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Article: Multimorbidity of Psoriasis: A Large-Scale Population Study of Its Associated Comorbidities.

Almenara-Blasco, Manuel / Gracia-Cazaña, Tamara / Poblador-Plou, Beatriz / Laguna-Berna, Clara / Carmona-Pírez, Jonás / Navarro-Bielsa, Alba / Prados-Torres, Alexandra / Gimeno-Miguel, Antonio / Gilaberte, Yolanda

Journal of clinical medicine

2024 Volume 13, Issue 2

Abstract: Introduction: Psoriasis is a chronic disease of the skin with a prevalence of 2% in the general population. The high prevalence of psoriasis has prompted the study of its comorbidities in recent decades. We designed a study to determine the prevalence ... ...

Abstract	Introduction: Psoriasis is a chronic disease of the skin with a prevalence of 2% in the general population. The high prevalence of psoriasis has prompted the study of its comorbidities in recent decades. We designed a study to determine the prevalence of psoriasis in a large-scale, population-based cohort, to exhaustively describe its comorbidities, and to analyze which diseases are associated with psoriasis. Methods: Retrospective, observational study based on the clinical information contained in the electronic health records of the individuals in the EpiChron Cohort with a diagnosis of psoriasis (31,178 individuals) in 2019. We used logistic regression models and calculated the likelihood of the occurrence of each comorbidity based on the presence of psoriasis ( Results: The prevalence of psoriasis was 2.84%, and it was more prevalent in men (3.31% vs. 2.43%). The most frequent chronic comorbidities were disorders of lipid metabolism (35.87%), hypertension (35.50%), and other nutritional-endocrine-metabolic disorders (21.79%). The conditions most associated with psoriasis were (odds ratio; 95% confidence interval) tuberculosis (2.36; 1.24-4.49), cystic fibrosis (2.15; 1.25-3.69), amongst others. We did not find a significant association between psoriasis and hypertension or neoplasms (0.90; 0.86-0.95). Conclusions: This study revealed significant associations between psoriasis and cardiac, psychological, and musculoskeletal comorbidities.
Language	English
Publishing date	2024-01-16
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm13020492
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Article ; Online: Mental health and risk of death and hospitalization in COVID-19 patients. Results from a large-scale population-based study in Spain.

Moreno-Juste, Aida / Poblador-Plou, Beatriz / Ortega-Larrodé, Cristina / Laguna-Berna, Clara / González-Rubio, Francisca / Aza-Pascual-Salcedo, Mercedes / Bliek-Bueno, Kevin / Padilla, María / de-la-Cámara, Concepción / Prados-Torres, Alexandra / Gimeno-Feliú, Luis A / Gimeno-Miguel, Antonio

PloS one

2024 Volume 19, Issue 2, Page(s) e0298195

Abstract: The COVID-19 pandemic has created unprecedented challenges for health care systems globally. This study aimed to explore the presence of mental illness in a Spanish cohort of COVID-19-infected population and to evaluate the association between the ... ...

Abstract	The COVID-19 pandemic has created unprecedented challenges for health care systems globally. This study aimed to explore the presence of mental illness in a Spanish cohort of COVID-19-infected population and to evaluate the association between the presence of specific mental health conditions and the risk of death and hospitalization. This is a retrospective cohort study including all individuals with confirmed infection by SARS-CoV-2 from the PRECOVID (Prediction in COVID-19) Study (Aragon, Spain). Mental health illness was defined as the presence of schizophrenia and other psychotic disorders, anxiety, cognitive disorders, depression and mood disorders, substance abuse, and personality and eating disorders. Multivariable logistic regression models were used to examine the likelihood of 30-day all-cause mortality and COVID-19 related hospitalization based on baseline demographic and clinical variables, including the presence of specific mental conditions, by gender. We included 144,957 individuals with confirmed COVID-19 from the PRECOVID Study (Aragon, Spain). The most frequent diagnosis in this cohort was anxiety. However, some differences were observed by sex: substance abuse, personality disorders and schizophrenia were more frequently diagnosed in men, while eating disorders, depression and mood, anxiety and cognitive disorders were more common among women. The presence of mental illness, specifically schizophrenia spectrum and cognitive disorders in men, and depression and mood disorders, substance abuse, anxiety and cognitive and personality disorders in women, increased the risk of mortality or hospitalization after COVID-19, in addition to other well-known risk factors such as age, morbidity and treatment burden. Identifying vulnerable patient profiles at risk of serious outcomes after COVID-19 based on their mental health status will be crucial to improve their access to the healthcare system and the establishment of public health prevention measures for future outbreaks.
MeSH term(s)	Male ; Humans ; Female ; COVID-19/epidemiology ; Mental Health ; Retrospective Studies ; SARS-CoV-2 ; Spain/epidemiology ; Pandemics ; Hospitalization ; Substance-Related Disorders/epidemiology
Language	English
Publishing date	2024-02-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0298195
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Article ; Online: Multimorbidity, social determinants and intersectionality in chronic patients. Results from the EpiChron Cohort.

Moreno-Juste, Aida / Gimeno-Miguel, Antonio / Poblador-Plou, Beatriz / Calderón-Larrañaga, Amaia / Cano Del Pozo, Mabel / Forjaz, Maria João / Prados-Torres, Alexandra / Gimeno-Feliú, Luis A

Journal of global health

2023 Volume 13, Page(s) 4014

Abstract: Background: Multimorbidity is influenced in an interconnected way, both in extent and nature, by the social determinants of health. We aimed at implementing an intersectional approach to analyse the association of multimorbidity with five important axes ...

Abstract	Background: Multimorbidity is influenced in an interconnected way, both in extent and nature, by the social determinants of health. We aimed at implementing an intersectional approach to analyse the association of multimorbidity with five important axes of social inequality (i.e. gender, age, ethnicity, residence area and socioeconomic class). Methods: We conducted a cross-sectional observational study of all individuals who presented with at least one chronic disease in 2019 (n = 1 086 948) from the EpiChron Cohort (Aragon, Spain). Applying intersectional analysis, the age-adjusted likelihood of multimorbidity was investigated across 36 intersectional strata defined by gender, ethnicity, residence area and socioeconomic class. We calculated odds ratios (OR) 95% confidence interval (CI) using high-income urban non-migrant men as the reference category. The area under the receiver operator characteristics curve (AUC) was calculated to evaluate the discriminatory accuracy of multimorbidity. Results: The prevalence of multimorbidity increased with age, female gender and low income. Young and middle-aged low-income individuals showed rates of multimorbidity equivalent to those of high-income people aged about 20 years older. The intersectional analysis showed that low-income migrant women living in urban areas for >15 years were particularly disadvantaged in terms of multimorbidity risk OR = 3.16 (95% CI = 2.79-3.57). Being a migrant was a protective factor for multimorbidity, and newly arrived migrants had lower multimorbidity rates than those with >15 years of stay in Aragon, and even non-migrants. Living in rural vs. urban areas was slightly protective against multimorbidity. All models had a large discriminatory accuracy (AUC = 0.7884-0.7895); the largest AUC was obtained for the model including all intersectional strata. Conclusions: Our intersectional approach uncovered the large differences in the prevalence of multimorbidity that arise due to the synergies between the different socioeconomic and demographic exposures, beyond their expected additive effects.
MeSH term(s)	Middle Aged ; Male ; Humans ; Female ; Aged ; Multimorbidity ; Cross-Sectional Studies ; Intersectional Framework ; Social Determinants of Health ; Socioeconomic Factors
Language	English
Publishing date	2023-02-03
Publishing country	Scotland
Document type	Observational Study ; Journal Article
ZDB-ID	2741629-X
ISSN	2047-2986 ; 2047-2986
ISSN (online)	2047-2986
ISSN	2047-2986
DOI	10.7189/13.04014
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Article ; Online: Multimorbidity patterns in COVID-19 patients and their relationship with infection severity: MRisk-COVID study.

Lleal, Marina / Corral-Vazquez, Celia / Baré, Montserrat / Comet, Ricard / Herranz, Susana / Baigorri, Francisco / Gimeno-Miguel, Antonio / Raurich, Maria / Fortià, Cristina / Navarro, Marta / Poblador-Plou, Beatriz / Baré, Marisa

PloS one

2023 Volume 18, Issue 8, Page(s) e0290969

Abstract: Background: Several chronic conditions have been identified as risk factors for severe COVID-19 infection, yet the implications of multimorbidity need to be explored. The objective of this study was to establish multimorbidity clusters from a cohort of ... ...

Abstract	Background: Several chronic conditions have been identified as risk factors for severe COVID-19 infection, yet the implications of multimorbidity need to be explored. The objective of this study was to establish multimorbidity clusters from a cohort of COVID-19 patients and assess their relationship with infection severity/mortality. Methods: The MRisk-COVID Big Data study included 14 286 COVID-19 patients of the first wave in a Spanish region. The cohort was stratified by age and sex. Multimorbid individuals were subjected to a fuzzy c-means cluster analysis in order to identify multimorbidity clusters within each stratum. Bivariate analyses were performed to assess the relationship between severity/mortality and age, sex, and multimorbidity clusters. Results: Severe infection was reported in 9.5% (95% CI: 9.0-9.9) of the patients, and death occurred in 3.9% (95% CI: 3.6-4.2). We identified multimorbidity clusters related to severity/mortality in most age groups from 21 to 65 years. In males, the cluster with highest percentage of severity/mortality was Heart-liver-gastrointestinal (81-90 years, 34.1% severity, 29.5% mortality). In females, the clusters with the highest percentage of severity/mortality were Diabetes-cardiovascular (81-95 years, 22.5% severity) and Psychogeriatric (81-95 years, 16.0% mortality). Conclusion: This study characterized several multimorbidity clusters in COVID-19 patients based on sex and age, some of which were found to be associated with higher rates of infection severity/mortality, particularly in younger individuals. Further research is encouraged to ascertain the role of specific multimorbidity patterns on infection prognosis and identify the most vulnerable morbidity profiles in the community. Trial registration: NCT04981249. Registered 4 August 2021 (retrospectively registered).
MeSH term(s)	Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Young Adult ; Big Data ; Cluster Analysis ; Correlation of Data ; COVID-19/epidemiology ; Multimorbidity
Language	English
Publishing date	2023-08-31
Publishing country	United States
Document type	Journal Article ; Observational Study ; Research Support, Non-U.S. Gov't
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0290969
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Article ; Online: A Data Transformation Methodology to Create Findable, Accessible, Interoperable, and Reusable Health Data: Software Design, Development, and Evaluation Study.

Sinaci, A Anil / Gencturk, Mert / Teoman, Huseyin Alper / Laleci Erturkmen, Gokce Banu / Alvarez-Romero, Celia / Martinez-Garcia, Alicia / Poblador-Plou, Beatriz / Carmona-Pírez, Jonás / Löbe, Matthias / Parra-Calderon, Carlos Luis

Journal of medical Internet research

2023 Volume 25, Page(s) e42822

Abstract: Background: Sharing health data is challenging because of several technical, ethical, and regulatory issues. The Findable, Accessible, Interoperable, and Reusable (FAIR) guiding principles have been conceptualized to enable data interoperability. Many ... ...

Abstract	Background: Sharing health data is challenging because of several technical, ethical, and regulatory issues. The Findable, Accessible, Interoperable, and Reusable (FAIR) guiding principles have been conceptualized to enable data interoperability. Many studies provide implementation guidelines, assessment metrics, and software to achieve FAIR-compliant data, especially for health data sets. Health Level 7 (HL7) Fast Healthcare Interoperability Resources (FHIR) is a health data content modeling and exchange standard. Objective: Our goal was to devise a new methodology to extract, transform, and load existing health data sets into HL7 FHIR repositories in line with FAIR principles, develop a Data Curation Tool to implement the methodology, and evaluate it on health data sets from 2 different but complementary institutions. We aimed to increase the level of compliance with FAIR principles of existing health data sets through standardization and facilitate health data sharing by eliminating the associated technical barriers. Methods: Our approach automatically processes the capabilities of a given FHIR end point and directs the user while configuring mappings according to the rules enforced by FHIR profile definitions. Code system mappings can be configured for terminology translations through automatic use of FHIR resources. The validity of the created FHIR resources can be automatically checked, and the software does not allow invalid resources to be persisted. At each stage of our data transformation methodology, we used particular FHIR-based techniques so that the resulting data set could be evaluated as FAIR. We performed a data-centric evaluation of our methodology on health data sets from 2 different institutions. Results: Through an intuitive graphical user interface, users are prompted to configure the mappings into FHIR resource types with respect to the restrictions of selected profiles. Once the mappings are developed, our approach can syntactically and semantically transform existing health data sets into HL7 FHIR without loss of data utility according to our privacy-concerned criteria. In addition to the mapped resource types, behind the scenes, we create additional FHIR resources to satisfy several FAIR criteria. According to the data maturity indicators and evaluation methods of the FAIR Data Maturity Model, we achieved the maximum level (level 5) for being Findable, Accessible, and Interoperable and level 3 for being Reusable. Conclusions: We developed and extensively evaluated our data transformation approach to unlock the value of existing health data residing in disparate data silos to make them available for sharing according to the FAIR principles. We showed that our method can successfully transform existing health data sets into HL7 FHIR without loss of data utility, and the result is FAIR in terms of the FAIR Data Maturity Model. We support institutional migration to HL7 FHIR, which not only leads to FAIR data sharing but also eases the integration with different research networks.
MeSH term(s)	Humans ; Electronic Health Records ; Software Design ; Software ; Health Level Seven ; Information Dissemination
Language	English
Publishing date	2023-03-08
Publishing country	Canada
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2028830-X
ISSN	1438-8871 ; 1438-8871
ISSN (online)	1438-8871
ISSN	1438-8871
DOI	10.2196/42822
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Article ; Online: Overuse or underuse? Use of healthcare services among irregular migrants in a north-eastern Spanish region.

Gimeno-Feliu, Luis Andrés / Pastor-Sanz, Marta / Poblador-Plou, Beatriz / Calderón-Larrañaga, Amaia / Díaz, Esperanza / Prados-Torres, Alexandra

International journal for equity in health

2021 Volume 20, Issue 1, Page(s) 41

Abstract: Background: There is little verified information on global healthcare utilization by irregular migrants. Understanding how immigrants use healthcare services based on their needs is crucial to establish effective health policy. We compared healthcare ... ...

Abstract	Background: There is little verified information on global healthcare utilization by irregular migrants. Understanding how immigrants use healthcare services based on their needs is crucial to establish effective health policy. We compared healthcare utilization between irregular migrants, documented migrants, and Spanish nationals in a Spanish autonomous community. Methods: This retrospective, observational study included the total adult population of Aragon, Spain: 930,131 Spanish nationals; 123,432 documented migrants; and 17,152 irregular migrants. Healthcare utilization data were compared between irregular migrants, documented migrants and Spanish nationals for the year 2011. Multivariable standard or zero-inflated negative binomial regression models were generated, adjusting for age, sex, length of stay, and morbidity burden. Results: The average annual use of healthcare services was lower for irregular migrants than for documented migrants and Spanish nationals at all levels of care analyzed: primary care (0.5 vs 4 vs 6.7 visits); specialized care (0.2 vs 1.8 vs 2.9 visits); planned hospital admissions (0.3 vs 2 vs 4.23 per 100 individuals), unplanned hospital admissions (0.5 vs 3.5 vs 5.2 per 100 individuals), and emergency room visits (0.4 vs 2.8 vs 2.8 per 10 individuals). The average annual prescription drug expenditure was also lower for irregular migrants (€9) than for documented migrants (€77) and Spanish nationals (€367). These differences were only partially attenuated after adjusting for age, sex, and morbidity burden. Conclusions: Under conditions of equal access, healthcare utilization is much lower among irregular migrants than Spanish nationals (and lower than that of documented migrants), regardless of country of origin or length of stay in Spain.
MeSH term(s)	Adolescent ; Adult ; Aged ; Facilities and Services Utilization/statistics & numerical data ; Female ; Health Services/statistics & numerical data ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Spain ; Transients and Migrants/statistics & numerical data ; Young Adult
Language	English
Publishing date	2021-01-20
Publishing country	England
Document type	Journal Article ; Observational Study ; Research Support, Non-U.S. Gov't
ISSN	1475-9276
ISSN (online)	1475-9276
DOI	10.1186/s12939-020-01373-3
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Article ; Online: Influenza Vaccination: An Ally to Mitigate Influenza-associated Risks During the Coronavirus Disease 2019 (COVID-19) Pandemic.

González-Rubio, Francisca / Ioakeim-Skoufa, Ignatios / Poblador-Plou, Beatriz / Gimeno-Miguel, Antonio / Prados-Torres, Alexandra

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

2020 Volume 72, Issue 12, Page(s) 2249–2250

MeSH term(s)	COVID-19 ; Humans ; Influenza Vaccines ; Influenza, Human/epidemiology ; Influenza, Human/prevention & control ; Pandemics/prevention & control ; SARS-CoV-2 ; Vaccination
Chemical Substances	Influenza Vaccines
Keywords	covid19
Language	English
Publishing date	2020-11-30
Publishing country	United States
Document type	Letter ; Research Support, Non-U.S. Gov't
ZDB-ID	1099781-7
ISSN	1537-6591 ; 1058-4838
ISSN (online)	1537-6591
ISSN	1058-4838
DOI	10.1093/cid/ciaa1190
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Article: Comorbidity Patterns in Patients with Atopic Dermatitis Using Network Analysis in the EpiChron Study.

Almenara-Blasco, Manuel / Carmona-Pírez, Jonás / Gracia-Cazaña, Tamara / Poblador-Plou, Beatriz / Pérez-Gilaberte, Juan Blas / Navarro-Bielsa, Alba / Gimeno-Miguel, Antonio / Prados-Torres, Alexandra / Gilaberte, Yolanda

Journal of clinical medicine

2022 Volume 11, Issue 21

Abstract: Background: Atopic dermatitis (AD) is associated with different comorbidities. Methods: Retrospective, observational study based on clinical information from the individuals of the EpiChron Cohort Study (Aragon, Spain) with a diagnosis of AD between 1 ... ...

Abstract	Background: Atopic dermatitis (AD) is associated with different comorbidities. Methods: Retrospective, observational study based on clinical information from the individuals of the EpiChron Cohort Study (Aragon, Spain) with a diagnosis of AD between 1 January 2010 and 31 December 2018. We calculated the tetrachoric correlations of each pair of comorbidities to analyze the weight of the association between them. We used a cut-off point for statistical significance of p-value < 0.01. Results: The prevalence of AD in the EpiChron Cohort was 3.83%. The most frequently found comorbidities were respiratory, cardio-metabolic, cardiovascular, and mental health disorders. Comorbidities were combined into 17 disease patterns (15 in men and 11 in women), with some sex and age specificities. An infectious respiratory pattern was the most consistently described pattern across all ages and sexes, followed by a cardiometabolic pattern that appeared in patients over 18 years of age. Conclusions: Our study revealed the presence of different clinically meaningful comorbidity patterns in patients with AD. Our results can help to identify which comorbidities deserve special attention in these types of patients and to better understand the physio-pathological mechanisms underlying the disease associations identified. Further studies are encouraged to validate the results obtained in different clinical settings and populations.
Language	English
Publishing date	2022-10-29
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm11216413
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Article ; Online: Multimorbidity Clusters in the Oldest Old: Results from the EpiChron Cohort.

Ioakeim-Skoufa, Ignatios / Clerencia-Sierra, Mercedes / Moreno-Juste, Aida / Elías de Molins Peña, Carmen / Poblador-Plou, Beatriz / Aza-Pascual-Salcedo, Mercedes / González-Rubio, Francisca / Prados-Torres, Alexandra / Gimeno-Miguel, Antonio

International journal of environmental research and public health

2022 Volume 19, Issue 16

Abstract: Multimorbidity is challenging for both patients and healthcare systems due to its increasing prevalence and high impact on people's health and well-being. The risk of multimorbidity increases with age, but there is still more to discover regarding the ... ...

Abstract	Multimorbidity is challenging for both patients and healthcare systems due to its increasing prevalence and high impact on people's health and well-being. The risk of multimorbidity increases with age, but there is still more to discover regarding the clinical profile of the oldest old. In this study, we used information from the EpiChron Cohort Study to identify multimorbidity patterns in individuals who died during the period 2010-2019 at the ages of 80-89, 90-99, and ≥100. This cohort links the demographic, clinical, and drug dispensation information of public health system users in Aragón, Spain. We saw a significantly lower number of chronic diseases and drugs and a lower prevalence of polypharmacy in centenarians compared to those aged 80-99. K-means clustering revealed different multimorbidity clusters by sex and age group. We observed clusters of cardiovascular and metabolic diseases, obstructive pulmonary conditions, and neoplasms, amongst other profiles. One in three octogenarian women had a metabolic pattern (diabetes, dyslipidaemia, and other endocrine-metabolic disorders) with the highest number of diseases (up to seven) and prevalence of polypharmacy (64%). We observed clusters of dementia and genitourinary disorders in individuals on medication with anticholinergic activity. Our study offers an opportunity to better understand the urgency of adequately addressing multimorbidity in our older adults.
MeSH term(s)	Aged ; Aged, 80 and over ; Chronic Disease ; Cohort Studies ; Cross-Sectional Studies ; Female ; Humans ; Metabolic Diseases ; Multimorbidity ; Polypharmacy ; Prevalence
Language	English
Publishing date	2022-08-17
Publishing country	Switzerland
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2175195-X
ISSN	1660-4601 ; 1661-7827
ISSN (online)	1660-4601
ISSN	1661-7827
DOI	10.3390/ijerph191610180
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Article ; Online: Identifying multimorbidity profiles associated with COVID-19 severity in chronic patients using network analysis in the PRECOVID Study.

Carmona-Pírez, Jonás / Gimeno-Miguel, Antonio / Bliek-Bueno, Kevin / Poblador-Plou, Beatriz / Díez-Manglano, Jesús / Ioakeim-Skoufa, Ignatios / González-Rubio, Francisca / Poncel-Falcó, Antonio / Prados-Torres, Alexandra / Gimeno-Feliu, Luis A

Scientific reports

2022 Volume 12, Issue 1, Page(s) 2831

Abstract: A major risk factor of COVID-19 severity is the patient's health status at the time of the infection. Numerous studies focused on specific chronic diseases and identified conditions, mainly cardiovascular ones, associated with poor prognosis. However, ... ...

Abstract	A major risk factor of COVID-19 severity is the patient's health status at the time of the infection. Numerous studies focused on specific chronic diseases and identified conditions, mainly cardiovascular ones, associated with poor prognosis. However, chronic diseases tend to cluster into patterns, each with its particular repercussions on the clinical outcome of infected patients. Network analysis in our population revealed that not all cardiovascular patterns have the same risk of COVID-19 hospitalization or mortality and that this risk depends on the pattern of multimorbidity, besides age and sex. We evidenced that negative outcomes were strongly related to patterns in which diabetes and obesity stood out in older women and men, respectively. In younger adults, anxiety was another disease that increased the risk of severity, most notably when combined with menstrual disorders in women or atopic dermatitis in men. These results have relevant implications for organizational, preventive, and clinical actions to help meet the needs of COVID-19 patients.
MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; COVID-19/epidemiology ; Female ; Humans ; Male ; Middle Aged ; Multimorbidity ; Retrospective Studies ; Spain/epidemiology ; Young Adult
Language	English
Publishing date	2022-02-18
Publishing country	England
Document type	Journal Article ; Observational Study ; Research Support, Non-U.S. Gov't
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-022-06838-9
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