Factors associated with coronary artery disease among people living with human immunodeficiency virus: Results from the Colombian HIV/AIDS registry.

Background: People living with HIV (PLWHIV) are at a higher risk of developing coronary artery disease (CAD). We aimed to assess the factors associated with CAD among PLWHIV in Colombia. Methods: We conducted a retrospective cohort study based on adults newly diagnosed with HIV, reported to the Colombian HIV/AIDS registry from 2018 to 2021. Baseline demographic and clinical characteristics were compared by age (<50 and ≥ 50 years). Our main outcome was the presence of CAD. Logistic regression models were used to assess the association between traditional and HIV-related factors with CAD. These associations were also evaluated in stratified models by age. Effect measures were odds ratios (OR) and their 95% confidence intervals. Results: Among 36,483 PLWHIV, the frequency of CAD was 0.53% (n = 196). There was a high prevalence of impaired fasting glucose/diabetes mellitus (12.62%), overweight/obesity (27.79%), elevated LDL-c (86.69%), and hypertriglyceridemia (72.76%). Factors associated with CAD included male gender (OR: 2.01, 95% CI: 1.12-3.58), age ≥50 years (OR: 4.96, 95% CI: 3.29-7.45), lipoatrophy or lipodystrophy (OR 5.12, 95% CI: 1.12-23.33), AIDS-defining conditions (OR: 1.83, 95% CI: 1.07-3.12), obesity (OR: 2.95, 95% CI: 1.69-5.10), diabetes mellitus (OR: 2.50, 95% CI: 1.25-4.97), and renal impairment (OR: 3.15, 95% CI: 1.83-5.42). Conclusions: Traditional CAD risk factors are common in PLWHIV. There were traditional and disease-specific factors associated with increased odds of CAD. These findings may aid clinicians and decision-makers in reducing the impact of CAD in PLWHIV.

Análisis de conglomerado de cáncer infantil y su relación con proximidad a fuentes de contaminación industrial en el Área Metropolitana del Valle de Aburrá, 2000-2015

Objetivo: Este estudio evaluó el efecto de la proximidad a fuentes industriales de contaminación del aire sobre la aparición de clústeres de casos de cáncer infantil en el Área Metropolitana del Valle de Aburrá, del departamento de Antioquia, durante el período 2000-2015. Metodología: La información de casos de cáncer infantil en menores de 15 años residentes del área metropolitana se obtuvo del Registro Poblacional de Cáncer de Antioquia, de dicho periodo. Se identificaron 32 conglomerados industriales, a partir del inventario de la autoridad ambiental local. Se realizaron pruebas de escaneo circular de Kulldorf locales y focalizadas, para detectar clústeres de cáncer infantil en los municipios y alrededor de los conglomerados industriales respectivamente. Se usó un modelo de regresión multivariable ajustado por estrato socioeconómico, para evaluar el efecto de las variables espaciales. Resultados: La tasa de incidencia específica en el Valle de Aburrá para el periodo evaluado fue de 117,13 casos por millón de niños menores de 15 años. Las tasas de incidencia más altas se presentaron en los municipios de Medellín y Sabaneta. La prueba de Kulldorf identificó 12 clústeres espaciales y 8 espacio-temporales con significación estadística en 7 de los municipios, particularmente en Bello y Medellín. Las pruebas focalizadas identificaron clústeres alrededor de 20 conglomerados industriales. En los modelos multivariables, un conglomerado en Bello evidenció asociación estadísticamente significativa e inversa entre la incidencia y la distancia al conglomerado con direccionalidad sureste. Conclusión: Algunos conglomerados espacio-temporales de cáncer infantil en el Área Metropolitana del Valle de Aburrá entre 2000 y 2015 están relacionados con proximidad a fuentes industriales de contaminación del aire.

Objective: This study evaluated the effect of proximity to industrial sources of air pollution on the occurrence of clusters of childhood cancer cases in the Aburrá Valley Metropolitan Area, Department of Antioquia, during the 2000-2015 period. Methodology: The information on childhood cancer cases in children under 15 years of age residing in the metropolitan area was obtained from the Registro Poblacional de Cáncer de Antioquia (Antioquia Cancer Population Registry) for that period. 32 industrial clusters were identified based on the local environmental authority's inventory. Local and targeted Kulldorff's circular scan tests were performed to detect childhood cancer clusters in the municipalities and surrounding the industrial clusters, respectively. We used a multivariate regression model adjusted for socioeconomic strata to assess the effect of spatial variables. Results: The specific incidence rate in the Aburrá Valley for the evaluated period was 117.13 cases per million children under 15 years of age. The highest incidence rates occurred in the municipalities of Medellín and Sabaneta. The Kulldorff test identified 12 spatial clusters and 8 space-time clusters that were statistically significant in 7 municipalities, particularly in Bello and Medellín. The targeted tests identified childhood cancer clusters surrounding 20 industrial clusters. In multivariate models, an industrial cluster in Bello showed a statistically significant inverse association between incidence and distance from the industrial cluster toward the southeast. Conclusion: Some space-time childhood cancer clusters in the Aburrá Valley Metropolitan Area between 2000 and 2015 are related to proximity to industrial sources of air pollution.

Objetivo: Este estudo avaliou o efeito da proximidade a fontes industriais de poluição do ar sobre a aparição de agrupações de casos de câncer infantil na Área Metropolitana do Valle de Aburrá, do departamento de Antioquia, durante o período 2000-2015. Metodología: A informação de casos de câncer infantil em menores de 15 anos residentes da área metropolitana foi obtida do Registro Populacional de Câncer de Antioquia, de tal período. Foram identificados 32 conglomerados industriais, a partir do inventário da autoridade ambiental local. Foram realizados testes de varredura circular de Kulldorf locais e focalizados, para detectar agrupações de casos de câncer infantil nos municípios e ao redor dos conglomerados industriais, respectivamente. Foi usado um modelo de regressão multivariável ajustado por nivel socioeconômico, para avaliar o efeito das variáveis espaciais. Resultados: A taxa de incidência específica no Valle de Aburrá para o período avaliado foi de 117,13 casos por milhão de crianças menores de 15 anos. As maiores taxas de incidencia apresentaram-se nos municípios de Medellín e Sabaneta. O teste de Kulldorf identificou 12 agrupações de casos espaciais e 8 espaço-temporais com significação estatística em 7 dos municípios, particularmente em Bello e Medellín. As provas focalizadas identificaram agrupações de casos ao redor de 20 conglomerados industriais. Nos modelos multivariáveis, um conglomerado em Bello evidenciou associação estatisticamente significativa e inversa entre a incidência e a distância com o conglomerado orientado ao sudeste. Conclusão: Algumas agrupações de casos espaço-temporais de câncer infantil na Área Metropolitana do Valle del Aburrá entre 2000 e 2015 estão relacionadas com a proximidade a fontes industriais de poluição do ar.

Regional variability of glycemic control among adults with diabetes mellitus in Colombia.

Not available.

Supervivencia en las personas que viven con VIH en el marco del sistema de salud colombiano 2011-2018 / Survival in people living with HIV in the framework the Colombian health system: 2011-2018

Resumen Objetivo: Describir la supervivencia a siete años y los principales factores asociados a esta, en las personas con VIH que fueron atendidas en el sistema de salud colombiano entre 2011 a 2018. Métodos: Análisis de supervivencia de una cohorte de 64 039 personas diagnosticadas con VIH en Colombia. Se aplicó el método de Kaplan-Meier para estimar la probabilidad de supervivencia a partir de la fecha del diagnóstico. Se ajustó un modelo de supervivencia paramétrico flexible de Royston Parmar. Resultados: La estimación de la supervivencia global a 7 años fue de 94,8% (IC 95%: 94,5-95,2). El mayor riesgo de muerte se presentó en los hombres (HR: 1,2; IC 95%: 1,1-1,4; p: 0,010); en personas ≥50 años de edad (HR: 3,1; IC 95%: 1,6-6,3; p: 0,002); en el régimen subsidiado (HR: 2,2; IC 95%: 1,9-2,5; p: <0,001); en la etapa sida (HR: 2,8; IC 95%: 2,1-3,7; p: <0,001); en quienes presentaron la última carga viral detectable (HR: 7,1; IC 95%: 6,0-8,3; p: <0,001); y en quienes mostraron conteo de linfocitos T CD4+ <350 células/μL (HR: 1,9; IC 95%: 1,4-2,4; p: <0,001). Conclusión: La probabilidad de la supervivencia de las personas que viven con VIH aumenta al ser diagnosticados en edades jóvenes, en quienes presenten un recuento de linfocitos T CD4+ ≥350 células/μL, una carga viral indetectable (< 50 copias/mL) y no se encuentren en etapa sida.

Summary Objective: to describe the seven-year survival and predictors of mortality among people with HIV who were treated in the Colombian health system between 2011 and 2018. Methods: 64 039 people diagnosed with HIV in Colombia were included. Kaplan-Meier analysis estimated the probability of survival from the date of diagnosis. A Royston Parmar flexible parametric survival model was fitted. Results: The overall survival at 7 years was 94.8% (95% CI: 94.5-95.2). Survival was related to sex (men, HR: 1.2; 95% CI: 1.1-1.4; p: 0.010); people ≥50 years of age (HR: 3.1; 95% CI: 1.6-6.3; p: 0.002); subsidized regime (HR: 2.2; 95% CI: 1.9-2.5; p: <0.001); AIDS stage (HR: 2.8; 95% CI: 2.1-3.7; p: <0.001); a detectable viral load (HR: 7.1; 95% CI: 6.0-8.3; p: <0.001); and a CD4+ Lymphocyte count <350 cells/μL (HR: 1.9; 95% CI: 1.4-2.4; p: <0.001). Conclusion: The probability of survival of people living with HIV increases when they are diagnosed at a young age, in those with a CD4+ T Lymphocyte count ≥350 cells/μL, an undetectable viral load (<50 copies/mL) and are not in the AIDS stage.

National Cancer Information System Within the Framework of Health Insurance in Colombia: A Real-World Data Approach to Evaluate Access to Cancer Care.

PURPOSE: The National Cancer Information System (NCIS) has been operating since 2014, including information reported by health care insurers and providers on people with cancer diagnosed and treated within the Colombian health system. Its main purpose is to identify barriers to an effective access to cancer diagnosis and treatment across the country. We aimed to describe the methodology, scope and results in terms of access to health services with real-world data provided by the NCIS. METHODS: Reporting of all cases of cancer by insurers and providers is mandatory by law. Data gathered include demographic and clinical information about new and old cases of cancer who receive health services. Over the years, the reporting process has been automated and it is currently performed in real time. Data quality is ensured through a standardized data-monitoring process. Access to health services is monitored by quality measures defined by consensus. RESULTS: Since 2015, prevalent cases of invasive cancer have increased from 163,776 to 331,021 in 2020 (increment of 102.12%). Regarding quality measures, the proportion of people staged at diagnosis has increased over the years, especially in breast cancer. Meanwhile, early diagnosis is still concerning for breast and prostate cancer. Time to diagnosis and treatment have not consistently reached the expected goals in breast, cervical, and prostate cancer, whereas they have shown a better level of compliance for stomach and colon and rectum tumors, still not reaching the highest performance. CONCLUSION: The real-world information approach provided by the NCIS may be complementary for cancer control planning in Colombia, emphasizing better management processes of health insurers and providers by identifying barriers for timely access to health care.

The effect of comorbidities on glycemic control among Colombian adults with diabetes mellitus: a longitudinal approach with real-world data.

BACKGROUND: Achieving an optimal glycemic control has been described to reduce the incidence of diabetes mellitus (DM) related complications. The association between comorbidities and glycemic control remains unclear. Our aim is to evaluate the effect of comorbidities on glycemic control in people living with DM. METHODS: A retrospective longitudinal study on data from the National Registry of Chronic Kidney Disease from 2014 to 2019 in Colombia. The outcome was poor glycemic control (PGC = HbA1c ≥7.0%). The association between each comorbidity (hypertension (HTN), chronic kidney disease (CKD) or obesity) and PGC was evaluated through multivariate mixed effects logistic regression models. The measures of effect were odds ratios (OR) and their 95% confidence intervals (CI). We also evaluated the main associations stratified by gender, insurance, and early onset diabetes as well as statistical interaction between each comorbidity and ethnicity. RESULTS: From 969,531 people at baseline, 85% had at least one comorbidity; they were older and mostly female. In people living with DM and CKD, the odds of having a PGC were 78% (OR: 1.78, CI 95%: 1.55-2.05) higher than those without CKD. Same pattern was observed in obese for whom the odds were 52% (OR: 1.52, CI 95%: 1.31-1.75) higher than in non-obese. Non-significant association was found between HTN and PGC. We found statistical interaction between comorbidities and ethnicity (afro descendant) as well as effect modification by health insurance and early onset DM. CONCLUSIONS: Prevalence of comorbidities was high in adults living with DM. Patients with concomitant CKD or obesity had significantly higher odds of having a PGC.

Rheumatoid arthritis in Colombia: a clinical profile and prevalence from a national registry.

BACKGROUND: There is a need to describe the demographic and clinical characteristics of people diagnosed with rheumatoid arthritis who are attended within the Colombian health system. This characterization allows prioritizing populations with specific risks, programming the use of health services, and planning the costs necessary to guarantee equitable care. OBJECTIVE: To assess the demographic and clinical characteristics of a cohort of patients with rheumatoid arthritis using national data collected by the High-Cost Disease Fund (CAC in Spanish). METHODS: A cross-sectional study from a secondary source. Data was gathered from a national administrative registry. A descriptive analysis was performed on sociodemographic and clinical characteristics. Age-standardized prevalence was estimated at national level and by geographical regions. Remission rates were also estimated for Colombian departments and regions. RESULTS: By 2019, 81,386 patients with rheumatoid arthritis were reported in Colombia. The relation female-male was 5.2:1. The median age was 59 years (IQR: 50-67). Prevalence was higher in people aged 50-69 years. The most frequent comorbidities were high blood pressure (31.15%) and osteoporosis (19.46%). Age-standardized prevalence of rheumatoid arthritis was 0.24 per 100 population (95% CI: 0.23-0.24). In cases with complete information, 57.57% of departments had remission rates up to 30%. CONCLUSION: Rheumatoid arthritis in Colombia was more frequent in females aged ≥50 year. Age-standardized prevalence was lower than reported by other studies performed in Colombia but similar to the estimated internationally for the country. Key Points • More than 80,000 rheumatoid arthritis patients were reported to this national registry in Colombia in 2019, finding an age-standardized prevalence of 0.24 per 100 population. • Hypertension was the most common comorbidity reported in people with rheumatoid arthritis. This finding is similar to the reports by similar studies such as the COMORA. • A major strength of this study is the large sample size since data come from a nationwide registry of people with rheumatoid arthritis, supported by the National Ministry of Health. Additionally, this registry has a rigorous data monitoring process that guarantees the internal validity of data and provides valuable information for decision-making based on local evidence. • Prevalence of rheumatoid arthritis was higher in females between 50 and 65 years. Age-standardized prevalence was lower than previously reported in Colombia, but similar to the world estimations.

Factors associated with delays in time to treatment initiation in Colombian women with cervical cancer: A cross-sectional analysis.

Cervical cancer (CC) is one of the leading causes of morbidity in upper-middle income countries such as Colombia. Several studies have reported poor prognosis when treatment is delayed. We aimed to describe the factors associated with delays in time to treatment initiation (TTI) in Colombian women with CC. Cross-sectional analysis including newly diagnosed cases of CC during 2018 and reported to the National Administrative Cancer Registry. TTI was defined as days from diagnosis to the first treatment (chemotherapy, radiation, or surgery). Linear and multinomial logistic regression models were estimated to analyze the association of interest. 1,249 new cases of CC were analyzed (26.98% in-situ and 40.11% locally advanced). The median age was 46 years (IQR: 36-58). Median TTI was 71 days (IQR: 42-105), varying from 70 days (IQR: 43-106) among the surgery group to 76 days (IQR: 41-118) in women under chemotherapy. Only 12.41% were treated within 30 days from diagnosis. TTI was significantly longer in women with state insurance (ß = 18.95 days, 95% CI: 11.77-26.13) compared with those insured by the third payer. Women from the Pacific and Eastern regions also had a significantly longer TTI than those living in the capital of Colombia. Age, health insurance, region of residence, and stage at diagnosis were associated with TTI longer than 45 days in the multinomial model. We concluded that demographic variables (age, region of residence, and health insurance) which are proxies of social disparities and poor access to quality health care services, were associated with delays in TTI.

Healthcare-related expenditures among immigrants and non-immigrants living with HIV in colombia.

The perception that immigrants represent a burden to national health systems can hinder the development of policies for their inclusion in health coverage. In order to inform the development of such policies, data on the healthcare needs and healthcare spending for immigrants is required. The objective of this article is to compare the clinical characteristics and healthcare-related expenditures of Venezuelan immigrants and non-migrants living with HIV in Colombia. We analysed data from the Colombian High-cost Diseases Fund from February 1, 2018 to January 31, 2019, identifying the hospital and non-hospital expenditures per patient for Venezuelan immigrants and non-migrant patients, in both the state-subsidised and the contributory coverage schemes. We employed binomial negative regression models to compare expenditures between the two groups. In the contributory scheme, the average annual per-capita expenditure for immigrants was USD $ 859.07 (SD: ± $793.37) for non-hospital care. For non-migrants, the average costs were 1,796.53. In the state-subsidised scheme expenditures were higher on average, but still lower for immigrants than for non-migrants. After adjusting by clinical and sociodemographic characteristics, non-hospital per capita expenditures were lower for immigrants as compared with non-migrants (25,37% lower in the state-subsidised scheme, and 33,75% lower in the contributory scheme). Hospital expenditures were also lower, but the small sample size limited analysis. To conclude, Venezuelan immigrants living with HIV do not represent a major economic burden to the health system in Colombia. Further studies are required in order to understand if the lower healthcare expenditures of this population are the result of limitations in healthcare access, of clinical characteristics that were not assessed in this study, or of other unmeasured aspects.

Childhood Leukemia in Small Geographical Areas and Proximity to Industrial Sources of Air Pollutants in Three Colombian Cities.

Acute leukemia is the most common childhood cancer and has been associated with exposure to environmental carcinogens. This study aimed to identify clusters of acute childhood leukemia (ACL) cases and analyze their relationship with proximity to industrial sources of air pollution in three capital cities in Colombia during 2000-2015. Incident ACL cases were obtained from the population cancer registries for the cities of Bucaramanga, Cali, and Medellín. The inventory of industrial sources of emissions to the air was obtained from the regional environmental authorities and industrial conglomerates were identified. The Kulldorf's circular scan test was used to detect city clusters and to identify clusters around industrial conglomerates. Multivariable spatial modeling assessed the effect of distance and direction from the industrial conglomerates controlling for socioeconomic status. We identified industrials sectors within a buffer of 1 km around industrial conglomerates related to the ACL clusters. Incidence rates showed geographical heterogeneity with low spatial autocorrelation within cities. The spatio-temporal tests identified one cluster in each city. The industries located within 1 km around the ACL clusters identified in the three cities represent different sectors. Exposure to air pollution from industrial sources might be contributing to the incidence of ACL cases in urban settings in Colombia.

A spatial analysis of childhood cancer and industrial air pollution in a metropolitan area of Colombia.

BACKGROUND: Air pollutants are considered carcinogenic to humans. In some European countries, an association between industrial air pollution and childhood cancer has been established. This relationship has not been addressed in Latin America, despite the spatial variability of air pollutants that may limit the extrapolation of the results to other geographical areas. OBJECTIVE: To conduct a spatial analysis of the relationship between childhood cancer and proximity to industrial sources of air pollution in a metropolitan area of Colombia. METHODS: Incident cases of childhood cancers were obtained from the Population-based Cancer Registry of the Metropolitan Area of Bucaramanga during 2000-2015. Local and focused cluster tests were used for the detection of spatial clusters, and the Poisson multivariable model was used to evaluate the combined effects of spatial variables. RESULTS: The Kulldorff's focused test found a significant spatial cluster (P < 0.001) around one industrial agglomerate and the multivariable model results suggests that the distance effect is modified by the directional effect of the wind. CONCLUSION: A spatial cluster of incident cases of childhood cancer occurred in the municipality of Bucaramanga, Colombia. Our finding supports the hypothesis that childhood cancer might be related with industrial air pollution exposure in a Latin American city.

Análisis espacial en epidemiología: revisión de métodos / Spatial analysis in epidemiology: methodological review

Resumen El análisis espacial es un conjunto de técnicas que utiliza como insumos la ubicación geográfica o espacial de los eventos que se analizan. El uso de técnicas de análisis espacial en los estudios epidemiológicos ha tenido un rápido crecimiento en las últimas décadas porque permiten incluir en los análisis la variabilidad espacial. En el presente trabajo se hace una revisión general de los métodos de análisis espacial aplicados a la epidemiología y tiene como propósitos incentivar el estudio del análisis espacial y promover la incorporación de estas técnicas en las investigaciones actuales. Se describen los métodos de análisis espacial desde el abordaje descriptivo y analítico haciendo énfasis en el uso, ventajas y limitaciones de mapas coropléticos, pruebas de hipótesis y la identificación de clústers de enfermedades.

Abstract Spatial analysis is a set of techniques that use the geographical locations of the events as input data. The use of spatial analysis techniques in epidemiological studies has been growing rapidly in the last decades because they allow geographic or spatial variability to be included in the analyses. This paper makes a general review of the methods of spatial analysis applied to epidemiology and aims to encourage the study of spatial analysis and promote the incorporation of these techniques in current research. We describe the methods of spatial analysis from the descriptive and analytical approach emphasizing the use, advantages and limitations of choropleth maps, hypothesis tests and the identification of clusters of diseases.