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BACKGROUND Opioid drug prescription (ODP) and opioid-related mortality (ORM) have increased in Spain. However, their relationship is complex, as ORM is registered without considering the type of opioid (legal/illegal). OBJECTIVE This ecological study aims to examine the correlation between ODP and ODP in Spain. METHODS Information on ODP (2000-2019) was obtained from the Spanish Medicines Agency in daily doses per 1,000 inhabitants per day (DHD) for: total ODP, total excluding those with better safety protocols (codeine and/or tramadol), and for each opioid drug separately. Rates of ORM (per 10^6 inhabitants) were calculated based on deaths registered (CIE-10) as opioid poisoning by the National Statistics Institute. The evolution of ODP and ORM was determined separately, as well as their correlations. Their temporal evolution was analyzed using cross-correlations with 24 lags and the cross-correlation function. RESULTS The rate of ORM (2000-2019) ranged between 14/10^6 and 23/10^6, with a minimum in 2006, and an increasing trend starting in 2010. The ODP ranged between 1.51 to 19.94 DHD. The rates of ORM were directly correlated with the DHD of total ODP (r=0.597;p=0.006), total without codeine and tramadol (r=0.934;p CONCLUSIONS There is a correlation between prescription of strong opioid drugs and ORM. The role of tramadol and fentanyl is especially important. Control measures should be implemented so that dispensation of these pharmaceuticals strictly follows clinical guidelines, and each patient should be frequently reevaluated.

Background In 2015, hepatitis C treatment with direct-acting antivirals (DAAs) became free and widespread in Spain, significantly reducing hepatitis C–related mortality. However, health interventions can sometimes widen health inequalities. The objective of this study is to assess the impact of DAA treatment on hepatitis C–related mortality by educational level. Methods We analyzed deaths from hepatitis C, unspecified liver cirrhosis, hepatocellular carcinoma, alcohol-related liver diseases, other liver diseases, and human immunodeficiency virus (HIV) disease among individuals living in Spain during 2012–2019 and aged ≥25 years. We calculated age-standardized mortality rates per million person-years by period, sex, and education. Using quasi-Poisson segmented regression models, we estimated the annual percent change in rates in pre- and postintervention periods by education level and the relative inequality index (RII). Results Hepatitis C mortality rates among low, middle, and highly educated people decreased from 25.2, 23.2, and 20.3/million person-years in the preintervention period to 15.8, 13.7, and 10.4 in the postintervention period. Mortality rates from other analyzed causes also decreased. Following the intervention, downward trends in hepatitis C mortality accelerated at all education levels, although more in highly educated people, and the RII increased from 2.1 to 2.7. For other analyzed causes of death, no favorable changes were observed in mortality trends, except for liver cirrhosis, hepatocellular carcinoma, HIV disease, and alcohol-related liver disease among higher educated people. Conclusions Results suggest that DAA treatments had a very favorable impact on hepatitis C mortality at all education levels. However, even in a universal and free healthcare system, highly educated people seem to benefit more from DAA treatment than less educated people.

Factor de impacto: 3,390 Q2 Factor de impacto: 3,390 Q2 Alcohol-related harm decreases as socioeconomic position increases, although sometimes the opposite happens with alcohol intake. The objective was to know the educational gradient in monthly measures of drinking amount and heavy episodic drinking (HED) among people aged 25-64 years in Spain from 1997-2017. Such gradient was characterized with the relative percent change (PC) in drinking measures per year of education from generalized linear regression models after adjusting for age, year, region, marital status and immigration status. Among men, the PCs were significantly positive (p < 0.05) for prevalence of 40 g/day (-6.0%) and ≥4 HED days (-3.2%), while among women they ranged from 3.6% to 5.7%. The gradient in prevalences of >40 g/day (men) and >20 g/day (women) was greatly attenuated after additionally adjusting for HED, while that of ≥4 HED days was only slightly attenuated after additionally adjusting for drinking amount. Among women, the gradients, especially in HED measures, seem steeper in 2009-2017 than in 1997-2007. Educational inequality remained after additional adjustment for income and occupation, although it decreased among women. These results can guide preventive interventions and help explain socioeconomic inequalities in alcohol-related harm. This study was funded by the Delegación del Gobierno para el Plan Nacional sobre Drogas (DGPNSD) [grant number 2021I034], Instituto de Salud Carlos III–ISCIII [grant numbers ENPY397/18-PFIS and PI18CIII/00047] and Instituto Mixto de Investigación UNED-Escuela Nacional de Sanidad [grant number IMIENS-2021-003-PII]. Sí

Ciertos jóvenes regresan al hogar familiar una vez emancipados, fenómeno conocido como boomerang. El fenómeno boomerang hace referencia al retorno al hogar familiar de los jóvenes tras haber vivido un periodo de emancipación. En este artículo se pretenden analizar los factores que influyen en la decisión de retornar, los modos en que se produce y los perfiles en el caso de jóvenes andaluces que vuelven al hogar familiar. Se ha analizado una encuesta de la juventud andaluza (2017) elaborada para el Diseño del III Plan Integral de Juventud de Andalucía. Los resultados muestran que determinadas variables y situaciones vividas aumentan la probabilidad de retornar -ser mujer, la intención de seguir estudiando, haber sido víctima de violencia o consumir ciertas sustancias estupefacientes de forma habitual-, mientras que otras la disminuyen -el aumento de edad, el mayor nivel de estudios, tener un contrato fijo, tener pareja estable o tener descendencia-. Las causas principales de retorno son las económicas, por razón de estudios y tras una disolución de pareja., Some young people return to the family home once they are independent, a phenomenon known as boomerang. The boomerang phenomenon refers to the return of youth to the family home after a period of independence. This article aims to analyse the factors that influence the decision to return, the ways in which this occurs and the profiles of young Andalusians who return to the family home. A survey of Andalusian youth (2017) prepared for the design of the 3rd Comprehensive Youth Plan of Andalusia has been analysed. The results show that certain variables and situations experienced increase the probability of return -being a woman, the intention to continue studying, having been a victim of violence or consuming certain drugs on a regular basis- while others decrease it -increasing age, higher level of studies, having a permanent contract, having a stable partner or having a descent-. The main causes of return are economic, due to studies and after a partner’s dissolution.

There are no recent estimates of alcohol-attributable mortality in Spain with Spanish alcohol consumption data. The objective is to estimate it and know its evolution between 2001 and 2017 in people ≥15 years, according to sex, age, period, cause of death and type of drinker. The cause-specific approach and Levin's equation were used. Survey consumption was corrected for underestimation with respect to sales statistics, and past consumption and binge drinking were considered. The average annual number of deaths attributable to alcohol in 2010-2017 was 14,927, 58.6% of which were premature (75 years). The age-standardized alcohol-attributable mortality rate was 39.4/100,000 inhabitants, representing 3.9% of overall mortality. Using standardized percentages, 68.7% corresponded to heavy drinkers. The most frequent causes of alcohol-attributable mortality were cancer (44.7%) and digestive diseases (33.2%). The rate of alcohol-attributable mortality was 3.5 times higher in men than in women (with higher ratios for young people and external causes). Between 2001-2009 and 2010-2017, the average annual rate decreased 16.8% (60.7% in 15-34 years; 19.4% in men and 9.8% in women). The contribution of heavy drinkers, digestive diseases and external causes to the risk of alcohol-attributable mortality decreased slightly between the two periods, while the contribution of cancer and circulatory diseases increased. These estimates are conservative. The contribution of alcohol to overall mortality is significant in Spain, requiring collective action to reduce it.En España no hay estimaciones recientes de la mortalidad atribuible a alcohol con datos de consumo de alcohol españoles. El objetivo es estimarla y conocer la evolución entre 2001 y 2017 en personas ≥15 años, según sexo, edad, periodo, causa de muerte y tipo de bebedor. Se utilizó el enfoque causa específico y la ecuación de Levin. El consumo de las encuestas se corrigió por subestimación con respecto a las estadísticas de ventas y se consideró el consumo pasado y los atracones de alcohol. El número medio anual de muertes atribuibles a alcohol en 2010-2017 fue 14.927, un 58,6% prematuras (75 años). La tasa de mortalidad atribuible a alcohol estandarizada por edad fue 39,4/ 100.000 habitantes, representando un 3,9% de la mortalidad general. Usando porcentajes estandarizados un 68,7% correspondió a bebedores de alto riesgo. Las causas de mortalidad atribuible a alcohol más frecuentes fueron cáncer (43,8%) y enfermedades digestivas (32,9%). La tasa de mortalidad atribuible a alcohol fue 3,5 veces mayor en hombres que en mujeres (con cocientes más elevados para jóvenes y causas externas). Entre 2001-2009 y 2010-2017 la tasa media anual disminuyó un 16,8% (60,7% en 15-34 años; 19,4% en hombres y 9,8% en mujeres). La contribución de los bebedores de alto riesgo y de las enfermedades digestivas y causas externas al riesgo de mortalidad atribuible a alcohol disminuyó ligeramente entre los dos períodos, mientras que aumentó la contribución del cáncer y enfermedades circulatorias. Estas estimaciones son conservadoras. La contribución del alcohol a la mortalidad general es importante en España, requiriendo medidas colectivas para reducirla.

The objective is to describe and discuss methods and assumptions to estimate the mortality attributable to alcohol in Spain in 2001-2017. The annual mean number of deaths attributable to alcohol (DAAs) was estimated based on 19 groups of alcohol-related causes of death (18 partially attributable and one directly attributable), and 20 alcohol population-attributable fractions (PAFs), resulting from combining sex, 5 age groups, and the periods 2001-2009 and 2010-2017, for each cause group. Deaths from causes were obtained from the Spanish National Institute of Statistics. For partially attributable causes, Spain-specific PAFs were calculated using the Levin formula with alcohol exposure data from health surveys and sales statistics, and relative risks from international meta-analyses. Annual prevalences of ex-drinkers and seven levels of daily alcohol consumption were considered. The underestimation of self-reported daily average consumption with respect to the sales statistics was corrected by multiplying by a factor of 1.58-3.18, depending on the calendar year. DAA rates standardized by age and standardized proportions of general mortality attributable to alcohol, according to sex, age group, calendar period, type of drinker and autonomous community were calculated. Sensitivity analyses were performed to assess how the DAA estimates changed when changing some methodological options, such as the ex-drinker criterion or the introduction of a latency period.El objetivo es describir y discutir los métodos y asunciones para estimar la mortalidad atribuible a alcohol en España en 2001-2017. Se estimó el nº medio anual de muertes atribuibles a alcohol (MAAs) basándose en 19 grupos de causas de muerte relacionadas con alcohol (18 parcialmente atribuibles y uno directamente atribuible), y 20 fracciones atribuibles poblacionales al alcohol (FAPs) para cada grupo de causas, resultantes de combinar sexo, 5 grupos de edad, y los períodos 2001-2009 y 2010-2017. Las muertes por causa se obtuvieron del Instituto Nacional de Estadística. Para las causas parcialmente atribuibles se calcularon FAPs específicas para España, usando la fórmula de Levin con datos de exposición al alcohol procedentes de encuestas de salud y estadísticas de ventas, y riesgos relativos procedentes de metanálisis internacionales. Se consideraron las prevalencias anuales de exbebedores y de siete niveles de consumo diario de alcohol. Se corrigió la subestimación del consumo medio diario autoinformado con respecto a las estadísticas de venta, multiplicando por un factor de 1,58-3,18, dependiendo del año-calendario. Se calcularon tasas de MAA y porcentajes de la mortalidad general atribuibles a alcohol estandarizados por edad, según sexo, grupo de edad, periodo-calendario, tipo de bebedor y comunidad autónoma. Se realizaron análisis de sensibilidad observando cómo cambiaban las estimaciones de MAA al hacerlo algunas opciones metodológicas, como el criterio de exbebedor o la introducción de un período de latencia.

Incluye versión en española e inglés Factor de impacto: 2,979 Q3 [ES] En España no hay estimaciones recientes de la mortalidad atribuible a alcohol con datos de consumo de alcohol españoles. El objetivo es estimarla y conocer la evolución entre 2001 y 2017 en personas ≥15 años, según sexo, edad, periodo, causa de muerte y tipo de bebedor. Se utilizó el enfoque causa específico y la ecuación de Levin. El consumo de las encuestas se corrigió por subestimación con respecto a las estadísticas de ventas y se consideró el consumo pasado y los atracones de alcohol. El número medio anual de muertes atribuibles a alcohol en 2010-2017 fue 14.927, un 58,6% prematuras (

Incluye versión en español e inglés Factor de impacto: 2,979 Q3 [ES] El objetivo es describir y discutir los métodos y asunciones para estimar la mortalidad atribuible a alcohol en España en 2001-2017. Se estimó el nº medio anual de muertes atribuibles a alcohol (MAAs) basándose en 19 grupos de causas de muerte relacionadas con alcohol (18 parcialmente atribuibles y uno directamente atribuible), y 20 fracciones atribuibles poblacionales al alcohol (FAPs) para cada grupo de causas, resultantes de combinar sexo, 5 grupos de edad, y los períodos 2001-2009 y 2010-2017. Las muertes por causa se obtuvieron del Instituto Nacional de Estadística. Para las causas parcialmente atribuibles se calcularon FAPs específicas para España, usando la fórmula de Levin con datos de exposición al alcohol procedentes de encuestas de salud y estadísticas de ventas, y riesgos relativos procedentes de metanálisis internacionales. Se consideraron las prevalencias anuales de exbebedores y de siete niveles de consumo diario de alcohol. Se corrigió la subestimación del consumo medio diario autoinformado con respecto a las estadísticas de venta, multiplicando por un factor de 1,58-3,18, dependiendo del año-calendario. Se calcularon tasas de MAA y porcentajes de la mortalidad general atribuibles a alcohol estandarizados por edad, según sexo, grupo de edad, periodo-calendario, tipo de bebedor y comunidad autónoma. Se realizaron análisis de sensibilidad observando cómo cambiaban las estimaciones de MAA al hacerlo algunas opciones metodológicas, como el criterio de exbebedor o la introducción de un período de latencia. The objective is to describe and discuss methods and assumptions to estimate the mortality attributable to alcohol in Spain in 2001-2017. [EN] The annual mean number of deaths attributable to alcohol (DAAs) was estimated based on 19 groups of alcohol-related causes of death (18 partially attributable and one directly attributable), and 20 alcohol population-attributable fractions (PAFs), resulting from combining sex, 5 age groups, and the periods 2001-2009 and 2010-2017, for each cause group. Deaths from causes were obtained from the Spanish National Institute of Statistics. For partially attributable causes, Spain-specific PAFs were calculated using the Levin formula with alcohol exposure data from health surveys and sales statistics, and relative risks from international meta-analyses. Annual prevalences of ex-drinkers and seven levels of daily alcohol consumption were considered. The underestimation of self-reported daily average consumption with respect to the sales statistics was corrected by multiplying by a factor of 1.58-3.18, depending on the calendar year. DAA rates standardized by age and standardized proportions of general mortality attributable to alcohol, according to sex, age group, calendar period, type of drinker and autonomous community were calculated. Sensitivity analyses were performed to assess how the DAA estimates changed when changing some methodological options, such as the ex-drinker criterion or the introduction of a latency period. Este artículo es un producto de trabajos realizados en el marco de un proyecto de investigación financiado por la Delegación del Gobierno para el Plan Nacional sobre Drogas (DGPNSD) [Nº Exp: 2015I040] y del apoyo con recursos humanos del Instituto de Salud Carlos III (Contrato ISCIII-PFIS, Nº Expediente: ENPY-397/18-PFIS). Sí

Background The public health impact of binge drinking depends on its population prevalence and its frequency and intensity among binge drinkers. The objective is to assess the consistency of time trends and age-sex disparities between binge-drinking prevalence and binge-drinking exposure indicators that combine such prevalence with the number of binge-drinking days among binge drinkers. Methods Data come from 11 biennial national household surveys from 1997 to 2017 in young (15−34 years) and middle-aged adults (35−64 years) in Spain (n = 211,961). Binge-drinking was the intake of 5+ standard drinks (4+ in women from 2009 onwards) in approximately two hours. Three monthly indicators were analyzed: binge-drinking prevalence, population rate of binge-drinking days, and proportion of drinking days with binge drinking. Results were stratified for sex and two age groups. Annual percent changes (APCs), ratios of young to middle-aged people (age ratios) and men-to-women ratios were obtained from negative binomial regression. Results Although the three indicators showed considerable consistency as an intense increase in binge drinking from 2009 to 2017 among middle-aged people, especially women, there were relevant inconsistencies. In 2009−2017 the APCs for prevalence and rate were +1.3 % and −1.6 %, respectively, in young women, and -0.6 % and −3.0 % in young men. Age ratios were significantly higher for prevalence and proportional ratio than rates, while men-to-women ratios were lower, especially in middle-aged people. Conclusions Adequate monitoring of binge drinking should incorporate indicators of absolute exposure, which better reflect its impact on public health, such as the population rate of binge-drinking days.

Background & Aims: Free treatments for hepatitis C virus (HCV) infection with direct-acting antivirals became widespread in Spain in April 2015. We aimed to test whether, after this intervention, there was a more favorable change in population mortality from HCV-related than from non-HCV-related causes. Approach & Results: Post-intervention changes in mortality were assessed using uncontrolled before-after and single-group interrupted time series designs. All residents in Spain during 2001-2018 were included. Various underlying death causes were analyzed: HCV infection, other HCV-related outcomes (hepatocellular carcinoma, liver cirrhosis, and HIV disease); and non-C hepatitis, other liver diseases, and non-hepatic causes as control outcomes. Changes in mortality after the intervention were first assessed by rate ratios (RR) between the post and pre-intervention age-standardized mortality rates. Subsequently, using Quasi-Poisson segmented regression models, we estimated the annual percent change (APC) in mortality rate in post- and pre-intervention periods. All mortality rates were lower during the post-intervention period, although RRs were much lower for HCV [0.53, 95% Confidence Interval -95%CI-: 0.51, 0.56] and HIV disease than other causes. After the intervention there was a great acceleration of the downward mortality trend from HCV, whose APC went from -3.2% [95%CI: -3.6%, -2.8%] to -18.4% [95%CI: -20.6%, -16.3%]. There were also significant accelerations in the downward trends in mortality from hepatocellular carcinoma and HIV disease, while they remained unchanged for cirrhosis and slowed or reversed for other causes. Conclusions: These results suggest that the favorable changes in HCV-related mortality observed for Spain after April 2015 are attributable to scaling up free treatment with direct-acting antivirals and reinforce that HCV eradication is on the horizon. This research was funded by Acción Estratégica Intramural, grant numbers PI18CIII/00047 and PI17CIII/00037.

Se propone conocer la influencia de ciertas variables socioeconómicas sobre la emancipación de los jóvenes dependiendo de si éste es sustentador principal de su hogar, o bien si es hijo o hija del mismo. Con ello se realiza una aproximación a la emancipación de los jóvenes. Tomando como referencia tres fechas concretas (2006, 2011 y 2015) se persigue constatar en qué medida afecta la recesión económica. Se utilizan análisis descriptivos y regresiones logísticas binarias usando la Encuesta de Presupuestos Familiares. Existen algunas diferencias dependiendo del año, así como también ciertas tendencias generales. A mayor nivel de estudios, es más probable que un joven viva con su sustentador principal, mientras que ser varón, tener entre 30 y 34 años o percibir un salario mayor de 1000 € se aproxima más al perfil de “cabeza de familia”. En cuanto a los sustentadores principales, un varón de 30 a 34 años con un nivel de ingresos mayor de 1000 € es el perfil más próximo al contrato indefinido.

La actualidad española se caracteriza por un retraso en el calendario en lo que respecta al logro de una emancipación completa, consecuencia de un alargamiento del periodo formativo y de una inestabilidad y una precariedad considerables en el empleo, entre otras cuestiones. Concretamente, Andalucía es una de las comunidades autónomas con más problemas en este sentido -mayor nivel de desempleo y de precariedad laboral, entre otros aspectos. El objetivo principal del presente artículo es conocer los factores que influyen en la probabilidad de que un joven se emancipe. Para ello se propone distinguir, dentro de la emancipación, cuáles son independientes residencialmente o económicamente para averiguar si existen diferencias en los factores que influyen en que un joven sea independiente residencialmente y no económicamente, y viceversa. Se ha utilizado una base de datos de 2017, con una muestra de 1.981 jóvenes de 14 a 35 años llevada a cabo con el propósito de diseñar el III Plan Integral de Juventud de Andalucía. La regresión logística multinomial ha sido la técnica de análisis utilizada. Los resultados muestran que los jóvenes que se aproximan más a la finalización de la transición de la juventud tienen más probabilidades de haber formado un hogar propio y de ser autosuficientes económicamente. Sin embargo, aquellos que todavía están formándose o tienen intención de retomar los estudios, están desempleados y no tienen descendencia ni intención de tenerla, se aproximan más a formas de independencia incompletas (residencial o económica) o bien nulas. L'actualitat espanyola es caracteritza per un retard en el calendari pel que fa a l'assoliment d'una emancipació completa, conseqüència d'un allargament del període formatiu i d'una inestabilitat i una precarietat considerables en l'ocupació, entre altres qüestions. Concretament, Andalusia és una de les comunitats autònomes amb més problemes en aquest sentit -major nivell de desocupació i de precarietat laboral, entre altres aspectes. L'objectiu principal d'aquest article és conèixer els factors que influeixen en la probabilitat que un jove s'emancipi. Per fer-ho, es proposa distingir, dins de l'emancipació, quins són independents residencialment o econòmicament per esbrinar si hi ha diferències en els factors que influeixen en el fet que un jove sigui independent residencialment i no econòmicament, i viceversa. S'ha utilitzat una base de dades de 2017, amb una mostra de 1.981 joves de 14 a 35 anys duta a terme amb el propòsit de dissenyar el III Pla Integral de Joventut d'Andalusia. La regressió logística multinomial ha estat la tècnica d'anàlisi utilitzada. Els resultats mostren que els joves que s'aproximen més a la finalització de la transició de la joventut tenen més probabilitats d'haver format una llar pròpia i de ser autosuficients econòmicament. No obstant això, aquells que encara estan formant-se o tenen intenció de reprendre els estudis, estan desocupats i no tenen descendència ni intenció de tenir-ne, s'aproximen més a formes d'independència incompletes (residencial o econòmica) o bé nul·les. In recent years, the situation of youth in Spain has been characterized by delayed residential and economic independence as the result of longer training periods, as well as job instability and precariousness, among others. Specifically, Andalusia is one of the regions that most suffers from high levels of unemployment and job insecurity. The main aim of this article is to identify factors that influence the probability that a young person will become emancipated. To this end, we distinguish between young people who are residential and/or economically independent and determine which factors influence whether a young person is residential but not economically independent, and vice versa. The analysis is carried out using a 2017 database with a sample of 1,981 young people aged 14 to 35 years designed for the III Andalusian Integral Youth Plan. The analysis is performed using multinomial logistic regression. The results show that people near the end of the transition from youth are more likely to have formed their own home and be financially self-sufficient. However, young people who are still in training or intend to return to education, are unemployed or have no offspring or intention of having one, are more likely to display incomplete forms of independence (residential or economic) or none at all.