Mortality trends for accidental falls in older people in Spain, 2000-2015.

BACKGROUND: Accidental falls in older people are a major public health problem but a relatively limited number of studies have analyzed the mortality trends from this cause. Effective public health interventions have been found to prevent the incidence of falls and their complications. Therefore, characterizing the mortality trends of falls for different subpopulations can help to identify their needs and contribute to develop more appropriate prevention programs for specific target groups. METHODS: This study was based on a longitudinal analysis of death rates from accidental falls (2000-2015) stratified by sex for the population ≥ 65 years and by age groups (65-74, 75-84, ≥85). A joinpoint regression model was used to identify trend inflection points. The Annual Percent Change (APC) was estimated for each trend. RESULTS: Mortality rates per 100,000 person-years increased from 20.6 to 30.1 for men and 13.8 to 20.8 for women between 2000 and 2015. Men presented a relevant trend increase between 2008 and 2015 (APC [95% CI] 7.2% [5.3;9.2]) and women between 2008 and 2013 (7.9% [4.1;11.8]) There were no trend differences between sexes. For 65-74 years old men we found a relevant increase in the last period (2011-2015) (7.8% [1.0;15.1]). Those aged 75-84 years showed a trend increase between 2007 and 2015 (6.4% [4.4;8.4]) and men ≥85 years presented a remarkably high trend between 2008 and 2015 (9.0% [5.2;13]). There were no relevant differences between age groups. Women aged 65-74 had no relevant trend through the period. Those aged 75-84 presented an uniform trend increase for the whole period, 2000-2015, (3.4% [2.3;4.4]) and women ≥85 had and important trend increase between 2008 and 2013 (11.1% [5.3;17.2]), that has reached an stable level in the last 2 years. There were no relevant differences between the 75-84 and ≥85 age groups. CONCLUSIONS: Recent mortality trends from accidental falls increased in men ≥65 years and women ≥75 years. These results recommend the implementation of specific preventive programs.

Trends in infectious disease mortality rates, Spain, 1980-2011.

Using mortality data from National Institute of Statistics in Spain, we analyzed trends of infectious disease mortality rates in Spain during 1980-2011 to provide information on surveillance and control of infectious diseases. During the study period, 628,673 infectious disease-related deaths occurred, the annual change in the mortality rate was -1.6%, and the average infectious disease mortality rate was 48.5 deaths/100,000 population. Although the beginning of HIV/AIDS epidemic led to an increased mortality rate, a decreased rate was observed by the end of the twentieth century. By codes from the International Classification of Diseases, 9th revision, the most frequent underlying cause of death was pneumonia. Emergence and reemergence of infectious diseases continue to be public health problems despite reduced mortality rates produced by various interventions. Therefore, surveillance and control systems should be reinforced with a goal of providing reliable data for useful decision making.

Inequalities in the risk of disability due to traffic injuries in the Spanish adult population, 2009-2010.

BACKGROUND: Although traffic injuries (TIs) are an important cause of disability the related factors are little known. We aimed to estimate the differences in risk of TI-related disability according to individual characteristics that might generate health inequalities. METHODS: Cross-sectional study using a representative Spanish population sample drawn from the European Health Interview Survey 2009/2010. We calculated traffic crashes in the preceding year which resulted in injuries. Disability was measured using the Global Activity Limitation Indicator and four indicators of limitations (sensory, physical functional, self-care and domestic activities). Principal socio-demographic and behavioural/lifestyle variables were studied. We used multivariate logistic regression to estimate the risk (ORs) of TI-related disability in the sample as whole and disability-related factors in persons who had experienced TIs. RESULTS: Persons with TIs had a higher risk of global disability (OR = 1.61; 95%CI:1.17-2.20), physical functional limitations (OR = 1.96; 95%CI:1.33-2.89) and self-care limitations (OR = 1.73; 95%CI:0.98-3.05). Among persons with TIs, GALI-related risk was higher in women (OR = 3.06, p = 0.002) and persons aged over 30 years (OR31-45years = 6.81, p < 0.001; OR46-64years = 5.96, p = 0.011; OR>64years = 4.54, p = 0.047). Lower risk was observed among persons with a higher educational level (OR = 0.22, p = 0.003). The risk of disability among persons with TIs who consumed illegal drugs was OR = 3.9 (p = 0.023). CONCLUSIONS: Traffic injuries in the preceding year are associated with higher risk of disability, which is unevenly distributed. Individual (women and persons over 30 years), socio-economic (lower educational level) and behavioural (illegal drug use) factors are involved. Actions aimed at changing the unequal risk among vulnerable subgroups and providing health, social and protective services should be implemented.

Impact of 2 Successive Smoking Bans on Hospital Admissions for Cardiovascular Diseases in Spain.

INTRODUCTION AND OBJECTIVES: To evaluate the impact of 2 smoking bans enacted in 2006 (partial ban) and 2011 (comprehensive ban) on hospitalizations for cardiovascular disease in the Spanish adult population. METHODS: The study was performed in 14 provinces in Spain. Hospital admission records were collected for acute myocardial infarction (AMI), ischemic heart disease (IHD), and cerebrovascular disease (CVD) in patients aged ≥ 18 years from 2003 through 2012. We estimated immediate and 1-year effects with segmented-linear models. The coefficients for each province were combined using random-effects multivariate meta-analysis models. RESULTS: Overall, changes in admission rates immediately following the implementation of the partial ban and 1 year later were -1.8% and +1.2% for AMI, +0.1 and +0.4% for IHD, and +1.0% and +2.8% for CVD (P>.05). After the comprehensive ban, immediate changes were -2.3% for AMI, -2.6% for IHD, and -0.8% for CVD (P>.05), only to return to precomprehensive ban values 1 year later. For patients aged ≥ 65 years of age, immediate changes associated with the comprehensive ban were -5.0%, -3.9%, and -2.3% for AMI, IHD, and CVD, respectively (P<.05). Again, the 1-year changes were not statistically significant. CONCLUSIONS: In Spain, smoking bans failed to significantly reduce hospitalizations for AMI, IHD, or CVD among patients ≥ 18 years of age. In the population aged ≥ 65 years, hospital admissions due to these diseases showed significant decreases immediately after the implementation of the comprehensive ban, but these reductions disappeared at the 1-year evaluation.

Changes in hospitalizations for chronic respiratory diseases after two successive smoking bans in Spain.

BACKGROUND: Existing evidence on the effects of smoke-free policies on respiratory diseases is scarce and inconclusive. Spain enacted two consecutive smoke-free regulations: a partial ban in 2006 and a comprehensive ban in 2011. We estimated their impact on hospital admissions via emergency departments for chronic obstructive pulmonary disease (COPD) and asthma. METHODS: Data for COPD (ICD-9 490-492, 494-496) came from 2003-2012 hospital admission records from the fourteen largest provinces of Spain and from five provinces for asthma (ICD-9 493). We estimated changes in hospital admission rates within provinces using Poisson additive models adjusted for long-term linear trends and seasonality, day of the week, temperature, influenza, acute respiratory infections, and pollen counts (asthma models). We estimated immediate and gradual effects through segmented-linear models. The coefficients within each province were combined through random-effects multivariate meta-analytic models. RESULTS: The partial ban was associated with a strong significant pooled immediate decline in COPD-related admission rates (14.7%, 95%CI: 5.0, 23.4), sustained over time with a one-year decrease of 13.6% (95%CI: 2.9, 23.1). The association was consistent across age and sex groups but stronger in less economically developed Spanish provinces. Asthma-related admission rates decreased by 7.4% (95%CI: 0.2, 14.2) immediately after the comprehensive ban was implemented, although the one-year decrease was sustained only among men (9.9%, 95%CI: 3.9, 15.6). CONCLUSIONS: The partial ban was associated with an immediate and sustained strong decline in COPD-related admissions, especially in less economically developed provinces. The comprehensive ban was related to an immediate decrease in asthma, sustained for the medium-term only among men.

Smoke-Free Legislation in Spain and Prematurity.

BACKGROUND AND OBJECTIVE: Spain implemented a partial smoking ban in 2006 followed by a comprehensive ban in 2011. The objective was to examine the association between these smoke-free policies and different perinatal complications. METHODS: Cross-sectional study including all live births between 2000 and 2013. Selected adverse birth outcomes were: preterm births (<37 gestational weeks), small for gestational age (SGA; <10th weight percentile according to Spanish reference tables), and low birth weight (<2500 g). We estimated immediate and gradual rate changes after smoking bans by using overdispersed Poisson models with different linear trends for 2000 to 2005 (preban), 2006 to 2010 (partial ban), and 2011 to 2013 (comprehensive ban). Models were adjusted for maternal sociodemographics, health care during the delivery, and smoking prevalence during pregnancy. RESULTS: The comprehensive ban was associated with preterm birth rate reductions of 4.5% (95% confidence interval [CI]: 2.9%-6.1%) and 4.1% (95% CI: 2.5%-5.6%) immediately and 1 year after implementation, respectively. The low birth weight rate also dropped immediately (2.3%; 95% CI: 0.7%-3.8%) and 1 year after the comprehensive ban implementation (3.5%; 95% CI: 2.1%-5.0%). There was an immediate reduction in the SGA rate at the onset of the partial ban (4.9%; 95% CI: 3.5%-6.2%), which was sustained 1 year postimplementation. Although not associated with the comprehensive ban at the onset, the SGA rate declined by 1.7% (95% CI: 0.3%-3.1%) 1 year postimplementation. CONCLUSIONS: The implementation of the Spanish smoke-free policies was associated with a risk reduction for preterm births and low birth weight infants, especially with the introduction of the more restrictive ban.

[Health system interventions assessment in Spain: an approach through the analysis of the time trends and the geographical variability of avoidable mortality between 1986 -2001]. / Medida del resultado de las intervenciones sanitarias en España: una aproximación mediante el análisis temporal y espacial de la mortalidad evitable entre 1986-2001.

BACKGROUND: Many studies have proposed Avoidable Mortality (ME) to monitor the performance of health services although its usefulness is limited by the multiplicity of the avoidable mortality lists being used. Time trends from 1986-2001 and the geographical distribution of avoidable mortality by provinces, are presented for Spain. METHODS: An Avoidable Mortality consensus list is being used. It includes avoidable mortality through the intervention of health services (ISAS in Spanish) and through health policy interventions (IPSI in Spanish). Time trends are analyzed adjusting Poisson or Joinpoint regression models and the annual percentages of change (APC) are estimated. Changes in geographical distribution between the first half of the analysed period and the second are tested by means of standard mortality ratios (SMR) and comparative mortality rates (CMR) for each province. RESULTS: Between 1986 and 2001 avoidable mortality decreased (APC: -1.68; CI: -1.99 and -1.38) slightly more than non-avoidable mortality (APC: -1.28; CI: -1.40 and -1.17). Higher reduction was observed for ISAS mortality (APC: -2.77; CI: -2.89 and -2.65) and an irregular trend for IPSI (between 1986-1990 increase APC: 4.86; CI: 3.32 and 6.41, between 1990-95 stabilization APC: -0.03; CI: -2.32 and 2.31 and finally 1995-2001 decrease APC: -3.57; CI: -4.72 and -2.40). CONCLUSIONS: Avoidable mortality decreased more than non avoidable mortality and important geographical variability can be observed among provinces which should be monitored in order to identify the health services weaknesses. The higher ISAS mortality was observed in southern provinces and the higher IPSI mortality in some areas on the coast. The pattern is somewhat similar for both analyzed periods.

Severity of disability related to road traffic crashes in the Spanish adult population.

BACKGROUND: The severity of disability related to road traffic crashes has been little studied, despite the significant health and socio-economic impacts that determine victims' quality of life. OBJECTIVE: To estimate the consequences of road traffic crashes on the severity of disability, in terms of individuals' capacity to execute activities and perform tasks in their current environment, using aids. METHODS: Cross-sectional study conducted on community-dwelling participants in the "2008 National Survey of Disability", with data on 91,846 households having 20,425 disabled persons, 443 of whom had disability due to road traffic crashes. We measured severity using two indicators, i.e., the Capacity (CSI) and Performance (PSI) Severity Indices. RESULTS: The highest proportion of disability was mild (CSI=70.5%; PSI=80.8%), while 7.6% (CSI) and 4.9% (PSI) was severe/complete respectively. The moderate/severe disability rate was 0.6 per thousand on the CSI, decreasing to 0.4 per thousand on the PSI. No differences were observed by age or sex. Moderate/severely disabled persons had a fourfold higher probability of being retired or unfit for work. Mental and nervous system impairments were more closely related to moderate/severe/complete problems of capacity and performance (p<0.001), disability for carrying out general tasks and demands, and interpersonal interactions and relationships (p<0.001). Being permanently bedridden (p<0.001), receiving aids (p<0.001), family support (p<0.05) and moving home (p<0.05) increased with an increase in the level of severity. CONCLUSION: Road traffic crashes mainly cause mild disability. Moderate/severe disability is associated with lower work capacity, greater functional dependence, and increased need of aids, moving home and family support.

[Spatial analysis of road traffic accidents with fatalities in Spain, 2008-2011]. / Análisis espacial de los accidentes de tráfico con víctimas mortales en carretera en España, 2008-2011.

OBJECTIVE: To estimate the areas of greatest density of road traffic accidents with fatalities at 24 hours per km(2)/year in Spain from 2008 to 2011, using a geographic information system. METHODS: Accidents were geocodified using the road and kilometer points where they occurred. The average nearest neighbor was calculated to detect possible clusters and to obtain the bandwidth for kernel density estimation. RESULTS: A total of 4775 accidents were analyzed, of which 73.3% occurred on conventional roads. The estimated average distance between accidents was 1,242 meters, and the average expected distance was 10,738 meters. The nearest neighbor index was 0.11, indicating that there were aggregations of accidents in space. A map showing the kernel density was obtained with a resolution of 1 km(2), which identified the areas of highest density. CONCLUSIONS: This methodology allowed a better approximation to locating accident risks by taking into account kilometer points. The map shows areas where there was a greater density of accidents. This could be an advantage in decision-making by the relevant authorities.

Disability related to road traffic crashes among adults in Spain.

BACKGROUND: Road traffic accidents cause substantial morbidity and disease burden; few studies have examined their impact on disability. OBJECTIVE: To estimate the magnitude and distribution of disability due to road traffic accidents according to socio-demographic variables, and its main socioeconomic and health determinants. METHODS: A cross-sectional study was conducted in community-dwelling participants in the "2008 Spanish National Disability Survey", a representative sample of 91,846 households with 20,425 disabled persons older than 15 years; 443 had disability due to road traffic accidents. RESULTS: The prevalence was 2.1 per 1000 inhabitants (95% CI:1.8-2.3), with no differences by sex. Risk was highest among persons aged 31 to 64 years, and onset of disability showed a sharp inflection point at age 16 years in both sexes. Odds ratios (ORs) were higher (OR=1.3; 95% CI:1.1- 1.7) for participants with secondary education than for those with the lowest educational levels and were lower (OR: 0.5; 95% CI:0.3-0.8) for participants with the highest household income levels than for those with lowest. Only 24% of disabled participants were gainfully employed. As compared to other sources of disability, traffic crashes caused greater disability in terms of mobility (OR=3.1;p<0.001), a greater need for health/social services (OR=1.5;p=0.003), and more problems with private transportation (OR=1.6;p<0.001), moving around outside the home (OR=1.6;p<0.001) and changes in economic activity (OR=2.4;p<0.001). CONCLUSIONS: The prevalence of disability due to road traffic accidents in Spain is lower than in other developed countries, with middle-aged and socio-economically underprivileged persons being the most affected. Disability due to road traffic accidents is related to a greater demand for social/health care support, problems of accessibility/commuting, and major changes in economic activity.

Assessing the effects of the Spanish partial smoking ban on cardiovascular and respiratory diseases: methodological issues.

OBJECTIVE: Recent research has assessed the impact of tobacco laws on cardiovascular and respiratory morbidity. In this study, we also examined whether the association between the implementation of the 2005 Spanish smoking ban and hospital admissions for cardiovascular and respiratory diseases varies according to the adjustment for potential confounders. DESIGN: Ecological time series analysis. SETTING: Residents of Madrid and Barcelona cities (Spain). OUTCOME: Data on daily emergency room admissions for acute myocardial infarction, cerebrovascular disease, chronic obstructive pulmonary disease (COPD), and asthma derived from the 2003-2006 Spanish hospital admissions registry. METHODS: Changes in admission rates between 2006 and the 2003-2005 period were estimated using additive Poisson models allowing for overdispersion adjusted for secular trend in admission, seasonality, day of the week, temperature, number of flu and acute respiratory infection cases, pollution levels, tobacco consumption prevalence and, for asthma cases, pollen count. RESULTS: In Madrid, fully adjusted models failed to detect significant changes in hospital admission rates for any disease during the study period. In Barcelona, however, hospital admissions decreased by 10.2% (95% CI 3.8% to 16.1%) for cerebrovascular diseases and by 16.0% (95% CI 7.0% to 24.1%) for COPD. Substantial changes in effect estimates were observed on adjustment for linear or quadratic trend. Effect estimates for asthma-related admissions varied substantially when adjusting for pollen count in Madrid, and for seasonality and tobacco consumption in Barcelona. CONCLUSIONS: Our results confirm that the potential impact of a smoking ban must be adjusted for the underlying secular trend. In asthma-related admissions, pollen count, seasonality and tobacco consumption must be specified in the model. The substantial variability in effects detected between the two cities of Madrid and Barcelona lends strong support for a nationwide study to assess the overall effect of a smoking ban in Spain and identify the causes of the observed heterogeneity.

[Economic crisis and communicable diseases. SESPAS report 2014]. / Crisis económica y patología infecciosa. Informe SESPAS 2014.

Past economic crises have increased the impact of communicable diseases especially on groups particularly vulnerable to the social and health consequences of the recession. However, it has been shown that the impact of these crises largely depends on the response of governments and the inhabitants of affected countries. We describe the consequences of the current crisis in the causal chain of infectious disease, including the response of the health system, and explore whether there is evidence of its impact in Spain. It is assumed that the possible effect of the crisis on living and working conditions is due to individual and social debt coupled with high unemployment as defining features of the crisis. We highlight the potential negative consequences of healthcare cuts on vulnerable populations, which have been partly excluded with the recent reform of health coverage. We compare mortality and morbidity data between two periods: before and after 2008, integrating, where possible, observed trends and institutional reports. Overall, no effect on infectious disease has been detected so far, although some signs of worsening, which could be compatible with the effects of the crisis, have been observed and need to be monitored and confirmed. We review the limitations of data sources that may not be sufficiently sensitive or up-to-date to detect changes that may require a latency period to become manifest. Instead of cutting resources, surveillance of these diseases should be improved, and an equitable social health response, which targets the population most affected by the crisis, should be guaranteed.

[Classification of illicit drug-induced deaths in Spain: toward the adoption of the European standard criteria]. / Codificación de la mortalidad directamente relacionada con drogas ilegales en España: hacia una adaptación a los criterios estándar europeos.

AIMS: To describe patterns of ICD-10 classification of illicit drug-induced deaths (DID) in the General Mortality Register (GMR), to assess the applicability of the European criterion (which excludes the X44 code) to extract these deaths from the GMR, and to estimate drug-induced mortality in Spain by applying a correction index for underestimation. METHODS: DID between 1999 and 2007 were extracted from the GMR using the European and the Spanish criteria. Both data sets were compared, and differences in classification patterns by time and space were assessed. Estimations of national mortality from DID were calculated by applying a correction index for underestimation, derived from a specific mortality register, to the deaths extracted from the GMR. RESULTS: Using the Spanish criterion, 5,878 DID were extracted from the GMR for 1999-2007, 88.4% within chapter XX, mainly X42 (48.4%) and X44 (38.8%), and the remaining within chapter V, mainly F19 (11.5%). Chapter V accounted for 6.6% in 1999, 24.6% in 2003 and 8.0% in 2007. Between 2005 and 2007, Catalonia and Andalusia were the autonomous regions showing greatest use of this chapter (34.9% and 30.1%, respectively). Substantially fewer deaths were extracted when the European criterion was used. When the Spanish indicator was used, the estimated DID mortality rate corrected by the underestimation index decreased slowly from 4.7/100,000 in 1999 to 4.1/100,000 inhabitants aged 15-49 years old in 2007. CONCLUSIONS: In Spain, applying the European criterion for extracting DID from the GMR created certain problems, because each DID is assigned a single code, which is sometimes non-specific. Common national criteria should be adopted, following the European criteria as far as possible.