Tendencia de la mortalidad por enfermedades cerebrovasculares en Chile entre 1980 y 2015 / Trend in stroke mortality in Chile from 1980 to 2015

Background: Stroke is the third largest single cause of death in Chile, responsible for 7.3% of all deaths in 2019. Large declines in stroke mortality rates in most Latin American countries in recent decades have been reported. Aim: To analyze the trend in stroke mortality in Chile between 1980 and 2015. Material and Methods: We extracted data for age-standardized death rate (ASDR) stroke mortality per 100,000 inhabitants in Chile for the period 1980-2015from the WHO Mortality Database. Joinpoint regression analysis was used to analyze the trend and compute the average annual percent change (AAPC) by gender in Chile. Results: The ASDR from stroke decreased from 92.8 per 100,000 in 1980 to 34.4 per 100,000 in 2015. The AAPC was −2.8% (-3.5, −2.1), with two jointpoints, 2008 and 2012. By gender, the AAPC was −2.4% and −2.9% in men and women, respectively. Conclusions: Stroke mortality rate decreased significantly between 1980 and 2015 in Chile, mainly in women.

Aproximaciones metodológicas al estudio de la mortalidad infantil en Chile / Methodological approaches to the study of infant mortality study in Chile

Introduction: Infant Mortality Rate (IMR) is still considered a relevant population health indicator. Knowing related factors and implementation of specific policies positively impacts its reduction. Objective: To evaluate the evolution of the studies on infant mortality in Chile in the last three decades. Patients and Methods: A systematic search using Medline, Lilacs and Scielo databases was carried out. Global and component IMR was reviewed. Results: IMR has been reduced considerably since 1980. Sixty-eight papers were found, mostly in national journals and bulletins. Most of them (73.5 percent were descriptive studies, although association studies have increased since 2000. The main data source was National Institute of Statistics (47 percent). The most frequently studied variables were: cause of death (42.6 percent), maternal age (30.9 percent) and site (17.6 percent). Analysis strategies are mostly descriptive, although studies of association most often utilize correlation indices. Conclusion: Infant Mortality continues to be a topic of interest to researchers, who use different strategies. Continued study is encouraged.

Introducción: La tasa de mortalidad infantil (TMI) sigue siendo considerada un indicador relevante de salud poblacional. Su estudio ha permitido conocer factores relacionados e implementar políticas específicas que han impactado positivamente en su reducción. Objetivo: Evaluar la evolución de los estudios sobre mortalidad infantil en Chile en las últimas décadas. Pacientes y Método: Se realizó una búsqueda sistemática en las bases referenciales Medline, Lilacs y Scielo. Se contrastó esta información con la TMI global y por componente. Se detectaron 68 artículos publicados en su mayoría en revistas y boletines nacionales. Resultados: Se observó una reducción de la TMI en el período, en tanto las publicaciones del tema aumentaron. Si bien 73,5 por ciento correspondió a estudios descriptivos, desde 2000 los estudios de asociación han aumentado. La principal fuente de datos corresponde al Instituto Nacional de Estadísticas (47 por ciento) y las variables más estudiadas fueron: causas de muerte (42,6 por ciento), edad materna (30,9 por ciento) y localidad (17,6 por ciento). Las estrategias de análisis en su mayoría se basan en estadística descriptiva mientras los de asociación lo hacen principalmente mediante análisis de correlación. Conclusión: La mortalidad infantil sigue siendo un tópico de interés para investigadores y para su estudio se han intentado distintas aproximaciones. Los sitios disponibles con información al respecto plantean la instancia de continuar focalizando en el tema para ayudar en su comprensión.

Estudio piloto: costos directos atribuibles al tabaquismo en dos hospitales de Santiago / Pilot study: tobacco-attributable direct costs in two hospitais in Santiago, Chile

Background: Tobaceo is the fourth cause of the global burden of disease, accounting for 79.9 million loss of disability-adjusted Ufe years (DALYs) in 2001. In 2002, tobacco-attributable mortality in Chile represented 17 percent of total mortality. Aim: To estimate the direct cost of tobaceo in Ischemic Heart Disease, Chronic Obstructive Pulmonary Disease and Lung Cáncer, explore patients' disposition to answer a health related expenses questionnaire, valídate the instruments used and determine an adequate sample size for an upcoming study. Material and methods: Socio-demographic and health care related variables were investigated among patients attending two publie hospitais for ischemic heart disease, chronic obstructive pulmonary disease and lung cancer, in a cross-sectional study. Costs were estimated using the national publie health insurance price list and market pnces. Tobacco-attributable fraction was then applied to calcúlate the tobacco-attributable cost ofeach disease. Results: The instruments used were validated. The group of lung cáncer patients was smaller due to increased mortality prior to interview. Lung cancer generated the largest total and attríbutable direct costs. The costs in patients with ischemic heart disease were significantly lower Conclusions: There were some difficulties in the application of the questionnaire to register medication use. The sample size needed in a larger study was calculated for each of the three diseases. We recommend that a definitive study addresses tobacco-attributable direct costs related to chronic obstructive pulmonary disease.

Consideraciones acerca del uso de la variable etnia/raza en investigación epidemiológica para la Salud Pública: A propósito de investigaciones en inequidades: [revisión] / Ethnicity and race as variables in epidemiological research about inequity: [review]

Epidemiology analyzes differences in states of health and disease of populations. Public Policies are established considering inequities associated with ethnicity and race. In this context, the identification of vulnerable groups for concentration of resources is relevant. Nevertheless, the lack of a clear definition of these variables might lead to biased results and interpretations. Two problems about the use of these variables are discussed. First, lack of a measurable and objective characteristic, even considering self reference (gold standard), considering that the opinion of a person can change in time. The second problem is a consequence of the former, basing research on a poorly defined variable. Uses of ethnicity and race variables between 1920-1999 in the American Journal of Epidemiology, Health Services Research and American Journal of Public Health were reviewed. In 919 articles, 27 different names identified to describe these variables and more than half did not describe the reason to use these variables. Almost half did not describe analytical methods. Although some articles found statistically significant relationships, ¡ess than half discussed those results. It has been suggested that there is enough evidence to exclude these variables in biomedical investigations. However, others propose that they cannot be excluded, given their multidimensional condition that includes social, cultural and genetic features. Therefore, provided the lack of clear definition, the assessment of ethnicity and race effects must be done as rigorously as possible