Health inequalities in childhood diseases: temporal trends in the inter-crisis period.

BACKGROUND: Since 2008, children in Catalonia (Spain) have suffered a period of great economic deprivation. This situation has generated broad-ranging health inequalities in a variety of diseases. It is not known how these inequalities have changed over time. The aim of the present study is to determine trends in inequalities over this period in ten relevant diseases in children according to sex and age. METHODS: A retrospective cross-sectional population-based study of all children under 15 years old resident in Catalonia during the 2014-2021 period (over 1.2 million children/year) and of their diagnoses registered by the Catalan Health System. Health inequalities were estimated by calculating the relative index of inequality and time trends using logistic regression models. Interaction terms were added to test for the effects of sex on time trends. RESULTS: Increasing significant temporal trends in inequalities were shown for both sexes in almost all the diseases or adverse events studied (asthma, injuries, poisoning, congenital anomalies, overweight and obesity), in mood disorders in boys, and in adverse birth outcomes in girls. Adjustment and anxiety and mood disorders in girls showed a decreasing temporal trend in inequalities. More than half of the diseases and adverse events studied experienced significant annual increases in inequality. Poisoning stood out with an average annual increase of 8.65% [4.30, 13.00], p ≤ 0.001 in boys and 8.64% [5.76, 11.52], p ≤ 0.001) in girls, followed by obesity with increases of 5.52% [4.15, 6.90], p = < 0.001 in boys and 4.89% [4.26, 5.51], p ≤ 0.001) in girls. CONCLUSIONS: Our results suggest that inequalities persist and have increased since 2014. Policy makers should turn their attention to how interventions to reduce Health inequalities are designed, and who benefits from them.

Hospital variation in quality indicators for patient blood management in total knee and hip arthroplasty: a retrospective cohort study.

BACKGROUND: Anaemia, blood loss, and blood transfusion are critical aspects of patient care in major orthopaedic surgery. We assessed hospital adherence to guideline-recommended Patient Blood Management (PBM) care, analysed variations between hospitals, and validated two composite indicators of hospital PBM performance in patients undergoing total knee arthroplasty (TKA) or total hip arthroplasty (THA). METHODS: This retrospective cohort study included all primary TKA and THA procedures performed during 2021 across 39 hospitals in Spain. We assessed hospital adherence to key guideline-recommended PBM interventions using nine individual quality indicators and two types of composite quality indicators (cQIs): opportunity-based (cQI1) and all-or-none (cQI2). We validated these cQIs by analysing their associations with the adjusted total transfusion index using linear regression. RESULTS: We included 8561 patient episodes from 33 hospitals in the analysis. Delivery of PBM care was similar for TKA and THA. Patients received 62% of the analysed PBM interventions and only 12% of patients underwent the full PBM pathway. Higher hospital cQIs scores were associated with a lower adjusted total transfusion index, both in TKA and THA. The greatest association was found for cQI1 in THA patients (ß=-1.18 [95% confidence interval -2.00 to -0.36]; P=0.007). CONCLUSIONS: Hospital adherence to guideline-recommended patient blood management care in total hip and knee arthroplasty was suboptimal and varied across centres. Using data that are widely available in hospitals, quality indicators and composite scores could become valuable tools for patient blood management monitoring and comparisons between healthcare organisations.

Socioeconomic inequalities in waiting times for planned and cancer surgery: Evidence from Spain.

Waiting times act as a non-price rationing mechanism to bring together the demand for and the supply of public healthcare services and ensure equal access independently of ability to pay. This study tests for the presence of socioeconomic inequalities in waiting times for ten publicly-funded planned and cancer surgeries in Catalonia (Spain) in 2015-2019. Socioeconomic status (SES), measured by four categories (very low, low, middle, high), is based on co-payment levels for medicines which depend on patient's income. Using administrative data, we estimate the association between SES and waiting times controlling for patient characteristics and hospital fixed effects. Compared to patients with low SES, patients with middle SES wait 2-6 fewer days for hip replacement, cataract surgery, and hysterectomy, and less than a day for breast cancer surgery. These inequalities arise within hospitals and are not explained by patient nor hospital characteristics. For some surgeries, the results also show that patients with higher SES are more likely to voluntarily exit the waiting list and have a lower probability of having a surgery canceled for medical reasons and dying while waiting.

How should healthcare be reported in Catalonia? Qualitative study with healthcare leaders.

BACKGROUND: The Results Centre is the name of a project that, since 2012, has been openly publishing the results of each healthcare centre in Catalonia, with the idea of promoting benchmarking among centres and transparency toward society. As the project evolves, it has become increasingly necessary to adapt its contents and formats. The objective of this study is to identify the preferences and expectations of healthcare leaders regarding the Results Centre. METHODS: A qualitative study was conducted using the nominal group technique. Five nominal groups were created with the participation of 58 professionals (26 from hospital care, 16 from primary care, and 16 from long-term care centres). The areas of analysis were: (1) what the Results Centre of the future should be like; (2) what information needs should be addressed; and (3) what novelties should be incorporated to stimulate quality improvement. The spontaneity of ideas, intensity of recommendations, and intergroup consistency were analysed. The study was conducted in April 2019. RESULTS: The requirements reported by the participants to be met by the Results Centre included: being a tool for benchmarking and strategic decision-making; adjusted and segmented indicators; non-clinical information (patient experience, socio-economic status, etc.); and data accessible to all stakeholders, including citizens. The ideas were consistent across the different levels of care, although the intensity of recommendations varied depending on their content. CONCLUSIONS: Regional agencies that are accountable for health outcomes should be consistently committed to adapting to the needs of different stakeholders in the health system. This project is an example of how this requirement has been addressed in Catalonia.

An estimation of the social cost of illicit drug consumption in Catalonia. / Estimación del coste social del consumo de drogas ilegales en Catalunya.

Worldwide, as well as in Spain, the use of illegal drugs is among the major contributors to the global burden of disease. Quantifying the costs that illegal drugs impose on society is key in terms of decision-making. The objective of this paper is to estimate the social cost of illicit drug consumption in Catalonia for a specific year, and to establish a methodology to be able to replicate such estimations regularly and monitor properly the impact of national plans. To do that, a cost of illness study was performed. For the estimation of mortality and morbidity costs, we relied on the Attributable Fraction approach. Only public sector costs were included: healthcare and non-healthcare costs. The cost of illegal drug consumption in Catalonia in 2011 was estimated at €326.39 million (0.16% of the Catalan GDP in 2011; 0.15% in 2018). Of the total cost, 82% corresponded to direct costs. Among direct costs, 30.32% corresponded to the penal system, 15.99% to hospitalizations, 13.48% to the police force, 17.19% to pharmacy, 8.34% to treatment in specialized centres, and 5.74% to therapeutic communities, among others. Indirect costs represented 18% of total costs, mostly lost income due to drug-related death. This study has been an opportunity to systematically collect data and think about the potential economic returns that could be achieved from effective policies and programs aimed at reducing the consumption of illegal drugs.

Mundialmente, así como en España, el consumo de drogas ilegales es uno los principales contribuyentes a la carga mundial de morbilidad. Cuantificar los costes que las drogas ilegales imponen a la sociedad es clave para la toma de decisiones. El objetivo de este trabajo es estimar el coste social del consumo de drogas ilegales en Cataluña para un año específico y establecer una metodología para poder replicar dichas estimaciones regularmente y monitorear el impacto de los planes nacionales. Se ha realizado un estudio de coste de la enfermedad. Para la estimación de los costes de mortalidad y morbilidad se ha utilizado el enfoque de la fracción atribuible. Solo se incluyeron los costes del sector público, sanitarios y no sanitarios. El coste del consumo de drogas ilegales en Cataluña en 2011 se estimó en 326,39 millones de € (0,16% del PIB catalán en 2011; 0,15% en 2018). El 82% del coste total correspondió a costes directos; de estos, el 30,32% correspondió al sistema penal, 15,99% a hospitalizaciones, 13,48% a la policía, 17,19% a farmacia, 8,34% a tratamiento en centros especializados y 5,74% a comunidades terapéuticas, entre otros. Los costes indirectos representaron el 18% de los costes totales, principalmente pérdidas de productividad debidas a muertes por el consumo de drogas. Este estudio ha sido una oportunidad para recopilar datos de forma sistemática y pensar en los posibles rendimientos económicos que podrían obtenerse de políticas y programas efectivos destinados a reducir el consumo de drogas ilegales.

Measuring health inequalities: a systematic review of widely used indicators and topics.

BACKGROUND: According to many conceptual frameworks, the first step in the monitoring cycle of health inequalities is the selection of relevant topics and indicators. However, some difficulties may arise during this selection process due to a high variety of contextual factors that may influence this step. In order to help accomplish this task successfully, a comprehensive review of the most common topics and indicators for measuring and monitoring health inequalities in countries/regions with similar socioeconomic and political status as Catalonia was performed. METHODS: We describe the processes and criteria used for selecting health indicators from reports, studies, and databases focusing on health inequalities. We also describe how they were grouped into well-known health topics. The topics were filtered and ranked by the number of indicators they accounted for. RESULTS: We found 691 indicators used in the study of health inequalities. The indicators were grouped into 120 topics, 34 of which were selected for having five indicators or more. Most commonly found topics in the list include "Life expectancy", "Infant mortality", "Obesity and overweight (BMI)", "Mortality rate", "Regular smokers/tobacco consumption", "Self-perceived health", "Unemployment", "Mental well-being", "Cardiovascular disease/hypertension", "Socioeconomic status (SES)/material deprivation". CONCLUSIONS: A wide variety of indicators and topics for the study of health inequalities exist across different countries and organisations, although there are some clear commonalities. Reviewing the use of health indicators is a key step to know the current state of the study of health inequalities and may show how to lead the way in understanding how to overcome them.

Socioeconomic inequalities in 29 childhood diseases: evidence from a 1,500,000 children population retrospective study.

BACKGROUND: Socioeconomic position (SEP) powerfully affects health status in the childhood population. However, the knowledge of which diseases are more affected by SEP and whose outcomes could be improved by having a more equitable society remains uncertain on a population basis. METHODS: We measured socioeconomic and gender inequalities in the pre-COVID-19 era for 29 diseases in the entire childhood population in Catalonia to identify which diseases are most impacted by inequalities. This population-based study included 1,449,816 children under 15 years old from 2014 to 2017 (48.52% girls) and each of their registered diagnoses within the Catalonia National Health System. We calculated frequency measures by SEP and their sex ratios for each disease. We estimated four regression-based inequality measures: slope index of inequality, relative index of inequality (RII), absolute population-attributable fraction, and population-attributable fraction. RESULTS: Twenty-five of the 29 diseases examined showed SEP inequalities. The diseases with the greatest inequalities in both sexes were tuberculosis, obesity, adjustment and anxiety disorders, essential hypertension, poisoning, short gestation, low birth weight, foetal growth retardation and intrauterine hypoxia and birth asphyxia and trauma (RII ≥ 2.0); only food allergy showed the opposite pattern (RII < 1.0). Overall, 80,188 (7.80%) of the disease events in boys and 74,921 (8.88%) in girls would be avoided if all children had the same disease rate as those in the medium-high SEP group, with tuberculosis, intrauterine hypoxia and birth asphyxia and trauma, obesity, and short gestation, low birth weight, foetal growth retardation being those that could be reduced the most in relative terms, and dermatitis, injuries, acute bronquitis, and being overweight those that could be reduced the most in absolute terms. Girls present higher RII than boys for respiratory allergy, asthma, dermatitis, being overweight, and obesity (p < 0.05). In contrast, boys showed higher RII compared to girls only in congenital anomalies (p < 0.05). CONCLUSIONS: Socioeconomic and gender inequalities are widely present in childhood health. This indicates that SEP plays a common role in their development although it varies in magnitude according to each disease. It is also a phenomenon that comprises all SEP groups in society. Action needs to be taken to ensure a fairer start in life in terms of health.

The experience of Catalonia measuring nurse-sensitive indicators: Trends study 2012-2018.

AIM: To describe nursing-sensitive indicators measured in Catalonia. BACKGROUND: In Catalonia, since 2012, under the umbrella of the Results Centre, outcomes of every health care setting have been published and made open to health care professionals and citizens. METHODS: Trends study of nursing-sensitive indicators was based on data collected systematically from each setting from 2012 to 2018. Percentages and rates were calculated for each of 14 indicators analysed from all primary care, hospitals and long-term care centres. RESULTS: Percentage of population aged 60 years or older correctly vaccinated against flu has been decreasing, while percentage of population aged 14 years or under with correct vaccine status is high (over 91%) and has remained stable over time. Mortality in patients who have developed complications has increased, from 27.1% in 2012 to 34.0% in 2017. Most centres achieved functional improvements during the first 30 days of admission. CONCLUSIONS: Among all indicators measured in primary care, hospital and long-term care, only 14 analysed are nursing-sensitive; no nursing-sensitive indicators regarding mental health are measured. IMPLICATIONS FOR NURSING MANAGEMENT: Research focused on development of nursing-sensitive indicators offers an opportunity to measure and benchmark nurses' quality of care and their contribution in achieving populations' health improvement and health care system sustainability.

Comorbidity patterns and socioeconomic inequalities in children under 15 with medical complexity: a population-based study.

BACKGROUND: Children with medical complexity (CMC) denotes the profile of a child with diverse acute and chronic conditions, making intensive use of the healthcare services and with special health and social needs. Previous studies show that CMC are also affected by the socioeconomic position (SEP) of their family. The aim of this study is to describe the pathologic patterns of CMC and their socioeconomic inequalities in order to better manage their needs, plan healthcare services accordingly, and improve the care models in place. METHODS: Cross-sectional study with latent class analysis (LCA) of the CMC population under the age of 15 in Catalonia in 2016, using administrative data. LCA was used to define multimorbidity classes based on the presence/absence of 57 conditions. All individuals were assigned to a best-fit class. Each comorbidity class was described and its association with SEP tested. The Adjusted Morbidity Groups classification system (Catalan acronym GMA) was used to identify the CMC. The main outcome measures were SEP, GMA score, sex, and age distribution, in both populations (CMC and non-CMC) and in each of the classes identified. RESULTS: 71% of the CMC population had at least one parent with no employment or an annual income of less than €18,000. Four comorbidity classes were identified in the CMC: oncology (36.0%), neurodevelopment (13.7%), congenital and perinatal (19.8%), and respiratory (30.5%). SEP associations were: oncology OR 1.9 in boys and 2.0 in girls; neurodevelopment OR 2.3 in boys and 1.8 in girls; congenital and perinatal OR 1.7 in boys and 2.1 in girls; and respiratory OR 2.0 in boys and 2.0 in girls. CONCLUSIONS: Our findings show the existence of four different patterns of comorbidities in CMC and a significantly high proportion of lower SEP children in all classes. These results could benefit CMC management by creating more efficient multidisciplinary medical teams according to each comorbidity class and a holistic perspective taking into account its socioeconomic vulnerability.

General Practitioners' Perceptions of Whether Teleconsultations Reduce the Number of Face-to-face Visits in the Catalan Public Primary Care System: Retrospective Cross-Sectional Study.

BACKGROUND: eConsulta is a teleconsultation service involving general practitioners (GPs) and patients. It is part of the information system belonging to Catalonia's primary care service. It has been in operation since the end of 2015 in conjunction with face-to-face consultations with Primary Care Teams as one of the services offered in the patient's Personal Health Folder. OBJECTIVE: This study aimed to assess the ability of using eConsulta to reduce the number of face-to-face visits to Primary Care Teams. METHODS: Using 13 categories proposed by the researchers, 18 GPs from the Central Catalonia Health Region retrospectively classified 2268 cases managed with eConsulta and indicated whether, in their opinion, the teleconsultations reduced the number of face-to-face visits. RESULTS: There was broad consensus among the GPs that eConsulta has the potential to resolve patient queries for every type of consultation. eConsulta avoided the need for a face-to-face visit in 87.9% of cases. In addition, the GPs reported that the ease of access increased the demand for health care support in 27.7% of cases; otherwise, the patient would not have initiated the queries. Therefore, based on the equation (88% x [1-28%]), eConsulta could replace 63%-88% of conventional appointments. The most frequent uses of the teleconsultation service were for management of test results (35.2%), medical enquiries (16.0%), and the management of repeat prescriptions (12.2%). On average, the teleconsultations consisted of a mean 1.57 messages (SD 0.54 messages); 45.9% (1040/2268) of the teleconsultations consisted of 1 message, and the majority of the remaining teleconsultations consisted of 2-5 interactions. The patient initiated 60.0% (1361/2268) of the teleconsultations. CONCLUSIONS: Based on the GPs' perceptions, eConsulta could replace 63%-88% of conventional appointments. Therefore, asynchronous teleconsultations between practitioners and patients in primary care could avoid interactions that have limited added clinical value.

Teleconsultation Between Patients and Health Care Professionals in the Catalan Primary Care Service: Message Annotation Analysis in a Retrospective Cross-Sectional Study.

BACKGROUND: Over the last decade, telemedicine services have been introduced in the public health care systems of several industrialized countries. In Catalonia, the use of eConsulta, an asynchronous teleconsultation service between primary care professionals and citizens in the public health care system, has already reached 1 million cases. Before the COVID-19 pandemic, the use of eConsulta was growing at a monthly rate of 7%, and the growth has been exponential from March 15, 2020 to the present day. Despite its widespread usage, there is little qualitative evidence describing how this tool is used. OBJECTIVE: The aim of this study was to annotate a random sample of teleconsultations from eConsulta, and to evaluate the level of agreement between health care professionals with respect to the annotation. METHODS: Twenty general practitioners retrospectively annotated a random sample of 5382 cases managed by eConsulta according to three aspects: the type of interaction according to 6 author-proposed categories, whether the practitioners believed a face-to-face visit was avoided, and whether they believed the patient would have requested a face-to-face visit had eConsulta not been available. A total of 1217 cases were classified three times by three different professionals to assess the degree of consensus among them. RESULTS: The general practitioners considered that 79.60% (4284/5382) of the teleconsultations resulted in avoiding a face-to-face visit, and considered that 64.96% (3496/5382) of the time, the patient would have made a face-to-face visit in the absence of a service like eConsulta. The most frequent uses were for management of test results (26.77%, 1433/5354), management of repeat prescriptions (24.30%, 1301/5354), and medical enquiries (14.23%, 762/5354). The degree of agreement among professionals as to the annotations was mixed, with the highest consensus demonstrated for the question "Has the online consultation avoided a face-to-face visit?" (3/3 professionals agreed 67.95% of the time, 827/1217), and the lowest consensus for the type of use of the teleconsultation (3/3 professionals agreed 57.60% of the time, 701/1217). CONCLUSIONS: This study shows the ability of eConsulta to reduce the number of face-to-face visits for 55% (79% × 65%) to 79% of cases. In comparison to previous research, these results are slightly more pessimistic, although the rates are still high and in line with administrative data proxies, showing that 84% of patients using teleconsultations do not make an in-person appointment in the following 3 months. With respect to the type of consultation performed, our results are similar to the existing literature, thus providing robust support for eConsulta's usage. The mixed degree of consensus among professionals implies that results derived from artificial intelligence tools such as message classification algorithms should be interpreted in light of these shortcomings.

Economic Impact of Smoke-Free Legislation: Did the Spanish Tobacco Control Law Affect the Economic Activity of Bars and Restaurants?

INTRODUCTION: The potential of smoke-free bans to negatively impact the hospitality business has been an argument of the hospitality and tobacco industry against such legislation. A partial smoke-free legislation was introduced in Spain in 2006 allowing smoking in most bars and restaurants due to the pressure of the hospitality sector. However, this partial ban was later amended in 2011 to include all the hospitality premises without exceptions. The stepped Spanish process permits to evaluate whether the entry into force of the smoke-free legislation had any effect on the economic activity of the hospitality sector. METHODS: We employed a pooled time series cross-sectional design, with national data over 6 years (2006-2011). The dependent variable used was the total number of bars and restaurants per 100,000 inhabitants. The explanatory variables used were the average amount of spending per household in bars and restaurants, and the total unemployment rate in Spain by regions. RESULTS: For every 1% increase in the unemployment rate there was a 0.05% decrease in the number of bars and restaurants. In 2007, the number of bars and restaurants was significantly reduced by 13.06% (all others factors being held constant), 4.87% in 2008, and 10.42% in 2009. No statistically significant effect of the smoke-free legislation emerged from 2010 (6.76%) to 2011 (7.69%). CONCLUSION: The new Spanish smoke-free legislation had no effect on the number of bars and restaurants.

Effect of CPAP Treatment on Cardiovascular Outcomes.

INTRODUCTION: Randomized controlled trials (RCT) have not demonstrated a role for continuous positive airway pressure (CPAP) on the secondary prevention of major cardiovascular events in obstructive sleep apnea (OSA) patients. However, participants in RCTs are substantially different from real-world patients. Therefore, we aimed to assess the effect of CPAP treatment on major cardiovascular events in real-world OSA patients. METHODS: Population-based longitudinal observational study including all OSA patients with an active CPAP prescription at the beginning of 2011 in Catalonia, Spain, that terminated CPAP treatment during 2011 and did not have CPAP prescriptions between 2012-2015; and propensity-score-matched OSA patients that continued CPAP treatment until the end of 2015 or death. Adjusted hazard ratios were used to assess the association between CPAP treatment and overall and cardiovascular mortality, cardiovascular hospitalizations, or major adverse cardiovascular events (MACEs). RESULTS: 3638 CPAP terminators and 10,914 propensity-score-matched continuators were included (median age 67 [57-77] years, 71.4% male). During a median follow-up of 47.9 months CPAP continuators showed a lower risk of cardiovascular death than terminators (hazard ratio [HR]: 0.61; 95% confidence interval [CI]: 0.50-0.75) after adjusting by age, sex and key comorbidities. Similar results were found for cardiovascular hospitalizations (HR: 0.87; 95% CI: 0.76-0.99) and MACEs (HR: 0.84; 95% CI: 0.75-0.95). CONCLUSION: CPAP treatment continuation could be associated with a significantly lower risk of major cardiovascular events in real-world OSA patients. This result highlights the importance of including real-world patients in studies on OSA.

Cost savings associated with 10 years of road safety policies in Catalonia, Spain.

OBJECTIVE: To determine whether the road safety policies introduced between 2000 and 2010 in Catalonia, Spain, which aimed primarily to reduce deaths from road traffic collisions by 50% by 2010, were associated with economic benefits to society. METHODS: A cost analysis was performed from a societal perspective with a 10-year time horizon. It considered the costs of: hospital admissions; ambulance transport; autopsies; specialized health care; police, firefighter and roadside assistance; adapting to disability; and productivity lost due to institutionalization, death or sick leave of the injured or their caregivers; as well as material and administrative costs. Data were obtained from a Catalan hospital registry, the Catalan Traffic Service information system, insurance companies and other sources. All costs were calculated in euros (€) at 2011 values. FINDINGS: A substantial reduction in deaths from road traffic collisions was observed between 2000 and 2010. Between 2001 and 2010, with the implementation of new road safety policies, there were 26 063 fewer road traffic collisions with victims than expected, 2909 fewer deaths (57%) and 25 444 fewer hospitalizations. The estimated total cost savings were around €18 000 million. Of these, around 97% resulted from reductions in lost productivity. Of the remaining cost savings, 63% were associated with specialized health care, 15% with adapting to disability and 8.1% with hospital care. CONCLUSION: The road safety policies implemented in Catalonia in recent years were associated with a reduction in the number of deaths and injuries from traffic collisions and with substantial economic benefits to society.

Résumé OBJECTIF: Déterminer si les politiques de sécurité routière introduites entre 2000 et 2010 en Catalogne, Espagne, qui visaient principalement à réduire de 50% les décès causés par des collisions routières avant 2010, ont été associées à des avantages économiques pour la société. MÉTHODES: Une analyse des coûts a été réalisée dans une perspective sociétale sur un horizon temporel de 10 ans. Elle a pris en compte les coûts suivants: les admissions à l'hôpital, les transports en ambulance, les autopsies, les soins de santé spécialisés, la police, les pompiers et les dépannages routiers, l'adaptation au handicap et la productivité perdue en raison du placement des personnes dans des établissements spécialisés, les décès ou les congés des blessés ou de leurs aidants, ainsi que les coûts matériels et les frais administratifs. Les données provenaient du registre d'un hôpital catalan, du système d´information du Service catalan de la circulation, des compagnies d'assurance et d'autres sources. Tous les coûts ont été calculés en euros (€), selon les valeurs de l'année 2011. RÉSULTATS: Une diminution substantielle des décès causés par collision routière a été observée entre 2000 et 2010. Entre 2001 et 2010, grâce à la mise en œuvre de nouvelles politiques de sécurité routière, on a recensé une diminution de 26 063 collisions routières avec victimes, une diminution de 2909 décès (57%) et une diminution de 25 444 hospitalisations. Le total des économies estimé sur les coûts était d'environ 18 000 millions d'euros. En ce qui concerne ce chiffre, environ 97% résultaient de la réduction des coûts liés à la perte de productivité. Parmi les économies restantes, 63% étaient associées aux soins de santé spécialisés, 15% à l'adaptation au handicap et 8,1% aux soins hospitaliers. CONCLUSION: Les politiques de sécurité routière mises en place en Catalogne ces dernières années ont été associées à une réduction du nombre de décès et de blessures causés par des collisions routières et à des avantages économiques substantiels pour la société.

Resumen OBJETIVO: Determinar si las políticas de seguridad vial introducidas entre los años 2000 y 2010 en Cataluña, España, cuyo propósito principal era la reducción de los fallecimientos causados por accidentes de tráfico en un 50% hasta el 2010, estuvieron asociadas a un beneficio económico para la sociedad. MÉTODOS: Se llevó a cabo un análisis de costes desde una perspectiva social y un horizonte temporal de 10 años. Se tomaron en consideración los costes de las hospitalizaciones, el transporte en ambulancia, las autopsias, la atención sanitaria especializada, la policía, bomberos y asistencia en carretera, la adaptación a la discapacidad y la pérdida de productividad debido a la institucionalización, las bajas por enfermedad o fallecimiento de los heridos o sus cuidadores, así como los costes materiales y administrativos. Los datos se obtuvieron del registro de un hospital catalán, el sistema de información del servicio catalán de tráfico, compañías aseguradoras y otras fuentes. Todos los costes se calcularon en euros (€) según los valores del 2011. RESULTADOS: Entre los años 2000 y 2010 se observó una reducción importante de los fallecimientos causados por accidentes de tráfico. Entre el 2001 y el 2010, con la puesta en práctica de las nuevas políticas de seguridad vial, se produjeron 26 063 colisiones con víctimas menos de las esperadas, 2909 fallecimientos menos (57%), así como 25 444 hospitalizaciones menos. El ahorro total estimado fue de aproximadamente 18 000 millones de euros. De éstos, un 97% se derivó de la reducción de la pérdida de productividad, y del ahorro restante, el 63% estuvo asociado con la atención sanitaria especializada, el 15% con la adaptación a la discapacidad y el 8,1% con la atención hospitalaria. CONCLUSIÓN: Las políticas de seguridad vial puestas en marcha en Cataluña en los últimos años estuvieron asociadas a una reducción en el número de fallecidos y heridos por accidentes de tráfico, así como con beneficios económicos importantes para la sociedad.

Living longer in declining health: Factors driving healthcare costs among older people.

BACKGROUND: Developed countries are facing challenges in caring for people who are living longer but with a greater morbidity burden. Such people are likely to be regular users of healthcare. OBJECTIVES: Our analytical aim is to identify factors that explain healthcare costs among: (1) people over 55 years old; (2) the top 5% and 1% high-cost users among this population; (3) those that transition into the top 5% and 1% from one year to the next; (4) those that appear in the top 5% and 1% over multiple years; and (5) those that remain in the top 5% and 1% over consecutive years. METHODS: The data covered 2011 to 2017 and comprised 1,485,170 observations for a random sample of 224,249 people aged over 55 years in the Catalan region of Spain. We analysed each person's annual healthcare costs across all public healthcare settings related to their age, gender, socio-economic status (SES), whether or not and when they died, and morbidity status, through Adjusted Morbidity Groups. RESULTS: After controlling for morbidity status, the oldest people did not have the highest costs and were less likely to be among the most costly patients. There was also only a modest impact on costs associated with SES and with dying. Healthcare costs were substantially higher for those with a neoplasm or four or more long term conditions (LTCs), costs rising with the complexity of their conditions. These morbidity indicators were also the most important factors associated with being and remaining in the top 5% or top 1% of costs. CONCLUSION: Our results suggest that age and proximity to death are poor predictors of higher costs. Rather, healthcare costs are explained mainly by morbidity status, particularly whether someone has neoplasms or multiple LTCs. Morbidity measures should be included in future studies of healthcare costs.

The influence of general practitioner and patient sex on the treatment of major depression.

Introduction: Biological and sociocultural factors may lead to a significant gender bias in the treatment of major depression and thus contribute to accentuating gender inequalities. However, the influence of the general practitioner's (GP's) sex on the prescription of antidepressants has not been adequately assessed in previous work and remains unclear. This retrospective cohort study aims to determine the influence of GP and patient sex on the treatment of major depression. Methods: The study population comprised 87,629 patients (33.56% male patients and 66.44% female patients) aged over 15 years newly diagnosed with major depression recorded between 2017 and 2019 in Catalonia, Spain. Logistic regression models were used to evaluate the effect of GP sex on the therapeutic strategy (i.e., whether antidepressants were prescribed at the first diagnostic visit). Cox proportional hazards models and survival analyses were conducted to compare, according to GP and patient sex, the probability that a patient would be prescribed an antidepressant at any time during the study period. Finally, a multiple linear regression analysis was performed to assess the pharmacological intensity of the treatment [monthly fluoxetine-equivalent defined daily dose (DDD)]. Results: Female patients were more likely to be prescribed an antidepressant at the time of diagnosis, both by male [OR = 1.11, 95% CI = (1.05, 1.17), p <0.001] and female GPs [OR = 1.13, 95% CI = (1.09, 1.17), p <0.001]. Similarly, female patients were 8% and 9% more likely than male patients to be prescribed an antidepressant from male [HR = 1.08, 95% CI = (1.05, 1.11), p <0.001] and female GPs [HR = 1.09, 95% CI = (0.92, 1.07), p <0.001], respectively, during the study period. Female GPs prescribed less antidepressants than male GPs: an average of 0.39 less monthly fluoxetine-equivalent DDD [ß = -0.39, 95% CI = (0.10, -3.92), p <0.001]. Discussion: Few differences are observed between male and female GPs regarding the therapeutic strategy and its intensity for the treatment of major depression. However, both male and female GPs are influenced by biases and stereotypes that entail differential antidepressant-prescribing behaviors in accordance with the sex of the patient and their characteristics.

Gender bias in pediatric care: Health professionals' opinions and perceptions.

Introduction: Gender bias in healthcare is understood as a misconception of the differences between males and females that may generate healthcare disparities and discrimination against one sex. However, is not well known how this implicit bias is manifested in pediatric clinical praxis. Thus, the goal of this study is to explore and analyse the attitudes of health personnel toward a possible gender bias in pediatric care in Catalonia. Methods: We undertake a descriptive and exploratory study applying a qualitative research methodology based on hermeneutic phenomenology and Grounded Theory using the focus group technique. The opinions collected were classified into four categories and 22 subcategories, and subsequently analyzed. Results: Three main ideas stood out regarding situations that might be affected by gender bias: (1) attitudes of health personnel and perceptions with regard to mental health problems and (to a lesser extent) to physical health problems; (2) the role of the child's family and the professional's assessment of this role; and (3) the professional's attention to children of the opposite sex, especially in the case of genital examinations. Discussion: The results stand out that differential attitudes depending on the gender of the child have been observed in clinical practice in pediatrics, which may have an impact on health inequality. Hence, academic training that includes the study and prevention of implicit biases in professional activity, campaigns aimed at the general population on how to detect implicit biases and promoting gender equity in education, should help to avoid the negative consequences of these misconceptions.

Understanding public procurement within the health sector: a priority in a post-COVID-19 world.

Every year, over 250,000 public authorities in the European Union (EU) spend about 14% of GDP on the purchase of services, works and supplies. Many are in the health sector, a sector in which public authorities are the main buyers in many countries. When these purchases exceed threshold values, EU public procurement rules apply. Public procurement is increasingly being promoted as a tool for improving efficiency and contributing to better health outcomes, and as a policy lever for achieving other government goals, such as innovation, the development of small and medium-sized enterprises, sustainable green growth and social objectives like public health and greater inclusiveness. In this paper, we describe the challenges that arise within health care systems with public procurement and identify potential solutions to them. We examined the tendering of pharmaceuticals, health technology, and e-health. In each case we identify a series of challenges relating to the complexity of the procurement process, imbalances in power on either side of transactions and the role of procurement in promoting broader public policy objectives. Finally, we recommend several actions that could stimulate better procurement, and suggest a few areas where further EU cooperation can be pursued.

Air Pollution and Birth Outcomes: Health Impact and Economic Value Assessment in Spain.

Air pollution is considered an ongoing major public health and environmental issue around the globe, affecting the most vulnerable, such as pregnant women and fetuses. The aim of this study is to estimate the health impact and economic value on birth outcomes, such as low birthweight (LBW), preterm birth (PTB), small for gestational age (SGA), attributable to a reduction of PM10 levels in Spain. Reduction based on four scenarios was implemented: fulfillment of WHO guidelines and EU limits, and an attributable reduction of 15% and 50% in annual PM10 levels. Retrospective study on 288,229 live-born singleton children born between 2009-2010, using data from Spain Birth Registry Statistics database, as well as mean PM10 mass concentrations. Our finding showed that a decrease in annual exposure to PM10 appears to be associated with a decrease in the annual cases of LBW, SGA and PTB, as well as a reduction in hospital cost attributed to been born with LBW. Improving pregnancy outcomes by reducing the number of LBW up to 5% per year, will result in an estimate associated monetary saving of 50,000 to 7,000,000 euros annually. This study agrees with previous literature and highlights the need to implement, and ensure compliance with, stricter policies that regulate the maximum exposure to outdoor PM permitted in Spain, contributing to decreased environmental health risk, especially negative birth outcomes.

Spinal cord injury and traumatic brain injury: a cost-of-illness study.

BACKGROUND: Among traumatic injuries, spinal cord injuries (SCI) and traumatic brain injuries (TBI) are of major importance because of their epidemiological and economic impact on society. The overall objective of this study was to estimate the economic cost associated with people with SCI and TBI in Spain in 2007. METHODS: A cost-of-illness analysis was performed, considering the perspective of society, using a 1-year time horizon. Medical costs, adaptation costs, material costs, administrative costs, and costs of police, firefighters and roadside assistance, productivity losses due to institutionalization and sick leave, as well as an estimate of productivity losses of carers, and productivity losses due to death were included. RESULTS: The economic cost associated with people with SCI is between EUR 92,087,080.97 and 212,496,196.41 (USD 131 million and 302 million) according to the injury mechanism, and between EUR 1,079,223,688.66 and 3,833,752,692.78 (USD 1,536 million and 5,458 million) for people with TBI. CONCLUSIONS: There is an urgent need to develop effective interventions known to prevent SCI and TBI, and to evaluate their effectiveness and efficiency.