Incidence of sickness absence by type of employment contract: one year follow-up study in Spanish salaried workers.

BACKGROUND: To examine the differences in the incidence of registered sickness absence by type of employment contract in a large representative sample of salaried workers in Spain in 2009. METHOD: A study of 653,264 salaried workers covered by the Social Security system who had 133,724 sickness absence episodes in 2009. Crude and adjusted rate ratios and their corresponding 95 % confidence intervals (CIs) were calculated with Poisson regression models. RESULTS: The incidence rate per 100 workers-year of sickness absence for temporary workers (IR = 32.2) was slightly higher than that of permanent workers (IR = 28.9). This pattern was observed in both men (RR = 1.12; 95 % CI 1.10-1.14) and women (RR 1.11; 95 % CI 1.09-1.12). However, after adjusting for age, company size, and occupational category, the differences disappeared in men (aRR = 1.01; 95 % CI 0.99-1.02) and decreased in women (aRR = 1.06; 95 % CI 1.04-1.07). CONCLUSION: Our findings provide evidence on the independence of sickness absence benefits from the type of employment contract as well as on the nonexistence of incentives for taking sickness absence in workers with a permanent employment contract. In the context of increasing market flexibility, these results show a positive functioning of the Social Security system.

Assessment of the magnitude of geographical variations in the duration of non-work-related sickness absence by individual and contextual factors / Evaluación de la magnitud de la variabilidad geográfica en la duración de la incapacidad temporal por contingencia común por factores individuales y contextuales

Objective: To examine variation in the duration of non-work-related sickness absence (NWRSA) across geographical areas and the degree to which this variation can be explained by individual and/or contextual factors. Methods: All first NWRSA episodes ending in 2007 and 2010 were analyzed. Individual (diagnosis, age, sex) and contextual factors (healthcare resources, socioeconomic factors) were analyzed to assess how much of the geographical variation was explained by these factors. Median NWRSA durations in quartiles were mapped by counties in Catalonia. Multilevel Cox proportional hazard regression models with episodes nested within counties were fitted to quantify the magnitude of this variation. The proportional change in variance (PCV), median hazard ratios (MHR) and interquartile hazard ratios (IHR) were calculated. Results: We found a geographical pattern in the duration of NWRSA, with longer duration in north western Catalonia. There was a small, but statistically significant, geographical variation in the duration of NWRSA, which mostly decreased after adjustment for individual factors in both women (PCV=34.98%, MHR=1.09, IHR=1.13 in 2007; PCV=34.68%, MHR=1.11, IHR=1.28 in 2010) and men (PCV=39.88%, MHR=1.10, IHR=1.27 in 2007; PCV=45.93%, MHR=1.10, IHR=1.25 in 2010); only in the case of women in 2010 was there a reduction in county-level variance due to contextual covariates (PCV=16.18%, MHR=1.12, IHR=1.32). Conclusions: County-level variation in the duration of NWRSA was small and was explained more by individual than by contextual variables. Knowledge of geographic differences in NWRSA duration is needed to plan specific programs and interventions to minimize these differences (AU)

Objetivo: Examinar la variabilidad de la duración la incapacidad temporal por contingencia común (ITcc) entre áreas geográficas y el grado en que factores individuales y/o contextuales la explican. Métodos: Se analizaron los primeros episodios de ITcc finalizados en 2007 y 2010. Se evaluó la variabilidad geográfica explicada por factores individuales (diagnóstico, edad, sexo) y contextuales (recursos sanitarios, socioeconómicos). Se representó gráficamente la duración mediana por comarcas de Cataluña. Se cuantificó la variabilidad geográfica de la duración de la ITcc entre comarcas ajustando modelos de regresión multinivel de riesgos proporcionales, con episodios anidados en comarcas. Se calculó el porcentaje de cambio de la varianza (PCV), el razón de riesgo mediano (RRM) y razón de riesgo intercuartílico (RRI). Resultados: Se encontró un patrón geográfico en la duración de la ITcc, con mayor duración en el noroeste de Cataluña. La variabilidad geográfica de la duración de la ITcc fue, aunque no elevada, estadísticamente significativa, y disminuyó después de ajustar por factores de nivel individual en mujeres (PCV=34.98%, RRM =1.09, RRI =1.13 en 2007; PCV=34.68%, RRM =1.11, RRI =1.28 en 2010) y hombres (PCV=39.88%, RRM =1.10, RRI =1.27 en 2007; PCV=45.93%, RRM =1.10, RRI =1.25 en 2010); y solo en el caso de las mujeres en 2010 hubo una reducción de la varianza debido a los factores contextuales (PCV=16.18%, RRM =1.12, RRI =1.32). Conclusiones: La variabilidad geográfica de la duración de la ITcc fue pequeña y explicada principalmente por los factores de nivel individual. El conocimiento de las diferencias geográficas en la duración de la ITcc es necesario para planificar programas e intervenciones específicas para reducir al mínimo estas diferencias (AU)

Assessment of the magnitude of geographical variations in the duration of non-work-related sickness absence by individual and contextual factors.

OBJECTIVE: To examine variation in the duration of non-work-related sickness absence (NWRSA) across geographical areas and the degree to which this variation can be explained by individual and/or contextual factors. METHODS: All first NWRSA episodes ending in 2007 and 2010 were analyzed. Individual (diagnosis, age, sex) and contextual factors (healthcare resources, socioeconomic factors) were analyzed to assess how much of the geographical variation was explained by these factors. Median NWRSA durations in quartiles were mapped by counties in Catalonia. Multilevel Cox proportional hazard regression models with episodes nested within counties were fitted to quantify the magnitude of this variation. The proportional change in variance (PCV), median hazard ratios (MHR) and interquartile hazard ratios (IHR) were calculated. RESULTS: We found a geographical pattern in the duration of NWRSA, with longer duration in northwestern Catalonia. There was a small, but statistically significant, geographical variation in the duration of NWRSA, which mostly decreased after adjustment for individual factors in both women (PCV=34.98%, MHR=1.09, IHR=1.13 in 2007; PCV=34.68%, MHR=1.11, IHR=1.28 in 2010) and men (PCV=39.88%, MHR=1.10, IHR=1.27 in 2007; PCV=45.93%, MHR=1.10, IHR=1.25 in 2010); only in the case of women in 2010 was there a reduction in county-level variance due to contextual covariates (PCV=16.18%, MHR=1.12, IHR=1.32). CONCLUSIONS: County-level variation in the duration of NWRSA was small and was explained more by individual than by contextual variables. Knowledge of geographic differences in NWRSA duration is needed to plan specific programs and interventions to minimize these differences.

Heterogeneity and event dependence in the analysis of sickness absence.

BACKGROUND: Sickness absence (SA) is an important social, economic and public health issue. Identifying and understanding the determinants, whether biological, regulatory or, health services-related, of variability in SA duration is essential for better management of SA. The conditional frailty model (CFM) is useful when repeated SA events occur within the same individual, as it allows simultaneous analysis of event dependence and heterogeneity due to unknown, unmeasured, or unmeasurable factors. However, its use may encounter computational limitations when applied to very large data sets, as may frequently occur in the analysis of SA duration. METHODS: To overcome the computational issue, we propose a Poisson-based conditional frailty model (CFPM) for repeated SA events that accounts for both event dependence and heterogeneity. To demonstrate the usefulness of the model proposed in the SA duration context, we used data from all non-work-related SA episodes that occurred in Catalonia (Spain) in 2007, initiated by either a diagnosis of neoplasm or mental and behavioral disorders. RESULTS: As expected, the CFPM results were very similar to those of the CFM for both diagnosis groups. The CPU time for the CFPM was substantially shorter than the CFM. CONCLUSIONS: The CFPM is an suitable alternative to the CFM in survival analysis with recurrent events, especially with large databases.

Pleural mesothelioma in relation to meteorological conditions and residential distance from an industrial source of asbestos.

OBJECTIVES: Few studies have focused on pleural mesothelioma and environmental exposure in individuals residing around an industrial source of asbestos. The aim of this study is to determine whether residential distance and wind conditions are related to the risk of developing pleural mesothelioma. METHODS: In this retrospective cohort study carried out in an area of Barcelona province (Catalonia, Spain), 24 environmental pleural mesothelioma cases were diagnosed between 2000 and 2009. We calculated the age-standardised incidence rate ratios of developing this disease in the population studied, taking into account the residential distance from the plant. For cases living within a 500-m radius of the plant, the geographical location in relation to the factory was also assessed. RESULTS: The incidence rate of environmental pleural mesothelioma was higher in the population living within 500 m of the plant than in those living in a radius of 500-2000 m and much higher than those living at 2000-10 000 m. The highest incidence rate ratio for pleural mesothelioma (161.9) was found in the southeast quadrant of the 500-m area, coinciding with the predominant wind direction. CONCLUSIONS: Residential distance from an industrial source of asbestos and local wind conditions have a considerable impact on the risk of developing environmental pleural mesothelioma.

Distribución de la duración de la incapacidad temporal por contingencia comúnpor diagnóstico médico (Cataluna, 2006-2008) / Distribution of the duration of nonoccupational sick leave by medical diagnosis (Catalonia, Spain, 2006-2008)

Presentamos una herramienta sencilla y práctica que permite consultar la distribución habitual de laduración de la incapacidad temporal por contingencia común, según el diagnóstico médico. Para ello seanalizaron 2.646.352 episodios de incapacidad temporal ocurridos en Cataluna y seguidos hasta el alta, ˜entre 2006 y 2008, incorporados a un aplicativo. La duración mediana, dado que sigue una distribuciónasimétrica, fue de 9 días. Los trastornos musculoesqueléticos fueron el grupo diagnóstico más frecuente(22,5%) y las neoplasias tuvieron la duración mediana más larga (56 días). Los diagnósticos específicos máscomunes fueron la diarrea-gastroenteritis (8,2%;mediana: 3 días) y la rinofaringitis aguda (5,2%;mediana:4 días). La distribución de la duración de la incapacidad temporal en una población varía por diagnósticoy es asimétrica; la mayoría de los episodios duran mucho menos que la media. Esta información esimportante para una mejor gestión, tanto clínica como administrativa, de la incapacidad temporal (AU)

We present a simple and practical tool that allows the usual distribution of the duration of nonoccupational sick leave to be determined by medical diagnosis. A total of 2,646,352 episodes of medicallycertified sick leave, registered by the Catalan Institute of Medical Evaluations for the period 2006-2008,were followed to closure and were entered into a spreadsheet. Given its asymmetric distribution, themedian duration of sick leave was 9 days. Musculoskeletal disorders were the most frequent diagnosticgroup (22.5%), while neoplasms had the longest median duration (56 days). The most common specific diagnoses were diarrhea-gastroenteritis (8.2%; median: 3 days) and acute rhinopharyngitis (5.2%;median: 4 days). The distribution of the duration of sick leave in a population varies by diagnosis and isasymmetric, with most episodes being much shorter than the mean duration. This finding is importantfor better clinical and administrative management of sick leave episodes (AU)

[Distribution of the duration of nonoccupational sick leave by medical diagnosis (Catalonia, Spain, 2006-2008)]. / Distribución de la duración de la incapacidad temporal por contingencia común por diagnóstico médico (Cataluña, 2006-2008).

We present a simple and practical tool that allows the usual distribution of the duration of non-occupational sick leave to be determined by medical diagnosis. A total of 2,646,352 episodes of medically certified sick leave, registered by the Catalan Institute of Medical Evaluations for the period 2006-2008, were followed to closure and were entered into a spreadsheet. Given its asymmetric distribution, the median duration of sick leave was 9 days. Musculoskeletal disorders were the most frequent diagnostic group (22.5%), while neoplasms had the longest median duration (56 days). The most common specific diagnoses were diarrhea-gastroenteritis (8.2%; median: 3 days) and acute rhinopharyngitis (5.2%; median: 4 days). The distribution of the duration of sick leave in a population varies by diagnosis and is asymmetric, with most episodes being much shorter than the mean duration. This finding is important for better clinical and administrative management of sick leave episodes.

Incapacidad temporal por enfermedad común y accidente no laboral en Cataluña, 2007-2010 / Nonoccupational temporary sickness absence in Catalonia, 2007-2010

Objetivos: Describir los episodios de incapacidad temporal por enfermedad común y accidente no laboral (ITcc) registrados en Cataluña entre 2007 y 2010. Métodos: Se analizaron 4.273.601 procesos de ITcc certificados en los Centros de Atención Primaria de Cataluña con alta entre 2007 y 2010. Se estimó para cada año la incidencia de episodios de ITcc por cada 100 afiliados en la Seguridad Social, la duración mediana y la duración media de días de baja por afiliado según el sexo, la edad, la provincia, el régimen de la seguridad social y la familia diagnóstica de la CIE-10.Resultados: Se observa una tendencia consistente en descenso de la duración media de días de baja por afiliado (de12,2 días en 2007 a 10,8 en 2010) y de la incidencia (de 34,4 a 30,4 casos por 100 afiliados). Este patrón se observa tanto en hombres como en mujeres, aunque los hombres presentan una incidencia, duración mediana y días de baja por afiliado menor que las mujeres. La mayoría de los diagnósticos fueron por enfermedades respiratorias (alrededor de 7 episodios porcada 100 afiliados), osteomusculares (que desciende de 6,9 a 3,2 en el periodo de estudio) e infeccionas (alrededor de 4). En cuanto a la duración mediana de los episodios destacan las enfermedades tumorales (sobre 50 días), mentales (sobre 30 días)y cardiovasculares (entre 20 y 30 días). Conclusiones: Las tendencias mostradas pueden servir como valores de referencia para la planificación y evaluación delas políticas de gestión de la ITcc(AU)

Objectives: To describe nonoccupational temporary sickness absence episodes registered in Catalonia between 2007and 2010.Methods: We analysed 4,273,601 sickness absence episodes (SA) that came to closure between 2007 and 2010, registered through Catalonian Primary Health centers. Annual incidence rates per 100 workers, and median and mean duration of days lost per worker were examined by gender, age, province, social security scheme, and major ICD-10 diagnostic groups. Results: There was a consistent downward trend in mean duration of days lost per worker (from 12.2 days in 2007 to10.8 in 2010), and in incidence rates (from 34.4 to 30.4 cases per 100 workers). This pattern was observed in both men and women, although overall men had a lower incidence, median duration and mean days lost per worker than women. The most frequent diagnostic groups were respiratory diseases (about 7 episodes per 100 workers), musculoskeletal disorders (decreasing from 6.9 to 3.2 over the study period), and infections (about 4 episodes per 100 workers). The longest median durations were those associated with neoplasms (about 50 days), mental disorders (30 days) and cardiovascular diseases (between 20and 30 days)(AU)

[Non-occupational temporary sickness absence in Catalonia, 2007-2010]. / Incapacidad temporal por enfermedad común y accidente no laboral en Cataluña, 2007-2010.

OBJECTIVES: To describe nonoccupational temporary sickness absence episodes registered in Catalonia between 2007 and 2010. METHODS: We analysed 4,273,601 sickness absence episodes (SA) that came to closure between 2007 and 2010, registered through Catalonian Primary Health centers. Annual incidence rates per 100 workers, and median and mean duration of days lost per worker were examined by gender, age, province, social security scheme, and major ICD-10 diagnostic groups. RESULTS: There was a consistent downward trend in mean duration of days lost per worker (from 12.2 days in 2007 to 10.8 in 2010), and in incidence rates (from 34.4 to 30.4 cases per 100 workers). This pattern was observed in both men and women, although overall men had a lower incidence, median duration and mean days lost per worker than women. The most frequent diagnostic groups were respiratory diseases (about 7 episodes per 100 workers), musculoskeletal disorders (decreasing from 6.9 to 3.2 over the study period), and infections (about 4 episodes per 100 workers). The longest median durations were those associated with neoplasms (about 50 days), mental disorders (30 days) and cardiovascular diseases (between 20 and 30 days). CONCLUSIONS: These trends may serve as a baseline for planning and evaluating policies directed at better management of sickness absence in Spain.

OBJETIVOS: Describir los episodios de incapacidad temporal por enfermedad común y accidente no laboral (ITcc) registrados en Cataluña entre 2007 y 2010. MÉTODOS: Se analizaron 4.273.601 procesos de ITcc certificados en los Centros de Atención Primaria de Cataluña con alta entre 2007 y 2010. Se estimó para cada año la incidencia de episodios de ITcc por cada 100 afiliados en la Seguridad Social, la duración mediana y la duración media de días de baja por afiliado según el sexo, la edad, la provincia, el régimen de la seguridad social y la familia diagnóstica de la CIE-10. RESULTADOS: Se observa una tendencia consistente en descenso de la duración media de días de baja por afiliado (de 12,2 días en 2007 a 10,8 en 2010) y de la incidencia (de 34,4 a 30,4 casos por 100 afiliados). Este patrón se observa tanto en hombres como en mujeres, aunque los hombres presentan una incidencia, duración mediana y días de baja por afiliado menor que las mujeres. La mayoría de los diagnósticos fueron por enfermedades respiratorias (alrededor de 7 episodios por cada 100 afiliados), osteomusculares (que desciende de 6,9 a 3,2 en el periodo de estudio) e infeccionas (alrededor de 4). En cuanto a la duración mediana de los episodios destacan las enfermedades tumorales (sobre 50 días), mentales (sobre 30 días) y cardiovasculares (entre 20 y 30 días). CONCLUSIONES: Las tendencias mostradas pueden servir como valores de referencia para la planificación y evaluación de las políticas de gestión de la ITcc.

Occupational health impact of the 2009 H1N1 flu pandemic: surveillance of sickness absence.

OBJECTIVES: Workplace absences due to illness can disrupt usual operations and increase costs for businesses. This study of sickness absence due to influenza and influenza-related illness presents a unique opportunity to characterise and measure the impact of the 2009 (H1N1) pandemic, by comparing trends during the pandemic to those of previous years, and adding this information to that obtained by traditional epidemiological surveillance systems. METHODS: We compared the numbers of cases of sickness absence due to illness caused by influenza and influenza-related illness in 2007-2009, and in the first 3 months of 2010 in Catalonia (n=811 940) using a time series approach. Trends were examined by economic activity, age and gender. The weekly endemic-epidemic index (EEI) was calculated and its 95% CI obtained with the delta method, with observed and expected cases considered as independent random variables. RESULTS: Influenza activity peaked earlier in 2009 and yielded more cases than in previous years. Week 46 (in November 2009) had the highest number of new cases resulting in sickness absence (EEI 20.99; 95% CI 9.44 to 46.69). Women and the 'education, health and other social activities' sector were the most affected. CONCLUSIONS: Results indicate that the new H1N1 pandemic had a significant impact on business, with shifts in the timing of peak incidence, a doubling in the number of cases, and changes in the distribution of cases by economic activity sector and gender. Traditional epidemiological surveillance systems could benefit from the addition of information based on sickness absence data.

[Comparison in Andalusia and Catalonia of sickness absence for influenza (H1N1) 2009]. / Comparación entre Andalucía y Cataluña de la frecuencia de incapacidad laboral durante la gripe (H1N1) 2009.

BACKGROUND: This study compared surveillance of cases of sickness absence due to illness caused by influenza and reported in Andalusia and Catalonia in the period 2007-2009. METHODS: A time series of incident cases of sickness absence due to influenza, by sex and age, in which episodes in Andalusia and Catalonia in a previous epidemic period (from 01/01/2007 through 30/09/2009) were compared to the pandemic period (last three months of 2009). The weekly number of new cases of sickness absence due to influenza was calculated, and the minimum, median and maximum values were plotted for each of these two periods. RESULTS: Unexpectedly, women had a higher proportion of new cases of sickness absence due to influenza during the pandemic period (52.2% in Catalonia and 49.7% in Andalusia). During both periods the 25 to 34 year old age group had a higher number of new cases of sickness absence both in Catalonia (37.439 in the epidemic period and 15.379 in the pandemic) and Andalusia (20.465 epidemic period and 9.630 pandemic period). The arrival of the pandemic was around November (approximately 10.000 cases in Catalonia and 5.000 cases in Andalusia), resulting in a significant increase of cases in contrast to the median of the epidemic period. CONCLUSIONS: During the 2009 pandemic, there was an increase in new cases of sickness absence due to influenza, somewhat greater in Catalonia than Andalusia, with an earlier peak in November, especially among women in these two autonomous communities.

Costs of depression in Catalonia (Spain).

OBJECTIVE: To estimate the cost of depression for the adult population in Catalonia (Spain) for 2006. METHOD: The total adult population of Catalonia for the reference year was close to 6 million. A cross-design synthesis study was conducted, combining "top-down" and "bottom-up" data from secondary data sources, as well as expert opinion (nominal groups). A societal perspective was adopted. Estimates included direct health costs (hospital, primary, specialised and pharmacological care) and the indirect costs derived from the productivity lost due to morbidity and mortality. Sensitivity analyses were carried out for primary and specialised care resource utilisation. A Monte Carlo simulation model was developed to handle the uncertainty of the unit costs of primary care, specialised care and hospital visits. RESULTS: The total annual cost of depression in Catalonia for 2006 was 735.4 million Euros. Of this figure, 21.2% corresponded to direct costs, including 41 million Euros in primary care (5.6%), 8.1 million Euros in mental health specialised care (1.1%), 5.6 million Euros due to hospitalisation (0.8%) and 101.1 million Euros due to pharmacological care (13.7%); and 78.8% to indirect costs due to productivity loss. 3.7 million work days were lost to temporary disability for depression with a cost of 199.6 million Euros (27.1%), and 353.3 million Euros due to permanent disability (48%). Mortality attributed to suicide accounted for 26.9 million Euros (3.7%). The average annual cost of an adult with depression was close to 1800 Euros. LIMITATIONS: The heterogeneity of the data sources, the uncertainty in several estimates (i.e. proportion of psychotropic expenditure attributed to the treatment of depression, suicide rate attributed to depression), and the difficulty in disaggregating anxiety and depressive disorders in a number of databases are study limitations. CONCLUSIONS: The burden of depression for the Catalan public health system and society as a whole due to the consumption of resources and, more importantly, the loss of productivity is significant. Inefficiencies may be found in the overuse of pharmaceuticals and in the eligibility criteria of disability for work.

Comparación entre Andalucía y Cataluña de la frecuencia de incapacidad laboral durante la gripe (H1N1) 2009 / Comparisson in andalusia and Catalonia of sickness absence because of influenza (H1N1) 2009

Fundamentos: La gripe estacional es una causa frecuente de episodios de incapacidad temporal por contingencia común (ITcc). En este estudio se valora el impacto laboral de la gripe pandémica (H1N1) 2009 en Andalucía y Cataluña durante el periodo 2007- 2009. Métodos: Estudio de series temporales de los casos de ITcc por gripe, según edad y sexo. Se compararon los nuevos casos de ITcc por gripe en un primer periodo epidémico (de 01/01/2007 hasta 30/09/2009) y un segundo periodo pandémico (tres últimos meses de 2009). Se calculó el número semanal de nuevos casos de ITcc por gripe, representándose gráficamente los valores mínimo, mediano y máximo de los casos notificados durante el periodo epidémico y el pandémico. Resultados:Al contrario de lo esperado, las mujeres presentaron 52,2% en Cataluña y 49,7% en Andalucía de nuevos casos de ITcc por gripe durante el periodo pandémico. Durante ambos periodos, el grupo de edad de 25 a 34 años presentó mayor número de casos tanto en Cataluña (37.439 en el periodo epidémico y 15.379 en el pandémico) como en Andalucía (periodo epidémico 20.465 y periodo pandémico 9.630). La llegada de la pandemia se situó alrededor del mes de noviembre (aproximadamente 10.000 casos en Cataluña y 5.000 casos en Andalucía), produciéndose un importante aumento de casos respecto a la mediana del periodo epidémico. Conclusiones: La aparición de la pandemia de gripe produjo un incremento importante de casos de ITcc, algo superior en Cataluña que en Andalucía, adelantándose su acmé a noviembre, especialmente en las mujeres de las dos Comunidades Autónomas(AU)

Background: This study compared surveillance of cases of sickness absence due to illness caused by influenza and reported in Andalusia and Catalonia in the period 2007-2009. Methods:Atime series of incident cases of sickness absence due to influenza, by sex and age, in which episodes in Andalusia and Catalonia in a previous epidemic period (from 01/01/2007 through 30/09/2009) were compared to the pandemic period (last three months of 2009). The weekly number of new cases of sickness absence due to influenza was calculated, and the minimum, median and maximum values were plotted for each of these two periods. Results: Unexpectedly, women had a higher proportion of new cases of sickness absence due to influenza during the pandemic period (52.2% in Catalonia and 49.7% in Andalusia). During both periods the 25 to 34 year old age group had a higher number of new cases of sickness absence both in Catalonia (37.439 in the epidemic period and 15.379 in the pandemic) and Andalusia (20.465 epidemic period and 9.630 pandemic period).The arrival of the pandemic was around November (approximately 10.000 cases in Catalonia and 5.000 cases in Andalusia), resulting in a significant increase of cases in contrast to the median of the epidemic period. Conclusions: During the 2009 pandemic, there was an increase in new cases of sickness absence due to influenza, somewhat greater in Catalonia than Andalusia, with an earlier peak in November, especially among women in these two autonomous communities(AU)

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

ObjetivosComparar la duración de los casos de incapacidad temporal por contingencia común gestionados por las mutuas con los gestionados por el Instituto Nacional de la Seguridad Social (INSS).MétodosCohorte retrospectiva de 289.686 casos de incapacidad de más de 15 días de duración iniciados en 2005 tras su certificación por un médico de primaria en Cataluña (156.676 gestionados por el INSS), registrados en el Institut Català d’Avaluacions Mèdiques, y seguidos hasta su alta. La duración mediana y los percentiles fueron calculados con el estimador de Wang-Chang, que tiene en cuenta los episodios repetidos (25% aproximadamente), y se compararon mediante un modelo de regresión log-logístico con fragilidad gamma compartida, lo que permite estimar la razón de tiempo (RT) y su intervalo de confianza del 95% (IC95%).ResultadosLa duración mediana fue de 43 días para los casos del INSS y de 39 para los de mutuas. Esta diferencia fue estadísticamente significativa para los hombres del régimen general (RT=0,87; IC95%: 0,85–0,88) y del régimen de autónomos (RT=0,78; IC95%: 0,75–0,80), y para las mujeres del régimen general (RT=0,85; IC95%: 0,84–0,87) y de autónomos (RT=0,84; IC95%: 0,81–0,88); diferencias que se mantienen en general después de ajustar por la edad y la región sanitaria.ConclusionesLos resultados confirman una finalización de los episodios más rápida para los casos de más de 15 días de duración gestionados por una mutua que para los gestionados por el INSS, tanto aquellos del régimen general como de autónomos. Es necesario investigar las causas de estas diferencias(AU)

ObjectivesTo 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).MethodsWe 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).ResultsThe 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.ConclusionsFor 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(AU)

Prospective study of asbestos-related diseases incidence cases in primary health care in an area of Barcelona province.

BACKGROUND: Asbestos related diseases include a number of conditions due to inhalation of asbestos fibres at work, at home or in the environment, such as pleural mesothelioma, asbestosis and calcified pleural plaques. Few epidemiological studies have established the incidence of asbestos related diseases in our area. The present proposal is based on a retrospective study externally funded in 2005 that is currently taking place in the same area and largely carried out by the same research team.The aim of the study is to achieve a comprehensive and coordinated detection of all new cases of Asbestos Related Diseases presenting to primary care practitioners. METHODS/DESIGN: This is a multicentre, multidisciplinary and pluri-institutional prospective study.Setting12 municipalities in the Barcelona province within the catchment area of the health facilities that participate in the study.SampleThis is a population based study, of all patients presenting with diseases caused by asbestos in the study area.MeasurementsA clinical and epidemiological questionnaire will be filled in by the trained researchers after interviewing the patients and examining their clinical reports. DISCUSSION: Data on the incidence of the different Asbestos Related Diseases in this area will be obtained and the most plausible exposure source and space-time-patient profile will be described. The study will also improve the standardization of patient management, the coordination between health care institutions and the development of preventive activities related with asbestos exposure and disease.

[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.

Enfermedad por amianto en una población próxima a una fábrica de fibrocemento / Asbestos-Related Diseases in a Population Neara Fibrous Cement Factory

Introducción: En 1907 se instaló en Cerdanyola (Barcelona) la primera fabrica de fibrocemento de España, que actuó como foco contaminante hasta su cierre en 1997. El objetivo del estudio ha sido conocer las características clinico epidemiológicas de la población afectada por enfermedades relacionadas con el amianto (ERA) que había trabajado o/y vivía en el entorno de esta fábrica. Material y métodos: Se trata de un estudio retrospectivo que reúne la información disponible de los pacientes afectados de ERA que residían en el momento del diagnóstico en la zona cercana a la factoría de fibrocemento. La información se obtuvo a partir de la documentación médica de los centros de atención primaria de las 12 poblaciones circundantes y del único hospital de referencia de la zona, para los casos diagnosticados entre el 1 de enero de 1970 y el 31 de diciembre de 2006. Resultados: En los 559 pacientes diagnosticados se identificaron 1.107 casos de ERA. La incidencia anual media entre 2000 y 2006 fue de 9,5 pacientes por 100.000 habitantes para toda la zona, y de 35,5 para la más próxima a la fábrica. La prevalencia de pacientes con ERA a fecha de 31 de diciembre de 2006 fue de 91 por 100.000 personas en toda la zona y de 353,4 en la más próxima a la fábrica. De los 1.107 casos, el 86,5%correspondía a enfermedad benigna y el 8,4%a mesotelioma pleural. Conclusiones: En lazona estudiada, la fábrica supuso un factor de riesgo importante de ERA para sus trabajadores y la población cercana. La detección de casos mostró una tendencia ascendente. La incidencia de ERA fue muy elevada (AU)

Background and Objective: The first fibrous cement factory in Spain was setup in Cerdanyola, Barcelona, in 1907 and was a source of pollution there untilit was closed in 1997. The aim of this study was to determine the clinical and epidemiologic characteristics of the population with by asbestos-related diseases who had worked in the factory and/or lived in the vicinity. Material and Methods: We retrospectively collected information available on patients with asbestos-related diseases who at the time of diagnosis had resided in the are an ear the fibrous cement factory. Information was obtained from the medical records of the primary care centers of the 12 surrounding towns and the sole referral hospital in the area for cases diagnosed between January 1, 1970 and December 31, 2006. Results: In the 559 patients diagnosed, 1107 cases of asbestos-related diseases were identified. Between 2000 and 2006, the average annual incidence was 9.5 cases per 100000 inhabitants for the entire study area and 35.5 cases per 100000 for the area nearest the factory. The prevalence of asbestos-related diseases as of December 31, 2006 was 91 cases per 100000 inhabitants in the entire study area and 353.4 cases per 100000 in the area nearest the factory. Of the 1107 asbestos-related disease cases identified, 86.5% were benignand 8.4%pleural mesothelioma. Conclusions: The factory introduced an important area-wide risk factor for asbestos-related diseases for both workers and for the nearby population. The number of cases of asbestos-related diseases detected annually showed an up ward trend. The incidence was extremely high in the period studied (AU)

[Asbestos-related diseases in a population near a fibrous cement factory]. / Enfermedad por amianto en una población próxima a una fábrica de fibrocemento.

BACKGROUND AND OBJECTIVE: The first fibrous cement factory in Spain was set up in Cerdanyola, Barcelona, in 1907 and was a source of pollution there until it was closed in 1997. The aim of this study was to determine the clinical and epidemiologic characteristics of the population with by asbestos-related diseases who had worked in the factory and/or lived in the vicinity. MATERIAL AND METHODS: We retrospectively collected information available on patients with asbestos-related diseases who at the time of diagnosis had resided in the area near the fibrous cement factory. Information was obtained from the medical records of the primary care centers of the 12 surrounding towns and the sole referral hospital in the area for cases diagnosed between January 1, 1970 and December 31, 2006. RESULTS: In the 559 patients diagnosed, 1107 cases of asbestos-related diseases were identified. Between 2000 and 2006, the average annual incidence was 9.5 cases per 100,000 inhabitants for the entire study area and 35.5 cases per 100,000 for the area nearest the factory. The prevalence of asbestos-related diseases as of December 31, 2006 was 91 cases per 100,000 inhabitants in the entire study area and 353.4 cases per 100,000 in the area nearest the factory. Of the 1107 asbestos-related disease cases identified, 86.5% were benign and 8.4% pleural mesothelioma. CONCLUSIONS: The factory introduced an important area-wide risk factor for asbestos-related diseases for both workers and for the nearby population. The number of cases of asbestos-related diseases detected annually showed an upward trend. The incidence was extremely high in the period studied.