Vaccination trends in people with HIV infection participanting in the hospital-based survey of patients infected with HIV, 2006-2021.

OBJECTIVE: To assess the trend in hepatitis A, hepatitis B, pneumococcal, tetanus and seasonal influenza vaccination in people with HIV infection and to analyse associated factors. METHODS: The Hospital Survey of Patients with HIV, an annual cross-sectional study conducted on a fixed day (2006-2021), was used. Inpatients and outpatients were included. Trends in vaccination and associated factors were analysed using logistic regression. RESULTS: A total of 8643 participants were included. Vaccination rates increased to 65.3% for hepatitis A, 83.7% for hepatitis B, 49.3% for tetanus, 68.9% for pneumococcal and 74.5% for seasonal influenza in 2021. Factors positively associated with vaccination were older age for pneumococcal and influenza vaccination; higher educational level for hepatitis A and tetanus; living in a closed institutions or prison for tetanus, pneumococcal and influenza; and having acquired HIV through sex between men for hepatitis A, B and pneumococcal. In addition, being on antiretroviral treatment and having a high CD4 count were positively associated with vaccination for all these diseases. Factors inversely associated with vaccination were being older (hepatitis A, B and tetanus), being an immigrant (tetanus and seasonal influenza) and being an injection drug user/ex-user for hepatitis A and B. CONCLUSIONS: Vaccination in people with HIV has increased in the study period. The results are in line with the recommendations in this population, although there is still room to reach the established vaccination indicators.

Inflammatory Potential of the Diet and Incidence of Crohn's Disease and Ulcerative Colitis in the EPIC-Spain Cohort.

Diet may influence the development of inflammatory bowel disease through the modulation of inflammation. We investigated whether the inflammatory potential of the diet is associated with the risk of Crohn's disease (CD) and ulcerative colitis (UC) in the Spanish cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC-Spain). The study included 32,633 participants aged 29-69 years. The inflammatory potential of the diet was measured by using an inflammatory score of the diet (ISD) based on a baseline dietary history questionnaire. Cox regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). During 21 years (674,547 person-years) of follow-up, 32 and 57 participants developed CD and UC, respectively. In multivariable analysis, a one-standard deviation (SD) increment in the ISD (two-unit increase) was associated with a higher risk of CD (HR of 1.71; 95% CI: 1.05-2.80; p = 0.031). By contrast, ISD was not associated with UC (HR for one-SD increment of 0.89; 95% CI: 0.66-1.19; p = 0.436). Our results suggest that consuming a more pro-inflammatory diet may contribute to the risk of CD, supporting that a healthy diet might be beneficial in its prevention. Further, larger studies are needed to verify these findings.

Stabilisation of the trend in prevalence of childhood overweight and obesity in Spain: 2001-11.

BACKGROUNDS: To ascertain whether the prevalence of childhood overweight and obesity had stabilised in Spain, in the same way as in other developed countries. METHODS: Data were drawn from the 2001, 2006 and 2011 Spanish National Health Surveys. We estimated overweight and obesity on the basis of body mass index, and then calculated the prevalence of overweight and obesity for each year studied among boys and girls, respectively, in two different age groups; 5 -9 and 10 -15 years. The statistical significance of the trend in prevalence was evaluated using the chi-squared test. RESULTS: The trend in the prevalence of overweight was not significant, with the magnitude generally proving similar in 2006 and 2011, e.g. prevalence among girls was 37.2% in 2006 and 37.5% in 2011 in the 5-9 age group, and 17.7% in 2006 and 17.5% in 2011 in the 10-15 age group. The magnitude of the prevalence of obesity in each sex and age group was similar across the 3 years of study, except in the case of boys aged 5-9 years, among whom a significant downward trend was observed, with prevalence declining from 16.8% in 2001 to 14.4% in 2006 and 12.6% in 2011. CONCLUSION: In Spain, the prevalence of childhood overweight and obesity stabilised during the first decade of the present century.

[Lifestyles and Styles of Parental Care Related to Childhood Obesity: compare Spain with Northern European Countries: ENERGY-Project]. / Hábitos de vida y estilos de cuidado de los progenitores relacionados con la obesidad infantil: comparación de una población española con poblaciones de países del Norte de Europa: ENERGY-Project.

BACKGROUND: The prevalence of childhood obesity is higher in Spain than in Northern European countries for reasons that are still unknown. The objective was to determine whether variables related to lifestyle habits and styles of parental care related to obesity in children differ between the countries of Northern Europe and Spain. METHODS: Data were obtained from the ENERGY international project using questionnaires. We analyzed data from Spain, the Netherlands, Belgium and Norway including 1937 boys and 2061 girls aged 10-12 years old. We have studied the behavior of parents related to dietary variables, variables related to physical activity and ways of care. We calculated the mean and the proportions of all the variables and then calculated the association between different variables with the country of origin using the beta coefficient and the odds ratio (OR) as a measure of association. RESULTS: Compared with parents in Northern Europe, Spanish parents consume significantly less days a week sugary drinks (Mean: 1.37 vs 2.16) but they consume more fruit juices (Mean: 2,61 vs 2,35). Spanish parents are more active going to their work, they are less sedentary but perform physical activity in their leisure time fewer days per week (Mean days per week they do physical activity in their leisure time: 1.88 vs 2.21). In addition, they are less negotiators with their children (Mean (0-4): 1.26 vs 1.68) and prevent less negative role models (Mean (0-4): 0.90 vs 1.29). However, they pay more attention (Mean (0-4): 3.42 vs 3.04) and encourage more healthy habits (Mean (0-4): 2.38 vs 2.06). CONCLUSIONS: The variables related to lifestyle habits and styles of care related to childhood obesity differ between Spanish parents and those of the countries of Northern Europe but these differences are not statistically significant. Therefore, differences in lifestyles and parenting practices might not explain the significant differences in childhood obesity between the Northern countries and Spain.

[Inequalities in Total Mortality and by Cause of Death According to the Level of Education in Navarra: findings from a Longitudinal Study from 2001 to 2008]. / Desigualdades en mortalidad total y por causa de muerte según el nivel de estudios en Navarra: hallazgos de un estudio longitudinal 2001-2008.

BACKGROUND: Due to the lack of evidence, the objective was to show the inequalities in mortality by educational level in Navarra and the contribution of the main causes of death to the magnitude of inequalities in mortality from all causes of death. METHODS: All citizens aged 25 years and older residing in Spain in 2001 were followed during 7 years to determine their vital status. Level of education was used as socioeconomic status indicator. It was estimated the age-adjusted total mortality rate and mortality rate from cause-specific mortality by educational level. Then it was calculated the relative difference (ratio) and the absolute difference in rates between the lowest and highest levels of education and the contribution of the main causes of death to the absolute difference. RESULTS: The rate ratio for all causes of death was 1.37 in men and 1.23 in women. The human immunodeficiency virus (HIV) (25.84) and unintentional injuries (3.78) are the causes of death with higher rate ratio in men and diabetes (4.92) and HIV (4.38) in women. Cardiovascular diseases were the leading causes of death that contribute most to the absolute difference in mortality: 26% in men and 48% women. CONCLUSIONS: The mortality rate in the Navarre population shows an inverse gradient with educational level, except in some cancer sites. Cardiovascular disease is the leading cause of death that contributes most to the absolute inequalities in mortality, while other causes of death that show significant relative inequalities, contribute little to the absolute inequalities.

Socioeconomic position and childhood-adolescent weight status in rich countries: a systematic review, 1990-2013.

BACKGROUND: Childhood obesity is a major problem in rich countries due to its high prevalence and its harmful health consequences. An exploratory analysis conducted in the PubMed database highlighted that the number of papers published on the relationship between socioeconomic position (SEP) and childhood-adolescent weight status had risen substantially with respect to an earlier review which had covered the period 1990-2005. METHODS: To describe the findings on the relationship between SEP and childhood-adolescent weight status in papers published in rich countries from 1990 through 2013, studies were identified in the following databases: PubMed; Web of Knowledge (WOK); PsycINFO; Global Health; and Embase. We included observational studies from the 27 richest OECD countries, which covered study populations aged 0 to 21 years, and used parental education, income and/or occupation as family SEP indicators. A total of 158 papers met the inclusion criteria and reported 134 bivariable and 90 multivariable analyses. RESULTS: Examination of the results yielded by the bivariable analyses showed that 60.4% of studies found an inverse relationship, 18.7% of studies did not found relationship, and 20.9% of studies found a relationship that varied depending on another variable, such as age, sex or ethnic group; the corresponding percentages in the multivariable analyses were 51.1, 20.0 and 27.8%, respectively. Furthermore, 1.1% found a positive relationship. CONCLUSION: The relationship between SEP and childhood-adolescent weight status in rich countries is predominantly inverse and the positive relationship almost has disappeared. The SEP indicator that yields the highest proportion of inverse relationships is parents' education. The proportion of inverse relationships is higher when the weight status is reported by parents instead using objective measurements.

Area-level socioeconomic context, total mortality and cause-specific mortality in Spain: Heterogeneous findings depending on the level of geographic aggregation.

The objective of this study was to estimate the association between area-level socioeconomic context and mortality in Spain, using two different geographic aggregations. Nation-wide prospective study covering all persons living in Spain in 2001. Mortality was analysed in Spanish citizens by province of residence and in citizens of Madrid by neighbourhood of residence. Provinces and neighbourhoods were grouped into quartiles according to two socioeconomic indicators: percentage of the population with university education and unemployment rate. The measure of association was the rate ratio for total mortality and cause-specific mortality, by each socioeconomic indicator in two age groups, 25-64 years (adult population) and 65 years and over (elderly population). After adjustment for all individual socioeconomic variables, the rate ratio for total mortality among residents in the provinces with the worst versus best socioeconomic context was 0.92 (95% CI 0.88-0.97) when the indicator was percentage of university population and 0.89 (0.85-0.93) when it was unemployment rate in the adult population, and 1.05 (1.00-1.11) and 1.08 (1.03-1.13), respectively, in the elderly population. No significant differences in mortality were observed between adults residing in neighbourhoods with the worst versus best socioeconomic context, but in the elderly population the mortality rate ratios for the two socioeconomic indicators were 1.04 (1.01-1.07) and 1.06 (1.03-1.09), respectively. Residents in provinces with the worst socioeconomic context had the lowest mortality from cancer and external causes and the highest mortality from cardiovascular diseases, while residents in neighbourhoods with the worst socioeconomic context had the highest mortality from respiratory and digestive diseases. Further research should find out the reasons for the lower total mortality in adult population residing in the Spanish provinces with the most adverse socioeconomic context and the reasons for excess mortality from digestive diseases and respiratory diseases among residents in neighbourhoods with the worst socioeconomic context.

The Association of Geographic Coordinates with Mortality in People with Lower and Higher Education and with Mortality Inequalities in Spain.

OBJECTIVE: Geographic patterns in total mortality and in mortality by cause of death are widely known to exist in many countries. However, the geographic pattern of inequalities in mortality within these countries is unknown. This study shows mathematically and graphically the geographic pattern of mortality inequalities by education in Spain. METHODS: Data are from a nation-wide prospective study covering all persons living in Spain's 50 provinces in 2001. Individuals were classified in a cohort of subjects with low education and in another cohort of subjects with high education. Age- and sex-adjusted mortality rate from all causes and from leading causes of death in each cohort and mortality rate ratios in the low versus high education cohort were estimated by geographic coordinates and province. RESULTS: Latitude but not longitude was related to mortality. In subjects with low education, latitude had a U-shaped relation to mortality. In those with high education, mortality from all causes, and from cardiovascular, respiratory and digestive diseases decreased with increasing latitude, whereas cancer mortality increased. The mortality-rate ratio for all-cause death was 1.27 in the southern latitudes, 1.14 in the intermediate latitudes, and 1.20 in the northern latitudes. The mortality rate ratios for the leading causes of death were also higher in the lower and upper latitudes than in the intermediate latitudes. The geographic pattern of the mortality rate ratios is similar to that of the mortality rate in the low-education cohort: the highest magnitude is observed in the southern provinces, intermediate magnitudes in the provinces of the north and those of the Mediterranean east coast, and the lowest magnitude in the central provinces and those in the south of the Western Pyrenees. CONCLUSION: Mortality inequalities by education in Spain are higher in the south and north of the country and lower in the large region making up the central plateau. This geographic pattern is similar to that observed in mortality in the low-education cohort.

[Geographic Patterns of Mortality and Socioeconomic Inequalities in Mortality in Spain]. / Patrones geográficos de la mortalidad y de las desigualdades socioeconómicas en mortalidad en España.

BACKGROUND: Estimates of socioeconomic inequalities in mortality coming from individual data sources were only available from Madrid, the Basque Country and the city of Barcelona. The aim of this study was to show the geographical pattern of mortality in different socio-economic groups, as well as that of inequalities in mortality in the whole Spanish territory. METHODS: All people aged 25 and older in the 2001 census were followed for seven years and two months to determine their vital status (196 470 401 person-years at risk and 2,379,558 deaths). The socioeconomic variable was educational level. Age-adjusted mortality rate was estimated for women and men in every province and in each category of educational level. Inequalities in mortality in each province have been estimated by the ratio of mortality in subjects with primary or lower level of education compared to subjects with university education. RESULTS: In women, the lowest rate ratios -between 1.06 and 1.16- are observed in Palencia, Segovia, Guadalajara, Avila and Castellon and the highest -between 1.53 and 1,75- in Malaga, Las Palmas, Ceuta, Melilla and Toledo. In men, the lowest rate ratios -between 1.00 and 1.12- are observed in Guadalajara, Teruel, Cuenca, La Rioja and Ávila and the highest -between 1.47 and 1,73- in Las Palmas, Cantabria, Murcia, Melilla and Ceuta. CONCLUSIONS: The geographical pattern of mortality rates in Spain varies by educational level. Inequalities in mortality by education have the lowest magnitude in central peninsular provinces.

The role of population change in the increased economic differences in mortality: a study of premature death from all causes and major groups of causes of death in Spain, 1980-2010.

BACKGROUND: An increase has been observed in differences in mortality between the richest and poorest areas of rich countries. This study assesses whether one of the proposed explanations, i.e., population change, might be responsible for this increase in Spain. METHODS: Observational study based on average income, population change and mortality at provincial level. The premature mortality rate (ages 0-74 years) was estimated for all causes and for cancer, cardiovascular disease and external causes across the period 1980-2010. In the years analysed, provinces were grouped into tertiles based on provincial income, with the mortality rate ratio (MMR) being estimated by taking the tertile of highest-income provinces as reference. Population change was then controlled for to ascertain whether it would modify the rate ratio. RESULTS: In all-cause mortality, the magnitude of the MRR for provinces in the poorest versus the richest tertile was 1.01 in 1980 and 1.12 in 2010; in cardiovascular mortality, the MMRs for these same years were 1.08 and 1.31 respectively; and in the case of cancer and external-cause mortality, MMR magnitude was similar in 1980 and 2010. The magnitude of the MMR remained unchanged in response to adjustment for population change, with the single exception of 1980, when it increased in all-cause and cardiovascular mortality. CONCLUSION: The increase in the difference in premature mortality between the richest and poorest areas in Spain is due to the increased difference in cardiovascular mortality. This increase is not accounted for by population change. In rich countries, more empirical evidence is thus needed to test other alternative explanations for the increase in economic differences in mortality.

[Variation in mortality inequalities in the autonomous communities of Spain: a matter of mortality in people with less education].

BACKGROUND: Given the importance of mortality rates in each socioeconomic group, as explanation for the variation in mortality inequalities across populations, the objective of the present study is to evaluate whether regional variation in mortality inequalities in Spain is related to the mortality rates in different socioeconomic groups. METHODS: The study included all persons aged 30-74 years living in Spain in 2001 and followed up for mortality over 7 years. In each of the 17 autonomous communities of Spain mortality rates were estimated for those with low and high education, as well as two measures of mortality inequality according to education: mortality rate difference and mortality rate ratio. Median value of mortality inequalities was calculated for the regions with the highest and lowest mortality rates and for those with intermediate mortality rates. And the Pearson correlation coefficient was used to estimate the relation between mortality rates and the measures of mortality inequality. RESULTS: The correlation coefficients between mortality rate in low education and mortality rate difference and mortality rate ratio were 0.87 and 0.78 in women and 0.81 and 0.73 in men, respectively. The correlation coefficients between mortality rate in high education and mortality rate difference and mortality rate ratio were -0.07 and -0.24 in women and 0.10 and -0.06 in men, respectively. CONCLUSION: Regions with the lowest and highest mortality rates in low education people generally had the lowest and highest inequalities in mortality. The variation in the magnitude of inequalities in mortality from one place to another can be explained by the variation in mortality in low education people. No relation was observed between mortality rate in high education and mortality inequality.

Educational differences in mortality and the relative importance of different causes of death: a 7-year follow-up study of Spanish adults.

BACKGROUND: The evidence on mortality patterns by education in Spain comes from regional areas. This study aimed to estimate these patterns in the whole Spanish population. METHODS: All citizens aged 25 years and over and residing in Spain in 2001 were followed during 7 years to determine their vital status, resulting in a total of 196,470,401 person-years and 2,379,558 deaths. We estimated the age-adjusted total and cause-specific mortality by educational level-primary, lower secondary, upper secondary and university education-and then calculated the relative and absolute measures of inequality in mortality and contribution of the leading causes of death to absolute inequalities. RESULTS: Except for some cancer sites, the mortality rate for the leading causes of death shows an inverse gradient with educational level. The leading causes of death with the highest relative index of inequality ratios were HIV disease (9.81 in women and 11.61 in men), diabetes in women (4.02) and suicide in men (3.52). The leading causes of death that contribute most to the absolute inequality in mortality are cardiovascular diseases (48.8%), respiratory diseases (9.3%) and diabetes mellitus (8.8%) in women, and cardiovascular diseases (20.8%), respiratory diseases (19.8%) and cancer (19.6%) in men. CONCLUSIONS: Although the causes of death with the strongest gradient in mortality rate are HIV disease in both sexes, diabetes mellitus in women and suicide in men, most of the absolute education-related inequalities in total mortality are due to cardiovascular diseases, respiratory diseases and diabetes mellitus in women and to cardiovascular diseases, respiratory diseases and cancer in men.

[Socioeconomic pattern in unhealthy diet in children and adolescents in Spain]. / Patrón socioeconómico en la alimentación no saludable en niños y adolescentes en España.

OBJECTIVE: To investigate the possible association of dietary patterns associated with obesity and socioeconomic status in Spanish children and adolescents. DESIGN: Cross-sectional study. PARTICIPANTS: Data were drawn from the 2007 National Health Survey, conducted on a representative sample of Spanish 0-15 years. In this study we have analyzed 6143 subjects from 5 to 15 years. MAIN MEASUREMENTS: It has been estimated prevalence of breakfast skipping, the prevalence of low consumption of fruit and vegetable and the prevalence of high fast food, snacks and sugary drinks consumption. Socioeconomic status indicators were educational level and social class of primary household earner. In each type of food consumption socioeconomic differences were estimated by prevalence ratio using the higher socioeconomic status as reference category. RESULTS: Both in childhood and adolescence, the magnitude of the prevalence ratio shows an inverse socioeconomic gradient in all foods consumption investigated: the lowest and highest prevalence ratios have been observed in subjects from families of higher socioeconomic status and lower, respectively. CONCLUSION: Unhealthy food related with obesity show a clear socioeconomic pattern in Spanish children and adolescents.