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PURPOSE The National Cancer Information System (NCIS) has been operating since 2014, including information reported by health care insurers and providers on people with cancer diagnosed and treated within the Colombian health system. Its main purpose is to identify barriers to an effective access to cancer diagnosis and treatment across the country. We aimed to describe the methodology, scope and results in terms of access to health services with real-world data provided by the NCIS. METHODS Reporting of all cases of cancer by insurers and providers is mandatory by law. Data gathered include demographic and clinical information about new and old cases of cancer who receive health services. Over the years, the reporting process has been automated and it is currently performed in real time. Data quality is ensured through a standardized data-monitoring process. Access to health services is monitored by quality measures defined by consensus. RESULTS Since 2015, prevalent cases of invasive cancer have increased from 163,776 to 331,021 in 2020 (increment of 102.12%). Regarding quality measures, the proportion of people staged at diagnosis has increased over the years, especially in breast cancer. Meanwhile, early diagnosis is still concerning for breast and prostate cancer. Time to diagnosis and treatment have not consistently reached the expected goals in breast, cervical, and prostate cancer, whereas they have shown a better level of compliance for stomach and colon and rectum tumors, still not reaching the highest performance. CONCLUSION The real-world information approach provided by the NCIS may be complementary for cancer control planning in Colombia, emphasizing better management processes of health insurers and providers by identifying barriers for timely access to health care.

Background Achieving an optimal glycemic control has been described to reduce the incidence of diabetes mellitus (DM) related complications. The association between comorbidities and glycemic control remains unclear. Our aim is to evaluate the effect of comorbidities on glycemic control in people living with DM. Methods A retrospective longitudinal study on data from the National Registry of Chronic Kidney Disease from 2014 to 2019 in Colombia. The outcome was poor glycemic control (PGC = HbA1c ≥7.0%). The association between each comorbidity (hypertension (HTN), chronic kidney disease (CKD) or obesity) and PGC was evaluated through multivariate mixed effects logistic regression models. The measures of effect were odds ratios (OR) and their 95% confidence intervals (CI). We also evaluated the main associations stratified by gender, insurance, and early onset diabetes as well as statistical interaction between each comorbidity and ethnicity. Results From 969,531 people at baseline, 85% had at least one comorbidity; they were older and mostly female. In people living with DM and CKD, the odds of having a PGC were 78% (OR: 1.78, CI 95%: 1.55-2.05) higher than those without CKD. Same pattern was observed in obese for whom the odds were 52% (OR: 1.52, CI 95%: 1.31-1.75) higher than in non-obese. Non-significant association was found between HTN and PGC. We found statistical interaction between comorbidities and ethnicity (afro descendant) as well as effect modification by health insurance and early onset DM. Conclusions Prevalence of comorbidities was high in adults living with DM. Patients with concomitant CKD or obesity had significantly higher odds of having a PGC.

The perception that immigrants represent a burden to national health systems can hinder the development of policies for their inclusion in health coverage. In order to inform the development of such policies, data on the healthcare needs and healthcare spending for immigrants is required. The objective of this article is to compare the clinical characteristics and healthcare-related expenditures of Venezuelan immigrants and non-migrants living with HIV in Colombia. We analysed data from the Colombian High-cost Diseases Fund from February 1, 2018 to January 31, 2019, identifying the hospital and non-hospital expenditures per patient for Venezuelan immigrants and non-migrant patients, in both the state-subsidised and the contributory coverage schemes. We employed binomial negative regression models to compare expenditures between the two groups. In the contributory scheme, the average annual per-capita expenditure for immigrants was USD $ 859.07 (SD: ± $793.37) for non-hospital care. For non-migrants, the average costs were 1,796.53. In the state-subsidised scheme expenditures were higher on average, but still lower for immigrants than for non-migrants. After adjusting by clinical and sociodemographic characteristics, non-hospital per capita expenditures were lower for immigrants as compared with non-migrants (25,37% lower in the state-subsidised scheme, and 33,75% lower in the contributory scheme). Hospital expenditures were also lower, but the small sample size limited analysis. To conclude, Venezuelan immigrants living with HIV do not represent a major economic burden to the health system in Colombia. Further studies are required in order to understand if the lower healthcare expenditures of this population are the result of limitations in healthcare access, of clinical characteristics that were not assessed in this study, or of other unmeasured aspects.

There is a need to describe the demographic and clinical characteristics of people diagnosed with rheumatoid arthritis who are attended within the Colombian health system. This characterization allows prioritizing populations with specific risks, programming the use of health services, and planning the costs necessary to guarantee equitable care.To assess the demographic and clinical characteristics of a cohort of patients with rheumatoid arthritis using national data collected by the High-Cost Disease Fund (CAC in Spanish).A cross-sectional study from a secondary source. Data was gathered from a national administrative registry. A descriptive analysis was performed on sociodemographic and clinical characteristics. Age-standardized prevalence was estimated at national level and by geographical regions. Remission rates were also estimated for Colombian departments and regions.By 2019, 81,386 patients with rheumatoid arthritis were reported in Colombia. The relation female-male was 5.2:1. The median age was 59 years (IQR: 50-67). Prevalence was higher in people aged 50-69 years. The most frequent comorbidities were high blood pressure (31.15%) and osteoporosis (19.46%). Age-standardized prevalence of rheumatoid arthritis was 0.24 per 100 population (95% CI: 0.23-0.24). In cases with complete information, 57.57% of departments had remission rates up to 30%.Rheumatoid arthritis in Colombia was more frequent in females aged ≥50 year. Age-standardized prevalence was lower than reported by other studies performed in Colombia but similar to the estimated internationally for the country. Key Points • More than 80,000 rheumatoid arthritis patients were reported to this national registry in Colombia in 2019, finding an age-standardized prevalence of 0.24 per 100 population. • Hypertension was the most common comorbidity reported in people with rheumatoid arthritis. This finding is similar to the reports by similar studies such as the COMORA. • A major strength of this study is the large sample size since data come from a nationwide registry of people with rheumatoid arthritis, supported by the National Ministry of Health. Additionally, this registry has a rigorous data monitoring process that guarantees the internal validity of data and provides valuable information for decision-making based on local evidence. • Prevalence of rheumatoid arthritis was higher in females between 50 and 65 years. Age-standardized prevalence was lower than previously reported in Colombia, but similar to the world estimations.

Objective The present study aimed to determine the association between chronic exposure to fine particulate matter (PM2.5), sociodemographic aspects, and health conditions with COVID-19 mortality in Colombia. Methods We performed an ecological study using data at the municipality level. We used COVID-19 data obtained from government public reports up to and including July 17th, 2020. We defined PM2.5 long-term exposure as the 2014–2018 average of the estimated concentrations at municipalities obtained from the Copernicus Atmospheric Monitoring Service Reanalysis (CAMSRA) model. We fitted a logit-negative binomial hurdle model for the mortality rate adjusting for sociodemographic and health conditions. Results Estimated mortality rate ratios (MRR) for long-term average PM2.5 were not statistically significant in either of the two components of the hurdle model (i.e., the likelihood of reporting at least one death or the count of fatal cases). We found that having 10% or more of the population over 65 years of age (MRR = 3.91 95%CI 2.24–6.81), the poverty index (MRR = 1.03 95%CI 1.01–1.05), and the prevalence of hypertension over 6% (MRR = 1.32 95%CI1.03–1.68) are the main factors associated with death rate at the municipality level. Having higher hospital beds capacity is inversely correlated to mortality. Conclusions There was no evidence of an association between long-term exposure to PM2.5 and COVID-19 mortality rate at the municipality level in Colombia. Demographics, health system capacity, and social conditions did have evidence of an ecological effect on COVID-19 mortality. The use of model-based estimations of long-term PM2.5 exposure includes an undetermined level of uncertainty in the results, and therefore they should be interpreted as preliminary evidence., Graphical abstract Unlabelled Image, Highlights • There was not a significant association between long-term exposure to PM2.5 and COVID-19 mortality in Colombia. • Demographic, health system, and social conditions are related to COVID-19 mortality. • Population over 65 years, poverty index, and prevalence of hypertension are associated to the death rate.

To describe the outcomes of risk management indicators for five types of cancer in population that is affiliated to the General System of Social Security in Health, in six cities of Colombia.Based on the data from the administrative cancer registry for the period 2016, the High Cost Disease Fund (CAC in Spanish) as a technical organization of the Colombian health system, processed and analyzed the data for the calculation of risk management indicators established in consensus based on the evidence found in six cities.There is a diversity in the indicators results found among the different cities, evidencing strengths and weaknesses in each of them for the different types of cancer. From the set of indicators, those with the best results presented are related to the greater detection of cancer in early stages or in situ, as well as a decrease in mortality, especially in colorectal and in gastric cancer. Most indicators in gastric cancer showed optimal results. Important measurements such as the opportunity for diagnosis and treatment are below the proposed standard for most types in all the six cities.The descriptive analysis of cancer risk management indicators shows certain weaknesses in the quality and timeliness of the care of cancer patients, the standards agreed upon in the consensus with the different actors of the system are not being reached, situation which may be due to a reality of problems of the Colombian health system, as well as deficiencies in the quality of the report to the CAC.Describir los resultados de los indicadores de gestión del riesgo para cinco cánceres en la población afiliada al Sistema General de Seguridad Social en Salud en Colombia en ciudades que tienen registros de cáncer.La Cuenta de Alto Costo (CAC) procesó y analizó la información del registro administrativo nacional de cáncer del periodo 2016 en Cali, Pasto, Bucaramanga, Manizales, Barranquilla y Medellín; para calcular los indicadores de gestión del riesgo establecidos en el consenso basado en la evidencia para la atención en cáncer.Existe diversidad en los resultados de los indicadores entre las diferentes ciudades, evidenciando fortalezas y debilidades en cada una de ellas y para los diferentes tipos de cáncer. Los indicadores que mejores resultados presentaron se relacionan con la mayor detección del cáncer en estadios tempranos, así como disminución de la mortalidad, especialmente en cáncer de colorrectal y en cáncer gástrico. El cáncer gástrico fue aquel que mayor cantidad de indicadores obtuvieron resultados óptimos. Mediciones importantes como la oportunidad de diagnóstico y de tratamiento se encuentran por debajo del estándar propuesto para la mayoría de los tipos de cáncer y de las ciudades.Se evidencia ciertas debilidades en la calidad y la oportunidad de la atención oncológica, no se están cumpliendo los estándares acordados en los consensos con los diferentes actores del sistema: puede deberse a una realidad de problemas del sistema de salud colombiano, así como a la necesidad de fortalecer la calidad del reporte por parte de las entidades a la CAC.

Background Leukemia is the most common cancer in childhood. The estimated incidence rate of childhood leukemia in Colombia is one of the highest in America and little is known about its spatial distribution. Purpose To explore the presence of space-time clustering of childhood leukemia in Colombia. Methods We included children less than 15 years of age with confirmed diagnosis of acute leukemia reported to the national surveillance system for cancer between 2009 and 2017. Kulldorff’s spatio-temporal scan statistics were used with municipality and year of diagnosis as units for spatial and temporal analysis. Results There were 3846 cases of childhood leukemia between 2009 and 2017 with a specific mean incidence rate of 33 cases per million person-years in children aged 0–14 years. We identified five spatial clusters of childhood leukemia in different regions of the country and specific time clustering during the study period. Conclusion Childhood leukemia seems to cluster in space and time in some regions of Colombia suggesting a common etiologic factor or conditions to be studied.