[The accuracy of the causes of death with judicial intervention in Catalonia in the period 2015-2020. Effect of declaration through IML-Web application]. / La precisión de las causas de defunción con intervención judicial en Cataluña en el periodo 2015-2020. Efecto de la declaración a través de la aplicación IML-Web.

OBJECTIVE: On January first, 2020, the Institutes of Legal Medicine and Forensic Sciences (IMLCF) began to inform the causes of death directly to the National Statistics Institute (INE) through a web application (IML-Web). The objective of this study was to evaluate the impact of the implementation of this application on the quality of the data collected. METHODS: A descriptive study using deaths data with judicial intervention that occurred in Catalonia was carried out. The data of the period 2015-2018 and 2019 was compared with 2020. The percentages, with confidence intervals, of the causes of death that were not specific, according to different classifications, were calculated on the total of cases by period and territory. RESULTS: The total percentage of non-specific deaths had decreased, not significantly, by 1.6 points between the period 2015-2018 and 2020. The same indicator between 2019 and 2020 had decreased by 13.4 points. The percentage of non-specific deaths from external causes showed significant drops between both periods and 2020. In general, the indicators displayed territorial differences. CONCLUSIONS: The roll-out of the IML-Web implies, compared to 2019, an improvement in the quality of the data. On the other hand, compared to the period 2015-2018, the data show a similar level of quality. Generally, it is assessed that the information provided by IMLCF of Catalonia through the IML-Web is accurate, but still has room for improvement.

OBJECTIVE: A partir del 1 enero de 2020, los Institutos de Medicina Legal y Ciencias Forenses (IMLCF) empezaron a declarar las causas de muerte directamente al Instituto Nacional de Estadística (INE) mediante una aplicación web (IML-Web). El objetivo de este trabajo fue evaluar el impacto de la implementación de esta aplicación en la calidad de los datos recogidos. METHODS: Se realizó un estudio descriptivo utilizando datos de las defunciones con intervención judicial ocurridas en Cataluña. Se comparó la información del período 2015-2018 y de 2019 con la de 2020. Se calcularon los porcentajes, con intervalo de confianza, de las causas de defunción poco específicas, según diferentes clasificaciones, sobre el total de causas por período y división judicial. RESULTS: El porcentaje total de causas de defunción poco específicas se redujo, de forma no significativa, 1,6 puntos entre el período 2015-2018 y el año 2020. El mismo indicador entre el año 2019 y 2020 se redujo 13,4 puntos. El porcentaje de defunciones poco específicas de causas externas mostró reducciones estadísticamente significativas entre ambos períodos. En general los indicadores mostraron diferencias territoriales. CONCLUSIONS: La implementación del IML-Web en el año 2020 supone, en comparación con 2019, una mejora en la calidad de la información notificada. En cambio, si se compara con el período 2015-2018, los datos muestran una calidad similar. A nivel general se valora que la información proporcionada por el IMLCF de Cataluña a través del IML-Web es precisa, pero todavía tiene margen de mejora.

Decreasing prevalence of chronic back pain in Catalonia. Analysis of the Catalan Health Survey.

OBJECTIVES: Chronic back pain is one of the main health problems reported by the adult population and its prevalence is influenced by different sociodemographic, work and lifestyle-related factors. The aim of this study was to describe the trend in the lifetime prevalence of chronic back pain in the adult Catalan population between 2011 and 2018 and its associated factors. STUDY DESIGN: Cross-sectional study. Secondary analysis of a health survey. METHODS: Trend in lifetime prevalence of chronic back pain by age and sex groups was estimated from the Catalan Health Survey. Association of chronic back pain with sex, age, health status, lifestyle factors, comorbidities, socio-economic and work-related variables was analysed. RESULTS: A total of 31,823 people were interviewed between 2011 and 2018. The prevalence of chronic back pain decreased from 29.7% to 24.2% between 2011-2014 and 2015-2018 in the total population with higher prevalence and a greater difference in women (35%-28.50%) than in men (24.2%-19.7%). Factors associated with higher prevalence of chronic back pain were female sex, older age, poor health status, smoking, alcohol consumption, insufficient physical activity, overweight or obesity, mental health problems, lower educational level or social class, dissatisfaction at workplace, poor social support and family financial problems. CONCLUSIONS: The analysis shows a decreasing prevalence of chronic back pain from 2011 to 2018 in the adult population of Catalonia in all age groups and more significantly in women. An improvement of healthy lifestyle habits, social and occupational determinants, could have reduced the burden of chronic back pain in our community.

Improving prevalence estimation through data fusion: methods and validation.

BACKGROUND: Estimation of health prevalences is usually performed with a single survey. Some attempts have been made to integrate more than one source of data. We propose here to validate this approach through data fusion. Data Fusion is the process of integrating two sources of data into one combined file. It allows us to take even greater advantage of existing information collected in databases. Here, we use data fusion to improve the estimation of health prevalences for two primary health factors: cardiovascular diseases and diabetes. METHODS: We use a real data fusion operation on population health, where the imputation of basic health risk factors is used to enrich a large-scale survey on self-reported health status. We propose choosing the imputation methodology for this problem through a suite of validation statistics that assess the quality of the fused data. The compared imputation techniques have been chosen from among the main imputation methodologies: k-nearest neighbor, probabilistic modeling and regression. We use the 2006 Health Survey of Catalonia, which provides a complete report of the perceived health status. In order to deal with the uncertainty problem, we compare these methodologies under the single and multiple imputation frames. RESULTS: A suite of validation statistics allows us to discern the strengths and weaknesses of studied imputation methods. Multiple outperforms single imputation by providing better and much more stable estimates, according to the computed validation statistics. The summarized results indicate that the probabilistic methods preserve the multivariate structure better; sequential regression methods deliver greater accuracy of imputed data; and nearest neighbor methods end up with a more realistic distribution of imputed data. CONCLUSIONS: Data fusion allows us to integrate two sources of information in order to take grater advantage of the available data. Multiple imputed sequential regression models have the advantage of grater interpretability and can be used for health policy. Under certain conditions, more accurate estimates of the prevalences can be obtained using fused data (the original data plus the imputed data) than just by using only the observed data.

Risk of dependence associated with health, social support, and lifestyle.

OBJECTIVE To analyze the prevalence of individuals at risk of dependence and its associated factors. METHODS The study was based on data from the Catalan Health Survey, Spain conducted in 2010 and 2011. Logistic regression models from a random sample of 3,842 individuals aged ≥ 15 years were used to classify individuals according to the state of their personal autonomy. Predictive models were proposed to identify indicators that helped distinguish dependent individuals from those at risk of dependence. Variables on health status, social support, and lifestyles were considered. RESULTS We found that 18.6% of the population presented a risk of dependence, especially after age 65. Compared with this group, individuals who reported dependence (11.0%) had difficulties performing activities of daily living and had to receive support to perform them. Habits such as smoking, excessive alcohol consumption, and being sedentary were associated with a higher probability of dependence, particularly for women. CONCLUSIONS Difficulties in carrying out activities of daily living precede the onset of dependence. Preserving personal autonomy and function without receiving support appear to be a preventive factor. Adopting an active and healthy lifestyle helps reduce the risk of dependence.

Risk of dependence associated with health, social support, and lifestyle / Riesgo de dependencia asociado a la salud, el apoyo social y el estilo de vida

OBJECTIVE To analyze the prevalence of individuals at risk of dependence and its associated factors.METHODS The study was based on data from the Catalan Health Survey, Spain conducted in 2010 and 2011. Logistic regression models from a random sample of 3,842 individuals aged ≥ 15 years were used to classify individuals according to the state of their personal autonomy. Predictive models were proposed to identify indicators that helped distinguish dependent individuals from those at risk of dependence. Variables on health status, social support, and lifestyles were considered.RESULTS We found that 18.6% of the population presented a risk of dependence, especially after age 65. Compared with this group, individuals who reported dependence (11.0%) had difficulties performing activities of daily living and had to receive support to perform them. Habits such as smoking, excessive alcohol consumption, and being sedentary were associated with a higher probability of dependence, particularly for women.CONCLUSIONS Difficulties in carrying out activities of daily living precede the onset of dependence. Preserving personal autonomy and function without receiving support appear to be a preventive factor. Adopting an active and healthy lifestyle helps reduce the risk of dependence.

OBJETIVO Analizar la prevalencia de personas en riesgo de dependencia y los factores asociados.MÉTODOS El estudio se basó en datos de la Encuesta de Salud de Cataluña, España, realizada de 2010 a 2011. A partir de una muestra aleatoria de 3.842 individuos, de 15 años o más, se llevaron a cabo modelos de regresión logística para clasificar a los individuos según el estado de su autonomía personal. Se plantearon modelos predictivos para identificar las variables susceptibles de intervención que permitieran distinguir a los individuos dependientes de aquellos en riesgo. Se consideraron variables acerca del estado de salud, apoyo social y estilos de vida.RESULTADOS El 18,6% de la población presentó riesgo de dependencia, con efecto más acusado a partir de los 65 años. En comparación con este colectivo, los individuos que se declararon dependientes (11,0%) manifestaron problemas para realizar las actividades cotidianas y obtuvieron apoyo para ello. Estilos de vida, como fumar, consumir alcohol en exceso y ser sedentario se asociaron con mayor probabilidad de dependencia, en particular para las mujeres.CONCLUSIONES Las dificultades para llevar a cabo las actividades cotidianas preceden a la aparición de dependencia. Preservar la propia autonomía y desenvolverse sin recibir apoyo aparecen como factores protectores. La adopción de un estilo de vida activo y saludable contribuye a reducir el riesgo de dependencia.

[Prevalence and determinants of obesity in children and young people in Catalonia, Spain, 2006-2012]. / Prevalencia y condicionantes de la obesidad en la población infantojuvenil de Cataluña, 2006-2012.

BACKGROUND AND OBJECTIVE: To estimate the prevalence of obesity and overweight in children aged 2 to 14 years in Catalonia, its trends between 2006 and 2010-2012, and to evaluate social determinants and lifestyle associated with obesity. MATERIAL AND METHODS: A cross-sectional study, using the data from 4,389 surveys from Catalonia Health Surveys of the years 2006 and 2010-2012, was conducted. Obesity and overweight were determined by World Health Organization criteria. Socioeconomic position, parent's education, usual diet and activity, and hours of sleep were assessed. RESULTS: The prevalence of obesity and overweight were: 15.4 and 20.2% in 2010-2012. The prevalence of obesity was higher in boys (15.5%) compared to girls (12.8%) (P<.05), and higher in children ranging from 2 to 9 years old (17.5%) than children aged 10 to 14 years (7.7%) (P<.05). In 2006, the prevalence of obesity and overweight were similar to the prevalence in 2010-2012. Obesity was more frequent in children with parents with a low socioeconomic position and/or a primary or elementary parent's education. CONCLUSIONS: During the last 5 years (2006-2012), child obesity and overweight have remained stable in Catalonia, yet they are relatively high in Europe. Public health programmes against obesity must consider conducting an intersectional action taking social determinants and family life styles into account.

[New design of the Health Survey of Catalonia (Spain, 2010-2014): a step forward in health planning and evaluation]. / Nuevo diseño de la Encuesta de Salud de Cataluña (2010-2014): un paso adelante en planificación y evaluación sanitaria.

This article presents the genesis of the Health Survey of Catalonia (Spain, 2010-2014) with its semiannual subsamples and explains the basic characteristics of its multistage sampling design. In comparison with previous surveys, the organizational advantages of this new statistical operation include rapid data availability and the ability to continuously monitor the population. The main benefits are timeliness in the production of indicators and the possibility of introducing new topics through the supplemental questionnaire as a function of needs. Limitations consist of the complexity of the sample design and the lack of longitudinal follow-up of the sample. Suitable sampling weights for each specific subsample are necessary for any statistical analysis of micro-data. Accuracy in the analysis of territorial disaggregation or population subgroups increases if annual samples are accumulated.

Impact of the economic crisis on children's health in Catalonia: a before-after approach.

OBJECTIVES: To analyse changes in the family living conditions of children in Catalonia between 2006 and the 2010-2012 period, and to study associations between these changes and health outcomes. DESIGN: A before-after analysis of two cross-sectional surveys. SETTING: Population younger than 15 years of age from Catalonia, Spain. PARTICIPANTS: Representative samples of children in the 2006 Catalan Health Survey (ESCA), baseline, before the crisis; n=2200) and the first four waves of ESCA 2010-2012 (after start of the crisis, n=1967). MAIN OUTCOME MEASURES: Overweight/obesity, health behaviour, mental health and health-related quality of life (HRQOL). Logistic regression and multiple linear regression models were used to analyse the influence of changes in family conditions on outcome measures, including interaction terms to describe the potential influence of the study period on the results. RESULTS: The percentage of unemployed families rose from 9.1% (2006) to 20.6% (2010-2012), with inequalities by level of education. Overweight/obesity increased from 18.4% (95% CI 16.5% to 20.4%) to 26.9% (24.6% to 29.2%) in 2010-2012, and inequalities related to maternal education and employment status persisted. Eating habits have improved in 2010-2012 in disadvantaged families (ie, junk food consumption improved in families with a maternal primary education level; beta (B)=2.85; 0.83 to 4.88, for the survey interaction by primary education level). An improvement in HRQOL was found in the second survey (B=6.07; 4.15 to 7.99), although children whose mothers had a primary education showed poorer HRQOL scores in this survey than in 2006 (B=-4.14; -7.17 to -1.12). CONCLUSIONS: Although some health-related behaviour improved during the study period, childhood obesity increased and inequalities in HRQOL appeared. Policy measures that fight against these inequalities should be urgently implemented to avoid their negative impact on the health of future generations of Catalans.

The local burden of emotional disorders. An analysis based on a large health survey in Catalonia (Spain).

OBJECTIVE: Mental health conditions are associated with a significant burden on individuals. Using data from a large population health survey, the present study aimed to quantify the burden of emotional disorders (depression and anxiety) on health-related quality of life (HRQoL) in the region of Catalonia (Spain) for evidence-informed policy making. METHODS: Regression models were used to estimate the impact of emotional disorders on HRQoL, controlling by socioeconomic factors and somatic health problems. The rate of emotional disorders was based on the General Health Questionnaire (GHQ-12) and quality of life scores were based on the EQ-5D. RESULTS: The impact of emotional disorders on HRQoL was equal to a reduction of 0.17 in the EQ-5D score. Translation of this individual impact to population figures yielded a total loss of 78,742 quality-adjusted life years (QALYs) for 2006. This strong impact highlights the need for global policies aiming to reduce this burden. CONCLUSION: The negative relation between emotional disorders and the HRQoL of individuals was confirmed and quantified for the population of Catalonia. The use of quality of life scales such as the SF or EQ-5D, combined with data on quasi-specific health conditions provides substantial information for prioritizing and planning health programs.

[Methodological characteristics of the Catalan Health Survey 2006]. / Características metodológicas de la Encuesta de Salud de Cataluña 2006.

The Health Survey of Catalonia (ESCA) gives essential population information for health planning and evaluation. On the edition of 2006, 18,126 non-institutionalized persons were interviewed. The sample design is complex with the aim to guarantee the representatively also in small geographic areas with interest in health and service planning. There are certain novelties in the third edition such as the relevance given to the territory, questionnaires adaptations to the interviewed population and new subject areas studied. This paper describes the useful methodological aspects for the ESCA 2006 users. In the first part we describe the sample design, questioners, field work, interviewer's formation, codification and quality micro data control. In the second part compound variables, used tools and their references are shown. And the third part describes the indicators construction since the sample design determines the use of weighing and elevation factors to obtain representative estimation values.

[Impact of chronic diseases on life expectancy in the population of Catalonia, Spain, in 1994 and 2006]. / Impacto de los trastornos crónicos en la esperanza de vida de la población de Cataluña en 1994 y 2006.

This paper analyzes the changes in the prevalence of selected chronic conditions and their impact on the life expectancy in the population of Catalonia. The chronic conditions selected are: hypertension, diabetes, stroke, heart diseases, chronic bronchitis, asthma, chronic allergies, musculoskeletal system diseases, and anxiety/depression. The prevalence of these diseases is estimated from data collected by the Health Survey of Catalonia in 1994 and 2006. The most frequently chronic conditions among the Catalan population are the musculoskeletal disorders, the high blood pressure and the depression and/or anxiety. By the analysis of the changes in the life expectancy free of chronic disorders, this study shows the impact of these disorders in the life expectancy. The burden of the chronic morbidity in our community, and its impact on the health systems, requires further studies to increase the knowledge of this phenomenon.

[Individual and population-based risk in mental health in Catalonia, Spain]. / Riesgo individual y poblacional en salud mental en Cataluña.

Mental health disorders are health problems with a high health, social and economic impact and with relevant effects on the quality of life of both the patients and their families. The objective of this article is to measure the prevalence of mental disorders in Catalonia and to analyze changes the changes in the results obtained in the Goldberg General Health Questionnaire in the Catalan Health Survey editions developed in 1994 and 2006. The prevalence of population at risk of suffering of a mental health disorder does not differ in both years (12.6% in 1994 and 11.6% in 2006). Women showed a higher risk than men in both surveys. Paradoxically, it is amongst the people without risk where the highest number of cases of depression, anxiety, antidepressant use, psychiatry visits or bad perception of health was declared. The results agreed with the risk and prevention paradox and are relevant at the time of designing strategies for mental health disorders prevention.

[The health of men and women in Catalonia, Spain. Are changes occurring?]. / La salud de los hombres y las mujeres en Cataluña. ¿Se están produciendo cambios?

The aim of this work is to show the changes observed in the health profile according to gender in 2006 with respect to 1994 of the population of Catalonia, through the comparison of data obtained in 1994 and 2006 from the Encuesta de Salud de Cataluña. The increase of the level of studies of the population has tended to comparing both sexes. The pattern of the social classes has been invested, so that in 2006 the proportion of women who place themselves in the upper classes and intermediate is superior to that of the men, and the proportion of women belonging to the lower class is inferior to that of the men. The number of women who incorporate into the work and handicapped world has increased those who are declared housewives. The little healthy behaviors continue being more frequent among men but the proportion of smoker and sedentary women increased between 1994 and 2006. Women have a more preventive than men in relation to the taking of blood pressure and measurement of cholesterol levels. People who value their health as positive has increased, but maintains that the percentage of women is lower than in males. The women continue to have more chronic diseases, mental disorders and disabilities. In 2006, and in comparison with 1994, it is observed that in Catalonia the health profile by gender, wherein women have poorer perception of health status, greater number of chronic diseases and disabilities and greater risk of poor mental health than men. Unhealthy habits are still more prevalent among men with the exception of the sedentarism, which is more frequent among women. Women continue practicing preventive activities in greater proportion than men.

[Dependency for activities of daily living in the elderly in Catalonia, Spain]. / Dependencia para la realización de actividades de la vida diaria en las personas mayores de Cataluña.

The aim of this article is to estimate the disabilty prevalence for the activities of daily living (ADL), the socioeconomic and demographic characteristics and the use of health services, distinguishing between the population receiving assistance for ADL and not. Cross-sectional study (Encuesta de Salud de Cataluña [ESCA] 2006). We have analyzed 17 ADL. Differences among proportions are estimated with a 95% confidence interval to characterize the analysis groups. Logistic regression describes the explanatory variables about getting help or not. Disabilty prevalence for the ADL: 26.6% men and 48.2% in women. Of these, 79.6% is getting help. There is a socioeconomic gradient in prevalence, not being observed in relation to assistance or not. We must deepen our understanding of the phenomenon and its evolution to which the ESCA is an essential tool.

[Health-related quality of life and factors associated with overweight and obesity in the pediatric population of Catalonia, Spain]. / Calidad de vida relacionada con la salud y factores asociados al sobrepeso y la obesidad en la población infantil de Cataluña.

The aim of this work is to describe the health-related quality of life (HRQOL), and to analyze the associated factors to overweight/obesity in a representative sample of the Catalan population 0-14 years old. Proxyrespondents answered the child's questionnaire of the Encuesta de Salud de Cataluna (ESCA) 2006 (n = 2.200). Variables analyzed were weight and height, the KIDSCREEN-10 HRQOL questionnaire, and also scales on risky behaviors, physical activity, frequency of fast food consumption, and number of hours of television viewing. Logistic regression models were adjusted. In 31% of children HRQOL was excellent/very good. Risky behaviors and restriction of activity were the associated factors to the best and the worst HRQOL. Maternal level of education and some habits and behaviors were associated to overweight/obesity. The ESCA contributes with useful information to monitor and to assess interventions addressed to the children population.

[Health surveys in Catalonia, Spain: a literature review]. / Encuestas de salud en Cataluña: revisión bibliográfica.

The aim of this study is to analyze biomedical publications on health surveys (HS) in the Catalan territory from documents published in various bibliographic databases to 2010. Analysis of 1,287 HS documents on 3 bibliographic sources of information relating to Catalonia, between 1991 and 2010. Scientific papers on HS in the Catalan territory have been 196. We studied the variables related to the topic of the article published, the magazine publication of the survey, the characteristics of sampling and the sample size, geographical area and timing of the survey. The articles reviewed represent 15.23% of all original documents. Half of them have been published in Spanish journals, stressing Gaceta Sanitaria and Medicina Clínica and the most studied issues are health and lifestyles. A 40.8% clearly explicit the characteristics of the sample, the size of them range between 49 and 23,126 individuals. It is suggested that HS in Catalonia are useful for generating knowledge about health, lifestyle and health resource utilization of the population, and its disclosure among health experts and the public.

[Health surveys: lights and shadows]. / Encuestas de salud: luces y sombras.

Surveys are relevant tolls to analyze social changes and its methods are appropriate to know about the distribution of perceptions and behaviors of different phenomena related to health and disease. Health surveys (HS) are usually focused on areas like social and demographic characteristics, health related behaviors, health status and health services utilization. They provide with information that is not possible to reach through other systematic data sources and are crucial to assist decision making in health policy. HS provide data from the general population which is complementary of that obtained through other procedures and takes into account the various dimensions and connections of health and health system. They are very important in health planning because of its adaptability different need, circumstances or population groups, and in all cases, when properly used, they provide with new knowledge that can be shared. Among its limitations it must be emphasized its reduced capacity to catch all the complexity of social phenomena, its high cost, and the need of a very strong work to coordinate different expert teams and its poor capacity to offer accurate estimates when little geographic areas or low prevalence phenomena are studied. The areas and opportunities for innovation in the design, data gathering and data analysis of HS are actually various and there is a need to try to optimize all its potentialities to get a better knowledge about populations' health and social reality.

[Prevalence of urinary incontinence in Catalonia, Spain]. / Prevalencia de incontinencia urinaria en Cataluña.

BACKGROUND AND OBJECTIVE: To study the prevalence and severity of urinary incontinence (IU) in the population of Catalonia. DESIGN: Descriptive and cross-sectional study. PATIENTS AND METHOD: Sample of 18.126 individuals, representative of the population of Catalonia, not institutionalized. 15.926 of them were older than 15 years and answered the Survey of Health of Catalonia (ESCA). Two questions about frequency and quantity of leakages of urine were added to the ESCA, a health questionnaire with 197 questions. Questions about UI were the Spanish version of Incontinence Severity Index (ISI). RESULTS: In Catalonia (Spain) 7.9% of the population (more than 500.000 persons) had symptoms of IU, corresponding to 12.2% of the women and 3.6% of the men. 77.8% of the total population with UI symptoms were women. The prevalence increased with age in both sexes. 12% of women with an age between the 45-64-years, 26.6% between 65-74 years and 41.8% with 75 years or more, had UI symptoms. Symptoms of UI were present in only 2.8% of the men between 45-64 years , 10.2% between 65-74 years and 22.7% of those of 75 years or more. CONCLUSIONS: A high prevalence of IU was found in the population of Catalonia. In two thirds of individuals with IU, their symptoms were moderate to severe. Severity of UI increases with age in men and women. Overall, symptoms of UI are 3 times more prevalent in women than in men.