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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Plasma biomarkers of immune regulation and senescence are associated with incident skeletal-related events in people with HIV: a case-cohort study.
(Springer Nature, 2026-07-27) Pita-Martínez, Carlos; Rava, Marta; Virseda-Berdices, Ana; Martinez, Isidoro; Moreno, Santiago; Gómez Rodríguez, Carmen Elena; Armiñanzas, Carlos; Mena de Cea, Álvaro; Gisbert Pérez, Laura; Rodríguez-Rosado, Rafael; Jimenez-Sousa, Maria Angeles; Resino, Salvador; Martín-Escolano, Rubén; Instituto de Salud Carlos III; Agencia Estatal de Investigación (España); Centro de Investigación Biomédica en Red - CIBERINFEC (Enfermedades Infecciosas); Ministerio de Ciencia, Innovación y Universidades (España); Comunidad de Madrid (España)
Background: persistent immune dysregulation in people with HIV (PWH) on antiretroviral therapy (ART) contributes to an increased risk of skeletal-related events (SREs), serving as a critical paradigm for understanding accelerated aging and age-related diseases. We investigated the association between plasma biomarkers of immune regulation and senescence with incident SRE risk and evaluated potential effect modification by sex. Methods: in a case-cohort study nested within the Spanish CoRIS cohort (65 incident SRE cases; 252 subcohort, including 5 overlapping cases), we quantified 24 baseline biomarkers of immune checkpoints and senescence-associated secretory phenotype factors. We estimated adjusted hazard ratios (aHR) using Borgan II-weighted cause-specific Cox regression models adjusted for clinical confounders (age, region of origin, prior AIDS diagnosis, CD4 + T-cell count, coinfections, and lifestyle factors). Sex-biomarker interactions were assessed as exploratory endpoints. Results: nineteen biomarkers were independently associated with increased SRE risk (p < 0.05 & q < 0.10). Angiogenic factors (VEGF-A; aHR = 1.94; 95% CI, 1.40–2.68), immune checkpoints (PD-L2; aHR = 1.95; 95% CI, 1.09–3.49), and tissue remodeling markers (MMP-1; aHR = 1.91; 95% CI, 1.08–3.39) displayed independent associations, alongside consistent signals for TIM-3, PD-L1, and IL-8. Pairwise correlation analysis demonstrated clustering between checkpoints and inflammatory cytokines. Exploratory interaction analysis indicated that sex modified these associations; signals for seven markers (e.g., IL-1α, VEGF-A) were stronger in females, although the limited number of events warrants caution. Conclusions: circulating biomarkers of immune exhaustion, inflammation, and senescence are independently associated with incident SREs in PWH on long-term ART. Our findings indicate a systemic pro-inflammatory signature and suggest that females exhibit higher sensitivity to inflammatory damage.
Recent infections among newly diagnosed cases of HIV infection in Spain, 2015-2016. National estimates using cohort data.
(Taylor & Francis, 2021-06) Hernando Sebastian, Victoria; Cuevas, Maria Teresa; Perez-Olmeda, Mayte; Tasias, Maria; Vera, Mar; Jaen, Angels; Mena, Alvaro; Jarrin Vera, Inmaculada; Diaz Franco, Asuncion; CoRIS-HIV Biobank; Instituto de Salud Carlos III; Unión Europea. Fondo Europeo de Desarrollo Regional (FEDER/ERDF)
Background: To estimate the prevalence of recent infection (RI) among people newly diagnosed with HIV in Spain using a representative sample collected by the AIDS Research Network cohort (CoRIS) during 2015-2016. Methods: Stratified sampling of CoRIS data was used with proportional allocation by mode of transmission of new HIV diagnoses notified to National Surveillance System. Samples used were from patients in the CoRIS cohort with available stored plasma collected within 6 months after diagnosis. Weighted methods were used to estimate the prevalence of RI and multivariate logistic regression models were used to determine associated factors. Results: Of the 669 individuals included, 55.1% were men who had sex with men (MSM), 24.6% were heterosexual, and 20.3% were non-MSM non-heterosexual. The weighted prevalence of RI was 11.8% (95% Confidence interval [CI] 9.4-14.8%) overall, 15.5% (12.2-19.4%) among MSM, 6.3% (3.9-10.0%) among heterosexual, and 8.6% (3.2-20.9%) in non-MSM non-heterosexual persons. Factors associated with prevalence of RI were: MSM (OR 2.05; 95% CI 1.02-4.14) vs. heterosexual, being Spanish (OR 2.92; 1.36-6.26) or European (OR 3.42; 1.28-9.13) vs. Latin American, having a secondary or higher education level (OR 3.08; 0.95-1.00) vs. primary, and having a CD4 count of 350-499 (OR 3.26; 1.46-7.30) or >500 (OR 6.26; 2.92-13.39) vs. <350 cells/mm3. Conclusions: In the absence of direct data from surveillance systems, the use of cohort data is a very valuable option for identifying the prevalence of RI at national level. This is the first nationwide study carried out in Spain to determine the prevalence of RI using an avidity assay.
Factors associated with low levels of HIV testing among young men who have sex with men (MSM) participating in EMIS-2017 in Spain.
(BMJ Publishing Group, 2022-11) Gallego, Nuria; Diaz Franco, Asuncion; Folch, Cinta; Meyer, Sebastian; Vazquez, Maria; Casabona, Jordi; Hernando, Victoria
Purpose: The European Men who have sex with men Internet Survey looked over the characteristics and needs of men who have sex with men (MSM) across Europe. Our objective was to estimate the prevalence of HIV testing and its associated factors among MSM younger than 25 years old participating in the EMIS-2017 in Spain. Methods: Multivariable regression model was used to compare those who had been tested for HIV within the last 12 months and those that had not. Results: Of 2313 participants, 1070 (46.3%) had been tested for HIV in the past 12 months. Increased age (age 19-21 years, aOR=3.38 (95% CI 2.57 to 4.44); age 22-24 years, aOR=5.26 (4.06 to 6.92) compared with age 16-18 years); being migrant (Latin America: aOR=1.34 (0.98 to 1.84); Europe, North America and Mediterranean countries (aOR=1.56 (0.98 to 2.51) compared with those from Spain); living more openly with one's sexuality (out to some people (aOR=1.53 (1.19 to 1.96)); out to all or almost all people (aOR=2.24 (1.75 to 2.87) compared with those out to none or a few people); having had one condomless steady partners in the las year ((aOR=1.59 (1.26 to 2.02)); having had condomless non-steady partners in the last year (one: aOR=1.76 (1.35 to 2.29)); two or more partners: aOR=2.37 (1.84 to 3.04)); and having practised sex work in the past year (aOR=1.52 (1.07 to 2.13)) were associated with increased odds of HIV testing. Living in a smaller city was associated with less likelihood of HIV testing (<1 00 000 inhabitants: aOR=0.51 (95% CI 0.41 to 0.64); 100 000-500 000: aOR=0.68 (95% CI 0.54 to 0.86) compared with more than 500 000). Conclusion: Young MSM showed low HIV testing rate. Future programming specifically targeting this population, especially those middle adolescents, living in a medium-small city and having less 'outness', can help increase HIV testing and prevent access barriers.
COVID-19 pandemic in prisons in Spain: characteristics of cases and implemented control measures, March 2020-June 2022.
(Elsevier, 2023-05) Hernando Sebastian, Victoria; Vázquez, Isabel; Diaz Franco, Asuncion; Gómez-Pintado, Pilar; Martínez-Aznar, Carmen; Acín, Enrique
Objectives: Our aim was to describe the epidemiological characteristics of COVID-19 cases in prison inmates in Spain and the control measures implemented to response to this public health challenge. Study design: Retrospective observational study. Methods: All COVID-19-confirmed cases reported to the Spanish information system in prisons between March 2020 and June 2022 were analyzed. Prevention plans and protocols established by penitentiary and health authorities were reviewed. Likewise, information on vaccines administered to prison inmates was described. Results: A total of 8500 COVID-19 cases were reported to penitentiary public health surveillance. The overall cumulative incidence (CI) was 2054.18 cases per 10,000 inmate population. By epidemic periods, the average weekly CI was 1.15 per 10,000 inmate population during the first period, 6.91 during the second, 25.18 during the third, 3.53 during the fourth, 23.27 during the fifth, 34.72 during the sixth and 25.68 during the seventh period. The median age of cases was 49.2 years, 69.1% was born in Spain, 64.1% was asymptomatic and 16 cases died. Ninety-four percent were vaccinated. Control measures such as lockdown, suspending visitation rights and confining inmates in their cells were adopted at the beginning of the pandemic. These measures changed in accordance with the COVID-19 situation in the general population with a view to restoring the inmates' rights. Conclusion: The COVID-19 pandemic has had a moderate incidence in Spanish prisons. Hospitalization and CFR were lower than the general population. The control measures adopted against COVID-19 have contributed to preventing and controlling the number of cases in prisons.
Increased trends in reported sexually transmitted infections according to age groups and sex in Spain, 2016-2022.
(Taylor & Francis, 2025-03) Hernando Sebastian, Victoria; Lorusso, Nicola; Montaño, Carmen; Boone, An Ld; Garí, Antonia; Perez, Guillermo; Viloria, Luis; Morales, Raquel; Marcos, Henar; Casabona, Jordi; Bellmut, Patricia; Vicente, Santiago; Perez, Olaia; Miguel, Angel; Barranco-Boada, Maria Isabel; Castilla, Jesus; Latasa, Pello; Martinez, Eva; Rivas, Ana Isabel; Castrillejo, Daniel; Villegas-Moreno, María Teresa; Simon Mendez, Lorena; Diaz Franco, Asuncion
Objective: Our objective was to assess trends in three sexually transmitted infections (STIs) - gonorrhoea, chlamydia and syphilis - in Spain, by age group and sex from 2016 to 2022. Study design: Retrospective observational study. Methods: Data from epidemiological surveillance system were used to calculate the incidence rate for each STIs by age group and sex. Poisson regression was employed to examine the trends for 2016 to 2022. Results: For gonorrhoea, higher incidence rates were observed among men than women for all period. The incidence rate ratio (IRR) varied between 1.14 (95% CI 1.12-1.16) for the 15-19 age group to 1.24 (1.23-1.25) for the 35-44 age group among men, and between 1.14 (1.09-1.19) for 55 years or more to 1.27 (1.24-1.29) for the 15-19 age group among women. For chlamydia, women showed higher incidence rate for all age groups than men during the period. Individuals aged 55 years and over showed the highest increase, IRR = 1.30 (1.27-1.34) for men, while it was the lowest for women, IRR = 1.22 (1.16-1.27). The incidence rates for syphilis were lower than for the other STIs. IRR values varied between 1.04 (1.02-1.06) in the 20-24 age group and 1.15 (1.14-1.16) in the 35-44 age group for males; and between 1.13 (1.06-1.16) for the 25-34 age group and 1.18 (1.13-1.25) for the 25-34 age group for females.
Tendencia en la vacunación en personas con infección por VIH participantes en la Encuesta Hospitalaria de pacientes con VIH, 2006-2021.
(Elsevier, 2024) Hernando Sebastian, Victoria; Suárez, Lucia; Gutiérrez, Gonzalo; López, Juan Carlos; Navarro-Soler, Roser; Cabello, Alfonso; Sanz, Jesús; Suarez-García, Inés; Fernández, Maria Teresa; Losa, Juan Emilio; Pérez, Jose Luis; Ramos-Ruperto, Luis; Pérez-Elías, Maria Jesús; Ben Cheikh El Aayuni, Wafa; Cuesta, Mar; González, Gustavo; Izquierdo, Ana; Viloria, Luis; López, Irene; Martínez, Eva; Castrillejo, Daniel; Jaume Amengual, Maria Glòria; Belmonte, Maria Antonia; Arraiza, Antonio; De la Torre, Javier; Miqueleiz, Estrella; Marcos, Henar; Ruiz-Alguero, Marta; Villegas-Moreno, María Teresa; Simon Mendez, Lorena; Diaz Franco, Asuncion; Grupo de Trabajo de la Encuesta Hospitalaria
[ES]Objetivo: Evaluar la tendencia en la vacunación de hepatitis A, hepatitis B, neumococo, tétanos y gripe estacional en personas con infección por VIH, y analizar sus factores asociados. Métodos: Como fuente se utilizó la Encuesta Hospitalaria de pacientes con VIH, estudio transversal anual realizado un día prefijado (2006-2021). Se incluyeron los pacientes hospitalizados o atendidos ambulatoriamente. Se analizaron las tendencias en vacunación y los factores asociados mediante regresión logística. Resultados: Se incluyeron 8.643 participantes. Los porcentajes de vacunación aumentaron hasta el 65,3% para hepatitis A, el 83,7% para hepatitis B, el 49,3% frente a tétanos, el 68,9% frente a neumococo y el 74,5% para la gripe estacional en 2021. Los factores asociados positivamente con la vacunación fueron tener mayor edad para la vacuna de neumococo y gripe; mayor nivel de estudios para hepatitis A y tétanos; residir en un establecimiento colectivo o en prisión para tétanos, neumococo y gripe; y haber adquirido el VIH mediante relaciones sexuales entre varones para hepatitis A, hepatitis B y neumococo. Además, estar recibiendo tratamiento antirretroviral y tener un alto recuento de CD4 se asoció positivamente con la vacunación de todas estas enfermedades. Los factores asociados inversamente con la vacunación fueron tener mayor edad (hepatitis A, hepatitis B y tétanos), ser inmigrante (tétanos y gripe estacional) y ser usuario/ex usuario de drogas inyectadas para hepatitis A y hepatitis B. Conclusiones: La vacunación en personas con VIH ha aumentado en el periodo de estudio. Los resultados se ajustan a las recomendaciones en esta población, aunque queda margen para alcanzar los indicadores de vacunación establecidos. [EN]Objective: To assess the trend in hepatitis A, hepatitis B, pneumococcal, tetanus and seasonal influenza vaccination in people with HIV infection and to analyse associated factors. Methods: The hospital survey of patients with HIV, an annual cross-sectional study conducted on a fixed day (2006-2021), was used. Inpatients and outpatients were included. Trends in vaccination and associated factors were analysed using logistic regression. Results: A total of 8643 participants were included. Vaccination rates increased to 65.3% for hepatitis A, 83.7% for hepatitis B, 49.3% for tetanus, 68.9% for pneumococcal and 74.5% for seasonal influenza in 2021. Factors positively associated with vaccination were older age for pneumococcal and influenza vaccination; higher educational level for hepatitis A and tetanus; living in a closed institutions or prison for tetanus, pneumococcal and influenza; and having acquired HIV through sex between men for hepatitis A, hepatitis B and pneumococcal. In addition, being on antiretroviral treatment and having a high CD4 count were positively associated with vaccination for all these diseases. Factors inversely associated with vaccination were being older (hepatitis A, hepatitis B and tetanus), being an immigrant (tetanus and seasonal influenza) and being an injection drug user/ex-user for hepatitis A and hepatitis B. Conclusions: Vaccination in people with HIV has increased in the study period. The results are in line with the recommendations in this population, although there is still room to reach the established vaccination indicators.
Epidemiology and control of human immunodeficiency and hepatitis C virus in Spanish prisons over the last 30 years: Towards the achievement of sustainable development goals.
(2026-02) Hernando Sebastian, Victoria; Filipe Santos, Catarina; Cuenca, Natalia; Del Amo, Julia; Diaz Franco, Asuncion; Acín, Enrique; Martinez-Aznar, Carmen
Objectives: Our aims were to describe the public health interventions for the prevention and control of HIV and HCV infections in penitentiary institutions in Spain from 1989 until 2023 and to describe the epidemiological trends of HIV and HCV among inmates from 1993 until 2023. Study design: Ecological and retrospective observational study. Methods: All prevention programs and control measures for HIV and HCV infections implemented in Spanish prisons were reviewed. Aggregate data were extracted from central registries, reports, official documents (grey literature) and epidemiological bulletins issued by the Public Health division of the General Subdirectorate of Prison Health. Results: Various control measures, such as harm reduction programs, including syringe exchange and methadone maintenance programs, have been implemented in Spanish prisons since 1989. These measures have been modified and adapted in response to changes in the prison population. The prevalence of HIV and HCV infection among inmates in Spanish prisons has decreased markedly over the study period: from 23.5 % in 1993 to 3.2 % in 2023 for HIV, and from 48.6 % in 1998 to 9.6 % in 2023 for HCV. In the past three years, fewer than 1 % of inmates had a detectable HCV viral load. No HIV or HCV seroconversions have been reported in Spanish prisons since 2015 and 2020, respectively. Conclusions: This ecological study found a correlation between interventions designed and implemented in Spanish prisons for the prevention, diagnosis and treatment of HIV and HCV, and a reduction in the prevalence of these infections among the prison population.
Social frailty as a predictor of mortality among older adults in four Colombian departments: evidence from the SABE survey.
(Springer Nature, 2026-06-11) García-Botina, Hernán-David; Curcio, Carmen-Lucia; Calderón-Larrañaga, Amaia; Rodriguez-Blazquez, Carmen; Forjaz, Maria João; Instituto de Salud Carlos III; Comunidad de Madrid (España)
Background: Social frailty, defined as a decline in social resources and participation, has emerged as a critical yet underrecognized dimension of vulnerability in older adults. While its association with adverse outcomes is increasingly documented, evidence from low- and middle-income countries remains limited. This study aimed to examine the association between social frailty and mortality among community-dwelling older adults in Colombia. Methods: We conducted a nested cohort study using data from the Colombian Health, Well-being, and Aging Survey (SABE; fieldwork 2015, official report 2016). The analysis was restricted to adults aged ≥ 60 years residing in four Colombian departments (Antioquia, Caldas, Risaralda, and Quindío). A total of 3,213 participants with verified vital status were included. Social frailty was measured using a multidimensional index incorporating functionality, social participation, emotional isolation, and perceived healthcare support. Individuals in the highest quartile (≥ 75th percentile) were classified as socially frail. Mortality follow-up was assessed through administrative linkage over 90 months. Cox proportional hazards models were used to estimate hazard ratios (HRs), adjusting for age and multimorbidity. Results: Using the percentile-based threshold, 25.2% of participants were classified as socially frail, and 22.2% died during follow-up. In multivariable analysis, social frailty was independently associated with higher mortality risk (HR = 1.18; 95% CI: 1.01-1.39; p = 0.039). Age, sex and multimorbidity were also significantly associated with mortality. Conclusions: Social frailty was independently associated with all-cause mortality among older adults in this Colombian regional cohort. These findings suggest that incorporating social vulnerability measures into geriatric assessment may improve risk stratification and help identify individuals who could benefit from supportive interventions.
SIPrEP: A tool to monitor HIV pre-exposure prophylaxis in Spain.
(Elsevier, 2025-10) Iniesta, Carlos; Hernando Sebastian, Victoria; Jarrin Vera, Inmaculada; Pérez de la Cámara, Santiago; De la Torre-Lima, Javier; Villanueva, Vicent; Mayorga, Mª Isabel; Belda, Josefina; Soteras, Maribel; Torres Lana, Álvaro; Echeverria, Aitziber; Monteagudo-Piqueras, Olga; Marcos, Henar; Ben Cheikh, Wafa; Portocarrero-Núñez, Julián-Alexander; Álvarez-Del Arco, Débora; Diaz Franco, Asuncion; Del Amo, Julia; SIPrEP
Objectives: Pre-exposure prophylaxis (PrEP) has been available in Spain since November 2019 and implemented nationally in 2021. Monitoring the implementation process is essential to optimize the strategy. This manuscript describes the Spanish PrEP Programme Information System (SIPrEP), its methodology, and characteristics of PrEP users from November 2019 to May 2024. Methods: Nationwide open cohort that collects data on persons ≥16 years who were prescribed PrEP in Spain. The study included participants with public program PrEP prescriptions since November 1, 2019. The project was piloted and fully implemented in July 2020. Results: By May 2024, 28,798 people received public program PrEP in Spain, and 4159 users were included in SIPrEP. Most were men (99%, n=4117), primarily gay, bisexual, and other men who have sex with men (GBMSM) (97%, n=4005), with a median age of 36 years (IQR: 30-43). Most were born in Spain (74%, n=3075), and 36% (n=1503) had university education. Referrals came from STI centers (19%, n=805) and primary care (20%, n=820). At entry, 8% (n=348) had syphilis, 7% chlamydia (n=270) and 7% (n=300) had gonococcal infection. Among users, 15% (n=642) discontinued PrEP, and 34% (n=216) of them restarted later. There were four HIV seroconversions (incidence 0.12/100 person-years [95% CI: 0.05-0.33]). Conclusions: SIPrEP provides valuable real-world data for optimizing interventions but requires improved national coverage.
Trends in Congenital Syphilis Cases by Maternal Country of Birth, Spain, 2016-2024.
(Centers for Disease Control and Prevention (CDC), 2026-07) Hernando Sebastian, Victoria; Montaño, Carmen; Fernandez, Ana; Molina, Laura; Pérez, Guillermo; Viloria, Luis; Morales, Raquel; Marcos, Henar; Lopez-Corbeto, Evelin; Silvestre, Paula; Vicente, Santiago; Perez-Martinez, Olaia; Montero, Laura; Barranco-Boada, M Isabel; Castilla, Jesus; Latasa, Pello; Martinez, Eva; Lopez, Ninoska; Castrillejo, Daniel; Roldan, Ana; Diaz Franco, Asuncion; STIs Group of National Epidemiological Surveillance Network
The number of congenital syphilis cases in Spain remains low; 40 cases were confirmed during 2016-2024. However, a slight increase has been observed, particularly in children born to migrant mothers. Young maternal age, migrant status, and social disadvantages are warning signs that underscore the need to strengthen prenatal screening.
Trends in Paediatric Viral Meningitis and Encephalitis With Unconfirmed Aetiology: A Spanish Population-Based Study, 2016-2020.
(Wiley, 2025-09) Pons-Espinal, Marina; Lopez-Perea, Noemi; Masa-Calles, Josefa; Muñoz-Almagro, Carmen; Tarrago Asensio, David; Launes, Cristian; Centro de Investigación Biomédica en Red - CIBERESP (Epidemiología y Salud Pública)
Aim: The prevalence of meningitis and encephalitis of unknown aetiology in Spanish children has not been specifically documented before. The aim of this study is to describe the epidemiology and trends of these clinical conditions between 2016 and 2020. Methods: Retrospective study analysing hospitalised children < 15 years with meningitis and encephalitis/encephalomyelitis of unknown origin (ICD-10 codes) in Spain (2016-2020). Data from National Registry of Hospitalizations and National Institute for Statistics were used to calculate age-stratified hospitalisation rates (HR). Statistical analysis included Poisson regression to calculate hospitalisation rate ratios (HRR) by age groups and years and forecasting methods to predict 2020 HRs. Results: Four thousand six hundred childrens were hospitalised with viral meningitis and encephalitis-encephalomyelitis of unknown origin, resulting in a HR of 7.8/105 inhabitants. The highest HR was observed in children under 1 year (49.1/105) and those aged 5-9 (10.4/105). The global HR for viral meningitis (3.64/105) was lower than for encephalitis-encephalomyelitis (4.2/105). Hospitalisations decreased from 1475 (2016) to 452 (2020), attributed to enhanced pathogen detection methods and COVID-19 preventive measures. Conclusion: Undiagnosed central nervous system entities remain a significant cause of paediatric hospitalisations in Spain, despite a declining incidence. Enhanced diagnostic strategies, including expanded microbiological testing and molecular epidemiology surveillance, could prove beneficial.
Association of disability with cardiovascular mortality in the community-dwelling Spanish adult population.
(Elsevier, 2026-01) Pastor-Barriuso, Roberto; Padron-Monedero, Alicia; Garcia Lopez, Fernando Jose; Almazan-Isla, Javier; Pedro-Cuesta, Jesus de; Damian, Javier; Instituto de Salud Carlos III
Introduction and objectives: Adults with disability have higher risk of all-cause mortality, but evidence on their risk of cardiovascular mortality is scarce. This study aimed to evaluate the association between disability severity and mortality from cardiovascular causes among community-dwelling adults. Methods: A representative cohort of 105 743 community-dwelling Spanish adults aged 40 years or older was screened for disability severity within the framework of the international classification of functioning, disability, and health from 2007 to 2008 and was followed up for cardiovascular mortality until 2017. Five- and 10-year cardiovascular mortality risks in each disability category were standardized by sociodemographic characteristics using inverse probability weighting and corrected for competing causes of death. Bias analyses were performed to quantify residual confounding by unmeasured baseline cardiovascular conditions. Results: The baseline prevalence of disability was 16.2% (95%CI, 15.9-16.4), including 11.5% with mild, 3.5% with moderate, and 1.1% with severe/complete disability. Compared with no disability, the standardized 5-year risk ratios for cardiovascular mortality (95%CI) were 1.70 (1.49-1.93), 3.92 (3.23-4.76), and 4.77 (3.42-6.66) for mild, moderate, and severe/complete disability, respectively, corresponding to 11.7 (8.4-15.0), 49.0 (37.0-60.9), and 63.1 (37.0-89.3) excess cardiovascular deaths per 1000 persons. The positive confounding in these risk ratios by unmeasured prevalent cardiovascular conditions was 5.9%. Results were similar for ischemic heart disease and cerebrovascular mortality and were sustained after 10 years of follow-up. Conclusions: Adults with disability have higher mortality from cardiovascular causes. Conditions that increase cardiovascular risk in people with disability should be investigated. Preventive measures and health promotion initiatives are needed to reduce the risk of cardiovascular mortality in this population.
Body mass index as a predictive factor for efficacy of adjuvant taxane-based chemotherapy in early-stage breast cancer patients: A pooled analysis from adjuvant GEICAM Spanish Breast Cancer Group and TRIO Translational Research in Oncology Group studies.
(Wiley, 2025-08-15) García-Saenz, José A; Spera, Gonzalo; Pollan-Santamaria, Marina; Bermejo, Begoña; Ruiz-Borrego, Manuel; Chan, Arlene; Martín, Miguel; Guerrero-Zotano, Ángel; Calvo, Lourdes; Rodríguez-Lescure, Álvaro; Marín, María; Chap, Linnea; Crown, John; Pienkowski, Tadeusz; Bee, Valerie; Casas, Maribel; Polonio, Óscar; Bezares, Susana; Slamon, Dennis
Adjuvant anthracyclines and taxanes reduce recurrence and death in early-stage breast cancer (EBC) patients, but toxicity is a concern. Studies show conflicting results on the correlation between body mass index (BMI) and outcomes. Limited data exist on the efficacy of adjuvant taxanes among BMI categories and the impact of different taxane-based chemotherapies (paclitaxel vs. docetaxel) on disease recurrence. Here, we present a pooled analysis of 13,486 EBC patients treated with adjuvant anthracyclines ± taxanes from seven GEICAM and TRIO trials (1996-2008) conducted. Patients were classified into four BMI categories: normal (<25.0), overweight (25.0-29.9), obese (30.0-34.9), and severely obese (≥35.0). BMI was evaluated as a predictive factor for the efficacy and toxicity of taxane-based chemotherapy. Our results show the following findings: patients' distribution by BMI was 44% normal, 33% overweight, 16% obese, and 8% severely obese. Seventy-nine percent received taxane-based chemotherapy. Ten-year invasive disease-free survival (iDFS) was 71%, 70%, 68%, and 64% for normal, overweight, obese, and severely obese patients, respectively. Obese and severely obese patients had significantly worse outcomes (HR 1.15 and 1.29, respectively). Invasive disease-free survival with docetaxel vs. non-docetaxel was significant in the normal BMI group, while iDFS with paclitaxel was significant in the obese group. Relevant toxicity was observed in 5%, 5.5%, 5.9%, and 9.3% of normal, overweight, obese, and severely obese patients who received docetaxel. In conclusion, heavier EBC patients had a worse prognosis with adjuvant taxane-based chemotherapy. Normal BMI patients benefited more from docetaxel, while obese patients benefited more from paclitaxel.
Association of neighborhood physical environment with falls and fear of falling in older adults: A prospective cohort study.
(Elsevier, 2025-06) Arias-Fernández, Lucía; Carcedo-Argüelles, Lucía; García-Esquinas, Esther; Caballero, Francisco Félix; Rodríguez-Artalejo, Fernando; Lana, Alberto; Instituto de Salud Carlos III; Centro de Investigación Biomédica en Red - CIBERESP (Epidemiología y Salud Pública); Instituto de Investigación Sanitaria del Principado de Asturias (España)
Objectives: To explore the prospective association between physical environment characteristics of the neighborhood and risk of falls/fear of falling among community-dwelling older adults. Study design: Prospective cohort analysis using data from the Seniors-ENRICA-2 cohort (metropolitan Madrid, Spain). Methods: At baseline (2015-17), a neighborhood physical characteristics score was developed using the Physical Activity Neighborhood Environment Scale and an additional indicator of distance to green areas. In the second wave of follow-up (2019-20) we collected self-reported incident falls and fear of falling, assessed with the Short Falls Efficacy Scale International. Adjusted odds ratios (OR) and 95 % confidence intervals (CI) for the association between neighborhood environment perception and incidence of falls/fear of falling were calculated using logistic regression. Results: Among 1823 participants, 27.7 % reported a fall during the previous year and 32.1 % were concerned about having a fall. Better neighborhood environment was associated with lower risk of falls (OR: 0.75; 95 %CI: 0.57-0.99) and fear of falling (0.73; 0.55-0.96). Specifically, low traffic intensity (0.68; 0.52-0.90) and sidewalks in good condition (0.75; 0.59-0.95) were associated with lower risk of falling. Moreover, available facilities for biking (0.77; 0.61-0.96), sidewalks in good condition (0.67; 0.52-0.86), night security (0.80; 0.60-0.99) and day security (0.62; 0.44-0.98) were independently associated with lower fear of falling. Conclusions: Better neighborhood physical environments could play a key role in the prevention of falls and fear of falling among older adults. Policies aiming to improve residential environments can have broad implications for achieving healthy aging.
Distribución Espacio-Temporal de la Mortalidad por Cáncer en España por Edad y Sexo (DETEMOCAES). Data Management Plan V1.0.
(Instituto de Salud Carlos III (ISCIII). Centro Nacional de Epidemiología (CNE), 2026-06-20) Fernandez-Navarro, Pablo L; Instituto de Salud Carlos III
Plan de Gestión de Datos del proyecto DETEMOCAES. El proyecto tiene como objetivo analizar la distribución espacio-temporal de la mortalidad por cáncer en España utilizando información de mortalidad en áreas pequeñas junto con indicadores socioeconómicos, demográficos, ambientales y territoriales. El proyecto pretende identificar patrones geográficos de mortalidad, evaluar su evolución temporal y desarrollar nuevas metodologías para el estudio de desigualdades territoriales en cáncer. Los datos gestionados incluyen registros individuales de mortalidad facilitados por el Instituto Nacional de Estadística (INE), datos poblacionales, indicadores territoriales procedentes de diferentes organismos oficiales, información cartográfica y resultados derivados de análisis estadísticos y espaciales. Asimismo, se generan scripts, pipelines y herramientas informáticas destinadas al análisis, visualización y difusión de resultados. Los resultados esperados incluyen la identificación de patrones espaciales de mortalidad por cáncer, el desarrollo de metodologías avanzadas para el análisis en áreas pequeñas, la actualización de atlas de mortalidad y la generación de herramientas de apoyo para la investigación epidemiológica y la salud pública. El presente Plan de Gestión de Datos describe los procedimientos de almacenamiento, acceso, preservación, reutilización y protección de los datos utilizados y generados durante el desarrollo del proyecto, de acuerdo con los principios FAIR, la normativa aplicable y las condiciones de uso establecidas por las instituciones proveedoras de información.
Sur8/Shoc2 como nuevo actor en envejecimiento y fragilidad (SENFRA-4). Data Management Plan V1.0.
(Instituto de Salud Carlos III (ISCIII). Centro Nacional de Epidemiología (CNE), 2026-06-17) Fernandez-Navarro, Pablo L; Instituto de Salud Carlos III
El proyecto globalmente es un esfuerzo colaborativo y multidisciplinar entre varios grupos del ISCIII que investigan de forma cooperativa el papel de Sur8/Shoc2 como nuevo actor molecular implicado en los procesos de envejecimiento y fragilidad. A partir de estudios previos, el proyecto pretende caracterizar los mecanismos biológicos asociados a la eliminación de Sur8 en distintos modelos experimentales y evaluar su relevancia en los procesos relacionados con el envejecimiento. Dentro de la acción colaborativa conjunta, este subproyecto (SENFRA-4) tiene como finalidad realizar el análisis bioinformático e integración de los datos ómicos generados por los distintos grupos participantes. En concreto, se analizan datos transcriptómicos (mRNA y microRNA), proteómicos, fosfoproteómicos y de oxidación proteica procedentes de modelos animales y celulares utilizados en el proyecto. Los datos gestionados en este subproyecto incluyen información derivada de tecnologías de secuenciación masiva y proteómica cuantitativa, así como los resultados obtenidos mediante procedimientos de análisis diferencial, integración transcriptómica-proteómica, análisis funcional e integración multi-ómica. Los resultados generados tienen carácter fundamentalmente exploratorio y están orientados a identificar mecanismos moleculares asociados a la actividad biológica de Sur8/Shoc2, contribuyendo a una comprensión más integrada de los procesos relacionados con envejecimiento y fragilidad. El presente Plan de Gestión de Datos describe los procedimientos de almacenamiento, acceso, preservación, reutilización y protección de los datos gestionados durante el desarrollo del subproyecto, de acuerdo con los principios FAIR y con las políticas institucionales del Instituto de Salud Carlos III.
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.

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