Isabel Aguilar-palacio | University of Zaragoza (original) (raw)

Papers by Isabel Aguilar-palacio

International Journal of Environmental Research and Public Health, Aug 24, 2018

Background: This study describes the prevalence of non-steroidal anti-inflammatory drug (NSAID) u... more Background: This study describes the prevalence of non-steroidal anti-inflammatory drug (NSAID) use, and analyses prescribing patterns of NSAIDs and associated gastroprotection. Methods: The study population consisted of 5650 workers at the General Motors automobile assembly plant in Zaragoza, Spain. NSAID prescription data for 2014 were obtained from the prescription database of Aragon (Spain). NSAID consumption was determined based on the number of defined daily doses purchased per year. Heavy NSAIDs users were identified using Lorenz curves. Results: NSAID use in the cohort was high (40.7% of workers, 95% CI 39.4-41.9). The prescription of proton pump inhibitors increased with age. Gastrointestinal protection was lacking in some participants who were being treated with drugs associated with a high risk of gastrointestinal bleeding. Heavy NSAID users (defined as those above the 95th percentile of consumption), accounted for 26% of total DDDs, and consumed a greater proportion of coxibs than non-heavy users. Conclusions: The rate of NSAID consumption in the cohort was high. To reduce the risk of gastrointestinal complications, monitoring and adequate gastroprotection are essential in patients who are prescribed NSAIDs for long periods of time or who are treated concomitantly with drugs that increase the risk of gastrointestinal bleeding.

International Journal of Environmental Research and Public Health, Dec 3, 2020

Primary Care Diabetes, Oct 1, 2017

Aim: To analyze the geographical pattern of diabetes mellitus (DM) mortality and its association ... more Aim: To analyze the geographical pattern of diabetes mellitus (DM) mortality and its association with socioeconomic factors in 26 Spanish cities. Methods: We conducted an ecological study of DM mortality trends with two cross-sectional cuts (1996-2001; 2002-2007) using census tract (CT) as the unit of analysis. Smoothed standardized mortality rates (sSMR) were calculated using Bayesian models, and a socioeconomic deprivation score was calculated for each CT. Results: In total, 27,757 deaths by DM were recorded, with higher mortality rates observed in men and in the period 1996-2001. For men, a significant association between CT deprivation score and DM mortality was observed in 6 cities in the first study period and in 7 cities in the second period. The highest relative risk was observed in Pamplona (RR, 5.13; 95% credible interval (95%CI), 1.32-15.16). For women, a significant association between CT deprivation

PLOS ONE, Feb 23, 2018

Benefits of cardiovascular disease (CVD) risk factors control are well known, but goals achieveme... more Benefits of cardiovascular disease (CVD) risk factors control are well known, but goals achievement remains low. The objective of this study is to evaluate the prevalence of CVD risk factors among men ina worker's cohort with no previous CVD, to study control variations across time and the factors associated with poor control. To this end, we conducted a cohort reexamination (2010-2014) within the context of the Aragon Workers Health Study (AWHS). Data from working characteristics, analytical values and pharmacological prescription were included in the analysis. Prevalences of risk factor diagnosis and control were calculated, as well as factors associated with poor control. The prevalence of CVD risk factors was high. In 2014dyslipidaemia was the most prevalent (85.2%) followed by Hypertension (HT) (42.0%). People under treatment increased for the period analysed (p<0.001). The proportion of people treated varied from 72.2% in Diabetes Mellitus to 31.1% in dyslipidaemia in 2014. 46.2% of the workers with HT were controlled, decreasing to 21.9% in Diabetes and 11.0% in dyslipidaemia (2014). Working in a turn different to central shift was associated with poor control, especially for those working at night with HT (

American Journal of Tropical Medicine and Hygiene, Apr 7, 2021

The COVID-19 pandemic has now imposed an enormous global burden as well as a large mortality in a... more The COVID-19 pandemic has now imposed an enormous global burden as well as a large mortality in a short time period. Although there is no promising treatment, identification of early predictors of in-hospital mortality would be critically important in reducing its worldwide mortality. We aimed to suggest a prediction model for in-hospital mortality of COVID-19. In this case-control study, we recruited 513 confirmed patients with COVID-19 from February 18 to March 26, 2020 from Isfahan COVID-19 registry. Based on extracted laboratory, clinical, and demographic data, we created an inhospital mortality predictive model using gradient boosting. We also determined the diagnostic performance of the proposed model including sensitivity, specificity, and area under the curve (AUC) as well as their 95% CIs. Of 513 patients, there were 60 (11.7%) in-hospital deaths during the study period. The diagnostic values of the suggested model based on the gradient boosting method with oversampling techniques using all of the original data were specificity of 98.5% (95% CI: 96.8-99.4), sensitivity of 100% (95% CI: 94-100), negative predictive value of 100% (95% CI: 99.2-100), positive predictive value of 89.6% (95% CI: 79.7-95.7), and an AUC of 98.6%. The suggested model may be useful in making decision to patient's hospitalization where the probability of mortality may be more obvious based on the final variable. However, moderate gaps in our knowledge of the predictors of in-hospital mortality suggest further studies aiming at predicting models for in-hospital mortality in patients with COVID-19.

Gaceta sanitaria, May 1, 2020

Objective: To analyse the effect of the Great Recession (2008) on primary care (PC) and secondary... more Objective: To analyse the effect of the Great Recession (2008) on primary care (PC) and secondary care (SC) inequalities in Spain. Method: Repeated cross-sectional study using Spanish Health Surveys from 2001 to 2017 (n = 139,566). Prevalence of PC and SC utilization were calculated standardized by age. Chi square tests for trend were conducted to explore the evolution. We performed logistic regression analyses adjusted by the Andersen's model of demand for care to explore inequalities prior to, during and following the recession. All the analyses were stratified by sex. Results: Healthcare use trends changed from a rapid increase in the pre-recession period to a plateau during the recession and a decrease in the post-recession period. Healthcare use was higher in women (PC: 15.8% to 32.5%; SC: 8.2% to 16.2%) than in men (PC: 11.3% to 24.1%; SC: 5.4% to 11.6%) and the gender gap increased. During the recession the likelihood of PC use was higher in disadvantaged groups, while SC had greater usage amongst more advantaged social groups. Inequalities in SC use increased during the recession and could not be attributed to factors of need. Conclusions: Healthcare use trends changed as a result of the recession. There are socioeconomic inequalities in the use of PC and SC in Spain, which increased in secondary care, during the recession and in the post-recession period. It is necessary to take into account socioeconomic determinants in health planning, in order to achieve equity in healthcare services.

Atencion Primaria, Apr 1, 2016

I. Aguilar-Palacio et al. Conclusiones: Existen diferencias en salud y utilización de servicios s... more I. Aguilar-Palacio et al. Conclusiones: Existen diferencias en salud y utilización de servicios sanitarios en mayores según clase social. Resulta necesario prestar atención a la salud percibida como predictor de la utilización de servicios sanitarios y revisar la accesibilidad-equidad de nuestros servicios.

Atencion Primaria, Dec 1, 2013

Resumen Objetivo: El objetivo del estudio es conocer las características de la población que se a... more Resumen Objetivo: El objetivo del estudio es conocer las características de la población que se asocian al consumo y autoconsumo de fármacos en Aragón. Diseño: Estudio transversal a través de la Encuesta Nacional de Salud de 2006. Emplazamiento: Comunidad autónoma de Aragón. Participantes: Población adulta residente en Aragón. Mediciones principales: Consumo y autoconsumo de fármacos, así como características sociodemográficas, de salud y de estilos de vida. Resultados: El 65,1% de los adultos aragoneses habían consumido al menos un fármaco en las últimas 2 semanas, el 11,7% lo hizo sin receta médica. Se observó mayor consumo en las mujeres y en personas de mayor edad. El mal estado de salud percibido incrementaba de manera significativa el consumo de fármacos. Las personas con bajo nivel de estudios tenían mayor consumo, mientras que el autoconsumo fue más frecuente en el grupo de mayor nivel de estudios Conclusiones: El consumo de fármacos en Aragón es elevado, así como la prevalencia de autoconsumo. Resulta de gran interés conocer el perfil de estos pacientes para poder realizar intervenciones dirigidas a reducir el consumo innecesario y mejorar la adecuación y seguridad de los fármacos utilizados

Nutrients, Dec 30, 2021

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

Revista española de cardiología, 2018

Introducción y objetivos: El objetivo de este estudio es analizar el patró n de persistencia con ... more Introducción y objetivos: El objetivo de este estudio es analizar el patró n de persistencia con estatinas en prevenció n primaria de enfermedad cardiovascular en una cohorte de trabajadores españ oles. Me´todos: Este estudio descriptivo se llevó a cabo en el marco del estudio prospectivo longitudinal Aragon Workers' Health Study (n = 5.400). Se identificó a los nuevos usuarios de estatinas varones a partir de datos recogidos en el sistema de informació n de consumo farmacé utico de Aragó n. Se analizaron los patrones de persistencia con estatinas prescritas en prevenció n primaria cardiovascular, así como los potenciales predictores. Resultados: De los 725 nuevos usuarios de estatinas, menos de un tercio habían persistido durante el añ o de seguimiento. Alrededor de un 15% de los usuarios no persistentes interrumpieron la terapia con estatinas tras la dispensació n de la primera receta y, el 42,1% de ellos no reiniciaron el tratamiento durante el resto del añ o. La mayor edad (HR = 0,55; IC95%, 0,39-0,77) y el cotratamiento con fá rmacos antihipertensivos (HR = 0,68; IC95%, 0,56-0,82) redujeron la probabilidad de que se interrumpiera el tratamiento. No se observó asociació n entre la persistencia con el tratamiento y la toma concomitante de fá rmacos antidiabé ticos o antitrombó ticos, las concentraciones basales de lipoproteínas de baja densidad o las de colesterol total. Sin embargo, la persistencia sí estuvo influida por el tipo de la primera estatina prescrita. Conclusiones: Nuestro aná lisis en una cohorte de trabajadores varones sanos muestra una baja persistencia con estatinas. Estos resultados reflejan la necesidad de comprender mejor los patrones de utilizació n de estatinas, especialmente por individuos aparentemente sanos, y de incorporar la conducta del paciente a las decisiones de prescripció n.

Journal of Psychosomatic Research, Sep 1, 2019

Background: There is little evidence comparing the role of subjective versus objective indicators... more Background: There is little evidence comparing the role of subjective versus objective indicators of socioeconomic status (SES) on individuals' self-rated health (SRH) in Iran. Objectives: We aimed to investigate underlying predictors of SRH including subjective and objective SES in Tehran, a multi-ethnic city. Method: This is an analysis of cross-sectional survey data on subjective and objective SES from a populationbased case-control study conducted in Tehran, Iran (2015). We used random digit dialing for study sample recruitment. Linear regression models were used for estimating crude and adjusted coefficients (95% confidence intervals). Age, gender, SES as well as cigarette smoking were included as confounders. Results: 15-50 years old residents of Tehran were recruited in the study (n = 1057). High reported objective and subjective SES was consistently associated with a better SRH. Subjective current SES (p < .001), subjective adolescence SES (p = .018), change in subjective SES (current vs. adolescent) (p = .034) and participants' education years (p < .001). Improvements over time in current SES in comparison to SES rated during adolescence increased the participants' SRH after adjustment for potential confounders (coefficient = 0.170, 95% CI: (0.015, 0.325)). Female participants (coefficient = −0.305, 95% CI: (−0.418, −0.192)) and smokers (high category vs. never smokers) (coefficient = −0.456, 95% CI: (−0.714, −0.197)) reported significantly worse SRH. Increasing age − 0.008 (95% CI: −0.014, −0.002) was associated with decreased SRH. Conclusion: High subjective and objective SES consistently was the most important predictor of high SRH.

Revista Espanola De Cardiologia, 2018

Public Health, 2018

Objectives: Employment status and economic recession have been associated with negative effects o... more Objectives: Employment status and economic recession have been associated with negative effects on self-rated health, and this effect differs by gender. We analysed the effects of the Spanish economic recession in terms of self-rated health, its differential effect among genders and its influence on gender gap. Study design: Repeated cross-sectional study using Spanish health surveys (2001e2014). Methods: Logistic regression models were conducted to explore the association between self-rated health and employment status and its evolution over time and gender. To test the impact of the economic recession, pooled data regression models were conducted. Results: In this study, we considered 104,577 subjects. During the last 15 years, women have entered the labour market, leading to wide changes in the Spanish traditional family roles. Instead of an increasing proportion of women workers, gender employment differences persist. Therefore, in 2014, the prevalence of workers was 55.77% in men, whereas in women, it was 44.01%. Self-rated health trends during the economic recession differ by gender, with women improving slightly their self-rated health from a low self-rated health prevalence of 38.76% in 2001 to 33.78% in 2014. On the contrary, men seem more vulnerable to employment circumstances, which have led to substantial reduction in the gender gap. Conclusions: Although a gender gap persists, the change in socioeconomic roles seems to increase women self-rated health, reducing this gap. It is important to promote women labour market inclusion, even in economic recession periods.

BMJ Open, Apr 1, 2019

Co-prescription patterns of cardiovascular preventive treatments: a cross-sectional study in the ... more Co-prescription patterns of cardiovascular preventive treatments: a cross-sectional study in the Aragon worker' health study (Spain). BMJ Open 2019;9:e023571.

PLOS ONE, Jan 15, 2021

To analyze patterns of antihypertensive drug use among new users in a Southern European populatio... more To analyze patterns of antihypertensive drug use among new users in a Southern European population, and identify patient-and treatment-related factors that influence persistence. Methods This is a retrospective observational study of new antihypertensive drug users aged �40 years in Aragó n, Spain. Information on antihypertensive drugs (2014-2016) prescribed and dispensed at pharmacies via the public health system were collected from a regional electronic population-based pharmacy database. Persistence was assessed using the gap method. Kaplan-Meier and Cox regression analyses were conducted to analyze patterns of use and factors that influence persistence. Results The 25,582 new antihypertensive drug users in Aragó n during the study period were prescribed antihypertensive drugs in monotherapy (73.3%), fixed combination (13.9%), free combination (9.1%), or other (3.7%). One in five received antihypertensive drugs within 15 days of the prescription date, but not after. During the first year of follow-up, 38.6% of the study population remained persistent. The likelihood of treatment discontinuation was higher for participants who were male, aged �80 years, and received an antihypertensive drug in monotherapy compared with fixed combination. Conclusion Overall persistence with antihypertensive therapy was poor, and was influenced by the sex, age and type of therapy. Fixed combinations appear to be a good choice for initial therapy, especially in patients with a higher risk of discontinuation. Nonetheless, adverse drug effects and the patient's preferences and clinical profile should be taken into account.

Journal of Personalized Medicine, Apr 20, 2022

Expert Review of Pharmacoeconomics & Outcomes Research, Jan 29, 2019

Background: Antihypertensive drugs play a crucial role in reducing cardiovascular morbidity and m... more Background: Antihypertensive drugs play a crucial role in reducing cardiovascular morbidity and mortality. Variability in prescribing patterns constitutes a major challenge for current healthcare systems. This study aimed to compare patterns of use of antihypertensives in general practice in two southern European populations. Methods: Observational study. Data on antihypertensive drugs consumption in primary care setting (2016) were obtained from pharmacy refill records in Campania (Italy) and Aragon (Spain). Prescribing rates and the number of defined daily doses [DDD]/1,000 inhabitants/day (DID) were calculated, and the Drug Utilization 90% (DU90%) approach used to reveal differences in prescribing patterns in both regions. Results: Antihypertensive prescribing rates in Campania and Aragon were 250.8 (95%CI: 250.2-251.3) and 201.7 (95%CI: 200.9-202.5) users/1,000 inhabitants/year. Overall consumption was of 310.1 and 256.8 DID, respectively. Spanish users, especially women and the elderly, consumed a greater volume of diuretics. Conversely, other therapeutic subgroups were more consumed in Campania. However, the most prescribed subgroups accounted for comparable proportions of the total consumption in each region. Conclusions: Both prescribing rates and intensity of antihypertensive use were higher in Campania. Pharmacy refill records in cross-national comparisons allow to know the factors influencing variability in prescribing habits with a view to improving prescribing quality.

Journal of Medical Internet Research, Aug 27, 2020

Despite half a century of dedicated studies, medication adherence remains far from perfect, with ... more Despite half a century of dedicated studies, medication adherence remains far from perfect, with many patients not taking their medications as prescribed. The magnitude of this problem is rising, jeopardizing the effectiveness of evidence-based therapies. An important reason for this is the unprecedented demographic change at the beginning of the 21st century. Aging leads to multimorbidity and complex therapeutic regimens that create a fertile ground for nonadherence. As this scenario is a global problem, it needs a worldwide answer. Could this answer be provided, given the new opportunities created by the digitization of health care? Daily, health-related information is being collected in electronic health records, pharmacy dispensing databases, health insurance systems, and national health system records. These big data repositories offer a unique chance to study adherence both retrospectively and prospectively at the population level, as well as its related factors. In order to make full use of this opportunity, there is a need to develop standardized measures of adherence, which can be applied globally to big data and will inform scientific research, clinical practice, and public health. These standardized measures may also enable a better understanding of the relationship between adherence and clinical outcomes, and allow for fair benchmarking of the effectiveness and cost-effectiveness of adherence-targeting interventions. Unfortunately, despite this obvious need, such standards are still lacking. Therefore, the aim of this paper is to call for a consensus on global standards for measuring adherence with big data. More specifically, sound standards of formatting and analyzing big data are needed in order to assess, uniformly present, and compare

Gaceta sanitaria, 2015

Palabras clave: Encuestas de salud Nivel educativo Determinantes sociales de la salud r e s u m e... more Palabras clave: Encuestas de salud Nivel educativo Determinantes sociales de la salud r e s u m e n Objetivo: Conocer la evolución de la prevalencia de mala salud percibida en España por comunidades autónomas (CC.AA.) para el periodo 2001-2012, las diferencias por sexo y edad, y la influencia del nivel educativo. Método: Estudio transversal de la Encuesta Nacional de Salud de 2001 a 2011-12, y de la Encuesta Europea de 2009. Se realizó un estudio descriptivo por sexo, edad, nivel educativo y C.A. de residencia ajustado por edad. Se utilizaron análisis de regresión logística para estudiar la evolución temporal y conocer la asociación entre el nivel educativo y la salud percibida, calculando su capacidad predictiva mediante el estadístico C. Resultados: La prevalencia de mala salud percibida fue mayor en las mujeres con nivel educativo bajo y mejoró en las de nivel educativo alto (18,6% en 2001 y 14,6% en 2012). La mayor prevalencia de mala salud percibida se observó en Andalucía, Canarias, Galicia y Murcia, con diferencias por sexo. El nivel educativo bajo se asoció con una peor salud percibida en la mayoría de las CC.AA., con buena capacidad predictiva. En todas las CC.AA., excepto Asturias, existió una mayor percepción de mala salud en las mujeres que en los hombres. En España, la prevalencia de mala salud percibida se mantuvo sin cambios en el periodo analizado, pero mejoró en Baleares, Cataluña y Madrid. Conclusiones: En España existen diferencias en la prevalencia de mala salud percibida por CC.AA. Aunque no varía en el periodo analizado, se observan desigualdades en su evolución según el nivel educativo y el sexo, que podrían conllevar un aumento de las desigualdades en mujeres según el nivel educativo.

Research in Social & Administrative Pharmacy, Sep 1, 2023