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.

Reproductive desire in women with HIV infection in Spain, associated factors and motivations: a mixed-method study.

BACKGROUND: Antiretroviral therapy has created new expectations in the possibilities of procreation for persons living with HIV. Our objectives were to evaluate reproductive desire and to analyze the associated sociodemographic and clinical factors in HIV-infected women in the Spanish AIDS Research Network Cohort (CoRIS). METHODS: A mixed qualitative-quantitative approach was designed. Women of reproductive age (18-45) included in CoRIS were interviewed by phone, and data were collected between November 2010 and June 2012 using a specifically designed questionnaire. Reproductive desire was defined as having a desire to be pregnant at present or having unprotected sex with the purpose of having children or wanting to have children in the near future. RESULTS: Overall, 134 women were interviewed. Median age was 36 years (IQR 31-41), 55% were Spanish, and 35% were unemployed. 84% had been infected with HIV through unprotected sex, with a median time since diagnosis of 4.5 years (IQR 2.9-6.9). Reproductive desire was found in 49% of women and was associated with: 1) Age (women under 30 had higher reproductive desire than those aged 30-39; OR = 4.5, 95% CI 1.4-14.3); 2) having no children vs. already having children (OR = 3.2; 1.3-7.7 3); Being an immigrant (OR = 2.2; 1.0-5.0); and 4) Not receiving antiretroviral treatment (OR = 3.6; 1.1-12.1). The main reasons for wanting children were related to liking children and wanting to form a family. Reasons for not having children were HIV infection, older age and having children already. Half of the women had sought or received information about how to have a safe pregnancy, 87% had disclosed their serostatus to their family circle, and 39% reported having experienced discrimination due to HIV infection. CONCLUSIONS: The HIV-infected women interviewed in CoRIS have a high desire for children, and the factors associated with this desire are not fundamentally different from those of women in the general population. Maternity may even help them face a situation they still consider stigmatized and prefer not to disclose. Health-care protocols for handling HIV-positive women should incorporate specific interventions on sexual and reproductive health to help them fulfill their procreation desire and experience safe pregnancies.

The influence of parental education on child mental health in Spain.

PURPOSE: To analyze the association between parental education and offspring's mental health in a nationally representative Spanish sample, and assess the contribution of other socioeconomic factors to the association. METHODS: We conducted a secondary analysis of data on 4- to 15-year-olds participating in the 2006 Spanish National Health Survey. Mental health was assessed using the parent-reported Strengths & Difficulties Questionnaire. Parents' respective educational levels were summarized in a single variable. Univariate and multivariate analyses, controlling for family-, child- and parent-related characteristics, were used to study the association. RESULTS: The final sample comprised 5,635 children. A strong association between parental education and parent-reported child mental health was observed among 4- to 11-year-olds, with odds ratios (ORs) increasing as parental educational level decreased. Where both parents had a sub-university level, maternal education showed a stronger association than did paternal education. Following adjustment for covariates, parental education continued to be the strongest risk factor for parent-reported child mental health problems, OR = 3.7 (95% CI 2.4-5.8) for the lowest educational level, but no association was found among 12- to 15-year-olds. Male sex, immigrant status, activity limitation, parent's poor mental health, low social support, poor family function, single-parent families, low family income and social class were associated with parent-reported child mental health problems in both age groups. CONCLUSIONS: Our results show that there is a strong association between parental education and parent-reported child mental health, and that this is indeed stronger than that for income and social class. Among adolescents, however, the effect of parental education would appear to be outweighed by other factors.

Absence of protective ethnic density effect on Ecuadorian migrants' mental health in a recent migration setting: a multilevel analysis.

PURPOSE: We aimed to study the association between the Ecuadorians' ethnic density (EED) of the areas of residence (AR) with the mental health of Ecuadorians in Spain. METHODS: Multilevel study of 568 Ecuadorian adults in 33 AR randomly selected from civil registries and interviewed at home. Possible psychiatric case (PPC) was measured by scoring ≥5 in General Health Questionnaire-28. Ecuadorians' ethnic density was dichotomized in high and low EED (<6 %). Multilevel logistic regression was used to estimate odds ratios (OR) and 95 % confidence intervals (CI). RESULTS: Prevalence of PPC, 24 % (95 %CI 20-28 %), varied by area of residence. Ecuadorians' ethnic density varied by area of residence ranging from 0.9 to 19.5 %. PPC prevalence in High Ecuadorians' ethnic density AR was 29.5 and 20.4 % in low EED AR (p 0.013). Ecuadorians from High EED AR had higher odds of PPC than those from Low EED AR (OR 1.65 95 %CI 1.01-2.72). Adjusting for individual confounders (largely self-perceived discrimination), OR decreased to 1.48 (95 %CI 0.87-2.55). The final model, adjusted by area of residence and educational level, yielded an OR 1.37 (95 %CI 0.78-2.40). CONCLUSIONS: No protective association between the Ecuadorians' ethnic density of the Area of residence and Ecuadorian migrants' mental health was found. Mechanisms underlying beneficial ethnic density effects may be absent in recent migration settings.

Mental health in Ecuadorian migrants from a population-based survey: the importance of social determinants and gender roles.

PURPOSE: To describe the prevalence of and the risk factors for poor mental health in female and male Ecuadorian migrants in Spain compared to Spaniards. METHOD: Population-based survey. Probabilistic sample was obtained from the council registries. Subjects were interviewed through home visits from September 2006 to January 2007. Possible psychiatric case (PPC) was measured as score of ≥5 on the General Health Questionnaire-28 and analyzed with logistic regression. RESULTS: Of 1,122 subjects (50% Ecuadorians, and 50% women), PPC prevalence was higher in Ecuadorian (34%, 95% CI 29-40%) and Spanish women (24%, 95% CI 19-29%) compared to Ecuadorian (14%, 95% CI 10-18%) and Spanish men (12%, 95% CI 8-16%). Shared risk factors for PPC between Spanish and Ecuadorian women were: having children (OR 3.1, 95% CI 1.4-6.9), work dissatisfaction (OR 4.1, 95% CI 1.6-10.5), low salaries (OR 2.5, 95% CI 1.1-5.9), no economic support (OR 1.8, 95% CI 0.9-3.4), and no friends (OR 2.2, 95% CI 1.1-4.2). There was an effect modification between the nationality and educational level, having a confidant, and atmosphere at work. Higher education was inversely associated with PPC in Spanish women, but having university studies doubled the odds of being a PPC in Ecuadorians. Shared risk factors for PPC in Ecuadorian and Spanish men were: bad atmosphere at work (OR 2.4, 95% CI 1.3-4.4), no economic support (OR 3.5, 95% CI 1.3-9.5), no friends (OR 2.5, 95% CI 0.9-6.6), and low social support (OR 1.6, 95% CI 0.9-2.9), with effect modification between nationality and partner's emotional support. CONCLUSIONS: Mental health in Spanish and Ecuadorian women living in Spain is poorer than men. Ecuadorian women are the most disadvantaged group in terms of prevalence of and risk factors for PPC.

The contribution of a gender perspective to the understanding of migrants' health.

In 2005 women represented approximately half of all 190 million international migrants worldwide. This paper addresses the need to integrate a gender perspective into epidemiological studies on migration and health, outlines conceptual gaps and discusses some methodological problems. We mainly consider the international voluntary migrant. Women may emigrate as wives or as workers in a labour market in which they face double segregation, both as migrants and as women. We highlight migrant women's heightened vulnerability to situations of violence, as well as important gaps in our knowledge of the possible differential health effects of factors such as poverty, unemployment, social networks and support, discrimination, health behaviours and use of services. We provide an overview of the problems of characterising migrant populations in the health information systems, and of possible biases in the health effects caused by failure to take the triple dimension of gender, social class and ethnicity into account.

Accuracy of cancer death certificates in Spain: a summary of available information.

OBJECTIVES: Differences in mortality rates within Europe might be partly due to the quality of mortality statistics. The present article summarizes the available data on the quality of cancer death certification in Spain. A short description of the temporal distribution of the proportion of deaths due to ill-defined tumors in Spain -an indirect indicator of the quality of cancer death certification- is also provided. METHODS: Relevant studies were identified from electronic databases (MEDLINE, EMBASE, IME and IBECS) and from manual searches of the references contained in the articles retrieved. Quality data on death certificates for all tumors and for each specific cancer location were summarized, and all main cancer sites were classified according to their pooled accuracy indicators. Trends for the percentage of deaths due to ill-defined tumors and conditions were studied for the period from 1980 to 2002. RESULTS: In Spain, deaths from cancer as a whole and leading cancer sites (lung, colon-rectum, prostate, stomach, pancreas, female breast, uterus, brain, leukemia, lymphomas and myeloma) were well-certified. However, other frequent locations, such as the larynx, esophagus and liver were overcertified, while deaths from bladder, kidney and ovarian cancer were undercertified. The percentage of deaths due to ill-defined tumors and causes was regularly higher in females and decreased in both sexes during the study period. However, the recent introduction of the International Classification of Diseases (ICD)-10 has reversed this trend. CONCLUSIONS: Spanish death certificates can be considered as accurate and useful to estimate the burden of cancer, though certification of some frequent sites should be improved. The possible effect of the introduction of the ICD-10 requires careful surveillance.

[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.

[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.

Impact of the economic crisis on the health of older persons in Spain: research clues based on an analysis of mortality. SESPAS report 2014.

Older adults are seldom considered in studies on the health impact of economic recessions or crises. However, they constitute a population group that is highly vulnerable to decreases in investment in health and social services and social security. Our aim is to examine the relationship between the economic crisis starting in 2008 and the health status of older adults in Spain. More specifically, we analyze changes in trends of mortality in relation to the crisis, the specific impact of winter on mortality and gender differences in the crisis' impact on mortality. Using data from the National Institute of Statistics of Spain on people over 60 years of age, the number of monthly deaths by age and sex from January 2005 to December 2012 was analyzed. Interrupted time series analyses and the "difference in differences" method were used. During the crisis, for adults 60 years and older: 1) the observed mortality seems to be decreasing at a slower rate than what would have been expected in the absence of the crisis; 2) there has been an increase in winter mortality; 3) the impact of the crisis has been greater for female than for male mortality. These results suggest sizable effects of the economic crisis on the mortality of older adults and argue for research done using more detailed analyses integrating economic indicators.

Violence in adulthood and mental health: gender and immigrant status.

The aim of this study was to describe perceived abuse in adult Spanish and Ecuadorian women and men and to assess its association with mental health. A population-based survey was conducted in Spain in 2006. Data were taken from a probabilistic sample allowing for an equal number of men and women, Spaniards and Ecuadorians. Mental disorder was measured with the General Health Questionnaire-28. The nine questions on exposure to physical, sexual, and psychological abuse during the previous year were self-administered. Multivariate logistic regression was used to assess the association between exposure to abuse and poor mental health, adjusting for potential confounders. The sample was composed of 1,059 individuals aged 18 to 54, 104 of whom reported physical, psychological, or sexual abuse. Some 6% refused to answer the questions on abuse. Overall, reported abuse ranged from 13% in Ecuadorian women to 5% in Spanish men. Psychological abuse was the most frequent. Half the abused women, both Spanish and Ecuadorian, reported intimate partner violence (IPV), as did 22% of abused men. Poor mental health was found in 61% of abused Spanish women (adjusted Odds Ratio [ORa] = 5.1; 95% CI: 1.8-14.4), and 62% abused Ecuadorian women (ORa = 4; 95% CI: 2-7.9), in 36% of abused Spanish men (ORa = 3; 95% CI: 0.9-10.7) and in 30% abused Ecuadorian men (ORa = 2.8; 95% CI: 1-7.7). Interpersonal violence is frequent in relations with the partner, the family, and outside the family, and it seriously affects the mental health. Ecuadorian women stand out as the most vulnerable group.

Differences in preterm and low birth weight deliveries between spanish and immigrant women: influence of the prenatal care received.

OBJECTIVES: To compare the risk of preterm and low birth weight among newborns from native and immigrant women and to assess the role of prenatal care in the association between the ethnic origin of the women and their reproductive outcomes. METHODS: Cross-sectional study of 21,708 women giving birth between 1997 and 2008 in a region of Spain. Multinomial logistic regression models were adjusted to evaluate associations between mother's area of origin and adverse reproductive outcomes and to assess the role of prenatal care in the occurrence of adverse reproductive results. RESULTS: Our results indicate a worse prenatal control in immigrants than in natives. Very preterm birth (VPTB) and very low birth weight (VLBW) were greater among immigrants (odds ratio [OR], 1.78; 95% confidence interval [95% CI], 1.14-2.79 for VPTB and OR, 1.73; 95% CI, 0.89-3.33 for VLBW) but after adjustment for prenatal care the differences were substantially reduced (OR, 1.43; 95% CI 0.85-2.42 for VPTB and OR 1.15; 95% CI 0.53-2.52 for VLBW). CONCLUSIONS: Given the positive impact of prenatal care on reproductive results, strategies to improve it among immigrant women should be implemented. The difference found in the direction of the association between area of origin and different categories of low birth weight and preterm suggest that very and moderate categories should be analyzed separately in immigrant studies.