Excesos de mortalidad en España durante la transmisión de gripe pandémica en el año 2009 / Excess mortality in Spain during transmission of pandemic influenza in 2009

Fundamento: El sistema español de monitorización de la mor-talidad y el «Programa Europeo de monitorización de excesos de mortalidad para la acción en salud pública» detectaron dos excesos de mortalidad en España en noviembre y diciembre de 2009. El obje-tivo de este trabajo es valorar su posible asociación con la transmi-sión de gripe pandémica. Métodos: Se analizó la evolución de la mortalidad en España en los meses citados utilizando métodos de análisis de series temporales basados en las series históricas de mortalidad y se comparó en el tiempo con la transmisión de gripe. Resultados: La mortalidad observada en la población total fue mayor de lo esperado en dos periodos: semanas 46-47/2009 con 5,75% de exceso y las semanas 51-52/2009 con 7,35% de exceso. También se registró un exceso de mortalidad en niños de 5 a 14 años en las semanas 46-48/2009 con 41 defunciones vs las 21 esperadas. El exceso de mortalidad en noviembre fue concomitante con las mayores tasas de gripe. El exceso de diciembre se observó 5 semanas después del pico de gripe y coincidió con un descenso dramático de las temperaturas. El virus sincitial respiratorio y los accidentes de tráfico fueron descartados como factores asociados. Conclusiones: Mientras que las temperaturas podrían explicar la mayoría del exceso de mortalidad observado en diciembre, ningún factor por si solo podría explicar el exceso de noviembre(AU)

Background: The Spanish daily mortality monitoring system and the program «European monitoring of excess mortality for public health action» found two excesses of mortality in Spain in November and December 2009. Methods: We analyzed the evolution of mortality in Spain during those months using time-series analysis methods based on historical mortality series and compared it in the time with influenza transmission. Results: Observed mortality for the total population was higher than expected in two periods: weeks 46-47/2009 with 5.75% excess and weeks 51-52/2009 with 7.35% excess. Observed mortality hig-her than expected, was also observed in children 5-14 years old during weeks 46-48/2009 with 41 deaths vs 21 expected. Exces mor-tality in November occurred before or was concomitant with highest influenza incidence rates. Excess mortality in December occurred five weeks after the influenza incidence peak and along with drama-tic drop in temperatures. RSV and traffic accidents were ruled out as factor associated to these excesses. Conclusions: While temperatures could explain most of the excess mortality observed in December, no single factor could be associated with observed excess mortality in November(AU)

[Excess mortality in Spain during transmission of pandemic influenza in 2009]. / Excesos de mortalidad en España durante la transmisión de gripe pandémica en el año 2009.

BACKGROUND: The Spanish daily mortality monitoring system and the program «European monitoring of excess mortality for public health action¼ found two excesses of mortality in Spain in November and December 2009. METHODS: We analyzed the evolution of mortality in Spain during those months using time-series analysis methods based on historical mortality series and compared it in the time with influenza transmission. RESULTS: Observed mortality for the total population was higher than expected in two periods: weeks 46-47/2009 with 5.75% excess and weeks 51-52/2009 with 7.35% excess. Observed mortality higher than expected, was also observed in children 5-14 years old during weeks 46-48/2009 with 41 deaths vs 21 expected. Exces mortality in November occurred before or was concomitant with highest influenza incidence rates. Excess mortality in December occurred five weeks after the influenza incidence peak and along with dramatic drop in temperatures. RSV and traffic accidents were ruled out as factor associated to these excesses. CONCLUSIONS: While temperatures could explain most of the excess mortality observed in December, no single factor could be associated with observed excess mortality in November.

Distribución espacial de la tuberculosis en España mediante métodos geoestadísticos / Space distribution of tuberculosis in Spain by geostatistical methods

Fundamentos: La incidencia de tuberculosis (TB) se haasociado a factores, epidemiológicos y sociales. En España, laTB es una enfermedad de declaración obligatoria e individualizada.Las tasas de TB respiratoria experimentan un descensoconstante en los últimos años. El objetivo es valorar la asociaciónentre la morbilidad por TB respiratoria y variables socioeconómicasy epidemiológicas así como su distribución espacialmediante métodos geoestadísticos.Método: Las tasas de incidencia se estandarizaron poredad y sexo con datos de la Red Nacional de Vigilancia (2006).Las variables socioeconómicas incluidas son: condiciónsocioeconómica, nivel de estudios, tasa de hacinamiento, densidadde población, tasa de inmigración estandarizada porsexo, tasa de analfabetismo, tasa de paro, gasto medio en eurospor persona. Las variables epidemiológicas incluidas han sidola tasa de SIDA y la tasa de incidencia de gripe. Se realizó unanálisis multivariable mediante un Modelo Lineal Generalizadopoisson. Se aplicó la técnica geoestadística Cokringingajustada por las variables estadísticamente significativas paraver la distribución espacial de riesgo.Resultados: Las variables estadísticamente significativasson la tasa de hacinamiento, tasa de inmigración, tasa de analfabetismo,tasa de paro, gasto medio euros por persona, tasa degripe y tasa de sida. La técnica geoestadística muestra unavariabilidad espacial del riesgo y una concentración del riesgoen el noroeste y sureste de la península.Conclusiones: Los resultados permiten afirmar que elmétodo Cokriging es una herramienta útil para representar ladistribución espacial del riesgo. Existe asociación entre variablessocioeconómicas , epidemiológicas y TB en España(AU)

Background: Tuberculosis incidence has been associatedwith many factors, both epidemiological and social. In Spain,tuberculosis is a statutorily notifiable disease requiringindividualised reporting. During the last few years rates ofrespiratory tuberculosis show a steady decline. This study soughtto assess respiratory tuberculosis morbidity and mortality inassociation to socio-economic and epidemiological covariatesand estimate its spatial distribution across the country, using geostatisticalmethods.Methods: Respiratory tuberculosis incidence rates werestandardised by age and sex with the data of the NationalEpidemiological Surveillance Network (RENAVE, RedNacional de Vigilancia Epidemiológica) for 2006. Thefollowing socio-economic variables were included in thestudy: socio-economic status, educational level, overcrowdingrate, population density, standardised immigration rate by sex,unemployment rate and average spending per person in euros.The epidemiological variables included were, such as, AIDSrate and the influenza incidence rate. To assess the associationof covariables a multivariate analysis was performed using aGeneralised Linear Model assuming Poisson distribution. Thegoestatistical method Co-kriging was adjusted with thesignificant variables to built the spatial distribution of risk.Results: The statistically significant covariates wereovercrowding rate, standardised immigration rate by sex,educational level, unemployment rate, average spending perperson in euros, AIDS rate and the influenza incidence rate. Thegeostatistical method shows spatial variability of the risk withhigher risks in the northwest and southeast of the peninsula.Conclusion: Results prove that the Co-kriging method is auseful tool to show the spatial distribution of risk. Alternatively,tuberculosis is associated with both social and epidemiologicalcovariates(AU)

[Space distribution of tuberculosis in Spain by geostatistical methods]. / Distribución espacial de la tuberculosis en España mediante métodos geoestadísticos.

BACKGROUND: Tuberculosis incidence has been associated with many factors, both epidemiological and social. In Spain, tuberculosis is a statutorily notifiable disease requiring individualised reporting. During the last few years rates of respiratory tuberculosis show a steady decline. This study sought to assess respiratory tuberculosis morbidity and mortality in association to socio-economic and epidemiological covariates and estimate its spatial distribution across the country, using geo-statistical methods. METHODS: Respiratory tuberculosis incidence rates were standardised by age and sex with the data of the National Epidemiological Surveillance Network (RENAVE, Red Nacional de Vigilancia Epidemiológica) for 2006. The following socio-economic variables were included in the study: socio-economic status, educational level, overcrowding rate, population density, standardised immigration rate by sex, unemployment rate and average spending per person in euros. The epidemiological variables included were, such as, AIDS rate and the influenza incidence rate. To assess the association of covariables a multivariate analysis was performed using a Generalised Linear Model assuming Poisson distribution. The goestatistical method co-kriging was adjusted with the significant variables to built the spatial distribution of risk. RESULTS: The statistically significant covariates were overcrowding rate, standardised immigration rate by sex, educational level, unemployment rate, average spending per person in euros, AIDS rate and the influenza incidence rate. The geostatistical method shows spatial variability of the risk with higher risks in the northwest and southeast of the peninsula. CONCLUSION: Results prove that the co-kriging method is a useful tool to show the spatial distribution of risk. Alternatively, tuberculosis is associated with both social and epidemiological covariates.