Diferencias por sexo y nivel de renta en la mortalidad por causas directamente relacionadas con el alcohol en Navarra, 1993-2017 / Differences by sex and income level in mortality from causes directly related to alcohol in Navarre, 1993-2017

FUNDAMENTO: El consumo de alcohol es factor de riesgo para muchos problemas de salud. Se estudia la mortalidad por causas directamente atribuibles al consumo de alcohol por sexo y nivel de renta y se analizan las tendencias en el periodo 1993-2017 en Navarra. MÉTODO: Se seleccionaron mediante los códigos CIE-9 y CIE-10 los fallecimientos por trastornos mentales inducidos por alcohol, dependencia y abuso, cardiomiopatía alcohólica, cirrosis alcohólica y otras enfermedades alcohólicas del hígado, y envenenamiento accidental por alcohol. Se utilizaron las categorías de renta asociadas al copago farmacéutico como indicador de la posición socioeconómica. Finalmente, se calcularon las tasas de mortalidad ajustadas a la población estándar europea mediante el método directo y se utilizó regresión joinpoint para evaluar la tendencia temporal. RESULTADOS: Se registraron un total de 441 fallecimientos en la población de 35-79 años, siendo la cirrosis hepática la causa más frecuente (77,5%). En 1993-1997 y 2013-2017, las tasas de mortalidad en los hombres eran diez y cinco veces más altas que en las mujeres, respectivamente. Las tasas de mortalidad fueron cinco veces más elevadas en hombres con rentas menores de 18.000 €. No se observaron cambios estadísticamente significativos en la tendencia de las tasas de mortalidad en el periodo estudiado. CONCLUSIONES: La mortalidad por causas totalmente atribuibles alcohol no ha disminuido en Navarra en las últimas tres décadas, siendo superior en hombres y en la población con menores rentas económicas

BACKGROUND: Alcohol consumption is a risk factor for many health problems. Mortality from causes of death wholly attributable to alcohol consumption by sex and income level was studied and trends in the 1993-2017 period were analyzed in Navarre (Spain). METHODS: Deaths due to alcohol-induced mental disorders, dependence and abuse, alcoholic cardiomyopathy, alcoholic cirrhosis and other alcoholic liver diseases, and accidental alcohol poisoning were selected through codes ICD-9 and ICD-10. Annual income that determines copayment level was used as an indicator of socioeconomic status. Mortality rates adjusted to the European standard population were calculated using the direct method and joinpoint regression was used to evaluate the temporal trend. RESULTS: A total of 441 deaths were recorded in the population aged 35-79 years. It highlights liver cirrhosis as the most common cause (77,5%). Death rates in men were ten and five times higher than in women in 1993-1997 and 2013-2017 periods, respectively. Compared to men with incomes above 18,000 €, mortality rates were five times higher in the population with incomes below 18,000 €. No statistically significant changes were observed in the trend of mortality rates throughout the period studied. CONCLUSIONS: Mortality by causes of death wholly attributable to alcohol has not decreased in Navarre in the last three decades, it is higher in men than in women and in the population with lower incomes

[Differences by sex and income level in mortality from causes directly related to alcohol in Navarre, 1993-2017]. / Diferencias por sexo y nivel de renta en la mortalidad por causas directamente relacionadas con el alcohol en Navarra, 1993-2017.

BACKGROUND: Alcohol consumption is a risk factor for many health problems. Mortality from causes of death wholly attributable to alcohol consumption by sex and income level was studied and trends in the 1993-2017 period were analyzed in Navarre (Spain). METHODS: Deaths due to alcohol-induced mental disorders, dependence and abuse, alcoholic cardiomyopathy, alcoholic cirrhosis and other alcoholic liver diseases, and accidental alcohol poisoning were selected through codes ICD-9 and ICD-10. Annual income that determines copayment level was used as an indicator of socioeconomic status. Mortality rates adjusted to the European standard population were calculated using the direct method and joinpoint regression was used to evaluate the temporal trend. RESULTS: A total of 441 deaths were recorded in the population aged 35-79 years. It highlights liver cirrhosis as the most common cause (77,5%). Death rates in men were ten and five times higher than in women in 1993-1997 and 2013-2017 periods, respectively. Compared to men with incomes above 18,000 €, mortality rates were five times higher in the population with incomes below 18,000 €. No statistically significant changes were observed in the trend of mortality rates throughout the period studied. CONCLUSIONS: Mortality by causes of death wholly attributable to alcohol has not decreased in Navarre in the last three decades, it is higher in men than in women and in the population with lower incomes.

Prostate cancer incidence and mortality in Navarre (Spain) / Incidencia y mortalidad del cáncer de próstata en Navarra (España)

Background: Prostate cancer is one of the most commonly diagnosed malignancies among males worldwide. In this study, overall and age-specific incidence and mortality trends are analyzed in order to present the past and current epidemiological situation of the disease in Navarre (Spain). Methods: Population-based incidence data from the 1975- 2010 period, provided by the Cancer Registry of Navarre and prostate cancer specific mortality data for 1975-2013, provided by the Spanish Statistical Office, were used in the analysis. Age-standardized incidence and mortality rates, change-points and annual percentage changes (APC) were estimated by joinpoint regression analysis. One-dimensional P-spline models were used to estimate projections up to 2016. Results: Considerable increases of cancer incidence rates in men aged 45-74 years were observed, with APC of +4.5% (p<0.001), +9.5% (p<0.001) and +2.4% (p<0.05) in the 1975- 1990, 1990-2000 and 2000-2010 periods, respectively. In the older than 74 age-group, an increase of incidence rates in the 1975-1999 period was registered (APC +3.3%, p<0.001), followed by a significant decrease up to 2010 (APC -4.0%, p<0.01). Mortality rates rose until 1995 (APC +2.2%, p<0.001) whereas a decline occurred afterwards up to 2013 (APC -3.4%, p<0.001). Conclusion: Even though overall prostate cancer incidence rates seem to have stabilized in 2002-2010 in Navarra, trends were different by age groups: increased in men 45-74 years old and decreased in the 75+ year age-group. A decline in mortality rates was observed in both age groups since about 1995. Changes in the use of prostate specific antigen test for screening in oncoming years could affect future prostate cancer trends

Fundamento: A nivel mundial, el cáncer de próstata es uno de los tumores malignos más comúnmente diagnosticados en los hombres. En este estudio, se analizan las tendencias de la incidencia y mortalidad de cáncer de próstata, global y por grupos de edad, para mostrar la situación epidemiológica pasada y actual de la enfermedad en Navarra (España). Método: Para el estudio se utilizaron los casos incidentes diagnosticados entre 1975 y 2010, y las muertes observadas entre 1975 y 2013. Los datos fueron proporcionados por el Registro de Cáncer de Navarra y el Instituto Nacional de Estadística respectivamente. Se calcularon las tasas de incidencia y mortalidad estandarizadas por edad, los puntos de cambio y el porcentaje de cambio anual (PCA) mediante modelos de regresión de joinpoint. Se usaron modelos unidimensionales de P-splines para estimar proyecciones hasta 2016. Resultados: Se observó un considerable incremento en lastasas de incidencia de cáncer de próstata en hombres de 45-74 años, con PCA de +4,5% (p<0,001), +9,5% (p<0,001) y +2,4% (p<0,05) en los periodos 1975-1990, 1990-2000 y 2000- 2010, respectivamente. En el grupo de mayores de 74 se registró un aumento de incidencia en el período 1975-1999 (PCA +3,3%, p<0,001), seguido de una disminución significativa hasta 2010 (PCA -4,0%, p<0,01). Las tasas de mortalidad aumentaron hasta 1995 (PCA +2,2%, p<0,001), mientras que descendieron en el periodo 1995-2013 (PCA -3.4%, p<0,001). Conclusión: Aunque las tasas globales de incidencia de cáncer de próstata parecen estabilizarse en 2002-2010 en Navarra, las tendencias fueron diferentes según los grupos de edad, aumentando en los hombres de 45-74 años y disminuyendo en el grupo de mayores de 74 años. Se observó una disminución en las tasas de mortalidad en ambos grupos de edad desde 1995. Cambios en el uso del antígeno prostático específico para cribado en los próximos años podrían afectar las futuras tendencias del cáncer de próstata

Prostate cancer incidence and mortality in Navarre (Spain).

BACKGROUND: Prostate cancer is one of the most commonly diagnosed malignancies among males worldwide. In this study, overall and age-specific incidence and mortality trends are analyzed in order to present the past and current epidemiological situation of the disease in Navarre (Spain). METHODS: Population-based incidence data from the 1975-2010 period, provided by the Cancer Registry of Navarre and prostate cancer specific mortality data for 1975-2013, provided by the Spanish Statistical Office, were used in the analysis. Age-standardized incidence and mortality rates, change-points and annual percentage changes (APC) were estimated by joinpoint regression analysis. One-dimensional P-spline models were used to estimate projections up to 2016. RESULTS: Considerable increases of cancer incidence rates in men aged 45-74 years were observed, with APC of +4.5% (p<0.001), +9.5% (p<0.001) and +2.4% (p<0.05) in the 1975-1990, 1990-2000 and 2000-2010 periods, respectively. In the older than 74 age-group, an increase of incidence rates in the 1975-1999 period was registered (APC +3.3%, p<0.001), followed by a significant decrease up to 2010 (APC -4.0%, p<0.01). Mortality rates rose until 1995 (APC +2.2%, p<0.001) whereas a decline occurred afterwards up to 2013 (APC -3.4%, p<0.001). CONCLUSION: Even though overall prostate cancer incidence rates seem to have stabilized in 2002-2010 in Navarra, trends were different by age groups: increased in men 45-74 years old and decreased in the 75+ year age-group. A decline in mortality rates was observed in both age groups since about 1995. Changes in the use of prostate specific antigen test for screening in oncoming years could affect future prostate cancer trends.

Trends in transport accident mortality from 1999 to 2013 in Navarra. Characteristics of people and vehicles involved / Evolución de la mortalidad por accidentes de transporte en Navarra durante 1999-2013. Características de las personas y vehículos involucrados.

Objective. To analyze transport accident mortality trends in Navarra, a region in the North of Spain, between 1999 and 2013 and assess the effect of the Demerit Point System. Methods. Cause of death coding was done according to ICD-10 with information from the medical death certificate and forensic reports. Mortality rates by age, sex, type of victim and residence (urban/rural) were calculated. We performed an ARIMA Box and Jenkins analysis to estimate the effect on mortality rates due to transport accidents of the Demerit Point System, which had been introduced in Spain in July 2006. Results. From January 1st 1999 to December 31st 2013, 1,052 deaths were registered, 1,044 of which were from accidents involving ground transport vehicles (1,020 from road traffic accidents and 24 from non-road traffic accidents). Mortality rates were higher in men and people aged 18-24 and 65-84. Most of the deaths amongst younger men and adults occurred in drivers, while fatalities occurring in those older than 84 years were mostly in pedestrians. Men and women living in rural areas had a mortality risk from transport accident 33% and 21% higher than people living in urban areas. Since the introduction of the Demerit Point System, mortality rates have fallen by 51%. Conclusions. Mortality statistics for Navarra show the effectiveness of preventive strategies designed in Spain during recent years.

Evolución de la mortalidad por accidentes de transporte en Navarra durante 1999-2013. Características de las personas y vehículos involucrados / Trends in transport accident mortality from 1999 to 2013 in Navarra. Characteristics of people and vehicles involved

Fundamento: Se analizan las tendencias de la mortalidad por accidentes de transporte entre 1999 y 2013 y se evalúa el impacto de la introducción del permiso de conducción por puntos en Navarra. Material y métodos: Los datos para la realización de este estudio proceden de los ficheros de defunciones según la causa de muerte que anualmente publica el Instituto Nacional de Estadística (INE). La codificación de la causa de defunción se realizó con la CIE-10, a partir de la información de los documentos estadísticos de defunción y los informes forenses. Se calcularon tasas por edad, sexo, tipo de víctima, tipo de accidente y residencia (urbano/rural). Para estimar el efecto de la ley del permiso de conducción por puntos que entró en vigor en julio de 2006 se utilizó un modelo ARIMA de Box and Jenkins de series temporales. Resultados: Se registraron un total de 1.052 fallecimientos por accidentes de transporte, de los cuales 1.044 fueron de vehículos de transporte terrestre (1.020 por accidentes de tráfico y 24 por accidentes no de tráfico). Entre los jóvenes, destaca la mortalidad en conductores de vehículo de motor; mientras que entre los mayores de 84 años, las víctimas fueron en mayor proporción peatones. Los hombres y mujeres residentes en zonas rurales presentaron tasas de mortalidad un 33% y un 21% más elevadas. Tras la instauración del permiso de conducción por puntos, la tasa de mortalidad por accidente de tráfico descendió un 51%. Conclusiones: Las estadísticas de mortalidad de Navarra muestran la efectividad de las estrategias preventivas organizadas en España (AU)

Objective: To analyze transport accident mortality trends in Navarra, a region in the North of Spain, between 1999 and 2013 and assess the effect of the Demerit Point System. Methods: Cause of death coding was done according to ICD-10 with information from the medical death certificate and forensic reports. Mortality rates by age, sex, type of victim and residence (urban/rural) were calculated. We performed an ARIMA Box and Jenkins analysis to estimate the effect on mortality rates due to transport accidents of the Demerit Point System, which had been introduced in Spain in July 2006. Results: From January 1st 1999 to December 31st 2013, 1,052 deaths were registered, 1,044 of which were from accidents involving ground transport vehicles (1,020 from road traffic accidents and 24 from non-road traffic accidents). Mortality rates were higher in men and people aged 18-24 and 65-84. Most of the deaths amongst younger men and adults occurred in drivers, while fatalities occurring in those older than 84 years were mostly in pedestrians. Men and women living in rural areas had a mortality risk from transport accident 33% and 21% higher than people living in urban areas. Since the introduction of the Demerit Point System, mortality rates have fallen by 51%. Conclusions: Mortality statistics for Navarra show the effectiveness of preventive strategies designed in Spain during recent years (AU)

Cause of death in hospitalized patients with laboratory-confirmed influenza.

BACKGROUND: We analyzed the underlying cause of death recorded in hospitalized patients with laboratory-confirmed influenza. METHODS: The present study included all patients with a laboratory-confirmed diagnosis of influenza during the influenza seasons 2009-2010 to 2013-2014 who were attended to in hospital and died. Their underlying cause of death according to the International Classification of Diseases 10th Revision was obtained from the Navarre Mortality Registry. RESULTS: Among 49 patients studied, the underlying causes of death were 35% influenza, 4% pneumonia, 14% other respiratory diseases, 10% circulatory disease and 37% other causes. CONCLUSIONS: Non-cardiorespiratory causes accounted for a third of deaths in patients with confirmed influenza, thus all-cause mortality should be considered in estimating the full burden of influenza mortality.

Cause of death in hospitalized patients with laboratory-confirmed influenza / Causa de muerte en pacientes hospitalizados con gripe confirmada por laboratorio

Background: We analyzed the underlying cause of death recorded in hospitalized patients with laboratory-confirmed influenza. Methods: The present study included all patients with a laboratory-confirmed diagnosis of influenza during the influenza seasons 2009-2010 to 2013-2014 who were attended to in hospital and died. Their underlying cause of death according to the International Classification of Diseases 10th Revision was obtained from the Navarre Mortality Registry. Results: Among 49 patients studied, the underlying causes of death were 35% influenza, 4% pneumonia, 14% other respiratory diseases, 10% circulatory disease and 37% other causes. Conclusions: Non-cardiorespiratory causes accounted for a third of deaths in patients with confirmed influenza, thus all-cause mortality should be considered in estimating the full burden of influenza mortality (AU)

Fundamento: La mortalidad por gripe no se conoce bien porque la mayoría de las personas que mueren por gripe no se confirman por laboratorio. Analizamos la causa básica de muerte registrada en los pacientes hospitalizados con gripe confirmada por laboratorio. Métodos: Se incluyeron todos los pacientes con diagnóstico de gripe por laboratorio que habían sido atendidos en el hospital y murieron durante las temporadas 2009-2010 a 2013-2014 en Navarra. La causa básica demuerte se obtuvo del Registro de Mortalidad. Resultados: Entre los 49 pacientes estudiados, la causa básica de muerte fue en el 35% gripe, en el 4% neumonía, en el 14% otras enfermedades respiratorias, en el 10% enfermedades cardiovasculares y en el 37% otras causas. Conclusiones: Un tercio de las muertes en pacientes con gripe confirmada se asignaron a causas no cardiorrespiratorias. Deberían tenerse en cuenta todas las causas para estimar la carga total de la mortalidad por gripe (AU)

[Socioeconomic inequalities in mortality in Pamplona and Logroño (cities in the North of Spain) in the 1996-2007 period]. / Desigualdades socioeconómicas en la mortalidad en Pamplona y Logroño en el periodo 1996-2007.

BACKGROUND: The objective of this study was to describe inequalities in mortality in the cities of Logroño and Pamplona, using a socioeconomic privation index by census tract. METHODS: Deaths were geocoded using the mailing address of the Death Statistics Bulletin and, in its absence, that of the Spanish Municipal Register or the Spanish Health Card. The socioeconomic variables used to construct the deprivation index were obtained from the Spanish Population and Housing Census of 2001. Census tracts were grouped by socioeconomic deprivation quintiles. In each quintile, age-adjusted mortality rates were computed by sex and age group (0-64, ≥ 65). RESULTS: In both cities, higher mortality rates were observed in the geographical areas with higher socio-economic deprivation. This was particularly evident among men under 65 for whom a positive gradient between mortality and the deprivation index was observed. The areas with higher deprivation reached a relative risk (RR) of 1.61 (CI 95%, 1, 33-1, 92) and 1.77 (CI 95%, 1, 55-2 01) in Pamplona and Logroño respectively. Among women under 65, a RR of 1.44 (CI 95%, 1, 18-1, 74) and 1.48 (CI 95%, 1, 10-1, 95) were shown for the most depressed areas of Pamplona and Logroño respectively. CONCLUSIONS: The study highlighted inequalities in mortality associated with socioeconomic deprivation in the cities of Logroño and Pamplona. Also showed was the utility of analysing socio-economic indicators and mortality by small areas in order to identify inequality in health.

Desigualdades socioeconómicas en la mortalidad en Pamplona y Logroño en el periodo 1996-2007 / Socioeconomic inequalities in mortality in Pamplona and Logroño (cities in the North of Spain) in the 1996-2007 period

Fundamento. Describir las desigualdades en mortalidad en Logroño y Pamplona, ciudades del norte de España, utilizando un indicador de privación socioeconómica por secciones censales. Métodos. Para geocodificar la residencia de los fallecidos en base a las unidades censales se utilizó la dirección postal del Boletín Estadístico de Defunción y en su defecto la del Padrón Municipal o Tarjeta Sanitaria. Las variables socioeconómicas que componen el índice de privación se obtuvieron del Censo de Población y Vivienda de 2001. Se agruparon las secciones censales por quintiles de menor a mayor privación socioeconómica y se calcularon tasas ajustadas para la mortalidad total y para una lista de causas por sexo, grupo de edad (0-64,≥ 65) y quintil del índice de privación socioeconómico. Resultados. La comparación de la mortalidad de las zonas con menor privación socioeconómica respecto a zonas geográficas con mayor privación mostró en ambas ciudades una mayor mortalidad principalmente entre los hombres menores de 65 años. En este subgrupo se observó un gradiente positivo entre la mortalidad y el índice de privación. Las zonas situadas en el quintil de mayor privación alcanzaron un riesgo relativo (RR) de 1,61 (IC 95%, 1,33-1,92) en Pamplona y de 1,77 (IC 95%, 1,55-2,01) en Logroño. Las mujeres menores de 65 años mostraron un RR de 1,44 (IC 95%, 1,18-1,74) y de1,48 (IC 95%, 1,10-1,95) en las zonas situadas en el quintil de mayor privación de Pamplona y Logroño, respectivamente. Conclusiones. El estudio evidenció desigualdades en mortalidad asociadas a la privación socioeconómica en las ciudades de Logroño y Pamplona. También mostró la utilidad de los indicadores socioeconómicos y de mortalidad a nivel de área pequeña para identificar desigualdades en salud (AU)

Background. The objective of this study was to describe inequalities in mortality in the cities of Logroño and Pamplona, using a socioeconomic privation index by census tract. Methods. Deaths were geocoded using the mailing address of the Death Statistics Bulletin and, in its absence, that of the Spanish Municipal Register or the Spanish Health Card. The socioeconomic variables used to construct the deprivation index were obtained from the Spanish Population and Housing Census of 2001. Census tracts were grouped by socioeconomic deprivation quintiles. In each quintile, age-adjusted mortality rates were computed by sex and age group (0-64, ≥ 65). Results. In both cities, higher mortality rates were observed in the geographical areas with higher socio-economic deprivation. This was particularly evident among men under65 for whom a positive gradient between mortality and the deprivation index was observed. The areas with higher deprivation reached a relative risk (RR) of 1.61 (CI 95%, 1,33-1, 92) and 1.77 (CI 95%, 1, 55-2 01) in Pamplona and Logroño respectively. Among women under 65, a RR of 1.44 (CI95%, 1, 18-1, 74) and 1.48 (CI 95%, 1, 10-1, 95) were shown for the most depressed areas of Pamplona and Logroño respectively. Conclusions. The study highlighted inequalities in mortality associated with socioeconomic deprivation in the cities of Logroño and Pamplona. Also showed was the utility of analysing socio-economic indicators and mortality by small areas in order to identify inequality in health (AU)

[Analysis of weekly mortality as a tool for the early detection of alerts in public health]. / Análisis de la mortalidad semanal como herramienta para la detección temprana de alertas en salud pública.

BACKGROUND: There is a growing interest in public health in monitoring indicators in real time that permit immediate action to be taken. The aim of this study is to evaluate the utility of the analysis of weekly mortality for the early detection of alerts in public health. METHODS: We analysed the early reception of mortality (ERM) from five computerised civil registers in Navarre and gathered 70% of total mortality (TM) for the 2003-2007 period. We identified the weeks when mortality exceeded the threshold calculated on the basis of the five previous years. We analysed the correspondence of these excesses in mortality with flu levels of incidence and with high atmospheric temperatures. RESULTS: The was moderate concordance between the alerts detected from the information proceeding from the ERM and TM sources (Kappa index 0.59; CI 95% 0.42-0.76). Both sources behaved analogously in the detection of excesses of mortality when these occurred in weeks of severe flu, with 13 and 12 alerts respectively. In relation to high temperatures, TM only generated alerts in the years when heat waves were declared, while ERM also generated them in other weeks which were hot but did not reach the heat wave threshold. CONCLUSION: The early availability of results, the acceptable concordance between sources and the high percentage of excesses of mortality attributable to identified public health problems, show the potential utility of monitoring weekly mortality in epidemiological surveillance.

Análisis de la mortalidad semanal como herramienta para la detección temprana de alertas en salud pública / Analysis of weekly mortality as a tool for the early detection of alerts in public health

Fundamento. En salud pública tiene interés crecientemonitorizar indicadores en tiempo real que posibiliten laactuación inmediata. Se plantea como objetivo del estudioevaluar la utilidad del análisis de la mortalidad semanalpara la detección temprana de alertas en salud pública.Métodos. Se analizó la mortalidad de recepción temprana(MRT) que proviene de cinco registros civiles informatizadosde Navarra y recogen el 70% de la mortalidadtotal (MT) para el periodo 2003-2007. Se identificaronlas semanas en las que la mortalidad registrada habíasobrepasado el umbral calculado a partir de los 5 añosprecedentes. Se analizó la correspondencia de estos excesosde mortalidad con los niveles de incidencia degripe y con las temperaturas ambientales elevadas.Resultados. La concordancia entre las alertas detectadasa partir de la información de las fuentes de MRT yMT fue moderada (índice Kappa 0,59; IC 95% 0,42-0,76).Ambas fuentes se comportaron de forma análoga en ladetección de excesos de mortalidad cuando estos ocurrieronen semanas con actividad gripal, con 13 y 12alertas respectivamente. En relación a las temperaturaselevadas, la MT generó alertas únicamente en los añosen los que se declararon olas de calor, mientras que laMRT también las generó en otras semanas calurosas,pero que no alcanzaron el umbral de ola de calor.Conclusión. La disponibilidad temprana de resultados,la concordancia aceptable entre fuentes y el alto porcentajede excesos de mortalidad que pueden atribuirsea problemas de salud pública identificados, muestranla potencial utilidad de la monitorización de lamortalidad semanal en vigilancia epidemiológica(AU)

Background. There is a growing interest in publichealth in monitoring indicators in real time that permitimmediate action to be taken. The aim of this study isto evaluate the utility of the analysis of weekly mortalityfor the early detection of alerts in public health.Methods. We analysed the early reception of mortality(ERM) from five computerised civil registers in Navarreand gathered 70% of total mortality (TM) for the 2003-2007 period. We identified the weeks when mortalityexceeded the threshold calculated on the basis of thefive previous years. We analysed the correspondence ofthese excesses in mortality with flu levels of incidenceand with high atmospheric temperatures.Results. The was moderate concordance between thealerts detected from the information proceeding fromthe ERM and TM sources (Kappa index 0.59; CI 95%0.42-0.76). Both sources behaved analogously in the detectionof excesses of mortality when these occurred inweeks of severe flu, with 13 and 12 alerts respectively.In relation to high temperatures, TM only generatedalerts in the years when heat waves were declared, whileERM also generated them in other weeks which werehot but did not reach the heat wave threshold.Conclusion. The early availability of results, the acceptableconcordance between sources and the highpercentage of excesses of mortality attributable toidentified public health problems, show the potentialutility of monitoring weekly mortality in epidemiologicalsurveillance(AU)

Estimating the impact of the 2009 influenza A(H1N1) pandemic on mortality in the elderly in Navarre, Spain.

We analysed mortality among people aged 65 years or older in Navarre, Spain in 2009 and compared it with the mean for the same period of time in the previous three years. In the pandemic weeks 24 to 52 2009 we observed 4.9% more deaths than expected (p=0.0268). Excess mortality occurred during the circulation of seasonal influenza (8.0%, p=0.0367) and the first wave of pandemic influenza (9.9%, p=0.0079). In the second wave of pandemic influenza there was a non-significant excess of deaths (5.2%, p=0.1166). Surveillance of laboratory-confirmed severe influenza cases detected only one death in this age group.

[Varicella and herpes zoster incidence prior to the introduction of systematic child vaccination in Navarre, 2005-2006]. / Incidencia de la varicela y el herpes zóster antes de la introducción de la vacunación sistemática infantil en Navarra, 2005-2006.

Varicella is an acute and highly contagious disease produced by the varicella-zoster virus, which leaves lasting immunity. Herpes zoster is produced by reactivation of a latent infection of the same virus. The introduction of systematic and free vaccination against varicella in children of 15 months in Navarre from 2007 onwards can be expected to produce important epidemiological changes. For this reason we describe the previous epidemiological situation in the period from 2005 to 2006. We analysed all cases of varicella and herpes zoster registered in the electronic clinical files of primary care, in the database of hospital discharges and in the mortality register. Between 2005 and 2006, 9,908 cases of varicella were diagnosed (8.29 annually per 1,000 inhabitants), with 90% in children under 15 years old. There were 80 hospital admissions (8 for every 1,000 cases), complications in 2.5 out of every 1,000 cases, and there was one death due to this cause (0.1 per 1,000 cases). In the same period, 4,959 cases of herpes zoster were diagnosed (4.15 cases per 1,000 inhabitants), half in people over 55 years old. There were 179 hospital admissions (36 per 1,000 cases), whose average age was 77, and 83 presented complications (16.7 per 1,000 cases). This epidemiological pattern is similar to that found in other places before the introduction of the vaccine.

Incidencia de la varicela y el herpes zóster antes de la introducción de la vacunación sistemática infantil en Navarra, 2005-2006 / Varicella and herpes zoster incidence prior to the introduction of systematic child vaccination in Navarre, 2005-2006

La varicela es una enfermedad aguda muy contagiosa producida por el virus varicela-zoster, que deja inmunidad duradera. El herpes zóster se produce por reactivación de una infección latente por el mismo virus. La introducción de la vacunación sistemática y gratuita frente a la varicela en niños de 15 meses de Navarra desde 2007, previsiblemente producirá cambios epidemiológicos importantes. Por ello, describimos la situación epidemiológica previa, en el periodo 2005-2006.Se han analizado los casos de varicela y herpes zóster registrados en las historias clínicas informatizadas de atención primaria, en la base de datos de altas hospitalarias (CMBD) y en el registro de mortalidad. Entre 2005 y 2006 se diagnosticaron 9908 casos de varicela (8,29 anuales por 1000 habitantes), siendo el 90% en menores de 15 años. Hubo 80 ingresos (8 por cada 1000 casos), complicaciones en 2,5 de cada 1.000 casos y se produjo un fallecimiento por esta causa (0,1 por 1000 casos). En el mismo periodo se diagnosticaron 4.959 casos de herpes zóster (4,15 casos anuales por 1.000 habitantes), la mitad en mayores de 55 años. Hubo 179 ingresos (36 por 1.000 casos), cuya edad media fue de77 años, y 83 presentaron complicaciones (16,7 por 1.000 casos). Este patrón epidemiológico es similar al encontrado en otros lugares antes de la introducción de la vacuna (AU)

Varicella is an acute and highly contagious disease produced by the varicella-zoster virus, which leaves lasting immunity. Herpes zoster is produced by reactivation of a latent infection of the same virus. The introduction of systematic and free vaccination against varicella in children of 15 months in Navarre from 2007 onwards can be expected to produce important epidemiological changes. For this reason we describe the previous epidemiological situation in the period from 2005 to 2006.We analysed all cases of varicella and herpes zoster registered in the electronic clinical files of primary care, in the database of hospital discharges and in the mortality register. Between 2005 and 2006, 9,908 cases of varicella were diagnosed (8.29 annually per 1,000 in habitants), with 90% in children under 15 years old. There were 80 hospital admissions (8 for every 1,000 cases), complications in 2.5 out of every 1,000 cases, and there was one death due to this cause (0.1 per 1,000 cases). In the same period, 4,959 cases of herpes zoster were diagnosed (4.15 cases per 1,000 in habitants), half in people over 55 years old. There were 179 hospital admissions (36 per 1,000 cases), whose average age was 77, and 83 presented complications (16.7 per 1,000 cases).This epidemiological pattern is similar to that found in other places before the introduction of the vaccine (AU)

[Incidence and mortality due to cancer in Navarre, 1998-2002. Trends in the last 30 years]. / Incidencia y mortalidad por cáncer en Navarra, 1998-2002. Evolución en los últimos 30 años.

Between 1998-2002, 16,952 new cases of cancer were registered in Navarre. In men, the most frequently diagnosed cancers were in the following order: prostate, lung, colon and rectum, bladder and stomach, which accounted for 63.2%. In women, the sites were breast, colon and rectum, corpus uteri, stomach and ovary, which accounted for 57.6% of the cases. In the same period, 1998-2002, 4,127 men and 2,470 women died from cancer. Sixty percent of all deaths due to malign tumours in men were due to cancer of the lung, prostate, colon and rectum, stomach and bladder. In women this was due to cancers of colon and rectum, breast, stomach, pancreas and lung, which accounted for 49% of the cases. In men in Navarre there has been an increase in the incidence rates of cancer of the prostate, kidney and non-Hodgkin lymphoma. Avoidable cancers such as those related to smoking (lung, oral cavity and pharynx or pancreas) continue to rise, and represent a greater global risk of dying from cancer in the latest period studied than in the decades of the 1970s and 1980s. From 1995 up to the present, mortality due to cancer has moved from occupying the second place to become the first cause of death among men in Navarre. The global risk of death due to cancer in men is now equal to the first period studied, 1975-1977. Amongst women the global risk of death due to cancer fell by 25% between 1975 and 2002, basically at the cost of breast and stomach cancer. Tumours related to smoking increased both in mortality and in incidence and appear as a significant health problem amongst women in Navarre. Breast cancer has increased in incidence, with lower mortality figures than those of the first period 1975-1977. Invasive cancer of the cervix remains at very low rates in comparison with many European countries, including Spain. In both sexes colorectal and skin cancer has increased, while the incidence and mortality of stomach cancer continues to fall.

Incidencia y mortalidad por cáncer en Navarra, 1998-2002. Evolución en los últimos 30 años / Incidence and mortality due to cancer in Navarre, 1998-2002. Trends in the last 30 years

entre 1998-2002 se registraron 16.952 nuevos casos de cáncer en Navarra. En los hombres, los cánceres más frecuentes diagnosticados fueron, por este orden próstata, pulmón,colon y recto, vejiga y estómago, que sumaron el 63,2% de todos los casos de cáncer. En mujeres las localizaciones de mama, colon y recto, cuerpo de útero, estómago y ovario sumaron el 57,6% del total de los casos. En el mismo periodo, 1998-2002, fallecieron por cáncer 4.127 hombre y 2.470 mujeres. el 60% de todas las muertes producidas por tumores malignos en hombres se debieron a las localizaciones de pulmón, próstata,colon y recto, estómago y vejiga. En las mujeres las localizaciones de colon y recto, mama,estómago, páncreas y pulmón, sumaron el 49% de las defunciones por cáncer. En los hombre de Navarra han aumentado las tasas de incidencia del cáncer de próstata, riñón y linfoma no Hodgkin. Cánceres evitables, como los relacionados con el hábito de fumar (pulmón,cavidad oral y faringe o páncreas),continúan en ascento, y representan mayor riesgo global de morir por cáncer en el último periodo estudiado que en las décadas de los años 1970 y 1980. A partir de 1995 y hasta la actualidad, la mortalidad por cáncer pasó a ocupar el segundo lugar a ser la primera causa de muerte por cáncer en hombres se ha igualado al primer periodo estudiado 1975-1977. Entre las mujeres el riesgo gloval de muerte por cáncer descendió un 25% entre 1975 y 2002, a costa fundamentalmente del cáncer de mama y de estómago. Los tumores relacionados con el hábito de fumar muestran incrementos tanto en la mortalidad como en la incidencia y emergencia como un problema importante de salud entre las mujeres de Navarra. Ha aumentado la incidencia de cáncer de mama, en cambio en la mortalidad se sitúa en cifras inferiores a las del primer periodo 1975-1977. El cáncer invasivo de cérvix se mantiene en tasas muy bajas respecto a muchos países europeos, incluida España. En ambos sexos ha aumentado el cáncer colorrectal y el melanoma mientras que continúa el descenso de la incidencia y mortalidad por cáncer de estómago

Between 1998-2002, 16,952 new cases of cancer were registered in Navarre. In men, the most frequently diagnosed cancers were in the following order: prostate, lung, colon and rectum, bladder and stomach, which accounted for 63.2%, In women, the sites were breast, colon and rectum, corpus uteri, stomach and ovary, which accounted for 57,6% of the cases. In the same period, 1998-2002m 4,127 men and 2,470 women died from cancer. Sixty percent of all deaths due to malign tumours in men were due to cancer od the lung, prostate, colon and rectum, stomach and bladder. In women this was due to cancers of colon and rectum, breast, stomach, pancreas and lung, which accounted for 49% of the cases. In men in Navarre there has been an increase in the incidence rates of cancer on the prostate, kidney and non Hodgkin lymphoma. Avoidable cancers such as those related to smoking (lung, oral cavity and pharynx or pancreas) continue to rise, and represent a greater global risk of dying from cancer in the latest period studied than in the decades of the 1970s and 1980s. From 1995 up to the present, mortality due to cancer has moved from occupying the second place to become the first cause of death among men in Navarre. The global risk of death due to cancer in men is now equal to the first period studied 1975-1977. Amongst women the global risk of death due to cancer fell by 25% between 1975 and 2002 basically at the cost of breast and stomach cancer. Tumours related to smoking increased both in mortality and in incidence and appear as a significant health problem amongst women in Navarre. Breast cancer has increased in incidence, with lower mortality figures than those of the first period 1975-1977. Invasive cancer of the cervix remains at very low rates in comparison with many European countries, including Spain

Tendencias recientes de las principales causas de muerte en Navarra. 1995-2004 / Recent trends of the main causes of death in Navarre. 1995-2004

Se presentan las estadísticas de mortalidad de Navarra para el periodo 1995-2004 por sexo, edad y causa de muerte. Material y métodos. Los datos proceden de los boletines estadísticos de defunción. Se comparan el periodo 1995-1999 con el periodo 2000-2004, utilizando las tasas ajustadas a la población de Navarra del año 2001 y la tasa de años potenciales de vida perdidos entre 0-70 años ajustada a la población europea. Resultados. La esperanza de vida al nacer en el periodo 2000-2004 fue de 77,9 años en los hombres y 85 años en las mujeres, esta última una de las más altas registradas a nivel mundial. El riesgo de muerte ha diminuido en prácticamente todos los grupos de edad, destacando un descenso de la mortalidad del 40% en el grupo de 25-34 años a costa del sida. La mortalidad infantil bajó hasta 3,3 por 1.000 recién nacidos vivos. Ha habido un importante incremento de la mortalidad por cáncer de pulmón entre las mujeres menores de 65 años (46%) en el quinquenio 2000-04 respecto al anterior y un fuerte descenso de la mortalidad por cáncer de mama (45,4%). Han continuado disminuyendo en ambos sexos la mortalidad por enfermedades cerebrovasculares, enfermedad isquémica del corazón, insuficiencia cardiaca y arterioesclerosis así como la mortalidad por úlceras y cirrosis. Las tasas de mortalidad de Navarra de todos los grandes grupos de causas son más bajas que las de España excepto la tasa de mortalidad por causas externas. Conclusiones. El incremento de la mortalidad por cáncer de pulmón y de otros cánceres relacionados con el tabaquismo debido a la extensión del consumo en las últimas décadas puede influir negativamente en la esperanza de vida de las mujeres de Navarra en los próximos años. La prevención de la mortalidad por causas externas y la prevención de las muertes ligadas al consumo de tabaco son dos prioridades que se desprenden de los datos de mortalidad de esta comunidad autónoma

We present the statistics for mortality in Navarre for the 1995-2004 period by sex, age and cause of death. Methods. The data proceeds from the statistical bulletins on death. The 1995-1999 period is compared with the 2000-2004 period, using adjusted rates to the population of Navarre for the year 2001 and the rate of potential years of life lost between 0- 70 years adjusted to the European population. Results. Life expectancy at birth in the 2000-2004 period was 77.9 years in men and 85 years in women, the latter being one of the highest registered at the world level. Infant mortality fell to 3.3 per 1,000 living newborn infants. The risk of death has fallen in practically all age groups, with a notable fall in mortality of 40% in the 25-34 group at the cost of AIDS. There has been a significant increase of mortality due to lung cancer amongst women under 65 years of age (46%) in the 2000-2004 period with respect to the previous five year period and a sharp fall in mortality due to breast cancer (45.4%). In both sexes there has been a continued fall of mortality due to cerebrovascular diseases, ischaemic heart diseases, cardiac failure and arteriosclerosis and of mortality due to ulcer and cirrhosis. The rates of mortality in Navarre in all the main groups of causes are lower than those of Europe, except for the rate of mortality due to external causes. Conclusions. The increase of mortality due to lung cancer and other cancers related to smoking, due to the spread of consumption in recent decades, could have a negative influence on the life expectancy of women in Navarre in coming years. The prevention of mortality due to external causes and the prevention of deaths linked to tobacco consumption are the two priorities that emerge from the data on mortality in this autonomous community

[Recent trends of the main causes of death in Navarre. 1995-2004]. / Tendencias recientes de las principales causas de muerte en Navarra. 1995-2004.

UNLABELLED: We present the statistics for mortality in Navarre for the 1995-2004 period by sex, age and cause of death. METHODS: The data proceeds from the statistical bulletins on death. The 1995-1999 period is compared with the 2000-2004 period, using adjusted rates to the population of Navarre for the year 2001 and the rate of potential years of life lost between 0-70 years adjusted to the European population. RESULTS: Life expectancy at birth in the 2000-2004 period was 77.9 years in men and 85 years in women, the latter being one of the highest registered at the world level. Infant mortality fell to 3.3 per 1,000 living newborn infants. The risk of death has fallen in practically all age groups, with a notable fall in mortality of 40% in the 25-34 group at the cost of AIDS. There has been a significant increase of mortality due to lung cancer amongst women under 65 years of age (46%) in the 2000-2004 period with respect to the previous five year period and a sharp fall in mortality due to breast cancer (45.4%). In both sexes there has been a continued fall of mortality due to cerebrovascular diseases, ischaemic heart diseases, cardiac failure and arteriosclerosis and of mortality due to ulcer and cirrhosis. The rates of mortality in Navarre in all the main groups of causes are lower than those of Europe, except for the rate of mortality due to external causes. CONCLUSIONS: The increase of mortality due to lung cancer and other cancers related to smoking, due to the spread of consumption in recent decades, could have a negative influence on the life expectancy of women in Navarre in coming years. The prevention of mortality due to external causes and the prevention of deaths linked to tobacco consumption are the two priorities that emerge from the data on mortality in this autonomous community.

Incidencia y mortalidad por cáncer en Navarra, 1993-1997. Tendenciasen los últimos 25 años / Incidence and mortality of cancer in Navarra, 1993-1997. Tendencies in the last 25 years

Entre 1993-97 se registraron 14.023 nuevos casos de cáncer en Navarra. En los hombres, los cánceres más frecuentemente diagnosticados fueron por este orden: pulmón, próstata, colon y recto, estómago y vejiga que sumaron el 60 por ciento de todos los casos de cáncer. En mujeres las localizaciones de mama, colon y recto, cuerpo de útero, estómago y ovario sumaron el 57 por ciento del total de los casos. En el mismo periodo, 1993-97, fallecieron por cáncer 3.875 hombres y 2.332 mujeres. El 60 por ciento de todas las muertes producidas por tumores malignos en hombres se debieron a las localizaciones de pulmón, colón y recto, próstata, estómago y vejiga. En las mujeres las localizaciones de mama, colon y recto, estómago, páncreas e hígado, sumaron el 51 por ciento de las defunciones por cáncer. En los hombres de Navarra, han aumentado de manera importante en las dos ultimas décadas las tasas de incidencia y mortalidad por cánceres relacionados con el hábito de fumar (pulmón, cavidad oral y faringe o páncreas), siendo además el riesgo global de morir por cáncer más alto a finales de la década de los 90 que en los 70 y 80. A partir de 1995, la mortalidad por cáncer pasó de ocupar el segundo lugar a ser la primera causa de muerte entre los hombres de Navarra. Entre las mujeres, las enfermedades cardiovasculares continúan siendo la primera causa de muerte. Entre las mujeres, el riesgo global de muerte por cáncer descendió un 20 por ciento entre 1975 y 1997, a costa fundamentalmente del cáncer de estómago. Los tumores relacionados con el hábito de fumar no muestran, por el momento, incrementos sustanciales entre las mujeres de Navarra. El cáncer de mama ha aumentado en los últimos años, aunque la incidencia y mortalidad de las mujeres de Navarra continúa siendo algo más baja que la media de la Unión Europea o la de los Estados Unidos. El cáncer invasivo de cérvix se mantiene en tasas muy bajas respecto a muchos países europeos, incluida España. En ambos sexos han aumentado el cáncer colorrectal y el melanoma mientras que continúa el descenso de la incidencia y mortalidad por cáncer de estómago (AU)