Sex-related disparities in the incidence and outcomes of infective endocarditis according to type 2 diabetes mellitus status in Spain, 2016-2020

BACKGROUND

We performed a study to assess sex-differences in incidence (2016-2020), clinical characteristics, use of therapeutic procedures, and in-hospital outcomes in patients with infective endocarditis (IE) according to T2DM status.

METHODS

Ours was a retrospective cohort study using data from the Spanish National Hospital Discharge Database. We estimated the incidence of hospitalizations for IE in men and women aged ≥ 40 years with and without T2DM. Propensity score matching (PSM) and multivariable logistic regression were used to compare subgroups according to sex and the presence of T2DM.

RESULTS

From 2016 to 2020, IE was coded in 9,958 patients (66.79% men). T2DM was diagnosed in 2,668 (26.79%). The incidence of IE increased significantly from 15.29 cases per 100,000 persons with T2DM in 2016 to 17.69 in 2020 (p < 0.001). However, this increment was significant only among men with T2DM (19.47 cases per 100,000 in 2016 vs. 22.84 in 2020; p = 0.003). The age-adjusted incidence of IE was significantly higher in people with T2DM (both sexes) than in those without T2DM (IRR, 2.86; 95% CI, 2.74-2.99). The incidence of IE was higher in men with T2DM than in women with T2DM (adjusted IRR, 1.85; 95% CI, 1.54-3.31). After PSM, in-hospital mortality (IHM) was higher among T2DM women than matched T2DM men (22.65% vs. 18.0%; p = 0.018). The presence of T2DM was not associated with IHM in men or women.

CONCLUSIONS

T2DM is associated with a higher incidence of hospitalization for IE. Findings for T2DM patients who had experienced IE differed by sex, with higher incidence rates and lower IHM in men than in women. T2DM was not associated to IHM in IE in men or in women.

Influenza Vaccination Coverages among Spanish Children, Adults and Health Care Workers

BACKGROUND

This study aimed at describing influenza vaccination coverage among Spanish children, adults and health care workers (HCWs).

PATIENTS AND METHODS

We analyzed 27,791 questionnaires on subjects aged 6 months or over, drawn from the 2003 Spanish National Health Survey. As the dependent variable, we took the answer to the question, "Did you (or your child) have a flu shot in the last campaign?". Independent variables were age group, gender, nationality, occupation (HCWs) and coexistence of chronic conditions.

RESULTS

Overall influenza vaccination coverage for the total sample was 19.58%. Coverage for the pediatric population was 5.55%, with 20.74% of those with and 4.67% of those without chronic condition being vaccinated. Vaccination coverages were: 63.7% among subjects aged > or = 65 years; 30.5% among high-risk subjects aged < 65 years; and 19.65% among HCWs.

CONCLUSIONS

We conclude that the available results show low levels of influenza vaccination coverage among high-risk subjects aged under 65 years, children in particular, and HCWs.

Evolution of anti-influenza vaccination coverage in Spain from 1993 to 2001

The objective of this study is to describe the evolution of anti-influenza vaccination coverage in Spain from 1993 to 2001. We analysed 55,040 questionnaires taken from the Spanish National Health Surveys from the years 1993, 1995, 1997 and 2001. The reply to the question "Did you vaccinate yourself against influenza during the last campaign?" is the dependent variable. Independent variables were the year of the survey, age, sex and the coexistence of chronic conditions. After adjusting using logistic regression, we found a significant improvement during the study period among those subjects at risk of suffering complications from influenza (OR 1.21). Nevertheless, this increase was essentially at the cost of subjects aged 65 and over. Subjects with high-risk conditions under 65 did not undergo significant changes.

CONCLUSIONS

A significant but insufficient improvement has been achieved and this must lead us to consider the possible need to modify anti-influenza vaccination recommendations.