Factores asociados a eventos adversos ocurridos en fallecidos en un hospital universitario / Adverse events and associated factors in patients who died in a University Hospital

Fundamento y objetivo. El presente trabajo de investigación pretende relacionar los eventos adversos (EA) asociados a la asistencia sanitaria con otro indicador de calidad asistencial como es la mortalidad hospitalaria, determinando la proporción de fallecidos en los que está presente algún EA y qué factores se asocian a una mayor proporción de EA en personas fallecidas. Material y métodos. Inicialmente se realizó un estudio descriptivo de mortalidad de base hospitalaria, seguido de un estudio de casos y controles en pacientes fallecidos. Se estudió la presencia de EA, la probabilidad con la que se hubieran podido prevenir y predecir y su asociación con diversos factores. Resultados. La proporción de EA encontrada fue del 19,8% (82/414), siendo la proporción de pacientes fallecidos que padeció algún EA del 15,5% (64/414). La razón de EA por persona era de 1,28. El EA más frecuente fue la infección nosocomial. El 48,8% de los EA eran prevenibles. No se ha encontrado una diferencia en la presencia de EA por edad ni por sexo. Entre los factores que se asociaron a la presencia de EA destacan la intervención quirúrgica, la estancia y el tipo de servicio en el que estaban ingresados los pacientes. Discusión. La proporción de pacientes fallecidos con EA, el porcentaje de EA prevenibles, el tipo más frecuente (la infección nosocomial) y la relación de la estancia y la intervención quirúrgica con su presencia, nos hacen centrar la atención en el desarrollo de medidas que reduzcan la estancia hospitalaria y en la difusión de las medidas de prevención y control de la infección nosocomial(AU)

Objective. This study aims to associate adverse events related to health care with another indicator of quality of care such as hospital mortality, and determining the proportion of adverse events (AEs) and associated factors in deceased patients. Methods. First a descriptive study of hospital-based mortality was performed, followed by a case-control study in deceased patients. We studied the presence of AEs, the probability which they could be predicted and prevented, and their association with several factors. Results. The proportion of AEs found was 19.8% (82/414), and the proportion of deceased patients who suffered an AE was 15.5% (64/414). The AE ratio per person was 1.28. The most common AE was nosocomial infection, and 48.8% of all AEs were preventable. No difference was found with the presence of an AE by age or sex. Factors associated with the presence of AEs were surgery, length of stay and hospital unit to which patients were admitted. Discussion. The proportion of AEs found between patients who died, the percentage of preventable AEs, the most common AE (nosocomial infection) and the association of their presence with stay and the surgery should make us focus on the development of measures to reduce hospital stay and the dissemination of information on prevention and control of nosocomial infection(AU)

[Adverse events and associated factors in patients who died in a university hospital]. / Factores asociados a eventos adversos ocurridos en fallecidos en un hospital universitario.

OBJECTIVE: This study aims to associate adverse events related to health care with another indicator of quality of care such as hospital mortality, and determining the proportion of adverse events (AEs) and associated factors in deceased patients. METHODS: First a descriptive study of hospital-based mortality was performed, followed by a case-control study in deceased patients. We studied the presence of AEs, the probability which they could be predicted and prevented, and their association with several factors. RESULTS: The proportion of AEs found was 19.8% (82/414), and the proportion of deceased patients who suffered an AE was 15.5% (64/414). The AE ratio per person was 1.28. The most common AE was nosocomial infection, and 48.8% of all AEs were preventable. No difference was found with the presence of an AE by age or sex. Factors associated with the presence of AEs were surgery, length of stay and hospital unit to which patients were admitted. DISCUSSION: The proportion of AEs found between patients who died, the percentage of preventable AEs, the most common AE (nosocomial infection) and the association of their presence with stay and the surgery should make us focus on the development of measures to reduce hospital stay and the dissemination of information on prevention and control of nosocomial infection.

[Analysis of avoidable mortality in Valencia Community hospitals]. / Análisis de la mortalidad evitable en los hospitales de la Comunidad Valenciana.

Using a list of avoidable mortality (AM) causes as indicators of medical care (IMC) according to the Holland classification, a study on AM was conducted in the Valencia Community hospitals during 1994 and 1995. A total of 617 patients out of 106,540 discharges with IMC criteria died (mortality rate: 0.58%). The most common causes of AM included hypertension and cerebrovascular disease, with 46% of avoidable deaths; maternalperinatal disease, with 36%, and tuberculosis, 7%. According to the logistic regression analysis, men had a higher risk of AM than women, the age groups at highest risk were those over 50 years and less than 18 years, and the presence of a higher number of diagnoses was associated with increased risk.

Análisis de la mortalidad evitable en los hospitales de la Comunidad Valenciana / Analysis of avoidable deaths in the Valencia Community hospitals

Utilizando el listado de causas de mortalidad evitable (ME) conocidas como indicadores de asistencia médica (IAM) según la clasificación de Holland se ha llevado a cabo un estudio de la ME ocurrida en los hospitales de la Comunidad Valenciana durante 1994 y 1995. De 106.540 altas con criterios de IAM, fallecieron 617 pacientes (letalidad: 0,58 por ciento). Las causas más frecuentes de ME fueron la enfermedad hipertensiva y cerebrovascular, con el 46 por ciento de los fallecimientos evitables; la maternoperinatal, con el 36 por ciento, y la tuberculosis, con el 7 por ciento. Según el análisis de regresión logística, los hombres presentaron mayor riesgo de ME que las mujeres; los grupos de edad con mayor riesgo fueron los de más de 50 años y los menores de 18 años, y la presencia de un mayor número de diagnósticos se asoció a un riesgo más elevado (AU)

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Estudio longitudinal de factores de riesgo de cardiopatía isquémica en España

Se han estudiado de forma longitudinal (1987-1995) los principales factores de riesgo ligados a la evolución de la mortalidad por cardiopatía isquémica con el fin de obtener una valoración del problema en España, así como de sus medidas preventivas. Material y métodos: la mayor parte de los factores de riesgo considerados se obtuvieron de las Encuestas Nacionales de Salud Españolas de los años 1987, 1993 y 1995, procediendo a su adaptación correspondiente. Las defunciones por cardiopatía isquémica se consultaron de los Movimientos Naturales de la Población Española, se calcularon las tasas de mortalidad por 105 personas-año y se estandarizaron por el método directo. Asimismo se realizó un ajuste polinomial de segundo grado en la línea de tendencia y se comprobaron diferencias significativas en la prevalencia de los factores de riesgo entre cada dos encuestas consecutivas. Resultados: observamos que la situación no es satisfactoria en cuanto a niveles de salud percibida, siendo claramente decreciente en ambos sexos. El consumo de tabaco para ambos sexos sólo es ligeramente decreciente en el período considerado, aunque con grandes diferencias por sexo. Lo mismo sucede con el alcohol, disminuyendo los bebedores excesivos. Los datos de obesidad permanecen constantes, con una tendencia prácticamente horizontal, mientras que parece decrecer el sedentarismo para ambos sexos. Es estable para todo el período estudiado el conocimiento del padecimiento de diabetes, hipertensión y colesterol (AU)

[Age-period-cohort analysis of mortality caused by traffic accidents in Spain]. / Análisis edad-periodo-cohorte de la mortalidad por accidentes de tráfico en España.

OBJECTIVE: To study the evolution of traffic accidents mortality in Spain and its possible application to an age-period-cohort analysis, as well as the effect of selected road safety measures. MATERIAL AND METHODS: Road accidents rates of mortality were obtained, and five-year interval age rates for each sex, which allows the study of specific rates of age by birth cohorts. To determine the association between the selected road safety measures and mortality. Poisson regression models were adjusted. RESULTS: Two waves emerge in the evolution of traffic accidents. There was no clear effect with respect to age, nor was there a cohort effect for men or women. As to the road safety measures, we discuss the consistency between the selected models and graphic results. The compulsory use of helmet and of crossing lights is significantly associated to a reduction in mortality (RR 0.73, p < 0.05). CONCLUSIONS: Road accidents mortality shows a slight increase in the studies period. This rate performance cannot be sufficiently explained by age effects, diagnostic period nor birth cohort, however, road safety measures are considered positive.

[Geographic distribution of avoidable mortality in the community of Valencia (1975-1990)]. / Distribución geográfica de la mortalidad evitable en la Comunidad Valenciana (1975-1990).

BACKGROUND: Avoidable mortality (AM) has been proposed as the indicator of the quality and the efficacy of health care services and a parameter useful to distribute health care resources. The aim of this study was to analyze the size and geographic variability of AM in the Community of Valencia, Spain (1975-1990). METHODS: The causes of AM were analyzed by the classification of Holland divided into indicators of medical care (IMC) and indicators on national health care policy (INHCP) in addition to the causes of the Charlton classification. Standard rates for Spain and the European Community, the rate of masculinity and contribution to total mortality were calculated. Geographic distribution by areas and provinces was analyzed by the rate of standardized mortality. RESULTS: According to the Holland classification AM was 30% of the deaths from 5 to 64 years of age. Out of these cases, 18.5% corresponded to INHCP and 11.1% to IMC. According to the Charlton classification, this percentage was 3.6%. A considerable variation was observed among the 20 areas analyzed due to many causes. The geographic distribution by groups (IMC, INHCP and the Charlton classification) is quite homogeneous. The worse results corresponded to the city of Valencia and to the area 21 (area of the city of Alicante). CONCLUSIONS: A great variation was found in the results regarding geographic distribution for individual causes of death while the distribution was quite homogeneous for all of the groups of mortality with the worst results being observed in large urban centers.

[The trends in cancer mortality, especially lung cancer, in Spain compared with other developed countries]. / Tendencias de la mortalidad por cáncer en España, en especial del cáncer de pulmón, en comparación con otros países desarrollados.

In this paper we study the general mortality trends by cancer in Spain (1951-1987), and also by sex and age groups. We focus on lung cancer, establishing comparisons with USA, England and Wales. We appreciate on the general mortality trend that only young age groups show a higher decrease, while in other countries this decrease was also in old age groups. We observed a lower mortality trend in Spain by lung cancer than in the other countries, however increasing the rates in both sexes and more in males. That evolution could be related with the evolution of cancer risk factors and especially lung cancer. On concluded that the general mortality trend in Spain is the same than other developed countries but with some delay in the evolution, when comparing lung cancer. Spain is now in an increasing phase and USA, England and Wales have stabilized their rates and begin to decrease their trends.

[Vasectomy and prostatic cancer]. / Vasectomía y cáncer de próstata.

Considering the growing of vasectomy worldwide, its likely association with several conditions, mainly prostate cancer, has been studied in recent years with sometimes contradictory results. In the light of recent epidemiological studies, it appears that the increased risk derived from a previous vasectomy is limited, and it is influenced by whether the operation is performed during puberty and with a long "latency period". It is acknowledged that there is no scientifically proven reasons to appraise the current methods, although there is some insistence on the need to carry out analytical studies, most specially in developmental areas.

Testing a new health indicator: using avoidable causes of death and life expectancy for Spain between 1975-1986.

The concept of avoidable cause of death serves as the basis for measuring the quality and diversity of a health care system. In this study the authors propose a new way to use this kind of mortality by combining with the concept of life expectancy to obtain what they call "life expectancy free of avoidable mortality" (LEFAM). This indicator was 76.9 in 1986 in Spain while life expectancy was 75.83. If these deaths were avoidable there would be a gain of 1.09 years per person born. There is an important difference between the would-be male gain of 1.76 years and the would-be female gain of 0.6. In the ecological study, LEFAM would better explain the year to year changes of the resources in the health sector, measured in terms of the human resources (R = 0.96), the hospital beds per thousand persons (R = -0.86), and would also increase the relation with other health indicators such as infant mortality rate (R = 0.98) and mortality rate (R = 0.59) as compared with life expectancy alone.

Correlation between mortality trends of ischaemic cardiopathy and some nutritional factors in Spain 1968-1986.

After describing the evolution of mortality from ischaemic cardiopathy (IC) in Spain from 1951 to 1986, which is tending to stabilize in some age groups, and from cerebrovascular accidents (CVA), which is clearly declining, an attempt is made to relate these developments to the prevalence of the main risk factors (hypertension, cholesterol, tobacco) associated with IC and CVA. Certain advances, though of a limited number, have been made in recent years in the control of arterial hypertension in Spain, although campaigns on a national scale as in other countries have not been carried out. Regarding alimentary factors, there is an obvious increase in the consumption of food rich in proteins and animal fats, abandoning to a great extent the traditional "Mediterranean diet", with health care action being limited to the improvement of nutrition education of the public. Furthermore, the consumption of tobacco has been increasing in Spain during the study period in spite of health legislation in force in recent years. It is therefore deduced that there is no obvious relationship between mortality due to IC and CVA and the prevalence of the main risk factors associated with these diseases, especially when taking into account that preventive actions on a public health level have been very limited.

Job absenteeism and arterial hypertension: results of a hypertension control program.

This study reports the findings of one of the stages of a programme for the detection and control of arterial hypertension, started in 1980 in an automobile company with a workforce of 9,782. In the initial screening, 522 hypertensive males were found using epidemiological criteria and 206 of these fulfilled the criteria of definite hypertension. The objective of this study consisted of evaluating, 9 years after the start of the program, the indirect cost in terms of the reduction in the morbidity indicator-temporary work incapacity (TWI). Analysis is based on a comparison of the prevalence of hypertension in the population when the program was begun (6%) and in 1989 (9.8%). It can be observed that the TWI rate of the hypertensive population was significantly higher than that of the rest of the workforce, and that this remained true for the reference group (RG) hypertensives a year after the study was initiated. In contrast, the intervention group (IG) showed significantly lower TWI levels, not only in comparison with the RG but also with the rest of the workers. The estimated reduction in TWI for 1989 was 4.500 days/year, which corresponds to an estimated saving of 76.500.000 pesetas/year.

[Epidemiological observations on the evolutive tendency of asthma mortality in Spain]. / Observaciones epidemiológicas sobre la tendencia evolutiva de la mortalidad por asma en España.

We have studied asthma mortality in Spain from 1951 to 1985, applying epidemiological descriptive methodology. A global decrease in the tendency is observed when comparing it to other countries. We have observed, however, an increased mortality in the four age groups proposed (5-19, 5-39, 40-64 and 5-64), based on previous international publications which avoid interferences with other causes of death. We have also observed that when applying the method of mortality related to natality rate, there was a decrease in mortality, specially in older generations. Finally, several hypothesis related to risk factors which would explain this tendency are presented.

[Trends in kidney cancer mortality in Spain (1951-1985) and review of hospital case histories]. / Tendencias en la mortalidad por cáncer de riñón en España (1951-1985) e investigación de una casuística hospitalaria.

The present study is a descriptive epidemiological study of the mortality trends for renal cancer based on the data available for the period spanning 1951 to 1985. The specific death rates show a rising trend that is more marked in males than in females. These have been observed to increase constantly for the group aged 60-64 years. The mortality rates by birth cohorts show the cohort effect to be less evident in the younger male and female population. A review of 81 clinical records (1984-1988) of La Fe Hospital in Valencia based on a protocol that focussed on selected risk factors showed a higher frequency (33.75%) for the group aged 60-69 followed by the 50-59 age group (26.75%) and a higher incidence in men (66.67%).

[Epidemiologic study of mortality caused by cancer of the larynx in Spain, from 1951 to 1983]. / Estudio epidemiológico de la mortalidad por cáncer de laringe en España, período 1951-1983.

We have reviewed the mortality from laryngeal cancer in Spain (1951-1983). An evident increase of the tendency for males has been observed, while an stabilization in females, with lower rates, has been appreciated. It is reflected in the increase of the sex ratio along the studied period, specially since 1970. Concerning the morbidity, through hospital diagnostic data in Spain, as much the absolute numbers as the corresponding morbidity rates have been clearly increasing in males, specially during the last years of our study (1977-1985).

[Investigation of various risk factors associated with colorectal cancer by studying cases and controls]. / Investigación de diversos factores de riesgo asociados al cáncer colorrectal mediante un estudio de casos y controles.

A retrospective study was made of cases of colorectal cancer and controls using 571 cases from various hospitals in Valencia (Spain) and 1,497 controls from the general population with similar sex, age and residence. The relative risks (RR) and levels of statistical significance of various "risk factors" presumably linked to this cancer were calculated. It was associated with: smoking, the Quetelet index (which relates weight and height), chronic constipation and, possibly, sedentary life style, previous cholecystectomy and biliary lithiasis. No association was observed with: civil status, weight, coffee and alcohol intake, or professional status.

[Bladder cancer: study of mortality in Spain (1968-1982)]. / Cáncer de vejiga: Estudio de la mortalidad en España (1968-1982).

In review of the rising bladder cancer mortality rate in Spain and its involvement in connection with other "risk factors", according to recent contributions, we proceeded to review these factors involved and to carry out an epidemiological study describing its mortality from 1968 to 1982, through specific mortality rates per hundred thousand in males and females, as well as the study by age groups from 50 upwards, concentrating on more highly affected ages. We also carried out transverse studies for the three years 1968, 1975 and 1982 and reviewed the evolution of mortality in accordance with the chorts of births. On the whole, we observe a continual rise in mortality due to this cancer, at a much higher level in the masculine sex, and we make interpretation as to its association with "risk factors" connected with life style.