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Open AccessArticle

Temporal and Cartographic Analyses of the Distribution within Spain of Mortality Due to Granulomatosis with Polyangiitis (1984–2016)

1
Institute of Rare Diseases Research (IIER), Instituto de Salud Carlos III, 28029 Madrid, Spain
2
Department of Geology, Geography and Environmental Sciences, University of Alcala, 28801 Alcalá de Henares, Spain
3
Centre for Biomedical Network Research on Rare Diseases (CIBERER), 28029 Madrid, Spain
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2019, 16(8), 1388; https://doi.org/10.3390/ijerph16081388
Received: 14 March 2019 / Revised: 12 April 2019 / Accepted: 13 April 2019 / Published: 17 April 2019
(This article belongs to the Section Environmental Health)
The aim is to conduct a descriptive, population-based study in order to assess temporal and spatial changes in mortality due to granulomatosis with polyangiitis (GPA) in Spain from 1984 to 2016. Mortality data were obtained from the Spanish Annual Death Registry. Deaths in which GPA was the underlying cause were selected using the 446.4 and M31.3 codes from the International Classification of Diseases, 9th and 10th revision. Annual average age at death and age-adjusted mortality rates were calculated. Geographic analysis was performed at municipality and district level. Variations in mortality according to the type of municipality (urban, agro-urban or rural), district and geographic location (degrees of latitude) were assessed using standardized mortality ratios (SMRs) and smoothed-SMRs. Over the whole period, 620 deaths due to GPA were identified. Age at death increased at an average annual rate of 0.78% over the period 1987–2016 (p < 0.05). Age-adjusted mortality rates increased by an annual average of 20.58% from 1984 to 1992, after which they fell by 1.91% a year (p < 0.05). The agro-urban category had the highest percentage (4.57%) of municipalities with a significantly higher GPA mortality rate than expected. Geographic analysis revealed four districts with a higher risk of death due to GPA, two in the North of Spain and two in the South. This population-based study revealed an increase in the age at death attributed to GPA. Age-adjusted mortality rates went up sharply until 1992, after which they started to decline until the end of the study period. Geographic differences in mortality risk were identified but further studies will be necessary to ascertain the reasons for the distribution of GPA disease. View Full-Text
Keywords: mortality; Spain; granulomatosis with polyangiitis; geographic patterns; temporal trends; latitude; mapping; Wegener mortality; Spain; granulomatosis with polyangiitis; geographic patterns; temporal trends; latitude; mapping; Wegener
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Sánchez-Díaz, G.; Escobar, F.; Villaverde-Hueso, A.; Posada de la Paz, M.; Alonso-Ferreira, V. Temporal and Cartographic Analyses of the Distribution within Spain of Mortality Due to Granulomatosis with Polyangiitis (1984–2016). Int. J. Environ. Res. Public Health 2019, 16, 1388.

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