Multimorbidity, social determinants and intersectionality in chronic patients. Results from the EpiChron Cohort.

Background: Multimorbidity is influenced in an interconnected way, both in extent and nature, by the social determinants of health. We aimed at implementing an intersectional approach to analyse the association of multimorbidity with five important axes of social inequality (i.e. gender, age, ethnicity, residence area and socioeconomic class). Methods: We conducted a cross-sectional observational study of all individuals who presented with at least one chronic disease in 2019 (n = 1 086 948) from the EpiChron Cohort (Aragon, Spain). Applying intersectional analysis, the age-adjusted likelihood of multimorbidity was investigated across 36 intersectional strata defined by gender, ethnicity, residence area and socioeconomic class. We calculated odds ratios (OR) 95% confidence interval (CI) using high-income urban non-migrant men as the reference category. The area under the receiver operator characteristics curve (AUC) was calculated to evaluate the discriminatory accuracy of multimorbidity. Results: The prevalence of multimorbidity increased with age, female gender and low income. Young and middle-aged low-income individuals showed rates of multimorbidity equivalent to those of high-income people aged about 20 years older. The intersectional analysis showed that low-income migrant women living in urban areas for >15 years were particularly disadvantaged in terms of multimorbidity risk OR = 3.16 (95% CI = 2.79-3.57). Being a migrant was a protective factor for multimorbidity, and newly arrived migrants had lower multimorbidity rates than those with >15 years of stay in Aragon, and even non-migrants. Living in rural vs. urban areas was slightly protective against multimorbidity. All models had a large discriminatory accuracy (AUC = 0.7884-0.7895); the largest AUC was obtained for the model including all intersectional strata. Conclusions: Our intersectional approach uncovered the large differences in the prevalence of multimorbidity that arise due to the synergies between the different socioeconomic and demographic exposures, beyond their expected additive effects.

Baseline Chronic Comorbidity and Mortality in Laboratory-Confirmed COVID-19 Cases: Results from the PRECOVID Study in Spain.

We aimed to analyze baseline socio-demographic and clinical factors associated with an increased likelihood of mortality in men and women with coronavirus disease (COVID-19). We conducted a retrospective cohort study (PRECOVID Study) on all 4412 individuals with laboratory-confirmed COVID-19 in Aragon, Spain, and followed them for at least 30 days from cohort entry. We described the socio-demographic and clinical characteristics of all patients of the cohort. Age-adjusted logistic regressions models were performed to analyze the likelihood of mortality based on demographic and clinical variables. All analyses were stratified by sex. Old age, specific diseases such as diabetes, acute myocardial infarction, or congestive heart failure, and dispensation of drugs like vasodilators, antipsychotics, and potassium-sparing agents were associated with an increased likelihood of mortality. Our findings suggest that specific comorbidities, mainly of cardiovascular nature, and medications at the time of infection could explain around one quarter of the mortality in COVID-19 disease, and that women and men probably share similar but not identical risk factors. Nonetheless, the great part of mortality seems to be explained by other patient- and/or health-system-related factors. More research is needed in this field to provide the necessary evidence for the development of early identification strategies for patients at higher risk of adverse outcomes.

A Methodological Approach for Implementing an Integrated Multimorbidity Care Model: Results from the Pre-Implementation Stage of Joint Action CHRODIS-PLUS.

Patients with multimorbidity (defined as the co-occurrence of multiple chronic diseases) frequently experience fragmented care, which increases the risk of negative outcomes. A recently proposed Integrated Multimorbidity Care Model aims to overcome many issues related to fragmented care. In the context of Joint Action CHRODIS-PLUS, an implementation methodology was developed for the care model, which is being piloted in five sites. We aim to (1) explain the methodology used to implement the care model and (2) describe how the pilot sites have adapted and applied the proposed methodology. The model is being implemented in Spain (Andalusia and Aragon), Lithuania (Vilnius and Kaunas), and Italy (Rome). Local implementation working groups at each site adapted the model to local needs, goals, and resources using the same methodological steps: (1) Scope analysis; (2) situation analysis-"strengths, weaknesses, opportunities, threats" (SWOT) analysis; (3) development and improvement of implementation methodology; and (4) final development of an action plan. This common implementation strategy shows how care models can be adapted according to local and regional specificities. Analysis of the common key outcome indicators at the post-implementation phase will help to demonstrate the clinical effectiveness, as well as highlight any difficulties in adapting a common Integrated Multimorbidity Care Model in different countries and clinical settings.

Programa de cribado poblacional de cáncer colorrectal en Aragón. Primeros resultados / Colorectal cancer screening programme in Aragon (Spain): preliminary results

Objetivo: Describir los primeros resultados del programa de cribado de cáncer colorrectal en Aragón para valorar su implantación. Métodos: Se recogen los datos del programa en el primer año de implantación (2014), basado en la realización de test de sangre oculta en heces inmunoquímico para personas de 60-69 años de edad. Se reportan los indicadores principales de la red nacional de cribado. Resultados: Población invitada tras exclusiones: 12.518 personas. Tasa de participación: 45,28% (intervalo de confianza del 95% [IC95%]: 44,41-46,15). Test inadecuados: 0,21% (IC95%: 0,12-0,37). Test positivos: 10,75% (IC95%: 9,97-11,58). Aceptación de colonoscopia: 95,07% (IC95%: 93,04-96,52). Colonoscopias completas: 97,58% (IC95%: 95,98-98,55). Tasas de detección de adenomas de alto riesgo: 14,7‰ (IC95%: 11.9-18.2); adenomas de bajo riesgo: 5,55‰ (IC95%: 3,9-7,8). Valor predictivo positivo (VVP) para cualquier adenoma: 58,55% (IC95%: 54,49-62,49); VVP para cáncer invasivo: 5,36% (IC95%: 3,8-7,51). Conclusión: El análisis de los indicadores muestra que el programa se está implantando de forma adecuada

Objective: To describe preliminary findings from the colorectal cancer screening programme in Aragon (Spain) to evaluate its implementation. Methods: We have collected data from the first year of the program (2014) based on faecal occult blood immunochemical (FOBTi) test in patients 60-69 years old. We report "indicators" defined by the "Red Nacional de Cribado". Results: Invited population after exclusions: 12,518. Program participation rate: 45.28% (95%CI: 44.41-46.15). Inadequate tests: 0.21% (95%CI: 0.12-0.37); positive FOBTi test 10.75% (95%CI: 9.97-11.58) and colonoscopy acceptance 95.07% (95%CI: 93.04-96.52). Colonoscopy was appropriate and complete in 97.58% (95%CI: 95.98-98.55) of cases. The high- and low-risk adenoma detection rates were 14.7‰ (95%CI: 11.9-18.2) and 5.55‰ (95%CI: 3.9-7.8) respectively. The positive predictive value for any adenoma was 58.55% (95%CI: 54.49-62.49) and for invasive cancer was 5.36% (95%CI: 3.8-7.51). Conclusion: The indicator analysis of the ongoing programme suggests the programme is being implemented correctly in our community

[Colorectal cancer screening programme in Aragon (Spain): preliminary results]. / Programa de cribado poblacional de cáncer colorrectal en Aragón. Primeros resultados.

OBJECTIVE: To describe preliminary findings from the colorectal cancer screening programme in Aragon (Spain) to evaluate its implementation. METHODS: We have collected data from the first year of the program (2014) based on faecal occult blood immunochemical (FOBTi) test in patients 60-69 years old. We report "indicators" defined by the "Red Nacional de Cribado". RESULTS: Invited population after exclusions: 12,518. Program participation rate: 45.28% (95%CI: 44.41-46.15). Inadequate tests: 0.21% (95%CI: 0.12-0.37); positive FOBTi test 10.75% (95%CI: 9.97-11.58) and colonoscopy acceptance 95.07% (95%CI: 93.04-96.52). Colonoscopy was appropriate and complete in 97.58% (95%CI: 95.98-98.55) of cases. The high- and low-risk adenoma detection rates were 14.7‰ (95%CI: 11.9-18.2) and 5.55‰ (95%CI: 3.9-7.8) respectively. The positive predictive value for any adenoma was 58.55% (95%CI: 54.49-62.49) and for invasive cancer was 5.36% (95%CI: 3.8-7.51). CONCLUSION: The indicator analysis of the ongoing programme suggests the programme is being implemented correctly in our community.