Obesity in Pregnancy as a Risk Factor in Maternal and Child Health-A Retrospective Cohort Study.

The prevalence of overweight and obesity has risen dramatically in the last few years. This has led to an increase in both conditions in pregnant women. Obesity and overweight are associated with complications for both the mother and the newborn. The aim of this study is to determine the prevalence of obesity and its association with the risk of complications during pregnancy. Materials and Methods: We conducted a retrospective cohort study of pregnant women who delivered from 1 January 2012 to 31 December 2018. Results: A higher prevalence of obesity is observed in the group of women aged 35 or older. Women with a BMI > 25 present a higher risk of cesarean section (aOR 1.49, 95% CI: 1.37-1.61), preeclampsia (aOR 1.64, 95% CI: 1.19-2.26), high-risk pregnancy (aOR 2.34, 95% CI: 1.68-2.6), Apgar < 7 at one minute (aOR 1.53, 95% CI: 1.25-1.89) and macrosomia (aOR 2.08, 95% CI: 1.83-2.37). Maternal overweight and obesity are important determinants of the risk of complications for both the mother and the newborn.

Prevalence, risk factors, and consequences of hypothyroidism among pregnant women in the health region of Lleida: A cohort study.

BACKGROUND: Primary maternal hypothyroidism is defined as the increase of TSH levels in serum during pregnancy. Hypothyroidism in pregnancy is the second most common endocrine disease, after diabetes mellitus, with a prevalence ranging between 3.2 and 5.5%. Its variability depends on ethnical differences. Hypothyroidism in pregnancy is associated with other chronic diseases and fetal and maternal outcomes. OBJECTIVE: To analyze the prevalence of hypothyroidism among multiethnic pregnant women, and to evaluate the comorbidity with chronic diseases and outcomes leaded during pregnancy and newborn. METHODS: Retrospective observational cohort study in pregnant women during the years 2012-2018 in the health region of Lleida. The relationship of hypothyroidism with different variables was analyzed by calculating the adjusted odds ratio (aOR) and the 95% confidence intervals (CI) with multivariate logistic regression models. RESULTS: We analyzed a sample of 17177 pregnant women, which represents more than 92% of the total of pregnant women in the health region of Lleida. The annual prevalence of hypothyroidism was 5.7-7.1%. According to the region of origin, the lowest prevalence was found in the population from Sub Saharian Africa (2.1%), while the highest was from Asia and the Middle East (8.6%). Other factors associated with hypothyroidism were age, hypertension, diabetes mellitus, and dyslipidemia. In addition, we did not observe an effect of hypothyroidism on the course of pregnancy, childbirth, and on the newborn. Finally, there was a good control of the disease during pregnancy. CONCLUSIONS: The prevalence of hypothyroidism in pregnancy was 6,5% in this study which depends on the country of origin, lower values were found in Sub Saharian African women and higher in those from Asia and the Middle East. Hypothyroidism was associated with age, diabetes mellitus, arterial hypertension, or dyslipidemia, and was not related to the Apgar score or the weight of the newborn.

Ethnic Disparities and Obesity Risk Factors in Pregnant Women: A Retrospective Observational Cohort Study.

(1) Background: This article focuses on the prevalence of overweight and obesity in pregnancy in different ethnic groups and assesses the existence of associated comorbidities. (2) Materials and Methods: A retrospective observational cohort study of 16803 pregnant women was carried out between 2012 and 2018 in the health region of Lleida (72% of the total). The relationship between overweight and obesity and different variables was analyzed by calculating the adjusted odds ratio (aOR) and 95% confidence intervals with multivariate logistic regression models. (3) Results: The prevalence of obesity in pregnant women rose from 11.1% in 2012 to 13.4% in 2018, and there was an age-related weight gain. A high incidence of overweight and obesity was recorded in pregnant women from ethnic groups: Maghrebi, sub-Saharan African and Latin America populations presented ORs of 4.08, 3.18 and 1.59, respectively. Hypertension was the variable most affected by body mass index (BMI) > 25 (OR = 3.39) followed by gestational diabetes mellitus (OR = 2.35). Depression was also associated with obesity. (4) Conclusions: The BMI of pregnant women is influenced by individual, ethnic and clinical factors. Mental health conditions such as depression are associated with BMI.

Estudio observacional del gasto farmacéutico en población inmigrante y autóctona de la región sanitaria de Lleida (Cataluña) / Observational study on drug spending in the immigrant and the indigenous population in the Lleida (Catalonia) health region

ObjetivosAnalizar si hay diferencias en el gasto farmacéutico entre inmigrantes y autóctonos en la población general y si el ámbito de residencia (urbano/rural) está asociado al gasto en farmacia.DiseñoEstudio observacional transversal.EmplazamientoRegión Sanitaria Lleida.ParticipantesSe estudiaron 22.847 inmigrantes y 174.768 autóctonos de 15 a 64 años de edad, residentes en la Región Sanitaria Lleida.Mediciones principalesGasto en farmacia durante el año 2007, variables demográficas, zona de procedencia y área de residencia (urbana/rural).ResultadosEn todos los grupos terapéuticos, los individuos autóctonos gastaron más que los inmigrantes. En los hombres, la ratio de riesgo relativo de estar en el cuartil superior de gasto era de 3,2 (ICntervalo de confianza [IC] 95%: 2,96–3,44) en autóctonos respecto a inmigrantes y en las mujeres era de 2,1 (IC 95%: 1,97–2,27). Los inmigrantes de Europa del Este eran los que tenían un riesgo inferior de realizar gasto farmacéutico elevado (último cuartil), con diferencias estadísticamente significativas. Los residentes en el medio rural tenían riesgo superior de realizar gasto farmacéutico elevado respecto a los residentes en el medio urbano.ConclusiónSe observaron desigualdades en el gasto en medicamentos entre inmigrantes y autóctonos. Futuros estudios, cualitativos o mixtos, deberían indagar qué factores se asocian a estas diferencias y proponer acciones dirigidas a reducirlas(AU)

ObjectiveTo evaluate whether there are differences in drug spending between immigrant and Spanish-born populations and to assess whether drug consumption is associated with living environment (urban/rural).DesignObservational cross-sectional study.SettingLleida Health Region (LHR).Participants22,847 immigrants and 174,768 native born subjects, aged 15 to 64 years, residing in the LHR.Main measurementsDrug spending during the year 2007, demographical variables, region of origin and residence area (urban/rural).ResultsNative-born subjects spent more in all therapeutic drug groups than immigrants. In men, the relative risk ratio (RRR) of being in the highest quartile of expenditure was 3.2 (95% CI: 2.96–3.44) for native born versus immigrant and in women it was 2.1 (95% CI: 1.97–2.27). Immigrants from eastern Europe had the lowest risk of being in the highest quartile of expenditure, with statistically significant differences. Residents in the rural environment were more likely to have a higher pharmaceutical consumption than residents in the urban environment.ConclusionInequalities in drug spending were observed between immigrants and native born subjects. Further studies, either qualitative or mixed, should explore which factors are related to these differences and propose strategies addressed to reducing them(AU)

[Observational study on drug spending in the immigrant and the indigenous population in the Lleida (Catalonia) health region]. / Estudio observacional del gasto farmacéutico en población inmigrante y autóctona de la región sanitaria de Lleida (Cataluña).

OBJECTIVE: To evaluate whether there are differences in drug spending between immigrant and Spanish-born populations and to assess whether drug consumption is associated with living environment (urban/rural). DESIGN: Observational cross-sectional study. SETTING: Lleida Health Region (LHR). PARTICIPANTS: 22,847 immigrants and 174,768 native born subjects, aged 15 to 64 years, residing in the LHR. MAIN MEASUREMENTS: Drug spending during the year 2007, demographical variables, region of origin and residence area (urban/rural). RESULTS: Native-born subjects spent more in all therapeutic drug groups than immigrants. In men, the relative risk ratio (RRR) of being in the highest quartile of expenditure was 3.2 (95% CI: 2.96-3.44) for native born versus immigrant and in women it was 2.1 (95% CI: 1.97-2.27). Immigrants from eastern Europe had the lowest risk of being in the highest quartile of expenditure, with statistically significant differences. Residents in the rural environment were more likely to have a higher pharmaceutical consumption than residents in the urban environment. CONCLUSION: Inequalities in drug spending were observed between immigrants and native born subjects. Further studies, either qualitative or mixed, should explore which factors are related to these differences and propose strategies addressed to reducing them.

Emergency hospital services utilization in Lleida (Spain): A cross-sectional study of immigrant and Spanish-born populations.

BACKGROUND: The use of emergency hospital services (EHS) has increased steadily in Spain in the last decade while the number of immigrants has increased dramatically. Studies show that immigrants use EHS differently than native-born individuals, and this work investigates demographics, diagnoses and utilization rates of EHS in Lleida (Spain). METHODS: Cross-sectional study of all the 96,916 EHS visits by patients 15 to 64 years old, attended during the years 2004 and 2005 in a public teaching hospital. Demographic data, diagnoses of the EHS visits, frequency of hospital admissions, mortality and diagnoses at hospital discharge were obtained. Utilization rates were estimated by group of origin. Poisson regression was used to estimate the rate ratios of being visited in the EHS with respect to the Spanish-born population. RESULTS: Immigrants from low-income countries use EHS services more than the Spanish-born population. Differences in utilization patterns are particularly marked for Maghrebi men and women and sub-Saharan women. Immigrant males are at lower risk of being admitted to the hospital, as compared with Spanish-born males. On the other hand, immigrant women are at higher risk of being admitted. After excluding the visits with gynecologic and obstetric diagnoses, women from sub-Saharan Africa and the Maghreb are still at a higher risk of being admitted than their Spanish-born counterparts. CONCLUSION: In Lleida (Spain), immigrants use more EHS than the Spanish born population. Future research should indicate whether the same pattern is found in other areas of Spain and whether EHS use is attributable to health needs, barriers to access to the primary care services or similarities in the way immigrants access health care in their countries of origin.

Differences in pharmaceutical consumption and expenses between immigrant and Spanish-born populations in Lleida, (Spain): a 6-months prospective observational study.

BACKGROUND: There are few studies comparing pharmaceutical costs and the use of medications between immigrants and the autochthonous population in Spain. The objective of this study is to evaluate whether there are differences in pharmaceutical consumption and expenses between immigrant and Spanish-born populations. METHODS: Prospective observational study in 1,630 immigrants and 4,154 Spanish-born individuals visited by fifteen primary care physicians at five public Primary Care Clinics (PCC) during 2005 in the city of Lleida, Catalonia (Spain). Data on pharmaceutical consumption and expenses was obtained from a comprehensive computerized data-collection system. Multinomial regression models were used to estimate relative risks and confidence intervals of pharmaceutical expenditure, adjusting for age and sex. RESULTS: The percentage of individuals that purchased medications during a six-month period was 53.7% in the immigrant group and 79.2% in the autochthonous group. Pharmaceutical expenses and consumption were lower in immigrants than in autochthonous patients in all age groups and both genders. The relative risks of being in the highest quartile of expenditure, for Spanish-born versus immigrants, were 6.9, 95% CI = (4.2, 11.5) in men and 5.3, 95% CI = (3.5, 8.0) in women, with the reference category being not having any pharmaceutical expenditure. CONCLUSION: Pharmaceutical expenses are much lower for immigrants with respect to autochthonous patients, both in the percentage of prescriptions filled at pharmacies and the number of containers of medication obtained, as well as the prices of the medications used. Future studies should explore which factors explain the observed differences in pharmaceutical expenses and if these disparities produce health inequalities.

Sick leave among native and immigrant workers in Spain--a 6-month follow-up study.

OBJECTIVES: The incidence and the duration of sick leave were studied among immigrants and the native-born population in Spain. METHODS: This observational follow-up study included 1427 immigrants and 2793 Spanish natives treated at five primary care centers in Lleida in 2005 and followed for 6 months. The sick leave causes were coded according to the International Classification of Diseases (10th revision). Multivariate Poisson regressions estimated the rate ratio (RR) for sick leave adjusted for age, and linear regressions evaluated the effect of age, gender, and region of origin on the total number of sick-leave days. RESULTS: Altogether 19.5% of the natives and 12.7% of the immigrants had at least one sick-leave episode. The incidence of new episodes per 100 person-years was lower for the immigrants than for the natives (32.5 versus 43.3 for the men and 18.6 versus 35.6 for the women, respectively). The mean duration of sick leave in the 6-month period was 19.4 (SD 29.4) days for the immigrants and 33.5 (SD 39.2) days for the natives. For the men, the risk of sick leave was greater for the natives than for the immigrants (adjusted RR 1.70, 95% confidence interval 1.43-2.02). After adjustment for age, the duration of sick leave for the native workers was 1.5 times greater than for the immigrants. CONCLUSIONS: Even though sick leave was less frequent among the immigrants than among the natives and the immigrant sick-leave periods were of shorter duration, the two study populations did not show differences in the causes of disability.