Morbilidad y estado de salud autopercibido, dos aproximaciones diferentes al estado de salud / Morbidity and self-perception of health, two different approaches to health status

OBJETIVO: Determinar el grado de asociación entre el estado de salud percibido y el obtenido a partir de información sobre morbilidad atendida. MÉTODO: Se estudió la población de cuatro áreas básicas de salud de la comarca del Baix Empordà (N=91.067), en el año 2016, con una muestra de 1202 personas a las que se realizó una encuesta de salud. Paralelamente, las personas encuestadas se clasificaron en estados de salud mediante el agrupador Clinical Risk Groups. El grado de asociación se analizó mediante regresión logística. RESULTADOS: Un 27% de las personas con más de dos enfermedades crónicas mayores o con condiciones de salud complejas afirmaron tener buena salud. Se detectó asociación entre percepción de salud y carga de enfermedad. El sexo, la situación laboral, la clase social y especialmente la edad también mostraron asociación con la percepción de salud. CONCLUSIONES: La inferencia del estado de salud a partir de registros clínicos sobre morbilidad atendida aproxima la percepción subjetiva de la salud, y viceversa. No obstante, determinados factores sociodemográficos modulan la percepción individual. Los resultados obtenidos son esperanzadores en relación con el desarrollo de nuevas metodologías de cálculo de indicadores de calidad de vida

OBJECTIVE: To determine the degree of association between perceived health status and that obtained from information on attended morbidity. METHOD: The population of four health areas of the Baix Empordà region (Catalonia, Spain) (N=91,067) was studied in 2016, by means of a sample of 1202 individuals. A health survey was conducted on sample individuals. At the same time, the respondents were classified by health status through the Clinical Risk Groups system. The degree of association was analysed by logistic regression. RESULTS: 27% of patients with more than two major chronic diseases or with complex health conditions stated they were in good health. An association was detected between health perception and disease burden. Sex, work situation, social class and especially age also showed association with the perception of health. CONCLUSIONS: The inference of health status from clinical records on attended morbidity approximates to the subjective perception of health and vice versa. However, certain sociodemographic factors modulate individual perception. The results obtained are encouraging in relation to the development of new methodologies for calculating quality of life indicators

[Morbidity and self-perception of health, two different approaches to health status]. / Morbilidad y estado de salud autopercibido, dos aproximaciones diferentes al estado de salud.

OBJECTIVE: To determine the degree of association between perceived health status and that obtained from information on attended morbidity. METHOD: The population of four health areas of the Baix Empordà region (Catalonia, Spain) (N=91,067) was studied in 2016, by means of a sample of 1202 individuals. A health survey was conducted on sample individuals. At the same time, the respondents were classified by health status through the Clinical Risk Groups system. The degree of association was analysed by logistic regression. RESULTS: 27% of patients with more than two major chronic diseases or with complex health conditions stated they were in good health. An association was detected between health perception and disease burden. Sex, work situation, social class and especially age also showed association with the perception of health. CONCLUSIONS: The inference of health status from clinical records on attended morbidity approximates to the subjective perception of health and vice versa. However, certain sociodemographic factors modulate individual perception. The results obtained are encouraging in relation to the development of new methodologies for calculating quality of life indicators.

Mejora de la estadística de mortalidad por suicidio en Tarragona (Cataluña, España) entre 2004 y 2012 / Improving suicide mortality statistics in Tarragona (Catalonia, Spain) between 2004-2012

Introducción: La vigilancia y prevención de la conducta suicida requiere, entre otros datos, conocer con precisión las muertes por suicidio (MPS). Frecuentemente existe una infradeclaración o mala clasificación de las MPS en las estadísticas oficiales de mortalidad. El objetivo del estudio es analizar la infradeclaración de la estadística de mortalidad por suicidio en Tarragona (Cataluña, España). Material y métodos: Análisis de las MPS ocurridas en la División de Tarragona del Institut de Medicina Legal i Ciències Forenses de Catalunya (DT-IMLCFC) entre los años 2004 y 2012. Las fuentes de información fueron el fichero de defunciones del Registre de Mortalitat de Catalunya (RMC) y el archivo de autopsias del DT-IMLCFC. Se compararon estadísticamente las tasas y las características demográficas de las MPS declaradas en el RMC y las recuperadas. Resultados: La media de casos no declarados en el período fue del 16,2%, con el mínimo en el año 2005 (2,2%) y el máximo en el año 2009 (26,8%). La tasa bruta de mortalidad por suicidio pasó de 6,6 por 100.000 habitantes a 7,9 por 100.000 habitantes tras la incorporación de los datos forenses. Se detectaron diferencias poco importantes en el perfil sociodemográfico de los suicidios declarados inicialmente y los definitivos, excepto en el método de suicidio, con un aumento significativo de los envenenamientos y los arrollamientos en vía férrea. Conclusiones: La recuperación de datos en las MPS a partir de las fuentes forenses mejora la información estadística, corrigiendo su infradeclaración y ampliando el conocimiento sobre el método de suicidio y las características personales

Introduction: Monitoring and preventing suicidal behaviour requires, among other data, knowing suicide deaths precisely. They often appear under-reported or misclassified in the official mortality statistics. The aim of this study is to analyse the under-reporting found in the suicide mortality statistics of Tarragona (a province of Catalonia, Spain). Method and materials: The analysis takes into account all suicide deaths that occurred in the Tarragona Area of the Catalan Institute of Legal Medicine and Forensic Sciences (TA-CILMFS) between 2004 and 2012. The sources of information were the death data files of the Catalan Mortality Register, as well as the Autopsies Files of the TA-CILMFS. Suicide rates and socio-demographic profiles were statistically compared between the suicide initially reported and the final one. Results: The mean percentage of non-reported cases in the period was 16.2%, with a minimum percentage of 2.2% in 2005 and a maximum of 26.8% in 2009. The crude mortality rate by suicide rose from 6.6 to 7.9 per 100,000 inhabitants once forensic data were incorporated. Small differences were detected between the socio-demographic profile of the suicide initially reported and the final one. Supplementary information was obtained on the suicide method, which revealed a significant increase in poisoning and suicides involving trains. Conclusions: An exhaustive review of suicide deaths data from forensic sources has led to an improvement in the under-reported statistical information. It also improves the knowledge of the method of suicide and personal characteristics

Improving suicide mortality statistics in Tarragona (Catalonia, Spain) between 2004-2012. / Mejora de la estadística de mortalidad por suicidio en Tarragona (Cataluña, España) entre 2004 y 2012.

INTRODUCTION: Monitoring and preventing suicidal behaviour requires, among other data, knowing suicide deaths precisely. They often appear under-reported or misclassified in the official mortality statistics. The aim of this study is to analyse the under-reporting found in the suicide mortality statistics of Tarragona (a province of Catalonia, Spain). METHOD AND MATERIALS: The analysis takes into account all suicide deaths that occurred in the Tarragona Area of the Catalan Institute of Legal Medicine and Forensic Sciences (TA-CILMFS) between 2004 and 2012. The sources of information were the death data files of the Catalan Mortality Register, as well as the Autopsies Files of the TA-CILMFS. Suicide rates and socio-demographic profiles were statistically compared between the suicide initially reported and the final one. RESULTS: The mean percentage of non-reported cases in the period was 16.2%, with a minimum percentage of 2.2% in 2005 and a maximum of 26.8% in 2009. The crude mortality rate by suicide rose from 6.6 to 7.9 per 100,000 inhabitants once forensic data were incorporated. Small differences were detected between the socio-demographic profile of the suicide initially reported and the final one. Supplementary information was obtained on the suicide method, which revealed a significant increase in poisoning and suicides involving trains. CONCLUSIONS: An exhaustive review of suicide deaths data from forensic sources has led to an improvement in the under-reported statistical information. It also improves the knowledge of the method of suicide and personal characteristics.

Evolución de la cirugía mayor ambulatoria en Cataluña, 2001-2011 / Trends in ambulatory surgical procedures in Catalonia (Spain), 2001-2011

Objetivo: Analizar la evolución de la cirugía mayor ambulatoria en los hospitales de Cataluña, en relación con la actividad del servicio de cirugía con hospitalización y la dotación estructural quirúrgica. Métodos: Estudio descriptivo con datos de la Estadística de Establecimientos Sanitarios con Régimen de Internamiento del Departament de Salut, Generalitat de Cataluña, durante el periodo 2001-2011. Se realizó para hospitales de agudos, agrupados en hospitales públicos y privados. Discusión: El porcentaje de cirugía ambulatoria aumentó un 63,2% y la actividad de cirugía con hospitalización disminuyó un 23,5% (de forma más marcada en los hospitales públicos). Esto coincide con una disminución de los recursos estructurales (camas y quirófanos) y con una mejora de los índices de actividad de cirugía con hospitalización (disminución de la estancia media y del índice de ocupación en todos los hospitales). Así mismo, se optimizaron los recursos estructurales y se mejoró la eficiencia en los servicios de cirugía hospitalaria (AU)

Objective: To analyse the trend in ambulatory surgery procedures in Catalonia (Spain) hospitals with regard to the activity in inpatient care units and structural resources in surgery. Methods: A descriptive study was performed using data from the Statistics of Health Facilities with Inpatient Care of the Health Department of the Catalan Government from 2001 to 2011. Data from acute care hospitals were analysed and were classified in public and private hospitals. Discussion: The percentage of ambulatory surgical procedures increased by 63.2% and the percentage of inpatient surgery decreased by 23.5% (this trend was more pronounced in public hospitals). This result coincided with a decrease of structural resources in surgery (beds and operating rooms) and with an improvement in inpatient surgical activity (a decrease in the mean length of stay and bed occupancy rate in all hospitals). Structural surgery resources were optimized and efficiency was improved in surgery inpatient care units (AU)

[Trends in ambulatory surgical procedures in Catalonia (Spain), 2001-2011]. / Evolución de la cirugía mayor ambulatoria en Cataluña, 2001-2011.

OBJECTIVE: To analyse the trend in ambulatory surgery procedures in Catalonia (Spain) hospitals with regard to the activity in inpatient care units and structural resources in surgery. METHODS: A descriptive study was performed using data from the Statistics of Health Facilities with Inpatient Care of the Health Department of the Catalan Government from 2001 to 2011. Data from acute care hospitals were analysed and were classified in public and private hospitals. DISCUSSION: The percentage of ambulatory surgical procedures increased by 63.2% and the percentage of inpatient surgery decreased by 23.5% (this trend was more pronounced in public hospitals). This result coincided with a decrease of structural resources in surgery (beds and operating rooms) and with an improvement in inpatient surgical activity (a decrease in the mean length of stay and bed occupancy rate in all hospitals). Structural surgery resources were optimized and efficiency was improved in surgery inpatient care units.

Comentarios sobre las diferencias en el número de muertes por suicidio en España / Comments about the differences in the number of suicide deaths in Spain

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RiskDiff: a web tool for the analysis of the difference due to risk and demographic factors for incidence or mortality data.

BACKGROUND: Analysing the observed differences for incidence or mortality of a particular disease between two different situations (such as time points, geographical areas, gender or other social characteristics) can be useful both for scientific or administrative purposes. From an epidemiological and public health point of view, it is of great interest to assess the effect of demographic factors in these observed differences in order to elucidate the effect of the risk of developing a disease or dying from it. The method proposed by Bashir and Estève, which splits the observed variation into three components: risk, population structure and population size is a common choice at practice. RESULTS: A web-based application, called RiskDiff has been implemented (available at http://rht.iconcologia.net/riskdiff.htm), to perform this kind of statistical analyses, providing text and graphical summaries. Code from the implemented functions in R is also provided. An application to cancer mortality data from Catalonia is used for illustration. CONCLUSIONS: Combining epidemiological with demographical factors is crucial for analysing incidence or mortality from a disease, especially if the population pyramids show substantial differences. The tool implemented may serve to promote and divulgate the use of this method to give advice for epidemiologic interpretation and decision making in public health.

Status of human assisted reproduction in Spain: results from the new registry of Catalonia.

The FIVCAT. NET database in Catalonia is the only official obligatory registry of human assisted reproduction practitioners in Spain. The present study assessed the effectiveness and outcomes of assisted reproduction over the period 2001-2005 relative to other established worldwide registries. The data analysed were derived from all centres conducting assisted reproduction in Catalonia, and included users of the services (resident and non-resident); all cycles performed; descriptive characteristics of the assisted reproduction procedures; and sociodemographic characteristics of the women. Effectiveness of assisted reproduction was measured by standard indicators such as rates of pregnancy and rates of live births per pregnancy. The results indicated that the preferred number of embryos for transfer changed from three to two over this period. Pregnancies per transfer improved from 33.2% to 37.1% (from 36.9% to 40.2% using fresh embryos and from to 18.4% to 27.0% with frozen embryos). Multiple births decreased from 50.1% to 38.6%, premature births from 37.5% to 28.3% and low-birth-weight infants from 38.0% to 25.6%. It is concluded that the conduct of assisted reproduction in Catalonia has improved considerably and compares favourably with other countries, not only with respect to the level of activity, but also the effectiveness and outcomes achieved, although the quality of the sociodemographic information requires improvement.

Competing risks to breast cancer mortality in Catalonia.

BACKGROUND: Breast cancer mortality has experienced important changes over the last century. Breast cancer occurs in the presence of other competing risks which can influence breast cancer incidence and mortality trends. The aim of the present work is: 1) to assess the impact of breast cancer deaths among mortality from all causes in Catalonia (Spain), by age and birth cohort and 2) to estimate the risk of death from other causes than breast cancer, one of the inputs needed to model breast cancer mortality reduction due to screening or therapeutic interventions. METHODS: The multi-decrement life table methodology was used. First, all-cause mortality probabilities were obtained by age and cohort. Then mortality probability for breast cancer was subtracted from the all-cause mortality probabilities to obtain cohort life tables for causes other than breast cancer. These life tables, on one hand, provide an estimate of the risk of dying from competing risks, and on the other hand, permit to assess the impact of breast cancer deaths on all-cause mortality using the ratio of the probability of death for causes other than breast cancer by the all-cause probability of death. RESULTS: There was an increasing impact of breast cancer on mortality in the first part of the 20th century, with a peak for cohorts born in 1945-54 in the 40-49 age groups (for which approximately 24% of mortality was due to breast cancer). Even though for cohorts born after 1955 there was only information for women under 50, it is also important to note that the impact of breast cancer on all-cause mortality decreased for those cohorts. CONCLUSION: We have quantified the effect of removing breast cancer mortality in different age groups and birth cohorts. Our results are consistent with US findings. We also have obtained an estimate of the risk of dying from competing-causes mortality, which will be used in the assessment of the effect of mammography screening on breast cancer mortality in Catalonia.

[Differences in disability-free life expectancy by gender and autonomous regions in Spain]. / Diferencias en la esperanza de vida libre de discapacidad por sexo y comunidades autónomas en España.

BACKGROUND: Improvement of population health is the main aim and an important challenge for the health system. To monitor the population health indicators like disability-free life expectancy (DFLE) have been implemented. The purpose of this paper was to analyze the geographical distribution of DFLE according to autonomous regions in Spain. METHODS: Data of mortality, population and disability for the year 1999, provided by the National Institute of Statistics (INE), were used. To calculate DFLE by gender and region we used the Sullivan method that weights the expected time to live according to the status of disablement of the population. The standard error of DFLE, the expectation of disability and the proportion of time lived free of disability have also been estimated. RESULTS: In 1999 the DFLE at birth in Spain was 68.5 year for men and 72.2 years in women. Men lived proportionally more time free of disability than women (91% versus 87.7%) with an expectation of disability of 6.8 and 10.1 years respectively. Variability among regions was higher in DFLE than in life expectancy (LE). The regions with highest LE are not always those with the highest proportion of time lived without disability. CONCLUSIONS: Highest life expectancy does not always mean best health as it has been assumed currently. The DFLE indicator is a useful tool to show health status differences among the Spanish population.

Criterios para determinar la lista de causas de mortalidad evitable: una discusión inevitable / Criteria to define the list of causes of avoidable mortality: an unavoidable discussion

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Diferencias en la esperanza de vida libre de discapacidad por sexo y Comunidades Autónomas en España / Differences in disability-free life expectancy by gender and autonomous regions in Spain

Fundamentos: La mejora de la salud de la población esel principal objetivo y el mayor reto del sistema sanitario ypara monitorizarla se dispone de indicadores como la esperanzade vida libre de discapacidad (EVLD). El objetivo esanalizar la distribución de este indicador por comunidadesautónomas (CCAA) en España.Métodos: Los datos de mortalidad, de población y de discapacidadpara el año 1999 proceden del INE. La EVLD seha calculado por el método de Sullivan, que pondera la tablade vida en función del estado de discapacidad, por sexo yCCAA. También se ha estimado el error estándar de laEVLD, la expectativa de discapacidad y la proporción deltiempo vivido libre de discapacidad.Resultados: En 1999 la EVLD al nacer fue de 68,5 años enhombres y de 72,2 años en mujeres. El tiempo vivido sin discapacidadesfue superior en hombres (91%) que en mujeres(87,7%) y la expectativa de discapacidad de 6,8 años y de 10,1años respectivamente. La diversidad entre comunidades es superioren la EVLD que en la esperanza de vida (EV). Las CCAAcon mayor esperanza de vida no coinciden siempre con las quetienen una mayor proporción de tiempo vivido sin discapacidad.Conclusiones: Una mayor EV no significa necesariamenteuna mejor salud, tal como se asume tradicionalmente.La EVLD es útil para evidenciar diferencias del estado desalud en la población española

Background: Improvement of population health is themain aim and an important challenge for the health system. Tomonitor the population health indicators like disability-freelife expectancy (DFLE) have been implemented. The purposeof this paper was to analyze the geographical distribution ofDFLE according to autonomous regions in Spain.Methods: Data of mortality, population and disability forthe year 1999, provided by the National Institute of Statistics(INE), were used. To calculate DFLE by gender and region weused the Sullivan method that weights the expected time to liveaccording to the status of disablement of the population. Thestandard error of DFLE, the expectation of disability and theproportion of time lived free of disability have also beenestimated.Results: In 1999 the DFLE at birth in Spain was 68.5 yearfor men and 72.2 years in women. Men lived proportionallymore time free of disability than women (91% versus 87.7%)with an expectation of disability of 6.8 and 10.1 yearsrespectively. Variability among regions was higher in DFLEthan in life expectancy (LE). The regions with highest LE arenot always those with the highest proportion of time livedwithout disability.Conclusions: Highest life expectancy does not alwaysmean best health as it has been assumed currently. The DFLEindicator is a useful tool to show health status differencesamong the Spanish population

Evolución temporal y distribución geográfica de la mortalidad por suicidio en Cataluña y España (1986-2002) / Geographical distribution an time trends of suicide mortality in Catalonia and Spain [1986-2002]

Objetivos: Estudiar la evolución temporal de la mortalidad por suicidio en Cataluña (1986-2002) y España (1986-2001), y analizar su distribución geográfica en esta comunidad autónoma. Métodos: Se calcularon las tasas anuales estandarizadas por edad para ambos sexos por el método directo y el porcentaje de cambio anual mediante un modelo de regresión de Poisson, por sexo y grupos de edad para Cataluña (1986-2002) y España (1986-2001). Para Cataluña, se calculó la razón de mortalidad estandarizada por el método indirecto (RME) por sexo, para los 46 sectores sanitarios y para todo el período, y la razón de mortalidad comparativa (RMC) y los intervalos de confianza (IC del 95%) agrupando los años en período 1 (1986-1994) y período 2 (1995-2002). Resultados: En Cataluña, la mortalidad en hombres es inferior que en España y se aprecia un incremento (no significativo) en el período estudiado en ambos territorios; en mujeres, la evolución y la magnitud de las tasas son similares a las del conjunto del Estado, y en los dos lugares se observa un ligero descenso (significativo) de las tasas. La evolución según la edad y el sexo muestra patrones diferenciados, destacando el descenso de las tasas en edades avanzadas en ambos sexos y el aumento en jóvenes en España y Cataluña. Los sectores sanitarios de la zona central, noreste y sur de Cataluña presentan una mortalidad superior a la media. Conclusiones: La evolución temporal de la mortalidad por suicidio en Cataluña y España muestra patrones diferentes según la edad y el sexo. En la distribución territorial en Cataluña se observa una progresiva homogeneización por sectores sanitarios

Objective: To analyze time trends in Catalonia (1986-2002) and Spain (1986-2001) in suicide mortality and its geographical variation by health areas in Catalonia. Methods: Standard annual mortality rates were calculated by the direct method for Catalonia (1986-2002) and Spain (1986-2001) (standard population of Catalonia 1991). The adjusted annual percent change was analyzed by means of a Poisson regression by gender and by age group for Catalonia and Spain. For the geographical variation in Catalonia, standardized mortality ratio using the indirect method (SMR) were calculated by gender and for the 46 health areas for the entire period and the comparative mortality figures and its confidence intervals at 95% were analyzed grouping the years in period 1(1986-1994) and period 2 (1995-2002). Results: Men's mortality in Catalonia was lower than in Spain and an increase (not significant) was observed in both places during the period; for women, the evolution and rates were similar, with a small decrease (significant) for Catalonia and Spain. Differences in patterns and trends for age and sex were observed, showing a decrease in the elderly groups for both sexes and an increase for the young for Spain and Catalonia. In terms of geographic distribution, the health sectors of the Central, Northeast and South Catalonia zones show higher than average mortality. Conclusions: The time trends of mortality by suicide in Catalonia shows different patterns according to age and gender. A progressive homogenization in the territorial distribution by health areas was observed

[Survival changes among AIDS cases in Catalonia, Spain (1981-2001)]. / Cambio de la supervivencia de los casos de sida en Cataluña (1981-2001).

BACKGROUND AND OBJECTIVE: Our goal was to assess survival changes among AIDS patients in Catalonia. PATIENTS AND METHOD: We analyzed AIDS cases older than 13 years notified in the Catalonian AIDS Registry from January 1981 to December 2001. Sex, age, transmission category, AIDS-defining disease and diagnostic period were included. The survival cumulative risk was computed for each diagnostic period with Kaplan-Meier methods. RESULTS: During the study period 13,485 AIDS cases were reported. Median survival time was 0.9 years for 1981-1987, 1.7 for 1988-1993 and 2.4 years for 1994-August 1996. The survival time of 75% of patients diagnosed in September 1996-1997 and 1998-2001 was 1.57 and 2.02 years, respectively. Multivariate analyses showed a higher risk among intravenous drug users (hazard ratio = 1.25; 95% confidence interval, 1.17-1.33) than in homo/bisexual men. When we compared heterosexual and homo/bisexual groups, we found that the result was not significant (hazard ratio = 0.99; 95% confidence interval, 0.92-1.08). The analysis stratified by AIDS-defining disease showed a decrease in the risk of death in most illnesses. CONCLUSIONS: Our results confirm the increase in survival in AIDS cases related to highly active antirretroviral therapy (HAART).