Centro Nacional de Epidemiología (CNE)

Permanent URI for this collectionhttps://hdl.handle.net/20.500.12105/19608

La misión del Centro Nacional de Epidemiología es el estudio epidemiológico del binomio salud-enfermedad con el fin de mejorar el nivel de salud de la población mediante la vigilancia de la salud pública, el estudio de la conducta de las enfermedades (transmisibles y no transmisibles), la cuantificación de su impacto, la monitorización de su evolución y la investigación de los factores que comprometen la salud.

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Evaluación de los cursos de certificación de las causas de la defunción para médicos en formación de la especialidad.
(Ministerio de Sanidad (España), 2026-03-10) Cirera Suárez, Lluís; Maeso Martínez, Sergio; Fernández-Somoano, Ana; Salmerón Martínez, Diego
[ES] Fundamentos: Las causas de defunción son las patologías que el personal médico consigna en los certificados médicos de defunción. La calidad de las causas de defunción es un requisito necesario para la utilidad de la estadística de mortalidad. Es fundamental formar en la correcta cumplimentación médica de las causas de defunción. El objetivo de este trabajo fue evaluar la eficacia de los cursos de certificación de las causas de la defunción a todo médico especialista en formación (MIR). Métodos: Se realizó un estudio epidemiológico observacional descriptivo de la eficacia del aprendizaje en certificación médica mediante dieciocho cursos presenciales evaluados con diseño cuasiexperimental pre y postest, dirigidos a todo MIR y especialidad en España. Evaluamos: escritura legible; secuencia lógica; ausencia de abreviaturas y acrónimos; secuencia causal, sin causas añadidas o no omitidas; y causas inmediata, intermedia, fundamental, otros procesos y causa básica. Se consideró Correcto obtener dos tercios de la puntuación máxima; y Apto, obtener la puntuación correcta en secuencias lógica y causal, sin causas añadidas u omitidas, y las tres causas básicas de los casos iniciales y finales. Se aplicaron técnicas estadísticas bivariantes para indicadores no/emparejados entre pre-postest individuales/agrupados, y multivariantes ajustando por evaluadora y curso. Resultados: Se incluyeron el 96% de casos y el 85% de indicadores emparejados. Los indicadores grupales Forma, Concepto, Resultado y Total mejoraron significativamente. Los análisis ajustados de los casos emparejados pre-postest aumentaron los MIR aptos del 26% al 80%. Conclusiones: Los cursos de certificación MIR de la defunción evidencian eficacia. Se deberían implementar cursos sistemáticos MIR de certificación de las causas de la defunción. [EN] Objective: The causes of death are the pathologies that physicians fill on death certificates. The causes of death quality is a mandatory requirement for useful mortality statistics. To train physicians is essential for the correct fulfillment of death causes. The objective of this paper was to evaluate the efficacy of courses on causes of death certification to all physicians in specialty training. Methods: A descriptive observational epidemiological study was conducted to evaluate the efficacy of medical death certification in eighteen in-person courses using a quasi-experimental pre- and posttest design aimed to all physicians during their specialty training in Spain. We assessed: legible handwriting; logical sequence; absence of abbreviations and acronyms; causal sequence, no added causes, no omitted causes; immediate, intermediate, fundamental causes, other conditions, and underlying cause. Correct toll was the achievement of 2/3 of the maximum score; and Suitable, the achievement of the correct score in logical and causal sequences, without added or omitted causes, and the three underlying causes of initial and final paired cases. We applied bivariate statistics to paired/unpaired indicators between individual/grouped pre-posttests, and multivariate statistics adjusting for evaluator and course. Results: 96% of cases were included, and the 85% paired pre-posttests. The individual indicators grouped into Form, Concept, Result, and Total, improved significantly from the pretest. The matched and adjusted analysis showed a 26% to 80% increase of Suitable physicians in specialty training. Conclusions: The efficacy of the courses on medical certification is assessed. Systematic courses on certification of causes of death for all physicians in specialty training should be implemented.
Mortalidad en las residencias de mayores en Castilla-La Mancha en 2020 según área de salud.
(Instituto de Salud Carlos III (ISCIII). Centro Nacional de Epidemiología (CNE), 2026-04-10) Zunzunegui Pastor, Victoria; Rubio Mengual, Iñaki; Villar Baile, Álvaro; Garcia Lopez, Fernando Jose
Incluye datos de defunciones por COVID-19 y por todas las causas en las residencias de mayores en Castilla la Mancha entre Marzo y el 12 de enero de 2021 según área de salud, características de las residencias e incidencia de COVID-19 en el municipio. El proyecto analiza las desigualdades en la mortalidad por COVID-19 y por todas las causas en las residencias de mayores en Castilla la Mancha según área de salud durante 2020.
Elevated Zonulin-1 is Associated With an Increased Risk of Non-AIDS-Defining Cancers in People With HIV With Suboptimal Immune Recovery: A Case-Cohort Study.
(Wiley, 2026-04) Pita-Martínez, Carlos; Muñoz-García, Paula; Martinez, Isidoro; Rava, Marta; Bautista Hernández, Azucena; Pérez-Somarriba, Juncal; Campins, Antoni; Novella Mena, María; Vera, Francisco; Montero-Alonso, Marta; Jimenez-Sousa, Maria Angeles; Resino, Salvador; Martín-Escolano, Rubén; CoRIS cohort; Instituto de Salud Carlos III; Unión Europea. Fondo Europeo de Desarrollo Regional (FEDER/ERDF); Agencia Estatal de Investigación (España); Centro de Investigación Biomédica en Red - CIBERINFEC (Enfermedades Infecciosas); Comunidad de Madrid (España); Centro de Investigación Biomédica en Red - CIBERBBN (Bioingeniería, Biomateriales y Nanomedicina)
People with HIV (PWH) on antiretroviral therapy (ART) exhibit a heightened risk of non-AIDS-defining cancers (NADCs), linked to chronic inflammation driven by microbial translocation. We investigated whether plasma biomarkers of gut barrier dysfunction are associated with NADC risk, hypothesizing this association is modified by immune status. We conducted a case-cohort study nested within the Spanish CoRIS cohort. Plasma levels of zonulin-1, lipopolysaccharide, LPS-binding protein, and flagellin were measured in 71 incident NADC cases and a 261-individuals subcohort. Multivariable Cox proportional hazards models were used to estimate NADC risk, testing for effect modification by baseline CD4 + T-cell count. Zonulin-1 was not independently associated with NADC risk. However, a strong statistical interaction with baseline CD4 + T-cell count was detected (p = 0.001). Among individuals with suboptimal immune recovery (defined as CD4 + T-cell count < 500 cells/mm³), higher zonulin-1 levels were associated with a nearly threefold increased NADC risk (aHR = 2.94 (1.28-6.76)). Conversely, no association was observed in those with robust immune reconstitution (≥ 500 cells/mm³; aHR= 0.84 (0.41-1.72)). Other biomarkers showed no association. This supports a "two-hit" model of carcinogenesis where a compromised gut barrier and impaired immune competence are associated with an increased risk of cancer. Zonulin-1 is a key biomarker for identifying this high-risk phenotype, suggesting targeted cancer prevention strategies restoring gut integrity.
Monitoring effectiveness of nirsevimab immunization against RSV hospitalization using surveillance data: a test-negative case-control study, Spain, October 2024-March 2025.
(Cambridge University Press, 2025-12-09) Campos Mena, Sandra; Pérez-Gimeno, Gloria; Lorusso, Nicola; Álvarez Río, Virginia; Basile, Luca; Batalla Rebollo, Noa; García-Comas, Luis; Andreu Ivorra, Blanca; Pérez-Panadés, Jordi; Ramos Marín, Violeta; Castrillejo, Daniel; Fernández Ibáñez, Ana; Rafael de la Cruz López, María Ángeles; Nuñez, Olivier; Monge Corella, Susana; Grupo SiVIRA de vigilancia y efectividad vacunal en España
Effectiveness of nirsevimab against respiratory syncytial virus (RSV) hospitalization during the 2024/2025 season in Spain was estimated using a test-negative design (TND) and hospital-based respiratory infections surveillance data. Children born between 1 April 2024 and 31 March 2025 and hospitalized with severe respiratory infection between the start of the 2024 immunization campaign (regionally variable, between 16 September and 1 October 2024) and 31 March 2025 were systematically RT-PCR RSV-tested within 10 days of symptom onset and classified as cases if positive or controls if negative. Nirsevimab effectiveness ((1 - odds ratio) × 100) was estimated using logistic regression, adjusted for admission week, age, sex, high-risk factors, and regional RSV hospitalization rate. We included 199 cases (68.8% immunized) and 360 controls (86.4% immunized). Overall effectiveness was 65.5% (95% confidence interval: 45.2 to 78.3). Effectiveness was similar among infants born before and after the campaign start (63.6% vs. 70.4%, respectively). We found an unexpected early decrease in effectiveness with increasing time since immunization and age, albeit with wide confidence intervals for some groups. Strong age-period-cohort effects and potential sources of bias were identified, highlighting the need to further explore methodological challenges of implementing the TND in the dynamic population of newborns.
Asociación entre la región geográfica de origen y la mortalidad por COVID-19 en España.
(Instituto de Salud Carlos III (ISCIII). Escuela Nacional de Sanidad (ENS), 2024-07) Campos Mena, Sandra; Monge Corella, Susana
Introducción: La inmigración en España es un fenómeno reciente, ya que la mayoría de las personas nacidas en el extranjero han llegado al país en las últimas dos décadas. Desde el ámbito de la salud pública ha surgido un interés creciente por conocer su estado de salud y los patrones de mortalidad para detectar vulnerabilidades y áreas de mejora. Según la literatura internacional, los migrantes podrían haber enfrentado un mayor riesgo de morbilidad y mortalidad por COVID-19 debido a una posible mayor exposición al virus influenciada por determinantes sociales. Este estudio tiene como objetivo evaluar la relación entre la región geográfica de origen y la mortalidad por COVID-19 en España. Metodología: Estudio observacional basado en registros poblacionales. La fuente de información del evento objeto de estudio fueron las bases de microdatos de mortalidad anonimizados aportadas por el Instituto Nacional de Estadística (INE) correspondientes a los años 2020, 2021 y 2022, con cobertura en todo el territorio español. Se seleccionaron como fallecimientos debidos a COVID-19 aquellos cuya causa básica de defunción tuvo consignado el código CIE-10 (Clasificación Internacional de Enfermedades, 10ª revisión ) correspondiente a infección por SARS-CoV-2 confirmada (U07.1). El denominar, constituido por la población residente, se obtuvo de las Cifras de Población y la Estadística Continua de Población del INE. Las variables de exposición fueron el país de nacimiento y de nacionalidad, ambas agrupadas en las siguientes regiones de nacimiento y de nacionalidad, respectivamente: 1) España, 2) Europa occidental y otros países occidentales, 3) Europa del este, 4) África subsahariana, 5) Norte de África y países del Medio Oriente, 6) Centroamérica y Caribe, 7) Sudamérica, 8) Sudeste asiático. Se calcularon las tasas de defunción debida a infección por SARS-CoV-2 confirmada para cada región de nacimiento o nacionalidad y se estimaron las razones de tasas con sus correspondientes intervalos de confianza al 95% mediante un modelo de regresión binomial negativa ajustado por Comunidad Autónoma, sexo y edad. El análisis se llevó a cabo utilizando el programa estadístico Stata v16. Resultados: Se obtuvieron 130.024 fallecimientos por infección por SARS-CoV-2 confirmada para el análisis según región de nacimiento. En comparación con la población nacida en España, para el periodo global, la región de Sudamérica (SA) fue la única con un aumento significativo del riesgo de mortalidad, siendo un 30% superior en el grupo de edad de 40 y 64 años (RT: 1,30; IC95%: 1,09 - 1,55) y un 49% superior en el de 65 y 79 años (RT: 1,49; IC95%: 1,30 - 1,70). En el resto de regiones, hubo una tendencia hacia una reducción del riesgo en el grupo de ≥80 años. Por periodos, la mayoría de las regiones (excepto SA) mostraron un riesgo de mortalidad igual o inferior, especialmente en los periodos 1, 3 y 6. Sin embargo, se observó un aumento del riesgo en el periodo 2 para la región del Norte de África y Oriente Medio (NAOM) y especialmente en el periodo 4 para la mayoría de las regiones, coincidiendo con el verano y con el inicio de la vacunación generalizada. En el periodo 5, se mantuvo un aumento del riesgo solo en las regiones de Europa Occidental y Otros Países Occidentales y Europa del Este, mientras que en el periodo 6 el riesgo volvió a ser igual o menor en todas las regiones. Se registraron 130.424 fallecimientos por infección confirmada de SARS-CoV-2 para el análisis por región de nacionalidad. Los resultados fueron consistentes con los obtenidos para la región de nacimiento. Sin embargo, se observó un aumento del riesgo en las regiones que ya presentaban riesgo en el análisis previo, además de un mayor riesgo en otras regiones y grupos de edad que no mostraban riesgo anteriormente, como en el grupo de edad de 65 a 79 años en las regiones de NAOM y América Central y Caribe durante el periodo global. Conclusiones: Los migrantes nacidos en Sudamérica, la principal población migrante en España, exhibieron el mayor riesgo de mortalidad por infección por SARS-CoV-2. El mayor riesgo de mortalidad se ha relacionado con una sobreexposición al virus y un retraso en la búsqueda de atención sanitaria en relación a unas peores condiciones de vida. Este riesgo fue más pronunciado en el análisis por región de nacionalidad, sugiriendo una mayor vulnerabilidad a menor tiempo de residencia en el país. Es posible que entre la migración más reciente haya una mayor proporción de migrantes irregulares, forzados o con mayores necesidades. Estos hallazgos subrayan las disparidades de salud persistentes entre minorías incluso en sistemas de salud inclusivos como el español.
Decision tree and glossary for classifying study designs: interactive version (WCT EVI MAP Project). Version Jun 2025.
(Instituto de Salud Carlos III, 2026-02) Craciun, Oana Marilena; García-Ovejero, Ester; Montes Mota, Marina; Holdenrieder, Stefan; Trulson, Inga; Worf, Karolina; Gabriel, Sophie; Chechlińska, Magdalena; Kowalewska, Magdalena; Michalek, Irmina; Maslova, Kateryna; Taraszkiewicz, Lukasz; Del-Águila-Mejía, Javier; Colling, Richard; Tan, Puay Hoon; Goldman-Lévy, Gabrielle; Giesen, Christine; Cierco Jimenez, Ramon; Lokuhetty, Dilani; Cree, Ian A; Indave, Iciar; Campbell, Fiona; Perez-Gomez, Beatriz; Pollan-Santamaria, Marina; Plans-Beriso, Elena; WCT EVI MAP Project Team; Unión Europea. Comisión Europea; Innovate UK; UK Research and Innovation
The WCT EVI MAP project seeks to create a comprehensive map of the scientific evidence relevant to the World Health Organization's tumour classification. This endeavour involves the significant challenge of reviewing an extensive number of records within a highly constrained timeframe. To address this, the review process will primarily focus on article abstracts, which, however, may occasionally be unclear or incomplete. Furthermore, the classification and coding tasks will involve researchers from diverse fields of expertise. To mitigate these and other challenges, a decision tree accompanied by a glossary has been developed. This document correspond to the integrated interactive version of these tools. A decision tree for classifying study designs and a related glossary are presented in an interactive platform for ease of use.
Exposición ambiental y laboral a sustancias contaminantes y densidad mamográfica en mujeres premenopáusicas.
(Universidad Autónoma de Madrid (UAM) (España), 2025-09-24) Jiménez Castellanos, Tamara; Lope Carvajal, Virginia; García-Pérez, Javier; Ministerio de Sanidad (España)
[ES] El cáncer de mama es el tipo de tumor más frecuente en las mujeres españolas. Su incidencia sigue en aumento y, además, representa la mayor causa de muerte por cáncer en mujeres. El principal fenotipo marcador de riesgo de cáncer de mama es la densidad mamográfica (DM), definida como la cantidad de tejido fibroglandular radiológicamente denso en comparación con el tejido graso. Aunque la DM se ha asociado con diversos factores de riesgo, aún se desconoce si las exposiciones ambientales a las que nos encontramos expuestos a diario podrían influir en una mayor o menor DM. La Agencia Internacional para la Investigación sobre el Cáncer (International Agency for Research on Cancer – IARC) reconoció 47 agentes o mezclas y 12 ocupaciones, industrias o procesos con evidencia suficiente de carcinogenicidad en humanos. Asimismo, la IARC ha clasificado la contaminación del aire exterior como carcinógeno reconocido en humanos. Sin embargo, apenas disponemos de estudios que hayan centrado su investigación en la influencia que pueden ejercer las exposiciones ambientales sobre la DM. Una característica clave de la DM, que la diferencia de otros factores de riesgo de cáncer de mama, es su naturaleza dinámica y modificable. La identificación de exposiciones ambientales que aumenten o disminuyan dicha DM podría ser el camino para desarrollar estrategias de prevención primaria. Además, la DM se ha incorporado a los modelos de predicción individual de riesgo de cáncer de mama, lo cual permite considerar intervenciones en una población específica. Por todo ello, esta investigación pretende evaluar la influencia de las siguientes exposiciones sobre la DM: a) exposición a ocupaciones y agentes ocupacionales; b) exposición (proximidad) a focos contaminantes industriales; y c) exposición al tráfico vehicular y contaminantes atmosféricos. Para dar respuesta a los objetivos planteados se utilizó la información recogida en el proyecto DDM-Madrid (EC11-2273), estudio epidemiológico transversal que reclutó a 1466 trabajadoras premenopáusicas, de entre 39 y 50 años, que se realizaron su examen ginecológico laboral en el Centro de Diagnóstico Médico del Ayuntamiento de Madrid entre 2013 y 2015. La DM fue medida a través de una herramienta digital previamente validada (DM-Scan). Las exposiciones laborales se identificaron gracias a la Matriz Empleo-Exposición Española (MatEmEsp). La exposición (proximidad) a focos contaminantes industriales se obtuvo del Registro Estatal de Emisiones y Fuentes Contaminantes (PRTR-España). La exposición a la contaminación por tráfico se estimó mediante un Índice Ponderado de Exposición al Tráfico, y los datos de tráfico se obtuvieron de mediciones del número medio de vehículos/día proporcionadas por el Ayuntamiento de Madrid. Por último, la exposición, a largo plazo, a contaminantes atmosféricos específicos (dióxido de azufre, monóxido de carbono, óxidos de nitrógeno, material particulado y ozono) se estimó con datos horarios sobre los contaminantes obtenidos de las estaciones de control del Sistema Integral de Calidad del Aire del Ayuntamiento de Madrid, geocodificando las direcciones residenciales y aplicando métodos de kriging (interpolación) para estimar la media anual de 3 años de exposición de cada mujer. Para analizar la asociación entre la DM (variable respuesta) y los potenciales factores de riesgo (variables explicativas) se utilizaron modelos de regresión lineal múltiple. Estos modelos fueron ajustados por potenciales confusores: edad, índice masa corporal, paridad, existencia de biopsias mamarias previas, antecedentes familiares de cáncer de mama, uso de anticonceptivos orales, consumo de alcohol y tabaco, nivel educativo y número de calorías diarias ingeridas. Los hallazgos de este trabajo muestran que, aunque ninguna ocupación se asoció de manera estadísticamente significativa con la DM, se observó una relación inversa, casi significativa, en las trabajadoras de huertos, invernaderos, viveros y jardines y en las técnicas de las tecnologías de la información y las comunicaciones, así como una asociación positiva en las técnicas de galerías de arte y trabajadoras de museos y bibliotecas. También se observó una menor DM en mujeres expuestas laboralmente a fungicidas, herbicidas e insecticidas. Por otro lado, los resultados del estudio sobre focos industriales revelaron asociaciones significativas entre una mayor DM y vivir cerca de ciertos sectores industriales (tratamiento de superficies metálicas y plásticas, química orgánica, farmacéuticas y depuradoras) y contaminantes industriales específicos (amoníaco, diclorometano, etilbenceno y fenoles). Además, los hallazgos mostraron que vivir cerca de ciertos clusters o agrupaciones industriales podría asociarse con una mayor DM. Finalmente, ni la presencia de mayor cantidad de tráfico en el entorno domiciliario de las mujeres, ni la exposición a contaminantes atmosféricos específicos se asoció de manera significativa con la DM. Dada la relevancia de la DM como importante biomarcador del riesgo de cáncer de mama, identificar exposiciones que pueden modular la DM es fundamental para prevenir el cáncer de mama, mejorar su detección temprana, comprender los mecanismos subyacentes y diseñar políticas de salud pública más efectivas. [EN] Breast cancer is the most common type of tumor in Spanish women. Its incidence continues to increase and, moreover, it represents the leading cause of cancer-related death in women. The main phenotype marker of breast cancer risk is mammographic density (MD), defined as the amount of radiologically dense fibroglandular tissue compared to fatty tissue. Although MD has been associated with several risk factors, it is not yet known whether the environmental exposures to which we are exposed on a daily basis could influence more or less on MD. The International Agency for Research on Cancer (IARC) recognized 47 agents or mixtures and 12 occupations, industries or processes with sufficient evidence of carcinogenicity in humans. IARC has also classified outdoor air pollution as a recognized carcinogen to humans. However, there are few studies that have focused their research on the influence of environmental exposures on MD. A key feature of MD, which differentiates it from other breast cancer risk factors, is its dynamic and modifiable nature. Identifying environmental exposures that increase or decrease MD could be the pathway to developing primary prevention strategies. In addition, MD has been incorporated into individual breast cancer risk prediction models, allowing for population-specific interventions to be considered. Therefore, this research aims to assess the influence of the following exposures on MD: a) exposure to occupations and occupational agents; b) exposure (proximity) to industrial pollutants; and c) exposure to vehicular traffic and air pollutants. In order to respond to the stated objectives, the information collected in the DDM-Madrid project (EC11-2273) was used, a cross-sectional epidemiological study that recruited 1466 premenopausal female workers, aged 39-50 years, who underwent their gynecological examination at the Medical Diagnostic Centre of the Madrid City Council between 2013 and 2015. MD was measured using a previously validated digital tool (DM-Scan). Occupational exposures were identified thanks to the Spanish Employment-Exposure Matrix (MatEmEsp). Exposure (proximity) to industrial pollutants was obtained from the Spanish Pollutant Release and Transfer Register (PRTR-España). Exposure to traffic pollution was estimated using a Weighted Traffic Exposure Index, and traffic data were obtained from measurements of the average number of vehicles/day provided by the Madrid City Council. Finally, long-term exposure to specific air pollutants (sulfur dioxide, carbon monoxide, nitrogen oxides, particulate matter and ozone) was estimated with hourly data on pollutants obtained from the monitoring stations of the Integrated Air Quality System of the Madrid City Council, geocoding residential addresses and applying kriging (interpolation) methods to estimate the 3-year annual average exposure for each woman. Multiple linear regression models were used to analyze the association between MD (response variable) and potential risk factors (explanatory variables). These models were adjusted for potential confounders: age, body mass index, parity, existence of previous breast biopsies, family history of breast cancer, use of oral contraceptives, alcohol and tobacco consumption, educational level and number of daily calories ingested. The findings of this work show that, although no occupation was statistically significantly associated with MD, an inverse, almost significant, relationship was observed for women working in orchards, greenhouses, nurseries and gardens, as well as for information and communication technology technicians. In contrast, a positive association was found for women technicians in art galleries, museums, and libraries. Lower MD was also observed in women occupationally exposed to fungicides, herbicides, and insecticides. On the other hand, the results of the study about industrial foci revealed significant associations between higher MD and living near certain industrial sectors (surface treatment of metals and plastic, organic chemical industry, pharmaceutical industry, and urban waste-water treatment plants) and specific industrial pollutants (ammonia, dichloromethane, ethylbenzene, and phenols). In addition, the findings showed that living close to certain industrial clusters could be associated with higher MD. Finally, neither the presence of more traffic in the women's home environment nor exposure to specific air pollutants was significantly associated with MD. Given the relevance of MD as an important biomarker of breast cancer risk, identifying exposures that may modulate MD is essential to prevent breast cancer, improve early detection, understand the underlying mechanisms, and design more effective public health policies.
Metal and metalloid levels in topsoil and municipal cardiovascular mortality in Spain.
(Elsevier, 2022-03) Ayuso-Alvarez, Ana Maria; Nuñez, Olivier; Martín-Méndez, Iván; Bel-Lán, Alejandro; Tellez-Plaza, Maria; Perez-Gomez, Beatriz; Galan, Iñaki; Fernandez-Navarro, Pablo L
The role of metals and metalloids beyond arsenic, copper, lead and cadmium in cardiovascular disease is not entirely clear. The aim of this study was to assess the association between 18 metal or metalloid levels in topsoil (upper soil horizon) with all-cause and specific cardiovascular mortality endpoints in Spain. We designed an ecological spatial study, to assess cardiovascular mortality in 7941 Spanish mainland towns from 2010 to 2014. The estimation of metals and metalloids concentration in topsoil came from the Geochemical Atlas of Spain from 13,317 soil samples. We also summarized the joint variability of the metals using principal components analysis (PCA). These components (PCs) were included in a Besag, York, and Mollié model to assess their association with cardiovascular mortality from all causes, coronary heart disease, cerebrovascular, hypertension, and conduction disorders. Our results showed, both in men and women, that at the lowest component scores range, PC2 (mainly reflecting Al, Be, Tl and U) was positively associated with coronary heart disease and cerebrovascular mortality. At medium/highest scores range, PC4 (mainly reflecting Hg) was positively associated with cerebrovascular mortality. For PC3 (reflecting Se), the association with coronary heart disease mortality was positive only in men at the highest PC scores range. For PC1 (partly reflecting metals such as Pb, As, Cu or Cd), we observed a strongly suggestive positive association with all-cause cardiovascular diseases mortality. Our ecological results are consistent with the available evidence supporting a cardiovascular role of excessive exposure to Se, Hg, Pb, As, Cu and Cd, but also identify Al, Be, Tl and U as potentially novel cardiovascular factors. Additional research is needed to confirm the biological relevance of our findings.
Antibody reactivity against Helicobacter pylori proteins in a sample of the Spanish adult population in 2008-2013.
(Wiley, 2017-10) Fernandez de Larrea-Baz, Nerea; Michel, Angelika; Romero, Beatriz; Butt, Julia; Pawlita, Michael; Perez-Gomez, Beatriz; Castaño-Vinyals, Gemma; Moreno, Victor; Martín, Vicente; Amiano, Pilar; Castilla, Jesús; Fernández-Tardón, Guillermo; Dierssen-Sotos, Trinidad; Clofent, Juan; Alguacil, Juan; Huerta, José María; Jiménez-Moleón, José Juan; Barricarte, Aurelio; Molinuevo, Amaia; Fernández-Villa, Tania; Casabonne, Delphine; Sierra, Maria Angeles; Kogevinas, Manolis; de Sanjosé, Silvia; Pollan-Santamaria, Marina; Del Campo, Rosa; Waterboer, Tim; Aragones, Nuria
Background: Differences in Helicobacter pylori protein expression have been related to the risk of severe gastric diseases. In Spain, a marked geographic pattern in gastric cancer mortality has long been reported. Objective: To characterize antibody reactivity patterns against 16 H. pylori proteins, by age, sex, and region of birth, in a large sample of the Spanish adult population. Materials and methods: Antibody reactivity was quantified by H. pylori multiplex serology in a sample from the control group of the multicase-control study MCC-Spain. For this analysis, 2555 population-based controls were included. Each participant was classified as seropositive or seronegative for each protein according to specific cutoffs. Overall H. pylori seroprevalence was defined as positivity against ≥4 proteins. Descriptive analyses by age, sex, and region of birth were performed for both seroprevalence and seroreactivity (continuous measure). Differences among groups were tested by logistic and linear regression models. Results: Overall H. pylori seroprevalence increased with age in both sexes. For ages 55-74, seroprevalence was lower in women than in men (84% vs 92%, P<.001). Region of birth explained 7% of the variability in seroprevalence. Among H. pylori seropositive subjects, proteins with the highest seroprevalence were GroEL, NapA, HP231, and Omp. Seropositivity for most of the proteins increased or remained stable with age, rising mainly for CagA, GroEL, and HyuA in women. A clear cohort effect was not observed. Conclusions: This is the first study to describe the antibody patterns against 16 H. pylori proteins in the Spanish population. We found variability in the H. pylori antibody profiles according to both individual factors such as age and sex, and environmental factors such as the region of birth. The slightness of the reduction in seropositivity with decreasing age highlights the ongoing importance of this infection.
Años de vida ajustados por discapacidad perdidos por cardiopatía isquémica en España.
(Elsevier, 2015-11) Fernandez de Larrea-Baz, Nerea; Morant-Ginestar, Consuelo; Catalá-López, Ferrán; Gènova-Maleras, Ricard; Álvarez-Martín, Elena
[ES] Introducción y objetivos: Los años de vida ajustados por discapacidad aúnan en una medida consecuencias mortales y no mortales de las enfermedades. El objetivo fue cuantificar la carga de enfermedad de la cardiopatía isquémica en España en 2008 mediante el cálculo de años de vida ajustados por discapacidad. Métodos: Años perdidos por muerte prematura calculados a partir de defunciones por cardiopatía isquémica por edad y sexo del Instituto Nacional de Estadística y tabla de vida del estudio de carga global de enfermedad 2010. Años vividos con discapacidad calculados para el síndrome coronario agudo, la angina estable y la insuficiencia cardiaca isquémica, con datos del registro de altas hospitalarias y de estudios poblacionales, y pesos de discapacidad del estudio de carga global de enfermedad 2010. Se calcularon tasas brutas y estandarizadas por edad (población estándar europea). Se realizaron análisis de sensibilidad univariantes. Resultados: En 2008 se perdieron en España 539.570 años de vida ajustados por discapacidad por cardiopatía isquémica (tasa bruta: 11,8/1.000; estandarizada: 8,6/1.000). El 96% correspondía a años perdidos por muerte prematura y el 4% por discapacidad. De estos últimos, el 83% por insuficiencia cardiaca, el 15% por angina estable y el 2% por síndrome coronario agudo. En el análisis de sensibilidad, el factor que más modificó los resultados fue la ponderación por edad. Conclusiones: La cardiopatía isquémica sigue teniendo un gran impacto en la salud de la población, principalmente por mortalidad prematura. Los resultados aportan una visión global de la situación epidemiológica y pueden servir para evaluar intervenciones sobre las manifestaciones agudas y crónicas de la isquemia cardiaca. [EN] Introduction and objectives: The health indicator disability-adjusted life years combines the fatal and nonfatal consequences of a disease in a single measure. The aim of this study was to evaluate the burden of ischemic heart disease in 2008 in Spain by calculating disability-adjusted life years. Methods: The years of life lost due to premature death were calculated using the ischemic heart disease deaths by age and sex recorded in the Spanish National Institute of Statistics and the life-table in the 2010 Global Burden of Disease study. The years lived with disability, calculated for acute coronary syndrome, stable angina, and ischemic heart failure, used hospital discharge data and information from population studies. Disability weights were taken from the 2010 Global Burden of Disease study. We calculated crude and age standardized rates (European Standard Population). Univariate sensitivity analyses were performed. Results: In 2008, 539 570 disability-adjusted life years were lost due to ischemic heart disease in Spain (crude rate, 11.8/1000 population; standardized, 8.6/1000). Of the total years lost, 96% were due to premature death and 4% due to disability. Among the years lost due to disability, heart failure accounted for 83%, stable angina 15%, and acute coronary syndrome 2%. In the sensitivity analysis, weighting by age was the factor that changed the results to the greatest degree. Conclusions: Ischemic heart disease continues to have a huge impact on the health of our population, mainly because of premature death. The results of this study provide an overall vision of the epidemiologic situation in Spain and could serve as the basis for evaluating interventions targeting the acute and chronic manifestations of cardiac ischemia.
High adherence to Western dietary pattern and prostate cancer risk: findings from the EPIC-Spain cohort.
(Wiley, 2023-09) Castelló Pastor, Adela; Rodríguez-Barranco, Miguel; Perez-Gomez, Beatriz; Chirlaque, Maria Dolores; Bonet, Catalina; Amiano, Pilar; Ardanaz, Eva; Huerta, José María; Zamora-Ros, Raúl; Quirós, José Ramon; Barricarte-Gurrea, Aurelio; Pollan-Santamaria, Marina; Sanchez, María-José
Objective: To explore the association between three previously identified dietary patterns (Western, Prudent and Mediterranean) and prostate cancer (PCa) risk by tumour aggressiveness. Subjects and methods: The Spanish cohort of the European Prospective Investigation into Cancer and Nutrition study provided dietary and epidemiological information from 15 296 men recruited during the period 1992-1996. The associations between the adherence to the three dietary patterns and PCa risk (global, for Gleason grade groups 6 and >6, and for International Society of Urological Pathology [ISUP] grade 1 + 2 and ISUP grade 3 + 4 + 5) was explored with multivariable Cox proportional hazards regression models stratified by centre and age. Results: While no effect on PCa risk was detected for the Prudent and Mediterranean dietary patterns, a suggestion of a detrimental effect of the Western dietary pattern was found (hazard ratio [HR]Q4vsQ1 1.29 [95% confidence interval {CI} 0.96;1.72]). This effect was only observed for Gleason grade group >6 (HRQ3vsQ1 1.61 [95% CI 1.00; 2.59] and HRQ4vsQ1 1.60 [95% CI 0.96; 2.67]) and in particular ISUP grade 3 + 4 + 5 tumours (HRQ2vsQ1 1.97 [95% CI 0.98; 3.93]; HRQ3vsQ1 2.72 (95% CI 1.35; 5.51); HRQ4vsQ1 2.29 [95% CI 1.07; 4.92]). Conclusions: Our results suggest that a high adherence to a healthy diet such as that represented by the Prudent and Mediterranean dietary patterns is not enough to prevent prostate cancer. Additionally, reducing adherence to a Western-type diet seems to be necessary.
Key role of whole genome sequencing in resolving an international outbreak of monophasic Salmonella Typhimurium linked to chocolate products.
(BioMed Central (BMC), 2025-02-20) Laisnez, Valeska; Vusirikala, Amoolya; Nielsen, Charlotte Salgaard; Cantaert, Vera; Delbrassinne, Laurence; Mattheus, Wesley; Verhaegen, Bavo; Delamare, Hugues; Jourdan-Da Silva, Nathalie; Lachmann, Raskit; Simon, Sandra; Cormican, Martin; Garvey, Patricia; McKeown, Paul; Stephan, Roger; Brown, Derek; Browning, Lynda; Hoban, Ann; Larkin, Lesley; Pardos de la Gandara, Maria; Jernberg, Cecilia; Takkinen, Johanna; Balasegaram, Sooria; Van Cauteren, Dieter; Varela Martinez, Maria del Carmen; Herrera-León, Silvia; S. Typhimurium Outbreak Investigation Group; Varela Martinez, Maria del Carmen, col.; Herrera-León, Silvia, col.
Background: In February 2022, the United Kingdom (UK) detected a cluster of monophasic Salmonella Typhimurium based on whole genome sequencing (WGS). Subsequently, several countries reported cases belonging to this cluster. Epidemiological, microbiological and traceability investigations pointed toward a chocolate food business operator (FBO) in Belgium. We describe the magnitude of the outbreak, investigations performed and control measures taken. Methods: Cases were ascertained based on internationally agreed case definitions and interviewed about food consumption prior to disease onset. Analytical epidemiological studies were conducted by the UK and Ireland. The Belgian food safety authority (FSA) coordinated microbiological and traceability investigations. Results: A total of 456 cases (61% female), belonging to two genetically different WGS clusters, in 14 countries of the European Union, the UK, Switzerland, Canada and the United States were linked to the outbreak, between December 2021 and June 2022. 87% of cases were younger than 10 years. Brand A chocolate eggs, marketed for children, were reported as consumed by 168 cases (80%) with information. Analytical studies in the UK and Ireland showed a significantly higher odds of disease associated with consumption of brand A chocolate products. Retrospective investigations by the FSA revealed that routine samples (raw materials, intermediate, semi-finished and finished products as well as environmental and rinse oil samples) taken by the FBO linked to the Brand A products between December 2021 and January 2022 had tested positive for salmonella. Nine isolates were submitted to EnteroBase and matched with human isolates from both WGS clusters. The authorization for production was temporarily withdrawn on 8 April 2022 and all products of brand A were recalled worldwide, followed by a decrease in cases. Conclusions: A multi-country salmonellosis outbreak linked to chocolate occurred in the months before Easter 2022. International collaboration between stakeholders from epidemiological, microbiological and food safety entities with rapid sharing of WGS results from human and nonhuman isolates were key in containing the outbreak. Implementation of routine WGS on human and nonhuman isolates will strengthen public health responses to future outbreaks. The magnitude of the outbreak underlines the importance of timely and open communication of FBOs to FSAs in case of salmonella detection.
Severity of the clinical presentation of hepatitis A in five European countries from 1995 to 2014.
(Elsevier, 2022-05) Severi, Ettore; Georgalis, Leonidas; Pijnacker, Roan; Veneti, Lamprini; Turiac, Iulia Adelina; Chiesa, Flaminia; Rizzo, Caterina; Martinelli, Domenico; Vold, Line; Herrador, Bernardo Guzman; Varela Martinez, Maria del Carmen; Martínez-Sánchez, Elena Vanesa; Semenza, Jan C; Lopalco, Pierluigi; Dahlström, Lisen Arnheim; Giesecke, Johan
Objectives: We analysed hepatitis A (HepA) notifications and hospitalisations in Italy, the Netherlands, Norway, Spain, and Sweden for available periods between 1995 and 2014. We aimed to investigate whether decreasing HepA incidence is associated with increasing age at infection and worsening HepA presentation and to identify groups at risk of severe disease. Methods: We performed a retrospective cohort study including 36 734 notified and 36 849 hospitalised patients. We used negative binomial regressions to identify over time: i) trends in hospitalisation and notification rates; ii) proportion of hospitalised and notified patients aged ≥40 years; iii) proportion of "severe hospitalisations"; and iv) risk factors for severe hospitalisation. Results: During the study period both HepA notifications and hospitalisations decreased, with notification rates decreasing faster, patients aged ≥40 years increased, however, the proportion of severe HepA hospitalisations remained stable. Older patients and patients with comorbidities, particularly liver diseases, were more likely to experience severe disease. Conclusions: We used digitalised health information to confirm decreasing trends in HepA hospitalisations and notifications, and the increasing age of patients with HepA in Europe. We did not identify an increase in the severity of the clinical presentation of patients with HepA. Older patients with liver diseases are at increased risk of severe disease and should be prioritised for vaccination.
Toenails as a biomarker of exposure to arsenic: A review.
(Elsevier, 2021-04) Signes-Pastor, Antonio J; Gutiérrez-González, Enrique; García-Villarino, Miguel; Rodriguez-Cabrera, Francisco David; López-Moreno, Jorge J; Varea-Jiménez, Elena; Pastor-Barriuso, Roberto; Pollan-Santamaria, Marina; Navas-Acien, Ana; Perez-Gomez, Beatriz; Karagas, Margaret R
This systematic review summarizes the current evidence related to the reliability of toenail total arsenic concentrations (thereafter "arsenic") as a biomarker of long-term exposure. Specifically, we reviewed literature on consistency of repeated measures over time, association with other biomarkers and metal concentrations, factors influencing concentrations, and associations with health effects. We identified 129 papers containing quantitative original data on arsenic in toenail samples covering populations from 29 different countries. We observed geographic differences in toenail arsenic concentrations, with highest median or mean concentrations in Asian countries. Arsenic-contaminated drinking water, occupational exposure or living in specific industrial areas were associated with an increased toenail arsenic content. The effects of other potential determinants and sources of arsenic exposure including diet, gender and age on the concentrations in toenails need further investigations. Toenail arsenic was correlated with the concentrations in hair and fingernails, and with urine arsenic mainly among highly exposed populations with a toenail mean or median ≥1 μg/g. Overall, there is a growing body of evidence suggesting that arsenic content from a single toenail sample may reflect long-term internal dose-exposure. Toenail arsenic can serve as a reliable measure of toxic inorganic arsenic exposure in chronic disease research, particularly promising for cancer and cardiovascular conditions.
Design and Implementation of a Nationwide Population-Based Longitudinal Survey of SARS-CoV-2 Infection in Spain: The ENE-COVID Study.
(American Public Health Association (APHA), 2023-05) Pastor-Barriuso, Roberto; Perez-Gomez, Beatriz; Oteo-Iglesias, Jesus; Hernán, Miguel A; Perez-Olmeda, Mayte; Fernandez de Larrea-Baz, Nerea; Molina, Marta; Fernandez-Garcia, Aurora; Martín, Mariano; Cruz, Israel; Sanmartín, José L; Paniagua-Caparros, Jose Leon; Muñoz-Montalvo, Juan F; Blanco, Faustino; Yotti-Alvarez, Raquel; Pollan-Santamaria, Marina
Data System. The Spanish National Seroepidemiological Survey of SARS-CoV-2 (or ENE-COVID; SARS-CoV-2 [severe acute respiratory syndrome coronavirus 2] is the causative agent of COVID-19) was funded by the Spanish Ministry of Health, the Instituto de Salud Carlos III, and the Spanish National Health System. Data Collection/Processing. A stratified 2-stage probability sampling was used to select a representative cohort of the noninstitutionalized population of Spain. ENE-COVID collected longitudinal data from epidemiological questionnaires and 2 SARS-CoV-2 IgG antibody tests. From April 27 to June 22, 2020, 68 287 participants (77.0% of contacted persons) received a point-of-care test and 61 095 (68.9%) also underwent a laboratory immunoassay. A second follow-up phase was conducted between November 16 and 30, 2020. Data Analysis/Dissemination. Analyses use weights to adjust for oversampling and nonresponse and account for design effects of stratification and clustering. ENE-COVID data for research purposes will be available upon request from the official study Web page. Public Health Implications. ENE-COVID, a nationwide population-based study, allowed monitoring seroprevalence of antibodies against SARS-CoV-2 at the national and regional levels, providing accurate figures by gender, age (from babies to nonagenarians), and selected risk factors; characterizing symptomatic and asymptomatic infections; and estimating the infection fatality risk during the first pandemic wave. (Am J Public Health. 2023;113(5):525-532. https://doi.org/10.2105/AJPH.2022.307167).
SARS-CoV-2 Infection During the First and Second Pandemic Waves in Spain: the ENE-COVID Study.
(American Public Health Association (APHA), 2023-05) Perez-Gomez, Beatriz; Pastor-Barriuso, Roberto; Fernandez de Larrea-Baz, Nerea; Hernán, Miguel A; Perez-Olmeda, Mayte; Oteo-Iglesias, Jesus; Fernandez-Navarro, Pablo L; Fernandez-Garcia, Aurora; Martín, Mariano; Cruz, Israel; Sanmartín, José L; Paniagua-Caparros, Jose Leon; Muñoz-Montalvo, Juan F; Blanco, Faustino; Yotti-Alvarez, Raquel; Pollan-Santamaria, Marina
Objectives. To describe participant characteristics associated with severe acute respiratory syndrome coronavirus 2 infection in Spain's first 2 COVID-19 waves per the Spanish National Seroepidemiological Survey of SARS-CoV-2 Infection (ENE-COVID). Methods. A representative cohort of the noninstitutionalized Spanish population, selected through stratified 2-stage sampling, answered a questionnaire and received point-of-care testing April to June 2020 (first wave: n = 68 287); previously seronegative participants repeated the questionnaire and test November 2020 (second wave: n = 44 451). We estimated seropositivity by wave and participant characteristics, accounting for sampling weights, nonresponse, and design effects. Results. We found that 6.0% (95% confidence interval [CI] = 5.7%, 6.4%) of Spain's population was infected by June and 3.8% (95% CI = 3.5%, 4.1%) more by November 2020. Both genders were equally affected. Seroprevalence decreased with age in adults 20 years and older in the second wave; socioeconomic differences increased. Health care workers were affected at 11.1% (95% CI = 9.0%, 13.6%) and 6.1% (95% CI = 4.4%, 8.5%) in the first and second waves, respectively. Living with an infected person increased infection risk to 22.1% (95% CI = 18.9%, 25.6%) in the first and 35.0% (95% CI = 30.8%, 39.4%) in the second wave. Conclusions. ENE-COVID characterized the first 2 pandemic waves, when information from surveillance systems was incomplete. (Am J Public Health. 2023;113(5):533-544. https://doi.org/10.2105/AJPH.2023.307233).
Risk prediction of Lecanosticta acicola spore abundance in Atlantic climate regions.
(Elsevier, 2025-03) García-García, David; Mesanza, Nebai; Raposo, Rosa; Pascual, Mª Teresa; Barrena, Iskander; Urkola, Amaia; Berano, Nagore; Iturritxa, Eugenia
Brown spot needle blight disease, caused by the fungus Lecanosticta acicola, affects pine trees across the northern hemisphere. In recent years, its incidence has expanded to new areas and host species. This is in association with climate change. Interest in understanding the basis of its epidemiology and proposing appropriate management measures has also increased. However, there is a lack of studies that characterise the relationship between spore abundance trends and climatic factors, which are essential to understand the spread of the disease. We collected spore abundance data for three years from 16 traps located in pine plantations over the Basque Country (north of Spain), the first European region where L. acicola was detected. A rapid change in pathogen behaviour led to serious financial losses in the forestry sector. We then modelled the relationship between spore abundance and weather variables in terms of generalised additive models. The resulting model was used to estimate the risk of disease spread over the whole area of Basque Country. We also generated a risk projection for the north of the Iberian Peninsula, an area influenced by the Atlantic climate, where the disease is currently causing severe damage. Cumulative rainfall acted as a reliable predictor of the spore abundance of the pathogen; thus, data from weather stations can be directly incorporated into early warning protocols to inform effective preventive actions.
Mortality due to lung, laryngeal and bladder cancer in towns lying in the vicinity of combustion installations.
(Elsevier, 2009-04-01) García-Pérez, Javier; Pollan-Santamaria, Marina; Boldo, Elena; Perez-Gomez, Beatriz; Aragones, Nuria; Lope Carvajal, Virginia; Ramis, Rebeca; Vidal, Enric; Lopez-Abente, Gonzalo
Background: Installations that burn fossil fuels to generate power may represent a health problem due to the toxic substances which they release into the environment. Objectives:To investigate whether there might be excess mortality due to tumors of lung, larynx and bladder in the population residing near Spanish combustion installations included in the European Pollutant Emission Register. Methods: Ecologic study designed to model sex-specific standardized mortality ratios for the above three tumors in Spanish towns, over the period 1994-2003. Population exposure to pollution was estimated on the basis of distance from town of residence to pollution source. Using mixed Poisson regression models, we analyzed: risk of dying from cancer in a 5-kilometer zone around installations that commenced operations before 1990; effect of type of fuel used; and risk gradient within a 50-kilometer radius of such installations. Results: Excess mortality (relative risk, 95% confidence interval) was detected in the vicinity of pre-1990 installations for lung cancer (1.066, 1.041-1.091 in the overall population; 1.084, 1.057-1.111 in men), and laryngeal cancer among men (1.067, 0.992-1.148). Lung cancer displayed excess mortality for all types of fuel used, whereas in laryngeal and bladder cancer, the excess was associated with coal-fired industries. There was a risk gradient effect in the proximity of a number of installations. Conclusions: Our results could support the hypothesis of an association between risk of lung, laryngeal and bladder cancer mortality and proximity to Spanish combustion installations.
Toenail zinc and risk of prostate cancer in the MCC-Spain case-control study.
(Elsevier, 2024-03-15) Gutiérrez-González, Enrique; Pastor-Barriuso, Roberto; Castelló Pastor, Adela; Castaño-Vinyals, Gemma; Fernandez de Larrea-Baz, Nerea; Dierssen-Sotos, Trinidad; Jiménez-Moleón, José Juan; Molina-Barceló, Ana; Fernández-Tardón, Guillermo; Zumel-Marne, Ángela; Moreno, Víctor; Gómez-Ariza, José Luis; Sierra, Maria Angeles; García-Barrera, Tamara; Espinosa, Ana; Plans-Beriso, Elena; Gómez-Acebo, Inés; Aragonés, Nuria; Kogevinas, Manolis; Pollan-Santamaria, Marina; Perez-Gomez, Beatriz
Background: Some researchers have suggested that zinc (Zn) could reduce the risk of prostate cancer (PC). However, research from observational studies on the relationship between PC risk and biomarkers of Zn exposure shows conflicting results. Objectives: To evaluate the association between toenail Zn and PC, considering tumour extension and aggressiveness, along with a gene-environment approach, exploring the interaction of individual genetic susceptibility to PC in the relationship between toenail Zn and PC. Methods: In MCC-Spain study we invited all incident PC cases diagnosed in the study period (2008-2013) and recruited randomly selected general population controls. In this report we included 913 cases and 1198 controls with toenail Zn determined by inductively coupled plasma mass spectrometry. To measure individual genetic susceptibility, we constructed a polygenic risk score based on known PC-related single nucleotide polymorphisms. The association between toenail Zn and PC was explored with mixed logistic and multinomial regression models. Results: Men with higher toenail Zn had higher risk of PC (OR quartile 4 vs.1: 1.41; 95% CI: 1.07-1.85). This association was slightly higher in high-grade PC [(ISUP≤2 Relative risk ratio (RRR) quartile 4 vs.1: 1.36; 1.01-1.83) vs. (ISUP3-5 RRR quartile 4 vs.1: 1.64; 1.06-2.54)] and in advanced tumours [(cT1-cT2a RRR quartile 4 vs.1: 1.40; 95% CI: 1.05-1.89) vs. (cT2b-cT4 RRR quartile 4 vs.1: 1.59; 1.00-2.53)]. Men with lower genetic susceptibility to PC were those at higher risk of PC associated with high toenail Zn (OR quartile 4 vs.1: 2.18; 95% CI: 1.08-4.40). Discussion: High toenail Zn levels were related to a higher risk for PC, especially for more aggressive or advanced tumours. This effect was stronger among men with a lower genetic susceptibility to PC.
Blood-based Lead Biomarkers And Sarcopenia Indicators In Older Adults
(Wiley, 2026) Koni, Aida; Santos-Cuerva, Alvaro; Sotos-Prieto, Mercedes; Ortolá, Rosario; Olmedo, Pablo; García-Pérez, Javier; Ramis, Rebeca; Carballo-Casla, Adrián; Gil, Fernando; González-Palacios, Javier; Pastor-Barriuso, Roberto; Navas Acién, Ana; Plans-Beriso, Elena; Fernandez-Navarro, Pablo L; Rodríguez-Artalejo, Fernando; García-Esquinas, Esther
Background: Chronic exposure to low levels of lead (Pb) remains a widespread public health issue, especially among older adults. While its neurotoxic and cardiovascular effects are well recognized, its potential role in accelerating age-related musculoskeletal decline is less understood. Emerging evidence suggests Pb may contribute to sarcopenia, but epidemiological data, especially regarding the most informative biomarkers of exposure, are limited. Methods: We analyzed data from 11,842 participants aged ≥60 years across four population-based studies (NHANES III, NHANES 1999-2006, NHANES 2011-2012 and Seniors-ENRICA-2). Sarcopenia indicators included muscle strength (grip strength and chair stand test), muscle mass (Dual energy X-ray Absorptiometry, calf circumference and arm circumference), and muscle function (gait speed and Short Physical Performance Battery scores). Sarcopenia was defined in the Seniors-ENRICA-2 using the European Working Group on Sarcopenia in Older People 2 criteria. Associations between Pb exposure (serum and whole blood) and sarcopenia indicators were estimated using multivariable regression and meta-analyses. Results: Pb levels were associated with residential environmental exposures such as traffic proximity, industrial emissions, and soil contamination, explaining approximately 11% of variability in whole blood Pb and 9% in serum Pb. Both whole blood and serum Pb showed dose-dependent inverse associations with muscle sarcopenia indicators, including measures of strength, mass, and function. Associations with lower-limb outcomes were generally stronger for serum Pb comparted to whole blood Pb. An interquartile range increase in serum Pb was associated with a 1.33-fold increase in the odds of confirmed or severe sarcopenia (95% CI: 1.02, 1.70), compared to a 1.20-fold increase for whole blood Pb (95% CI: 1.06, 1.36). Conclusions: Environmental Pb exposure is associated with detrimental effects on musculoskeletal health and contributes to sarcopenia in older adults. Serum Pb may be a more sensitive biomarker of musculoskeletal aging than whole blood Pb and should be considered in future research and surveillance strategies.

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