title: Cystic Echinococcosis Epidemiology in Spain Based on Hospitalization Records, 1997-2012.
abstract: Cystic echinococcosis (CE) is a parasitic disease caused by the tapeworm Echinococcus granulosus. Although present throughout Europe, deficiencies in the official reporting of CE result in under-reporting and misreporting of this disease, which in turn is reflected in the wrong opinion that CE is not an important health problem. By using an alternative data source, this study aimed at describing the clinical and temporal-spatial characteristics of CE hospitalizations in Spain between 1997 and 2012.
  
  
  
  We performed a retrospective descriptive study using the Hospitalization Minimum Data Set (CMBD in Spanish). All CMBD's hospital discharges with echinococcosis diagnosis placed in first diagnostic position were reviewed. Hospitalization rates were computed and clinical characteristics were described. Spatial and temporal distribution of hospital discharges was also assessed. Between 1997 and 2012, 14,010 hospitalizations with diagnosis of CE were recorded, 55% were men and 67% were aged over 45 years. Pediatric hospitalizations occurred during the whole study period. The 95.2% were discharged at home, and only 1.7% were exitus. The average cost was 8,439.11 €. The hospitalization rate per 100,000 per year showed a decreasing trend during the study period. All the autonomous communities registered discharges, even those considered as non-endemic. Maximum rates were reached by Extremadura, Castilla-Leon and Aragon. Comparison of the CMBD data and the official Compulsory Notifiable Diseases (CND) reports from 2005 to 2012 showed that official data were lower than registered hospitalization discharges.
  
  
  
  Hospitalizations distribution was uneven by year and autonomous region. Although CE hospitalization rates have decreased considerably due to the success of control programs, it remains a public health problem due to its severity and economic impact. Therefore, it would be desirable to improve its oversight and surveillance, since officially reported data are underestimating the real burden of CE in Spain.
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.identifier: 0000-0002-6508-3818
authors.initials: Z
authors.lastname: Herrador
authors.affiliation: Laboratory of Parasitology, Instituto de Recursos Naturales y Agrobiología de Salamanca (IRNASA), Consejo Superior de Investigaciones Científicas (CSIC), Salamanca, Spain.
authors.forename: Mar
authors.initials: M
authors.lastname: Siles-Lucas
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
authors.affiliation: Network Biomedical Research on Tropical Diseases (RICET in Spanish), Madrid, Spain.|National Referral Centre for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal Hospital, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain.
authors.forename: Rogelio
authors.initials: R
authors.lastname: Lopez-Velez
authors.affiliation: National Centre of Epidemiology, Health Institute Carlos III (ISCIII), Madrid, Spain.
authors.forename: Alin
authors.initials: A
authors.lastname: Gherasim
authors.affiliation: Network Biomedical Research on Tropical Diseases (RICET in Spanish), Madrid, Spain.|National Centre of Microbiology, Health Institute Carlos III (ISCIII), Madrid, Spain.
authors.forename: Teresa
authors.initials: T
authors.lastname: Garate
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
mesh_terms: D000328:Adult; D000818:Animals; D002648:Child; D017281:Cost of Illness; D018563:Disease Notification; D004443:Echinococcosis / Q000175:diagnosis / Q000453:epidemiology* / Q000469:parasitology; D048209:Echinococcus granulosus / Q000302:isolation & purification; D005260:Female; D006753:Hospital Records; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology; D062211:Spatio-Temporal Analysis; D013997:Time Factors