Chronic renal disease in Spain: Prevalence and related factors in persons with diabetes mellitus older than 64 years

Introducción La diabetes mellitus tipo 2 y la enfermedad renal crónica (ERC) son afecciones de elevada prevalencia en personas = 65 años y constituyen un importante problema de salud pública. Objetivos Conocer la prevalencia de la ERC, sus categorías y su relación con diversos factores demográficos y clínicos, en pacientes ancianos con diabetes mellitus tipo 2 en España. Métodos Estudio epidemiológico, observacional, transversal, multicéntrico, ámbito nacional. Se incluyeron pacientes con diabetes mellitus tipo 2 conocida, edad = 65 años atendidos en Atención Primaria. Se recogieron variables demográficas, antropométricas y analíticas de los últimos 12 meses, incluyendo el cociente albúmina-creatinina y el filtrado glomerular estimado para evaluar la función renal. Resultados La prevalencia de ERC fue del 37, 2% (IC95%, 34, 1-40, 3%), de insuficiencia renal del 29, 7% (IC95%, 26, 8-32, 6%) y de elevación de la albuminuria del 20, 6% (IC95%, 17, 3-23, 9%), moderadamente elevada 17, 8% (IC95%, 14, 7-20, 9%), severamente elevada 2, 8% (IC95%, 1, 4-4, 2%). La prevalencia de las categorías de ERC fueron: G1 1, 3% (IC95%, 0, 6-2%), G2 6, 2% (IC95%, 4, 6-7, 8%), G3a 17, 2% (IC95%, 14, 8-19, 6%), G3b 9, 8% (IC95%, 7, 9-11, 7%), G4 2% (IC95%, 1, 1-2, 9%) y G5 0, 7% (IC95%, 0, 2-1, 2%). En el análisis multivariante, después de ajustar por el resto de variables, la ERC se asoció a mayor edad OR 5, 13, (IC95%, 3, 15-8, 35), alta comorbilidad OR 3, 36 (IC95%, 2, 2-5, 12) y la presencia de tratamiento antihipertensivo OR 2, 43 (IC95%, 1, 48-4, 02). Conclusiones La ERC es frecuente en la población diabética = 65 años y se asocia con mayor edad, alta comorbilidad e hipertensión tratada. No se ha encontrado asociación con el género y años de evolución de la diabetes. Introduction: Type 2 diabetes mellitus and chronic kidney disease (CKD) are conditions which have a high prevalence in individuals =65 years of age and represent a major public health problem. Objectives: To determine the prevalence of CKD, its categories and its relationship with various demographic and clinical factors in elderly patients with type 2 diabetes mellitus in Spain. Methods: Observational, cross-sectional, multicenter, Spanish epidemiological study. Patients with known type 2 diabetes mellitus, age =65 years of age treated in Primary Care were included. We collected demographic, anthropometric and analytical variables from the previous 12 months, including the albumin-to-creatinine ratio and estimated glomerular filtration rate to evaluate renal function. Results: The prevalence of CKD was 37.2% (95% CI, 34.1–40.3%), renal failure was 29.7% (95% CI, 26.8–32.6%) and increased albuminuria was 20.6% (95% CI, 17.3–23.9%), moderately increased albuminuria was 17.8% (95% CI, 14.7–20.9%) and severely increased albuminuria was 2.8% (95% CI, 1.4–4.2%). In turn, the prevalence of CKD categories were: G1 1.3% (95% CI, 0.6–2%), G2 6.2% (95% CI, 4.6–7.8%), G3a 17.2% (95% CI, 14.8–19.6%), G3b 9.8% (95% CI, 7.9–11.7%), G4 2% (95% CI, 1.1–2.9%) and G5 0.7% (95% CI, 0.2–1.2%). In the multivariate analysis, after adjusting for the remaining variables, CKD was associated with elderly age (OR 5.13, 95% CI, 3.15–8.35), high comorbidity (OR 3.36, 95% CI, 2.2–5.12) and presence of antihypertensive treatment (OR 2.43, 95% CI, 1.48–4.02). Conclusions: CKD is frequent in the diabetic population =65 years of age and is associated with elderly age, high comorbidity and with treated hypertension. No relationship has been found with gender and time in years since onset of diabetes

Enfermedad renal crónica en España: prevalencia y factores relacionados en personas con diabetes mellitus mayores de 64 años

Introducción: La diabetes mellitus tipo 2 y la enfermedad renal crónica (ERC) son afecciones de elevada prevalencia en personas = 65 años y constituyen un importante problema de salud pública. Objetivos: Conocer la prevalencia de la ERC, sus categorías y su relación con diversos factores demográficos y clínicos, en pacientes ancianos con diabetes mellitus tipo 2 en España. Métodos: Estudio epidemiológico, observacional, transversal, multicéntrico, ámbito nacional. Se incluyeron pacientes con diabetes mellitus tipo 2 conocida, edad = 65 años atendidos en Atención Primaria. Se recogieron variables demográficas, antropométricas y analíticas de los últimos 12 meses, incluyendo el cociente albúmina-creatinina y el filtrado glomerular estimado para evaluar la función renal. Resultados: La prevalencia de ERC fue del 37, 2% (IC95%, 34, 1-40, 3%), de insuficiencia renal del 29, 7% (IC95%, 26, 8-32, 6%) y de elevación de la albuminuria del 20, 6% (IC95%, 17, 3-23, 9%), moderadamente elevada 17, 8% (IC95%, 14, 7-20, 9%), severamente elevada 2, 8% (IC95%, 1, 4-4, 2%). La prevalencia de las categorías de ERC fueron: G1 1, 3% (IC95%, 0, 6-2%), G2 6, 2% (IC95%, 4, 6-7, 8%), G3a 17, 2% (IC95%, 14, 8-19, 6%), G3b 9, 8% (IC95%, 7, 9-11, 7%), G4 2% (IC95%, 1, 1-2, 9%) y G5 0, 7% (IC95%, 0, 2-1, 2%). En el análisis multivariante, después de ajustar por el resto de variables, la ERC se asoció a mayor edad OR 5, 13, (IC95%, 3, 15-8, 35), alta comorbilidad OR 3, 36 (IC95%, 2, 2-5, 12) y la presencia de tratamiento antihipertensivo OR 2, 43 (IC95%, 1, 48-4, 02). Conclusiones: La ERC es frecuente en la población diabética = 65 años y se asocia con mayor edad, alta comorbilidad e hipertensión tratada. No se ha encontrado asociación con el género y años de evolución de la diabetes. Introduction: Type 2 diabetes mellitus and chronic kidney disease (CKD) are conditions which have a high prevalence in individuals >= 65 years of age and represent a major public health problem. Objectives: To determine the prevalence of CKD, its categories and its relationship with various demographic and clinical factors in elderly patients with type 2 diabetes mellitus in Spain. Methods: Observational, cross-sectional, multicenter, Spanish epidemiological study. Patients with known type 2 diabetes mellitus, age >= 65 years of age treated in Primary Care were included. We collected demographic, anthropometric and analytical variables from the previous 12 months, including the albumin-to-creatinine ratio and estimated glomerular filtration rate to evaluate renal function. Results: The prevalence of CKD was 37.2% (95% CI, 34.1-40.3%), renal failure was 29.7% (95% CI, 26.8-32.6%) and increased albuminuria was 20.6% (95% CI, 17.3-23.9%), moderately increased albuminuria was 17.8% (95% CI, 14.7-20.9%) and severely increased albuminuria was 2.8% (95% CI, 1.4-4.2%). In turn, the prevalence of CKD categories were: G1 1.3% (95% CI, 0.6-2%), G2 6.2% (95% CI, 4.6-7.8%), G3a 17.2% (95% CI, 14.8-19.6%), G3b 9.8% (95% CI, 7.9-11.7%), G4 2% (95% CI, 1.1-2.9%) and G5 0.7% (95% CI, 0.2-1.2%). In the multivariate analysis, after adjusting for the remaining variables, CKD was associated with elderly age (OR 5.13, 95% CI, 3.15-8.35), high comorbidity (OR 3.36. 95% CI, 2.2-5.12) and presence of antihypertensive treatment (OR 2.43. 95% CI, 1.48-4.02). Conclusions: CKD is frequent in the diabetic population >= 65 years of age and is associated with elderly age, high comorbidity and with treated hypertension. No relationship has been found with gender and time in years since onset of diabetes

Ocular related emergencies in Spain during the COVID-19 pandemic, a multicenter study

Purpose: To evaluate ophthalmological emergencies (OE) during the COVID-19 pandemic comparing them with the same period of the previous year. Methods: Retrospective observational study of all OE visits in four tertiary hospitals in Spain comparing data from March 16th to April 30th, 2020 (COVID-19 period) and the same period of 2019 (pre-COVID-19 period). Severity of the conditions was assessed following Channa et al. publication. Data on demographics, diagnosis and treatments were collected from Electronic Medical Records. Results: During lockdown, OE significantly declined by 75.18%, from 7, 730 registered in the pre-COVID-19 period to 1, 928 attended during the COVID-19 period (p < 0.001). In 2019, 23.86% of visits were classified as emergent, 59.50% as non-emergent, and 16.65% could not be determined. In 2020, the percentage of emergent visits increased up to 29.77%, non-emergent visits significantly decreased to 52.92% (p < 0.001), and 17.31% of the visits were classified as “could not determine”. During the pandemic, people aged between 45 and 65 years old represented the largest attending group (37.89%), compared to 2019, where patients over 65 years were the majority (39.80%). In 2019, most frequent diagnosis was unspecified acute conjunctivitis (11.59%), followed by vitreous degeneration (6.47%), and punctate keratitis (5.86%). During the COVID-19 period, vitreous degeneration was the first cause for consultation (9.28%), followed by unspecified acute conjunctivitis (5.63%) and punctate keratitis (5.85%). Conclusions: OE visits dropped significantly during the pandemic in Spain (75.18%), although more than half were classified as non-urgent conditions, indicating a lack of understanding of the really emergent ocular pathologies among population. © 2021, The Author(s)

Does the pharmacy expenditure of patients always correspond with their morbidity burden? Exploring new approaches in the interpretation of pharmacy expenditure

<p>Abstract</p> <p>Background</p> <p>The computerisation of primary health care (PHC) records offers the opportunity to focus on pharmacy expenditure from the perspective of the morbidity of individuals. The objective of the present study was to analyse the behaviour of pharmacy expenditure within different morbidity groups. We paid special attention to the identification of individuals who had higher values of pharmacy expenditure than their morbidity would otherwise suggest (i.e. outliers).</p> <p>Methods</p> <p>Observational study consisting of 75,574 patients seen at PHC centres in Zaragoza, Spain, at least once in 2005. Demographic and disease variables were analysed (ACG^®8.1), together with a response variable that we termed 'total pharmacy expenditure per patient'. Outlier patients were identified based on boxplot methods, adjusted boxplot for asymmetric distributions, and by analysing standardised residuals of tobit regression models.</p> <p>Results</p> <p>The pharmacy expenditure of up to 7% of attendees in the studied PHC centres during one year exceeded expectations given their morbidity burden. This group of patients was responsible for up to 24% of the total annual pharmacy expenditure. There was a significantly higher number of outlier patients within the low-morbidity band which matched up with the higher variation coefficient observed in this group (3.2 vs. 2.0 and 1.3 in the moderate- and high-morbidity bands, respectively).</p> <p>Conclusions</p> <p>With appropriate validation, the methodologies of the present study could be incorporated in the routine monitoring of the prescribing profile of general practitioners. This could not only enable evaluation of their performance, but also target groups of outlier patients and foster analyses of the causes of unusually high pharmacy expenditures among them. This interpretation of pharmacy expenditure gives new clues for the efficiency in utilisation of healthcare resources, and could be complementary to management interventions focused on individuals with a high morbidity burden.</p

Primary care utilisation patterns among an urban immigrant population in the Spanish National Health System

<p>Abstract</p> <p>Background</p> <p>There is evidence suggesting that the use of health services is lower among immigrants after adjusting for age and sex. This study takes a step forward to compare primary care (PC) utilisation patterns between immigrants and the native population with regard to their morbidity burden.</p> <p>Methods</p> <p>This retrospective, observational study looked at 69,067 individuals representing the entire population assigned to three urban PC centres in the city of Zaragoza (Aragon, Spain). Poisson models were applied to determine the number of annual PC consultations per individual based on immigration status. All models were first adjusted for age and sex and then for age, sex and case mix (ACG System^®).</p> <p>Results</p> <p>The age and sex adjusted mean number of total annual consultations was lower among the immigrant population (children: IRR = 0.79, p < 0.05; adults: IRR = 0.73, p < 0.05). After adjusting for morbidity burden, this difference decreased among children (IRR = 0.94, p < 0.05) and disappeared among adults (IRR = 1.00). Further analysis considering the PC health service and type of visit revealed higher usage of routine diagnostic tests among immigrant children (IRR = 1.77, p < 0.05) and a higher usage of emergency services among the immigrant adult population (IRR = 1.2, p < 0.05) after adjusting for age, sex and case mix.</p> <p>Conclusions</p> <p>Although immigrants make lower use of PC services than the native population after adjusting the consultation rate for age and sex, these differences decrease significantly when considering their morbidity burden. These results reinforce the 'healthy migration effect' and discount the existence of differences in PC utilisation patterns between the immigrant and native populations in Spain.</p

Association between Use of Enhanced Recovery after Surgery Protocol and Postoperative Complications in Total Hip and Knee Arthroplasty in the Postoperative Outcomes Within Enhanced Recovery after Surgery Protocol in Elective Total Hip and Knee Arthroplasty Study (POWER2)

Importance: The Enhanced Recovery After Surgery (ERAS) care protocol has been shown to improve outcomes compared with traditional care in certain types of surgery. Objective: To assess the association of use of the ERAS protocols with complications in patients undergoing elective total hip arthroplasty (THA) and total knee arthroplasty (TKA). Design, Setting, and Participants: This multicenter, prospective cohort study included patients recruited from 131 centers in Spain from October 22 through December 22, 2018. All consecutive adults scheduled for elective THA or TKA were eligible for inclusion. Patients were stratified between those treated in a self-designated ERAS center (ERAS group) and those treated in a non-ERAS center (non-ERAS group). Data were analyzed from June 15 through September 15, 2019. Exposures: Total hip or knee arthroplasty and perioperative management. Sixteen individual ERAS items were assessed in all included patients, whether they were treated at a center that was part of an established ERAS protocol or not. Main Outcomes and Measures: The primary outcome was postoperative complications within 30 days after surgery. Secondary outcomes included length of stay and mortality. Results: During the 2-month recruitment period, 6146 patients were included (3580 women [58.2%]; median age, 71 [interquartile range (IQR), 63-76] years). Of these, 680 patients (11.1%) presented with postoperative complications. No differences were found in the number of patients with overall postoperative complications between ERAS and non-ERAS groups (163 [10.2%] vs 517 [11.4%]; odds ratio [OR], 0.89; 95% CI, 0.74-1.07; P =.22). Fewer patients in the ERAS group had moderate to severe complications (73 [4.6%] vs 279 [6.1%]; OR, 0.74; 95% CI, 0.56-0.96; P =.02). The median overall adherence rate with the ERAS protocol was 50.0% (IQR, 43.8%-62.5%), with the rate for ERAS facilities being 68.8% (IQR, 56.2%-81.2%) vs 50.0% (IQR, 37.5%-56.2%) at non-ERAS centers (P <.001). Among the patients with the highest and lowest quartiles of adherence to ERAS components, the patients with the highest adherence had fewer overall postoperative complications (144 [10.6%] vs 270 [13.0%]; OR, 0.80; 95% CI, 0.64-0.99; P <.001) and moderate to severe postoperative complications (59 [4.4%] vs 143 [6.9%]; OR, 0.62; 95% CI, 0.45-0.84; P <.001) and shorter median length of hospital stay (4 [IQR, 3-5] vs 5 [IQR, 4-6] days; OR, 0.97; 95% CI, 0.96-0.99; P <.001). Conclusions and Relevance: An increase in adherence to the ERAS program was associated with a decrease in postoperative complications, although only a few ERAS items were individually associated with improved outcomes

Coste del tratamiento farmacológico de los factores de riesgo cardiovascular en población diabética anciana según género (Estudio ESCADIANE)

Objetivo Estudiar el coste del tratamiento farmacológico utilizado para el control de los factores de riesgo cardiovascular en pacientes con diabetes mellitus tipo 2 > 65 años y la prevalencia de complicaciones cardiovasculares en función del género. Diseño Estudio transversal, observacional, multicéntrico. Emplazamiento Ámbito nacional. Participantes Pacientes con diabetes mellitus tipo 2 > 65 años. Mediciones principales Prevalencia de factores de riesgo cardiovascular y su coste en pacientes con diabetes mellitus tipo 2. Resultados Se estudiaron 947 pacientes (53% mujeres) con una edad media de 76, 2 ± 7, 3 años. El 14% habían sufrido un infarto agudo de miocardio (17, 8% varones vs. 10, 7% mujeres; p = 0, 001), el 11, 9% un accidente cerebrovascular (13, 7% varones vs. 10, 5% mujeres; p = ns), el 11, 3% insuficiencia cardíaca (10, 9% varones vs. 11, 7% mujeres; p = ns) y el 9% enfermedad arterial periférica (12, 1% varones vs. 6, 3% mujeres; p = 0, 001). El mayor coste en el tratamiento fue para los antidiabéticos orales (414, 76 ± 210, 18 € paciente/año), debido fundamentalmente a los inhibidores DPP-4 (49, 9% del coste de los antidiabéticos), seguidos de la insulina basal (29, 95%) y sin diferencias significativas entre género. El gasto anual de antihipertensivos por paciente/año fue mayor en mujeres que en varones (86, 80 € ± 32, 84 vs. 78, 24 € ± 26, 86; p = 0, 0001). El de antiagregantes significativamente menor (20, 87 € ± 7, 25 en mujeres vs. 30, 21 € ± 13, 68; p = 0, 0001). Conclusiones Los antidiabéticos supusieron el mayor coste en el control de los factores de riesgo cardiovascular del paciente diabético > 65 años, seguido de los hipotensores, hipolipemientes y por último los antiagregantes. Las mujeres presentaron mayor gasto en hipotensores y los hombres en antiagregantes. En varones, las complicaciones macrovasculares más frecuentes fueron infarto IAM, arritmias y ACV. Solo hubo diferencias con respecto al género para infarto. Aims To study the cost of pharmacological treatment used for the control of cardiovascular risk factors in patients with type 2 diabetes mellitus (DM2) > 65 years and the prevalence of cardiovascular complications according to gender. Design Cross-sectional, observational, multicentric study. Location National study. Participants Patients with diabetes mellitus 2 > 65 years. Main measurements prevalence of cardiovascular risk factors and their cost in patients with diabetes mellitus 2. Results We studied 947 patients (53% females) with a mean age of 76.2 ± 7.3 years. 14% had suffered acute myocardial infarction (17.8% men vs. 10.7% women, p = .001), 11.9% had stroke (13.7% men vs. 10.5% women; p = ns), 11.3% heart failure (10.9% men vs. 11.7% women, p = ns) and 9% peripheral arterial disease (12.1% men vs. 6.3% women; p = .001). Oral antidiabetic drugs accounted for the highest cost (414.76 ± 210.18 € patient / year), mainly due to DPP-4 inhibitors (49.9% of the cost of antidiabetics), followed by basal insulin (29.95%) and without significant differences between gender. The annual expenditure of antihypertensive drugs per patient/year was higher in women than in men (86.80 ± 32.84 € vs. 78.24 € ± 26.86, p = 0.0001). The antiaggregants significantly lower in women (20.87 ± 7.25 € vs. € 30.21 ± 13.68, p = 0.0001). Conclusions Antidiabetic drugs represented the highest cost in controlling cardiovascular risk factors in diabetic patients > 65 years of age, followed by hypotensives, hypolipements and antiaggregants. Women had higher spending on anti-hypertensives and men on antiaggregants. The most frequent macrovascular complications in men were AMI, arrhythmias and stroke. There were only gender differences for infarction