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Berenguer J, Calvo-Alcántara MJ, Alvaro-Meca A, Estévez JC, Basanta M, Ruiz S, Matáix ÁL, Bienzóbas C, Cosano L, Silva AP, Salas P, Gullón P, Franco M, Arribas JR, Molero JM, Hernán MA. Three Years of the Coronavirus Disease 2019 Pandemic in a European Region: A Population-Based Longitudinal Assessment in Madrid Between 2020 and 2022. Open Forum Infect Dis 2024; 11:ofad635. [PMID: 38173846 PMCID: PMC10763997 DOI: 10.1093/ofid/ofad635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/13/2023] [Indexed: 01/05/2024] Open
Abstract
Background Our objective was to assess the health impact of coronavirus disease 2019 (COVID-19) during 2020-2022 in the Madrid region. Methods We included all individuals registered in the Madrid Health System Registry as of 31 December 2019, and followed them until 31 December 2022. Using a unique personal identifier, we linked the databases of primary care, hospitals, pharmacies, certified laboratories performing diagnostic tests, vaccines, and mortality. Results Of 6 833 423 individuals, 21.4% had a confirmed COVID-19 diagnosis, and 1.5% had a COVID-19 hospitalization (primary diagnosis). Thirty-day mortality was 1.6% for confirmed COVID-19 (from 11.4% in first semester 2020 to 0.4% in first semester 2022). Thirty-day mortality was 10.8% for COVID-19 hospitalizations (from 14.0% in first semester 2020 to 6.0% in second semester 2022). There were 24 073 deaths within 30 days of a confirmed COVID-19 diagnosis. Advanced age, male sex, higher socioeconomic deprivation, and comorbidities were associated with higher mortality. Conclusions By linking administrative and clinical databases, we characterized the burden of the COVID-19 pandemic in Madrid over 3 years. Our analysis proposes a high-level framework for comparisons of the burden of COVID-19 across areas worldwide.
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Affiliation(s)
- Juan Berenguer
- Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
| | | | - Alejandro Alvaro-Meca
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
- Medicina Preventiva y Salud Pública, Universidad Rey Juan Carlos, Madrid, Spain
| | - José C Estévez
- Gerencia Asistencial de Atención Primaria, Madrid, Spain
| | - Miguel Basanta
- Dirección General de Sistemas de Información y Equipamientos Sanitarios, Madrid, Spain
| | - Sergio Ruiz
- Gerencia Asistencial de Atención Primaria, Madrid, Spain
| | - Ángel L Matáix
- Subdirección General de Farmacia y Productos Sanitarios, Madrid, Spain
| | - César Bienzóbas
- Dirección General de Inspección y Ordenación Sanitaria, Madrid, Spain
| | - Lourdes Cosano
- Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Aura P Silva
- Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Pilar Salas
- Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Pedro Gullón
- Departamento de Cirugía, Ciencias Médicas y Sociales, Grupo de Investigación en Epidemiología y Salud Pública, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain
| | - Manuel Franco
- Departamento de Cirugía, Ciencias Médicas y Sociales, Grupo de Investigación en Epidemiología y Salud Pública, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain
| | - José R Arribas
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
- Infectious Diseases, Internal Medicine, Hospital Universitario La Paz, Madrid, Spain
- Instituto de Investigación Hospital Universitario La Paz, Madrid, Spain
- Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Miguel A Hernán
- CAUSALab, Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
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López-Centeno B, Badenes-Olmedo C, Mataix-Sanjuan Á, McAllister K, Bellón JM, Gibbons S, Balsalobre P, Pérez-Latorre L, Benedí J, Marzolini C, Aranguren-Oyarzábal A, Khoo S, Calvo-Alcántara MJ, Berenguer J. Polypharmacy and Drug-Drug Interactions in People Living With Human Immunodeficiency Virus in the Region of Madrid, Spain: A Population-Based Study. Clin Infect Dis 2021; 71:353-362. [PMID: 31428770 DOI: 10.1093/cid/ciz811] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 08/17/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Drug-drug interactions (DDIs) that involve antiretrovirals (ARVs) tend to cause harm if unrecognized, especially in the context of comorbidity and polypharmacy. METHODS A linkage was established between the drug dispensing registry of Madrid and the Liverpool human immunodeficiency virus (HIV) DDI database (January 2017-June 2017). Polypharmacy was defined as the use of ≥5 non-HIV medications, and DDIs were classified by a traffic-light ranking for severity. RESULTS A total of 22 945 people living with HIV (PLWH) and 6 613 506 individuals without HIV had received medications. ARV regimens were predominantly based on integrase inhibitors (51.96%). Polypharmacy was higher in PLWH (32.94%) than individuals without HIV (22.16%; P < .001); this difference was consistently observed across all age strata except for individuals ≥75 years. Polypharmacy was more common in women than men in both PLWH and individuals without HIV. The prevalence of contraindicated combinations involving ARVs was 3.18%. Comedications containing corticosteroids, quetiapine, or antithrombotic agents were associated with the highest risk for red-flag DDI, and the use of raltegravir- or dolutegravir-based antiretroviral therapy was associated with an adjusted odds ratio of 0.72 (95% confidence interval, .60-.88; P = .001) for red-flag DDI. CONCLUSIONS Polypharmacy was more frequent among PLWH across all age groups except those aged ≥75 years and was more common in women. The detection of contraindicated medications in PLWH suggests a likely disconnect between hospital and community prescriptions. Switching to alternative unboosted integrase regimens should be considered for patients with risk of harm from DDIs.
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Affiliation(s)
- Beatriz López-Centeno
- Subdirección General de Farmacia y Productos Sanitarios, Servicio Madrileño de Salud, Madrid, Spain
| | - Carlos Badenes-Olmedo
- Ontology Engineering Group, Escuela Técnica Superior de Ingeniería Informática, Universidad Politécnica de Madrid, Madrid, Spain
| | - Ángel Mataix-Sanjuan
- Subdirección General de Farmacia y Productos Sanitarios, Servicio Madrileño de Salud, Madrid, Spain
| | - Katie McAllister
- Department of Pharmacology, University of Liverpool, Liverpool, United Kingdom
| | - José M Bellón
- Unidad de Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón (Instituto de Investigación Sanitaria Gregorio Marañón [IiSGM]), Madrid, Spain.,IiSGM, Madrid, Spain
| | - Sara Gibbons
- Department of Pharmacology, University of Liverpool, Liverpool, United Kingdom
| | - Pascual Balsalobre
- Unidad de Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón (Instituto de Investigación Sanitaria Gregorio Marañón [IiSGM]), Madrid, Spain.,IiSGM, Madrid, Spain
| | - Leire Pérez-Latorre
- Unidad de Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón (Instituto de Investigación Sanitaria Gregorio Marañón [IiSGM]), Madrid, Spain.,IiSGM, Madrid, Spain
| | - Juana Benedí
- Departamento de Farmacología, Facultad de Farmacia, Universidad Complutense de Madrid, Madrid, Spain
| | - Catia Marzolini
- Department of Pharmacology, University of Liverpool, Liverpool, United Kingdom.,Division of Infectious Diseases & Hospital Epidemiology, University Hospital of Basel, Basel, Switzerland
| | | | - Saye Khoo
- Department of Pharmacology, University of Liverpool, Liverpool, United Kingdom
| | - María J Calvo-Alcántara
- Subdirección General de Farmacia y Productos Sanitarios, Servicio Madrileño de Salud, Madrid, Spain
| | - Juan Berenguer
- Unidad de Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón (Instituto de Investigación Sanitaria Gregorio Marañón [IiSGM]), Madrid, Spain.,IiSGM, Madrid, Spain
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López-Centeno B, Badenes-Olmedo C, Mataix-Sanjuan A, Bellón JM, Pérez-Latorre L, López JC, Benedí J, Khoo S, Marzolini C, Calvo-Alcántara MJ, Berenguer J. Potentially inappropriate medications in older adults living with HIV. HIV Med 2020; 21:541-546. [PMID: 32516849 DOI: 10.1111/hiv.12883] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES We assessed the prevalence of potentially inappropriate medication (PIM) among older (≥ 65 years) people living with HIV (O-PLWH) in the region of Madrid. METHODS We analysed the dispensation registry of community and hospital pharmacies from the Madrid Regional Health Service (SERMAS) for the period between 1 January and 30 June 2017, looking specifically at PIMs according to the 2019 Beers criteria. Co-medications were classified according to the Anatomical Therapeutic Chemical (ATC) classification system. RESULTS A total of 6 636 451 individuals received medications. Of these individuals, 22 945 received antiretrovirals (ARVs), and of these 1292 were O-PLWH. Overall, 1135 (87.8%) O-PLWH were taking at least one co-medication, and polypharmacy (at least five co-medications) was observed in 852 individuals (65.9%). A PIM was identified in 482 (37.3%) O-PLWH. Factors independently associated with PIM were polypharmacy [adjusted odds ratio (aOR) 7.08; 95% confidence interval (CI) 5.16-9.72] and female sex (aOR 1.75; 95% CI 1.30-2.35). The distribution of PIMs according to ATC drug class were nervous system drugs (n = 369; 28.6%), musculoskeletal system drugs (n = 140; 10.8%), gastrointestinal and metabolism drugs (n = 72; 5.6%), cardiovascular drugs (n = 61; 4.7%), respiratory system drugs (n = 13; 1.0%), antineoplastic and immunomodulating drugs (n = 10; 0.8%), and systemic anti-infectives (n = 2; 0.2%). Five drugs accounted for 84.8% of the 482O PLWH with PIMs: lorazepam (38.2%), ibuprofen (18.0%), diazepam (10.2%), metoclopramide (9.9%), and zolpidem (8.5%). CONCLUSIONS Prescription of PIMs is highly prevalent in O-PLWH. Consistent with data in uninfected elderly people, the most frequently observed PIMs were benzodiazepines and nonsteroidal anti-inflammatory drugs . Targeted interventions are warranted to reduce inappropriate prescribing and polypharmacy in this vulnerable population.
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Affiliation(s)
- B López-Centeno
- Directorate for Pharmacy and Health Products, Madrid Regional Health Service (SERMAS), Madrid, Spain
| | - C Badenes-Olmedo
- Ontology Engineering Group (OEG), School of Telecommunications and System Engineering, Polytechnic University of Madrid (UPM), Madrid, Spain
| | - A Mataix-Sanjuan
- Directorate for Pharmacy and Health Products, Madrid Regional Health Service (SERMAS), Madrid, Spain
| | - J M Bellón
- Gregorio Marañón General Hospital, Institute of Health Research Gregorio Marañón (IiSGM), Madrid, Spain
| | - L Pérez-Latorre
- Gregorio Marañón General Hospital, Institute of Health Research Gregorio Marañón (IiSGM), Madrid, Spain
| | - J C López
- Gregorio Marañón General Hospital, Institute of Health Research Gregorio Marañón (IiSGM), Madrid, Spain
| | - J Benedí
- Department of Pharmacology, Faculty of Pharmacy, Complutense Universtiy (UCM), Madrid, Spain
| | - S Khoo
- Department of Pharmacology, University of Liverpool, Liverpool, UK
| | - C Marzolini
- Division of Infectious Diseases & Hospital Epidemiology, University Hospital of Basel, Basel, Switzerland
| | - M J Calvo-Alcántara
- Directorate for Pharmacy and Health Products, Madrid Regional Health Service (SERMAS), Madrid, Spain
| | - J Berenguer
- Gregorio Marañón General Hospital, Institute of Health Research Gregorio Marañón (IiSGM), Madrid, Spain
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