Spatiotemporal variability in socioeconomic inequalities in COVID-19 vaccination in Catalonia, Spain.

OBJECTIVES: Socioeconomic inequalities have played a significant role in the unequal coverage of the COVID-19 vaccine. The objectives of this study were to (1) assess the socioeconomic inequalities in COVID-19 vaccination coverage in Catalonia, Spain; (2) analyse the spatial variation over time of these inequalities; and (3) assess variations in time and space in the effect of vaccination on inequalities in COVID-19 outcomes. STUDY DESIGN: A mixed longitudinal ecological study design was used. METHODS: Catalonia is divided in to 373 Basic Health Areas. Weekly data from these Basic Health Areas were obtained from the last week of December 2020 until the first week of March of 2022. A joint spatio-temporal model was used with the dependent variables of vaccination and COVID-19 outcomes, which were estimated using a Bayesian approach. The study controlled for observed confounders, unobserved heterogeneity, and spatial and temporal dependencies. The study allowed the effect of the explanatory variables on the dependent variables to vary in space and in time. RESULTS: Areas with lower socioeconomic level were those with the lowest vaccination rates and the highest risk of COVID-19 outcomes. In general, individuals in areas that were located in the upper two quartiles of average net income per person and in the lower two quartiles of unemployment rate (i.e., the least economically disadvantaged) had a higher propensity to be vaccinated than those in the most economically disadvantaged areas. In the same sense, the greater the percentage of the population aged ≥65 years, the higher the propensity to be vaccinated, while areas located in the two upper quartiles of population density and areas with a high percentage of poor housing had a lower propensity to be vaccinated. Higher vaccination rates reduced the risk of COVID-19 outcomes, while COVID-19 outcomes did not influence the propensity to be vaccinated. The effects of the explanatory variables were not the same in all areas or between the different waves of the pandemic, and clusters of excess risk of low vaccination in the most disadvantaged areas were detected. CONCLUSIONS: COVID-19 vaccination inequalities in the most disadvantaged areas could be a result of structural barriers, such as the lack of access to information about the vaccination process, and/or logistical challenges, such as the lack of transportation, limited Internet access or difficulty in scheduling appointments. Public health strategies should be developed to mitigate these barriers and reduce vaccination inequalities.

Short-term effects of air pollution and noise on emergency hospital admissions in Madrid and economic assessment.

INTRODUCTION: The aim of this study was to study the effect of air pollution and noise has on the population in Madrid Community (MAR) in the period 2013-2018, and its economic impact. METHODS: Time series study analysing emergency hospital admissions in the MAR due to all causes (ICD-10: A00-R99), respiratory causes (ICD-10: J00-J99) and circulatory causes (ICD-10: I00-I99) across the period 2013-2018. The main independent variables were mean daily PM2.5, PM10, NO2, 8-h ozone concentrations, and noise. We controlled for meteorological variables, Public Holidays, seasonality, and the trend and autoregressive nature of the series, and fitted generalised linear models with a Poisson regression link to ascertain the relative risks and attributable risks. In addition, we made an economic assessment of these hospitalisations. RESULTS: The following associations were found: NO2 with admissions due to natural (RR: 1.007, 95% CI: 1.004-1.011) and respiratory causes (RR: 1.012, 95% CI: 1.005-1.019); 8-h ozone with admissions due to natural (RR: 1.049, 95% CI: 1.014-1.046) and circulatory causes (RR: 1.088, 95% CI: 1.039-1.140); and diurnal noise (LAeq7-23h) with admissions due to natural (RR: 1.001, 95% CI: 1.001-1.002), respiratory (RR: 1.002, 95% CI: 1.001-1.003) and circulatory causes (RR: 1.003, 95% CI: 1.002-1.005). Every year, a total of 8246 (95% CI: 4580-11,905) natural-cause admissions are attributable to NO2, with an estimated cost of close on €120 million and 5685 (95% CI: 2533-8835) attributed to LAeq7-23h with an estimated cost of close on €82 million. CONCLUSIONS: Nitrogen dioxide, ozone and noise are the main pollutants to which a large number of hospitalisations in the MAR are attributed, and are thus responsible for a marked deterioration in population health and high related economic impact.

Will there be cold-related mortality in Spain over the 2021-2050 and 2051-2100 time horizons despite the increase in temperatures as a consequence of climate change?

INTRODUCTION: Global warming is resulting in an increase in temperatures which is set to become more marked by the end of the century and depends on the accelerating pace of greenhouse gas emissions into the atmosphere. Yet even in this scenario, so-called "cold waves" will continue to be generated and have an impact on health. OBJECTIVES: This study sought to analyse the impact of cold waves on daily mortality at a provincial level in Spain over the 2021-2050 and 2051-2100 time horizons under RCP4.5 and RCP 8.5 emission scenarios, on the basis of two hypotheses: (1) that the cold-wave definition temperature (T threshold) would not vary over time; and, (2) that there would be a variation in T threshold. MATERIAL AND METHODS: The results of a retrospective study undertaken for Spain as a whole across the period 2000-2009 enabled us to ascertain the cold-wave definition temperature at a provincial level and its impact on health, measured by reference to population attributable risk (PAR). The minimum daily temperatures projected for each provincial capital considering the above time horizons and emission scenarios were provided by the State Meteorological Agency. On the basis of the T threshold definition values and minimum daily temperatures projected for each province, we calculated the expected impact of low temperatures on mortality under the above two hypotheses. Keeping the PAR values constant, it was assumed that the mortality rate would vary in accordance with the available data. RESULTS: If T threshold remained constant over the above time horizons under both emission scenarios, there would be no cold-related mortality. If T threshold were assumed to vary over time, however, then cold-related mortality would not disappear: it would instead remain practically constant over time and give rise to an estimated overall figure of around 250 deaths per year, equivalent to close on a quarter of Spain's current annual cold-related mortality and entailing a cost of approximately €1000 million per year. CONCLUSION: Given that cold waves are not going to disappear and that their impact on mortality is far from negligible and is likely to remain so, public health prevention measures must be implemented to minimise these effects as far as possible.

Mortality attributable to high temperatures over the 2021-2050 and 2051-2100 time horizons in Spain: Adaptation and economic estimate.

BACKGROUND: In recent years, a number of studies have been conducted with the aim of analysing the impact that high temperatures will have on mortality over different time horizons under different climate scenarios. Very few of these studies take into account the fact that the threshold temperature used to define a heat wave will vary over time, and there are practically none which calculate this threshold temperature for each geographical area on the assumption that there will be variations at a country level. OBJECTIVE: To analyse the impact that high temperatures will have on mortality across the periods 2021-2050 and 2051-2100 under a high-emission climate scenario (RCP8.5), in a case: (a) where adaptation processes are not taken into account; and (b) where complete adaptation processes are taken into account. MATERIAL AND METHODS: Based on heat-wave definition temperature (Tthreshold) values previously calculated for the reference period, 2000-2009, for each Spanish provincial capital, and their impact on daily mortality as measured by population attributable risk (PAR), the impact of high temperatures on mortality will be calculated for the above-mentioned future periods. Two hypotheses will be considered, namely: (a) that Tthreshold does not vary over time (scenario without adaptation to heat); and, (b) that Tthreshold does vary over time, with the percentile to which said Tthreshold corresponds being assumed to remain constant (complete adaptation to heat). The temperature data were sourced from projections generated by Coupled Model Intercomparison Project (CMIP5) climate models adapted to each region's local characteristics by the State Meteorological Agency (Agencia Estatal de Meteorología/AEMET). Population-growth projections were obtained from the National Statistics Institute (Instituto Nacional de Estadística/INE). In addition, an economic estimate of the resulting impact will be drawn up. RESULTS: The mean value of maximum daily temperatures will rise, in relation to those of the reference period (2000-2009), by 1.6°C across the period 2021-2050 and by 3.3°C across the period 2051-2100. In a case where there is no heat-adaptation process, overall annual mortality attributable to high temperatures in Spain would amount to 1414 deaths/year (95% CI: 1089-1771) in the period 2021-2050, rising to 12,896 deaths/year (95% CI: 9852-15,976) in the period 2051-2100. In a case where there is a heat-adaptation process, annual mortality would be 651 deaths/year (95% CI: 500-807) in the period 2021-2050, and 931 deaths per year (95% CI: 770-1081) in the period 2051-2100. These results display a high degree of heterogeneity. The savings between a situation that does envisage and one that does not envisage an adaptive process is €49,100 million/year over the 2051-2100 time horizon. CONCLUSION: A non-linear increase in maximum daily temperatures was observed, which varies widely from some regions to others, with an increase in mean values for Spain as a whole that is not linear over time. The high degree of heterogeneity found in heat-related mortality by region and the great differences observed on considering an adaptive versus a non-adaptive process render it necessary for adaptation plans to be implemented at a regional level.

Coste de la hipertensión arterial en España / Cost of arterial hypertension in Spain

La hipertensión arterial (HTA) es uno de los principales factores de riesgo cardiovascular por lo que se refiere a su prevalencia y al riesgo de complicaciones. La prevalencia de la hipertensión en nuestro país se situaría en torno al 15-20% en población de 15 o más años, del 30 al 36%, en población de 45 años o más, y el 45-48% en población de 65 o más años. En promedio, un hipertenso costaría el doble que lo que costaría un individuo normotenso. En 1992, un 56,07% de los costes totales de la HTA correspondían a costes indirectos, el 61,06%de los mismos estaban asociados con la mortalidad y el resto con la incapacidad. Por lo que se (..) (AU)

Arterial hypertension (AHT) is one of the major cardiovascular risk factors regarding its prevalence and risk of complications. The prevalence of hypertension in our country is approximately 15-20% in the aged 15 or older population, 30% to 36% in the aged 45 years or more population, and 45-48% among those 65 or older. On average, hypertensive patients would cost twice that of a normotensive individual. In1992, 56.07% of the total costs of AHT corresponded to indirect costs, 61.06% of which were (..) (AU)

Area deprivation and mortality in the provincial capital cities of Andalusia and Catalonia (Spain).

OBJECTIVE: To study the linkage between material deprivation and mortality from all causes, for men and women separately, in the capital cities of the provinces in Andalusia and Catalonia (Spain). METHODS: A small-area ecological study was devised using the census section as the unit for analysis. 188,983 Deaths occurring in the capital cities of the Andalusian provinces and 109,478 deaths recorded in the Catalan capital cities were examined. Principal components factorial analysis was used to devise a material deprivation index comprising the percentage of manual labourers, unemployment and illiteracy. A hierarchical Bayesian model was used to study the relationship between mortality and area deprivation. MAIN RESULTS: In most cities, results show an increased male mortality risk in the most deprived areas in relation to the least depressed. In Andalusia, the relative risks between the highest and lowest deprivation decile ranged from 1.24 (Malaga) to 1.40 (Granada), with 95% credibility intervals showing a significant excess risk. In Catalonia, relative risks ranged between 1.08 (Girona) and 1.50 (Tarragona). No evidence was found for an excess of female mortality in most deprived areas in either of the autonomous communities. CONCLUSIONS: Within cities, gender-related differences were revealed when deprivation was correlated geographically with mortality rates. These differences were found from an ecological perspective. Further research is needed in order to validate these results from an individual approach. The idea to be analysed is to identify those factors that explain these differences at an individual level.

[Ponderal evolution in the Girona population, 1989-1999]. / Evolución ponderal en la población de Girona, 1989-1999.

BACKGROUND AND OBJECTIVE: Despite the number of plans leading to lose weight among individuals in the developed countries, the prevalence of obesity has increased since 1980. The knowledge of ponderal evolution in a given population is very important because the adverse effects of obesity vary greatly among individuals and populations. The objective of the present paper was to determine the modifications in the different degrees of body adiposity in a population in Catalunya. PATIENTS AND METHODS: A measurement was made of weight and height of 24554 users aged over 14 years (10595 males and 13959 females) attended at four basic health areas (BHA): Girona 1, Girona 4, Salt and Camprodon, and a Primary Health Center (PHC) in the Girona province, for a five-year period, 1995-1999. The prevalence of the different degrees of obesity was compared with that obtained in a previous study with 6373 individuals during the 1986-1989 period (4,579 males and 1794 females). RESULTS: The prevalence of women with overweight (defined as a body mass index [BMI] > 25 kg/m2) increased from 7.3% (1986-1989, study 0) to 17.6% (1995-1999, study 1) for women aged 15 to 24 years ( p < 0.001), from 17.9 % to 28.1% for women aged 25 to 34 years (p < 0.001), and from 37.5% to 44.7 % for women aged 35 to 44 years (p < 0.001). In the latter age group, the proportion of women with obesity (BMI > 30 kg/m2) increased from 6.9% to 12.9%. Similar trends were observed among men, and the change in the 35-44 year age group (from 10.5 % of obese men to 16% [p < 0.001]), and 55 to 65 years (from 16.6% of obese men to 22.7% [p < 0.001] was particularly significant. And lastly, it is also noteworthy the proportion of individuals with low weight (BMI < 18.5 kg/m2) which increased from 7.3% to 11.6% for women aged 15 to 24 years, and from 0.3% to 2.2% for women aged 35 to 44 years. This trend was also observed for men aged 15 to 24 years (11% to 17.2%). CONCLUSIONS: The relative increase in the prevalence of overweight and obesity runs in parallel to that found in other surrounding countries. Also, it is worth mentioning that among women aged 15 to 24 years the increase in the prevalence of low weight and obesity is almost identical, which invalidates the mean and median values as a means to assess the ponderal evolution in this population. The current compartmentalization between the extreme BMIs, particularly among the youngest portion of population should be addressed from a multidisciplinary perspective.

Evolución ponderal en la población de Girona, 1989-1999 / Ponderal evolution in the Girona population, 1989-1999

Introducción y objetivo. A pesar de los numerosos planes encaminados a perder peso en los países desarrollados, la prevalencia de obesidad se ha incrementado desde 1980. El conocimiento de la evolución ponderal de una población dada es muy importante porque los efectos adversos de la obesidad son muy variables entre individuos y entre poblaciones. El objetivo de este estudio fue determinar las modificaciones de los diferentes grados de adiposidad corporal en población catalana. Pacientes y métodos. Se midió el peso y la talla a 24.554 usuarios mayores de 14 años (10.595 hombres y 13.959 mujeres) atendidos en cuatro áreas básicas de salud (ABS): Girona 1, Girona 4, Salt y Camprodon y un Centro de Atención Primaria (CAP) de la provincia de Girona, durante un período de 5 años, 1995-1999. La prevalencia de los diferentes grados de obesidad se comparó con la obtenida en un estudio previo sobre 6.373 sujetos durante el período 1986-1989 (4.579 hombres y 1.794 mujeres).Resultados. La prevalencia de las mujeres que presentaban sobrepeso (definido como un índice de masa corporal [IMC] > 25 kg/m2) creció de un 7,3 por ciento (1986-1989, estudio 0) a un 17,6 por ciento (1995-1999, estudio 1) entre las mujeres de 15 a 24 años ( p 30 kg/m2) pasó del 6,9 por ciento al 12,9 por ciento. En los hombres se observaron tendencias similares, siendo especialmente significativo el cambio en la década de 35 a 44 años (de un 10,5 por ciento de hombres obesos a un 16 por ciento [p < 0,001]) y de 55 a 65 años (de un 16,6 por ciento de hombres obesos a un 22,7 por ciento [p < 0,001]). Por último, también es de destacar el cambio en la proporción de sujetos con bajo peso (IMC < 18,5 kg/m2), que creció de un 7,3 por ciento a un 11,6 por ciento en las mujeres de 15 a 24 años y de un 0,3 por ciento a un 2,2 por ciento en las mujeres de 35 a 44 años. Esta tendencia también se observó entre los hombres de 15 a 24 años (11 por ciento a 17,2 por ciento). Conclusiones. El crecimiento relativo de la prevalencia de sobrepeso y de obesidad es paralela a la de otros países de nuestro entorno. Además es de destacar que en el caso de las mujeres de 15 a 24 años el aumento de la prevelancia de bajo peso y de obesidad es casi idéntico, lo que invalida a la media y mediana de IMC como medio de valorar la evolución ponderal en esta población. Es necesario abordar desde una perspectiva multidisciplinaria la tendencia a la compartimentalización actual entre los IMC extremos, especialmente en el segmento más joven de la población (AU)

Prevalencia de la obesidad en la población atendida en asistencia primaria de Girona, 1995-1999 / Prevalence of obesity in the population of Girona, Spain, 1995-1999

Objetivos: Estimar y comparar la prevalencia de la obesidad y el sobrepeso en la población de Girona, entre 1995 y 1999, estratificando geográficamente por sexo y edad. Métodos: Medidas directas de talla y peso correspondientes a 24.554 usuarios mayores de 14 años (10.595 varones y 13.959 mujeres) atendidos en cuatro áreas básicas de salud (ABS): Girona 1, Girona 4, Salt y Camprodon, así como en un centro de atención primaria (CAP) de la provincia de Girona. Se calculó el índice de masa corporal (IMC) como el cociente entre el peso y la talla al cuadrado. La obesidad se define como los grados II y III del índice de Garrow (IMC 30 kg/m2) y el sobrepeso como el grado I (25 kg/m2 IMC < 30 kg/m2). Al no utilizarse una muestra aleatoria de sujetos, el cálculo de prevalencias y de sus errores estándar se corrigió mediante el uso de ponderaciones adecuadas. La comparación de las prevalencias entre dos ABS distintas para cada sexo se realizó utilizando un contraste paramétrico de diferencia de proporciones La comparación entre las prevalencias de un determinado grado del índice de Garrow, controlando por sexo y edad, se llevó a cabo utilizando una regresión logística j árquica. Resultados: La prevalencia de la obesidad se estimó en 15,6 por ciento entre los varones de 20 a 74 años (desde el 14,0 por ciento en Girona 1 hasta el 22,4 por ciento en Camprodon) y en un 17,5 por ciento entre las mujeres (un 15,6 por ciento en Girona 1 y un 22,7 por ciento en Camprodon), un 16,7 por ciento de promedio ponderado. La prevalencia del sobrepeso se sitúa en el 44 por ciento en varones y en un 33 por ciento en mujeres, un 37,8 por ciento de promedio ponderado. Existe una gradación en las prevalencias de la obesidad, con diferencias estadísticamente significativas: Girona 1, Salt, Girona 4, Camprodon y Sils (AU)

[Time series methods in epidemiological studies on air pollution]. / Métodos de series temporales en los estudios epidemiológicos sobre contaminación atmosférica.

The time series methods in the epidemiological studies on air pollution are reviewed, illustrated by means of an autoregressive Poisson regression which was employed in the APHEA and EMECAM Projects. A listing is provided of the variations in the daily number of deaths of people over age 70 (all causes, CIE-9:001-799) in Barcelona, 1991-1995, with the average variations in the daily smog pollution levels. A Poisson regression is used insofar as the dependent random variable presumably follows such a probability distribution. As variable possibly leading to confusion, the impact of weather variables (daily temperature and relative humidity averages), seasonal, tendency-related behaviours and day of the year on the death rate are taken into account (all estimated on a determinist basis), in addition to any other variable which behaves in a way that it can be related to the dependent variable (i.e. flu epidemics). The relationship between the death rate and the confusing-causing variables is modelled on a non-linear basis, and the foreseeable lag times are also taken into account (i.e. by using explicative variable time lags). However, due to control not being perfect, it has been decided to opt for estimating an autoregressive Poisson model (adding in some different explicative variables time giving rise to a lag in the death rate) offsetting the residual autocorrelation. The main advantage of the method of analysis described above is that of making it possible to control confusing variables from a determinist standpoint with a software to which all of the groups taking part in this Project had access. This also affords the possibility of using this method in a set, standardized manner, facilitating the comparison of results and making an objective point analysis possible.

[The EMECAM protocol: an analysis of the short-term effect of air pollution on mortality. Estudio Multicéntrico Español sobre la Relación entre la Contaminación Atmosférica u la Mortalidad]. / Protocolo EMECAM: análisis del effecto a corto plazo de la contaminacion atmosférica sobre la mortalidad.

The aim of this study is to Mortality show the protocol of analysis which was set out as part of the EMECAM Project, illustrating the application thereof to the effect of pollution has on the mortality in the city of Valencia. The response variables considered will be the daily deaths rate resulting from all causes, except external ones. The explicative variables are the daily series of different pollutants (black smoke, SO2, NO2, CO, O3). As possible confusion variables, weather factors, structural factors and weekly cases of flu are taken into account. A Poisson regression model is built up for each one of the four deaths series in two stages. In the first stage, a baseline model is fitted using the possible confusion variables. In the second stage, the pollution variables or the time legs thereof are included, controlling the residual autocorrelation by including mortality time lags. The process of fitting the baseline model is as follows: 1) Include the significant sinusoidal terms up to the sixth order. 2) Include the significant temperature or temperature squared terms with the time lags thereof up to the 7th order. 3) Repeat this process with the relative humidity. 4) Add in the significant terms of calendar years, daily tendency and tendency squared. 5) The days of the week as dummy variables are always included in the model. 6) Include the holidays and the significant time lags of up to two weeks of flu. Following the reassessment of the model, each one of the pollutants and the time lags thereof up to the fifth order are proven out. The impact is analyzed by six-month periods, including interaction terms.

[The short-term effects of air pollution on mortality. The results of the EMECAM project in the city of Barcelona, 1991-1995. Estudio Multicéntrico Español sobre la Relación entre la Contaminación Atmosférica y la Mortalidad]. / Efectos a corto plazo de la contaminación atmosférica sobre la mortalidad. Resultados del proyecto EMECAM en la ciudad de Barcelona, 1991-95.

BACKGROUND: Most of the studies which demonstrate the existence of a short-term relationship between air pollution and morbidity and the Mortality analyze the impact of "classic" pollutants which are by-products of combustion. However, the changes in the sources of these emissions, shifting basically toward road traffic, has made a change in air pollution, heightening the importance of the photochemical components, such as ozone (O3) and nitrogen dioxide (NO2). Barcelona is a city located in a mild climate zone, and its air pollution comes mainly from vehicle emissions. The main objective of this article is that of analyzing the relationship between the photochemical pollutants, NO2 and O3 and the death rate for different causes in the city of Barcelona throughout the 1991-1995 period, using the procedure for analysis set out as part of the EMECAM Project. METHODS: Daily changes in the number of deaths resulting from all causes, of the number of deaths for all causes of those over age 70, of the number of deaths resulting from cardiovascular diseases, and of the number of deaths resulting from respiratory-related causes are related to the daily changes in the photochemical pollutants using autoregressive Poisson models, controlling confusion-causing variables such as the temperature, the relative humidity, the systematic time structure and the autoregressive structure. RESULTS: Except for the relationship between O3 and the mortality for causes involving respiratory diseases, the relationships between photochemical pollutants and the mortality for all the causes considered were statistically significant. The risks related to dying as a result of rises in O3 were greater than as a result of rises in NO2, almost triple among cardiovascular diseases. The risks related to dying for all the causes are lower than for specific causes and than for those individuals over age 70. The results of the analysis by six-month periods are quite similar to the overall results, revealing, in any event, relative risks somewhat greater during the warm months (May to October). CONCLUSIONS: Photochemical pollution, especially that which is caused by O3, comprises a health risk. In the case of NO2, this might not be more than an indicators of the suspended particles or of other pollutants stemming from city traffic. There may be a certain adjustment between six-month periods of the impact of O3 on the mortality for causes of the circulatory system.

Sex differences in mortality of people who visited emergency rooms for asthma and chronic obstructive pulmonary disease.

We assess the sex differences in mortality in a population-based cohort of those Barcelona residents older than 14 yr of age who received emergency room services (ERS) for either chronic obstructive pulmonary disease (COPD) or asthma, during the period from 1985 to 1989. Vital status was followed to the end of 1995. A total of 15,517 individuals, 9,918 males and 5,599 females were included in the study. Asthma was diagnosed in 16% of males and 53% of females. Overall, 50% of males and 30% of females died during the follow-up period. The mortality rates in both males and females who visited emergency rooms for COPD or asthma were significantly higher than the expected rates in the general population. These relative increases in the mortality rates were significantly higher in females than in males for both causes of death, COPD (age-adjusted female/male ratio = 2.39), and asthma (ratio = 3.95). However, survival was better in females than males among individuals in the study. The higher fatality in males than females was observed for all causes of death, all respiratory causes, and COPD (risk ratio among patients with COPD = 0.42, 0.29-0.59, and among patients with asthma = 0.11, 0.02-0.60), but not for asthma. Mortality for asthma was higher in females with a diagnosis of COPD (2.79, 1.52-5.13), but it was not different among individuals in whom asthma was diagnosed (1.02, 0.56-1.87). Greater severity of COPD in males than in females could explain a higher risk of dying for all respiratory causes and COPD in males. The increased risk of asthma death in females may be due to problems of coding the term "asthma" in death certificates. The higher rates in females than in males when comparing with the general population, may be an expression of a greater similarity in risk factors, such as smoking, in our population than in males and females of the general population.

Risk factors for asthma in young adults. Spanish Group of the European Community Respiratory Health Survey.

We assessed the association of asthma prevalence in young adults with susceptibility factors and environmental exposures, taking into account the age at asthma onset. A random sample of the general population, aged 20-44 yrs, in five areas of Spain (Albacete, Barcelona, Galdakao, Huelva, and Oviedo) was selected in the frame of the European Community Respiratory Health Survey (ECRHS). Overall, 2,646 subjects (response rate = 60.9%) responded to a respiratory questionnaire and 1,797 (41.4%) finalized a bronchial challenge. Atopy to perennial (odds ratio (OR) = 10.2, 95% confidence interval 4.2-25) and seasonal allergens (11.5, 4.6-28), parental asthma (4.5, 2.5-8.4), and birth order (OR for no older siblings in comparison to having more than two = 3.2, 1.2-9.1) were associated with current asthma whatever the age of asthma onset. Past asthma was associated to a lesser extent with atopy (OR around 3.5 to both perennial and seasonal allergens). Lower respiratory tract infections before the age of 5 yrs (LRTI), having had a pet in childhood, and being born in a younger cohort were associated with asthma starting before the age of 15 yrs, but not after. Male gender was more frequent in childhood asthma and female gender in adulthood. In addition to the known risk factors of asthma (atopy to perennial allergens, parental asthma) we provide evidence for an association of asthma (whatever the age of onset) with sensitization to seasonal allergens, and having less than three older siblings; and for an association of childhood asthma with lower respiratory tract infections.