Analgesic Use and Risk for Acute Coronary Events in Patients With Osteoarthritis: A Population-based, Nested Case-control Study.

PURPOSE: Recent controversies on the safety profiles of opioids and paracetamol (acetaminophen) have led to changes in clinical guidance on osteoarthritis (OA) management. We studied the existing association between the use of different OA drug therapies and the risk for acute coronary events. METHODS: A cohort of patients with clinically diagnosed OA (according to ICD-10 codes) was identified in the SIDIAP database. Within the cohort, cases with incident acute coronary events (acute myocardial infarction or unstable angina) between 2008 and 2012 were identified using ICD-10 codes and data from hospital admission. Controls were matched 3:1 to acute coronary event-free patients matched by sex, age (±5 years), geographic area, and years since OA diagnosis (±2 years). Linked pharmacy dispensation data were used for assessing exposure to drug therapies. Multivariate conditional logistic regression models were fitted to estimate adjusted odds ratios of acute coronary events. FINDINGS: Totals of 5663 cases and 16,989 controls were studied. Previous morbidity and cardiovascular risk were higher in cases than in controls, with no significant differences in type or number of joints with OA. Multivariate adjusted analyses showed increased risks (odds ratio; 95% CI) related to the use of diclofenac (1.16; 1.06-1.27), naproxen (1.25; 1.04-1.48), and opioid analgesics (1.13; 1.03-1.24). No significant associations were observed with cyclooxygenase-2 selective NSAIDs, topical NSAIDs, glucosamine, chondroitin sulfate, paracetamol, or metamizole. IMPLICATIONS: In patients with clinically diagnosed OA, the use of nonselective NSAIDs or opioid analgesics is associated with an increased risk for acute coronary events. These risks should be considered when selecting treatments of OA in patients at high cardiovascular risk.

Missed opportunities for HIV testing of patients diagnosed with an indicator condition in primary care in Catalonia, Spain.

OBJECTIVE: To estimate the prevalence of HIV testing among patients diagnosed with an indicator condition (IC) for HIV, seen in primary care (PC) in Catalonia, and to estimate the prevalence of HIV infection among those patients. DESIGN: Cross-sectional and population-based study in patients aged between 16 and 65 diagnosed with an IC within PC in Catalonia. METHODS: Data used in this study were extracted from a large population-based public health database in Spain, the Information System for the Development of Research in Primary Care (SIDIAP). All participants registered in SIDIAP from 1 January 2010 to 31 August 2012 and with a diagnosis of an IC were screened to identify those with an HIV test within the following 4 months. RESULTS: 99 426 patients were diagnosed with an IC during the study period. In these patients, there were 102 647 episodes in which at least one IC was diagnosed. An HIV test was performed within 4 months in only 18 515 of the episodes in which an IC was diagnosed (18.5%). The prevalence of HIV infection was 1.46%. Women (OR 1.35, 95% CI 1.30 to 1.39), people aged 50 or over (OR 2.85, 95% CI 2.69 to 3.00) and patients having a single IC (OR 3.59. 95% CI 3.20 to 4.03) had the greatest odds of not having an HIV test. CONCLUSIONS: The study highlights the persistence of missed opportunities for HIV testing within PC in Catalonia. Urgent engagement with PC professionals is required in order to increase HIV testing and prevent late HIV diagnoses.

Socioeconomic status and its association with the risk of developing hip fractures: a region-wide ecological study.

PURPOSE: To determine the association between socioeconomic deprivation (SES) and hip fracture risk. METHODS: Retrospective cohort study using a population-based database (primary care records) of over 5 million people. Eligibility: all living subjects registered during the period 2009-2012 and resident in an urban area. MEASURES: a validated SES composite index (proportion of unemployed, temporary workers, manual workers, low educational attainment and low educational attainment among youngsters) estimated for each area based on census data. OUTCOME: incident hip fracture rates as coded in medical records using ICD-10 codes. STATISTICS: zero-inflated Poisson models fitted to study the association between SES quintiles and hip fracture risk, adjusted for age, sex, obesity, smoking and alcohol consumption. RESULTS: Compared to the most deprived, wealthy areas had a higher hip fracture incidence (age- and sex-adjusted incidence 38.57 (37.14-40.00) compared to 34.33 (32.90-35.76) per 10,000 person-years). Similarly, most deprived areas had a crude and age- and sex-adjusted lower risk of hip fracture, RR of 0.71 (0.65-0.78) and RR of 0.90 (0.85-0.95), respectively, compared to wealthiest areas. The association was attenuated and no longer significant after adjustment for obesity: RR 0.96 (0.90-1.01). Further adjustment for smoking and high alcohol consumption did not make a difference. CONCLUSION: Wealthiest areas have an almost 30% increased risk of hip fracture compared to the most deprived. Differences in age-sex composition and a higher prevalence of obesity in deprived areas could explain this higher risk.

Linking of primary care records to census data to study the association between socioeconomic status and cancer incidence in Southern Europe: a nation-wide ecological study.

BACKGROUND: Area-based measures of economic deprivation are seldom applied to large medical records databases to establish population-scale associations between deprivation and disease. OBJECTIVE: To study the association between deprivation and incidence of common cancer types in a Southern European region. METHODS: Retrospective ecological study using the SIDIAP (Information System for the Development of Research in Primary Care) database of longitudinal electronic medical records for a representative population of Catalonia (Spain) and the MEDEA index based on urban socioeconomic indicators in the Spanish census. Study outcomes were incident cervical, breast, colorectal, prostate, and lung cancer in 2009-2012. The completeness of SIDIAP cancer recording was evaluated through linkage of a geographic data subset to a hospital cancer registry. Associations between MEDEA quintiles and cancer incidence was evaluated using zero-inflated Poisson regression adjusted for sex, age, smoking, alcoholism, obesity, hypertension, and diabetes. RESULTS: SIDIAP sensitivity was 63% to 92% for the five cancers studied. There was direct association between deprivation and lung, colorectal, and cervical cancer: incidence rate ratios (IRR) 1.82 [1.64-2.01], IRR 1.60 [1.34-1.90], IRR 1.22 [1.07-1.38], respectively, comparing the most deprived to most affluent areas. In wealthy areas, prostate and breast cancers were more common: IRR 0.92 [0.80-1.00], IRR 0.91 [0.78-1.06]. Adjustment for confounders attenuated the association with lung cancer risk (fully adjusted IRR 1.16 [1.08-1.25]), reversed the direction of the association with colorectal cancer (IRR 0.90 [0.84-0.95]), and did not modify the associations with cervical (IRR 1.27 [1.11-1.45]), prostate (0.74 [0.69-0.80]), and breast (0.76 [0.71-0.81]) cancer. CONCLUSIONS: Deprivation is associated differently with the occurrence of various cancer types. These results provide evidence that MEDEA is a useful, area-based deprivation index for analyses of the SIDIAP database. This information will be useful to improve screening programs, cancer prevention and management strategies, to reach patients more effectively, particularly in deprived urban areas.

Utilización de servicios de salud y flujos asistenciales / Health services provision and geographic accessibility

Este estudio describe la oferta de servicios de salud de Cataluña como parte del análisis de la situación del Mapa Sanitario, fijando un punto de partida para el proceso de adaptación de los servicios a las necesidades de la población. Incluye también un análisis de la accesibilidad geográfica a los centros sanitarios del sistema público de salud mediante la utilización de un sistema de información geográfica (SIG), con variables de georreferenciación y cálculos de distancia y tiempo de desplazamiento, y se exponen sus principales resultados, de los cuales se constata, por un lado, la adecuación de la red asistencial catalana a la distribución de la población, con una elevada proximidad geográfica de los servicios a la población y un alto grado de capilaridad, principalmente en la atención primaria. Por otro lado, se pone de manifiesto la importancia que pueden adquirir las herramientas y procedimientos SIG en la planificación sanitaria

This article analyses the use of healthcare services in Catalonia with reference to their variability and cross-territory healthcare flows. The coefficients of variation show a lower degree of territorial dispersion in acute-care and primary-care hospitalisation, and a greater degree in social-healthcare. In the territorial analysis of the penetration indices, five large attraction poles are salient. There is no significant association among healthcare flows between the specialised healthcare given in acute healthcare hospitals, mental healthcare and social-healthcare,whereas a strong association was observed between the set of services associated to the acute-care hospital structure (hospitalisation, outpatient service and emergency care) and also among the social healthcareinternment services (medium and long-term stays). This would seem to suggest that the association between flows refers to services that are habitually rendered from one single healthcare mechanism, and not so much to a pattern of cross-territory relations

[Use of health services and healthcare flows]. / Utilización de servicios de salud y flujos asistenciales.

This article analyses the use of healthcare services in Catalonia with reference to their variability and cross-territory healthcare flows. The coefficients of variation show a lower degree of territorial dispersion in acute-care and primary-care hospitalisation, and a greater degree in social-healthcare. In the territorial analysis of the penetration indices, five large attraction poles are salient. There is no significant association among healthcare flows between the specialised healthcare given in acute healthcare hospitals, mental healthcare and social-healthcare, whereas a strong association was observed between the set of services associated to the acute-care hospital structure (hospitalisation, outpatient service and emergency care) and also among the social healthcare internment services (medium and long-term stays). This would seem to suggest that the association between flows refers to services that are habitually rendered from one single healthcare mechanism, and not so much to a pattern of cross-territory relations.