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Percorrer Departamento de Epidemiologia por Domínios Científicos e Tecnológicos (FOS) "Ciências Médicas::Ciências da Saúde"
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- Associação entre o Índice de Vulnerabilidade à Pobreza Energética e os Níveis de Tensão Arterial na População PortuguesaPublication . Rodrigues, Madalena; Gouveia, João Pedro; Sousa-Uva, MafaldaEm Portugal, estima-se que entre 1,8 e 3 milhões de pessoas vivam em situação de pobreza energética, estando entre 609 mil e 660 mil em condição severa. A exposição a temperaturas extremas dentro das habitações pode agravar problemas de saúde existentes e aumentar o risco de doenças cardiovasculares, como a hipertensão arterial, que afeta cerca de 36% da população portuguesa entre 25 e 74 anos. A pobreza energética resulta da combinação de baixos rendimentos, má eficiência energética das habitações e dificuldades no pagamento das faturas de energia. Este problema é intensificado pelas alterações climáticas, que elevam a frequência de eventos extremos. Apesar das preocupações expressas em políticas europeias, poucos estudos populacionais avaliaram a associação entre pobreza energética e saúde utilizando medidas objetivas. Este trabalho tem como objetivo estimar a associação entre o Índice de Vulnerabilidade à Pobreza Energética (IVPE) desenvolvido ao nível da freguesia (#3092) e os níveis de tensão arterial na população adulta portuguesa. Trata-se de um estudo epidemiológico, observacional, transversal e analítico, com dados do Inquérito Nacional de Saúde com Exame Físico 2015 (INSEF), abrangendo 4911 indivíduos de 25 a 74 anos. O IVPE foi categorizado em tercis (baixo, médio e alto) e as associações foram analisadas por regressão linear, ajustada para fatores sociodemográficos e económicos. Os resultados evidenciam que viver em áreas com elevada vulnerabilidade à pobreza energética está associado a um aumento significativo da tensão arterial. No contexto do arrefecimento, observou-se um acréscimo de 2,28% na Tensão Arterial Sistólica (TAS) e de 2,08% na Tensão Arterial Diastólica (TAD), enquanto para o aquecimento verificou-se um aumento significativo na TAS, mas sem relevância na TAD. Estes reforçam a pobreza energética como um fator de risco relevante para a saúde, sublinhando a necessidade de políticas públicas eficazes para mitigar os seus impactos. Num contexto de alterações climáticas e envelhecimento da população portuguesa, garantir condições habitacionais adequadas pode ser uma estratégia essencial para reduzir desigualdades sociais, promover a saúde e o bem-estar, bem como aliviar a pressão sobre os sistemas de saúde pública.
- Characteristics and incidence trends of adults hospitalized with community-acquired pneumonia in Portugal, pre-pandemicPublication . Carneiro, Joana; Teixeira, Rita; Leite, Andreia; Lahuerta, Maria; Catusse, Julie; Ali, Mohammad; Lopes, SílviaCommunity-acquired pneumonia (CAP) is a major cause of hospitalization that leads to substantial morbidity, mortality, and costs. Evaluating CAP trends over time is important to understand patterns and the impact of public health interventions. This study aims to describe the characteristics and trends in the incidence of adults hospitalized with CAP in Portugal between 2010 and 2018. In this study, we included hospitalization data, prevalence of comorbidities, and population data. CAP hospitalizations of adults (≥18y) living in mainland Portugal discharged from public hospitals were identified using ICD-9-CM or ICD-10-CM codes. Based on previous CAP studies, we selected nine relevant comorbidities. We described the frequency and incidence of CAP hospitalizations per sex, age group, comorbidity, and year of discharge. Trends were explored using Joinpoint regression. We observed 470,545 CAP hospitalizations falling into the 2010-18 period. The majority were males (54.8%) and aged ≥75 years (65.3%). Most often recorded comorbidities were congestive heart failure (26.4%), diabetes (25.5%), and chronic pulmonary disease (19.2%). The Joinpoint regression identified a gradual decline in the incidence rates of CAP hospitalizations for both sexes and all age groups. Of the nine comorbidities selected, seven showed a progressive increase in incidence rates followed by a subsequent decline (all except HIV/AIDS and chronic renal disease). Our findings offer valuable insights for selecting priority groups for public health interventions and design strategies to mitigate the burden of CAP.
- Characterizing stakeholders in cancer primary prevention in European countries: an exploration of challenges and opportunities using a penta-helix frameworkPublication . Roxo, Luis; Carvalho da Silva Santos, Ana João; Girvalaki, Charis; Geantă, Marius; 4P-CAN WP2 study team; Sousa Uva, MafaldaObjectives: Cancer incidence has been increasing in Europe, with stark disparities between Western and Eastern regions. Cancer primary prevention (CPP) is a cost-effective strategy tackling lifestyle and risk factor exposure, but its implementation goes beyond the actions of the governments. This study aims to characterize stakeholders’ role in CPP, using a penta-helix approach, with the objective of shedding a new light in the Iron Curtain of Cancer Cases. Methods: We followed a mixed-methods approach, with quantitative and qualitative data from CPP stakeholders from the public sector, academia/research, private sector, media and civil society. Snowball sampling was used to distribute a survey where participants (n = 110) were asked which sector was the main driver of change, the most proactive and the most influential. Purposive sampling was used for semi-structured interviews (n = 33), where stakeholders were asked about their CPP activities, motivations, barriers and opportunities, and the role of other sectors. Countries were coded as Western or Eastern. Descriptive analysis was used for quantitative data, while thematic analysis was used for qualitative data. Results: The public sector is viewed as the main driver of change, and the most proactive and influential in both Western and Eastern Europe. However, Eastern European countries emphasize the role of other sectors in CPP more strongly. Thematic analysis identified key roles and themes for the public sector (Strategy: “Looking after citizen’s health,” “Making the system work,” “Operational Engagement”), academia/research (Knowledge: “Scientific credibility,” “Diversity of approaches,” “Getting out of the lab,” “Life in academia/research”), private sector (Responsibility: “Profit-oriented,” “Resources and operational activities,” “Ethics and responsibility”), media (Dissemination: “Capacity to reach people,” “Diversity and scope,” “Information and dissemination”) and civil society (Engagement: “Proximity to people,” “Advocacy and voice,” “Do what others do not do”). Although no meaningful differences were identified between Western and Eastern countries, the results highlight opportunities for Eastern countries to reduce regional disparities. Conclusion: Overall, results point to the complementary role of the sectors, emphasizing that involving different stakeholders and promoting adequate collaborations between them is crucial to unravel the full potential of CPP.
- Comparative Analysis of Direct Costs of Cancer and Risk Factors in EuropePublication . Herțeliu, Claudiu; Horobeț, Alexandra; Nerău, Vlad; Paraschiv, Anca (Gherman); Ștefan, George; Volintiru, Clara; Zaharia, Rodica Milena; Geantă, Marius; Boata Azis, Adriana Elena; Popescu, Ramona; Semenov, Viktor; Kriachkova, Lilia; Kuzmanovska, Milica; Carvalho da Silva Santos, Ana João; Boccia, Stefania; Villani, Leonardo; Espina, Carolina; Mileva, Bilyana; Tchalakov, Ivan; Petrov, Ivaylo; Roxo, Luis Filipe de Almeida; Sousa Uva, Mafalda; Loghin, Cornel Radu; Girvalaki, CharisThis study explores the direct costs and risk factors associated with cancer across European Union member states, emphasizing the economic and public health implications. A Cancer Risk Factors Index (CRFI) is developed to quantify and compare the impact of various determinants, including obesity, smoking, alcohol consumption, socioeconomic conditions, and pollution. Using data from Eurostat and other authoritative sources, we analyze the correlation between CRFI scores, healthcare expenditures, and cancer mortality rates. Results reveal significant disparities in cancer risk factors and healthcare investments across countries, with lower CRFI scores generally associated with higher healthcare spending and improved outcomes. The findings underscore the importance of comprehensive public health strategies and targeted interventions to address modifiable risk factors, reduce cancer-related mortality, and promote equitable healthcare access.
- COVID-19 vaccine effectiveness in the paediatric population aged 5-17 years: a multicentre cohort study using electronic health registries in six European countries, 2021 to 2022Publication . Soares, Patricia; Machado, Ausenda; Nicolay, Nathalie; Monge, Susana; Sacco, Chiara; Hansen, Christian Holm; Meijerink, Hinta; Martínez-Baz, Iván; Schmitz, Susanne; Humphreys, James; Fabiani, Massimo; Echeverria, Aitziber; AlKerwi, Ala'a; Nardone, Anthony; Mateo-Urdiales, Alberto; Castilla, Jesús; Kissling, Esther; Nunes, Baltazar; VEBIS-Lot 4 working groupBackground: During the first year of the COVID-19 pandemic, vaccination programmes targeted children and adolescents to prevent severe outcomes of SARS-CoV-2 infection. Aim: To estimate COVID-19 vaccine effectiveness (VE) against hospitalisation due to COVID-19 in the paediatric population, among those with and without previously documented SARS-CoV-2 infection. Methods: We established a fixed cohort followed for 12 months in Denmark, Norway, Italy, Luxembourg, Navarre (Spain) and Portugal using routine electronic health registries. The study commenced with paediatric COVID-19 vaccination campaign at each site between June 2021 and January 2022. The outcome was hospitalisation with a laboratory-confirmed SARS-CoV-2 infection or COVID-19 as the main diagnosis. Using Cox proportional hazard models, VE was estimated as 1 minus the confounder-adjusted hazard ratio of COVID-19 hospitalisation between vaccinated and unvaccinated. A random-effects meta-analysis was used to pool VE estimates. Results: We included 4,144,667 5-11-year-olds and 3,861,841 12-17-year-olds. In 12-17-year-olds without previous infection, overall VE was 69% (95% CI: 40 to 84). VE declined with time since vaccination from 77% ≤ 3 months to 48% 180-365 days after immunisation. VE was 94% (95% CI: 90 to 96), 56% (95% CI: 3 to 80) and 41% (95% CI: -14 to 69) in the Delta, Omicron BA.1/BA.2 and BA.4/BA.5 periods, respectively. In 12-17-year-olds with previous infection, one dose VE was 80% (95% CI: 18 to 95). VE estimates were similar for 5-11-year-olds but with lower precision. Conclusion: Vaccines recommended for 5-17-year-olds provided protection against COVID-19 hospitalisation, regardless of a previously documented infection of SARS-CoV-2, with high levels of protection in the first 3 months of the vaccination.
- Effectiveness of JN.1 monovalent COVID-19 vaccination in EU/EEA countries between October 2024 and January 2025: a VEBIS electronic health record network studyPublication . Humphreys, James; Blake, Alexandre; Nicolay, Nathalie; Braeye, Toon; Van Evercooren, Izaak; Hansen, Christian Holm; Moustsen-Helms, Ida Rask; Sacco, Chiara; Mateo-Urdiales, Alberto; Castilla, Jesús; Martínez-Baz, Iván; Machado, Ausenda; Brito, André; Ljung, Rickard; Pihlstrom, Nicklas; Mansiaux, Yohann; Monge, Susana; Bacci, Sabrina; Nunes, Baltazar; VEBIS-Lot 4 working groupWe estimated vaccine effectiveness (VE) of Omicron JN.1-adapted COVID-19 vaccines administered during the 2024 autumnal vaccination campaign against COVID-19 hospitalisation and death among eligible individuals aged ≥65 years. The study period was October 2024-January 2025. Using a common protocol across six EU/EEA study sites, we linked electronic health records to construct retrospective cohorts and applied Cox modelling to estimate VE via confounder-adjusted hazard ratios. The majority of vaccines administered during the study period were Omicron JN.1-adapted COVID-19 vaccines (99 %). VE against hospitalisation was 60 % (95 % Confidence Interval: 48-70 %) and against COVID-19-related death was 78 % (95 %CI: 64-87 %) among individuals aged 65-79 years; 58 % (95 %CI: 48-66 %) and 62 % (95 %CI: 32-79 %) among those aged ≥80 years. These results indicate high effectiveness in the initial months of the campaign. Continued monitoring is necessary to confirm these results, including estimates of VE in those with longer time since vaccination and during different variant predominance periods.
- Effectiveness of the XBB.1.5 COVID-19 Vaccines Against SARS-CoV-2 Hospitalisation Among Adults Aged ≥ 65 Years During the BA.2.86/JN.1 Predominant Period, VEBIS Hospital Study, Europe, November 2023 to May 2024Publication . Antunes, Liliana; Rojas-Castro, Madelyn; Lozano, Marcos; Martínez-Baz, Iván; Leroux-Roels, Isabel; Borg, Maria-Louise; Oroszi, Beatrix; Fitzgerald, Margaret; Dürrwald, Ralf; Jancoriene, Ligita; Machado, Ausenda; Petrović, Goranka; Lazar, Mihaela; Součková, Lenka; Bacci, Sabrina; Howard, Jennifer; Verdasca, Nuno; Basile, Luca; Castilla, Jesús; Ternest, Silke; Džiugytė, Aušra; Túri, Gergő; Duffy, Roisin; Hackmann, Carolin; Kuliese, Monika; Gomez, Verónica; Makarić, Zvjezdana Lovrić; Marin, Alexandru; Husa, Petr; Nicolay, Nathalie; Rose, Angela M.C.; VEBIS SARI VE network teamWe estimated the effectiveness of the adapted monovalent XBB.1.5 COVID-19 vaccines against PCR-confirmed SARS-CoV-2 hospitalisation during the BA.2.86/JN.1 lineage-predominant period using a multicentre test-negative case-control study in Europe. We included older adults (≥ 65 years) hospitalised with severe acute respiratory infection from November 2023 to May 2024. Vaccine effectiveness was 46% at 14-59 days and 34% at 60-119 days, with no effect thereafter. The XBB.1.5 COVID-19 vaccines conferred protection against BA.2.86 lineage hospitalisation in the first 4 months post-vaccination.
- High burden of hospital morbidity and mortality due to Chagas disease in Bahia state, Northeast Brazil, 2000-2022Publication . García, Gabriela Soledad Márdero; Leite, Andreia; de Souza, Eliana Amorim; Ferreira, Anderson Fuentes; de Sousa, Andrea Silvestre; Luiz, Ronir Raggio; Luquetti Ostermayer, Alejandro; Heukelbach, Jorg; Palmeira, Swamy Lima; de Castro, Cleudson Nery; de Carvalho, Cristiane Medeiros Moraes; Ribeiro, Suzana Cristina Silva; Oliveira, Cândida Carolina Lima; Ramos, Alberto NovaesChagas disease (CD) is a chronic condition associated with high morbidity and mortality in endemic regions of Brazil, particularly in the state of Bahia. The clinical-epidemiologic analysis of hospital admissions is strategic due to limited data on chronic CD infections and the general lack of access to diagnosis and treatment. This study examines sociodemographic and clinical-epidemiological patterns of hospital morbidity and mortality from CD and its temporal trends from 2000 to 2022 in Bahia, Northeast Brazil. A mixed ecological study was conducted using data from hospital and mortality information systems. We calculated the hospital case fatality and all-cause mortality rates for CD, analysing temporal trends through joinpoint regression. Out of 20,189,658 hospital admissions, 4,557 (0.02%) were associated with CD, yielding a hospital lethality of 0.10 per 100,000 inhabitants. Of 1,832,325 Death Certificates, 16,960 (0.93%) were attributed to CD, equating to 5.16 deaths per 100,000 inhabitants. The risk ratios for hospital case fatality and mortality were higher among males, residents of municipalities with a 'medium' Brazilian Deprivation Index, those in the Central-North region, and patients with megacolon. Hospital case fatality significantly increased among males, the elderly (≥70 years) and residents in municipalities with 'high' or 'very high' Brazilian Deprivation Index in the Central-North and Central-East regions. The all-cause mortality trend for CD also rose among women and in municipalities with 'high' and 'very high' Brazilian Deprivation Index across the Southwest, West, North and Central-East regions. Programmatic vulnerabilities related to healthcare access within the Unified Health System likely contributed to delayed diagnoses and the increasing severity of specific forms of CD.
- Long term bivalent mRNA vaccine effectiveness against COVID-19 hospitalisations and deaths in Portugal: a cohort study based on electronic health recordsPublication . Machado, Ausenda; Kislaya, Irina; Soares, Patricia; Magalhães, Sarah; Nunes, Baltazar; On behalf of PT-EHR vaccine groupBackground: In Autumn 2022, there were recommendations for a COVID-19 booster vaccination with adapted bivalent vaccines to eligible population. Evaluating vaccine effectiveness (VE), in a short period after the vaccination, is key to guide public health decisions on the vaccine performance, allowing implementation of mitigation strategies promptly. However, to assess long-term protection post-vaccination and evaluate the need for additional boosters, it is crucial to conduct studies that span the maximum duration of the vaccination program. This study aims to estimate the VE of bivalent mRNA vaccines against COVID-19-related hospitalisation and death in the Portuguese population aged 65 years or older, from September 2022 to May 2023. Methods: We used a cohort approach to analyse six electronic health registries using deterministic linkage, with a follow-up period of eight months. Severe outcomes included COVID-19-related hospitalisations and death, classified using discharge ICD-10 codes as proxies. The exposure of interest was the bivalent mRNA vaccine. VE was estimated for 14-97, 98-181 and 182-240 days after bivalent vaccination. Confounder-adjusted hazard ratio (aHR) was obtained by fitting a time-dependent Cox regression model with time-dependent vaccination status, adjusted for sociodemographic, history of influenza and pneumococcus vaccination, previous SARS-CoV-2 tests and infection, and comorbidities. VE was estimated by one minus the aHR between vaccinated with bivalent vaccine person-years versus those without bivalent vaccine person-years. Results: The cohort included 2,151,531 individuals aged 65 or older (27.8% with 80 or more years). In the ≥ 80 years old, VE was 41.3% (95%CI: 34.5-47.5%) and 50.3% (95%CI: 44.6-55.3%) against COVID-19-related hospitalisation and death, respectively. In the 65-79 years old, VE was 58.5% (95%CI: 51.9-64.2%) against COVID-19-related hospitalisation, and 65.1% (95%CI: 59.0-70.4%) against COVID-19-related death. VE waned for both age groups and outcomes. Among adults aged 65 years or older, we observed long-term moderate VE estimates against severe COVID-19-related outcomes. Conclusions: These results support the need for yearly boosters of COVID-19 vaccination to maximise the protection of the senior population against COVID-19 severe disease. Additional (spring boosters) during a vaccination campaign should be evaluated considering the epidemiological context and results from long-term VE studies.
- Mapping susceptibility to air pollution and its association with birth defects: a tool for public health interventionPublication . Aniceto, Carlos; Braz, Paula; Machado, Ausenda; Dias, Carlos MatiasEpidemiological studies evaluating the relation of environmental air pollution (AP) and birth defect (BD) are relevant to public health. Some limitations on these studies may derive from multiple factors contributing to the spatial variation of AP. This study aimed to integrate multifactorial AP indicators into an index and explore its application in a case-control study conducted in Portugal between 2016 and 2021. Spatial multicriteria analysis was employed to identify areas susceptible to AP. Variables included: (i) Euclidean distance to industrial units; (ii) kernel estimation of industrial units density; (iii) land occupation; (iv) Euclidean distance to main roads; and (v) areas conductive to radiation fog formation. Variables were classified into high, moderate, and low susceptibility. An AP susceptibility map was generated using the weighted linear combination method, with the analytic hierarchy process assigning weights to the variables. Georeferenced BD cases and controls were overlaid with environmental exposure variables and the AP index. Three AP susceptibility areas were identified: consolidated urban, peri-urban area, and a residential–industrial area. In areas of high susceptibility, 47 cases (29%) and 65 controls (31%) were observed; and in areas of low susceptibility 25 cases (15%) and 21 controls (10%) were observed. The development of the AP susceptibility map has been demonstrated to be a valuable tool for identifying patterns, generating hypotheses regarding the potential environmental exposure of NB to AP agents during pregnancy. When integrated into more complex analyses, these findings may contribute to assess the potential risk factors that play a major role in BD.