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Vitullo F.,Transfusion Medicine and Biotechnology | Biagio K.D.,Regional Environmental Protection Agency of Marche | Murgano A.,Health Information Systems Unit | Bartolomeo P.D.,Transfusion Medicine and Biotechnology
Tumori | Year: 2016

Purpose: To test the feasibility of using hospital discharge records (HDR) to monitor frequency indicators of hematologic malignancies (HM) in Abruzzo, an Italian region without a cancer registry. Methods: Hospital discharge records contain a primary diagnosis field for principal disease and 5 secondary diagnosis fields for other diseases related or not to the principal diagnosis. In order to build patient indicators of HM-non- Hodgkin lymphoma (NHL), Hodgkin lymphoma (HL), multiple myeloma (MM), and leukemia (acute lymphoblastic leukemia [ALL], chronic lymphoid leukemia [CLL], acute myeloid leukemia [AML], and chronic myeloid leukemia [CML])-residents with first ICD-9-CM code 200-208 in any HDR field, or only in primary field, were identified. Results: Among 3,955 patients with first diagnosis of HM registered in primary or secondary fields of HDR in the 2009-2013 period, and never recognized in 2005-2008 (791/year) (60.5/100,000), patients with first HM only in primary field were 2,304 (461/year) (35.2/100,000): 42% were NHL, 34% leukemia, 16% MM, 8% HL. Patient percentage of 461/791/year (58%) (64% among ordinary HDR and 49% in day-hospital HDR) was 35% for CLL (28/81), 47% for MM (74/152), 50% for CML (16/32), 57% for HL (36/63), 62% for NHL (194/314), and 82% for ALL (18/22) and AML (64/78). Conclusions: Applying the cancer registries national rate, expected new diagnoses of HM in Abruzzo are about 620/year (46.4/100,000), compared to HDR estimates of 461 and 791/year (primary/all diagnoses fields: 58%). Since this percentage varies between 35% and 82%, our findings on the 2 methods seem useful for a validation process in the starting Cancer Registry © 2016 The Authors. Source


Malmusi D.,Research Center Biomedica en Red en Epidemiologia y Salud Publica | Malmusi D.,Health Information Systems Unit
European Journal of Public Health | Year: 2015

Background: Recent efforts to characterize integration policy towards immigrants and to compare immigrants' health across countries have rarely been combined so far. This study explores the relationship of country-level integration policy with immigrants' health status in Europe. Methods: Cross-sectional study with data from the 2011 European Union Survey on Income and Living Conditions. Fourteen countries were grouped according to a typology of integration policies based on the Migrant Integration Policy Index: 'multicultural' (highest scores: UK, Italy, Spain, Netherlands, Sweden, Belgium, Portugal, Norway, Finland), 'exclusionist' (lowest scores: Austria, Denmark) and 'assimilationist' (high or low depending on the dimension: France, Switzerland, Luxembourg). People born in the country (natives, n = 177 300) or outside the European Union with >10 years of residence (immigrants, n = 7088) were included. Prevalence ratios (PR) of fair/poor self-rated health between immigrants in each country cluster, and for immigrants versus natives within each, were computed adjusting by age, education, occupation and socio-economic conditions. Results: Compared with multicultural countries, immigrants report worse health in exclusionist countries (age-adjusted PR, 95% CI: men 1.78, 1.49-2.12; women 1.58, 1.37-1.82; fully adjusted, men 1.78, 1.50-2.11; women 1.47, 1.26-1.70) and assimilationist countries (age-adjusted, men 1.21, 1.03-1.41; women 1.21, 1.06-1.39; fully adjusted, men 1.19, 1.02-1.40; women 1.22, 1.07-1.40). Health inequalities between immigrants and natives were also highest in exclusionist countries, where they persisted even after adjusting for differences in socio-economic situation. Conclusion: Immigrants in 'exclusionist' countries experience poorer socio-economic and health outcomes. Future studies should confirm whether and how integration policy models could make a difference on migrants' health. © The Author 2014. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved. Source


Gotsens M.,CIBER ISCIII | Gotsens M.,Health Information Systems Unit | Gotsens M.,Biomedical Research Institute Sant Pau | Malmusi D.,CIBER ISCIII | And 13 more authors.
European Journal of Public Health | Year: 2015

Background: The immigrant population living in Spain grew exponentially in the early 2000s but has been particularly affected by the economic crisis. This study aims to analyse health inequalities between immigrants born in middle- or low-income countries and natives in Spain, in 2006 and 2012, taking into account gender, year of arrival and socioeconomic exposures. Methods: Study of trends using two cross-sections, the 2006 and 2012 editions of the Spanish National Health Survey, including residents in Spain aged 1564 years (20 810 natives and 2950 immigrants in 2006, 14 291 natives and 2448 immigrants in 2012). Fair/poor self-rated health, poor mental health (GHQ-12 > 2), chronic activity limitation and use of psychotropic drugs were compared between natives and immigrants who arrived in Spain before 2006, adjusting robust Poisson regression models for age and socioeconomic variables to obtain prevalence ratios (PR) and 95% confidence interval (CI). Results: Inequalities in poor self-rated health between immigrants and natives tend to increase among women (age-adjusted PR2006 = 1.39; 95% CI: 1.241.56, PR2012 = 1.56; 95% CI: 1.331.82). Among men, there is a new onset of inequalities in poor mental health (PR2006 = 1.10; 95% CI: 0.861.40, PR2012 = 1.34; 95% CI: 1.061.69) and an equalization of the previously lower use of psychotropic drugs (PR2006 = 0.22; 95% CI: 0.110.43, PR2012 = 1.20; 95% CI: 0.732.01). Conclusions: Between 2006 and 2012, immigrants who arrived in Spain before 2006 appeared to worsen their health status when compared with natives. The loss of the healthy immigrant effect in the context of a worse impact of the economic crisis on immigrants appears as potential explanation. Employment, social protection and re-universalization of healthcare would prevent further deterioration of immigrants health status. © The Author 2015. Source


Palencia L.,CIBER ISCIII | Palencia L.,Health Information Systems Unit | Palencia L.,Biomedical Research Institute Sant Pau | Malmusi D.,CIBER ISCIII | And 15 more authors.
Social Science and Medicine | Year: 2014

Few studies have addressed the effect of gender policies on women's health and gender inequalities in health. This study aims to analyse the relationship between the orientation of public gender equality policies and gender inequalities in health in European countries, and whether this relationship is mediated by gender equality at country level or by other individual social determinants of health. A multilevel cross-sectional study was performed using individual-level data extracted from the European Social Survey 2010. The study sample consisted of 23,782 men and 28,655 women from 26 European countries. The dependent variable was self-perceived health. Individual independent variables were gender, age, immigrant status, educational level, partner status and employment status. The main contextual independent variable was a modification of Korpi's typology of family policy models (Dual-earner, Traditional-Central, Traditional-Southern, Market-oriented and Contradictory). Other contextual variables were the Gender Empowerment Measure (GEM), to measure country-level gender equality, and the Gross Domestic Product (GDP). For each country and country typology the prevalence of fair/poor health by gender was calculated and prevalence ratios (PR, women compared to men) and 95% confidence intervals (CI) were computed. Multilevel robust Poisson regression models were fitted.Women had poorer self-perceived health than men in countries with traditional family policies (PR=1.13, 95%CI: 1.07-1.21 in Traditional-Central and PR=1.27, 95%CI: 1.19-1.35 in Traditional-Southern) and in Contradictory countries (PR=1.08, 95%CI: 1.05-1.11). In multilevel models, only gender inequalities in Traditional-Southern countries were significantly higher than those in Dual-earner countries.Gender inequalities in self-perceived health were higher, women reporting worse self-perceived health than men, in countries with family policies that were less oriented to gender equality (especially in the Traditional-Southern country-group). This was partially explained by gender inequalities in the individual social determinants of health but not by GEM or GDP. © 2014 Elsevier Ltd. Source

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