Mortality in Catalonia during the summer of 2022 and its relation with high temperatures and COVID-19 cases

Purpose

To analyse the association between the mortality during the summer 2022 and either high temperatures or the COVID-19 wave with data from the Catalan Health Care System (7.8 million people).

Methods

We performed a retrospective study using publicly available data of meteorological variables, influenza-like illness (ILI) cases (including COVID-19) and deaths. The study comprises the summer months of the years 2021 and 2022. To compare the curves of mortality, ILI and temperature we calculated the z-score of each series. We assessed the observed lag between curves using the cross-correlation function. Finally, we calculated the correlation between the z-scores using the Pearson correlation coefficient (R²).

Results

During the study period, 33,967 deaths were reported in Catalonia (16,416 in the summer of 2021 and 17,551 in the summer of 2022). In 2022, the observed lag and the correlation between the z-scores of temperature and all-cause deaths was 3 days and R² = 0.86, while between ILI and all-cause deaths was 22 days and R² = 0.21. This high correlation between temperature and deaths increased up to 0.91 when we excluded those deaths reported as COVID-19 deaths, while the correlation between ILI and non-COVID-19 deaths decreased to -0.19. No correlation was observed between non-COVID deaths and temperature or ILI cases in 2021.

Conclusion

Our study suggests that the main cause of the increase in deaths during summer 2022 in Catalonia was the high temperatures and its duration. The contribution of the COVID-19 seems to be limited.

Socioeconomic Status and Distance to Reference Centers for Complex Cancer Diseases: A Source of Health Inequalities? A Population Cohort Study Based on Catalonia (Spain)

The centralization of complex surgical procedures for cancer in Catalonia may have led to geographical and socioeconomic inequities. In this population-based cohort study, we assessed the impacts of these two factors on 5-year survival and quality of care in patients undergoing surgery for rectal cancer (2011–12) and pancreatic cancer (2012–15) in public centers, adjusting for age, comorbidity, and tumor stage. We used data on the geographical distance between the patients’ homes and their reference centers, clinical patient and treatment data, income category, and data from the patients’ district hospitals. A composite ‘textbook outcome’ was created from five subindicators of hospitalization. We included 646 cases of pancreatic cancer (12 centers) and 1416 of rectal cancer (26 centers). Distance had no impact on survival for pancreatic cancer patients and was not related to worse survival in rectal cancer. Compared to patients with medium–high income, the risk of death was higher in low-income patients with pancreatic cancer (hazard ratio (HR) 1.46, 95% confidence interval (CI) 1.15–1.86) and very-low-income patients with rectal cancer (HR 5.14, 95% CI 3.51–7.52). Centralization was not associated with worse health outcomes in geographically dispersed patients, including for survival. However, income level remained a significant determinant of survival.

Smoking-attributable mortality in the autonomous communities of Spain, 2017

INTRODUCTION AND OBJECTIVES

To estimate smoking-attributable mortality (SAM) in the regions of Spain among people aged ≥ 35 years in 2017.

METHODS

SAM was estimated using a prevalence dependent method based calculating the population attributable fraction. Observed mortality was derived from the National Statistics Institute. The prevalence of smoking by age and sex was based on the Spanish National Health Survey for 2011 and 2017 and the European Survey for 2014. Relative risks were reported from the follow-up of 5 North American cohorts. SAM and population attributable fraction were estimated for each region by age group, sex, and causes of death. Cause-specific and adjusted SAM rates were estimated.

RESULTS

Smoking caused 53 825 deaths in the population aged ≥ 35 years (12.9% of all-cause mortality). SAM ranged from 10.8% of observed mortality in La Rioja to 15.3% in the Canary Islands. The differences remained after rates were adjusted by age. The highest adjusted SAM rates were observed in Extremadura in men and in the Canary Islands in women. Adjusted SAM rates in men were inversely correlated with those in women. The percentage of total SAM represented by cardiovascular diseases in each region ranged from 21.8% in Castile-La Mancha to 30.3% in Andalusia.

CONCLUSIONS

The distribution of SAM differed among regions. Conducting a detailed region-by-region analysis provides relevant information for health policies aiming to curb the impact of smoking.

Mental well-being of the general population: direct and indirect effects of socioeconomic, relational and health factors

PURPOSE

The aim of this study was to analyse the association between individual mental well-being and social, economic, lifestyle and health factors.

METHODS

Cross-sectional study on a representative sample of 13,632 participants (> 15y/o) from the Catalan Health Interview Survey 2013-2016 editions. Mental well-being was assessed with the Warwick-Edinburg Mental Well-being Scale (WEMWBS). Linear regressions were fitted to associate well-being and sociodemographic, relational, lifestyle and health variables according to minimally sufficient adjustment sets identified using directed acyclic graphs. Predictors entered the model in blocks of variable types and analysed individually. Direct and total effects were estimated.

RESULTS

Health factors significantly contributed to mental well-being variance. Presence of a mental disorder and self-reported health had the largest effect size (eta2 = 13.4% and 16.3%). The higher individual impact from a variable came from social support (β = - 12.8, SE = 0.48, eta2 = 6.3%). A noticeable effect gradient (eta2 = 4.2%) from low to high mental well-being emerged according to economic difficulties (from β = 1.59, SE = 0.33 for moderate difficulties to β = 6.02 SE = 0.55 for no difficulties). Younger age (β = 5.21, SE = 0.26, eta2 = 3.4%) and being men (β = 1.32, SE = 0.15, eta2 = 0.6%) were associated with better mental well-being. Direct gender effects were negligible.

CONCLUSIONS

This study highlights health and social support as the most associated factors with individual mental well-being over socioeconomic factors. Interventions and policies aimed to these factors for health promotion would improve population mental well-being.

Natural outdoor environments and mental and physical health: relationships and mechanisms

BACKGROUND

Evidence is growing for the beneficial impacts of natural outdoor environments on health. However, most of the evidence has focused on green spaces and little evidence is available on health benefits of blue spaces and about possible mediators and modifiers of such impacts. We investigated the association between natural outdoor environments (separately for green and blue spaces) and health (general and mental) and its possible mediators and modifiers.

METHODS

Cross-sectional data from adults interviewed in Catalonia (Spain) between 2010 and 2012 as part of the Catalonia Health Survey were used. The collected data included sociodemographic characteristics, self-perceived general health, mental health, physical activity and social support. Indicators of surrounding greenness and access to natural outdoor environments within 300 m of the residence and degree of urbanization were derived for residential addresses. Associations were estimated using logistic regression and negative binominal models.

RESULTS

Green spaces were associated with better self-perceived general health and better mental health, independent of degree of urbanization. The associations were more consistent for surrounding greenness than for access to green spaces. The results were consistent for different buffers, and when stratifying for socioeconomic status. Slightly stronger associations were found for women and residents of non-densely populated areas. No association was found between green spaces and social contacts and physical activity. The results for blue spaces were not conclusive.

CONCLUSION

Green spaces are associated with better general and mental health across strata of urbanization, socioeconomic status, and genders. Mechanisms other than physical activity or social support may explain these associations.

[Importance of chronic musculoskeletal problems in the population of Catalonia (Spain): prevalence and effect on self-perceived health, activity restriction and use of health services]

OBJECTIVE

To determine the importance of chronic musculoskeletal problems in the adult population of Catalonia (Spain) and their effect on self-perceived health, activity restriction and use of health services.

METHODS

A population-based survey of 15,926 adults was performed. Multistage stratified sampling was performed. The variables gathered were sociodemographic characteristics, self-reported chronic health problems, self-perceived health, activity restriction and use of health services. Musculoskeletal problems were grouped into four categories: osteoarthritis-arthritis or rheumatism (OA), chronic dorsal or lumbar pain (LBP), chronic cervical pain (UBP), and osteoporosis.

RESULTS

Chronic health problems were reported by 77.4% of the adult population. The most frequent health problem was LBP, followed by UBP and OA. After adjustment by age was performed, female sex increased the risk of reporting OA, LBP, UBP and osteoporosis (OR=2.6, 1.5, 2.3, and 5.3, respectively). The prevalence increased with greater age and with lower socioeconomic status. After adjustment was performed by age, sex, social class and obesity, self-perceived health was worse in people with these problems (42.7% vs 11%). The four categories were the main causes of activity restriction in the last year (OR 2.70) and the last 15 days (OR=2.32) and were associated with a higher use of health services.

CONCLUSIONS

Los problemas reumáticos son los principales problemas de salud crónicos declarados por la población adulta. La prevalencia es mayor es las mujeres, aumenta con la edad y en las clases desfavorecidas. Hay una asociación significativa entre declarar problemas musculoesqueléticos y salud autopercibida mala o regular, y mayor restricción de actividades y uso de servicios sanitarios.

Discriminative capacity of the EQ-5D, SF-6D, and SF-12 as measures of health status in population health survey

PURPOSE

To compare the EQ-5D, SF-6D, and SF-12 in terms of their capacity to discriminate between groups defined by relevant socio-demographic and health characteristics in a general population survey.

METHODS

Data were obtained from the 2006 Catalan Health Interview Survey, a representative sample (n = 4,319) of the general population of Catalonia (Spain). Effect sizes (ES) and Receiver Operating Characteristic (ROC) curves were calculated to evaluate the instruments' capacity to distinguish between groups based on socio-demographic variables, recent health problems, perceived health, psychological distress, and selected chronic conditions.

RESULTS

All instruments showed a similar discriminative capacity between groups based on socio-demographic variables, recent medical visit (ES = 0.47-0.55), activity limitations (ES = 0.92-0.98), perceived health (ES = 0.97-1.33), and psychological well-being (ES = 1.17-1.57). Effect sizes between respondents with and without any of fourteen selected chronic conditions were large (0.76-1.04) for 4, moderate (0.55-0.74) for 8, and small (0.17-0.39) for two on the EQ-5D index. A similar pattern was observed for the SF-12 but ES were predominantly moderate (7 conditions) or small (6 conditions) on the SF-6D.

CONCLUSIONS

The EQ-5D and SF-12 were largely comparable in estimating the health burden of chronic conditions, recent health problems, and social inequalities. The SF-6D was less sensitive than the EQ-5D index and SF-12, particularly for physical chronic conditions.

[Performance assessment of health services in Catalonia (Spain): evaluation of initial results of the Catalan healthcare service project]

Performance assessment of healthcare services is receiving greater attention due to increasing health care expenditures, greater expectations among the population, and the need to obtain results from the invested resources. Taking advantage of the existing experience of the Agència de Salut Pública de Barcelona and the Consorci Sanitari de Barcelona, which compared the healthcare services of Barcelona and Montreal, a grant from the Agència d'Avaluació de Tecnologia i Recerca Mèdiques, and the health planning interest of the Departament de Salut, the performance assessment of the Catalan healthcare service project was started in Catalonia in 2005. This article aims to present the development of the project, to provide some examples that illustrate the kind of numerical and graphical information that could be obtained and the kind of analysis that could be performed, to provide possible explanations for the results shown, and to discuss some limitations and implications. Currently, the added value of this project is that it identifies the extent to which the healthcare system is achieving its objectives, establishes a set of homogeneous indicators that could be used in the future, and is a key tool in the development of the Central de Resultats del Departament de Salut de la Generalitat de Catalunya.

[Mortality due to dementias in Catalonia, Spain: an emergent health problem]

BACKGROUND

The aims of this study were to describe the trends of mortality from dementias according to gender and age in Catalonia (Spain) and to estimate their evolution from 1979 to 2003.

MATERIAL AND METHOD

The dementia death data (ICD-9: 290-290.9 298.9, 294.9, 331.0, and 331.2) between 1979 and 1998 come from the Catalonian Mortality Register of the Department of Health as well as the official population census, lineal estimations and projections made by the Institute of Statistics of Catalonia. For the calculation of trend and mortality projections up to 2003, a Poisson regression model was adjusted for each gender, using the variables age, period and birth cohort.

RESULTS

Dementia mortality rate moved from 2.14 per 100,000 inhabitants during 1979-1983 to 41.95 during 1994-1998. With regard to the period 1989-1998, the average percentage of the annual variation of mortality is estimated to be 7.5% for males and 9.6% for females. The increase is in part due to population aging and also to a cohort effect of people born before 1925. The expected annual mean number of dementia deaths during 1999-2003 is estimated at 4,594.

CONCLUSIONS

Mortality from dementias in Catalonia has experienced a substantial increase over the last 20 years. Given the health and social impact of this group of diseases and the future perspectives, dementias should be considered as an emergent problem in public health.

[Impact of voluntary pregnancy termination on fertility in Catalonia]

BACKGROUND

The objectives of this study are to describe the recent evolution of fertility since 1975 and of the abortions since 1987, and to evaluate the effect of abortions in the total fertility in Catalonia (Spain) in 1993.

METHODS

Data were obtained from abortion register and live births from Instituto Nacional de Estadistica and from Institut d'Estadistica de Catalunya. Total fertility rate (TFR), modal age at childbearing (MACH) and average age at childbearing (AHUSE), both total and at first pregnancy were estimated using the number of live births, abortions and known pregnancies.

RESULTS

Fertility in Catalonia has decreased between 1975 and 1993 from 2.73 to 1.20 children per woman. In this period the mean age at childbearing has also been delayed from 28.3 to 29.8 years. The number of abortions have increased since their legalization in 1987, being currently near to 10,000 per year. For every six births one abortion is informed, being the ratio 2 to 1 in women younger than 20 years old. The TFG estimated for 74 the known pregnancies increases from 1.20 to 1.41 children per woman, and MACH is 3 months younger.

CONCLUSIONS

Induced abortion has not shown a relevant weight to explain the low fertility rate in Catalonia in 1993.

[Hospital utilization for acute problems of the elderly. Catalonia, 1982-1990]

OBJECTIVE

Analyse the total and causal hospital utilization in Catalonia from 1982 to 1990 for the elderly.

METHODS

Hospital admissions and the length of stay will be analysed using direct adjusted rates, age specific rates, percentage variation and the corresponding confidence intervals and significance tests.

RESULTS

In population older than 65, male population have a greater hospital utilization and there is an increase in usage of hospitals with age. Sex differences are stressed among the elderly that in general population. Circulatory system diseases are the principal cause of admission in acute hospitals for the elderly of both sexes.

CONCLUSIONS

Men and old people make greater hospital utilization. Circulatory system diseases comprise the major part of admissions in acute hospitals, even though other causes are gaining importance, especially mental disorders.

[The health care system and regional mortality: a causal analysis]

"We examine the impact of the health care system on regional adult mortality differences in Spain, distinguishing between the demand and supply of health care. We have used a covariance analysis model, fitted to the data using LISREL 7. The distinction made between supply and demand of medical care leads to a significant spatial impact of the use of the health care system on adult mortality." (SUMMARY IN ENG)