Síntomas gastrointestinales, disfunción respiratoria, hepática y renal, principales factores asociados a letalidad por rickettsiosis trasmitida por garrapatas en Mexicali, Baja California, México / Gastrointestinal symptoms, respiratory, hepatic and renal dysfunction, main factors associated with lethality due to tickborne rickettsiosis in Mexicali, Baja California, Mexico

INTRODUCCIÓN: La rickettsiosis, enfermedad potencialmente mortal, es trasmitida por vectores como Rhipicephalus sanguineus, Dermacentor variabilis y D. andersonii, reservorios de Rickettsia rickettsii. En Baja California, México, es endémica, multifactorial, tiene alta letalidad, sus manifestaciones clínicas inespecíficas y ataque multisistémico dificultan el diagnóstico y tratamiento oportuno. OBJETIVO: Identificar los factores de riesgo asociados a la letalidad por rickettsiosis trasmitida por garrapatas en Mexicali, Baja California. PACIENTES Y MÉTODOS : Estudio observacional, analítico, transversal, retrospectivo, de 40 registros de pacientes con diagnóstico confirmado de rickettsiosis, periodo 2014 a 2018. Variables analizadas: sociodemográficas, clínicas, laboratorio clínico, evolución y desenlace. Se reportan frecuencias y medidas de asociación. RESULTADOS: 24 defunciones y 16 vivos. Más de 90% tuvo contacto conocido con garrapatas. Afectó en su mayoría a < 45 años en ambos grupos. La evolución antes del ingreso fue similar y la estancia hospitalaria fue mayor en los pacientes vivos (3,2 ± 4.7 vs 10,62 ± 7,6 p = 0,0002). Fiebre, cefalea, mialgias fueron predominantes. Datos asociados con letalidad: disfunción respiratoria (OR 38,33 IC95% 4,06-361,3 p < 0,0001), creatinina elevada (OR 15,4 IC95% 3,08-76,77 p < 0,0003), retardo del llenado capilar (OR 13,0 IC95% 2,73-61,78 p = 0,0005), dolor abdominal (OR 8,33, IC95% 1,90-36,44 p = 0,0029), AST (OR 7,5, IC95% 1,69-33,27 p = 0,005). CONCLUSIÓN: Esta enfermedad requiere de identificación temprana de factores que se asocian con letalidad para un tratamiento oportuno y adecuado.

BACKGROUND: Rickettsiosis, a potentially fatal disease, is transmitted by vectors such as Rhipicephalus sanguineus, Dermacentor variabilis and D. andersonii, reservoirs of Rickettsia rickettsii. In Baja California, Mexico, it is endemic, multifactorial, has high lethality, its nonspecific clinical manifestations and multisystem attack make diagnosis and timely treatment difficult. AIM: Identify the risk factors associated with lethality due to tick-transmitted rickettsiosis in Mexicali, Baja California. METHODS: Observational, analytical, cross-sectional, retrospective study of 40 records of patients with a confirmed diagnosis of rickettsiosis, period 2014 to 2018. Analyzed variables: sociodemographic, clinical, clinical laboratory, evolution and outcome. Frequencies and association measures are reported. RESULTS: 24 patients died and 16 survived. More than 90% had reported contact with ticks. It mostly affected ≤ 45 years in both groups. The evolution before admission was similar, and the hospital stay was longer in patients who lived (3.2 ± 4.7 vs 10.62 ± 7.6 p = 0.0002). Fever, headache, and myalgia are predominant. Data associated with lethality: respiratory dysfunction (OR 38.33 95% CI 4.06-361.3 p < 0.0001), elevated creatinine (OR 15.4 95% CI 3.08-76.77 p < 0.0003), delayed capillary refill (OR 13.0, 95% CI 2.73-61.78 p = 0.0005), abdominal pain (OR 8.33, 95% CI 1.90-36.44 p = 0.0029), AST (OR 7.5, 95% CI 1.69-33.27 p = 0.005). CONCLUSION: This disease requires early identification of factors that are associated with lethality for timely and adequate treatment.

Reduction in the incidence of invasive infections caused by encapsulated bacteria after the onset of the COVID-19 pandemic / Reducción de la incidencia de infecciones invasivas por bacterias capsuladas luego del inicio de la Pandemia por COVID-19

Abstract Interaction between severe acute respiratory coronavirus 2 (SARS-CoV-2) and IIEB remains under investigation. Objective: to compare IIEB incidence before and during COVID-19 pandemic, and assess incidence of coinfection with COVID-19 and case fatality. A cross-sectional study was performed on data from a centralized microbiology laboratory serving a network of healthcare centers comprising 713 pediatric and adult inpatient beds, expanded by 20% during the pandemic. Three periods were evaluated: (1) pre-pandemic: March 1, 2019-February 29, 2020; (2) pandemic year 1: March 1, 2020-February 28, 2021; (3) pandemic year 2: March 1, 2021-July 31, 2021. Descriptive statistical analysis was performed. 56502 samples (96% blood cultures) from 27224 patients were analyzed. Of these, 54 samples (from 54 patients) were positive for encapsulated bacteria. IIEB incidence was: 167.4, 32.6, and 50.4 per 100000 samples for periods 1, 2, and 3, respectively. Twelve IIEB episodes occurred during the pandemic period: 10 Streptococcus pneumoniae, and 2 Haemophilus influenzae, of which 7 were SARS-CoV-2/S. pneumoniae coinfections, with an incidence of 5.68 per 10000 COVID-19-related hospitalizations (0.056%). IIEB case fatality was 31%, 29%, and 60% for each period, respectively, 3/7 patients with coinfection died (43%). Case fatality for invasive pneumococcal disease (IPD) in patients without COVID-19, was 32.5%. Significant reduction in IIEB incidence was observed during the pandemic, coinciding with implementation of containment measures. The incidence of SARS-CoV-2/S. pneumoniae coinfection was low, with higher case fatality than IPD patients without COVID-19.

Resumen La interacción entre SARS-CoV-2 e infecciones invasivas por bacterias capsuladas (IIBC) continúa bajo estudio. Objetivos: comparar la incidencia de IIBC antes y durante la pandemia por COVID-19, evaluar la incidencia de coinfección con COVID-19 y la letalidad. Estudio transversal de registros de un laboratorio centralizado de Microbiología, que asiste a una red de centros asistenciales con 713 camas de internación para adultos y pediátricos, expandida 20% durante la pandemia. Tres periodos evaluados: 1) Pre-pandemia: 1-Marzo-2019 al 29-Febrero-2020; 2) Primer año de Pandemia: 1-Marzo-2020 al 28-Febrero-2021; 3) Pandemia 2021: 1-Marzo-2021 al 31-Julio-2021. Análisis estadístico descriptivo: Se analizaron 56.502 muestras (96% hemocultivos) correspondientes a 27.224 pacientes. De estas, 54 muestras (de 54 pacientes) fueron positivas para bacterias capsuladas. La incidencia de IIBC fue 167,4, 32,6 y 50,4 por cada 100.000 muestras para los periodos 1, 2 y 3, respectivamente. Doce IIBC ocurrieron durante la pandemia: 10 Streptococcus pneumoniae y dos Haemophilus influenzae, siete de ellos corresponden a coinfección SARS-CoV-2/S. pneumoniae, con una incidencia de 5,68 por cada 10.000 internaciones por COVID 19 (0,056%). La letalidad de las IIBC fue de 31, 29 y 60% para los tres periodos, respectivamente, 3/7 coinfectados fallecieron (43%). La letalidad por enfermedad neumocócica invasiva (ENI), sin COVID fue de 32,5%. Se evidenció una reducción significativa de la incidencia de IIBC luego del comienzo de la pandemia, coincidente con la implementación de las medidas sanitarias de contención de la pandemia. La incidencia de coinfección de SARS-CoV-2/S. pneumoniae fue baja y presentó mayor letalidad que las ENI sin COVID-19.

Reduction in the incidence of invasive infections caused by encapsulated bacteria after the onset of the COVID-19 pandemic.

Interaction between severe acute respiratory coronavirus 2 (SARS-CoV-2) and IIEB remains under investigation. Objective: to compare IIEB incidence before and during COVID-19 pandemic, and assess incidence of coinfection with COVID-19 and case fatality. A cross-sectional study was performed on data from a centralized microbiology laboratory serving a network of healthcare centers comprising 713 pediatric and adult inpatient beds, expanded by 20% during the pandemic. Three periods were evaluated: (1) pre-pandemic: March 1, 2019-February 29, 2020; (2) pandemic year 1: March 1, 2020-February 28, 2021; (3) pandemic year 2: March 1, 2021-July 31, 2021. Descriptive statistical analysis was performed. 56 502 samples (96% blood cultures) from 27224 patients were analyzed. Of these, 54 samples (from 54 patients) were positive for encapsulated bacteria. IIEB incidence was: 167.4, 32.6, and 50.4 per 100000 samples for periods 1, 2, and 3, respectively. Twelve IIEB episodes occurred during the pandemic period: 10 Streptococcus pneumoniae, and 2 Haemophilus influenzae, of which 7 were SARS-CoV-2/S. pneumoniae coinfections, with an incidence of 5.68 per 10000 COVID-19-related hospitalizations (0.056%). IIEB case fatality was 31%, 29%, and 60% for each period, respectively, 3/7 patients with coinfection died (43%). Case fatality for invasive pneumococcal disease (IPD) in patients without COVID-19, was 32.5%. Significant reduction in IIEB incidence was observed during the pandemic, coinciding with implementation of containment measures. The incidence of SARS-CoV-2/S. pneumoniae coinfection was low, with higher case fatality than IPD patients without COVID-19.

[Effect of the Omicron variant on cumulative incidence of infection and lethality during the sixth wave of the COVID-19 epidemic in Spain]. / Efecto de la variante Ómicron sobre la incidencia y la letalidad durante la 6.ª onda epidémica COVID-19 en España.

The COVID-19 pandemic has strained healthcare systems globally. The successive epidemic waves have shown different characteristics. The Omicron variant of SARS-CoV-2 modified the epidemic behavior that previous variants had followed. The aim of this analysis was to determine the epidemiological characteristics of COVID-19 during the sixth epidemic wave and its differences according to the predominance of the Delta or Omicron variants. The epidemiological data corresponding to the sixth wave of the epidemic published by official organizations were analyzed, and the cumulative incidence of infection (CI-I) and case fatality rates (CFR) were calculated, both for Spain as a whole and for the different Autonomous Communities, in the population as a whole and by age groups. The results showed that the CI-I was higher with the Ómicron variant (10.89% vs 0.75% with Delta) while the CFR was higher with the Delta variant (4.2‰ vs 1.3‰ with Ómicron), as well as a higher rate of hospitalization and ICU admission with the Delta variant.

Application of GIS and spatiotemporal analyses in viral infection modelling using multiple datasets - A case study on the SARS-CoV-2 epidemic.

INTRODUCTION/OBJECTIVE: Viral and infectious diseases such as COVID-19 continue to pose a significant public health threat. In order to create an early warning system for new pandemics or emerging versions of the virus, it is imperative to study its epidemiology. In this study, we created a geospatial model to predict the weekly contagion and lethality rates of COVID-19 in Ireland. METHODS: More than forty parameters including atmospheric pollutants, metrological variables, sociodemographic factors, and lockdown phases were introduced as input variables to the model. The significant parameters in predicting the number of new cases and the death toll were identified. QGIS software was employed to process input data, and a principal component regression (PCR) model was developed using the statistical add-on XLSTAT. RESULTS AND CONCLUSIONS: The developed models were able to predict more than half of the variations in contagion and lethality rates. This indicates that the proposed model can serve to help prediction systems for the identification of future high-risk conditions. Nevertheless, there are additional parameters that could be included in future models, such as the number of deaths in care homes, the percentage of contagion and mortality among health workers, and the degree of compliance with social distancing.

COVID-19 en sujetos de riesgo participantes en ensayos clínicos durante la pandemia en Argentina / COVID-19 in subjects at risk participating in clinical trials during the pandemic in Argentina

Resumen Introducción : Existe poca información sobre la pre sencia de COVID-19 en participantes de ensayos clínicos. El objetivo del estudio fue evaluar la tasa de infección acumulada por SARS-CoV-2 en esta población. Además, investigamos el riesgo, letalidad y mortalidad por CO VID-19. Métodos : Diseño observacional retrospectivo que incluyó adultos participantes en ensayos clínicos de intervención aprobados por nuestro comité de ética du rante los dos primeros años de la pandemia (31/3/2020 a 31/3/2022). Se excluyeron protocolos pediátricos, obser vacionales, de corta duración y con sujetos internados. Resultados : Se incluyeron 513 sujetos adultos que participaron en ensayos clínicos durante ese período de la pandemia por COVID-19. Los pacientes con CO VID-19 se caracterizaron por tener una edad de 59.7 ± 13.7 años (50% sexo femenino) y el 92% presentó riesgo incrementado de letalidad por COVID-19. La tasa acu mulada de COVID-19 fue de 9.74% (IC 95%: 7.32-12.64%) que se situó por debajo del 17% de la población de 60 a 69 años de la Argentina (p<0.0001). La tasa de letalidad por COVID-19 fue de 14% (IC 95%: 5.8-26.7), que se situó por encima del 2.45% de la población de 50 a 69 años de la Argentina (p<0.0001). Conclusión : La tasa de COVID-19 en los sujetos adultos participantes de ensayos clínicos estuvo por debajo de las cifras de la población argentina de simi lar edad. La tasa de letalidad estuvo por encima de las cifras poblacionales y se explica por el alto riesgo de esa población.

Abstract Introduction : There is little information on the pres ence of COVID-19 in clinical trial participants. The objec tive of the study was to evaluate the cumulative infec tion rate for SARS-CoV-2 in this population. Additionally, we investigated the risk, lethality, and mortality from COVID-19. Methods : The design was observational retrospective that included adult subjects participating in clinical intervention trials approved by our ethics committee during the first two years of the pandemic (March 31, 2020 to March 31, 2022). Pediatric, observational, short-term, and inpatient protocols were excluded. Results : We included 513 adult subjects who par ticipated in clinical trials during the first two years of the COVID-19 pandemic. Patients with COVID-19 were characterized as being 59.7 ± 13.7 years old (50% fe male), and 92% had an increased risk of fatality from COVID-19. The cumulative rate of COVID-19 was 9.74% (95% CI: 7.32-12.64%) and its confidence intervals were below 17% of the population aged 60 to 69 in Argentina (p<0.0001). The case fatality rate for COVID-19 was 14% (95% CI: 5.8%-26.7%) and its confidence intervals were above 2.45% of the population aged 50 to 69 in Argentina (p< 0.0001). Conclusion : The rate of COVID-19 in adult subjects participating in clinical trials was below the figures for the Argentine population of similar age. The fatality rate was above the population figures, and it is explained by the high risk of the population.

Analysis of myocardial infarction incidence and case-fatality in the last three decades in the province of Girona.

INTRODUCTION AND OBJECTIVES: Myocardial infarction (MI) incidence and case fatality trends are highly informative but relatively untested at the population level. The objective of this work was to estimate MI incidence and case fatality in the Girona population aged 35-74 years, and to determine their 30-year trends (1990-2019). METHODS: The REGICOR (Girona Heart Registry) monitored MI incidence and case fatality rates from 1990 to 2008. For the period 2008 to 2019, we linked discharges from Girona hospitals (n=4 974 977) and mortality registry (n=70 405) during this period. Our linkage algorithm selected key MI diagnostic codes and removed duplicates. Estimates from the linkage algorithm and the REGICOR registry were compared using chi-square tests for overlapping years (2008-2009). We estimated the annual percent change (APC) of standardized MI incidence and 28-day case fatality, and analyzed their trends using joinpoint regression. RESULTS: MI incidence and case fatality estimates were similar in the linkage algorithm and the REGICOR registry. We observed significant decreasing trends in the incidence of MI. The trend was APC, -0.96% (95% confidence interval (95%CI), -1.4 to -0.53) in women from 1990 to 2019 and -4.2% (95%CI, -5.5 to -3.0) in men from 1994 to 2019. The largest decrease in case fatality was -3.8% (95%CI, -5.1 to -2.5) from 1995 to 2003 in women and -2.4% (95%CI, -2.9 to -1.9) from 1995 to 2004 in men, mainly due to prehospital case fatality declines: -1.8% (95%CI, -2.6 to -1.1) in men and -3.2% (95%CI, -4.6 to -1.8) in women. CONCLUSIONS: In Girona, MI incidence and case fatality decreased between 1990 and 2019. The incidence showed a slow but continuous decrease while case fatality only stabilized in the last decade, particularly in women.

[Epidemiology of pneumococcal pneumonia among middle-aged and older adults in Catalonia, 2017-2018]. / Epidemiología de la neumonía neumocócica en adultos mayores de 50 años: estudio de cohortes en Cataluña, 2017-2018.

OBJECTIVE: To analyse population-based incidence and lethality of pneumococcal pneumonia (PP) requiring hospitalisation among Catalonian adults after universal vaccination implementation in infants. DESIGN: Population-based cohort study. SETTING: Primary care/hospital, Catalonia. PARTICIPANTS: 2,059,645 individuals ≥50 years old affiliated to the Institut Catala de la Salut retrospectively followed between 01/01/2017 and 31/12/2018. MAIN OUTCOME MEASURES: The Catalonian information system for the development of research in primary care (SIDIAP, Sistema de Información para el Desarrollo de la Investigación en Atención Primaria) was used to establish baseline characteristics and risk-strata of cohort members at study start: low-risk (immunocompetent persons without risk conditions), intermediate-risk (immunocompetent persons with at-risk condition) and high-risk (immunocompromising conditions). PP requiring hospitalisation among cohort members across study period were collected from CMBD (Conjunto Mínimo Básico de Datos) discharge data of 64 reference Catalonian hospitals. RESULTS: An amount of 3592 episodes of HPP were observed, with an incidence density of 90.7 cases per 100,000 person-years (95% CI: 85.2-96.5), being 11.9 bacteremic (95% CI: 10.8-13.1) and 78.8 non-bacteremic (95% CI: 74.0-83.8). Incidence rates substantially increased by age (37.3 in 50-64 years vs. 98.3 in 65-79 years vs. 259.8 in ≥80 years) and baseline-risk stratum (42.1, 120.7 and 238.6 in low-, intermediate- and high-risk stratum, respectively). Overall case-fatality rate was 7.6% (10.8% in invasive cases vs. 7.1% in non-invasive cases; pP=.004). In multivariable analyses, high-risk stratum and oldest age were the strongest predictors for invasive and non-invasive cases, respectively. CONCLUSION: Incidence and lethality of PP remained moderate among adults >50 years in Catalonia during 2017-2018 (earlier period after universal vaccination introduction for infants).

Tendencias del síndrome coronario agudo en el Hospital Universitario Clínico Quirúrgico Comandante Faustino Pérez Hernández

Introducción: los síndromes coronarios agudos representan la forma aguda de la cardiopatía isquémica. Esta constituye, en Cuba, la primera causa de muerte en los últimos años. La provincia de Matanzas muestra un comportamiento similar. Objetivo: evaluar las tendencias de morbilidad y letalidad de los pacientes con síndrome coronario agudo en un período de cinco años. Materiales y métodos: se realizó un estudio descriptivo retrospectivo de corte transversal, con 734 pacientes ingresados con síndrome coronario agudo en la Unidad de Cuidados Intensivos Emergentes del Hospital Universitario Clínico Quirúrgico Comandante Faustino Pérez Hernández, de Matanzas, entre enero de 2016 y diciembre de 2020. Se caracterizaron los pacientes según variables clínicas. Los datos se extrajeron de las historias clínicas. Se aplicó el test Chi cuadrado. Resultados: hubo una disminución progresiva y continua del total de pacientes con síndrome coronario agudo en los cinco años estudiados. Sobresalió el sexo masculino, con un 53,67 % (p < 0,02). El grupo etario más afectado fue el de 60 a 69 años. El síndrome coronario agudo sin elevación del segmento ST prevaleció en cuatro de los años analizados. Preponderó la instauración del tratamiento trombolítico en el 78,75 % de los pacientes con síndrome coronario agudo con elevación del ST. El total de fallecidos decreció en el período estudiado. Se demostró la importancia de la aplicación de la trombolisis. Conclusiones: en el quinquenio estudiado, disminuyó gradualmente el total de pacientes con diagnóstico de síndrome coronario agudo, y la letalidad por esta causa, en la Unidad de Cuidados Intensivos Emergentes del Hospital Universitario Clínico Quirúrgico Comandante Faustino Pérez Hernández, de Matanzas.

Introduction: acute coronary syndromes represent the acute form of ischemic heart disease. In Cuba, it is the first cause of death in recent years. The province of Matanzas shows similar behavior. Objective: to evaluate morbidity and lethality tendencies of the patients with acute coronary syndrome in a period of five years. Materials and methods: a descriptive, retrospective, cross-sectional study was carried out with 734 patients admitted with acute coronary syndrome in the Emergency Intensive Care Unit of the Clinical Surgical University Hospital Comandante Faustino Perez, of Matanzas, between January 2016 and December 2020. The patients were characterized according to clinical variables. The data were extracted from clinical records. The Chi-square test was applied. Results: there was a progressive and continuous decrease of the total of patients with acute coronary syndrome in the studied five years. Male gender stood up with 53.67% (p < 0, 02). The most affected age group was the 60-69 years one. The acute coronary syndrome without ST segment elevation prevailed in four of the analyzed years. The establishment of the thrombolytic treatment prevailed in 78.75% of the patients with ST segment elevated acute coronary syndrome. The total of deaths decreased in the studied period. The importance of thrombolysis application was demonstrated. Conclusions: the total of patients with diagnosis of acute coronary syndrome and lethality due to this cause gradually decreased in the studied five-year period in the Emergency Intensive Care Unit of the Clinical Surgical Hospital Comandante Faustino Perez Hernandez, of Matanzas.

Características y factores de riesgo de mortalidad por COVID-19 en Tamaulipas, a un año de pandemia / Characteristics and risk factors of COVID-19 mortality in Tamaulipas, one year after the pandemic

Resumen Coronavirus 19 (COVID-19), es una enfermedad viral prevalente y diseminada a nivel mundial, considerada una pandemia con alta tasa de mortalidad. A la fecha no existen estudios que describan la influencia de las variables asociadas a la enfermedad en el estado fronterizo de Tamaulipas, México. El objetivo del presente estudio fue evaluar y analizar las características, complicaciones, tasas de letalidad y factores de riesgo asociados a mortalidad en paciente positivos a COVID-19 en el estado de Tamaulipas, a un año de la emergencia local. Se utilizó la frecuencia de casos observados en relación a características, complicaciones y comorbilidades para estimar prevalencias y tasas de letalidad. Se ajustó un modelo de regresión logística multivariada para estimar los factores de riesgo significativos y se utilizaron curvas de supervivencia de Kaplan-Meier para describir las comorbilidades más importantes. Los análisis indicaron una mayor infección en pacientes en edad productiva, con una probabilidad significativa de muerte a partir de los 40 años, más evidente en pacientes masculinos. Los riesgos asociados a la hospitalización, como intubación endotraqueal y neumonía, son factores muy importantes. Las comorbilidades con alta prevalencia (diabetes, hipertensión y obesidad) y enfermedad renal crónica (ERC) están asociados significativamente (P < 0.01) a mayor mortalidad por COVID-19 en pacientes positivos. El presente estudio demostró algunos patrones generales de prevalencia y tasas de letalidad por COVID-19, por lo que se sugieren particularidades en los factores asociados a mortalidad en la población de Tamaulipas que requieren atención en sus grupos vulnerables, sobre todo en posibles casos de rebrotes de la enfermedad.

Abstract Coronavirus 19 (COVID-19) is a prevalent and globally disseminated viral disease that has become a pandemic associated with a high case fatality rate. To date, there are no published studies that describe the influence of the variables associated with the disease, specifically in the border state of Tamaulipas, Mexico. The objective of the present study was to assess the characteristics, complications, fatality rates and risk factors associated to mortality in patients positive to COVID-19 in Tamaulipas, one year after the local emergency. Descriptive frequency of characteristics, complications for prevalence and case fatality rates were used. A multivariate logistic regression model was adjusted to estimate the meaningful risk factors, and Kaplan-Meier survival curves were used to describe the most important comorbidities. The analysis indicated higher infection rates in patients of productive age, with a significant death probability in male patients from the age of 40. The risks associated with hospitalization, such as endotracheal intubation and the presence of pneumonia are important risk factors. Comorbidities with high prevalence; diabetes, hypertension, obesity, and chronic kidney disease (CKD) were significantly associated (P < 0.01) with higher COVID-19 mortality risk in the assessed population. The present study demonstrated some COVID-19 general patterns on frequency and mortality rates. It also suggested particularities in factors associated to mortality in the Tamaulipas population, which require proper attention in vulnerable groups, especially in future outbreaks of the disease.

Impacto indirecto de COVID-19 en las tasas de incidencia de enfermedades transmitidas por vector en México / Indirect impact of COVID-19 on the incidence rates of vector-borne diseases in Mexico

Resumen Introducción: La distribución espacial y temporal de la infección por SARS-CoV-2 sobrepasa las áreas endémicas de enfermedades transmitidas por vector (ETV), cuya vigilancia en México ha cambiado sustancialmente a partir del primer caso confirmado de COVID-19. Objetivos: Estimar y comparar las tasas de incidencia de las ETV antes y después de la introducción del SARS-CoV-2 en México. Métodos: Estudio retrospectivo de casos de ETV de 2014 a 2021. Las tasas de incidencia de cada ETV en el periodo previo (2014-2019) y posterior (2020-2021) a la introducción del SARS-CoV-2 en México fueron calculadas y comparadas. Resultados: Antes de la introducción del SARS-CoV-2, las tasas de incidencia de las ETV fueron altas y posterior a la introducción del coronavirus hubo un descenso en los índices epidemiológicos; sin embargo, solo se identificó diferencia estadística significativa en la tasa de incidencia de la malaria (p ≤ 0.05) y otras rickettsias (p ≤ 0.05). Conclusiones: Algunas medidas para reducir los casos de COVID-19, como el distanciamiento social, el confinamiento domiciliario, la reducción en el aforo en el transporte público y el trabajo en casa, probablemente contribuyeron a disminuir temporalmente el número de casos de las ETV; sin embargo, puede haber rebrote de las ETV en el futuro cercano.

Abstract Introduction: SARS-CoV-2 infection spatial and temporal distribution overlaps with endemic areas of vector-borne diseases (VBD), whose surveillance in Mexico has substantially changed since the first COVID-19 confirmed case. Objectives: To estimate and compare the incidence rates of VBDs before and after the introduction of SARS-CoV-2 in Mexico. Methods: Retrospective study of VBD cases from 2014 to 2021. The incidence rates of each VBD in the period before (2014-2019) and after (2020-2021) the introduction of SARS-CoV-2 in Mexico were calculated and compared. Results: Before the introduction of SARS-CoV-2, the incidence rates of VBDs were high and after the introduction of coronavirus there was a decrease in epidemiological indices; however, there was only statistically significant difference in the incidence rate of malaria (p ≤ 0.05) and other rickettsiae (p ≤ 0.05). Conclusions: Some measures to reduce COVID-19 cases, such as social distancing, home confinement, reductions in public transport and working at home (home office), probably temporarily decreased the number of VBD cases; however, there may be a resurgence of VBDs in the near future.

[Impact of COVID-19 pandemic in terms of incidence and lethality in nursing homes in Galicia (Spain)]. / Impacto de la pandemia de COVID-19 en términos de incidencia y letalidad en los centros residenciales de mayores de Galicia.

OBJECTIVES: To know the impact of COVID-19 in incidence and lethality in nursing homes in Galicia. METHODS: This is a descriptive study of nursing homes residents and workers with confirmed COVID-19. The analysis spanned from March 1, 2020 to March 27, 2022, stratified into 6 periods (one per wave). The impact on incidence (attack rate, number of outbreaks, reinfections, sex, age, and diagnostic technique) and lethality (by sex, age, place of death, and number of centers with deaths) was analyzed. RESULTS: There were 15,819 people affected, 51.9% of the jobs and 47.0% of the workers. The attack rate in residents was: 5.8% in the first wave, 10.4% in the second, 6.3% in the third, 0.1% in the fourth, 2.1% in the fifth and 27.3% in the sixth. In the sixth wave, there were 11.3% reinfections and the number of outbreaks in was 3 times higher than in the second. The case fatality in residents was higher during the first wave (21.8%) and lower during the sixth (2.4%). He only had one worker in relation to COVID-19. CONCLUSIONS: Surveillance of COVID-19 in nursing homes was essential to understand the dynamics of the disease. The sixth wave was the one with the highest incidence and the lowest lethality. Lethality was higher in the first wave. The fourth and fifth waves had a lower incidence due to the effects of vaccination.

Incidence and lethality by COVID-19 in the population of the Federal District: an ecological study / Incidência e letalidade por COVID-19 na população do Distrito Federal: um estudo ecológico / Incidencia y letalidad por COVID-19 en la población del Distrito Federal: un estudio ecológico

Background and objectives: understanding the social situation of COVID-19 in poor and less developed countries is still doubtful. Thus, this study aimed to estimate the incidence and lethality by COVID-19, according to the per capita income of the administrative regions of the Federal District (FD). Methods: this is a descriptive ecological study, based on secondary data. Thirty-one administrative regions of the FD were included, and the population consisted of 382,488 individuals. The variables considered were sex, incidence, mortality, lethality, age group, population estimate and education. Results: despite the greater contamination by women, in terms of total mortality, more men died, representing 57.3% of the total deaths in the period. Regarding the influence of the level of education and income on the incidence, it appears that the highest rates of confirmed cases occurred in groups with higher levels of education and income. Despite this higher incidence, it is the group that exhibits the lowest lethality and the third lowest mortality per 100,000 inhabitants. Conclusion: the highest incidence rates were observed in regions with higher per capita income. On the other hand, lethality occurred more incisively in regions with lower purchasing power. In view of this, it is necessary to apply long-term preventive measures in unequal regions.(AU)

Justificativa e objetivos: o entendimento da situação social da COVID-19 em países pobres e menos desenvolvidos ainda é dubitável. Desse modo, o objetivo deste estudo é estimar a incidência e letalidade por COVID-19, de acordo com a renda per capita das regiões administrativas do Distrito Federal (DF). Métodos: trata-se de um estudo ecológico descritivo, baseado em dados secundários. Foram incluídas 31 regiões administrativas do DF, e a população foi composta por 382.488 indivíduos. Consideraram-se como variáveis sexo, incidência, mortalidade, letalidade, faixa etária, estimativa populacional e escolaridade. Resultados: apesar da contaminação maior por parte das mulheres, em termos de mortalidade total, mais homens foram a óbito, representando 57,3% do total de mortos no período. A respeito da influência do grau de escolaridade e da renda na incidência, verifica-se que os maiores índices de casos confirmados aconteceram em grupos com maior nível de escolaridade e de renda. Apesar dessa maior incidência, é o grupo que exibe a menor letalidade e a terceira menor mortalidade por 100.000 habitantes. Conclusão: as mais altas taxas de incidência foram observadas nas regiões com maior renda per capita. Por outro lado, a letalidade ocorreu, de forma mais incisiva, nas regiões de menor poder aquisitivo. Diante disso, é necessário aplicar medidas preventivas de longo prazo em regiões desiguais.(AU)

Justificación y objetivos: la comprensión de la situación social del COVID-19 en los países pobres y menos desarrollados aún es dudosa. Así, el objetivo de este estudio es estimar la incidencia y letalidad por COVID-19, según el ingreso per cápita de las regiones administrativas del Distrito Federal (DF). Métodos: se trata de un estudio ecológico descriptivo, basado en datos secundarios. Se incluyeron 31 regiones administrativas del DF, la población estuvo conformada por 382,488 individuos. Se consideraron como variables el sexo, la incidencia, la mortalidad, la letalidad, el grupo de edad, la población estimada y la escolaridad. Resultados: a pesar de la mayor contaminación por mujeres, en términos de mortalidad total, fallecieron más hombres, representando el 57,3% del total de defunciones en el período. En cuanto a la influencia del nivel de educación e ingresos en la incidencia, parece que las tasas más altas de casos confirmados ocurrieron en grupos con mayores niveles de educación e ingresos. A pesar de esta mayor incidencia, es el grupo que presenta la menor letalidad y la tercera mortalidad más baja por 100.000 habitantes. Conclusión: las tasas de incidencia más altas se observaron en las regiones con mayor ingreso per cápita. Por otro lado, la letalidad se produjo de forma más incisiva en las regiones de menor poder adquisitivo. Ante esto, es necesario aplicar medidas preventivas a largo plazo en regiones desiguales.(AU)

Time trends in the epidemiology of nonrheumatic aortic valve disease in Spain, 2003-2018.

INTRODUCTION AND OBJECTIVES: The impact of therapeutic improvements in nonrheumatic aortic valve disease (NRAVD) has been assessed at the patient level but not in the whole population with the disease. Our objective was to assess temporal trends in hospitalization rates, treatment and fatality rates in patients with a main or secondary NRAVD diagnosis. METHODS: Retrospective analysis of administrative claims from patients hospitalized with a main or secondary NRAVD diagnosis between 2003 and 2018 in Spain. Time trends in age- and sex-standardized hospitalization and procedure rates, baseline characteristics and case fatality rates by diagnosis type were assessed by Poisson regression and joinpoint analysis. RESULTS: Hospital admissions in patients with NRAVD increased from 69 213 in 2003 to 136 185 in 2018. The crude in-hospital fatality rate increased from 6.7% to 8.7% (IRR, 1.015; 95%CI, 1.012-1.018; P <.001) without changes after adjustment. Adjusted fatality rates decreased in patients with a main NRAVD diagnosis (5.5% to 3.5%; IRR, 0.953; 95%CI, 0.942-0.964) but increased in those with a secondary diagnosis (8.0% to 8.8%; IRR, 1.005; 95%CI, 1.002-1.009). Aortic valve replacements increased from 10.5 to 17.1 procedures per 100 000 population (IRR, 1.033; 95%CI, 1.030-1.037), mainly driven by transcatheter procedures (IRR, 1.345; 95%CI, 1.302-1.389). CONCLUSIONS: Hospitalizations in patients with NRAVD are increasing, with most being secondary diagnoses. The use of aortic valve replacement is increasing with a reduction in fatality rates but only in patients with a main diagnosis.

Una mirada sociodemográfica a la incidencia de la COVID-19 en Cuba / A socio-demographic look at the incidence of COVID-19 in Cuba

Introducción: En Cuba el comportamiento de la epidemia de la COVID-19 ha sido analizado desde el enfoque de varias ciencias, con la guía de la Epidemiología, para frenar su expansión. Se requiere estudiar su comportamiento atendiendo al estado de la población para identificar sus diferenciales, lo cual puede ayudar en la adopción de medidas para su enfrentamiento. Objetivo: Evaluar la incidencia de la COVID-19 en Cuba a partir de indicadores sociodemográficos. Métodos: Se utilizaron los cálculos de las tasas de incidencia, mortalidad y la letalidad de la COVID-19 por grupos de edades y sexo a nivel de país y sus territorios. Se compararon estas tasas con indicadores demográficos seleccionados. Se utilizaron los datos aportados por diversos sitios oficiales del país en el periodo del 11 de marzo al 12 de junio de 2020. Resultados: La edad fue el principal diferencial de las tasas de mortalidad y la letalidad por COVID-19, con mayor frecuencia en los mayores de 60 años, fundamentalmente en hombres. No se evidenció ninguna variación proporcional entre dichas tasas y el grado de urbanización, la densidad poblacional y el grado de envejecimiento de la población. Conclusiones: Para disminuir el impacto de la COVID-19 en Cuba fueron decisivas las medidas adoptadas por el Gobierno, fundamentalmente las que estaban en función de los grupos más vulnerables. El estudio de los diferenciales de la COVID-19 desde la Demografía constituye un punto de partida para la búsqueda de factores de diversa naturaleza que influyen en su comportamiento(AU)

Introduction: In Cuba, the behavior of the COVID-19 epidemic has been analyzed from the approach of several sciences, with the guidance of Epidemiology, to stop its spread. It is necessary to study its behavior according to the state of the population to identify their differentials, which can help in the adoption of measures to confront them. Objective: Asses the incidence of COVID-19 in Cuba based on socio-demographic indicators. Methods: Calculations of COVID-19 incidence, mortality and lethality rates by age groups and sex were used at the country and territory levels. These rates were compared with selected demographic indicators. The data provided by various official sites of the country in the period from March 11 to June 12, 2020 were used. Results: Age was the main differential in mortality rates and lethality due to COVID-19, with greater frequency in those over 60 years of age, mainly in men. There was no evidence of any proportional variation between these rates and the degree of urbanization, population density and degree of population ageing. Conclusions: To reduce the impact of COVID-19 in Cuba, the measures adopted by the Government were decisive, mainly those that were based on the most vulnerable groups. The study of the differentials of COVID-19 from Demography constitutes a starting point for the search of different nature factors that influence its behavior(AU)

[Case-fatality rates of SARS-CoV-2 infection according to Autonomous Communities during the second epidemic wave in Spain]. / Tasas de letalidad por SARS-CoV-2 según Comunidades Autónomas durante la segunda onda epidémica en España.

INTRODUCTION: In Spain, health systems are transferred to the Autonomous Communities (AC), constituting 19 health systems with differentiated management and resources. During the first epidemic wave of COVID-19, differences were observed in reporting systems and in case-fatality rates (FR) between the AC. The objective of this study was to analyze the FR according to AC. during the 2 nd epidemic wave (from July 20 to December 25, 2020), and its relationship with the prevalence of infection. MATERIAL AND METHODS: A descriptive observational study was carried out, extracting the information available on the number of deaths from COVID-19 registered in the Ministry of Health, the Health Councils and the Public Health Departments of the AC, and according to the excess mortality reported by the System Monitoring of Daily Mortality (MoMo). The prevalence of infection was estimated from the differences between the second and fourth rounds of the ENE-COVID study and their 95% confidence intervals. The global FR (deaths per thousand infected) were calculated according to sex, age groups (< 65 and ≥ 65 years) and AC. The age-Standardized Fatality Rates (SFR) of the AC were calculated using the FR of Spain for each age group. These estimates were made with officially declared deaths (FRo) and excess deaths estimated by MoMo (FRMo). The correlations between the prevalences of infection and the FRo and FRMo were estimated, weighting by population. RESULTS: For the whole of Spain, the FRo during the second epidemic wave was 7.6%, oscillating between 3.8% in the Balearic Islands and 16.4% in Asturias, and the TLMo was 10.1%, oscillating between 4.8% from Madrid and 21.7% in Asturias. Significant differences were observed between the FRo and the FRMo in the Canary Islands, Castilla la Mancha, Extremadura, the Valencian Community, Andalusia and the Autonomous Cities of Ceuta and Melilla. The FRo was significantly higher in men (8.2%) than in women (7.1%). The FRo and FRMo were significantly higher in the age group ≥ 65 years (55.4% and 72.2% respectively) than in the group <65 years (0.5% and 1.4% respectively). The Basque Country, Aragon, Andalusia and Castilla la Mancha presented SFR significantly higher than the global FR of Spain. The correlations between the prevalence of infection and the FRo were inverse. CONCLUSIONS: The case-fatality from COVID-19 during the second epidemic wave in Spain improved compared to the first wave. The case-fatality rates were higher in men and the elderly people, and varied significantly between AC. It is necessary to delve into the analysis of the causes of these differences.

Indirect impact of COVID-19 on the incidence rates of vector-borne diseases in Mexico.

INTRODUCTION: SARS-CoV-2 infection spatial and temporal distribution overlaps with endemic areas of vector-borne diseases (VBD), whose surveillance in Mexico has substantially changed since the first COVID-19 confirmed case. OBJECTIVES: To estimate and compare the incidence rates of VBDs before and after the introduction of SARS-CoV-2 in Mexico. METHODS: Retrospective study of VBD cases from 2014 to 2021. The incidence rates of each VBD in the period before (2014-2019) and after (2020-2021) the introduction of SARS-CoV-2 in Mexico were calculated and compared. RESULTS: Before the introduction of SARS-CoV-2, the incidence rates of VBDs were high and after the introduction of coronavirus there was a decrease in epidemiological indices; however, there was only statistically significant difference in the incidence rate of malaria (p ≤ 0.05) and other rickettsiae (p ≤ 0.05). CONCLUSIONS: Some measures to reduce COVID-19 cases, such as social distancing, home confinement, reductions in public transport and working at home (home office), probably temporarily decreased the number of VBD cases; however, there may be a resurgence of VBDs in the near future.

INTRODUCCIÓN: La distribución espacial y temporal de la infección por SARS-CoV-2 sobrepasa las áreas endémicas de enfermedades transmitidas por vector (ETV), cuya vigilancia en México ha cambiado sustancialmente a partir del primer caso confirmado de COVID-19. OBJETIVOS: Estimar y comparar las tasas de incidencia de las ETV antes y después de la introducción del SARS-CoV-2 en México. MÉTODOS: Estudio retrospectivo de casos de ETV de 2014 a 2021. Las tasas de incidencia de cada ETV en el periodo previo (2014-2019) y posterior (2020-2021) a la introducción del SARS-CoV-2 en México fueron calculadas y comparadas. RESULTADOS: Antes de la introducción del SARS-CoV-2, las tasas de incidencia de las ETV fueron altas y posterior a la introducción del coronavirus hubo un descenso en los índices epidemiológicos; sin embargo, solo se identificó diferencia estadística significativa en la tasa de incidencia de la malaria (p ≤ 0.05) y otras rickettsias (p ≤ 0.05). CONCLUSIONES: Algunas medidas para reducir los casos de COVID-19, como el distanciamiento social, el confinamiento domiciliario, la reducción en el aforo en el transporte público y el trabajo en casa, probablemente contribuyeron a disminuir temporalmente el número de casos de las ETV; sin embargo, puede haber rebrote de las ETV en el futuro cercano.

Letalidad por SARS-CoV-2 en Colombia años 2020 y 2021 / ARS-COV-2 lethality rate in Colombia: years 2020 y 2021

Introducción: esta pandemia ha marcado la necesidad de comprender cómo sobrevivimos a las infecciones y por qué el tratamiento puede ser heterogéneo. Objetivo: reseñar la tasa de letalidad por COVID-19 en Colombia entre el 6 de marzo 2020 y 31 de diciembre 2021. Metodología: estudio transversal, como fuente de información se obtuvo el plan nacional de vacunación contra COVID-19 del sitio web del Ministerio de Salud y Protección Social. Resultados: se establecieron por meses las tasas de letalidad por COVID-19 por meses en 2020 y 2021 en Colombia. Se apreció que en el período mencionado el mes con mayor tasa de letalidad fue febrero 2021 con 3,69% y el de menor fue diciembre 2021 con 1,61%. Conclusión: los registros de letalidad y tasas de mortalidad por COVID-19 posibilitan monitorear la pandemia, pero están sesgados por el diagnóstico posterior de la infección por SAR-CoV2 y la demora en la notificación.

Introduction: This pandemic poses the need to understand how to survive infections and why treatment may be heterogenous. Objective: to review the COVID-19 case fatality rate in Colombia between March 6, 2020 and December 31, 2021. Methodology:a cross-sectional study. Data was obtained from the Ministry of Health and Social Protection website based on the COVID ­ 19 vaccination plan. Results: COVID-19 case fatality rates were established by months in 2020 and 2021 in Colombia. It wasobserved that for the abovementioned period, the month with the highest case fatality rate was February 2021 with 3.69% and the lowest was December 2021 with 1.61%. Conclusion: the records of lethality and mortality rates enable monitoring the pandemic but are biased due to delays in confirming SAR-CoV2 infection and delays in reporting.

Análisis temporal del covid-19 en Colombia: indicadores asociados y modelización / Temporal analysis of covid-19 in Colombia: associated indicators and modeling

AbstractIntroduction. This study shows statistical information regarding COVID-19 in Colombia up to this date (March 1-2022). Specifically, the daily, monthly and cumulative evolution of infections and deaths, correlated with the distribution of the population according to age and gender. Objective. Show statistical information about COVID-19 that allows help to plan and design, in future Pandemics, public health policy strategies in Colombia. Methods. Daily information since the official declaration of Pandemic in Colombia (March 16 ­ 2020) was obtained by the National Health Institute (INS) and was organized in a database in order to conduct respective analysis. This information was compared to similar studies obtained based on the bibliographical review. Results and Conclusions. Results and conclusions are similar to those found in the reference literature: most part of those dead by COVID-19 are of senior age and male gender. Regarding Case Fatality Rate (CFR), it notoriously increases with age. The most vulnerable population displays an average age of ≥ 52.8 years. The less vulnerable population are young persons under 30 years of age, but specifically, those within the age range of 10 and 20 years. Gompertz and Logistic models can mathematically simulate the evolution of deaths and the evolution of CFR according to age

ResumenIntroducción. Este estudio muestra información estadística sobre el COVID-19 en Colombia a la fecha (1 de marzo de 2022). Específicamente, la evolución diaria, mensual y acumulada de contagios y defunciones, correlacionada con la distribución de la población según edad y sexo. Objetivo. Mostrar información estadística sobre COVID-19 que permita ayudar a planificar y diseñar, en futuras Pandemias, estrategias de política de salud pública en Colombia. Metodología. La información diaria desde la declaratoria oficial de Pandemia en Colombia (16 de marzo de 2020) fue obtenida del Instituto Nacional de Salud (INS) y fue organizada en una base de datos para realizar los análisis respectivos. Esta información se comparó con estudios similares obtenidos a partir de revisión bibliográfica. Resultados y conclusiones. Los resultados y conclusiones son similares a los encontrados en la literatura de referencia: la mayor parte de los fallecidos por COVID-19 son de edad avanzada y sexo masculino. En cuanto a la tasa de letalidad (CFR), ésta aumenta notoriamente con la edad. La población más vulnerable presenta una edad promedio ≥ 52.8 años. La población menos vulnerable son los jóvenes menores de 30 años, pero específicamente, los que se encuentran en el rango de edad de 10 y 20 años. Los modelos Gompertz y Logistic pueden simular matemáticamente la evolución de las muertes y la evolución de la CFR según la edad.

Asociación del nivel socioeconómico y educacional en los egresos por cáncer de mama en Chile durante los años 2001 al 2016 / Association of the socioeconomic and educational level in the breast cancer hospital outbreaks in Chile during the years 2001 to 2016

Introducción: El cáncer de mama constituye la primera causa de muerte en los cánceres en Chile según Globocan 2018. Dentro de los factores que explican esta alta mortalidad encontramos una baja tasa de detección y de realización de mamografías en los niveles socioeconómicos altos. Es por esto que comprender las causas de defunción y los factores que afectan en la mortalidad y letalidad por cáncer de mama en los últimos 17 años nos permitirá enfocar las políticas públicas de los próximos 50 años. Los objetivos generales de este trabajo fueron caracterizar los egresos hospitalarios en los pacientes por cáncer de mama según la edad, el sexo, la previsión, el nivel socioeconómico y educacional en Chile durante los años 2001 al 2016 y calcular la mortalidad y letalidad específica en estas mismas variables durante los años 2001 a 2016. El objetivo específico es asociar las variables socioeconómicas y educacionales, estimando los Odd's ratios de las variables en los egresos hospitalarios por cáncer de mama en Chile durante los años 2001 al 2016. Materiales y Métodos: Estudio de cohorte longitudinal retrospectivo en 81,072 egresos hospitalarios y 20,220 defunciones obtenidas de la página DEIS MINSAL, años 2001-2016. Para el análisis univariado se efectuó una regresión de ajuste de tasas Prais-weinstein según edad y sexo según modelo OMS de ajuste de tasas. Para las variables de tipo discreta se describieron mediante porcentajes y tasas y para las variables de tipo continua se utilizó mediana y desviación estándar. Se efectuó un test de smirnov-kolmolgorov para determinar el tipo de distribución y de normalidad de las muestras. Para las variables de tipo dicotómica se utilizó un modelo de regresión logística binaria para describir estas variables y determinar la posible asociación entre el nivel socioeconómico y educacional de las pacientes diagnosticadas por cáncer de mama. Resultados: Murieron 1,88 veces más personas de nivel socioeconómico alto con un IC entre 1,83- 1,94 con respecto a la población de nivel socioeconómico bajo. En cambio, las personas con un mayor nivel educacional murieron 0,5 veces menos según la regresión realizada respecto al bajo nivel educacional con un IC entre 0,47- 0,52, pero a menor nivel educacional aumentó 20 veces la mortalidad, constituyendo una causa inversa. Respecto al sexo las mujeres murieron 2,08 veces más que los hombres. Para el nivel socioeconómico alto en relación al bajo un OR [1.88 (1.83 a 1,94)], p<0,0001], para el nivel educacional alto en relación al bajo fue a favor del mayor nivel educacional con OR [0,5 (0,47 - 0,52)] y en cuanto a la comparación de sexos un OR [1,04 (1,03-2,17), p=0,039]. Es decir, la diferencia entre mortalidad que hubo fue significativa para todos los intervalos tanto para sexo, nivel educacional como para nivel socioeconómico. Se encontró una constante de 0,013 de mortalidad basal, es decir, todos tienen 1,3% de riesgo de morir por cáncer de mama independiente del nivel socioeconómico, educacional y del sexo. Conclusión: Existen diferencias estadísticamente significativas respecto a la mortalidad entre los niveles socioeconómicos altos y bajos y también en nivel educacional, sin embargo, al realizar los métodos de regresión se obtuvo una mayor mortalidad y mayor riesgo de morir por cáncer de mama en los niveles socioeconómicos más altos asociados a, probablemente, la menor cantidad de tamizajes y realización de mamografías en este estrato. A partir del año 2008 se observó un incremento a los niveles originales observados al inicio del segundo milenio incrementando las diferencias existentes en los índices de desigualdad tanto por nivel educacional como por nivel socioeconómico incrementando en 20 veces respecto al nivel educacional, y 1.88 respecto al nivel socioeconómico.

Introduction: Breast cancer is the leading cause of death in cancers in Chile according to Globocan 2018. Among the factors that explain this high mortality, we find a low rate of detection and performance of mammograms in high socioeconomic levels. This is why understanding the causes of death and the factors that affect mortality and fatality from breast cancer in the last 17 years will allow us to focus on public policies for the next 50 years Materials and Methods: Retrospective longitudinal cohort study in 79,996 hospital discharges and 20,220 deaths obtained from the DEIS MINSAL page, years 2001 -2016. For the univariate analysis, a Prais-Weinstein rate adjustment regression was performed according to age and sex according to the WHO rate adjustment model. For discrete type variables, they were described by percentages and rates, and median and standard deviation were used for continuous type variables. A smirnov-kolmolgorov test was performed to determine the type of distribution and normality of the samples. For dichotomous variables, a binary logistic regression model was used to describe these variables and determine the possible association between the socioeconomic and educational level of the patients diagnosed with breast cancer. Abstract: In this observational, longitudinal and retrospective study with 101.292 patients that includes men and women of all ages with diagnosis of breast cancer all along Chile, we´ll analyze the impact of socioeconomic level, evaluated through educational level and money income, into the prevalence, mortality and lethality of breast cancer in the years 2001 to 2016. Results: People with a high socioeconomic level died 1.88 times more, with a CI between 1.83 and 1.94, than those with a low socioeconomic level. On the other hand, people with a higher educational level died 0.5 times less according to the regression carried out with respect to the low educational level with a CI between 0.47 and 0.52, but the lower the educational level the mortality increased 20 times, constituting an inverse cause. Regarding sex, women died 2.08 times more than men. For the high socioeconomic level in relation to the low one an OR [1.88 (1.83 to 1.94)], p<0.0001], for the high educational level in relation to the low one it was in favor of the higher educational level with OR [0.5 (0.47 - 0.52)] and as for the comparison of sexes an OR [1.04 (1.03-2.17), p=0.039]. In other words, the difference between mortality was significant for all the intervals for sex, educational level and socioeconomic level. A constant baseline mortality of 0.013 was found, i.e., everyone has a 1.3% risk of dying from breast cancer regardless of socioeconomic level, educational level and sex. Conclusions: There are statistically significant differences in mortality between high and low socioeconomic levels and also in educational level; however, when regression methods were used, a higher mortality and higher risk of dying from breast cancer was obtained in the higher socioeconomic levels, probably associated with the lower number of screenings and mammograms performed in this stratum. As of 2008, an increase to the original levels observed at the beginning of the second millennium was observed, increasing the existing differences in the inequality indexes both by educational level and socioeconomic level, increasing by 20 times with respect to educational level, and 1.88 times with respect to socioeconomic level.