Identifying Clusters of Adherence to Cardiovascular Risk Reduction Behaviors and Persistence with Medication in New Lipid-Lowering Drug Users. Impact on Healthcare Utilization.

We sought to identify specific profiles of new lipid-lowering drug users based on adherence to a healthy lifestyle and persistence with medication, and to characterize co-morbidities, co-treatments, and healthcare utilization for each of the profiles identified. Observational study in 517 participants in the Aragon Workers' Health Study (AWHS) without previous cardiovascular disease (CVD) and who initiated lipid-lowering therapy. Data were collected from workplace medical examinations and administrative health databases (2010-2018). Using cluster analysis, we identified distinct patient profiles based on persistence with therapy and lifestyle. We then compared characteristics, morbidity, and healthcare utilization across clusters. Participants were aggregated into four clusters based on persistence with therapy, smoking status, adherence to Mediterranean diet, and physical activity. In cluster 1 (n = 113), comprising those with a healthiest lifestyle (14.2% smokers, 84.0% with medium-high adherence to Mediterranean diet, high physical activity), 16.8% were persistent. In cluster 3 (n = 108), comprising patients with the least healthy lifestyle (100% smokers, poor adherence to the Mediterranean diet, low level of physical activity), all were non-persistent. Clusters 2 (n = 150) and 4 (n = 146) both comprised patients with intermediate lifestyle behaviors, but differed in terms of persistence (100 and 0%, respectively). Compared with other clusters, the burden of morbidity, cardiovascular score, and healthcare utilization were lower in cluster 1. The healthy adherer effect was only observed in new lipid-lowering drug users of certain profiles. Furthermore, we found that differences in adherence to lifestyle and medication recommendations for CVD prevention influenced morbidity burden and healthcare utilization.

[Use of area-level socioeconomic indicators in epidemiological research: experience in Spain and advancement opportunities]. / Uso de indicadores socioeconómicos del área de residencia en la investigación epidemiológica: experiencia en España y oportunidades de avance.

OBJECTIVE: To determine the use of area-level socioeconomic indicators in epidemiological studies in Spain. METHODS: We included studies analyzing the association of area-level socioeconomic indicators and health indicators in Spain published in peer-reviewed journals. An electronic search was conducted in PubMed-Medline, SCI-Expanded, SSCI, Embase, and the Spanish Medical Index (until December 31, 2012). A manual search was also conducted of the references of the selected studies. Each of the articles initially selected on the basis of the title and abstract was reviewed by two investigators. Information was obtained on the publication and methodology (design and study areas, information sources, health and socioeconomic indicators, and statistical analysis). RESULTS: We included 142 studies published since 1988 (58.4% since 2005). More than half (59.9%) were in English. The level of analysis was ecological in 73.2% and multilevel in 19.0%. The areas most frequently analyzed were census tracts (35 studies), especially within cities or autonomous regions, followed by the provinces (30 studies), mostly concerning Spain overall. The dependent variable most frequently analyzed was mortality and the socioeconomic dimension most commonly used was employment (71.1%). CONCLUSIONS: In the last decade in Spain, there has been an increase in the number of studies examining the association of area-level socioeconomic and health indicators, as well as in the complexity of design and analysis.

Bayesian analysis of the geographical variation of type 1 diabetes mellitus in under 15 yr olds in northeast Spain, 1991-2009.

OBJECTIVE: High variability has been observed in type 1 diabetes mellitus (DM1) incidence rates (IRs) in childhood. The aim of this study was to characterize DM1 in Aragón and to identify variations in the geographical pattern by gender. METHODS: A descriptive and ecological study was conducted to determine geographical variations in the DM1 incidence for the period 1991-2009. The source of information was the registry of DM1. To determine data completeness, a capture-recapture analysis was performed. Cases were georeferenced according to the Basic Healthcare Area (BHA) of residence. IRs for both genders, age group, 5 yr of diagnosis, and 95% confidence intervals (95% CIs) were calculated. Geographical pattern was studied applying Bayesian statistical model. The standardized incidence ratios (SIRs), smoothed SIR, and the posteriori risk probability (PRP) were represented cartographically for BHA stratified by gender. RESULTS: The completeness was 93.5%. The global IR was 19.2 cases/10(5) person-years (95% CI: 17.6-20.8), boys 21.4 (95% CI: 19.0-23.8) and girls 16.8 (95% CI: 14.7-19.1). The age-specific rates were significantly lower in the 0-4 year age group with respect to the groups of 5-9 and 10-14 years. For boys, areas with a statistically significant excess of risk were found in the north [smoothed SIR: 118-167.9 and PRP of what the smoothed SIR would be greater than 100 (PRP) above 0.8] and below average risk in the south (smoothed SIR: 65.9-79.1 and PRP less than 0.2). CONCLUSIONS: DM1 IR presented a north-south geographical pattern in boys. This pattern was not observed in girls or when both genders were considered together. Later studies should include gender as an essential variable.