title: Using hospital discharge database to characterize Chagas disease evolution in Spain: there is a need for a systematic approach towards disease detection and control.
abstract: After the United States, Spain comes second in the list of countries receiving migrants from Latin America, and, therefore, it is the European country with the highest expected number of infected patients of Chagas disease. We have studied the National Health System's Hospital Discharge Records Database (CMBD) in order to describe the disease evolution from 1997 to 2011 in Spain. We performed a retrospective descriptive study using CMBD information on hospitalizations including Chagas disease. Data was divided in two periods with similar length in time: 1997-2004 and 2005-2011. Hospitalization rates were calculated and clinical characteristics were described. We used multivariable logistic regression to calculate adjusted odds-ratio (aOR) for the association between various conditions and being hospitalized with organ affectation. A total of 1729 hospitalization records were identified. Hospitalization rates for the two periods were 18 and 242.8/100000 population, respectively. The median age was 35 years (range 0-87), 74% were female and the 16-45 age-group was mostly represented (69.8%). Overall, 23.4% hospitalizations included the diagnosis of Chagas disease with organ complications. Being male [aOR: 1.3 (1.00-1.77)], aged 45 and 64 years [aOR: 2.59 (1.42-4.71)], and a median hospitalization cost above 3,065 euro [aOR: 2.03 (3.73-7.86)] were associated with hospitalizations with organ affectation. Since 2005, the number of detected infections increased in Spain. The predominant patients' profile (asymptomatic women at fertile age) and the conditions associated with organ affectation underlines the need for increased efforts towards the early detection of T cruzi.
authors.affiliation: National Centre for Tropical Medicine, Health Institute Carlos III (ISCIII in Spanish), Madrid, Spain; Network Biomedical Research on Tropical Diseases (RICET in Spanish), Madrid, Spain.
authors.forename: Zaida
authors.initials: Z
authors.lastname: Herrador
authors.affiliation: Department of Preventive Medicine, University Hospital Nuestra Señora de la Candelaria, Tenerife, Spain.
authors.forename: Eva
authors.initials: E
authors.lastname: Rivas
authors.affiliation: National Centre for Tropical Medicine, Health Institute Carlos III (ISCIII in Spanish), Madrid, Spain.
authors.forename: Alin
authors.initials: A
authors.lastname: Gherasim
authors.affiliation: Biomedical Research Centre Network for Epidemiology and Public Health (CIBERESP), Health Institute Carlos III (ISCIII in Spanish), Madrid, Spain.
authors.forename: Diana
authors.initials: D
authors.lastname: Gomez-Barroso
authors.affiliation: Department of Preventive Medicine, University Hospital Nuestra Señora de la Candelaria, Tenerife, Spain.
authors.forename: Jezabel
authors.initials: J
authors.lastname: García
authors.affiliation: National Centre for Tropical Medicine, Health Institute Carlos III (ISCIII in Spanish), Madrid, Spain; Network Biomedical Research on Tropical Diseases (RICET in Spanish), Madrid, Spain.
authors.forename: Agustín
authors.initials: A
authors.lastname: Benito
authors.affiliation: National Centre for Tropical Medicine, Health Institute Carlos III (ISCIII in Spanish), Madrid, Spain; Network Biomedical Research on Tropical Diseases (RICET in Spanish), Madrid, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Aparicio
mesh_terms: D000367:Age Factors; D014355:Chagas Disease / Q000453:epidemiology*; D016208:Databases, Factual; D005260:Female; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007843:Latin America / Q000208:ethnology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013030:Spain / Q000453:epidemiology; D014171:Transients and Migrants / Q000706:statistics & numerical data*