Healthy and unhealthy migrant effect on the mortality of immigrants from wealthy countries residing in Spain.

This study attempts to identify the possible existence of a healthy migrant effect and an unhealthy migrant effect on the mortality of immigrants from wealthy countries who move to Spain. Immigrants aged 35-64 years from France, Germany, Great Britain and 16 other wealthy OECD countries who resided in Spain were compared with respect to: (1) mortality from cancer, cardiovascular disease, and all other diseases and (2) employment status, duration of residence, and educational level, in two geographic areas: the "preferred destination area"-the Mediterranean coast, Balearic Islands and Canary Islands-and the rest of Spain. In general, cancer mortality was lower and mortality from cardiovascular disease was higher in immigrants who resided in the preferred destination area than in their countries of origin and than in immigrants who resided in the rest of Spain. Immigrants in the preferred destination area had a higher percentage of retired persons, longer time of residence and a lower percentage of persons with university education. The largest differences between the two areas in cardiovascular and all-disease mortality and in the frequency of the aforementioned sociodemographic characteristics were observed in British immigrants and those from the 16 OECD countries. Possible explanations for these findings are suggested which are compatible with the presence of an unhealthy and/or healthy immigrant bias in the two areas.

Mortalidad por enfermedades cardiovasculares en inmigrantes residentes en la Comunidad de Madrid / Mortality from cardiovascular diseases in immigrants residing in Madrid

Fundamento y objetivo: Estimar la mortalidad por enfermedades cardiovasculares entre inmigrantes residentes en una de las comunidades españolas con la tasa de inmigración más alta en los primeros años del siglo xxi. Población y método: Se estudió a la población de 20 a 64 años de edad residente en la Comunidad de Madrid en el período 2000-2004. La mortalidad por enfermedades cardiovasculares en los inmigrantes de diferentes partes del mundo se comparó con la mortalidad en la población autóctona española. Para ello se estimó la razón de tasas ajustada por edad, sexo y renta per cápita del lugar de residencia. Resultados: Los inmigrantes del África subsahariana mostraron la mayor razón de tasas de mortalidad por el conjunto de enfermedades cardiovasculares y por enfermedad isquémica del corazón, y los procedentes de América del Sur, la menor. La mayor razón de tasas de mortalidad por enfermedad cerebrovascular se observó en los inmigrantes de América Central y el Caribe. Conclusiones: El patrón de mortalidad por enfermedades cardiovasculares en la población inmigrante es muy similar al encontrado en investigaciones realizadas en otros países y probablemente refleje la carga de enfermedad en sus lugares de origen (AU)

Background and objective: To estimate the mortality from cardiovascular diseases in immigrants residing in one of the regions of Spain with the highest immigration rate during the early years of the 21st century. Population and method: The study included people aged 20 to 64 years of age residing in Madrid for the period 2000-2004. Mortality form cardiovascular disease in immigrants from different parts of the world was compared with the mortality in the native Spanish population. Mortality rates ratios adjusted for age, sex and per capita income in the area of residence were estimated. Results: Immigrants from Sub-Saharan Africa and from South America showed, respectively, the highest and the lowest mortality rate ratio of cardiovascular diseases and ischemic heart disease. Immigrants from the region of Central America and the Caribbean showed the highest mortality rate ratio of cerebrovascular disease. Conclusions: The pattern of cardiovascular disease mortality in immigrants residing in Madrid is quite similar to those found in studies made in other countries, and probably reflect the burden of disease in their places of origin (AU)

Heterogeneity in cause-specific mortality according to birthplace in immigrant men residing in Madrid, Spain.

PURPOSE: To evaluate whether mortality in immigrants in the region of Madrid (Spain) differs from mortality in Spanish in-country migrants. METHODS: Analyses of mortality in men aged 20 to 64 years residing in Madrid were conducted, using data from the municipal population register and the cause of death register for the period 2000 through 2004. Mortality rate ratios were used to compare mortality in immigrants from different parts of the world with mortality in men residing in Madrid who were born in other regions in Spain. RESULTS: After adjustment was made for age and per capita income of the area of residence, the highest mortality rate ratio for the leading causes of death by disease category was observed in immigrants from sub-Saharan Africa and the lowest in those from South America and Asia. In immigrants from Western countries and from North Africa, the mortality rate ratios for most of the diseases studied did not differ significantly from those of Spanish in-country migrants. In general, the mortality rate ratios for external causes of death were higher than 1, and they were very high for mortality from homicide. CONCLUSIONS: Mortality from the leading causes of death in immigrants shows important heterogeneity depending on the place of origin and, with some exceptions, shows a pattern similar to that observed in studies carried out in other wealthy countries.

Income in large residential areas and premature mortality in six countries of the European Union.

We study the relation between per capita income and mortality within six countries of the European Union - Finland, the Netherlands, Belgium, France, Italy and Spain - in 1981-1985 and 1996-2000. We obtained information on gross domestic product per capita (GDPpc) and mortality in large residential areas. The areas in each country were grouped in quintiles as a function of GDPpc. In 1996-2000, a negative gradient was seen in premature mortality from all causes in men and women in accordance with the GDPpc quintile, except in the Netherlands and in women in Finland. In Belgium, France, Italy and Spain, the impact of GDPpc on premature mortality was stronger in 1996-2000 than in 1981-1985. All six countries showed a negative gradient in premature mortality from cardiovascular disease by GDPpc. The pathways by which residential area with lower wealth is associated with higher mortality are probably related with investment in economic and social resources over time, although for some causes of death, this association is not seen in some countries due to specific historic and cultural circumstances.

Occupational social class and mortality in a population of men economically active: the contribution of education and employment situation.

This study examines how education and employment situation contribute to the association between a classification of occupational class based on skill assets and mortality from different causes of death. Data were obtained by linking records from the 1996 population census for Spanish men aged 35-64 residing in Madrid with 1996 and 1997 mortality records. The risk of mortality was higher in skilled, semi-skilled and unskilled workers than in higher and lower managerial and professional workers. Adjusting for educational level substantially decreased the magnitude of the gradient. The decrease in the gradient after adjusting for employment situation was much smaller. Except in the case of mortality from respiratory diseases, the mortality gradient disappeared after adjusting for both variables. These results show that education and, to a much lesser degree, employment situation explain part of the social gradient observed in mortality from all causes and from broad causes of death, except from respiratory diseases.

The size of educational differences in mortality from specific causes of death in men and women.

This study examines the association between education and mortality from specific causes of death based on mortality records for 1996 and 1997, and 1996 population census data from the Region of Madrid (Spain). Poisson regression models were used to estimate the percentage increase in mortality associated with 1 year less education. The percentage increases in mortality from stomach cancer, lung, bladder and liver cancers, for aids, chronic obstructive pulmonary disease, pneumonia and influenza, and chronic liver disease and cirrhosis were higher in men than in women, whereas the percentage increases in mortality from colon cancer, diabetes mellitus, ischemic heart disease and nephritis, nephrosis and nephrotic syndrome were higher in women. The results found for some causes of death--lung cancer, ischemic heart disease, diabetes mellitus and chronic obstructive pulmonary disease--reflect the variations by educational level in the prevalence of lifestyle-related risk factors in men and women. Various hypotheses have been suggested for other causes of death, but it is not known why the magnitude of the association between education and mortality from some causes of death differs between men and women. Future studies of this subject may provide some clues as to the underlying mechanisms of this association.

[Socioeconomic circumstances and premature mortality from chronic diseases]. / Circunstancias socioeconómicas y mortalidad prematura por enfermedades crónicas.

BACKGROUND AND OBJECTIVE: Our aim was to investigate the association between socioeconomic factors in childhood or adolescence and adulthood and premature mortality from various causes of death. SUBJECTS AND METHOD: Men and women aged 25-74 years residing on May 1, 1996, in the Autonomous Community of Madrid. For the next 19 months, information on individuals who died and the cause of death were obtained from the Mortality Register. We estimated the mortality from 5 types of cancer and from 4 chronic diseases by the educational level--as an indicator of the socioeconomic circumstances in childhood or adolescence--and by income--as an indicator of the socioeconomic circumstances in adulthood. RESULTS: When both variables were included in the analysis simultaneously, the relative mortality ratio for men with second grade first phase and lower educational level versus those with second grade, second phase and higher educational level and the relative mortality ratio for men belonging to income quartiles 3 and 4 (lowest) versus those belonging to quartiles 1 and 2 were, respectively: 1.15 (95% confidence interval 1.01-1.31) and 1.22 (1.09-1.36) for lung cancer; 1.46 (1.19-1,93) and 1.13 (0.90-1.41) for gastric cancer; 1.80 (1.32-2.44) and 1.46 (1.18-1.80) for chronic obstructive pulmonary disease; and 1.18 (0.77-1.81) and 0.68 (0.47-0.98) for diabetes mellitus. For women the relative mortality ratios were, respectively: 0.63 (0.43-0.92) and 0.72 (0.52-0.99) for lung cancer; 1.68 (0.99-2.83) and 1.17 (0.86-1.60) for gastric cancer; 0.76 (0.61-0.94) and 0.98 (0.82-1.16) for breast cancer; 1.36 (0.95-1.95) and 1.20 (0.97-1.48) for ischemic heart disease; 1.72 (1.19-2.50) and 0.93 (0.75-1.16) for stroke; and 2.23 (0.94-5.27) and 1.51 (1.02-2.25) for diabetes mellitus. CONCLUSIONS: Premature mortality in adulthood is associated with several socioeconomic factors acting across the whole course of life. The contribution of these socioeconomic circumstances to mortality varies regarding the cause of death and gender.

Trends in the association between average income, poverty and income inequality and life expectancy in Spain.

In this paper, we study the relation between life expectancy and both average income and measures of income inequality in 1980 and 1990, using the 17 Spanish regions as units of analysis. Average income was measured as average total income per household. The indicators of income inequality used were three measures of relative poverty-the percentage of households with total income less than 25%, 40% and 50% of the average total household income-the Gini index and the Atkinson indices with parameters alpha=1, 1.5 and 2. Pearson and partial correlation coefficients were used to evaluate the association between average income and measures of income inequality and life expectancy. None of the correlation coefficients for the association between life expectancy and average household income was significant for men. The association between life expectancy and average household income in women, adjusted for any of the measures of income inequality, was significant in 1980, although this association decreased or disappeared in 1990 after adjusting for measures of poverty. In both men and women, the partial correlation coefficients between life expectancy and the measures of relative income adjusted for average income were positive in 1980 and negative in 1990, although none of them was significant. The results with regard to women confirm the hypothesis that life expectancy in the developed countries has become more dissociated from average income level and more associated with income inequality. The absence of a relation in men in 1990 may be due to the large impact of premature mortality from AIDS in regions with the highest average total income per household and/or smallest income inequality.

Circunstancias socioeconómicas y mortalidad prematura por enfermedades crónicas / Socioeconomic circunstances and premature mortality from chronic diseases

FUNDAMENTO Y OBJETIVO: Investigar la asociación entre las circunstancias socioeconómicas de la infancia o adolescencia y de la etapa de adulto y la mortalidad prematura por varias causas de muerte. SUJETOS Y MÉTODO: Se incluyó a todos los varones y mujeres de 25 a 74 años residentes en la Comunidad Autónoma de Madrid el 1 de mayo de 1996. A partir del Registro de Mortalidad se obtuvo su estado vital durante los 19 meses siguientes y la causa de muerte en caso de fallecimiento. Se estimó la mortalidad por 5 tipos de cáncer y 4 enfermedades crónicas según el nivel de estudios -como indicador de las circunstancias socioeconómicas de la infancia o adolescencia- y según el nivel de ingresos económicos -como indicador de las circunstancias socioeconómicas en la etapa de adulto. RESULTADOS: Cuando se incluyeron simultáneamente ambas variables en el análisis, la razón de tasas de mortalidad en los varones con estudios de segundo grado, segundo ciclo y superiores frente a los varones con estudios de segundo grado, primer ciclo e inferiores y la razón de tasas de mortalidad de los varones perteneciente a los cuartiles inferiores de ingresos 3 y 4 frente a los varones pertenecientes a los cuartiles superiores de ingresos 1 y 2 fueron, respectivamente, 1,15 (intervalo de confianza [IC] del 95 por ciento, 1,01-1,31) y 1,22 (IC del 95 por ciento, 1,09-1,36) en cáncer de pulmón; 1,46 (1,19-1,93) y 1,13 (0,90-1,41) en cáncer de estómago; 1,80 (1,322,44) y 1,46 (IC del 95 por ciento, 1,18-1,80) en enfermedad pulmonar obstructiva crónica, y 1,18 (IC del 95 por ciento, 0,77-1,81) y 0,68 (IC del 95 por ciento, 0,47-0,98) en diabetes mellitus. Por su parte, esas razones de tasas de mortalidad en mujeres fueron, respectivamente, 0,63 (IC del 95 por ciento, 0,430,92) y 0,72 (IC del 95 por ciento, 0,52-0,99) en cáncer de pulmón; 1,68 (IC del 95 por ciento, 0,99-2,83) y 1,17 (IC del 95 por ciento, 0,86-1,60) en cáncer de estómago; 0,76 (IC del 95 por ciento, 0,61-0,94) y 0,98 (IC del 95 por ciento, 0,82-1,16) en cáncer de mama; 1,36 (IC del 95 por ciento, 0,95-1,95) y 1,20 (IC del 95 por ciento, 0,97-1,48) en enfermedad isquémica del corazón; 1,72 (IC del 95 por ciento, 1,19-2,50) y 0,93 (IC del 95 por ciento, 0,75-1,16) en enfermedad cerebrovascular, y 2,23 (IC del 95 por ciento, 0,94-5,27) y 1,51 (IC del 95 por ciento, 1,02-2,25) en diabetes mellitus. CONCLUSIONES: La mortalidad prematura durante la etapa de adulto se asocia a diversas circunstancias socioeconómicas a lo largo de la vida. La contribución de estas circunstancias a la mortalidad varía dependiendo de la causa de muerte y del sexo. (AU)

Unusually strong association between education and mortality in young adults in a community with a high rate of injection-drug users.

BACKGROUND: To examine the association between education and mortality for various causes of death in young adults in a community with a high rate of injection-drug users. METHODS: Linked mortality study based on mortality records for 1996 and 1997 and on 1996 population census data from the Region of Madrid (Spain). The association between educational level and mortality was estimated by the mortality rate ratio. RESULTS: After adjustment for age and other socioeconomic variables the mortality rate in men and women aged 25-44 years with no education was, respectively, 4.7 and 3.7 times higher than in men and women with the highest educational level. The causes of death with the strongest association were chronic liver disease and cirrhosis, AIDS and diseases of the heart in both sexes and suicide in men. For these causes of death the mortality rate ratio between persons with the lowest and highest educational level ranged from 6.8 to 21.8 in men and from 4.1 to 16.9 in women. CONCLUSIONS: These causes of death are the leading specific causes of death in persons aged 25-44 years. Given that probably a substantial part of deaths from diseases of the heart in this age category are drug-related, the common denominator of the excess mortality related poor education seems to be drug injection.

Comparing social inequalities in health in Spain: 1987 and 1995/97.

To evaluate the trend in social inequalities in health in Spain between 1987 and 1995/97, we carried out a secondary analysis of the Spanish National Interview Surveys from 1987, 1995 and 1997. We studied less-than-good perceived general health and four chronic conditions--heart disease, diabetes mellitus, chronic bronchitis/asthma and allergies--by social class and educational level in men and women aged 25-74 years. Among men, the age-adjusted prevalence rate ratio of less-than-good perceived general health by social class decreased from 1.32 to 1.23 between 1987 and 1995,97: however, the prevalence rate ratio by educational level increased from 1.47 to 1.57. Among women, the prevalence rate ratio of less-than-good perceived general health increased between the first and second period as much by social class from 1.18 to 1.26, as by educational level--from 1.59 to 1.66. For heart disease the age-adjusted prevalence rate ratio by social class among men was 1.12 in 1987 and 0.72 in 1995/97, while the prevalence rate ratio by educational level was around I in both periods, among women, the prevalence rate ratio for heart disease by social class was the same in 1987 and in 1995/97, but the prevalence rate ratio by educational level increased between the first and second period. For diabetes mellitus and chronic bronchitis/asthma, the prevalence rate ratio increased by social class and educational level between the first and second period in both men and women. Finally, the prevalence rate ratio for allergies was always < 1, although its magnitude increased between 1987 and 1995/97. In general, health inequalities were larger by educational level than by social class and were larger in women than in men. Inequalities in perceived general health, diabetes mellitus and chronic bronchitis/asthma increased in Spain between 1987 and 1995/97.

Infant mortality at time of birth and cause-specific adult mortality among residents of the Region of Madrid born elsewhere in Spain.

BACKGROUND: To investigate the association between infant mortality at time of birth and mortality from various causes of death in adulthood in men and women. METHODS: Linked mortality study based on mortality records for 1996 and 1997 and on 1996 population census data of the Region of Madrid (Spain). Deaths from five cancer sites and from five chronic diseases were estimated for 1 224 894 people aged 35-74 years residing in the Region of Madrid who were born elsewhere in Spain. RESULTS: A gradient in mortality by infant mortality quartile was seen for mortality from stomach cancer, colon cancer, diabetes mellitus and chronic liver disease in men, and for stomach cancer, ischaemic heart disease and chronic liver disease in women. The association was positive for stomach cancer and negative for all other causes. The relative mortality rates adjusted for age and adult socioeconomic factors for men belonging to infant mortality quartiles 3 and 4 (highest) versus those belonging to quartiles 1 and 2 as baseline were 1.06 (95% CI : 0.75-1.56) for stomach cancer, 0.67 (95% CI : 0.47-0.95) for colon cancer, 0.59 (95% CI : 0.35- 1.00) for diabetes mellitus, and 0.70 (95% CI : 0.49-0.99) for chronic heart disease. The relative mortality rates for women were 2.06 (95% CI : 1.09-3.88) for stomach cancer, 0.58 (95% CI : 0.41-0.80) for ischaemic heart disease, and 0.44 (95% CI : 0.27-0.70) for chronic liver disease. CONCLUSION: Higher infant mortality at time of birth is associated with adult mortality from diabetes mellitus and colon cancer in men, from ischaemic heart disease in women, and from stomach cancer and chronic liver disease in both sexes. These results most likely reflect adverse living conditions and/or nutritional deprivation in childhood.

[Failure in the control of the number of traffic accident victims in Spain. Is this a result of the correct answer to the wrong question?]. / Fracaso en el control del número de víctimas por accidentes de tráfico en España. La repuesta correcta a la pregunta equivocada?

Although various measures have been implemented in Spain with the aim to modifying the behavior of motor vehicle users, it has not been observed a descending trend in traffic accident and injuries from traffic accident. This article considers the question of whether the measures taken to reduce motor vehicle crash-related injuries in Spain have targeted the causes that are truly responsible for this trend. Using several sources of data, beginning in 1990 it has been observed a significant reduction in traffic accidents and their consequences, but in the second half of the 90s the growth in motor vehicle crash-related injuries was similar to the increase observed in the 80s. Likewise per capita alcohol consumption shows a downward trend from 1980 while the number of injuries has been strong associated with the economic cycle during the last twenty years. We conclude pointing out that intervention measures to control this problem in Spain have focused mainly on modifying behaviour that increases the risk and severity of traffic accident injuries and have ignored the macro-economic determinants that explain the trend in the frequency of this health problem.

Fracaso en el control del número de víctimas por accidentes de tráfico en España. ¿La repuesta correcta a la pregunta equivocada? / Failure in the Control of Traffic Crash-Related Injuries in Spain: The Right Answer for the Wrong Question?

En España se han puesto en marcha diferentes medidas de intervención con el objeto de modificar la práctica de los conductores de vehículos de motor, sin embargo no se ha observado una tendencia descendente ni en la tasa de accidentes de tráfico ni en el número de víctimas relacionadas con los mismos. Este artículo se plantea el interrogante de si las medidas tomadas para reducir el número de víctimas por accidente de tráfico se han dirigido realmente hacia las causas responsables de esa tendencia. Utilizando diversas fuentes de datos se observa que en España al comienzo de los años noventa se produjo una importante reducción de la tasa de accidentes de tráfico y sus consecuencias, pero en la segunda mitad de la misma década el incremento en la tasa de lesiones por accidentes de tráfico fue similar al producido en los años ochenta. Igualmente se observa que desde 1980 el consumo per cápita de alcohol ha mostrado una tendencia descendente y que el número de lesiones por accidente de tráfico durante los últimos veinte años ha estado fuertemente asociado al ciclo económico. Se concluye señalando que las medidas para el control de este problema en España se han centrado principalmente en la modificación de la conducta que incrementa el riesgo y severidad de las lesiones por accidente de tráfico, pero se han ignorado los determinantes macroeconómicos que explican la tendencia de la frecuencia de este problema de salud (AU)

Mortalidad según características sociales y económicas: estudio de mortalidad de la Comunidad Autónoma de Madrid / Mortality by social and economic characteristics: The Mortality Study of the Autonomous Community of Madrid, Spain

FUNDAMENTO: Estimar el efecto del estado civil, el número de miembros del hogar, la situación laboral, el nivel de estudios y la ocupación sobre la mortalidad. SUJETOS Y MÉTODO: Alrededor de 3.100.000 personas mayores de 24 años de edad residentes en la Comunidad Autónoma de Madrid el 1 de mayo de 1996. A partir del Registro de Mortalidad se obtuvo de cada uno de esos individuos su estado vital durante los 19 meses siguientes mediante la conexión de la información de este registro con la información de los residentes contenida en la Estadística de Población de 1996. RESULTADOS: A excepción del número de miembros del hogar, el efecto sobre la mortalidad de las características analizadas fue mayor en el grupo de 25 a 44 años que en otros grupos de edad. En general, los casados experimentaron la menor mortalidad, excepto en varones mayores de 64 años, en quienes la mortalidad más baja la presentaron los solteros. Los varones de 45 a 64 años que vivían solos tuvieron mayor mortalidad que los que vivían acompañados, mientras que en las personas mayores de 64 años la mortalidad aumentó con el número de miembros del hogar. La población inactiva presentó mayor mortalidad que la población activa. Un mayor nivel de estudios y una mayor cualificación profesional se asociaban con una menor mortalidad, excepto en mujeres de 45 a 64 años. CONCLUSIONES: Este estudio ha identificado a grupos de población con alto riesgo de mortalidad. La monitorización de la tendencia de mortalidad en esos grupos permitirá sentar las bases racionales a la hora de llevar a cabo programas de intervención sociosanitaria (AU)

Evolución de las diferencias socioeconómicas en la utilización y accesibilidad de los servicios sanitarios en españa entre 1987 y 1995/97 / Evolution of the socio-economic differences in the use and accessibility of health services in Spain between 1987 and 1995-97

Fundamento: El objetivo del presente trabajo es evaluar la evolución de la utilización y accesibilidad de los servicios sanitarios en España, entre 1987 y 1995/1997, en grupos con diferentes características socioeconómicas.Métodos: Los datos utilizados proceden de las Encuestas Nacionales de Salud realizadas por el Ministerio de Sanidad y Consumo a la población adulta en los años 1987, y 1995/1997.Se ha agregado la información de 1995 y 1997 debido al diferente tamaño muestral, de forma que las estimaciones así obtenidas son una media de ambas. La población analizada ha sido la de los individuos mayores de 24 años de edad. Se han estudiado la consulta médica, la hospitalización, la consulta al dentista y la consulta al ginecólogo, el tiempo invertido en llegar a la consulta, el tiempo de espera en la misma y el tiempo de espera para un ingreso hospitalario ordinario. Las características socioeconómicas utilizadas han sido el nivel de estudios y el grupo socioeconómico de los entrevistados. La medida de la asociación estimada entre la utilización de servicios y las características socioeconómicas fue la razón de porcentajes, mediante regresión binomial. Igualmente, se estimó el índice relativo de desigualdad como medida resumen de la desigualdad.Resultados: La consulta médica fue más frecuente en los individuos sin estudios y en los grupos socioeconómicos bajos, en uno y en otro período, mientras que la consulta al dentista y la consulta al ginecólogo fueron más frecuentes en los individuos con estudios superiores y en los grupos socioeconómicos altos en ambos períodos. No se encontraron diferencias socioeconómicas estadísticamente significativas en la frecuencia de hospitalización en ambos períodos. Tanto en 1987 como en 1995/1997 no se hallaron diferencias estadísticamente significativas entre los distintos grupos socioeconómicos en el tiempo de llegada a la consulta (p > 0,05), pero sí en el tiempo de espera en la consulta (p < 0,05). En el segundo período desaparecieron las diferencias socioeconómicas en el tiempo de espera para ingreso hospitalario ordinario que se observaron en el primer período. Conclusiones: En la segunda mitad de los años noventa se observa el mismo perfil socioeconómico en la utilización de los servicios sanitarios y en los tiempos de espera para acceder a los mismos que en la segunda mitad de los años ochenta, con la excepción del tiempo de espera para ingreso hospitalario ordinario en el segundo período (AU)

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