Análisis de la mortalidad en ciudades: resultados en Valencia y Alicante

ResumenObjetivosDescribir los patrones de mortalidad, general y por causas específicas seleccionadas, en Valencia y Alicante; establecer las diferencias internas por distritos, y evaluar los cambios en la magnitud de estas desigualdades en el tiempo.MétodosLas defunciones ocurridas en residentes en las ciudades de Valencia y Alicante durante los períodos 1990-1992 y 1996-1998 se asignaron a los distritos municipales de residencia. La comparación entre los períodos de estudio o entre ciudades se ha realizado a través del riesgo relativo estimado mediante regresión de Poisson. Se calculó la razón comparativa de mortalidad (RCM) según los 17 grandes grupos de la Clasificación Internacional de Enfermedades (9.a revisión). Por distritos se han calculado en cada período de estudio las tasas ajustadas por el método directo, la razón de mortalidad estandarizada (RME), la razón de años potenciales de vida perdida (RAPVP) y la esperanza de vida al nacimiento.ResultadosLos riesgos de muerte por todas las causas disminuyen del primer al segundo período tanto en varones, como en mujeres en ambas ciudades. La esperanza de vida aumenta significativamente en ambas ciudades en los varones, y en Valencia en las mujeres. La ciudad de Valencia presenta un mayor riesgo de muerte en ambos períodos. Algunos grupos de causas de muerte aumentan (grupos 5 y 6, que incluyen trastornos mentales y enfermedades del sistema nervioso y órganos de los sentidos). Por distritos, se observa una mayor variabilidad en Valencia —donde destacan los distritos 1 y 11 con un elevado riesgo de mortalidad— que en Alicante.ConclusionesEl proceso de vigilancia de la mortalidad interna, por distritos, es reproducible. En la ciudad de Valencia existen diferencias en la mortalidad que se mantienen en el tiempo. La ciudad de Alicante presenta una menor variabilidad interna en sus indicadores de mortalidad.AbstractObjectivesTo describe mortality patterns, in general and by selected specific causes in Valencia and Alicante, to establish internal inequalities by districts, and to evaluate changes in the magnitude of these inequalities over time.MethodsDeaths among residents of Valencia and Alicante in the periods 1990-1992 and 1996-1998 were assigned to residential municipal districts. Comparisons between the periods studied and between cities were carried out using the relative risk derived from a Poisson regression model. A comparative mortality figure was calculated using the 17 largest groups of the 9th International Classification of Diseases. Rates adjusted by the direct method, standardized mortality ratio, potential years of life lost (PYLL) ratio and life expectancy at birth were calculated by districts in each study period.ResultsThe risks of death from all causes decreased between the first and second periods in both men and women in both cities. Life expectancy significantly increased in both cities for men and in Valencia for women. The city of Valencia had the greatest risk of death in both periods. Some causes of death increased (groups 5 and 6, mental and nervous system disorders and sensory organ diseases). By districts, there was greater variability in Valencia than in Alicante, especially in districts 1 and 11 in Valencia, which showed a high risk of death.ConclusionsThe process of internal mortality surveillance by districts is reproducible. In the city of Valencia there were inequalities in mortality that were maintained over time. The city of Alicante showed less internal variability in its mortality indicators

Treinta años de evolución de la mortalidad en la Comunitat Valenciana

Una sociedad más envejecida, el tabaquismo y las actuaciones y los programas preventivos, especialmente de prevención secundaria y la inclusión de nuevos tratamientos, son los factores más destacables que pueden haber influido en la evolución de la mortalidad en la Comunitat Valenciana en los treinta años transcurridos entre 1986 y 2015

Calidad y uso de los datos del Registro de Mortalidad de la Comunitat Valenciana

La creación del Registro de Mortalidad de la Comunitat Valenciana contribuyó a mejorar la fiabilidad y calidad de las estadísticas de mortalidad de la Comunitat Valenciana. A lo largo de los 30 años de existencia del Registro, este ha colaborado con el aporte de sus datos en 44 proyectos de investigación sobre el estudio de la salud de los valencianos

Evolution of the use of corticosteroids for the treatment of hospitalised COVID-19 patients in Spain between March and November 2020: SEMI-COVID national registry

Objectives: Since the results of the RECOVERY trial, WHO recommendations about the use of corticosteroids (CTs) in COVID-19 have changed. The aim of the study is to analyse the evolutive use of CTs in Spain during the pandemic to assess the potential influence of new recommendations. Material and methods: A retrospective, descriptive, and observational study was conducted on adults hospitalised due to COVID-19 in Spain who were included in the SEMI-COVID- 19 Registry from March to November 2020. Results: CTs were used in 6053 (36.21%) of the included patients. The patients were older (mean (SD)) (69.6 (14.6) vs. 66.0 (16.8) years; p < 0.001), with hypertension (57.0% vs. 47.7%; p < 0.001), obesity (26.4% vs. 19.3%; p < 0.0001), and multimorbidity prevalence (20.6% vs. 16.1%; p < 0.001). These patients had higher values (mean (95% CI)) of C-reactive protein (CRP) (86 (32.7-160) vs. 49.3 (16-109) mg/dL; p < 0.001), ferritin (791 (393-1534) vs. 470 (236- 996) µg/dL; p < 0.001), D dimer (750 (430-1400) vs. 617 (345-1180) µg/dL; p < 0.001), and lower Sp02/Fi02 (266 (91.1) vs. 301 (101); p < 0.001). Since June 2020, there was an increment in the use of CTs (March vs. September; p < 0.001). Overall, 20% did not receive steroids, and 40% received less than 200 mg accumulated prednisone equivalent dose (APED). Severe patients are treated with higher doses. The mortality benefit was observed in patients with oxygen saturation </=90%. Conclusions: Patients with greater comorbidity, severity, and inflammatory markers were those treated with CTs. In severe patients, there is a trend towards the use of higher doses. The mortality benefit was observed in patients with oxygen saturation </=90%

Avoidable mortality. Changes in the new century?

Objetivos: Estudiar la evolución temporal y la distribución geográfica de la mortalidad evitable en la Comunidad Valenciana y en sus Departamentos de Salud por sexo, en los períodos 1990-1994, 1995-1999 y 2000-2004. Material y método: Se han analizado 21 causas de mortalidad evitable agrupándolas en tratables y prevenibles. Las defunciones analizadas corresponden a residentes en la Comunidad Valenciana durante el período 1990-2004. Se han calculado las tasas ajustadas por edad (método directo) y las razones de mortalidad comparativas para el estudio de la evolución temporal en los ámbitos geográficos indicados por período y sexo. Las razones de mortalidad estandarizadas (método indirecto) se han utilizado en el análisis de la distribución geográfica. Resultados: El total de defunciones evitables son 38.061 (un 7,1% de la mortalidad global), el 76,2% corresponden a varones y el 23,8% a mujeres. Por grupos, el 82,4% son prevenibles y el 17,6% tratables. En varones, las prevenibles representan un 86,5%, y en mujeres un 69,4%. En la Comunidad Valenciana se observan descensos significativos de la mortalidad evitable en ambos sexos, más acusados en las tratables, y en hombres. La mortalidad por cáncer de pulmón en mujeres presenta un aumento significativo. En 2000-2004 ningún departamento de salud presenta excesos de mortalidad estadísticamente significativos en las tratables. Conclusiones: La mortalidad evitable desciende más que la mortalidad general en la Comunidad Valenciana. Cabe destacar el aumento de la mortalidad por cáncer de pulmón en las mujeres.Objectives: To analyze time trends and the geographical distribution of avoidable mortality in the autonomous community of Valencia and its health departments by sex in the periods 1990-1994, 1995-1999, and 2000-2004. Material and method: Twenty-one causes of avoidable mortality were analyzed. The deaths analyzed corresponded to residents in the autonomous community of Valencia between 1990 and 2004. Age-standardized mortality rates were calculated using the direct method. To study time trends in the geographical area of interest for each period and sex, comparative mortality ratios were calculated. To analyze geographical distribution, standardized mortality rates were calculated by the indirect method. Results: The total number of avoidable deaths was 38,061 (7.1% of overall deaths). Men accounted for 76.2% and women for 23.8%. By groups, 82.4% were preventable and 17.6% were treatable. Preventable deaths represented 86.5% of deaths in men and 69.4% of those in women. Avoidable mortality in Valencia significantly decreased in both sexes, this decrease being more marked in the group of treatable deaths and in men. Mortality from lung cancer in women significantly increased. Between 2000 and 2004, none of the health departments showed a significant excess of treatable mortality. Conclusions: In the autonomous community of Valencia, there was a greater decrease in avoidable mortality than in general mortality. The increase in lung cancer in women was notable

Análisis de la mortalidad en ciudades: resultados en Valencia y Alicante Mortality surveillance in cities: results in Valencia and Alicante [Spain]

Objetivos: Describir los patrones de mortalidad, general y por causas específicas seleccionadas, en Valencia y Alicante; establecer las diferencias internas por distritos, y evaluar los cambios en la magnitud de estas desigualdades en el tiempo. Métodos: Las defunciones ocurridas en residentes en las ciudades de Valencia y Alicante durante los períodos 1990-1992 y 1996-1998 se asignaron a los distritos municipales de residencia. La comparación entre los períodos de estudio o entre ciudades se ha realizado a través del riesgo relativo estimado mediante regresión de Poisson. Se calculó la razón comparativa de mortalidad (RCM) según los 17 grandes grupos de la Clasificación Internacional de Enfermedades (9.ª revisión). Por distritos se han calculado en cada período de estudio las tasas ajustadas por el método directo, la razón de mortalidad estandarizada (RME), la razón de años potenciales de vida perdida (RAPVP) y la esperanza de vida al nacimiento. Resultados: Los riesgos de muerte por todas las causas disminuyen del primer al segundo período tanto en varones, como en mujeres en ambas ciudades. La esperanza de vida aumenta significativamente en ambas ciudades en los varones, y en Valencia en las mujeres. La ciudad de Valencia presenta un mayor riesgo de muerte en ambos períodos. Algunos grupos de causas de muerte aumentan (grupos 5 y 6, que incluyen trastornos mentales y enfermedades del sistema nervioso y órganos de los sentidos). Por distritos, se observa una mayor variabilidad en Valencia --donde destacan los distritos 1 y 11 con un elevado riesgo de mortalidad-- que en Alicante. Conclusiones: El proceso de vigilancia de la mortalidad interna, por distritos, es reproducible. En la ciudad de Valencia existen diferencias en la mortalidad que se mantienen en el tiempo. La ciudad de Alicante presenta una menor variabilidad interna en sus indicadores de mortalidad.<br>Objectives: To describe mortality patterns, in general and by selected specific causes in Valencia and Alicante, to establish internal inequalities by districts, and to evaluate changes in the magnitude of these inequalities over time. Methods: Deaths among residents of Valencia and Alicante in the periods 1990-1992 and 1996-1998 were assigned to residential municipal districts. Comparisons between the periods studied and between cities were carried out using the relative risk derived from a Poisson regression model. A comparative mortality figure was calculated using the 17 largest groups of the 9th International Classification of Diseases. Rates adjusted by the direct method, standardized mortality ratio, potential years of life lost (PYLL) ratio and life expectancy at birth were calculated by districts in each study period. Results: The risks of death from all causes decreased between the first and second periods in both men and women in both cities. Life expectancy significantly increased in both cities for men and in Valencia for women. The city of Valencia had the greatest risk of death in both periods. Some causes of death increased (groups 5 and 6, mental and nervous system disorders and sensory organ diseases). By districts, there was greater variability in Valencia than in Alicante, especially in districts 1 and 11 in Valencia, which showed a high risk of death. Conclusions: The process of internal mortality surveillance by districts is reproducible. In the city of Valencia there were inequalities in mortality that were maintained over time. The city of Alicante showed less internal variability in its mortality indicators

Trends in mortality due to motor vehicle traffic accident injuries between 1987 and 2011 in a Spanish region (Comunitat Valenciana)

Objective: To analyse the time evolution of the rates of mortality due to motor vehicle traffic accidents (MVTA) injuries that occurred among the general population of Comunitat Valenciana between 1987 and 2011, as well as to identify trend changes by sex and age group. Methods: An observational study of annual mortality trends between 1987 and 2011. We studied all deaths due to MVTA injuries that occurred during this period of time among the non-institutionalised population residing in Comunitat Valenciana (a Spanish Mediterranean region that had a population of 5,117,190 inhabitants in 2011). The rates of mortality due to MVTA injuries were calculated for each sex and year studied. These rates were standardised by age for the total population and for specific age groups using the direct method (age-standardised rate – ASR). Joinpoint regression models were used in order to detect significant trend changes. Additionally, the annual percentage change (APC) of the ASRs was calculated for each trend segment, which is reflected in statistically significant joinpoints. Results: For all ages, ASRs decrease greatly in both men and women (70% decrease between 1990 and 2011). In 1990 and 2011, men have rates of 36.5 and 5.2 per 100,000 men/year, respectively. In the same years, women have rates of 8.0 and 0.9 per 100,000 women/year, respectively. This decrease reaches up to 90% in the age group 15–34 years in both men and women. ASR ratios for men and women increased over time for all ages: this ratio was 3.9 in 1987; 4.6 in 1990; and 5.8 in 2011. For both men and women, there is a first significant segment (p < 0.05) with an increasing trend between 1987 and 1989–1990. After 1990, there are 3 segments with a significant decreasing APC (1990–1993, 1993–2005 and 2005–2011, in the case of men; and 1989–1996, 1999–2007 and 2007–2011, in the case of women). Conclusion: The risk of death due to motor vehicle traffic accidents injuries has decreased significantly, especially in the case of women, for the last 25 years in Comunitat Valenciana, mainly as of 2006. This may be a consequence of the road-safety measures that have been implemented in Spain and in Comunitat Valenciana since 2004. The economic crisis that this country has undergone since 2008 may have also been a contributing factor to this decrease. Despite the decrease, ASR ratios for men and women increased over time and it is still a high-risk cause of death among young men. It is thus important that the measures that helped decrease the risk of death are maintained and improved over time

Anisotropic cryostructured collagen scaffolds for efficient delivery of RhBMP−2 and enhanced bone regeneration

In the treatment of bone non-unions, an alternative to bone autografts is the use of bone morphogenetic proteins (BMPs), e.g., BMP–2, BMP–7, with powerful osteoinductive and osteogenic properties. In clinical settings, these osteogenic factors are applied using absorbable collagen sponges for local controlled delivery. Major side effects of this strategy are derived from the supraphysiological doses of BMPs needed, which may induce ectopic bone formation, chronic inflammation, and excessive bone resorption. In order to increase the efficiency of the delivered BMPs, we designed cryostructured collagen scaffolds functionalized with hydroxyapatite, mimicking the structure of cortical bone (aligned porosity, anisotropic) or trabecular bone (random distributed porosity, isotropic). We hypothesize that an anisotropic structure would enhance the osteoconductive properties of the scaffolds by increasing the regenerative performance of the provided rhBMP–2. In vitro, both scaffolds presented similar mechanical properties, rhBMP–2 retention and delivery capacity, as well as scaffold degradation time. In vivo, anisotropic scaffolds demonstrated better bone regeneration capabilities in a rat femoral critical-size defect model by increasing the defect bridging. In conclusion, anisotropic cryostructured collagen scaffolds improve bone regeneration by increasing the efficiency of rhBMP–2 mediated bone healing