Bayesian approach to predicting cancer incidence for an area without cancer registration by using cancer incidence data from nearby areas.

This paper compares three different methods for performing cancer incidence prediction in an area without a cancer registry under a Bayesian framework, using linear and log-linear age-period models with either age-specific slopes or a common slope across age groups. The three methods assume that a nearby area with a cancer registration has similar incidence and mortality patterns as the area of interest without a cancer registry where the cancer incidence prediction is carried out. The three methods differ in modeling strategies: (i) modeling the incidence rate directly; (ii) modeling the ratio of the number of incident cases to that of mortality cases; and (iii) modeling the difference between the incidence rate and the mortality rate. Strategy (iii) is a new approach in this type of projection. Empirical assessment is made using real data from the cancer registry of Tarragona, Spain, to predict cancer incidence in Girona, Spain, and vice versa. Predictions of short-term (3-4 years) incidence were made for 2001 in Tarragona using observed cancer incidence and mortality data for 1994-1998 from Girona. Short-term predictions were made for 2002 in Girona using Tarragona's 1994-1998 data. Additionally, long-term (10 years) incidence rate predictions were made for 2002 in Girona using data from Tarragona for the period 1985-1992. Our results suggest that extrapolating time-trends of incidence rates minus mortality rates may have the best predictive performance overall. These methods of population-level disease-incidence prediction are highly relevant to health care planning and policy decisions.

[Incidence of permanent disability in a cohort of social security-affiliated workers (2004-2007)]. / Incidencia de incapacidad permanente en una cohorte de trabajadores afiliados a la Seguridad Social, 2004-2007.

OBJECTIVE: To describe the incidence of permanent disability, both work-related and non-work-related, by several socioeconomic and geographical variables. METHODS: We performed a retrospective study of a cohort of 768,454 workers covered by the General Social Security Regimen, followed-up from 2004 to 2007. This study was based on the Continuous Working Life Survey. In the 4 years of follow-up, 7,749 cases in 1,937,921 workers-years were identified. Incidence rates and crude and adjusted rate ratios were estimated by Poisson regression models. RESULTS: The incidence of non-work-related permanent disability was 10 times greater than that of work-related disability (36.3 versus 3.7 per 10,000 workers-years). The incidences for both non-work-related and work-related disability were higher in men and increased with age and lower education level. For non-work-related permanent disability, the region with the highest incidence was Asturias and that with the lowest was Madrid (56.7 vs. 23.3). For work-related permanent disability, the highest incidence was found in Asturias and the lowest in Navarre (7.8 vs. 1.4). This differential was maintained for work-related and non-work-related permanent disability for Asturias, after adjustment was made by sex, age, educational level, company size and economic activity. CONCLUSIONS: In this study, we observed substantial differences in the incidences of permanent disability by demographic, social and geographical characteristics, which should be analyzed in greater depth, especially the differences observed by regions.

[Evaluation of the management of nonwork-related sick leave lasting more than 15 days in Catalonia (Spain)]. / Evaluación de la gestión de los casos de incapacidad temporal por contingencia común de más de 15 días en Cataluña.

OBJECTIVES: To compare the length of nonwork-related sick leave among cases managed by an insurance company versus those managed by the National Institute of Social Security (NISS). METHODS: We performed a retrospective cohort study of 289,686 cases of sick leave lasting for more than 15 days that began in 2005 after certification by a primary care physician in Catalonia, were reported to the Catalonian Institute of Medical Evaluations, and were followed to term. Of the total, 156,676 cases were managed by the NISS. To account for repeat episodes (approximately 25% of the total), the Wang-Chang estimator was used to calculate the median duration and percentiles; comparisons were made using log-logistic regression with shared gamma frailty models, with calculation of time ratios (TR) and their corresponding 95% confidence intervals (95% CI). RESULTS: The median duration of sick leave was 43 days for cases managed by the NISS and 39 days for those managed by the insurance company. This difference was statistically significant both for men employed under contract (TR=0.87; 95% CI: 0.85-0.88) and for those who were self-employed (TR=0.78; 95% CI: 0.75-0.80) as well as for women under contract (TR=0.85; 95% CI: 0.84-0.87) and self-employed women (TR=0.84; 95% CI: 0.81-0.88). These differences persisted after adjustment was performed for age and health region. CONCLUSIONS: For sick leave lasting more than 15 days, these results confirm that cases managed by an insurance company ended earlier than for those managed by the NISS, both for contract and self-employed workers. Further research is needed to explore the reasons for these differences.

[Cost comparison of temporary sickness absence in 2006 between Barcelona and Madrid provinces, Spain]. / Comparación del coste de la incapacidad temporal por contingencia común en 2006 entre las provincias de Barcelona y Madrid.

BACKGROUND: Sickness absence due to non work-related conditions is a major public health issue with important socio-economic implications, and is not homogenously distributed in Spain. The objective of this study is to compare cost differences of temporary sickness absence between Barcelona and Madrid. METHODS: A study was carried out based on incident cases of temporary sickness absence of more than fifteen days of duration, followed to case closure, in a retrospective cohort of workers in 2006. The study population consisted of workers of companies covered by the general regime of the Social Security System, and managed by an insurance company based in the provinces of Barcelona and Madrid in the year 2006. We compared the incidence, median duration and daily income base between Barcelona and Madrid, adjusting by sex, age and economic sector, using statistical models that take into account recurrent events in the period. RESULTS: 24.527 cases of temporary sickness absence were identified, 62% of which originated in Barcelona. The mean cost was 33% higher in Barcelona with respect to Madrid (2.589 euros vs 1941 euros). The incidence was 22% higher in Barcelona than Madrid (1,22, IC95%: 1,10-1,36) and mean daily income base per episode was 7,80 euros higher (IC95% :7,20-8,40). In the duration the time ratio was: 1,03 ( IC95%: 1,01-1,05). CONCLUSIONS: The higher incidence and daily income base of temporary sickness absence in Barcelona with respect to Madrid may explain the higher costs observed in the former.