Carles Vilaplana-Carnerero

Background/Objectives: The study’s goal is to assess the association between long-term statin therapy and influenza incidence, influenza severity, and all-cause mortality. Methods: Two population-based dynamic cohorts (exposed and unexposed to statins) were followed from 2010 to 2019. Participants were 60 years or older; frail patients were excluded. The primary outcomes were influenza incidence, influenza-related intensive care unit (ICU) admission as a proxy for severity, and all-cause mortality. The exposed cohort comprised new statin users with a minimum of two pharmacy invoices within 90 days of enrollment. Adjusted risk ratios (aRRs) for influenza incidence, ICU admission, and mortality rate were calculated using Poisson regression. Results: The initial study population of 639,564 individuals was evenly split into exposed (319,782) and unexposed (319,782) cohorts; mean age was 71 years (standard deviation: 8 years), and 57% were women. Compared to non-users, new statin users showed a higher influenza incidence [9.39 (95% confidence interval: 9.36–9.42) vs. 7.64 (7.61–7.66) per 1000 person-years], ICU admission [1.65 (1.65–1.66) vs. 1.36 (1.35–1.36) per 1000 person-years], and overall mortality rate [97.09 (96.75–97.43) vs. 94.15 (93.82–94.47) per 1000 person-years]. Adjusted analysis revealed no significant association between statin use and influenza incidence [aRR: 1.04 (0.98–1.10)] or influenza-related ICU admission [aRR: 1.03 (0.89–1.19)] and shifted the effect on mortality from harmful to beneficial [aRR: 0.88 (0.87–0.89)]. Conclusions: Despite new users’ greater vulnerability at the start of treatment, our findings indicate that statins do not influence influenza incidence or severity but reduce all-cause mortality, warranting further exploration of their anti-inflammatory properties.

Background: Waiting times for elective surgery are widely used as indicators of health system performance, particularly following the disruption caused by COVID-19. The objective of this study is to compare the waiting times for major elective surgeries in the Southern Barcelona Metropolitan Area before (2018–2019) and after (2022–2023) the pandemic, examining differences according to sociodemographic characteristics. Methods: A retrospective comparative study was conducted using data from the Southern Barcelona Metropolitan Area between 2018 and 2023. Adults registered on the waiting list for major elective surgical procedures were included. All analyses were stratified by sex. A stratified pre–post pandemic analysis was conducted to examine differences in waiting times by Socioeconomic Index. Waiting times were modelled using generalized linear models with a Gamma distribution and log link, adjusting for age and Socioeconomic Index quartiles. Interaction between period and Socioeconomic Index was tested. Results: The analysis included 73,055 individuals (50.5% women). Median waiting time decreased after the COVID-19 pandemic for both sexes (women: 128 to 121 days; men: 99 to 94 days). This reduction showed an inverse socioeconomic gradient. Adjusted analyses showed longer waits in the lowest versus highest Socioeconomic Index quartile after the pandemic (women: RR = 1.23; men: RR = 1.30). Conclusions: Waiting times for major elective surgery decreased after COVID-19. An exclusive focus on waiting time indicators may conceal structural barriers to access and contribute to inequalities. Equity-sensitive monitoring of elective care is essential to ensure a fair recovery of surgical services.

Background: Socioeconomic inequalities in cardiovascular risk persist despite declining mortality. We examined the prevalence of cardiovascular risk factors and lifestyle behaviors across educational levels in men and women from a Mediterranean population. Methods: Cross-sectional analysis of adults aged 35–74 years from a population-based sample in north-eastern Spain. Risk factors and lifestyle were assessed with standardized measurements and validated questionnaires. Educational attainment was categorized as primary, secondary, or university. Analyses were sex-stratified; age-adjusted linear and logistic regression models were applied. Results: We included 943 adults (52.3% women). Among men, secondary and university education (vs. primary) were associated with lower LDL-cholesterol [β –11.76 (95% CI –21.68 to –1.83) and –17.83 (–28.03 to –7.63) mg/dL], lower odds of hypercholesterolemia [OR = 0.43 (0.20–0.90) for both], smoking [OR = 0.57 (0.33–0.97) and 0.53 (0.30–0.95)], and higher odds of high Mediterranean diet adherence [OR = 2.08 (1.04–4.16) and 3.05 (1.51–6.14)]. Among women, secondary and university education (vs. primary) were associated with lower body mass index [β –1.81 (–2.85 to –0.77) and –2.52 (–3.63 to –1.40) kg/m2] and lower odds of overweight/obesity [OR = 0.47 (0.29–0.76) and 0.34 (0.20–0.56)]. Lower odds of hypertension [OR = 0.44 (0.22–0.87)] and high Mediterranean diet adherence [OR = 2.14 (1.12–4.09)] were also more likely in university-educated women. Conclusions: Higher educational attainment was associated with healthier lifestyles and more favorable cardiometabolic profiles. Educational gradients were broader in women—spanning adiposity, blood pressure, glycemia, and lipidemia—whereas, in men, they mainly affected lipidemia and diet.

Objectives: This study aims to evaluate the impact of chronic statin therapy on the incidence of community-acquired pneumonia (CAP) and the rate of intensive care unit (ICU) admissions associated with CAP. Methods: Two population-based dynamic cohorts, consisting of individuals exposed and unexposed to statins, were followed from 2010 to 2019. Participants were older than 60 years, with frail patients excluded. The primary outcomes were the incidence of CAP and ICU admissions due to CAP, serving as a proxy for complicated cases. The exposed cohort included new statin users with at least two pharmacy invoices within 90 days of the recruitment period. Adjusted risk ratios (aRRs) for CAP incidence and CAP-associated ICU admissions were calculated using Poisson regression. Results: This study analyzed a sample of 639,564 individuals, evenly divided into exposed (319,782) and unexposed (319,782) groups, with a mean age of 71 years (standard deviation of 8 years) and 57% women. New statin users had a higher incidence of CAP [42.1 (95% confidence interval: 41.9–42.2) vs. 36.6 (36.5–36.8) per 1000 person-years] and ICU admissions [11.5 (11.5–11.6) vs. 10.1 (10.0–10.1) per 1000 person-years] compared to non-users. The adjusted analysis indicated that statin treatment reduced CAP risk by 6% [aRR: 0.94 (0.91–0.96)] and ICU admission by 7% [aRR: 0.93 (0.88–0.98)]. Conclusions: Prior statin therapy was associated with a clinically significant reduction in the incidence of CAP and ICU admissions due to CAP, despite the greater vulnerability of new users at the start of treatment compared to non-users.

Objectives: To develop an algorithm to identify pregnancy episodes in women at childbearing age using SIDIAP (Information System for the Improvement of Research in Primary Care) data (Catalunya, Spain). To describe drugs dispensed during gestation. Design: Construction of an algorithm to identify all pregnancy episodes occurred from January 2011 to June 2020 in women aged 12–50. The variables used to create the algorithm include first day of last menstrual period, reasons for pregnancy termination and diagnoses registered in the primary healthcare records. Population-based cohort study including the pregnancy episodes identified by the algorithm. Setting: Catalonia, Spain. Participants: All women aged 12–50 with at least one pregnancy episode occurred during January 2011–June 2020. Interventions: No interventions performed. Primary and secondary outcome measures: Identification of pregnancy episodes through an algorithm and description of drug exposure. Results: We identified 327 865 pregnancy episodes in 250 910 people with a mean age of 31.3 years. During the study period, 83.4% of the episodes were exposed to at least one drug. The most frequent groups dispensed were iron preparations (48% of pregnancy episodes), iodine therapy (40.2%), analgesics and antipyretics (28%), penicillins (19.8%), vitamin B₁₂ plus folic acid (19.7%) and non-steroidal anti-inflammatory drugs (NSAIDs, 15.1%). The supplements were more frequently dispensed at least twice, and the drugs for acute conditions were mainly dispensed only once during the pregnancy episode. Conclusions: We developed an algorithm to automatically identify the pregnancy periods in SIDIAP. We described prescription drugs used during pregnancy. The most used ones were supplements, analgesics, NSAID or antibiotics. SIDIAP might be an efficient database to study drug safety during pregnancy and the consequences of drug use in the offspring. Trial registration number: EUPAS37675.

The objective was to analyse the risk of partial school closure by economic level in Barcelona city. In this ecological study, the risk of partial school closure for the academic years 2020–21 and 2021–22 was estimated by dividing the total number of days that each child was in quarantine or isolation by the total number of days that each child was at risk to be in quarantine or isolation in the academic year. The association between partial school closure risk and mean income by district was estimated with the Spearman rho. The lower the mean income, the higher the risk of partial closure (Spearman rho = 0.83; P-value = 0.003) during the academic year 2020–21. Specifically, the children from the district with the lowest income had a six times greater risk of partial school closure compared with those from the highest-income district. This risk did not show a significant socioeconomic gradient in the academic year 2021–22. The risk of partial school closure presented an inverse socioeconomic gradient in the city of Barcelona according to average income by district in the academic year 2020–21. This distribution was not observed in the academic year 2021–22.

Atherosclerosis is a chronic inflammatory and degenerative process that mainly occurs in large- and medium-sized arteries and is morphologically characterized by asymmetric focal thickenings of the innermost layer of the artery, the intima. This process is the basis of cardiovascular diseases (CVDs), the most common cause of death worldwide. Some studies suggest a bidirectional link between atherosclerosis and the consequent CVD with COVID-19. The aims of this narrative review are (1) to provide an overview of the most recent studies that point out a bidirectional relation between COVID-19 and atherosclerosis and (2) to summarize the impact of cardiovascular drugs on COVID-19 outcomes. A growing body of evidence shows that COVID-19 prognosis in individuals with CVD is worse compared with those without. Moreover, various studies have reported the emergence of newly diagnosed patients with CVD after COVID-19. The most common treatments for CVD may influence COVID-19 outcomes. Thus, their implication in the infection process is briefly discussed in this review. A better understanding of the link among atherosclerosis, CVD, and COVID-19 could proactively identify risk factors and, as a result, develop strategies to improve the prognosis for these patients.

Background: A possible link between influenza immunization and susceptibility to the complications of COVID-19 infection has been previously suggested owing to a boost in the immunity against SARS-CoV-2. Objective: This study aimed to investigate whether individuals with COVID-19 could have benefited from vaccination against influenza. We hypothesized that the immunity resulting from the previous influenza vaccination would boost part of the immunity against SARS-CoV-2. Methods: We performed a population-based cohort study including all patients with COVID-19 with registered entries in the primary health care (PHC) electronic records during the first wave of the COVID-19 pandemic (March 1 to June 30, 2020) in Catalonia, Spain. We compared individuals who took an influenza vaccine before being infected with COVID-19, with those who had not taken one. Data were obtained from Information System for Research in Primary Care, capturing PHC information of 5.8 million people from Catalonia. The main outcomes assessed during follow-up were a diagnosis of pneumonia, hospital admission, and mortality. Results: We included 309,039 individuals with COVID-19 and compared them on the basis of their influenza immunization status, with 114,181 (36.9%) having been vaccinated at least once and 194,858 (63.1%) having never been vaccinated. In total, 21,721 (19%) vaccinated individuals and 11,000 (5.7%) unvaccinated individuals had at least one of their outcomes assessed. Those vaccinated against influenza at any time (odds ratio [OR] 1.14, 95% CI 1.10-1.19), recently (OR 1.13, 95% CI 1.10-1.18), or recurrently (OR 1.10, 95% CI 1.05-1.15) before being infected with COVID-19 had a higher risk of presenting at least one of the outcomes than did unvaccinated individuals. When we excluded people living in long-term care facilities, the results were similar. Conclusions: We could not establish a protective role of the immunity conferred by the influenza vaccine on the outcomes of COVID-19 infection, as the risk of COVID-19 complications was higher in vaccinated than in unvaccinated individuals. Our results correspond to the first wave of the COVID-19 pandemic, where more complications and mortalities due to COVID-19 had occurred. Despite that, our study adds more evidence for the analysis of a possible link between the quality of immunity and COVID-19 outcomes, particularly in the PHC setting.