed the effect of income inequality on health status (2 of the studies considered both the absolute level and distribution of income). The most used indicator of inequality in the literature was the Gini index. CONCLUSION: Although different types of analysis produce very different results concerning the role of health determinants, the general conclusion is that income distribution is related to health where it represents a measure of the differences in social class in the society. The effect of income inequality is to increase the gap between social classes or to widen differences in status.

The social cost of illicit drugs use in Spain.

BACKGROUND: Illegal drugs consumption not only has a notable impact on the population's health, but also leads to major socio-economic costs. A significant characteristic of drug consumers is that the majority are of working age. The main aim of this study is to estimate the economic impact of drug consumption in Spain from a social perspective. METHODS: A cost-of-illness methodology is carried out and a distinction is made between health-related and non-health related direct costs, as well as indirect costs. Among the direct health care costs included are hospitalisations, primary and emergency care, support programmes and HIV outpatient care. Expenditure on prevention, law enforcement and research was included as direct costs falling outside of health care. Productivity losses due to premature deaths attributed to substance abuse and patient hospitalisation formed part of indirect costs. RESULTS: For 2012, the total social cost related to drug consumption in Spain was somewhere between 1,436 and 1,651 million euros. The minimum cost of this consumption represented 0.14% of Spain's GDP for that year. CONCLUSION: The present cost estimations provide a measure of the social burden that illegal drug consumption represents for the community. When it comes to allocating resources, the obtained results quantify the potential economic returns that could be achieved from effective policies and programmes aimed at reducing the consumption of illegal drugs.

Crisis, suicide and labour productivity losses in Spain.

OBJECTIVES: Suicide became the first cause of death between the ages of 15 and 44 in Spain in the year 2013. Moreover, the suicide rate in Spain went up by more than 9 % with respect to the previous year. This increase could be related to the serious economic recession that Spain has been experiencing in recent years. In this sense, there is a lack of evidence to help assess to what extent these suicides have a social cost in terms of losses in human capital. Firstly, this article examines the relationship between the variables related to the economic cycle and the suicide rates in the 17 Spanish regions. Secondly, an estimate is made of the losses in labour productivity owing to these suicides. METHODOLOGY: In this article, panel data models are used to consider different variables related to the economic cycle. Demographic variables and the suicide rates for regions across Spain from 2002 to 2013 also come into play. The present and future production costs owing to premature death from suicide are calculated using a human capital model. These costs are valued from the gross salary that an individual no longer receives in the future at the very moment he or she leaves the labour market. RESULTS: The results provide a strong indication that a decrease in economic growth and an increase in unemployment negatively affect suicide rates. Due to suicide, 38,038 potential years of working life were lost in 2013. This has an estimated cost of over 565 million euros. CONCLUSIONS: The economic crisis endured by Spain in recent years has played a role in the higher suicide rates one can observe from the data in official statistics. From a social perspective, suicide is a public health problem with far-reaching consequences.

The Healthy Immigrant Effect on Mental Health: Determinants and Implications for Mental Health Policy in Spain.

Since the mid-1990s, Spain has started to receive a great number of migrant populations. The migration process can have a significantly negative impact on mental health of immigrant population and, consequently, generate implications for the delivery of mental health services. The aim of this article is to provide empirical evidence to demonstrate that the mental health of immigrants in Spain deteriorates the longer they are resident in the country. An empirical approach to this relationship is carried out with data from the National Survey of Health of Spain 2011-2012 and poisson and negative binomial models. Results show that immigrants who reside <10 years in Spain appear to be in a better state of mental health than that observed for the national population. Studying health disparities in the foreign population and its evolution are relevant to ensure the population's access to health services and care. The need for further research is especially true in the case of the immigrant population's mental health in Spain because there is scant evidence available on their situation.

[Labor productivity losses attributable to premature deaths due to traffic injuries between 2002 and 2012]. / Pérdidas laborales atribuibles a la mortalidad prematura por lesiones de tránsito entre 2002 y 2012.

OBJECTIVE: To estimate the years of potential life lost, years of potential productive life lost and the labor productivity losses attributable to premature deaths due to traffic injuries between 2002 and 2012 in Spain. METHOD: Several statistical sources were combined (Spanish Registry of Deaths, Labor Force Survey and Wage Structure Survey) to develop a simulation model based on the human capital approach. This model allowed us to estimate the loss of labor productivity caused by premature deaths following traffic injuries from 2002 to 2012. In addition, mortality tables with life expectancy estimates were used to compute years of potential life lost and years of potential productive life lost. RESULTS: The estimated loss of labour productivity caused by fatal traffic injuries between 2002 and 2012 in Spain amounted to 9,521 million euros (baseline year 2012). The aggregate number of years of potential life lost in the period amounted to 1,433,103, whereas the years of potential productive life lost amounted to 875,729. Throughout the period analyzed, labor productivity losses and years of life lost diminished substantially. CONCLUSIONS: Labor productivity losses due to fatal traffic injuries decreased throughout the period analyzed. Nevertheless, the cumulative loss was alarmingly high. Estimation of the economic impact of health problems can complement conventional indicators of distinct dimensions and be used to support public policy making.

Hemorragia digestiva alta no varicosa: comportamiento e índice de Rockall / Behavior and Rockall risk scoring in the non-variceal upper gastrointestinal bleeding

Introducción: la hemorragia digestiva alta no varicosa es actualmente una emergencia quirúrgica de difícil manejo, hecho que motivó el conocer su comportamiento y, usando el índice de Rockall, el riesgo de los afectados de sufrir resultados adversos durante su evolución, aquellos de posible alta precoz y las causas que la impiden. Métodos: estudio descriptivo de corte transversal realizado en el Hospital General Docente Ernesto Guevara de la Serna con 182 pacientes atendidos entre 2009 y 2010. Resultados: los hombres fueron los más afectados (54,4 por ciento) y el grupo de 60-80 años tuvo el mayor número de casos. La úlcera gastroduodenal fue la primera causa (52,7 por ciento). La melena se presentó como manifestación inicial en el 60,4 por ciento de los pacientes. La hipertensión arterial fue la comorbilidad más frecuente (60,7 por ciento). El 44,5 por ciento de los pacientes necesitó transfusión sanguínea. La mortalidad fue del 8,2 por ciento. La mayor parte de la muestra se ubicó en el grupo de riesgo intermedio de Rockall (40,1 por ciento). Recibió alta precoz solo el 11,5 por cientode los pacientes, y la inestabilidad hemodinámica (38 por ciento) fue la mayor responsable de este bajo número. El Rockall tuvo sensibilidad del 98,3 por ciento, especificidad del 56,9 por ciento, valor predictivo positivo del 52,3 por ciento, valor predictivo negativo del 98,6 por ciento y una exactitud del 70,9 por ciento. En los pacientes clasificados de bajo riesgo la única complicación fue la recidiva (1,4 por ciento). Conclusiones: el alta precoz puede ser dada a pacientes con Rockall bajo, siempre que se preste especial atención a la estabilidad hemodinámica.

Introduction: Non-variceal upper gastrointestinal bleeding is a current surgical emergency of difficult management. This fact prompted the authors to find out its behavior and to use Rockall risk scoring system to determine the risk of suffering adverse effects during the recovery period, those patients that may be early discharged and the causes that prevent it. Methods: Cross-sectional descriptive study conducted in 182 patients from Ernesto Guevara de la Serna general teaching hospital, who were seen in the period of 2009 through 2010. Results: Males were the most affected (54.4 per cent) and the 60-80 years age group registered the highest number of cases. Gastroduodenal ulcer was the first cause (52.7 por ciento). The initial manifestation was tarry stools in 64 per cent of cases. Blood hypertension was the most frequent comorbidity (60.7per cent). In the study group, 44.5per cent of patients needed blood transfusion. The mortality rate was 8.2 per cent. Most of patients were classified as intermediate risk cases according to Rockall system (40.1 per cent). Just 11.5 per cent of patients were early discharged since the hemodynamic instability (38 per cent) was the main responsible for this low number. Rockall risk scoring system showed 98.3per cent sensitivity, 56.9per cent specificity, 52.3 per cent positive predictive value, 98.6per cent negative predictive value and 70.9 per cent accuracy. The only complication in low risk patients were relapse (1.4 per cent). Conclusions: Early discharge from hospital occurs in low Rockall risk score patients provided that special attention is paid to hemodynamic stability.

[Health status and health services' utilization among immigrant children]. / Estado de salud y frecuentación de los servicios sanitarios de los menores hijos de inmigrantes.

OBJECTIVE: To provide empirical evidence to assess whether having immigrant parents is a source of variation in health status and in health services' utilization among children. METHOD: The analysis was based on the sample of children from the Catalan Health Survey, 2006. Modelling of health status and use of health services was developed from the specification of distinct probabilistic models. RESULTS: The results indicate that the children of immigrants had a significantly fewer chronic diseases, while perceived health status, according to the self-evaluation of the parents or responsible person, was worse if both parents belonged to this group. Significant differences were found in the utilization of distinct health services. CONCLUSIONS: The analyses developed suggest that parental origin leads to differences in the utilization of the various levels of the Spanish health system. While no widespread pattern of increased or decreased utilization of the whole system was identified, differences were found in the number of specialist visits and admissions. Statements of the child's perceived health status were influenced by immigrant families' socioeconomic conditions, which probably affected outcomes.