Disease In Catalonia Research Articles

Analysis of Sociodemographic and Clinical Characteristics of Inflammatory Bowel Disease in Catalonia Based on SIDIAP.

Background/Objectives: The increasing global prevalence of inflammatory bowel disease (IBD) presents significant challenges to healthcare systems. Our objective was to identify the sociodemographic and clinical characteristics of IBD patients in Catalonia. Methods: A cross-sectional analytical study was carried out on patients diagnosed with IBD in Catalonia (2021). The database of the Information System for the Development of Research in Primary Care of Catalonia was used. Results: In Catalonia, the prevalence of IBD was 474 cases per 100,000 people (pcm), with an average diagnosis age of 42.9 years. Crohn's disease (CD) represented 34.34% of cases, and 21.2% were smokers and 1% were alcoholics. Nutritional status showed 3% underweight, 36.2% overweight, and 20% obese, with only 0.27% diagnosed as malnutrition. Mental health issues are notable; 36,531 pcm patients were diagnosed with anxiety and 14,656 pcm with depression, and 8.24% had a high risk of mortality measured by the Charlson index. The most prevalent vaccine-preventable infections were influenza (19,356 pcm), herpes zoster (8099 pcm), and varicella zoster (6946 pcm), with 4.56% of patients requiring hospitalisation for one of these reasons and 32.8% of patients for IBD complications, with higher rates observed in cases of CD. Conclusions: The prevalence of IBD was high, especially in urban areas, and patients showed a relevant number of comorbidities. IBD requires a comprehensive evaluation and interdisciplinary management to improve disease control.

Newborn Screening for Sickle Cell Disease in Catalonia between 2015 and 2022-Epidemiology and Impact on Clinical Events.

In 2015, Catalonia introduced sickle cell disease (SCD) screening in its newborn screening (NBS) program along with standard-of-care treatments like penicillin, hydroxyurea, and anti-pneumococcal vaccination. Few studies have assessed the clinical impact of introducing NBS programs on SCD patients. We analyzed the incidence of SCD and related hemoglobinopathies in Catalonia and the change in clinical events occurring after introducing NBS. Screening 506,996 newborns from 2015 to 2022, we conducted a retrospective multicenter study including 100 screened (SG) and 95 unscreened (UG) SCD patients and analyzed SCD-related clinical events over the first six years of life. We diagnosed 160 cases of SCD, with an incidence of 1 in 3169 newborns. The SG had a significantly lower median age at diagnosis (0.1 y vs. 1.68 y, p < 0.0001), and initiated penicillin prophylaxis (0.12 y vs. 1.86 y, p < 0.0001) and hydroxyurea treatment earlier (1.42 y vs. 4.5 y, p < 0.0001). The SG experienced fewer median SCD-related clinical events (vaso-occlusive crisis, acute chest syndrome, infections of probable bacterial origin, acute anemia requiring transfusion, acute splenic sequestration, and pathological transcranial Doppler echography) per year of follow-up (0.19 vs. 0.77, p < 0.0001), a reduced number of annual emergency department visits (0.37 vs. 0.76, p < 0.0001), and fewer hospitalizations (0.33 vs. 0.72, p < 0.0001). SCD screening in Catalonia's NBS program has effectively reduced morbidity and improved affected children's quality of life.

Economic impact of inflammatory bowel disease in Catalonia: a population-based analysis.

Inflammatory bowel disease (IBD) has a major economic impact on healthcare costs. The aim of this study was to evaluate the current healthcare expenditure associated with IBD in a population-wide study in Catalonia. Retrospective observational study. All patients with IBD included in the Catalan Health Surveillance System (CHSS) were considered eligible. The CHSS compiles data on more than 7 million individuals in 2020 (34,823 with IBD). Data on the use of healthcare resources and its economic impact were extracted applying the International Classification of Diseases, 10th revision, Clinical Modification codes (ICD-10-CM codes). Health expenditure, comorbidities, and hospitalization were calculated according to the standard costs of each service provided by the Department of Health of the Catalan government. The data on the IBD population were compared with non-IBD population adjusted for age, sex, and income level. IBD costs were recorded separately for Crohn's disease (CD) and ulcerative colitis (UC). Prevalence of comorbidities was higher in patients with IBD than in those without. The risk of hospitalization was twice as high in the IBD population. The overall healthcare expenditure on IBD patients amounted to 164M€. The pharmacy cost represents the 60%. The average annual per capita expenditure on IBD patients was more than 3.4-fold higher (IBD 4200€, non-IBD 1200€). Average costs of UC were 3400€ and 5700€ for CD. The risk of comorbidities was twice as high in patients with IBD and their use of healthcare resources was also higher than that of their non-IBD counterparts. Per capita healthcare expenditure was approximately 3.4 times higher in the population with IBD. The study was not previously registered.

Comparison of next generation technologies and bioinformatics pipelines for capsular typing of Streptococcus pneumoniae.

Whole genome sequencing (WGS)-based approaches for pneumococcal capsular typing have become an alternative to serological methods. In silico serotyping from WGS has not yet been applied to long-read sequences produced by third-generation technologies. The objective of the study was to determine the capsular types of pneumococci causing invasive disease in Catalonia (Spain) using serological typing and WGS and to compare the performance of different bioinformatics pipelines using short- and long-read data from WGS. All invasive pneumococcal pediatric isolates collected in Hospital Sant Joan de Déu (Barcelona) from 2013 to 2019 were included. Isolates were assigned a capsular type by serological testing based on anticapsular antisera and by different WGS-based pipelines: Illumina sequencing followed by serotyping with PneumoCaT, SeroBA, and Pathogenwatch vs MinION-ONT sequencing coupled with serotyping by Pathogenwatch from pneumococcal assembled genomes. A total of 119 out of 121 pneumococcal isolates were available for sequencing. Twenty-nine different serotypes were identified by serological typing, with 24F (n = 17; 14.3%), 14 (n = 10; 8.4%), and 15B/C (n = 8; 6.7%) being the most common serotypes. WGS-based pipelines showed initial concordance with serological typing (>91% of accuracy). The main discrepant results were found at the serotype level within a serogroup: 6A/B, 6C/D, 9A/V, 11A/D, and 18B/C. Only one discrepancy at the serogroup level was observed: serotype 29 by serological testing and serotype 35B/D by all WGS-based pipelines. Thus, bioinformatics WGS-based pipelines, including those using third-generation sequencing, are useful for pneumococcal capsular assignment. Possible discrepancies between serological typing and WGS-based approaches should be considered in pneumococcal capsular-type surveillance studies.

Airborne inoculum dynamics of Polystigma amygdalinum and progression of almond red leaf blotch disease in Catalonia, NE Spain

AbstractThe dynamics of airborne ascospores and disease progress of red leaf blotch (RLB) of almond, caused by Polystigma amygdalinum, and their correlations with weather variables were studied from 2019 to 2021 in two almond orchards located in Lleida, NE Spain. Airborne ascospores were detected and quantified by real‐time qPCR using species‐specific primers for P. amygdalinum. Ascospores were detected mainly from April to June, with a high variability between the yearly cumulative concentrations. Positive significant correlations were found between the weekly proportion of airborne ascospores and the number of wet and mild days—either combined or separated— accumulated rainfall, number of rainy days, accumulated low temperatures on wet days, and mean and maximum relative humidity. In contrast, several thermal variables (maximum temperature, VPD, and number of warm days) were negatively correlated with ascospore catches. Positive significant correlations were found between the cumulative proportion of ascospores and RLB incidence and severity. Weekly variations in RLB incidence and severity showed significant positive correlations with the number of warm days while negative with the number of mild days. Severity was also positively correlated with several thermal variables (mean, maximum, and minimum temperature, and VPD), and negatively correlated with the number of cold days and wet and mild days. Stronger correlations were generally found with ascospore catches or disease progress when using concurrent weekly weather data. Gompertz, monomolecular, and logistic growth models were evaluated to describe RLB disease progress.

P826 Economic impact of inflamatory bowel disease in Catalonia. A population-based analysis

Abstract Background Background: Inflammatory Bowel Disease (IBD) has an important economic impact in healthcare costs and resources utilization. Population data on this topic are scarce. The aim of this study was to evaluate the current healthcare expenditures of IBD in a population-wide study Catalonia. Methods Methods: All patients with IBD included in the Catalan Health Surveillance System (CHSS) were included. CHSS includes data on more than 7 million individuals in 2020, 34,823 of them being diagnosed of IBD. Data on prevalence, incidence, comorbidities, stratification of risk, use of healthcare resources and economic impact were extracted from the CHSS according to ICD-10-CM codes. Health expenditure was calculated according to the standard costs of each service provided by the Department of Health (Generalitat de Catalunya). The utilization of healthcare services and associated expenditure of IBD were compared with a control group of patients not identified as IBD adjusted by age, sex, and income level (hereinafter referred to as “non-IBD”). IBD costs were separately provided for Crohn’s Disease (CD) and Ulcerative Colitis (UC). Results Results: The prevalence and incidence of IBD in 2020 was 405.6 and 27.2 per 100,000 inhabitants, respectively. Total number of IBD patients in 2020 was 37,381. Prevalence of comorbidities (neoplasia, arthritis, chronic obstructive pulmonary disease, asthma, cardiac disease, ictus and mental disease) was higher in IBD patients’ when compared to non-IBD population. The risk of hospitalization in IBD was twice those of the non-IBD individuals. The global healthcare expenditures of patient with IBD was 164M€. The average annual expenditure for an IBD patient was 4M€ versus 1M€ for non-IBD population; being more than 3.4-fold higher. Cost in UC was 3,360€ and 5,699€ for CD patient. Conclusion Conclusion: Patients with IBD presented a higher risk of comorbidities (1.5-2 fold) and healthcare resources utilization. Healthcare expenditure per patient were approximately 3.4 times higher than the non-IBD population.

Using Component-Resolved Diagnosis to Characterize the Sensitization to Specific Cat and Dog Allergens in Patients with Allergic Respiratory Diseases in Catalonia, Spain

Introduction: Sensitization to cat and dog allergens is common in patients with allergic respiratory diseases. The study objective was to determine the prevalence of immunoglobulin E (IgE) sensitization to specific cat and dog allergens using component-resolved diagnosis (CRD) in patients with allergic respiratory diseases plus cat and/or dog sensitization. Methods: We included 87 patients aged 8–62 years, diagnosed with allergic asthma and/or rhinitis plus cat and/or dog sensitization, and attended at the allergy section of a tertiary hospital in Badalona (Catalonia, Spain). We used CRD to determine IgE sensitization to specific cat/dog allergens and skin prick tests (SPTs) to determine differences between diagnostic test results. Results: Patients were monosensitized to cats (20.7%) or dogs (3.4%) or sensitized to both (75.9%). The highest positive allergen rates were for Fel d 1 (91.7%) and Fel d 4 (41%) in patients sensitized to cat allergens and for Can f 5 (80%) and Can f 1 (70%) in those sensitized to dog allergens. CRD and SPT results differed somewhat: 16.1% and 27.6% of patients CRD positive for cat or dog sensitization, respectively, were SPT negative, and 6.9% SPT positive for dog sensitization were CRD negative. Few statistically significant relationships were found between any allergen components and any respiratory disease characteristic or contact with furry animals. Conclusions: CRD may be used to determine the prevalence of IgE sensitization to specific cat and dog allergens in patients with allergic respiratory diseases plus cat and/or dog sensitization. As SPT may not correctly identify all patients sensitized to cats and dogs, our results support the use of CRD.

Prevalence and Incidence of Patients With Fibromyalgia in Catalonia Between 2010 and 2017: A Descriptive Observational Study.

Objective:To measure the prevalence and cumulative incidence of individuals diagnosed with fibromyalgia (FM) in Catalonia between 2010 and 2017.Methods:A retrospective observational study of the population of Catalonia between 2010 and 2017, both included, was designed to describe the incidence, prevalence, and sociodemographic characteristics of individuals diagnosed with fibromyalgia. A total of 56 098 patients were included in the study. The scope of the study were the 283 Primary Care Teams (PCT), all managed by the Instituto Catalán de la Salud [Catalan Institute of Health] (ICS).Results:The diagnosis of FM is higher in females (95.4%) than males (4.55%), with a mean age of 53.0 [45.0-61.0] years. The prevalence of FM in the total population was 0.4% in 2010 and 1.4% in 2017. The highest prevalence was found in the 55 to 65 age group (1.05% in 2010, and 2.46% in 2017). A relationship was found between the prevalence of FM and the degree of socioeconomic deprivation in urban areas: the greater the deprivation, the greater the prevalence of FM. The cumulative incidence of FM in the population remained constant over time (0.11% in 2010 and 0.10% in 2017), being more prevalent in women than men (0.18% women, 0.01% men in 2017).Conclusions:Our study confirms that FM is a prevalent disease in Catalonia, with an upward trend in recent years and it is more prevalent in women.

Impact of the 13-valent conjugate pneumococcal vaccine on the incidence of invasive pneumococcal disease in Catalonia: Retrospective study, 2014–2015 vs. 2017–2018

IntroductionInvasive pneumococcal disease (IPD) is a major public health problem worldwide with high morbidity and mortality that causes a wide spectrum of diseases, from otitis media to sepsis and meningitis. In Catalonia, the universal immunization program with the 13-valent conjugated pneumococcal vaccine (Pn13 vaccine) began in 2016. The objective of this study was to analyse the impact of the 13-valent pneumococcal conjugate vaccine (PCV13 vaccine) on the incidence of IPD during the years 2017−2018 compared to the years 2014−2015. MethodRetrospective study of IPD cases notified by reporting laboratories to the Microbiological Reporting System of Catalonia (MRSC) from 2014 to 2018. Incidence rates (IR) and relative risk (RR) were calculated. ResultsThe global incidence of IPD (2014–2018) was 12,6 cases per 100,000 persons/year. Comparing 2017−2018 vs 2014−2015, the incidence of IPD caused by the serotypes included in the PCV13 vaccine has decreased in children <5 years by 46% while it has remained stable in the rest of the groups. Serotype 3, despite being included in the PCV13 vaccine, remained a high incidence. In contrast, the incidence of IPD caused by non PCV13 serotypes increased in adults aged 20−64 years (35%) and ≥65 years (27%), mainly due to the increase of serotype 8. ConclusionsPCV13 introduction is beneficial for both, vaccinated and non-vaccinated people (due to herd immunity). However, a precise and continuous epidemiological surveillance of IPD must be carried out to detect changes in the incidence of the disease and circulating serotypes.

P604 Evaluation of management heterogeneity and complications of Crohn’s disease in Catalonia. A population quality care study

Abstract Background Heterogeneity in the treatment of a disease is a marker of suboptimal quality of care. Recent studies suggest that there is a marked heterogeneity in the management of inflammatory bowel disease. The aim of this study is to evaluate the heterogeneity in the treatment used and the outcomes (rate of hospitalization and surgery) for Crohn’s disease (CD) in the different health areas of Catalonia. Methods All patients with CD included in the Catalan Health Surveillance System (CHSS) including data on more than 7 million individuals from 2011 to 2017 were identified using with the ICD-9-CM codes. The different Catalonian health areas were grouped into 19 groups according to the reference hospital (figure 1). Exposures to different treatments were retrieved from the electronic dispensation records. Data on hospitalizations and surgeries were also extracted from the CHSS according to ICD-9-CM codes. Treatment used rates (systemic corticosteroids, non-biological and biological immunosuppressant) and outcome rates (hospitalization and surgery) were calculated. Results The use of systemic corticosteroids presented a decreasing trend over the study period, with an average rate of use of the total number of patients in the different territories between 10% and 16% (figure 2). The use of non-biological immunosuppressant treatment has remained stable, with an average rate of use ranging from 20% to 40% (figure 3). On the other hand, the use of biological immunosuppressant treatment increased, with an average rate of use in the different territories ranging from 10 to 22% (figure 4). Hospitalizations for any reason showed an increasing trend between 2011–2017 with an average rate between 19% and 30% per year depending on the area. Contrarily, hospitalizations for CD presented a decreasing trend, with an average rate between 5% and 10% per year. Surgical treatment (both resections and ostomies) remained stable over time. Rates per year were between 1% and 2%. Conclusion In this population study we appreciated an important heterogeneity in the use of non-biological and biological immunosuppressant treatments, identifying use rates of almost the double in some of the areas. There is also a remarkable variability in the rate of hospitalizations for CD between certain areas of Catalan territory.

Direct medical costs of non-alcoholic fatty liver disease in Catalonia at the hospital level: a retrospective multicenter study

ABSTRACT Background The prevalence of non-alcoholic fatty liver disease (NAFLD) is increasing worldwide, which is expected to correlate with significant medical and social costs. This study aimed to evaluate the clinical and economic burden of NAFLD in Catalonia at the hospital level. Methods Records of all patients diagnosed with NAFLD and treated in Catalan hospitals between the year 2007 and 2018 were extracted from a patient-level healthcare database. Results Admission files of 24,172 individual patients were obtained. High comorbidity rates were found across age groups, with a mean Charlson Comorbidity Index of 5.1. In-hospital mortality rate increased over the study period, and was associated to a higher comorbidity rate. Disease complexity was increased in this patient group, which is associated with larger medical costs. The mean annual cost per patient was €4073, with a total annual direct medical cost of €27,370,827. The greatest portion of costs was attributed to surgical interventions (€14,429,336). Conclusions The high level of comorbidity and disease complexity in this patient group versus the general population is expected to correlate with a more intensive use of medical resources and costs. This study provides novel data to inform resource allocation and disease management decisions at the regional level.

Time Trends of Crohn's Disease in Catalonia from 2011 to 2017. Increasing Use of Biologics Correlates with a Reduced Need for Surgery.

Background and Aims: Data from clinical trials suggest that biological drugs may improve the outcomes in Crohn’s disease (CD) by reducing the need for surgery or hospitalization. The aim of this study is to evaluate the time-trends of the use of biological drugs and other treatments for CD, and its relationship with outcomes in Catalonia. Materials and Methods: All patients with CD included in the Catalan Health Surveillance System (containing data on a population of more than 7.5 million) from 2011 to 2017 were identified. The exposures to different treatments for inflammatory bowel disease were retrieved from electronic invoicing records. Results: Between 2011 and 2017, the use of salicylates, corticosteroids and immunosuppressive treatment fell from 28.8% to 17.1%, 15.8% to 13.7%, and 32.9% to 29.6%, respectively (p < 0.001). Biological treatment use rose from 15.0% to 18.7% (p < 0.001). Ostomy rates per 1000 patients/year fell from 13.2 in 2011 to 9.8 in 2017 (p = 0.003), and surgical resection rates from 24.1 to 18.0 (p < 0.001). The rate of CD-related hospitalizations per 1000 patients/year also fell, from 92.7 to 72.2 (p < 0.001). Conclusions: Biological drug use rose from 15.0% to 18.7% between 2011 and 2017. During this period, we observed an improvement in the outcomes of CD patients.

P743 Time trends of Crohn’s disease in Catalonia from 2011 to 2017. Increasing use of biologics correlates with a reduced need for surgery. A population-based study in Catalonia

Abstract Background Data from clinical trials suggest that biological drugs may improve the outcomes in Crohn’s disease (CD) by reducing the need for surgery or hospitalisation. However, data on the trends in biological drug use and outcomes in CD patients are scarce. The aim of this study is to evaluate the time-trends of the use of biological drugs and other treatments for CD, and its relationship with outcomes such as surgery and hospitalisation in Catalonia. Methods All patients with CD included in the Catalan Health Surveillance System (containing data on a population of more than 7.5 million) from 2011 to 2017 were identified. The exposures to different treatments for inflammatory bowel disease were retrieved from electronic invoicing records. Time trends for surgery and hospitalisation were described and tested for correlation with treatment using the statistical package R, version 3.4.3. Results Between 2011 and 2017, the use of salicylates, corticosteroids and immunosuppressive treatment fell from 28.8% to 17.1%, 15.8% to 13.7%, and 32.9% to 29.6%, respectively. Biological treatment use rose from 15.0% to 18.7%. Adalimumab was the most frequently prescribed biologic (1604 patients; 52% of all biologics in 2017). Ostomy rates per 1000 patients/year fell from 13.2 in 2011 to 9.8 in 2017, and surgical resection rates from 24.1 to 18.0. The rate of CD-related hospitalisations per 1000 patients/year also fell, from 92.7 to 72.2. Conclusion Biological drug use rose from 15.0% to 18.7% between 2011 and 2017. During the same period, we observed an improvement in the outcomes of CD patients.

Prevalence, incidence and mortality of inflammatory bowel disease in Catalonia. A population-based analysis

Introduction: Few recent data on the epidemiology of inflammatory bowel disease (IBD) are available, especially in Southern Europe.Aim: To evaluate the prevalence, incidence and mortality of IBD in Catalonia during the period 2011–2016.Material and methods: Data on the prevalence, incidence and mortality of IBD were obtained from the Catalan Health Surveillance System (CHSS). Crude incidence and prevalence rates were calculated for all the Catalan population. Trends in age-sex-adjusted rates were also estimated, and logistic regression was used to calculate the adjusted mortality odds ratio (OR). Data for Crohn’s disease (CD) and ulcerative colitis (UC) were analyzed separately.Results: The prevalence per 100,000 inhabitants in 2016 was 353.9 for UC and 191.4 for CD. The total number of IBD patients rose from 29543 in 2011 to 40614 in 2016. IBD was associated with significantly elevated adjusted mortality ratios: 1.28 (95% CI: 1.6–1.4) for UC and 1.85 (95% CI: 1.62–2.12) for CD.Conclusions: IBD prevalence is very high and is increasing rapidly in Catalonia. Both CD and UC are associated with significantly higher mortality rates.Key messageCrohn disease and ulcerative colitis present a small but significant increase in mortality compared to non-inflammatory bowel disease.The prevalence of inflammatory bowel disease is increasing rapidly in Catalonia.Data on prevalence and incidence suggest that the number of patients may double in approximately 10 years.

PSY49 - BUDGETARY IMPACT OF ORPHAN DRUGS IN THE CATALAN HEALTHCARE SERVICE

To describe the actual patient access to orphan medicinal products (OMP) for the treatment of rare diseases in Catalonia over the past five years. The main source used to perform the analysis was the Pharmaceutical Reimbursement File of the Catalan Health Service (CatSalut). The selection criteria used to define the study population was that of medicines dispensed during 2013 to 2017 that held orphan drug designation of the European Medicines Agency (EMA) by the time of marketing authorisation. Among the 142 OMP approved by the EMA, 83 had been prescribed and/or dispensed in CatSalut during 2013 to 2017. As expected, the increasing number of OMP financed overtime was found to correlate with the number of patients treated in Catalonia, being 3690 in 2013 and up to 8853 at 2017, the latest representing a 0.12 % of Catalonia population. The treatments represented 84 M € (4.3% of the total pharmaceutical expenditure in CatSalut) in 2013 and raised up to 157 M € (6.7% total pharmaceutical expenditure) in 2017. The main therapeutic areas that influenced to such increase were onco-haematology, pulmonary diseases and metabolic endocrine disorders. The expenditure in OMP in Catalonia has almost duplicated in five years, paralleling the raise of the number of OMP approved by the EMA, and consistent with the elevated cost associated with these pharmaceuticals. The growth in expenditure is very relevant within the overall pharmaceutical billing and is in line with the data published in comparable environments. In the light of these results, measures should be proposed to guarantee the sustainability of access to innovation for Catalan patients in the field of rare diseases, as well as methods to assess their effectivity in terms of health outcomes.

GCAT|Genomes for life: a prospective cohort study of the genomes of Catalonia

PurposeThe prevalence of chronic non-communicable diseases (NCDs) is increasing worldwide. NCDs are the leading cause of both morbidity and mortality, and it is estimated that by 2030, they will be...

Serotypes and Clonal Diversity of Streptococcus pneumoniae Causing Invasive Disease in the Era of PCV13 in Catalonia, Spain.

The aim of this study was to study the serotypes and clonal diversity of pneumococci causing invasive pneumococcal disease in Catalonia, Spain, in the era of 13-valent pneumococcal conjugate vaccine (PCV13). In our region, this vaccine is only available in the private market and it is estimated a PCV13 vaccine coverage around 55% in children. A total of 1551 pneumococcal invasive isolates received between 2010 and 2013 in the Molecular Microbiology Department at Hospital Sant Joan de Déu, Barcelona, were included. Fifty-two serotypes and 249 clonal types—defined by MLST—were identified. The most common serotypes were serotype 1 (n = 182; 11.7%), 3 (n = 145; 9.3%), 19A (n = 137; 8.8%) and 7F (n = 122; 7.9%). Serotype 14 was the third most frequent serotype in children < 2 years (15 of 159 isolates). PCV7 serotypes maintained their proportion along the period of study, 16.6% in 2010 to 13.4% in 2013, whereas there was a significant proportional decrease in PCV13 serotypes, 65.3% in 2010 to 48.9% in 2013 (p<0.01). This decrease was mainly attributable to serotypes 19A and 7F. Serotype 12F achieved the third position in 2013 (n = 22, 6.4%). The most frequent clonal types found were ST306 (n = 154, 9.9%), ST191 (n = 111, 7.2%), ST989 (n = 85, 5.5%) and ST180 (n = 80, 5.2%). Despite their decrease, PCV13 serotypes continue to be a major cause of disease in Spain. These results emphasize the need for complete PCV13 vaccination.

Analysis of employment rate and social status in young adults with childhood-onset rheumatic disease in Catalonia.

BackgroundRheumatic diseases of childhood, in particular juvenile idiopathic arthritis, are chronic conditions associated with considerable morbidity and mortality that can have repercussions on aspects of adult life. The aim of this study was to determine the employment rate and social status of patients with childhood-onset rheumatic disease attending a pediatric rheumatology transition unit.MethodsA census was taken of patients seen in the Pediatric Rheumatology Transition Unit of Hospital Vall d’Hebron (Barcelona, Spain). We collected demographic and clinical variables and determined the patients’ functional capacity. All patients seen during the period of September to December 2013 underwent a survey containing items related to their social situation, maximum academic level achieved, and working life. Correlations were sought between clinical variables associated with a poor prognosis and the patients’ job performance. The data were analyzed and compared with those of an age-matched cohort from the general population of Catalonia.ResultsOf 130 patients included in the census, 96 responded to the survey. Steinbrocker grade III and IV disability (poorer functional capacity) (p = 0.0025) and longer disease duration (p = 0.017) were significantly related to greater difficulty getting a job. Patients with grade III and IV disability and those with more severe disease showed trends to having more problems carrying out work-related tasks. Our cohort included a higher percentage of students than the age-matched comparison population (50 % vs 24 %, respectively) (p = 0.0001); 82 % of patients had completed studies beyond the compulsory education level. The employment rate was lower in our patient cohort than in the comparison cohort (38.3 % vs 59.9 %) (p = 0.0001), whereas the percentage of unemployed was similar. Patients with milder disease had a higher probability of living with their parents up to a later age (OR = 3.2, 95 % CI 0.38-6.15; p = 0.029).ConclusionsDespite the advances in treatment, some patients with childhood-onset rheumatic disease encounter difficulties in their later social and working life. In our cohort, the time period needed to complete their studies tended to be longer, and incorporation into the workforce occurred at a later age. Our findings reinforce the idea that psychological support and vocational guidance are important factors in the management of these patients.

Incidence and clinical features of kawasaki disease in Catalonia (Spain)

between onset of the disease and diagnostic was 7.2±5.3 days. Ethnic distribution was: Caucasian 279 patients(69.9%), North African 26 (6.5%), Amerindian 21 (5.2%), Asian 14 (3.5%) and Sub-Saharan 4 (1%). Ethnicity was not available in 55 (13.8%) patients. Distribution of classical manifestations for KD was: fever in 100% of patients, changes in extremities 40.3% (desquamation in 31% of them), exanthema 84.2%, conjunctival injection 79.7%, changes in lips and oral cavity 55.6% and lymphadenopathy 28.8%. Other clinical findings reported were: sterile pyuria in 80(20%) patients, nausea and vomiting in 96(24%), abdominal pain in 85(21.3%), gallbladder distention in 14 (3.5%), transaminase elevation in 120(30%), jaundice in 21(5.1%), irritability in 118(29.5%), aseptic meningitis in 16(4%), sensorineural hearing loss in 2 patients, uveitis in 11(2.7%) and arthritis or arthralgia in 55(13.8%). Cardiologic findings were: perivascular brightness of the coronary wall in 42(10.5%) patients, pericarditis in 9(2.3%), myocarditis in 4(1%), mitral regurgitation in 28 (7%) and CA in 53 patients(13.3%), 26(49%) of them disappearing before the 2 nd month after the onset of KD. 4 patient had giant CA. Intravenous immunoglobulin (IVIG) was administered in 389(97.5%) patients with response to the 1 st dose in 332(83.2%). Day of IVIG administration was 7.5±3.1. Other treatment plans were: 2 nd (69% response) and 3 rd IVIG doses, oral or iv corticosteroids and abciximab (administered in 3 of the patients with giant CA). 97.7% of patients received anti-platelet dose aspirin in the convalescent phase. Conclusion

The burden of disease in Catalonia, Spain, using disability-adjusted life years (2005-2010)

Burden of disease allows measuring the health of the population including mortality and disability. The objectives of this paper are to estimate the burden of disease in Catalonia, to compare the results with Spain and Tarragones area and to assess the contribution of the local registers to the estimation of the disability. We calculated the disability-adjusted life years (DALYs) for 123 causes using the methodology developed by the World Health Organization. We compared the standardized rates with the Spanish rates. In Tarragones area, we calculated the DALYs, we compared them with the DALYs in Catalonia and moreover we used the cancer incidence local registry to calculate cancer burden disease. There were 801,140 DALYs (annual average) in Catalonia, 60.3% due to disability and 39.7% due to premature mortality. Neuropsychiatric disorders (30.9%), malignant neoplasms (15.8%) and cardiovascular diseases (11.3%) were the leading causes. The standardized rate of respiratory diseases (7.5 per 1,000) was significantly higher compared with the Spanish rate. Perinatal conditions (3.1 per 1,000), intentional injuries (2.2 per 1,000) and digestive diseases (4.9 per 1,000) were significantly higher in Tarragones area. DALYs attributable to cancer showed an increase of 13.4 % when they were calculated using the incidence of cases. Noncommunicable diseases were the leading causes for DALYs in Catalonia. There are differences between territories in respiratory diseases, perinatal conditions, digestive diseases and intentional injures. Local registries can be very useful in order to calculate the DALYs.