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1. National Cancer Information System Within the Framework of Health Insurance in Colombia: A Real-World Data Approach to Evaluate Access to Cancer Care

Author

Juliana Alexandra Hernández Vargas, Paula Ximena Ramírez Barbosa, Ana Maria Valbuena-Garcia, Lizbeth Alexandra Acuña-Merchán, Jaime A. González-Diaz, and Gilberto Lopes

Subjects
Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

PURPOSEThe 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.METHODSReporting 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.RESULTSSince 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.CONCLUSIONThe 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.

Published
2021
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3. Análisis de conglomerado de cáncer infantil y su relación con proximidad a fuentes de contaminación industrial en el Área Metropolitana del Valle de Aburrá, 2000-2015

Author

Laura Andrea Rodriguez Villamizar, Ana Maria Valbuena Garcia, Feisar Enrique Moreno Corzo, Maria Alejandra Jaimes Reyes, Mary Ruth Brome Bohorquez, and Hector Iván García García

Subjects
Health Information Management, Epidemiology, Health Policy, Public Health, Environmental and Occupational Health
Abstract

Objetivo: Este estudio evaluó el efecto de la proximidad a fuentes industriales de contaminación del aire sobre la aparición de conglomerados de casos de cáncer infantil en el Área Metropolitana del Valle de Aburrá, del departamento de Antioquia, durante el período 2000-2015. Metodología: La información de casos de cáncer infantil en menores de 15 años residentes del área metropolitana se obtuvo del Registro Poblacional de Cáncer de Antioquia, de dicho periodo. Se identificaron 32 conglomerados industriales, a partir del inventario de la autoridad ambiental local. Se realizaron pruebas de escaneo circular de Kulldorf locales y focalizadas, para detectar conglomerados de cáncer infantil en los municipios y alrededor de los conglomerados industriales respectivamente. Se usó un modelo de regresión multivariable ajustado por estrato socioeconómico, para evaluar el efecto de las variables espaciales. Resultados: La tasa de incidencia específica en el Valle de Aburrá para el periodo evaluado fue de 117,13 casos por millón de niños menores de 15 años. Las tasas de incidencia más altas se presentaron en los municipios de Medellín y Sabaneta. La prueba de Kulldorf identificó 12 conglomerados espaciales y 8 espacio-temporales con significación estadística en 7 de los municipios, particularmente en Bello y Medellín. Las pruebas focalizadas identificaron conglomerados alrededor de 20 conglomerados industriales. En los modelos multivariables, un conglomerado en Bello evidenció asociación estadísticamente significativa e inversa entre la incidencia y la distancia al conglomerado con direccionalidad sureste. Conclusión: Algunos conglomerados espacio-temporales de cáncer infantil en el Área Metropolitana del Valle de Aburrá entre 2000 y 2015 están relacionados con proximidad a fuentes industriales de contaminación del aire.

Published
2022
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4. Childhood Leukemia in Small Geographical Areas and Proximity to Industrial Sources of Air Pollutants in Three Colombian Cities

Author

Claudia Janeth Uribe Pérez, Jurg Niederbacher Velásquez, Ana Maria Valbuena-Garcia, Luis Eduardo Bravo, Laura A. Rodríguez-Villamizar, Mary Ruth Brome Bohórquez, Alvaro Osornio-Vargas, Feisar Enrique Moreno-Corzo, Rafael Gustavo Ortiz Martínez, and Héctor Iván García García

Subjects
Male, Childhood leukemia, Health, Toxicology and Mutagenesis, Population, Childhood cancer, air pollution, Air pollution, Colombia, medicine.disease_cause, Industrial pollution, Article, 03 medical and health sciences, 0302 clinical medicine, Air pollutants, Residence Characteristics, medicine, Humans, 030212 general & internal medicine, Cities, education, Socioeconomics, Child, Socioeconomic status, childhood, education.field_of_study, Air Pollutants, Leukemia, Public Health, Environmental and Occupational Health, industrial pollution, medicine.disease, Geography, 030220 oncology & carcinogenesis, Small-Area Analysis, Female, Particulate Matter, Environmental Monitoring, cluster analysis
Abstract

Acute leukemia is the most common childhood cancer and has been associated with exposure to environmental carcinogens. This study aimed to identify clusters of acute childhood leukemia (ACL) cases and analyze their relationship with proximity to industrial sources of air pollution in three capital cities in Colombia during 2000&ndash, 2015. Incident ACL cases were obtained from the population cancer registries for the cities of Bucaramanga, Cali, and Medell&iacute, n. The inventory of industrial sources of emissions to the air was obtained from the regional environmental authorities and industrial conglomerates were identified. The Kulldorf&rsquo, s circular scan test was used to detect city clusters and to identify clusters around industrial conglomerates. Multivariable spatial modeling assessed the effect of distance and direction from the industrial conglomerates controlling for socioeconomic status. We identified industrials sectors within a buffer of 1 km around industrial conglomerates related to the ACL clusters. Incidence rates showed geographical heterogeneity with low spatial autocorrelation within cities. The spatio-temporal tests identified one cluster in each city. The industries located within 1 km around the ACL clusters identified in the three cities represent different sectors. Exposure to air pollution from industrial sources might be contributing to the incidence of ACL cases in urban settings in Colombia.

Published
2020

5. Análisis espacial en epidemiología: revisión de métodos

Author

Ana Maria Valbuena-Garcia and Laura A. Rodríguez-Villamizar

Subjects
0301 basic medicine, 03 medical and health sciences, 030104 developmental biology, Geography, Humanities
Abstract

espanolEl analisis espacial es un conjunto de tecnicas que utiliza como insumos la ubicacion geografica o espacial de los eventos que se analizan. El uso de tecnicas de analisis espacial en los estudios epidemiologicos ha tenido un rapido crecimiento en las ultimas decadas porque permiten incluir en los analisis la variabilidad espacial. En el presente trabajo se hace una revision general de los metodos de analisis espacial aplicados a la epidemiologia y tiene como propositos incentivar el estudio del analisis espacial y promover la incorporacion de estas tecnicas en las investigaciones actuales. Se describen los metodos de analisis espacial desde el abordaje descriptivo y analitico haciendo enfasis en el uso, ventajas y limitaciones de mapas coropleticos, pruebas de hipotesis y la identificacion de clusters de enfermedades. EnglishSpatial analysis is a set of techniques that use the geographical locations of the events as input data. The use of spatial analysis techniques in epidemiological studies has been growing rapidly in the last decades because they allow geographic or spatial variability to be included in the analyses. This paper makes a general review of the methods of spatial analysis applied to epidemiology and aims to encourage the study of spatial analysis and promote the incorporation of these techniques in current research. We describe the methods of spatial analysis from the descriptive and analytical approach emphasizing the use, advantages and limitations of choropleth maps, hypothesis tests and the identification of clusters of diseases.

Published
2018
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6. A spatial analysis of childhood cancer and industrial air pollution in a metropolitan area of Colombia

Author

Claudia Janeth Uribe Pérez, Laura A. Rodríguez-Villamizar, Rafael Gustavo Ortiz Martínez, Feisar Enrique Moreno Corzo, and Ana Maria Valbuena-Garcia

Subjects
Male, Latin Americans, Population, Childhood cancer, Air pollution, Colombia, medicine.disease_cause, Disease cluster, 03 medical and health sciences, 0302 clinical medicine, Manufacturing and Industrial Facilities, Environmental health, Air Pollution, Neoplasms, Medicine, Humans, education, Child, education.field_of_study, Air Pollutants, Spatial Analysis, business.industry, Hematology, Environmental Exposure, Metropolitan area, Cancer registry, Geography, Disease Hotspot, Oncology, 030220 oncology & carcinogenesis, Child, Preschool, Pediatrics, Perinatology and Child Health, Spatial variability, Female, Particulate Matter, business, 030215 immunology
Abstract

BackgroundAir pollutants are considered carcinogenic to humans. In some European countries, an association with childhood cancer in children has been established. This phenomenon has not been addressed in Latin America, despite the spatial variability of air pollutants that may limit the extrapolation of the results to other geographical areas.ObjectiveTo conduct a spatial analysis of the relationship between childhood cancer and air pollution from industrial sources in a metropolitan area of Colombia.MethodsIncident cases of childhood cancers were obtained from the Population-based Cancer Registry of the Bucaramanga Metropolitan Area (2000-2015). Local and focused cluster tests were used for the detection of spatial clusters and the Poisson multivariable model was used to evaluate the combined effects of spatial variables.ResultsThe Kulldorff’s focused test found a significant spatial cluster (p=0.001) around one industrial agglomerate and the multivariable model results suggests that the distance effect is modified by the directional effect of the wind.ConclusionA spatial cluster of incident cases of childhood cancer occurred in the municipality of Bucaramanga. Our finding supports the hypothesis that childhood cancer might be related with industrial air pollution exposure in a Latin American city.

Published
2019

7. Factors associated with coronary artery disease among people living with human immunodeficiency virus: Results from the Colombian HIV/AIDS registry

Author

Manuel Urina-Jassir, Andrés Felipe Patiño-Aldana, Lina Johana Herrera-Parra, Juliana Alexandra Hernández Vargas, Silvia Juliana Trujillo-Cáceres, Ana María Valbuena-García, Lizbeth Acuña-Merchán, Daniela Urina-Jassir, and Miguel Urina-Triana

Subjects
HIV, Heart disease risk factors, Coronary artery disease, Colombia, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Background: People living with HIV (PLWHIV) are at a higher risk of developing coronary artery disease (CAD). We aimed to assess the factors associated with CAD among PLWHIV in Colombia. Methods: We conducted a retrospective cohort study based on adults newly diagnosed with HIV, reported to the Colombian HIV/AIDS registry from 2018 to 2021. Baseline demographic and clinical characteristics were compared by age (

Published
2023
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8. The effect of comorbidities on glycemic control among Colombian adults with diabetes mellitus: a longitudinal approach with real-world data

Author

Manuel Urina-Jassir, Lina Johana Herrera-Parra, Juliana Alexandra Hernández Vargas, Ana María Valbuena-García, Lizbeth Acuña-Merchán, and Miguel Urina-Triana

Subjects
Glycated hemoglobin A1c, Diabetes mellitus, Comorbidity, Hypertension, Chronic kidney Disease, Obesity, Diseases of the endocrine glands. Clinical endocrinology, RC648-665
Abstract

Abstract 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.

Published
2021
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9. Factors associated with delays in time to treatment initiation in Colombian women with cervical cancer: A cross-sectional analysis

Author

Juliana Alexandra Hernández Vargas, Paula Ximena Ramírez Barbosa, Ana María Valbuena-Garcia, Lizbeth Acuña, and Jaime A. González-Diaz

Subjects
Cervical cancer, Time-to-treatment, Delayed treatment, Health insurance, Gynecology and obstetrics, RG1-991, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

Cervical cancer (CC) is one of the leading causes of morbidity in upper-middle income countries such as Colombia. Several studies have reported poor prognosis when treatment is delayed. We aimed to describe the factors associated with delays in time to treatment initiation (TTI) in Colombian women with CC. Cross-sectional analysis including newly diagnosed cases of CC during 2018 and reported to the National Administrative Cancer Registry. TTI was defined as days from diagnosis to the first treatment (chemotherapy, radiation, or surgery). Linear and multinomial logistic regression models were estimated to analyze the association of interest. 1,249 new cases of CC were analyzed (26.98% in-situ and 40.11% locally advanced). The median age was 46 years (IQR: 36–58). Median TTI was 71 days (IQR: 42–105), varying from 70 days (IQR: 43–106) among the surgery group to 76 days (IQR: 41–118) in women under chemotherapy. Only 12.41% were treated within 30 days from diagnosis. TTI was significantly longer in women with state insurance (β = 18.95 days, 95% CI: 11.77–26.13) compared with those insured by the third payer. Women from the Pacific and Eastern regions also had a significantly longer TTI than those living in the capital of Colombia. Age, health insurance, region of residence, and stage at diagnosis were associated with TTI longer than 45 days in the multinomial model. We concluded that demographic variables (age, region of residence, and health insurance) which are proxies of social disparities and poor access to quality health care services, were associated with delays in TTI.

Published
2021
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