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OBJETIVO: Estimar el efecto a corto plazo de la contaminación atmosférica sobre la mortalidad en la ciudad de Zaragoza durante el período que abarca entre los años 2010 a 2013. MÉTODOS: Se han obtenido los niveles diarios de contaminantes de la Red Automática de Control de la Contaminación Atmosférica de Zaragoza y se han contrastado con diferentes índices de mortalidad diaria mediante modelos de regresión de Poisson autorregresivos. RESULTADOS: La mortalidad media diaria de Zaragoza durante el período excluyendo las causas externas es de 19,5 defunciones diarias. Se ha encontrado asociaciones entre el CO (IC99%: 1,001-1,036) y la mortalidad por todas las causas, así como para el SO2 (IC99%: 1,006-1,063) y la mortalidad por enfermedades del aparato circulatorio. CONCLUSIONES: A pesar de que se considera que Zaragoza tiene unos niveles de contaminación bajos, se ha encontrado un efecto significativo de la contaminación sobre la mortalidad diaria. Estos resultados son consistentes y coherentes con los obtenidos en investigaciones anteriores.

Introduction and objectives: The aim of this study was to assess patterns of treatment persistence in a cohort of male Spanish workers receiving statin therapy for primary prevention of cardiovascular disease. Methods: This descriptive study was conducted within the framework of the prospective longitudinal Aragon Workers’ Health Study (N = 5400). Incident male statin users were identified based on data collected from the regional government's medication consumption information system. Patterns of treatment persistence with statins prescribed for primary cardiovascular disease prevention were assessed and the relevance of potential predictors explored. Results: Among the 725 new statin users, less than one third remained persistent during the 1 year of follow-up. About 15% of nonpersistent users discontinued statin therapy after dispensation of the first prescription; of these, 42.1% did not recommence treatment within the following year. Factors reducing the likelihood of treatment discontinuation were older age (HR, 0.55; 95%CI, 0.39-0.77) and cotreatment with antihypertensive drugs (HR, 0.68; 95%CI, 0.56-0.82). No association was observed between treatment persistence and cotreatment with antidiabetic or antithrombotic drugs, baseline low-density lipoprotein levels, or total cholesterol levels. However, persistence was influenced by the type of statin first prescribed. Conclusions: Our analysis of a cohort of healthy male workers revealed poor statin persistence. These findings underscore the need for a better understanding of patterns of statin use, especially in apparently healthy individuals, and for the incorporation of patient behavior into prescribing decisions. Abstract Introduction and objectives The aim of this study was to assess patterns of treatment persistence in a cohort of male Spanish workers receiving statin therapy for primary prevention of cardiovascular disease. Methods This descriptive study was conducted within the framework of the prospective longitudinal Aragon Workers’ Health Study (N = 5400). Incident male statin users were identified based on data collected from the regional government's medication consumption information system. Patterns of treatment persistence with statins prescribed for primary cardiovascular disease prevention were assessed and the relevance of potential predictors explored. Results Among the 725 new statin users, less than one third remained persistent during the 1 year of follow-up. About 15% of nonpersistent users discontinued statin therapy after dispensation of the first prescription; of these, 42.1% did not recommence treatment within the following year. Factors reducing the likelihood of treatment discontinuation were older age (HR, 0.55; 95%CI, 0.39-0.77) and cotreatment with antihypertensive drugs (HR, 0.68; 95%CI, 0.56-0.82). No association was observed between treatment persistence and cotreatment with antidiabetic or antithrombotic drugs, baseline low-density lipoprotein levels, or total cholesterol levels. However, persistence was influenced by the type of statin first prescribed. Conclusions Our analysis of a cohort of healthy male workers revealed poor statin persistence. These findings underscore the need for a better understanding of patterns of statin use, especially in apparently healthy individuals, and for the incorporation of patient behavior into prescribing decisions. Resumen: Introducción y objetivos: El objetivo de este estudio es analizar el patrón de persistencia con estatinas en prevención primaria de enfermedad cardiovascular en una cohorte de trabajadores españoles. Métodos: 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 información de consumo farmacéutico de Aragón. Se analizaron los patrones de persistencia con estatinas prescritas en prevención primaria cardiovascular, así como los potenciales predictores. Resultados: De los 725 nuevos usuarios de estatinas, menos de un tercio habían persistido durante el año de seguimiento. Alrededor de un 15% de los usuarios no persistentes interrumpieron la terapia con estatinas tras la dispensación de la primera receta y, el 42,1% de ellos no reiniciaron el tratamiento durante el resto del año. La mayor edad (HR = 0,55; IC95%, 0,39-0,77) y el cotratamiento con fármacos antihipertensivos (HR = 0,68; IC95%, 0,56-0,82) redujeron la probabilidad de que se interrumpiera el tratamiento. No se observó asociación entre la persistencia con el tratamiento y la toma concomitante de fármacos antidiabéticos o antitrombóticos, 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 análisis en una cohorte de trabajadores varones sanos muestra una baja persistencia con estatinas. Estos resultados reflejan la necesidad de comprender mejor los patrones de utilización de estatinas, especialmente por individuos aparentemente sanos, y de incorporar la conducta del paciente a las decisiones de prescripción. Introducción y objetivos: El objetivo de este estudio es analizar el patrón de persistencia con estatinas en prevención primaria de enfermedad cardiovascular en una cohorte de trabajadores españoles. Métodos: 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 información de consumo farmacéutico de Aragón. Se analizaron los patrones de persistencia con estatinas prescritas en prevención primaria cardiovascular, así como los potenciales predictores. Resultados: De los 725 nuevos usuarios de estatinas, menos de un tercio habían persistido durante el año de seguimiento. Alrededor de un 15% de los usuarios no persistentes interrumpieron la terapia con estatinas tras la dispensación de la primera receta y, el 42, 1% de ellos no reiniciaron el tratamiento durante el resto del año. La mayor edad (HR = 0, 55; IC95%, 0, 39-0, 77) y el cotratamiento con fármacos antihipertensivos (HR = 0, 68; IC95%, 0, 56-0, 82) redujeron la probabilidad de que se interrumpiera el tratamiento. No se observó asociación entre la persistencia con el tratamiento y la toma concomitante de fármacos antidiabéticos o antitrombóticos, 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 análisis en una cohorte de trabajadores varones sanos muestra una baja persistencia con estatinas. Estos resultados reflejan la necesidad de comprender mejor los patrones de utilización de estatinas, especialmente por individuos aparentemente sanos, y de incorporar la conducta del paciente a las decisiones de prescripción. Introduction and objectives: The aim of this study was to assess patterns of treatment persistence in a cohort of male Spanish workers receiving statin therapy for primary prevention of cardiovascular disease. Methods: This descriptive study was conducted within the framework of the prospective longitudinal Aragon Workers' Health Study (N = 5400). Incident male statin users were identified based on data collected from the regional government's medication consumption information system. Patterns of treatment persistence with statins prescribed for primary cardiovascular disease prevention were assessed and, the relevance of potential predictors explored. Results: Among the 725 new statin users, less than one third remained persistent during the 1 year of follow-up. About 15% of nonpersistent users discontinued statin therapy after dispensation of the first prescription; of these, 42.1% did not recommence treatment within the following year. Factors reducing the likelihood of treatment discontinuation were older age (HR, 0.55; 95%CI, 039-0.77) and cotreatment with antihypertensive drugs (HR, 0.68; 95%CI, 0.56-0.82). No association was observed between treatment persistence and cotreatment with antidiabetic or antithrombotic drugs, baseline low-density lipoprotein levels, or total cholesterol levels. However, persistence was influenced by the type of statin first prescribed. Conclusions: Our analysis of a cohort of healthy male workers revealed poor statin persistence. These findings underscore the need for a better understanding of patterns of statin use, especially in apparently healthy individuals, and for the incorporation of patient behavior into prescribing decisions.

To assess suitability and comparability of the most common methods of treatment adherence and persistence assessment, as applied to the same pharmacy dataset.Data on drugs prescribed for cardiovascular primary prevention to participants in the Aragon Workers' Health Study (AWHS) were collected from a regional electronic drug prescription database. Several different approaches were used to measure treatment adherence (with the medication possession ratio [MPR]) and proportion of days covered [PDC]) and persistence in new users by therapeutic subgroup. Defined daily dose (DDD) was used as a proxy of the number of days' supply, or substituted with surrogate daily dose values.Higher mean adherence values and proportions of adherent patients were obtained using MPR versus PDC, with additional differences depending on the approach used. The proportion of adherent patients was lowest for oral antidiabetics (14.4%-30.6%) and highest for antihypertensives (70.2%-82.1%). The use of surrogate daily dose values increased adherence for antidiabetics and statins and decreased adherence for antihypertensives. After a 1 year follow-up, treatment persistence was observed for 21.1%, 58.7%, and 29.5% of antidiabetic, antihypertensive and statin users, respectively.Our findings indicate that use of multiple measures of treatment adherence and persistence provides a more complete overview of medication use patterns, and certain limitations associated with DDD for some drug groups can be overcome with replacement by surrogate doses. The PDC indicator seems to provide a more accurate reflection of patient behavior and treatment continuity than the MPR. Any comparison of adherence/persistence should always consider the method used, variables analyzed, and corresponding data collection process.