Participación del Departamento de crónicas en proyectos internacionales

Comunicación presentada en las II Jornada del Centro Nacional de Epidemiología - 2021Presentación donde se exponen los proyectos internacionales en los que participa el Departamento de enfermedades crónicas del Centro Nacional de Epidemiología del Instituto de Salud Carlos III. Entre ellos: PHIRI, URBANOME, HBM4EU y el Proyecto AMOCAPE

From disease mapping to focused clustering: assesment and exploration of spatial epidemiology techniques for studying cancer in spain

Tesis doctoral inédita leida en la Universidad Autónoma de Madrid. Facultad de Medicina.Dpto de Medicina Preventiva y Salud Pública. Fecha de lectura: 17 de Diciembre de 200

Bayesian joint spatio-temporal analysis of multiple diseases

In this paper we propose a Bayesian hierarchical spatio-temporal model for the joint analysis of multiple diseases which includes specific and shared spatial and temporal effects. Dependence on shared terms is controlled by disease-specific weights so that their posterior distribution can be used to identify diseases with similar spatial and temporal patterns. The model proposed here has been used to study three different causes of death (oral cavity, esophagus and stomach cancer) in Spain at the province level. Shared and specific spatial and temporal effects have been estimated and mapped in order to study similarities and differences among these causes. Furthermore, estimates using Markov chain Monte Carlo and the integrated nested Laplace approximation are compared.Peer Reviewe

Cesarean births in Spain (2010-2018)

Artículo BES V.31 N.1Introducción: en las últimas dos décadas, la tasa de cesáreas a nivel mundial y europeo ha aumentado. Cuando están indicadas, las cesáreas salvan vidas; sin embargo, realizadas de manera inoportuna tienen riesgos potenciales para la madre y el recién nacido. En España, los últimos datos muestran un gran porcentaje de partos por cesárea y, por lo tanto, es necesario encuadrar la información espacio-temporalmente y describir cómo se distribuye este fenómeno. Método: se realizó un estudio transversal de base poblacional usando los datos del Boletín Estadístico del Parto. Se incluyeron todos los partos que hubiesen tenido lugar en España entre 2010 y 2018. Se realizó un estudio descriptivo en función de distintas variables (edad materna, día de la semana y comunidad autónoma del parto…). Resultados: se incluyeron un total de 3.863.363 partos. En España, el porcentaje de cesáreas entre los años 2010 y 2018 fue del 26,9%. Se observa un ligero descenso en 2017 y 2018. Las cesáreas fueron más frecuentes en las mujeres mayores de 40 años que dieron a luz entre semana en Comunidad Valenciana, Extremadura, Cataluña y Melilla. Conclusiones: existe gran variabilidad en la tasa de cesáreas entre distintas autonomías. Existen otros factores de variabilidad como la edad materna y el día de la semana del parto. La heterogeneidad en el porcentaje de cesáreas sugiere una falta de criterios clínicos comunes. Es necesario un análisis de las causas subyacentes para estudiar el problema en profundidad y proponer soluciones.N

Methodological approaches to the study of cancer risk in the vicinity of pollution sources: the experience of a population-based case–control study of childhood cancer

Background: Environmental exposures are related to the risk of some types of cancer, and children are the most vulnerable group of people. This study seeks to present the methodological approaches used in the papers of our group about risk of childhood cancers in the vicinity of pollution sources (industrial and urban sites). A populationbased case–control study of incident childhood cancers in Spain and their relationship with residential proximity to industrial and urban areas was designed. Two methodological approaches using mixed multiple unconditional logistic regression models to estimate odds ratios (ORs) and 95% confdence intervals (95% CIs) were developed: (a) “near vs. far” analysis, where possible excess risks of cancers in children living near (“near”) versus those living far (“far”) from industrial and urban areas were assessed; and (b) “risk gradient” analysis, where the risk gradient in the vicinity of industries was assessed. For each one of the two approaches, three strategies of analysis were implemented: “joint”, “stratifed”, and “individualized” analysis. Incident cases were obtained from the Spanish Registry of Childhood Cancer (between 1996 and 2011). Results: Applying this methodology, associations between proximity (≤2 km) to specifc industrial and urban zones and risk (OR; 95% CI) of leukemias (1.31; 1.04–1.65 for industrial areas, and 1.28; 1.00–1.53 for urban areas), neuroblastoma (2.12; 1.18–3.83 for both industrial and urban areas), and renal (2.02; 1.16–3.52 for industrial areas) and bone (4.02; 1.73–9.34 for urban areas) tumors have been suggested. Conclusions: The two methodological approaches were used as a very useful and fexible tool to analyze the excess risk of childhood cancers in the vicinity of industrial and urban areas, which can be extrapolated and generalized to other cancers and chronic diseases, and adapted to other types of pollution sources

Analysis of matched geographical areas to study potential links between environmental exposure to oil refineries and non-Hodgkin lymphoma mortality in Spain

BACKGROUND: Emissions from refineries include a wide range of substances, such as chrome, lead, nickel, zinc, arsenic, cadmium, benzene, dioxins and furans, all of which are recognized by the International Agency for Research on Cancer (IARC) as carcinogens. Various studies have shown an association between non-Hodgkin lymphoma (NHL) and residence in the vicinity of industrial areas; however, evidence of specific association between refineries and residence in the vicinity has been suggested but not yet established. The aim of this study is to investigate potential links between environmental exposure to emissions from refineries and non-Hodgkin lymphoma mortality in Spain. The spatial distribution of NHL in Spain has an unusual pattern with regions some showing higher risk than others. METHODS: We designed an analysis of matched geographical areas to examine non-Hodgkin lymphoma mortality in the vicinity of the 10 refineries sited in Spain over the period 1997-2006. Population exposure to refineries was estimated on the basis of distance from town of residence to the facility in a 10 km buffer. We defined 10 km radius areas to perform the matching, accounting for population density, level of industrialization and socio-demographic factors of the area using principal components analysis. For the matched towns we evaluated the risk of NHL mortality associated with residence in the vicinity of the refineries and with different regions using mixed Poisson models. Then we study the residuals to assess a possible risk trend with distance. RESULTS: Relative risks (RRs) associated with exposure showed similar values for women and for men, 1.09 (0.97-1.24) and 1.12 (0.99-1.27). RRs for two regions were statistically significant: Canary Islands showed an excess of risk of 1.35 (1.05-1.72) for women and 1.50 (1.18-1.92) for men, whilst Galicia showed an excess of risk of 1.35 (1.04-1.75) for men, but not significant excess for women. CONCLUSIONS: The results suggest a possible increased risk of NHL mortality among populations residing in the vicinity of refineries; however, a potential distance trend has not been shown. Regional effects in the Canary Islands and Galicia are significantly greater than the regional average

Industrial pollution and mortality from digestive cancers at the small area level in a Spanish industrialized province

The province of Cadiz, Spain, is a highly industrialized area with numerous registered industrial plants, which has led to major concern regarding the possible influence of these facilities on the high rate of cancer-related mortality observed. Our objective was to evaluate the association between digestive cancer mortality and proximity to industrial installations in the province of Cadiz over the period 1992-2014 and to analyse this risk according to different categories of carcinogenic substances. An ecological study at the census tract level was carried out. Mortality due to digestive cancer (involving the oral cavity, pharynx, oesophagus, stomach, liver, pancreas, gallbladder, colon and rectum) was analysed. Using the spatial Besag, York and Mollié (BYM) approach, we assessed the relative risk of dying from these cancers for people living between 500 m and 5 km from industrial installations. The models were adjusted to account for socioeconomic deprivation. We detected a significant, excess risk of dying due to cancer in the following organs (expressed as relative risk with 95% confidence intervals): colon/rectum (1.13; 1.04-1.22 at 4 km), stomach (1.13; 1.00-1.29 at 2 km), liver (1.28; 1.02-1.61 at 1 km), pancreas (1.19; 1.03-1.39 at 2 km), oral and pharyngeal (1.40; 1.08-1.82 at 1 km), oesophagus (2.05; 1.18-3.56 at 500 m) and gallbladder (2.80; 1.14-6.89 at 500 m) for men; and from colorectal (1.21; 1.00-1.46 at 1 km), stomach (1.15; 1.01-1.31 at 4 km) and liver (1.58; 1.20- 2.07 at 1 km) cancers for women. The results support the hypothesis of an association between several digestive cancers and proximity to polluting industrial plants

Description of industrial pollution in Spain

BACKGROUND: Toxic substances released into the environment (to both air and water) by many types of industries might be related with the occurrence of some malignant tumours and other diseases. The publication of the EPER (European Pollutant Emission Register) Spanish data allows to investigate the presence of geographical mortality patterns related to industrial pollution. The aim of this paper is to describe industrial air and water pollution in Spain in 2001, broken down by activity group and specific pollutant, and to plot maps depicting emissions of carcinogenic substances. METHODS: All information on industrial pollution discharge in 2001 was drawn from EPER-Spain public records provided by the European Commission server. We described the distribution of the number of industries and amounts discharged for each pollutant, as well as emission by pollutant group and the industrial activities associated with each pollutant. Maps of Spain were drawn up, with UTM coordinates being used to plot pollutant foci, and circles with an area proportional to the emission to depict pollution emission values. RESULTS: The EPER-Spain contained information on 1,437 industrial installations. The industrial plants that discharge pollutant substances into air and water above the pollutant-specific EPER threshold were mainly situated in the Autonomous Regions of Aragon, Andalusia and Catalonia and in Catalonia, the Basque Country and Andalusia respectively. Pollution released in 2001 into air approached 158 million Mt. Emissions into water were over 8 million Mt. CONCLUSION: A few single industrial plants are responsible for the highest percentage of emissions, thus rendering monitoring of their possible health impact on the surrounding population that much simpler. Among European countries Spain is the leading polluter in almost one third of all EPER-registered pollutant substances released into the air and ranks among the top three leading polluters in two-thirds of all such substances. Information obtained through publication of EPER data means that the possible consequences of reported pollutant foci on the health of neighbouring populations can now be studied

Cancer Mortality and Deprivation in the Proximity of Polluting Industrial Facilities in an Industrial Region of Spain

Residential proximity to industrial facilities that release pollutants is a source of exposure to a high number of toxics, many of them known or suspected carcinogens. The objective of the study was to analyze the association between lung, larynx, bladder, and kidney cancer mortality and deprivation in areas proximate to polluting industrial facilities in Cadiz, a highly industrialized province in Spain. An ecological study at census tract level was carried out to estimate the mortality rates associated with deprivation and proximity to polluting industrial facilities (1-5 km) using the Besag-York-Mollié model. The results show a negative social gradient for lung and larynx cancers in males and greater risk of lung cancer was observed in the least deprived areas in females. These associations were found regardless the distance to industrial facilities. Increasing excess risk (relative risk; 95% credibility interval) of lung cancer for males (1.09; 1.02-1.16 at 5 km vs 1.24; 1.08-1.41 at 1 km) and bladder cancer for males (1.11; 1.01-1.22 at 5 km vs 1.32; 1.08-1.60 at 1 km) and females (1.32; 1.04-1.69 at 4 km vs 1.91; 1.28-2.86 at 1 km) was found as proximity to polluting industrial facilities increased. For kidney cancer, high risks were observed near such facilities for both sexes. Knowing the possible influence of industrial pollution and social inequalities over cancer risk allows the definition of policies aimed at reducing the risk.This work was supported by the LONGPOP (Methodologies and Data Mining Techniques for the Analysis of Big Data Based on Longitudinal Population and Epidemiological Registers) project, which has received funding from the European Union’s Horizon 2020 research and innovation program under the Marie Sklodowska–Curie grant 676060. J.G.-P. was funded by the Scientific Foundation of the Spanish Association Against Cancer (Fundación Científica de la Asociación Española Contra el Cáncer (AECC) – EVP-1178/14)