Comparabilidad de las ediciones 2006/07 y 2011/12 de la Encuesta Nacional de Salud de España

Fundamentos: La Encuesta Nacional de Salud de España (ENSE) es una de las fuentes principales sobre determinantes sociales de la salud. Los objetivos de este trabajo fueron describir el procedimiento de fusión de las ediciones 2006/07 y 2011/12 de la ENSE, y proporcionar acceso libre a las bases de datos y directorio de variables. Resultados: Identificamos 188 variables potencialmente comparables. Un 36,7% tuvieron algún problema para su comparabilidad y un 8% tuvieron que ser eliminadas, fundamentalmente en la muestra de adultos. El ámbito con peores consecuencias de la falta de comparabilidad fue el de condiciones de trabajo y empleo en la muestra de adultos. Conclusión: La fusión de ambas ediciones de la ENSE tuvo muchas incidencias en la muestra de adultos, afectando de manera importante a su comparabilidad. Este trabajo es útil para evaluar, diseñar y fusionar estas y otras ediciones de la ENSE, e incluso sirve como modelo para la fusión de otras encuestas transversales de base poblacional.Background: The Spanish Health Survey (SHS) is one of the main sources on social determinants of health. The objectives were to describe the data merging process of the 2006/07 and 2011/12 SHS editions, as well as to provide the merged databases and the directory of the variables. Results: 188 variables were identified as potentially comparable ones. 36,7% of them had difficulties for being comparable and 8% had to be removed. The topic with the worst consequences due to the lack of comparability was the working conditions and employment from the adult sample. Conclusion: The merging of both SHS editions had a lot of problems, especially in the adult’s sample. That affects to its comparability. This work may be useful to assess, design and merge these and other editions of the SHS, as well as to serve as a model to be applied in other cross-sectional population-based surveys.Este trabajo ha contado con la financiación del Subprograma de Investigación en Crisis y Salud del CIBER de Epidemiología y Salud Pública (CIBERESP)

Risk of suicide in households threatened with eviction: the role of banks and social support

Background: One of the greatest effects of the financial crisis in Spain has been the enormous increase in the number of evictions. Several studies have shown the association of evictions with different aspects of the physical and mental health. Furthermore, evictions have been associated with an increased risk of suicide. Our objective was to evaluate the risk of suicide among victims of eviction and investigate whether it is associated with specific characteristics of households and interviewees, the eviction process and social support, and health needs. Results: Almost half of the sample (46.7%) were at low (11.8%), moderate (16.9%), or high suicide risk (17.9%). Household and interviewee features had a limited association with suicide risk. On the contrary, the risk of suicide is greater with a longer exposure to the eviction process. In addition, threatening phone calls from banks increased significantly the risk of suicide, especially among men. Suicide risk was also associated with low social support, especially among women. Interviewees at risk of suicide received more help from nongovernmental organizations than those who were not at risk. In interviewees at risk, the main unmet needs were emotional and psychological help, especially in men. A high percentage of those at risk of suicide declare having large unmeet health needs. Finally, there was a tendency among the evicted at risk of suicide to visit emergency room and primary care more often than those not at risk, especially among women. Conclusions: To our knowledge, this is the first study showing that when banks adopt a threatening attitude, suicide risk increases among the evicted. As hypothesized, when the evicted felt socially supported, suicide risk decreased. Emotional help was the main mediator of suicide risk and the main unmet need, especially among me

Impact of COVID-19 on the Health of the General and More Vulnerable Population and Its Determinants: Health Care and Social Survey–ESSOC, Study Protocol

This manuscript describes the rationale and protocol of a real-world data (RWD) study entitled Health Care and Social Survey (ESSOC, Encuesta Sanitaria y Social). The study’s objective is to determine the magnitude, characteristics, and evolution of the COVID-19 impact on overall health as well as the socioeconomic, psychosocial, behavioural, occupational, environmental, and clinical determinants of both the general and more vulnerable population. The study integrates observational data collected through a survey using a probabilistic, overlapping panel design, and data from clinical, epidemiological, demographic, and environmental registries. The data will be analysed using advanced statistical, sampling, and machine learning techniques. The study is based on several measurements obtained from three random samples of the Andalusian (Spain) population: general population aged 16 years and over, residents in disadvantaged areas, and people over the age of 55. Given the current characteristics of this pandemic and its future repercussions, this project will generate relevant information on a regular basis, commencing from the beginning of the State of Alarm. It will also establish institutional alliances of great social value, explore and apply powerful and novel methodologies, and produce large, integrated, high-quality and open-access databases. The information described here will be vital for health systems in order to design tailor-made interventions aimed at improving the health care, health, and quality of life of the populations most affected by the COVID-19 pandemic.Andalusian Institute of Statistics and Cartography (IECA)Andalusian School of Public Health (EASP)SUPERA COVID-19 Fund of Santander Universities (SAUN)Conference of Spanish University Rectors (CRUE, Conferencia de Rectores de Universidades EspañolasSpanish National Research Council (CSIC, Consejo Superior de Investigaciones Científicas)COVID-19 Competitive Grant Program from Pfizer Global Medical GrantsIMAG–Maria de Maeztu grantMinisterio de Ciencia e Innovación, Spai

Factors associated with the incidence and mortality from COVID-19 in the autonomous communities of Spain

Objetivo Analizar la evolución de la epidemia de COVID-19 después del estado de alarma e identificar factores asociados a las diferencias entre las comunidades autónomas. Método Estudio ecológico que utilizó variables epidemiológicas, demográficas, ambientales y sobre la estructura de los servicios sanitarios como variables explicativas. El periodo de análisis fue desde el 15 de marzo (inicio del estado de alarma) hasta el 22 de abril de 2020. Las tasas de incidencia y de mortalidad fueron las variables respuesta principales. La magnitud de las asociaciones se ha estimado mediante el coeficiente de correlación de Spearman y el análisis de regresión múltiple. Resultados Las tasas de incidencia y de mortalidad en el momento del decreto del estado de alarma se asocian con las tasas de incidencia, mortalidad y demanda hospitalaria actuales. Las temperaturas medias más altas se asocian significativamente con una menor incidencia actual de COVID-19. Asimismo, una mayor proporción de personas mayores en residencias se asocia significativamente a una mortalidad actual más elevada. Conclusión Es posible predecir la evolución de la epidemia a través del análisis de la incidencia y de la mortalidad. Las temperaturas más bajas y la elevada proporción de personas mayores en residencias son factores asociados a un peor pronóstico. Estos parámetros deben ser considerados en las decisiones sobre el momento y la intensidad de la implantación de las medidas de contención. En este sentido, fortalecer la vigilancia epidemiológica es esencial para mejorar las predicciones.Objective Analyze the evolution of the epidemic of COVID-19 after the alarm state and identify factors associated with the differences between the autonomous communities. Method Ecological study that used epidemiological, demographic, environmental and variables on the structure of health services as explanatory variables. The analysis period was from March 15th (the start of the alarm state) until April 22nd, 2020. Incidence and mortality rates were the main response variables. The magnitude of the associations has been estimated using the Spearman correlation coefficient and multiple regression analysis. Results Incidence and mortality rates at the time of decree of alarm status are associated with current incidence, mortality and hospital demand rates. Higher mean temperatures are significantly associated with a lower current incidence of COVID-19 in the autonomous communities. Likewise, a higher proportion of older people in nursing homes is significantly associated with a higher current mortality in the autonomous communities. Conclusion It is possible to predict the evolution of the epidemic through the analysis of incidence and mortality. Lower temperatures and the proportion of older people in residences are factors associated with a worse prognosis. These parameters must be considered in decisions about the timing and intensity of the implementation of containment measures. In this sense, strengthening epidemiological surveillance is essential to improve predictions

Consumo de tabaco y alcohol en una muestra en proceso de desahucio

Introduction: In Spain, the current economic crisis has led to an unfortunate phenomenon little known until now: the eviction process. The aim was to eval­uate unhealthy habits such as consumption of tobacco and alcohol in a group of Granada as at risk of losing their residence. Methods: Participated 205 adult un­dergoing an eviction process from their homes (122 women and 83 men) who were given the items of health-related habits of the Andalusian Health Survey 2011. All participants were linked to the Platform Af­fected by Mortgage, Stop Desahucios of Granada. Results: Consumption of tobacco: observe higher percentage of daily smokers among men (54.22 %), people who live as a couple and workers. People who have entered the judicial process smoke more ciga­rettes per day (t = 1944, p = .055) and perceived an increase in the consumption of tobacco from the pro­cess of eviction. (c2 = 8.494, p = .037). Consumption of alcohol: find higher percentage in men (c2= 10.005, p = .019) and in people who do not live with a partner (c2= 8,553, p = .036); men perceive a greater increase in alcohol consumption due to the eviction process (c2 = 20,375, p = .000). Conclu­sions: The eviction process negatively affects health-related habits and should therefore be prioritized in Public Health policies as a population at riskResumenIntroducción: En España, la actual crisis económica nos ha llevado a un lamentable fenómeno poco conocido hasta ahora: el proceso del desahucio. Nuestro objetivo ha sido evaluar hábitos poco saludables como el consumo del tabaco y alcohol en un grupo de granadinos/as en riesgo de perder su vivienda habitual. Método: Han participado 205 personas adultas (122 mujeres y 83 hombres) a los que se les administró los ítems de hábitos relacionados con la salud de la Entrevista Andaluza de Salud 2011. Todos los participantes estaban vinculados a la Plataforma de Afectados por la Hipoteca Stop Desahucios de Granada. Resultados: Consumo de tabaco: observamos mayor porcentaje de fumadores a diario en hombres (54.22 %), personas que no viven en pareja y trabajadores. Las personas que han entrado en el proceso judicial fuman más cigarrillos al día (t = -1.944, p = .055) y perciben un aumento en el consumo de tabaco debido al proceso de desahucio (c2 = 8.494, p = .037). Consumo de alcohol: encontramos mayor porcentaje en hombres c2 = 10.005, p = .019) y en personas que no viven en pareja c2 = 8.553, p = .036); los hombres perciben un mayor aumento en el consumo de alcohol debido al proceso de desahucio (c2 = 20.375, p = .000). Conclusiones: El proceso de desahucio afecta negativamente a los hábitos relacionados con la salud por lo que debería priorizarse en las políticas de Salud Pública como una población de riesgo. AbstractIntroduction: In Spain, the current economic crisis has led to an unfortunate phenomenon little known until now: the eviction process. The aim was to eval­uate unhealthy habits such as consumption of tobacco and alcohol in a group of Granada as at risk of losing their residence. Methods: Participated 205 adult un­dergoing an eviction process from their homes (122 women and 83 men) who were given the items of health-related habits of the Andalusian Health Survey 2011. All participants were linked to the Platform Af­fected by Mortgage, Stop Desahucios of Granada. Results: Consumption of tobacco: observe higher percentage of daily smokers among men (54.22 %), people who live as a couple and workers. People who have entered the judicial process smoke more ciga­rettes per day (t = 1944, p = .055) and perceived an increase in the consumption of tobacco from the pro­cess of eviction. (c2 = 8.494, p = .037). Consumption of alcohol: find higher percentage in men (c2= 10.005, p = .019) and in people who do not live with a partner (c2= 8,553, p = .036); men perceive a greater increase in alcohol consumption due to the eviction process (c2 = 20,375, p = .000). Conclu­sions: The eviction process negatively affects health-related habits and should therefore be prioritized in Public Health policies as a population at ris

Factors associated with prehospital delay in men and women with acute coronary syndrome

Fundamento. Identificar factores asociados a la demora prehospitalaria en personas que han tenido un síndrome coronario agudo Método. Se estudiaron mediante encuesta pacientes ingresados por síndrome coronario agudo en los 33 hospitales públicos andaluces, obteniéndose información sobre diferentes tipos de variables: socio-demográficas, contextuales, clínicas, percepción, actuaciones, y transporte. Se aplicaron modelos de regresión logística multivariante para calcular las odds ratio para la demora. Resultados. De los 1.416 pacientes en total, más de la mitad tuvieron una demora superior a la hora. Se asocia a la distancia al hospital y al medio de transporte: cuando el evento ocurre en la misma ciudad del hospital, utilizar medios propios aumenta la demora, odds ratio= 1,51 (1,02-2,23); si la distancia es entre 1-25 kilómetros, no hay una diferencia entre medios propios y ambulancia, odds ratio = 1,41 y odds ratio = 1,43 respectivamente; y cuando supera los25 kilómetros la ambulancia implica mayor demora, odds ratio = 3,13 y odds ratio = 2,20 respectivamente. Además, la sintomatología típica reduce la demora entre los hombres, pero la aumenta entre las mujeres. Asimismo, no darle importancia, esperar a la resolución de los síntomas, buscar atención sanitaria diferente a urgencias hospitalarias o al 061, tener antecedentes, encontrarse fuera de la vivienda habitual, y tener ingresos menores de 1.500 euros aumentan la demora. Tener síntomas respiratorios la reduce. Conclusiones. La demora prehospitalaria no se ajusta a las recomendaciones sanitarias, asociándose al entorno físico y social, a factores clínicos, y de percepción y actitudinales de los sujetos.Objective. To identify factors associated with prehospital delay in people who have had an acute coronary syndrome. Methods. Using a survey we studied patients admitted due to acute coronary syndrome in the 33 Andalusian public hospitals, obtaining information about different types of variables: socio-demographic, contextual, clinical, perception, action, and transportation. Multivariate logistic regression models were applied to calculate the odds ratios for the delay. Results. Of the 1,416 patients studied, more than half had a delay of more than an hour. This is associated to distance to the hospital and means of transport: when the event occurs in the same city, using the patient’s own means of transport increases the delay, odds ratio = 1.51 (1.02 to 2.23); if the distance is 1 to25 kilometers from the hospital, there is no difference between the patient’s own means of transport and an ambulance, odds ratio = 1.41 and odds ratio =1.43 respectively; and when the distance exceeds25 kilometers transport by ambulance means more delay, odds ratio = 3.13 and odds ratio = 2.20 respectively. Also, typical symptoms reduce delay amongst men but increase amongst women. Also, not caring and waiting for the resolution of symptoms, seeking health care other than a hospital or emergency services, previous clinical history, being away from home, and having an income under 1,500 euros, all increase delay. Conclusions. Prehospital delay times do not meet health recommendations. The physical and social environment, in addition to clinical, perceptual and attitudinal factors, are associated with this delay.Consejería de Salud (Expte.0079/2006); Agencia de Evaluación de Tecnologías Sanitarias-ISCIII (Expte. PI06/90450); CIBER de Epidemiología y Salud Pública; Consejería de Economía y Hacienda de Andalucía, Fondos G+ 2010

Covid-19: la malinterpretación de los datos de la pandemia daña la confianza del público

Dos cartas publicadas en The Lancet y The Lancet Public Health en los últimos meses defienden la necesidad de evaluar de forma independiente la respuesta española ante la covid-19. Estamos de acuerdo, pero nos gustaría complementarlas con tres puntos que nos acercan a la ciencia abierta. Nos referimos a la confusión terminológica, la calidad de los datos y su disponibilidad