Ingresos hospitalarios en el área de la Bahía de Algeciras. Comparación con Andalucía y España (2001-2005) / Hospital admissions in Bahía de Algeciras (Cádiz, Spain). Comparison with the rest of Andalusia and Spain (2001-2005)

Objetivos Describir los ingresos hospitalarios en la Bahía de Algeciras en el periodo de 2001 a 2005, comparándolos con el resto de Andalucía y con España, y relacionándolos con las más frecuentes enfermedades que producen un exceso de mortalidad prematura en esta área. Métodos El estudio, de tipo transversal, ha utilizado como población a los residentes de los municipios de la Bahía de Algeciras. Esta información se obtuvo del Censo de población y viviendas del año 2001. Se compararon las tasas promedio anuales ajustadas por edad de los ingresos hospitalarios de la Bahía de Algeciras (2001-2005) con los de Andalucía y España, mediante las razones y las diferencias de las tasas ajustadas. Se relacionaron los ingresos hospitalarios y la mortalidad prematura mediante los riesgos relativos de las causas más importantes. Resultados La Bahía de Algeciras presenta unos menores ingresos hospitalarios y un exceso de mortalidad prematura en la mayoría de las principales afecciones estudiadas, destacando el grupo de las enfermedades circulatorias, con unos riesgos relativos para los ingresos hospitalarios de 0,79 en hombres y 0,87 en mujeres, y para la mortalidad prematura de 1,39 y 1,70, respectivamente. Por grupos específicos destacan la diabetes en ambos sexos y la enfermedad vascular cerebral y la cirrosis hepática en los hombres. Conclusiones Se ha constatado una menor utilización de los servicios hospitalarios en un área con un mayor riesgo de muertes prematuras por importantes enfermedades. Se recomienda seguir estudiando la situación real de riesgo y los posibles determinantes socioeconómicos y ambientales de la zona(AU)

Objectives To describe hospital admissions data in the Bay of Algeciras from 2001 to 2005 compared with the rest of Andalusia and Spain and to analyze the relationship between these data and the most frequent diagnoses leading to excessive premature mortality in this area. Methods We carried out a cross-sectional study. The study population consisted of the residents of the municipalities of the Bay of Algeciras, obtained from the Population and Household Census of 2001. Age-adjusted annual average hospital admission rates were compared between the Bay of Algeciras (2001-2005) and the rest of Andalusia and Spain using the relative and attributable risk. Hospital admissions and premature mortality rates were compared by means of the relative risk of the most important causes. Results Hospital admissions in the Bay of Algeciras were significantly lower for most of the diagnoses studied. There was also excessive premature mortality, especially for circulatory diseases (RR for hospital admissions: 0.79 in men and 0.87 in women; RR for premature mortality: 1.39 in men and 1.70 in women). Notable specific diseases were diabetes in both genders and cerebrovascular disease and liver cirrhosis in men. Conclusions This study found a lower use of healthcare services and a higher risk of premature mortality due to severe diseases in this region. Further studies analyzing the potential socioeconomic and environmental determinants of the area are required (AU)

[Hospital admissions in Bahía de Algeciras (Cádiz, Spain). Comparison with the rest of Andalusia and Spain (2001-2005)]. / Ingresos hospitalarios en el área de la Bahía de Algeciras. Comparación con Andalucía y España (2001-2005).

OBJECTIVES: To describe hospital admissions data in the Bay of Algeciras from 2001 to 2005 compared with the rest of Andalusia and Spain and to analyze the relationship between these data and the most frequent diagnoses leading to excessive premature mortality in this area. METHODS: We carried out a cross-sectional study. The study population consisted of the residents of the municipalities of the Bay of Algeciras, obtained from the Population and Household Census of 2001. Age-adjusted annual average hospital admission rates were compared between the Bay of Algeciras (2001-2005) and the rest of Andalusia and Spain using the relative and attributable risk. Hospital admissions and premature mortality rates were compared by means of the relative risk of the most important causes. RESULTS: Hospital admissions in the Bay of Algeciras were significantly lower for most of the diagnoses studied. There was also excessive premature mortality, especially for circulatory diseases (RR for hospital admissions: 0.79 in men and 0.87 in women; RR for premature mortality: 1.39 in men and 1.70 in women). Notable specific diseases were diabetes in both genders and cerebrovascular disease and liver cirrhosis in men. CONCLUSIONS: This study found a lower use of healthcare services and a higher risk of premature mortality due to severe diseases in this region. Further studies analyzing the potential socioeconomic and environmental determinants of the area are required.

Análisis epidemiológico de la mortalidad por causas en la Bahía de Algeciras (2001–2005) / Epidemiological analysis of mortality by causes in Bahía de Algeciras, Spain (2001–2005)

ObjetivosAnalizar la mortalidad general y prematura por causas de los habitantes de la Bahía de Algeciras, un área particularmente expuesta a la contaminación atmosférica.MétodosSe comparan las tasas ajustadas por edad y las tasas de años potenciales de vida perdidos de 1 a 70 años, por sexo y por causas, del área estudiada (años 2001 a 2005), con el resto de Andalucía (años 2001 a 2005) y el conjunto de España (año 2003) mediante la razón de las tasas (riesgo relativo) y su intervalo de confianza del 95% (IC95%), y las diferencias de las tasas (riesgo atribuible).ResultadosSe encuentra un exceso de mortalidad general y prematura estadísticamente significativo en los hombres y las mujeres de la Bahía de Algeciras, una zona próxima al estrecho de Gibraltar que soporta unos altos niveles de contaminación atmosférica. El riesgo relativo de la mortalidad prematura en los hombres es de 1,16 (IC95%: 1,15–1,17) respecto a Andalucía y de 1,30 (IC95%: 1,29–1,32) respecto a España, y en las mujeres es de 1,17 (IC95%: 1,15–1,19) y 1,24 (IC95%: 1,22–1,26), respectivamente. De los grandes grupos de causas estudiados destaca el mayor riesgo de muerte por enfermedades infecciosas y parasitarias, respiratorias y tumores malignos. Por causas específicas, sobresalen la isquemia cardiaca y los tumores mal definidos en ambos sexos. En los hombres destaca la sobremortalidad general y prematura de los tumores de traquea, bronquio y pulmón, vejiga urinaria y cirrosis hepática.ConclusionesSe constata un mayor riesgo de mortalidad general y prematura en los hombres y las mujeres de la Bahía de Algeciras, una zona con elevada concentración industrial y contaminación atmosférica. Se propone continuar con investigaciones específicas y plantear actuaciones concretas encaminadas a promover un desarrollo económico sostenible(AU)

ObjectiveTo analyze general mortality and premature mortality by cause in the population of Bahía de Algeciras, an area particularly exposed to air pollution.MethodsAge-adjusted mortality rates and potential years of life lost (PYLL) rates, by gender and by cause, were compared in the area studied (2001–2005), Andalusia (2001–2005) and Spain as a whole (2003) by using the ratio for mortality rates (relative risk) and its 95% confidence intervals (95%CI) and the differences between the rates (attributable risk).ResultsStatistically significant, high general and premature mortality were found in males and females in Bahía de Algeciras, an area near the Strait of Gibraltar, which is exposed to high levels of air pollution. The relative risk of premature mortality in males with respect to Andalusia was 1.16 (95%CI: 1.15–1.17) and with respect to Spain as a whole was 1.30 (95%CI: 1.29–1.32); in females this rate was 1.17 (95%CI: 1.15–1.19) and 1.24 (95%CI: 1.22–1.26), respectively. A high risk of death from infectious and parasitic diseases, diseases of the respiratory system and malignant tumors was observed. By specific causes, excess mortality due to ischemic heart disease and ill-defined tumors was found in both genders. In males, excess general and premature mortality due to tracheobronchopulmonary cancer, bladder cancer and cirrhosis of the liver were observed.ConclusionsThe present study found a greater risk of general and premature mortality in males and females in Bahía de Algeciras, an area with high industrial concentration and air pollution. We propose to continue with specific investigations in the area and to suggest precise actions aimed at promoting sustainable economic development(AU)

[Epidemiological analysis of mortality by causes in Bahía de Algeciras, Spain (2001-2005)]. / Análisis epidemiológico de la mortalidad por causas en la Bahía de Algeciras (2001-2005).

OBJECTIVE: To analyze general mortality and premature mortality by cause in the population of Bahía de Algeciras, an area particularly exposed to air pollution. METHODS: Age-adjusted mortality rates and potential years of life lost (PYLL) rates, by gender and by cause, were compared in the area studied (2001-2005), Andalusia (2001-2005) and Spain as a whole (2003) by using the ratio for mortality rates (relative risk) and its 95% confidence intervals (95%CI) and the differences between the rates (attributable risk). RESULTS: Statistically significant, high general and premature mortality were found in males and females in Bahía de Algeciras, an area near the Strait of Gibraltar, which is exposed to high levels of air pollution. The relative risk of premature mortality in males with respect to Andalusia was 1.16 (95%CI: 1.15-1.17) and with respect to Spain as a whole was 1.30 (95%CI: 1.29-1.32); in females this rate was 1.17 (95%CI: 1.15-1.19) and 1.24 (95%CI: 1.22-1.26), respectively. A high risk of death from infectious and parasitic diseases, diseases of the respiratory system and malignant tumors was observed. By specific causes, excess mortality due to ischemic heart disease and ill-defined tumors was found in both genders. In males, excess general and premature mortality due to tracheobronchopulmonary cancer, bladder cancer and cirrhosis of the liver were observed. CONCLUSIONS: The present study found a greater risk of general and premature mortality in males and females in Bahía de Algeciras, an area with high industrial concentration and air pollution. We propose to continue with specific investigations in the area and to suggest precise actions aimed at promoting sustainable economic development.

Enfermedad meningocócica e impacto de la vacunación sistemática con la vacuna conjugada antimeningocócica C en un área sanitaria de Andalucía / Impact of systematic vaccination with the antimeningococcal C conjugated vaccine in a health area in Andalusia

Fundamento: En la Comunidad Autónoma de Andalucía,comenzó en julio de 2000 la vacunación con vacuna conjugada antimeningocócicaC de todos los niños nacidos con posterioridad al 1 deenero de 1995, y en septiembre de 2001 se amplíó a los nacidos a partirdel 1 de enero de 1991, esto es, hasta los 10 años de edad. El objetivode este trabajo es valorar la efectividad de esta vacuna tras suintroducción masiva en los niños del área geográfica de un distritosanitario, midiendo su impacto.Métodos: Mediante un estudio longitudinal retrospectivo deincidencia poblacional se calculan las coberturas vacunales de losniños nacidos entre los años 1991 y 2001 y las tasas de incidencia delos casos declarados de enfermedad meningocócica en siete temporadasepidemiológicas (1997/98 a 2003/04). El impacto de la vacunaciónfrente a la meningitis del serogrupo C se calcula comparandolas tasas promedios anuales de las temporadas previas y posterioresa las campañas de vacunación en la población menor y mayor de 10años, utilizando el test exacto de Fisher.Resultados: En el periodo de estudio se declararon 109 casos deenfermedad meningocócica, de los que 50 eran de meningitis C. Apartir de la temporada 2000-2001 descendió la incidencia de meningitisC en los niños menores de 10 años. En este grupo de edad seencuentran diferencias significativas entre las tasas promedio anualde las temporadas prevacunales y postvacunales (de 8,2 a 2,0 por100.000 habitantes). En la población mayor de 10 años no se observaeste descenso en la incidencia. En el periodo de estudio no se hadeclarado ningún caso de fallo vacunal.Conclusiones: La ausencia de fallos vacunales y la disminuciónde la incidencia de enfermedad meningocócica C en los niños menoresde 10 años sugiere la buena efectividad de esta nueva vacuna conjugadafrente al meningococo C

Background: A retrospective longitudinal study of populationincidence was made to assess the effectiveness of meningococcalserogroup C conjugate vaccine, after its mass introduction in childrenin the geographic area of a health district, measuring its populationimpact, and we have studied the state of the meningococcaldisease.Methods: Vaccine coverage in children born between 1991 and2001, and rates of incidence in declared cases of meningococcaldisease in seven epidemiological seasons (1997/98 to 2003/04) werecalculated. The impact of vaccination against serogroup C meningitiswas assessed comparing the average annual rates of previous andlater seasons to the vaccination campaigns in population youngerand older than 10, using the Fisher exact test.Results: In all the study period, 109 cases of meningococcaldisease were declared, of which 50 were of serogroup C meningococcaldisease. Starting from 2000/2001 season the incidence ofserogroup C disease decreased in the population below 10. In thisage group, the annual average rate of post-vaccine seasons decreasesin respect to pre-vaccine (from 8.2 to 2.0 per 100,000 inhabitants)showing a statistically significant difference. In the population above10 years, this incidence reduction was not observed. In the studyperiod, no case of vaccine failure was declared.Conclusions: The absence of vaccine failure and the impactobserved on the incidence of serogroup C meningococcal disease inchildren under 10 suggests the effectiveness of this new conjugatevaccine, together with suitable vaccination conditions (vaccinationschedule, high catch-up, etc.) which are developing in our health district

[Impact of systematic vaccination with the antimeningococcal C conjugated vaccine in a health area in Andalusia]. / Enfermedad meningocócica e impacto de la vacunación sistemática con la vacuna conjugada antimeningocócica C en un área sanitaria de andalucía.

BACKGROUND: A retrospective longitudinal study of population incidence was made to assess the effectiveness of meningococcal serogroup C conjugate vaccine, after its mass introduction in children in the geographic area of a health district, measuring its population impact, and we have studied the state of the meningococcal disease. METHODS: Vaccine coverage in children born between 1991 and 2001, and rates of incidence in declared cases of meningococcal disease in seven epidemiological seasons (1997/98 to 2003/04) were calculated. The impact of vaccination against serogroup C meningitis was assessed comparing the average annual rates of previous and later seasons to the vaccination campaigns in population younger and older than 10, using the Fisher exact test. RESULTS: In all the study period, 109 cases of meningococcal disease were declared, of which 50 were of serogroup C meningococcal disease. Starting from 2000/2001 season the incidence of serogroup C disease decreased in the population below 10. In this age group, the annual average rate of post-vaccine seasons decreases in respect to pre-vaccine (from 8.2 to 2.0 per 100,000 inhabitants) showing a statistically significant difference. In the population above 10 years, this incidence reduction was not observed. In the study period, no case of vaccine failure was declared. CONCLUSIONS: The absence of vaccine failure and the impact observed on the incidence of serogroup C meningococcal disease in children under 10 suggests the effectiveness of this new conjugate vaccine, together with suitable vaccination conditions (vaccination schedule, high catch-up, etc.) which are developing in our health district.

Study of the immune response engendered by differents combined measles, mumps and rubella (MMR) vaccines in an area of Andalusia (Spain).

The objective of the study is to evaluate and compare the degree of serological protection conferred by the three components of two MMR vaccines: "Vac triple MSD" (Aventis Pasteur MSD) and "Triviraten" (Berna), and to study the effects of a second dose of "Priorix" (Glaxo SmithKline), in an unprotected population. In March 2001, this study was conducted in a sample of 86 children aged 3 and 4 years, in two Basic Health Zones of Cádiz (Spain). Mumps, measles and rubella antibody titers were evaluated by IgG enzyme linked immunosorbent assay (ELISA). All the children showing lack of response were revaccinated with the vaccine "Priorix" of GSK; in 12 of these children (all vaccinated previously with "Triviraten"), studies confirmed the existence of seroconversion utilizing the same methodology. The most outstanding finding has been the low percentage of children vaccinated with "Triviraten" possessing protective titers (>1:500) against mumps (14.3%) compared with those vaccinated with "Vac triple MSD" (81.1%, P<0.000001); geometric mean values (GMT) of 164 and 1631, respectively, were obtained. Significant differences, and in the same direction, were also found in respect of measles (83.7 and 100%, and GMT of 889 and 5076), although not so striking. However, all the children studied did have protective titres (>16UI/ml) of antibodies against rubella. Of the 12 children studied who had not responded with protective titers of anti-mumps antibodies, eight children (66.7%) showed seroconversion with "Priorix", and only one child (25%) presented seroconversion in the response to measles. We have thus proved that the "Rubini" strain provides insufficient protection against mumps in our child population. We have also found that the "Edmonston-Zagreb" strain confers less protection against measles than the "Enders" strain, although the "Schwarz" strain, after revaccination of the children who had failed with the "Edmonston-Zagreb" strain, did not achieve a satisfactory seroconversion, either.