COVID-19 epidemic in Spain in the first wave: Estimation of the epidemic curve inferred from seroprevalence data and simulation of scenarios based on SEIR model

The COVID-19 pandemic represents one of the most severe challenges in the recent history of public health. The aim of this study is to estimate the transmission rate parameter (β) and to predict the epidemic progression in Spain. We integrated data from Our World in Data. Our model considered a mean time from in fection to death to be 24 days and the results of the seroprevalence survey in Spain. We calculated β using a SEIR model estimated by least squares. We also used a SEIR model to evaluate four scenarios: 1) model 1: no containment measures, 2) model 2: containment measures from the beginning of the epidemic, 3) model 3: mild measures since the 20th day, 4) model 4: strict containment measures since the 20th day. The estimated β parameter was 1.087. We calculated 41,210,330 infected people and 725,302 deaths in model 1; 165,036 infected people and 2,905 deaths in model 2; 4,640,400 infected people and 81,671 deaths in model 3; and, 62.012 infected people and 1,091 deaths in model 4. Peak of the epidemic varied from 69th day in model 1 to 216th day in model 4. Containment measures prevented a scenario with a signifi cant increase in deaths and infected people. Our fi ndings showed that, by stricter interven tions such as quarantine and isolation could lead to reduce the potential peak number of COVID-19 cases and delay the time of peak infection.S

Impact of environmental and individual factors on COVID-19 mortality in children and adolescents in Mexico: An observational study

Background: During the Covid-19 pandemic, children and adolescents faced poverty, potentially dying from preventable causes, or missing out essential vaccines. The aim of this study was to assess potential environmental and individual factors associated to COVID-19 mortality in children and adolescents in Mexico. Methods: This cross-sectional study analysed the official data of 131,001 children under 10 years of age and adolescents between 10 and 19 years of age with COVID-19 disease, in Mexico. Participants were diagnosticated between March 2020 and June 13, 2021. The environmental variables such as malnutrition, vaccination coverage and social lag index were evaluated at the state level. Multilevel models were fitted to evaluate the association between environmental and individual factors and COVID-19 mortality. Findings: A total of 773 (0.6%) children and adolescents died due to COVID-19. Younger age (OR = 0.878, 95%CI: 0.869-0.888), diabetes (OR = 3.898, 95%CI: 2.596-5.851), immunosuppression (OR = 5.410, 95%CI: 4.088-7.158), obesity (OR = 1.876, 95%CI: 1.397-2.521), hypertension (OR = 1.906, 95%CI: 1.239-2.932), cardiovascular disease (OR = 2.288, 95%CI: 1.482-3.531), and chronic kidney disease (OR = 13.250, 95%CI: 9.066-19.350) were associated with mortality. COVID-19 mortality was directly associated with social lag index and malnutrition (ORvery high = 2.939, 95%CI: 1.111-7.775, and OR = 1.390, 95%CI: 1.073-1.802, respectively), and inversely associated with population density (OR = 0.374, 95%CI: 0.204-0.688). Finally, children and adolescents living in areas with a higher percentage of people with incomplete education (OR = 1.045, 95%CI: 1.011-1.081), of children of school age of 6-14 years who do not attend school (OR = 1.266, 95%CI: 1.032-1.554), and of illiterate population aged 15 and over (OR = 1.086, 95%CI: 0.999-1.179) were associated with a higher risk of COVID-19 mortality. Interpretation: Malnutrition, social lag index and population density are key factors to understand COVID-19 mortality in children and adolescents. Also, age and pre-existing comorbidities were also associated with worse COVID-19 prognosis.S

Racial and ethnic disparities in COVID-19 mortality in the United States

Background: Among COVID-19–associated deaths reported in the United States (U.S.), minority communities were disproportionately represented. The objective was to assess differences in mortality by race and ethnicity among patients with coronavirus disease 2019 (COVID-19) in the U.S. Methods: This is a retrospective case series study with information extracted from the U.S. Centers for Disease Control and Prevention between January 20 and December 29, 2020. Clinical and sociodemographic data were analyzed by race and ethnicity from non-hospitalized and hospitalized patients with COVID-19. Binary logistic models were fitted to evaluate factors associated with COVID-19-related mortality. Results: A total of 434,076 patients with COVID-19 were characterized; 284,574 cases were Non-Hispanic White, 10,468 cases were Non-Hispanic Asian, and 949,022 cases were Non-Hispanic Black, and 89,407 cases were Hispanic/Latino. For non-hospitalized patients, Hispanic/Latino with pneumonia (OR 3.34, 95%CI: 1.70-6.58) and Non-Hispanic Asian with comorbidities (OR 3.88, 95%CI: 0.99-15.2) had the highest odds for mortality. For hospitalized patients, Non-Hispanic Black with comorbidities (OR 3.02, 95%CI: 2.24-4.08) and Non-Hispanic Asian and Non-Hispanic Black with pneumonia (OR 2.98, 95%CI: 2.09-4.26; and OR 2.97, 95%CI: 2.60-3.38, respectively) had the highest odds for mortality. Conclusion: Racial/ethnic disparities in mortality persist among patients with COVID-19 in the U.S. These findings support the assertion that racial and ethnic minorities are disproportionately affected by COVID-19 in the U.S

Factors associated with the use of Emergency Services by the Spanish population in 2017

[ES] Fundamentos: En los sistemas sanitarios modernos, los Servicios de Urgencias (SU) constituyen una de las piedras angulares de la atención sanitaria y tienen una importancia esencial en la concepción de los servicios sanitarios actuales. El objetivo de este trabajo fue analizar el efecto de las características sociodemográficas y los factores clínicos en la utilización de los SU en España. Métodos: Se realizó un estudio transversal con los datos de la Encuesta Nacional de Salud de España (2017), en el que participaron 23.089 personas adultas (15 años o más). Se definieron tres perfiles poblacionales para analizar las visitas a los SU (jóvenes entre 15 y 24 años; personas con 75 años o más y con pluripatología; población general). Se realizaron análisis descriptivos por perfil poblacional, y se aplicaron modelos de regresión logística por perfil poblacional y tipo de servicio (hospital público, centro público de Urgencias no hospitalario y centro sanitario privado) para evaluar la asociación entre la utilización de los SU y distintas variables clínicas y sociodemográficas. Resultados: El porcentaje de utilización de los SU fue mayor en población anciana con pluripatología (41,1%) en comparación con los jóvenes (35,7%) y la población en general (28,4%). Las personas jóvenes utilizaron más los SU en centros privados, y los factores asociados fueron el sexo femenino (OR=2,862; IC 95%=1,139-7,191), la realización de pruebas diagnósticas (OR=9,401; IC 95%=3,183-27,760), pertenecer a una clase social menos favorecida (OR=0,207; IC 95%=0,073-0,585) y residir en municipios de más de 50.000 habitantes y capitales (OR=5,985; IC 95%=1,143-31,330). La población anciana con pluripatología presentó un peor estado de salud que los otros dos grupos poblacionales y con mayor demanda de los SU en hospitales públicos. Además, en el grupo de población anciana, los factores asociados a la utilización de los SU en hospitales públicos fueron haber sido hospitalizado (OR=2,229; IC 95%=1,333-3,730), pertenecer a una clase social menos favorecida (clase social III: OR=2,794; IC 95%=1,154-6,768/clase social IV-V-VI: OR=3,767; IC 95%=2,236-6,344), residir en municipios de más de 50.000 habitantes y capitales (OR=1,679; IC 95%=1,042-2,704) y tener sólo una consulta al médico de Atención Primaria (AP) (OR=0,603; IC 95%=0,396-0,918). Finalmente, en la población general se observó que las variables asociadas con mayor utilización de los SU en hospitales públicos fueron la edad (OR=1,009; IC 95%=1,001-1,016), un mayor número de consultas al médico de Atención Primaria (OR=1,550; IC 95%=1,180-2,170), la realización de pruebas diagnósticas (OR=1,480; IC 95%=1,236-1,773) y pertenecer a la clase social menos favorecida (clase social IV-V-VI: OR=1,581; IC 95%=1,229-2,033). Conclusiones: Las características asociadas con la utilización de los SU, tanto públicos como privados, así como hospitalarios y extrahospitalarios, difieren según las características socioeconómicas y los factores clínicos. Los resultados de este estudio sugieren reconducir las intervenciones para mejorar los resultados de la atención, así como conseguir un uso más racional de los SU. [EN] Background: In modern health systems, emergency services (ES) constitute one of the cornerstones of health care, and they have an essential role in the conception of current health services. The objective of this work was to analyze the effect of sociodemographic characteristics and clinical factors in the use of ES. Methods: A cross-sectional study was carried out with data from the National Health Survey of Spain (2017) in which 23,089 adults (15 years or more) participated. Three population profiles were defined to analyze visits to ES (young people between 15 and 24 years of age; people aged 75 or over and with multiple pathologies; the general population). Descriptive analyses were performed by population profile, and logistic regression models by population profile and type of service (public hospital, public non-hospital emergency center, and private health center) were applied to evaluate the association between the use of ES and the independent variables. Results: The percentage of use of ES was higher in the elderly population with multiple pathologies (41.1%) compared to young people (35.7%) and the general population (28.4%). Young people between 15 and 24 years of age used ES more in private centers, and the associated factors were female sex (OR=2.862; 95% CI=1.139-7.191), the use of diagnostic tests (OR=9.401; 95% CI=3.183-27.760), belonging to the lowest social classes (OR=0.207; 95% CI=0.073-0.585) and residing in municipalities with more than 50,000 inhabitants and capitals (OR=5.985; 95% CI=1.143-31.330). The elderly population with multiple pathologies presented a worse state of health than the other two population groups and with a higher demand for ES in public hospitals. In addition, in the elderly population group, the factors associated with the use of ES in public hospitals were having been hospitalized (OR=2.229; 95% CI=1.333-3.730), belonging to the lowest social classes (social class III: OR=2.794; 95% CI=1.154-6.768/social class IV-V- VI: OR=3.767; 95% CI=2.236-6.344), residing in municipalities with more than 50,000 inhabitants and capitals (OR=1.679; 95% CI=1.042-2.704) and having had at least one visit to the PC doctor (OR=0.603; 95% CI=0.396-0.918). Finally, in the general population the variables associated with increased use of ES in public hospitals were age (OR=1.009; 95% CI=1.001-1.016), the highest number of visits to the PC doctor (OR=1.550; 95% CI=1.180-2.170), the use of diagnostic tests (OR=1.480; 95% CI=1.236-1.773) and belonging to the lowest social classes (social class IV-V-VI: OR=1.581; 95% CI=1.229-2.033). Conclusions: The characteristics associated with the use of ES, both public and private, as well as hospital and extra-hospital, differ according to socioeconomic characteristics and clinical factors. The results of this study suggest redirecting interventions to improve care outcomes, as well as achieving a more rational use of ES.S

Factors associated with the use of Emergency Services by the Spanish population in 2017

[ES] Fundamentos: En los sistemas sanitarios modernos, los Servicios de Urgencias (SU) constituyen una de las piedras angulares de la atención sanitaria y tienen una importancia esencial en la concepción de los servicios sanitarios actuales. El objetivo de este trabajo fue analizar el efecto de las características sociodemográficas y los factores clínicos en la utilización de los SU en España. Métodos: Se realizó un estudio transversal con los datos de la Encuesta Nacional de Salud de España (2017), en el que participaron 23.089 personas adultas (15 años o más). Se definieron tres perfiles poblacionales para analizar las visitas a los SU (jóvenes entre 15 y 24 años; personas con 75 años o más y con pluripatología; población general). Se realizaron análisis descriptivos por perfil poblacional, y se aplicaron modelos de regresión logística por perfil poblacional y tipo de servicio (hospital público, centro público de Urgencias no hospitalario y centro sanitario privado) para evaluar la asociación entre la utilización de los SU y distintas variables clínicas y sociodemográficas. Resultados: El porcentaje de utilización de los SU fue mayor en población anciana con pluripatología (41,1%) en comparación con los jóvenes (35,7%) y la población en general (28,4%). Las personas jóvenes utilizaron más los SU en centros privados, y los factores asociados fueron el sexo femenino (OR=2,862; IC 95%=1,139-7,191), la realización de pruebas diagnósticas (OR=9,401; IC 95%=3,183-27,760), pertenecer a una clase social menos favorecida (OR=0,207; IC 95%=0,073-0,585) y residir en municipios de más de 50.000 habitantes y capitales (OR=5,985; IC 95%=1,143-31,330). La población anciana con pluripatología presentó un peor estado de salud que los otros dos grupos poblacionales y con mayor demanda de los SU en hospitales públicos. Además, en el grupo de población anciana, los factores asociados a la utilización de los SU en hospitales públicos fueron haber sido hospitalizado (OR=2,229; IC 95%=1,333-3,730), pertenecer a una clase social menos favorecida (clase social III: OR=2,794; IC 95%=1,154-6,768/clase social IV-V-VI: OR=3,767; IC 95%=2,236-6,344), residir en municipios de más de 50.000 habitantes y capitales (OR=1,679; IC 95%=1,042-2,704) y tener sólo una consulta al médico de Atención Primaria (AP) (OR=0,603; IC 95%=0,396-0,918). Finalmente, en la población general se observó que las variables asociadas con mayor utilización de los SU en hospitales públicos fueron la edad (OR=1,009; IC 95%=1,001-1,016), un mayor número de consultas al médico de Atención Primaria (OR=1,550; IC 95%=1,180-2,170), la realización de pruebas diagnósticas (OR=1,480; IC 95%=1,236-1,773) y pertenecer a la clase social menos favorecida (clase social IV-V-VI: OR=1,581; IC 95%=1,229-2,033). Conclusiones: Las características asociadas con la utilización de los SU, tanto públicos como privados, así como hospitalarios y extrahospitalarios, difieren según las características socioeconómicas y los factores clínicos. Los resultados de este estudio sugieren reconducir las intervenciones para mejorar los resultados de la atención, así como conseguir un uso más racional de los SU. [EN] Background: In modern health systems, emergency services (ES) constitute one of the cornerstones of health care, and they have an essential role in the conception of current health services. The objective of this work was to analyze the effect of sociodemographic characteristics and clinical factors in the use of ES. Methods: A cross-sectional study was carried out with data from the National Health Survey of Spain (2017) in which 23,089 adults (15 years or more) participated. Three population profiles were defined to analyze visits to ES (young people between 15 and 24 years of age; people aged 75 or over and with multiple pathologies; the general population). Descriptive analyses were performed by population profile, and logistic regression models by population profile and type of service (public hospital, public non-hospital emergency center, and private health center) were applied to evaluate the association between the use of ES and the independent variables. Results: The percentage of use of ES was higher in the elderly population with multiple pathologies (41.1%) compared to young people (35.7%) and the general population (28.4%). Young people between 15 and 24 years of age used ES more in private centers, and the associated factors were female sex (OR=2.862; 95% CI=1.139-7.191), the use of diagnostic tests (OR=9.401; 95% CI=3.183-27.760), belonging to the lowest social classes (OR=0.207; 95% CI=0.073-0.585) and residing in municipalities with more than 50,000 inhabitants and capitals (OR=5.985; 95% CI=1.143-31.330). The elderly population with multiple pathologies presented a worse state of health than the other two population groups and with a higher demand for ES in public hospitals. In addition, in the elderly population group, the factors associated with the use of ES in public hospitals were having been hospitalized (OR=2.229; 95% CI=1.333-3.730), belonging to the lowest social classes (social class III: OR=2.794; 95% CI=1.154-6.768/social class IV-V- VI: OR=3.767; 95% CI=2.236-6.344), residing in municipalities with more than 50,000 inhabitants and capitals (OR=1.679; 95% CI=1.042-2.704) and having had at least one visit to the PC doctor (OR=0.603; 95% CI=0.396-0.918). Finally, in the general population the variables associated with increased use of ES in public hospitals were age (OR=1.009; 95% CI=1.001-1.016), the highest number of visits to the PC doctor (OR=1.550; 95% CI=1.180-2.170), the use of diagnostic tests (OR=1.480; 95% CI=1.236-1.773) and belonging to the lowest social classes (social class IV-V-VI: OR=1.581; 95% CI=1.229-2.033). Conclusions: The characteristics associated with the use of ES, both public and private, as well as hospital and extra-hospital, differ according to socioeconomic characteristics and clinical factors. The results of this study suggest redirecting interventions to improve care outcomes, as well as achieving a more rational use of ES.S

A Comparison of Methods for Modeling Factors Associated with Hospital Admissions in Incident Cases of Heart Failure

OBJECTIVE: Heart failure (HF) is an important public health problem due to its increasing prevalence, and the decompensation associated with hospital admission represents an increased risk of death. The objective of this study was to compare several methods to model the variable hospitalizations and to determine the effect of factors associated with hospital admissions in incident cases of HF. METHODS: Study of a retrospective cohort of patients with information extracted from electronic medical records of PC was performed. Patients 24 year and older with at least 1 visit to PC in 2006 were included. Registered hospital admissions of HF incident cases between 2006 and 2010 or until death were analyzed and comparison of Poisson, Negative Binomial (NB), zero-inflated and Hurdle regression models were conducted to identify factors associated con hospitalizations. RESULTS: 3,061 patients were identified in a cohort of 227,984. Regarding the factors associated with hospitalizations and according to the zero inflated NB regression model, patients who presented valvular disease (OR=2.01; CI95% 1.22-3.30), or were being treated with antithrombotics (OR=3.45; CI95%: 1.61-7.42) or diuretics (OR=2.28; CI95% 1.13-4.58) had a lower likelihood of hospitalization. Factors associated with a higher rate of hospital admissions were having valvular disease (IRR=1.37; CI95% 1.03-1.81) or diabetes (IRR=1.38; 1.07-1.78), and being treated with calcium antagonists (IRR=1.35; CI95% 1.05- 1.73) or ACE inhibitors (IRR=1.43; CI95% 1.06- 1.92). Having being referred to a cardiologist had a protective effect (IRR=0.86; CI95% 0.76- 0.97). CONCLUSIONS: The regression model that obtained the best adjustment was the zero inflated NB. According to this model, the factors associated with an increase in hospital admissions were valvulopathies, diabetes and treatment with calcium antagonists.Financiación: REDISSEC (RETIC RD12/0001) y BRIGE HEALTH (Programa de Salud de la Unión Europea (2014-2020) proyecto 664691).S

Evaluation of the effect of hospitalization on mortality in patients with heart failure followed in primary care

[EN] Background: Heart failure (HF) is a serious health-care problem. The aim of this study is to evaluate the effect of the first acute episode of decompensated HF that requires a hospitalization on the survival of newly diagnosed cases of HF with follow-up for 5 years in primary care (PC). Methods: This was a longitudinal observational study of a retrospective cohort of patients with information extracted from electronic medical records of PC. Incident cases of HF from 2006 to 2010 or until death were studied through a survival analysis with Kaplan-Meier and Cox proportional hazards multivariate regression, after applying the propensity score matching technique (PSM). Results: A total of 3061 new cases of HF were identified. The PSM analysis was performed with 529 couples, with a total of 1058 patients. 5-year survival was 65% in no hospitalized and 53% in hospitalized patients. Factors with an increased risk of mortality were having prescribed nitrates (heart rate [HR] = 1.56; 1.08-2.24). Factors with protective effect were having received the annual influenza vaccine (HR = 0.04; 0.01-0.15) and having been indicated X-rays by PC physician (HR = 0.76; 0.67-0.88). Conclusions: The findings indicate that hospitalizations are associated with a significant increase in mortality in patients recently diagnosed with HF. It is important to reinforce the need for the prevention of acute decompensated HF and for strategies to improve post-discharge outcomes. [ES]REDISSEC (RETIC RD12/0001) and BRIGE HEALTH (European Union Health Program (2014-2020) project 6 6 4691).S

Efectividad del tratamiento guiado por el péptido natriurético para la insuficiencia cardiaca crónica. Meta-análisis

[EN] To evaluate the efficacy of natriuretic peptide (NP)-guided therapy compared to clinically-guided therapy in reducing mortality and hospital admissions in chronic heart failure (HF) patients. Randomised clinical trials (RCT) were selected through a systematic review. Four meta-analyses were conducted for the outcomes of overall mortality, HF-related mortality, overall hospital admissions, and HF-related hospital admissions. Heterogeneity between studies and publication bias were also assessed. Nine RCTs were found with a total of 1914 patients. NP-guided therapy significantly reduced overall mortality and HF-related hospital admissions. No significant results were found for HF-related mortality and overall hospital admissions. Some clinical heterogeneity regarding interventions performed was found between studies. Publication bias was found for HF-related and overall hospital admissions. NP-guided therapy seems to improve outcomes compared to clinically-guided therapy. However, heterogeneity found between interventions might reduce the generalisation of these results. Specific interventions of the clinical trials should be examined when making recommendations regarding NP-guided therapy. [ES] Evaluar la eficacia de la terapia guiada por el péptido natriurético (PN) en comparación con la terapia guiada clínicamente para reducir la mortalidad y la hospitalización de la insuficiencia cardiaca (IC) crónica. Los ensayos clínicos aleatorizados fueron seleccionados a través de una revisión sistemática. Cuatro metaanálisis se realizaron para los resultados de mortalidad general, mortalidad por IC, hospitalización general y la hospitalización por IC. Se evaluó la heterogeneidad entre los estudios y el sesgo de publicación. Nueve ensayos clínicos aleatorizados se encontraron con un total de 1,914 pacientes. La terapia guiada con el PN reduce significativamente la mortalidad general y la hospitalización por IC. No se encontraron resultados significativos para la mortalidad por IC y la hospitalización general. El sesgo de publicación se encontró para las hospitalizaciones por IC y globales. La terapia guiada por PN parece mejorar los resultados en comparación con la terapia guiada clínicamente. Sin embargo, la heterogeneidad encontrada entre las intervenciones podría reducir la generalización de estos resultados. Las intervenciones específicas de los ensayos clínicos deben ser analizadas al hacer recomendaciones con respecto a la terapia de guiada por PN.S

Comparación de métodos para modelizar los factores asociados con los ingresos hospitalarios en casos incidentes de insuficiencia cardíaca

ABSTRACT Background: Heart failure (HF) is an important public health problem due to its increasing prevalence, and the decompensation associated with hospital admission represents an increased risk of death. The objective of this study was to compare several methods to model the variable hospitalizations and to determine the effect of factors associated with hospital admissions in incident cases of HF. Methods: Study of a retrospective cohort of patients with information extracted from electronic medical records of PC was performed. Patients 24 year and older with at least 1 visit to PC in 2006 were included. Registered hospital admissions of HF incident cases between 2006 and 2010 or until death were analyzed and comparison of Poisson, Negative Binomial (NB), zero-inflated and Hurdle regression models were conducted to identify factors associated con hospitalizations. Results: 3,061 patients were identified in a cohort of 227,984. Regarding the factors associated with hospitalizations and according to the zero inflated NB regression model, patients who presented valvular disease (OR=2.01; CI95% 1.22-3.30), or were being treated with antithrombotics (OR=3.45; CI95%: 1.61-7.42) or diuretics (OR=2.28; CI95% 1.13-4.58) had a lower likelihood of hospitalization. Factors associated with a higher rate of hospital admissions were having valvular disease (IRR=1.37; CI95% 1.03-1.81) or diabetes mellitus (IRR=1.38; 1.07-1.78), and being treated with calcium antagonists (IRR=1.35; CI95% 1.05- 1.73) or ACE inhibitors (IRR=1.43; CI95% 1.06- 1.92). Having being referred to a cardiologist had a protective effect (IRR=0.86; CI95% 0.76- 0.97). Conclusion: The regression model that obtained the best adjustment was the zero inflated NB. According to this model, the factors associated with an increase in hospital admissions were valvulopathies, diabetes and treatment with calcium antagonists.RESUMEN Fundamento: La insuficiencia cardiaca (IC) es un importante problema de salud pública debido a su creciente prevalencia y la descompensación que conlleva un ingreso hospitalario representa un aumento del riesgo de muerte. El objetivo de este trabajo fue comparar varios métodos para modelizar la variable hospitalizaciones y determinar el efecto de los factores asociados con los ingresos hospitalarios en casos incidentes de IC. Método: Se realizó un estudio de cohortes restrospectivo con información extraída de la historia clínica electrónica de Atención Primaria (AP). Se incluyeron pacientes mayores de 24 años que habían realizado al menos 1 consulta en AP durante el año 2006. Se analizaron las hospitalizaciones registradas de casos incidentes de IC entre 2006 y 2010 o hasta su fallecimiento y se compararon modelos de regresión de Poisson, Binomial Negativa (BN), inflados con ceros y de Hurdle para identificar factores asociados a las hospitalizaciones. Resultados: Se identificó a 3.061 personas con IC en una cohorte de 227.984 pacientes. Respecto a los factores asociados con las hospitalizaciones y según el modelo de regresión BN inflado con ceros, los pacientes con valvulopatías (OR=2,01; IC95%: 1,22-3,30) o en tratamiento con antitrombóticos (OR=3,45; IC95%: 1,61-7,42) o diuréticos (OR=2,28; IC95%:1,13-4,58) tuvieron mayor probabilidad de hospitalización. Los factores asociados a una mayor tasa de ingresos fueron tener valvulopatías (IRR=1,37; IC95%: 1,03-1,81) o diabetes mellitus (IRR=1,38, 1,07-1,78) y estar en tratamiento con calcioantagonistas (IRR=1,35; IC95%: 1,05-1,73) o IECAS (IRR=1,43; IC95%:1,06-1,92). Haber tenido derivaciones a cardiología tuvo efecto protector (IRR=0,86; IC95%: 0,76-0,97). Conclusión: El modelo de regresión que tiene mejor ajuste es el BN inflado con ceros. Según este modelo los factores asociados con un incremento en los ingresos hospitalarios son las valvulopatías, la diabetes mellitus y el tratamiento con calcioantagonistas

Epidemiology and clinical characteristics of respiratory syncytial virus infections among children and adults in Mexico

BACKGROUND: Respiratory syncytial virus (RSV) is a leading etiological agent of acute respiratory tract infections and hospitalizations in children. However, little information is available regarding RSV infections in Latin American countries, particularly among adult patients. OBJECTIVE: To describe the epidemiology of RSV infection and to analyze the factors associated with severe infections in children and adults in Mexico. METHODS: Patients ≥1 month old, who presented with an influenza-like illness (ILI) to six hospitals in Mexico, were eligible for participation in the study. Multiplex reverse-transcriptase polymerase chain reaction identified viral pathogens in nasal swabs from 5629 episodes of ILI. Patients in whom RSV was detected were included in this report. RESULTS: Respiratory syncytial virus was detected in 399 children and 171 adults. RSV A was detected in 413 cases and RSV B in 163, including six patients who had coinfection with both subtypes; 414 (72.6%) patients required hospital admission, including 96 (16.8%) patients that required admission to the intensive care unit. Coinfection with one or more respiratory pathogens other than RSV was detected in 159 cases. Young age (in children) and older age (in adults) as well as the presence of some underlying conditions were associated with more severe disease. CONCLUSIONS: This study confirms that RSV is an important respiratory pathogen in children in Mexico. In addition, a substantial number of cases in adults were also detected highlighting the relevance of this virus in all ages. It is important to identify subjects at high risk of complications who may benefit from current or future preventive interventions.La Red is funded by the Mexico Ministry of Health and the U.S. National Institute of Allergy and Infectious Diseases. This project has been funded in part by funding provided by CONACYT (Fondo Sectorial SSA/IMSS/ISSSTE, Projects No. 71260 and No. 127088); National Institute of Allergy and Infectious Diseases, National Institutes of Health, through its Intramural Research Programs and a contract with Westat, Inc., Contract Number: HHSN2722009000031, Task Order Number: HHSN27200002; and through the National Cancer Institute, National Institutes of Health, under Contract No. HHSN261200800001E. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, or Westat, nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government.S