Epidemiological characteristics and outcomes of COVID-19 cases: mortality inequalities by socio-economic status, Barcelona, Spain, 24 February to 4 May 2020

Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Epidemiologia; Situació socioeconòmicaCoronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Epidemiología; Estatus socioeconómicoCoronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Epidemiology; Socio-economic statusBackground: Population-based studies characterising outcomes of COVID-19 in European settings are limited, and effects of socio-economic status (SES) on outcomes have not been widely investigated. Aim: We describe the epidemiological characteristics of COVID-19 cases, highlighting incidence and mortality rate differences across SES during the first wave in Barcelona, Catalonia, Spain. Methods: This population-based study reports individual-level data of laboratory-confirmed COVID-19 cases diagnosed from 24 February to 4 May 2020, notified to the Public Health Agency of Barcelona and followed until 15 June 2020. We analysed end-of-study vital status and the effects of chronic conditions on mortality using logistic regression. Geocoded addresses were linked to basic health area SES data, estimated using the composed socio-economic index. We estimated age-standardised incidence, hospitalisation, and mortality rates by SES. Results: Of 15,554 COVID-19-confirmed cases, the majority were women (n =9,028; 58%), median age was 63 years (interquartile range: 46–83), 8,046 (54%) required hospitalisation, and 2,287 (15%) cases died. Prevalence of chronic conditions varied across SES, and multiple chronic conditions increased risk of death (≥3, adjusted odds ratio: 2.3). Age-standardised rates (incidence, hospitalisation, mortality) were highest in the most deprived SES quartile (incidence: 1,011 (95% confidence interval (CI): 975–1,047); hospitalisation: 619 (95% CI: 591–648); mortality: 150 (95% CI: 136–165)) and lowest in the most affluent (incidence: 784 (95% CI: 759–809); hospitalisation: 400 (95% CI: 382–418); mortality: 121 (95% CI: 112–131)). Conclusions: COVID-19 outcomes varied markedly across SES, underscoring the need to implement effective preventive strategies for vulnerable populations

Trends in the Epidemiology of Leishmaniasis in the City of Barcelona (1996-2019)

Background: Leishmaniasis is a neglected zoonosis produced by 20 different flagellated parasites of the Leishmania genus, a protozoan transmitted to humans and other vertebrates by the bite of dipteran insects of the Phlebotominae subfamily. It is endemic in Mediterranean countries and the number of cases is expected to increase due to climate change and migration. Prioritizing public health interventions for prevention and control is essential. The objective was to characterize the epidemiology and temporal trends in the incidence of human leishmaniasis in the city of Barcelona, between the years 1996 and 2019. Methods: A population-based, analytical observational study among residents in the city of Barcelona was conducted of all the cases of leishmaniasis reported between 1996 and 2019 to the Public Health Agency. The epidemiological survey contains clinical, diagnostic, and epidemiological data, including contact with suspicious mammals or insects. Annual incidence-rates were calculated by sex, age, and country of origin. Chi-square tests were used to assess association between studied risk factors, periods of time and type of leishmaniasis. Results: During the study period a total of 177 cases of leishmaniasis were reported in Barcelona, being 74.6% (n = 132) of the total cases in Spanish born, although within the foreign-born population the incidence was higher. Median age was 34 years (IQR = 10-48) and 121 (66.8%) were male. The main type was cutaneous (46%) followed by visceral (35.1%). The cumulative incidence was 0.47 per 100,000 inhabitants, with the highest incidence found in 2017 (1.60 per 100,000 inhabitants). A higher incidence was observed in the 0-4-year-old group (1.73 per 100,000 inhabitants), but increased during the study period for all age groups. There was an increase of foreign origin cases, and a decrease in the number of cases associated to any immunosuppression. Conclusion: In Barcelona, leishmaniasis incidence continues to be higher in people under 5 years of age, and 25-64 years old males, but it has also increased in population from foreign country of birth. There is an increase of the cases since 2016, probably due to the changes in the notification system, increasing the diagnosis of cutaneous leishmaniasis. Improvements in the current surveillance system are needed. Notification of the disease, vector, and reservoir control activities are also essential for the control of the disease

Climate Change and Health in Urban Areas with a Mediterranean Climate : A Conceptual Framework with a Social and Climate Justice Approach

The consequences of climate change are becoming increasingly evident and highlight the important interdependence between the well-being of people and ecosystems. Although climate change is a global phenomenon, its causes and consequences vary dramatically across territories and population groups. Among settings particularly susceptible to health impacts from climate change are cities with a Mediterranean climate. Here, impacts will put additional pressure on already-stressed ecosystems and vulnerable economies and societies, increasing health inequalities. Therefore, this article presents and discusses a conceptual framework for understanding the complex relationship between climate change and health in the context of cities with Mediterranean climate from a social and climate justice approach. The different elements that integrate the conceptual framework are: (1) the determinants of climate change; (2) its environmental and social consequences; (3) its direct and indirect impacts on health; and (4) the role of mitigation and adaptation policies. The model places special emphasis on the associated social and health inequalities through (1) the recognition of the role of systems of privilege and oppression; (2) the distinction between structural and intermediate determinants of climate change at the root of health inequalities; (3) the role of individual and collective vulnerability in mediating the effects of climate change on health; and (4) the need to act from a climate justice perspective to reverse health inequities

Protocol per a la vigilància i el control de les arbovirosis importades transmeses per mosquits a Catalunya

Arbovirus; Mosquits; Malalties víriquesArboviruses; Mosquitoes; Viral diseasesArbovirus; Mosquitos; Enfermedades víricasThis protocol aims to provide a guide for the surveillance of the most likely arbovirosis transmitted by mosquito vectors in Catalonia (West Nile virus, dengue and chikungunya), establishing a set of surveillance activities for these diseases and control of the vectors, depending on the risk level of arbovirosisEste protocolo tiene como objetivo ofrecer una guía para la vigilancia de las arbovirosi más probables transmitidas por vectores mosquitos en Cataluña (virus del Nilo Occidental, dengue y chikungunya), estableciendo un conjunto de actividades de vigilancia de estas enfermedades y de control los vectores, según el nivel de riesgo de arbovirosiAquest protocol té com a objectiu oferir una guia per a la vigilància de les arbovirosis més probables transmeses per vectors mosquits a Catalunya (virus del Nil Occidental, dengue i chikungunya), establint un conjunt d’activitats de vigilància d’aquestes malalties i de control dels vectors, segons el nivell de risc d’arbovirosi

Protocol per a la vigilància i el control de les arbovirosis transmeses per mosquits a Catalunya

Arbovirus; Mosquits; Malalties víriquesArboviruses; Mosquitoes; Viral diseasesArbovirus; Mosquitos; Enfermedades víricasThis protocol aims to provide a guide for the surveillance of the most likely arbovirosis transmitted by mosquito vectors in Catalonia (West Nile virus, dengue and chikungunya), establishing a set of surveillance activities for these diseases and control of the vectors, depending on the risk level of arbovirosisEste protocolo tiene como objetivo ofrecer una guía para la vigilancia de las arbovirosi más probables transmitidas por vectores mosquitos en Cataluña (virus del Nilo Occidental, dengue y chikungunya), estableciendo un conjunto de actividades de vigilancia de estas enfermedades y de control los vectores, según el nivel de riesgo de arbovirosiAquest protocol té com a objectiu oferir una guia per a la vigilància de les arbovirosis més probables transmeses per vectors mosquits a Catalunya (virus del Nil Occidental, dengue i chikungunya), establint un conjunt d’activitats de vigilància d’aquestes malalties i de control dels vectors, segons el nivell de risc d’arbovirosi

Protocol per a la vigilància i el control de les arbovirosis transmeses per mosquits a Catalunya

Arbovirus; Mosquits; Malalties víriquesArboviruses; Mosquitoes; Viral diseasesArbovirus; Mosquitos; Enfermedades víricasThis protocol aims to provide a guide for the surveillance of the most likely arbovirosis transmitted by mosquito vectors in Catalonia (West Nile virus, dengue and chikungunya), establishing a set of surveillance activities for these diseases and control of the vectors, depending on the risk level of arbovirosisEste protocolo tiene como objetivo ofrecer una guía para la vigilancia de las arbovirosi más probables transmitidas por vectores mosquitos en Cataluña (virus del Nilo Occidental, dengue y chikungunya), estableciendo un conjunto de actividades de vigilancia de estas enfermedades y de control los vectores, según el nivel de riesgo de arbovirosiAquest protocol té com a objectiu oferir una guia per a la vigilància de les arbovirosis més probables transmeses per vectors mosquits a Catalunya (virus del Nil Occidental, dengue i chikungunya), establint un conjunt d’activitats de vigilància d’aquestes malalties i de control dels vectors, segons el nivell de risc d’arbovirosi

Trends in the Epidemiology of Leishmaniasis in the City of Barcelona (1996–2019)

Background: Leishmaniasis is a neglected zoonosis produced by 20 different flagellated parasites of the Leishmania genus, a protozoan transmitted to humans and other vertebrates by the bite of dipteran insects of the Phlebotominae subfamily. It is endemic in Mediterranean countries and the number of cases is expected to increase due to climate change and migration. Prioritizing public health interventions for prevention and control is essential. The objective was to characterize the epidemiology and temporal trends in the incidence of human leishmaniasis in the city of Barcelona, between the years 1996 and 2019. Methods: A population-based, analytical observational study among residents in the city of Barcelona was conducted of all the cases of leishmaniasis reported between 1996 and 2019 to the Public Health Agency. The epidemiological survey contains clinical, diagnostic, and epidemiological data, including contact with suspicious mammals or insects. Annual incidence-rates were calculated by sex, age, and country of origin. Chi-square tests were used to assess association between studied risk factors, periods of time and type of leishmaniasis. Results: During the study period a total of 177 cases of leishmaniasis were reported in Barcelona, being 74.6% (n = 132) of the total cases in Spanish born, although within the foreign-born population the incidence was higher. Median age was 34 years (IQR = 10–48) and 121 (66.8%) weremale. The main type was cutaneous (46%) followed by visceral (35.1%). The cumulative incidence was 0.47 per 100,000 inhabitants, with the highest incidence found in 2017 (1.60 per 100,000 inhabitants). A higher incidence was observed in the 0–4-year-old group (1.73 per 100,000 inhabitants), but increased during the study period for all age groups. There was an increase of foreign origin cases, and a decrease in the number of cases associated to any immunosuppression. Conclusion: In Barcelona, leishmaniasis incidence continues to be higher in people under 5 years of age, and 25–64 years old males, but it has also increased in population from foreign country of birth. There is an increase of the cases since 2016, probably due to the changes in the notification system, increasing the diagnosis of cutaneous leishmaniasis. Improvements in the current surveillance system are needed. Notification of the disease, vector, and reservoir control activities are also essential for the control of the disease.Peer reviewe

A public health surveillance system applied to climate change for cities Un sistema de vigilancia de salud pública para el cambio climático en las ciudades

This paper makes a first proposal for a public health surveillance system for climate change in cities, and describes the process that led to its definition. After several years of monitoring different aspects related to climate change and its impact, the public health services of Barcelona made a preliminary proposal and gathered a working group of experts to discuss and review it. Four categories of components were defined: climate data, health impacts of climate change and its determinants, contributions of the city to mitigation (especially those with health co-benefits), and actions to reduce vulnerability to extreme events. They were broken in twelve components, with indicators for each. The proposal was further refined with subsequent reviews, and is being used by the city public health services involved in this field

Epidemiological characteristics and outcomes of COVID-19 cases : mortality inequalities by socio-economic status, Barcelona, Spain, 24 February to 4 May 2020

Population-based studies characterising outcomes of COVID-19 in European settings are limited, and effects of socio-economic status (SES) on outcomes have not been widely investigated. We describe the epidemiological characteristics of COVID-19 cases, highlighting incidence and mortality rate differences across SES during the first wave in Barcelona, Catalonia, Spain. This population-based study reports individual-level data of laboratory-confirmed COVID-19 cases diagnosed from 24 February to 4 May 2020, notified to the Public Health Agency of Barcelona and followed until 15 June 2020. We analysed end-of-study vital status and the effects of chronic conditions on mortality using logistic regression. Geocoded addresses were linked to basic health area SES data, estimated using the composed socio-economic index. We estimated age-standardised incidence, hospitalisation, and mortality rates by SES. Of 15,554 COVID-19-confirmed cases, the majority were women (n = 9,028; 58%), median age was 63 years (interquartile range: 46-83), 8,046 (54%) required hospitalisation, and 2,287 (15%) cases died. Prevalence of chronic conditions varied across SES, and multiple chronic conditions increased risk of death (≥ 3, adjusted odds ratio: 2.3). Age-standardised rates (incidence, hospitalisation, mortality) were highest in the most deprived SES quartile (incidence: 1,011 (95% confidence interval (CI): 975-1,047); hospitalisation: 619 (95% CI: 591-648); mortality: 150 (95% CI: 136-165)) and lowest in the most affluent (incidence: 784 (95% CI: 759-809); hospitalisation: 400 (95% CI: 382-418); mortality: 121 (95% CI: 112-131)). COVID-19 outcomes varied markedly across SES, underscoring the need to implement effective preventive strategies for vulnerable populations

Epidemiological characteristics and outcomes of COVID-19 cases: mortality inequalities by socio-economic status, Barcelona, Spain, 24 February to 4 May 2020

Background: Population-based studies characterising outcomes of COVID-19 in European settings are limited, and effects of socio-economic status (SES) on outcomes have not been widely investigated. Aim: We describe the epidemiological characteristics of COVID-19 cases, highlighting incidence and mortality rate differences across SES during the first wave in Barcelona, Catalonia, Spain. Methods: This population-based study reports individual-level data of laboratory-confirmed COVID-19 cases diagnosed from 24 February to 4 May 2020, notified to the Public Health Agency of Barcelona and followed until 15 June 2020. We analysed end-of-study vital status and the effects of chronic conditions on mortality using logistic regression. Geocoded addresses were linked to basic health area SES data, estimated using the composed socio-economic index. We estimated age-standardised incidence, hospitalisation, and mortality rates by SES. Results: Of 15,554 COVID-19-confirmed cases, the majority were women (n = 9,028; 58%), median age was 63 years (interquartile range: 46–83), 8,046 (54%) required hospitalisation, and 2,287 (15%) cases died. Prevalence of chronic conditions varied across SES, and multiple chronic conditions increased risk of death (≥ 3, adjusted odds ratio: 2.3). Age-standardised rates (incidence, hospitalisation, mortality) were highest in the most deprived SES quartile (incidence: 1,011 (95% confidence interval (CI): 975–1,047); hospitalisation: 619 (95% CI: 591–648); mortality: 150 (95% CI: 136–165)) and lowest in the most affluent (incidence: 784 (95% CI: 759–809); hospitalisation: 400 (95% CI: 382–418); mortality: 121 (95% CI: 112–131)). Conclusions: COVID-19 outcomes varied markedly across SES, underscoring the need to implement effective preventive strategies for vulnerable populations