Talk:Population, human settlements and comorbidities

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The COVID-19 pandemic in Spain. First wave: from the first cases to the end of June 2020

Monographs from the National Atlas of Spain. New content


Thematic structure > The COVID-19 pandemic in Spain > Population, human settlements and comorbidities

This chapter focuses on some aspects that are present on a territory prior to the arrival of a disease and may favour or hinder the diffusion of the pandemic once the disease starts spreading, e.g. household overcrowding, healthy life years, age structure of the population, total amount of inhabitants per human settlement or the different types of human settlements. Population and human settlements are studied first in this chapter, whilst the text delves afterwards into a double-page devoted to comorbidities.

Map: Total population and population density. 2020. Spain. [ PDF]. [ Datos]. [ Versión interactiva].

There were 47,450,795 inhabitants in Spain as of 1 January 2020. This means an average population density of 93.6 inhabitants/km2. It is the fourth State within the European Union in terms of total population and ranks seventeenth in terms of population density. The spatial distribution of the population in Spain shows at first glance a sharp contrast between a denser periphery –together with the islands– and a more empty hinterland –with the only exceptions of Madrid, Saragossa (Zaragoza) and Valladolid– (see the map on Total population and population density).

A second relevant spatial contrast is the uneven ratio of the population living in rural municipalities to those living in urban municipalities. The threshold used for setting the difference between rural and urban municipalities is the one set out in the Rural Development Act from 2007 which considers rural municipalities to be those with less than 5,000 inhabitants (see the map on Rural population). There are 5,690,617 inhabitants living in 6,837 rural municipalities across the country. This means 12% of the total population and 84% of the total amount of municipalities. The spatial contrast is, however, in this case not as intense as in the spatial distribution of the population described before. It may be observed that there is less rural population in the hinterland than along the coast in absolute terms. Nevertheless, in relative terms, the percentage of rural population in relation to the total population of each province is higher in the hinterland than along the coast. Galicia stands out for its uniqueness in registering high figures in both absolute and relative terms. It shall be borne in mind, however, that the criterion used for considering the population rural or urban is merely quantitative or statistical, not qualitative or functional. Therefore, some municipalities have been considered rural even though most of the inhabitants may be in fact related to the industry or the service sector. This is the case in many municipalities in tourist areas and in peri-urban regions.

  • Map: Rural population. 2020. Spain. [ PDF]. [ Datos]. [ interactiva].
  • Map: Urban macrocephaly. 2020. Spain. [ PDF]. [ Datos]. Versiones interactivas []

Three noteworthy facts may be observed on the map on [[File:| Urban macrocephaly]]. In the first place, the coast from western Andalusia (Andalucía) to Catalonia (Catalunya/Cataluña) is well traced and a moderate dominance of major towns with a large amount of inhabitants is shown in this area. To a lesser extent, the Atlantic coast in Galicia, the northern coast, the Balearic Islands and the Canary Islands are also well outlined. In the hinterland, however, only Madrid, Valladolid and Saragossa (Zaragoza) stand out. Secondly, there is a sharp contrast between the Northern Plateau and the Southern Plateau as the presence of major towns with a larger amount of inhabitants is more significant in the former. Finally, it shall be noted that the weight of the municipality with most residents on the total population of each province is more significant in the northern half of the Spanish hinterland as well as in Madrid than in the rest of the country. It is also worthy of mention that the municipality with most residents within each province is the capital town of the province except for three cases out of fifty, i.e. Pontevedra, Asturias and Cádiz, where Vigo, Gijón/Xixón and Jerez de la Frontera are the largest towns in these provinces.

The maps showing human settlements throughout the Spanish territory seem to be very explanatory. At first glance, there is an outstanding number of human settlements in the Northwest in relation to the rest of the country (see the map on Human settlements). However, a more detailed analysis could conclude that certain differences may be observed in the rest of the country as the map on Density of human settlements, which shows a more detailed unit of anaysis as it moves from a provincial level to a municipal division, reveals areas with a significant density of human settlements such as the outskirts of the Metropolitan Area of Madrid, central and northern Catalonia (Catalunya/Cataluña), some areas in the Region of Valencia (Comunitat Valenciana), the southeast of the Region of Murcia (Región de Murcia), eastern Andalusia (Andalucía), the central area of the province of Salamanca as well as some of the Canary Islands (Canarias).

Besides, the maps showing the Population living in scattered villages (by province and by municipality), i.e. villages different to the capital town of the municipality, reveal a sharp contrast between the periphery [especially Galicia, western Asturias, the Basque Country (Euskadi/País Vasco), northwestern Navarre (Navarra), the district called Maestrazgo/Maestrat between the regions of Aragón and Valencia, as well as a long strip that goes from Alicante/Alacant to Cádiz], where more people live in scattered villages, and the Spanish hinterland, where lower figures are shown on both maps since more people live in the capital town of the municipality. In short, population distribution is more scattered along the coast, whether for geographical, historical or functional reasons. In the hinterland, by contrast, a greater concentration in terms of human settlements may be observed, yet certain differences shall be pointed out, i.e. human settlements are closer to each other although smaller in size in the Northern Plateau, whereas a smaller number of settlements that are more distant from each other and which have municipalities larger in size may be observed in the Southern Plateau.

Certain features of population distribution and human concentration have been described so far. Three further aspects are analysed in the following paragraphs, i.e. age structure, levels of household overcrowding and healthy life years.

  • Map: Population under 60 years of age. 2020. Spain. PDF. [ Datos]. [ Versión interactiva].
  • Map: Population from 60 to 85 years of age. 2020. Spain. PDF. Datos. Versión interactiva.
  • Map: Population over 85 years of age. 2020. Spain. PDF. [ Datos]. [ Versión interactiva].

Figures on the age structure of the population show a rather old population in Spain. The proportion of very old people, i.e. people over 85 years of age, on the total population in the country rises to 3.3%, what may be considered a very relevant figure. By contrast, the youngest age groups, i.e. children under 15, gather in total only 14.4% of the total population, what means that the age-sex pyramid is rather narrow at the bottom. A relevant spatial contrast may be observed throughout Spain on the maps depicting the age structure of the population by province. Age groups have been sorted in such a way as to allow disaggregation into the older categories. The map showing the proportion of people under 60 on the total amount of inhabitants reveals that this category rises to over 75% in southern, eastern and central Spain, whereas it drops to less than 65% in the Northwest. By contrast, maps showing the proportion of elderly people show the opposite picture as greater demographic ageing is registered in the Northwest than in the rest of the country.

  • The national average of households with five or more members out of the total amount of households lies by 5.7% (see the map on Households with 5 or more members). The provinces of Almería and Murcia stand out as their figures rise to around 9%, whilst on the other end of the scale some provinces on the Northern Plateau, next to the Portuguese border as well as Asturias fall to around 4%. Figures in the rest of the country are similar to the national average.

    The region is used as spatial unit of analysis on the map on Healthy life years. A double point of view is taken into account, i.e. healthy life years at birth and at the age of 65. In the first case, a graph shows the evolution from 2007 to 2018 with very contrasting profiles that do not allow deducing well-defined spatial behaviours. In the second case, however, a larger extension of healthy life at the age of 65 seems to be detected in the northern hinterland as well as in Galicia, the Basque Country (Euskadi/País Vasco) and the Balearic Islands (Illes Balears).


    • AUTORES.jpg

    Co-authorship of the text in Spanish: José Sancho Comíns y María Zúñiga Antón. See the list of members engaged



    Major comorbidities

    National and international studies have shown differences in the mortality and fatality of SARS-CoV-2 infected patients between territories. Part of these differences may be attributed to different levels of access to healthcare. In this regard, the Spanish National Health System is made up of the Regional Health Systems. There may be differences in the health service management and organisation from one region to another. However, all of them are based on the same principles, i.e. universal and free access.

    Another part of these differences is linked to risk factors or pathologies of the affected person (comorbidities), which determine the possible severity of the infection and, therefore, the need for healthcare resources. It shall always be borne in mind that advanced age and being male are the two main demographic factors linked to the severity and lethality of infection by this virus. However, the scientific community is unanimous in identifying the comorbidities included in this section as additional risk factors.

  • COPD
    Map: Reportered of COPD in the population over 15 years of age. 2017. Spain PDF. Data. Versión interactiva.

    Chronic Obstructive Pulmonary Disease (COPD) does not appear to be a predisposing factor for SARS-CoV-2 infection. However, once infection occurs and the disease develops, there is an increased risk of hospital admission, admission to intensive care unit (ICU) and death. Furthermore, the respiratory symptoms of COVID-19 may sometimes be confused with COPD exacerbations, which may delay diagnosis and affect the clinical course. The underlying pathophysiological mechanism would be an increased expression of ACE2 receptors (to which the virus binds to penetrate the cell) in the bronchial epithelium, amongst others.

    The SEMI-COVID-19 registry of the Spanish Society of Internal Medicine provides clinical data on patients from hospitals across the country, including a history of COPD in 7% of those patients.

    The map shows clear differences in reported prevalence between territories. Galicia, Asturias, Extremadura, Aragón and Castile and León (Castilla y León) stand out, with prevalences of around 5%, compared to regions such as the Balearic Islands (Illes Balears) and the Canary Islands (Canarias), with less than 3%. In relation to gender, it is interesting to note that the prevalence in women is higher or equal to that of men in some regions even though COPD is associated with smoking. There are two major limitations to the data shown. The first is that they are based on self-reported data, which may constitute a reporting bias. The second is that the data are not age- or sex-adjusted, so the differences shown in prevalence may be explained by a different population structure. COPD is an age-associated disease; the regions with the highest prevalence are those with a large elderly population.

  • HYPERTENSION
    Map: Reportered prevalence of hypertension in the population over 15 years. 2017. Spain. [ PDF]. [/ Data]. Versión interactiva.

    Hypertension is an important risk factor that has been discovered in 19% of patients with COVID-19 in Spain. The biological concept is based on its effect on the renin-angiotensin-aldosterone system and on angiotensin-converting enzyme 2 (ACE-2) overexpression.

    Two facts stand out in the data shown: on the one hand, the reported prevalence shows figures of 20-25% in all regions, except for the Balearic Islands (Illes Balears) that registers around 10%; on the other hand, the similarity of figures between men and women, except in the cases of Navarre (Navarra) and Melilla. However, the interpretation of the data has the same limitations as in the case of COPD.

    This risk factor is associated with greater severity. However, according to different studies, its influence does not seem to be as clear as that of COPD, cardiovascular diseases or diabetes.

  • OBESITY
    Map: Prevalence of obesity in the population over 18 years of age. 2017. Spain. [ PDF]. [/ Data]. Versión interactiva.

    Obesity is considered the epidemic of the 21st century, as its numbers are increasing in the adult population and, what is more worrying, in children. Being overweight/obese has been identified in numerous studies as a predictor of hospital admission and admission to the ICU, especially in patients under 65 years of age. The SEMI-COVID-19 registry shows its presence in 21% of patients.

    The increased risk in these patients has been attributed to a higher level of pro-inflammatory cytokines (aggravating hyperinflammatory processes) and to baseline lung volume changes due to mechanical factors.

    There is considerable variability in the prevalence of obesity, with some regions close to 20% and others to 15%. Even more important is the difference between sexes, both between regions and within the same region. It is important to note that there may be a certain geographical pattern according to the wealth of the territory: regions with lower obesity prevalence rates are those with higher Gross Domestic Product. There is a reason for this, as obesity is clearly linked to socio-economic variables.

    In this case, the reporting bias is reduced –not fully eliminated– as the survey methodology specifies a limit for considering obesity or not. However, it is impossible to determine geographical patterns that imply statistically significant differences if no adjustment for age and sex is carried out.

  • DIABETES
    Map: Reportered prevalence of diabetes in the population over 15 years. 2017. Spain. [ PDF]. [ Data]. Versión interactiva.

    This risk factor has been identified in 17% of the cases reported (8.9% of hospital admissions in Spain). It is clearly a higher risk factor for hospital admission, admission to the ICU and death. The biological mechanism on which this risk factor is based is that described for hypertension.

    The prevalence of reported diabetes also shows important geographical differences, with regions registering a prevalence of around 5%, such as the Balearic Islands (Illes Balears), La Rioja and Cantabria, and others around 10%, such as Galicia and Extremadura. The difference between men and women may also be significant (see the Basque Country [Euskadi/País Vasco]).

    Type II diabetes is basically a chronic age-associated pathology that could lie behind differences in mortality or lethality from COVID-19 between regions. However, as already mentioned in the comment on other variables, nothing can be inferred from the unadjusted data, which are subject to possible reporting biases.

  • HEART FAILURE
    Map: Reportered prevalence of hypertension in the population over 15 years. 2017. Spain. [ PDF]. [/ Data]. Versión interactiva.

    Heart failure has been described, either under this term or as a cardiovascular disease, as the most prevalent risk factor in the population diagnosed with COVID-19 (up to 30%) and is present in more than 50% of COVID-19 patients admitted to the ICU in Spain, according to several studies. Its mechanism of action is the same as for diabetes and hypertension.

    There are two clear patterns: one geographical and the other by sex. Castile and León (Castilla y León) and the Region of Valencia (Comunitat Valenciana) show a very high prevalence, around 14%. The data for Extremadura and Castile-La Mancha (Castilla-La Mancha) warrant a separate reading, with prevalences that are 30% lower than those in the regions with higher prevalence.

    Heart failure is more prevalent in women. However, as this figure is not adjusted by sex, it may be influenced by the higher life expectancy of women, since heart failure is more prevalent with age.

    The primary healthcare model in Spain, based on the primary care team that covers the care of the population in a healthcare area, is the same in all regions and its information system has been consolidated for years. Significant geographical differences in prevalence may certainly be explained in part by differences in population structure; but it is very likely that there are other additional factors, e.g. lifestyle and those linked to the follow-up care of the population.

  • CHRONIC KIDNEY DISEASE
    Map: Reportered prevalence of hypertension in the population over 15 years. 2017. Spain. [ PDF]. [/ Data]. Versión interactiva.

    Chronic Kidney Disease (CKD) is included in the range of comorbidities that are associated with worse COVID-19 outcomes. Kidneys have ACE-2 receptors and are primarily involved in the renin-angiotensin-aldosterone system that regulates blood pressure. These are usually patients with added comorbidities, such as diabetes and hypertension, who have a weakened immune system. Although studies linking CKD and COVID-19 are limited, increased mortality has been observed in these patients, especially in advanced stages of CKD. Other researches have not found an increased admission to the ICU of CKD patients infected by SARS-CoV-2. The regions of Catalonia (Catalunya/Cataluña), Valencia, Murcia, the Canary Islands (Canarias) and the town of Ceuta have higher adjusted rates than the other regions. Conversely, the lowest rates are recorded in Cantabria and Castile and León (Castilla y León). When rates are analysed by sex, men are clearly seen to have higher rates than women in all regions, except in the Balearic Islands (Illes Balears), Ceuta and Melilla, being almost twice as high in several regions. The Spanish Registry of Kidney Diseases was founded in 2006 as a result of merging the data provided by all regional registries. These consolidated data show a real difference in the prevalence of this pathology.

  • HIV-AIDS
    Map: Reportered prevalence of hypertension in the population over 15 years. 2017. Spain. [ PDF]. [/ Data]. Versión interactiva.

    HIV infection and AIDS diagnosis is not usually listed as a risk factor in most studies as such; immunodeficiency is. However, this term is very broad and difficult to define. So a pathology like VIH-AIDS, with a well-established information system and a clear impact on the immune system, especially cell-mediated immunity, was opted for in this study. How the vulnerability of an immunocompromised patient fits in with immune hyperactivation is not fully understood. There is no strong evidence to support an increased risk in immunocompromised patients. In the case of HIV/AIDS, studies suggest not so much an association with increased susceptibility to infection, but some association with rising fatalities. In the SEMI-COVID-19 registry, COVID-19 cases with HIV infection represent 0.7%. It is not possible to draw conclusions on its possible implication for the clinical severity of COVID-19 with such a low number of cases. HIV/AIDS prevalence in Spain is low in general, yet it shows significant differences between regions. It mainly affects males. There is an increasing number of cases in the Balearic Islands (Illes Baleares), the Canary Islands (Canarias) and the Region of Valencia (Comunitat Valenciana) that are linked to tourism, which could be a reason for relaxing protection/prevention measures. The Region of Madrid (Comunidad de Madrid) also follows this pattern of prevalence. On the other hand, Catalonia (Catalunya/Cataluña) shows a very low prevalence even though it is also a region where tourism plays an important role. Although the data are unadjusted for age and sex, it is very likely that these differences between regions are real, as the age group of people affected is more limited (young, young adults and adults) and the demographic differences between regions are somewhat smaller in these age groups than in the case of the elderly.


    • EPOC

    left|thumb|300px|Mapa: Prevalencia declarada de EPOC en la población mayor de 15 años. 2017. España. [//centrodedescargas.cnig.es/CentroDescargas/busquedaRedirigida.do?ruta=PUBLICACION_CNIG_DATOS_VARIOS/aneTematico/Espana_Prevalencia-declarada-de-EPOC-en-la-poblacion-mayor-de-15-anos_2017_mapa_17860_spa.pdf PDF]. [//centrodedescargas.cnig.es/CentroDescargas/busquedaRedirigida.do?ruta=PUBLICACION_CNIG_DATOS_VARIOS/aneTematico/Espana_Prevalencia-declarada-de-EPOC-en-la-poblacion-mayor-de-15-anos_2017_mapa_17860_spa.zip Datos]. [//interactivo-atlasnacional.ign.es/index.php#c=indicator&i=r_121_t.r_121_t&s=Total&t=A02&view=map10 Versión interactiva. ] La enfermedad pulmonar obstructiva crónica (EPOC) no parece ser un factor predisponente a la infección por SARS-CoV-2, pero una vez que se desarrolla la enfermedad, se tiene un mayor riesgo de hospitalización, ingreso en unidades de cuidados intensivos (UCI) y letalidad. Por otro lado, la clínica respiratoria de la COVID puede en ocasiones confundirse con exacerbaciones de la EPOC, lo que podría retrasar el diagnóstico y condicionar la evolución clínica. El mecanismo fisiopatológico subyacente sería un incremento de expresión de los receptores ACE2 (al que se une el virus para penetrar en la célula) en el epitelio bronquial entre otros.

    En el registro SEMI-COVID-19 de la Sociedad Española de Medicina Interna en el que se recogen las características clínicas de los pacientes procedentes de datos de hospitales de todo el país, el antecedente de EPOC se encuentra en el 7% de los pacientes.

    En el mapa se observan claras diferencias en la prevalencia declarada entre territorios, destacando Galicia, Asturias, Extremadura, Aragón o Castilla y León con prevalencias en torno a un 5%; frente a territorios como Illes Balears o Canarias que no alcanzan el 3%. En relación al sexo, llama la atención que la prevalencia en mujeres en algunas comunidades sea superior o igual a la de los hombres cuando es una patología asociada al hábito tabáquico.

    Hay dos grandes limitaciones en los datos mostrados. La primera es que se basa en datos declarados por el usuario que pueden condicionar un sesgo de información. La segunda, que no son datos ajustados por edad y sexo, por lo que las diferencias mostradas en prevalencia pueden explicarse por una estructura de población diferente. La EPOC es una enfermedad asociada a la edad y las comunidades autónomas de mayor prevalencia son todas ellas comunidades con un peso significativo de la población envejecida.


    HIPERTENSIÓN ARTERIAL
    File:Espana Prevalencia-declarada-de-hipertension-arterial-en-la-poblacion-mayor-de-15-anos 2017 mapa 17862 spa.jpg
    Mapa: Prevalencia declarada de hipertensión arterial en la población mayor de 15 años. 2017. España. PDF. Datos. Versión interactiva.
    La hipertensión arterial es un factor de riesgo importante que se ha descrito en el 19% de los pacientes con COVID en España. El fundamento biológico se basa en su efecto sobre el sistema renina-angiotensina-aldosterona y sobre la enzima convertidora de angiotensina 2 (ECA-2) por sobrexpresión.

    En los datos mostrados destacan dos hechos: por un lado, las prevalencias declaradas están entre valores del 20-25% en prácticamente todas las comunidades autónomas, siendo Illes Balears la excepción con valores entorno al 10% (la ciudad autónoma de Melilla tiene otra lectura); por otro lado, la semejanza de valores entre hombres y mujeres salvo en los casos de la Comunidad Foral de Navarra y la ciudad autónoma de Melilla. Sin embargo, la interpretación de los datos presenta las mismas limitaciones comentadas en el caso de la EPOC.

    Aunque este factor de riesgo está asociado a una mayor severidad, según diferentes estudios su peso no parece ser tan alto como la EPOC, las enfermedades cardiovasculares o la diabetes. No obstante, su alta prevalencia en la población supone un amplio margen de mejora para el sistema sanitario.


    OBESIDAD
    File:Espana Prevalencia-de-obesidad-en-la-poblacion-mayor-de-18-anos 2017 mapa 17861 spa.jpg
    Mapa: Prevalencia de obesidad en la población mayor de 18 años. 2017. España. PDF. Datos. Versión interactiva.
    La obesidad es considerada la epidemia del siglo XXI, ya que sus cifras están aumentando en la población adulta y, lo que es más preocupante, en la población infantil. El sobrepeso/obesidad se ha identificado en numerosos estudios como un factor predictor de hospitalización y de ingreso en UCI, especialmente en los pacientes por debajo de los 65 años. En el registro SEMI-COVID-19 está presente en el 21% de los pacientes.

    El riesgo aumentado de estos pacientes se ha atribuido a un nivel mayor de citoquinas pro-inflamatorias (agravarían los procesos de hiperinflamación) y a su alteración basal de los volúmenes respiratorios por factores mecánicos.

    Hay bastante variabilidad en la prevalencia de obesidad (comunidades próximas al 20% y otras del 15%). Más importante es aún la diferencia entre sexos, tanto entre comunidades autónomas como en la misma autonomía. Es importante señalar que, puede haber cierto patrón geográfico condicionado a la riqueza del territorio: las comunidades autónomas con prevalencias de obesidad más bajas se corresponden con las de mayor producto interior bruto. Tiene su razón de ser, ya que la obesidad tiene una vinculación clara con variables socioeconómicas.

    En este caso, el sesgo de información se reduce –no se elimina-, ya que se concreta en la metodología de la encuesta un valor para considerar o no la obesidad. Sin embargo, sin el ajuste por edad y sexo es imposible establecer un patrón geográfico que implique diferencias con valor estadístico.


    DIABETES
    File:Espana Prevalencia-declarada-de-diabetes-en-la-poblacion-mayor-de-15-anos 2017 mapa 17863 spa.jpg
    Mapa: Prevalencia declarada de diabetes en la población mayor de 15 años. 2017. España. PDF. Datos.Versión interactiva.
    Este factor de riesgo se ha identificado en el 17% de los casos declarados (8,9% de los hospitalizados en España). Es claramente un factor de mayor riesgo de hospitalización, ingreso en UCI y fallecimiento. El mecanismo biológico por el que actuaría este factor de riesgo es el descrito en la hipertensión arterial.

    Al igual que la obesidad, la prevalencia de diabetes declarada muestra diferencias geográficas importantes con comunidades con prevalencias entorno al 5% (Illes Balears, La Rioja o Cantabria) y otras en torno al 10% (Galicia y Extremadura). La diferencia entre hombres y mujeres puede ser importante (véase el País Vasco).

    La diabetes tipo II es fundamentalmente una patología crónica asociada a la edad que podría subyacer a diferencias en la mortalidad o letalidad por COVID entre comunidades autónomas. No obstante, como ya se ha mencionado en el comentario de otras variables, no se puede inferir nada al tratarse de unos datos sin ajustar y condicionados a posibles sesgos de información.


    INSUFICIENCIA CARDIACA
    File:Espana Prevalencia-de-la-insuficiencia-cardiaca 2017 mapa 17868 spa.jpg
    Mapa: Prevalencia de la insuficiencia cardiaca. 2017. España. PDF. Datos. Versiones interactivas 1 2 3.
    La insuficiencia cardiaca se ha descrito, bien bajo este término, bien como enfermedad cardiovascular, como el factor de riesgo más prevalente en la población diagnosticada de COVID-19 (hasta en un 30%) y está presente en más del 50% de los pacientes COVID con ingreso en UCI en nuestro país, según diversos estudios. Su mecanismo de acción sería el mismo que para la diabetes e hipertensión arterial.

    Hay dos patrones claros: uno geográfico y otro por sexo. Castilla y León y la Comunitat Valenciana muestran una prevalencia muy alta, esta última de más del 14%; en un nivel intermedio se sitúan las comunidades con prevalencias intermedias, en torno al 12%; y las comunidades con prevalencias más bajas, están en torno al 8%. Lectura independiente merece los datos de prevalencia de Extremadura y Castilla-La Mancha con prevalencias que son inferiores en un 30% a las que ostentan las comunidades con mayor prevalencia.

    La insuficiencia cardiaca es más prevalente en mujeres, pero este dato, al no estar ajustado por sexo, puede estar condicionado por la mayor esperanza de vida de las mujeres; esta patología es más prevalente con la edad.

    En nuestro país, el modelo de atención en primaria, basado en el equipo de atención primaria que abarca la atención de la población de una zona de salud, es el mismo en las comunidades autónomas y su sistema de información está consolidado desde hace años. Las significativas diferencias geográficas en la prevalencia es seguro que se explican en parte por las diferencias en la estructura de población; pero es muy probable que haya otros factores tanto de hábitos de vida como vinculados a la atención y seguimiento de la población.


    INSUFICIENCA RENAL CRÓNICA

    left|thumb|300px|Mapa: Prevalencia de la insuficiencia renal crónica. 2019. España. [//centrodedescargas.cnig.es/CentroDescargas/busquedaRedirigida.do?ruta=PUBLICACION_CNIG_DATOS_VARIOS/aneTematico/Espana_Prevalencia-de-la-insuficiencia-renal-cronica_2019_mapa_18373_spa.pdf PDF]. [//centrodedescargas.cnig.es/CentroDescargas/busquedaRedirigida.do?ruta=PUBLICACION_CNIG_DATOS_VARIOS/aneTematico/Espana_Prevalencia-de-la-insuficiencia-renal-cronica_2019_mapa_18373_spa.zip Datos]. [//interactivo-atlasnacional.ign.es/index.php#c=indicator&i=r_125_t.r_125_t&s=Total&t=A02&view=map10 Versión interactiva. ]La insuficiencia renal crónica (IRC) se incluye dentro del abanico de comorbilidades que se relacionan con una peor evolución de la COVID-19. Este órgano tiene receptores para ECA-2 y es el principal implicado en el sistema renina-angiotensina-aldosterona que regula, entre otros, la presión arterial. Además, su sistema inmune está debilitado y suelen ser pacientes con comorbilidades añadidas como diabetes e hipertensión.

    Aunque los estudios que relacionan la IRC y COVID son limitados, se ha observado una mayor mortalidad en estos pacientes, más manifiesta esta relación en los estadios avanzados de la IRC. Otros análisis no han encontrado un mayor ingreso en UCI de los pacientes con IRC infectados por el SARS-CoV-2.

    Las comunidades autónomas de Cataluña, Comunitat Valencia, Región de Murcia y Canarias tienen tasas ajustadas superiores al resto de comunidades, así como la ciudad autónoma de Ceuta. En el polo opuesto, con las tasas más bajas, están Cantabria y Castilla y León. Cuando se analizan las tasas por sexo se observa que los hombres tienen tasas claramente superiores a las mujeres en todas las comunidades (salvo Illes Balears, Ceuta y Melilla); siendo prácticamente el doble en bastantes comunidades autónomas.

    El Registro Español de Enfermos Renales fue creado en el 2006, fruto de la integración de los datos aportados por los registros de las comunidades autónomas y las dos ciudades autónomas. Son, por lo tanto, datos consolidados que evidencian una diferencia real en la prevalencia de esta patología.


    VIH-SIDA

    left|thumb|300px|Mapa: Prevalencia del VIH y SIDA. 2017. España. [//centrodedescargas.cnig.es/CentroDescargas/busquedaRedirigida.do?ruta=PUBLICACION_CNIG_DATOS_VARIOS/aneTematico/Espana_Prevalencia-del-VIH-y-SIDA_2017_mapa_17869_spa.pdf PDF]. [//centrodedescargas.cnig.es/CentroDescargas/busquedaRedirigida.do?ruta=PUBLICACION_CNIG_DATOS_VARIOS/aneTematico/Espana_Prevalencia-del-VIH-y-SIDA_2017_mapa_17869_spa.zip Datos]. Versiones interactivas [//interactivo-atlasnacional.ign.es/index.php#c=indicator&i=c12548.c12548&t=A02&view=map10 1] [//interactivo-atlasnacional.ign.es/index.php#c=indicator&i=c12549.c12549&t=A02&view=map10 2] [//interactivo-atlasnacional.ign.es/index.php#c=indicator&i=c12550.c12550&t=A02&view=map10 3].La infección por VIH o el diagnóstico de SIDA no suele recogerse entre los factores de riesgo en la mayoría de los estudios como tal; sí la inmunodeficiencia. Sin embargo, este término es muy amplio y difícil de definir por lo que se ha optado por la inclusión de una patología con un sistema de información bien establecido y que tiene un impacto claro en el sistema inmunitario, especialmente en la inmunidad celular.

    No se conoce bien cómo encaja la vulnerabilidad de un paciente inmunodeprimido con la hiperactivación inmune. No existe evidencia sólida que sustente un mayor riesgo en pacientes inmunodeprimidos. En el caso del VIH/SIDA, hay estudios que sugieren no tanto su asociación con un incremento de la susceptibilidad a la infección, pero sí cierta asociación con una mayor letalidad. En el registro SEMI-COVID-19 los casos COVID-19 con infección por VIH han representado el 0,7%. Con un número tan bajo de casos afectados no es posible sacar conclusiones de su posible implicación en la gravedad clínica de la COVID-19.

    Las prevalencias de VIH/SIDA en España son bajas en general, pero con diferencias sustanciales entre comunidades autónomas. Afecta fundamentalmente a varones, resulta llamativo el caso de Illes Balears, Canarias y Comunitat Valenciana, comunidades vinculadas al turismo de playa que podría condicionar la relajación en las medidas de protección/prevención. Madrid también sigue este patrón de prevalencia. Por el contrario, Cataluña, una comunidad con mucho turismo presenta unas prevalencias muy bajas.

    Aunque los datos están sin ajustar por edad y sexo, es muy probable que esas diferencias entre comunidades autónomas sean reales, ya que el colectivo de edad está más acotado (jóvenes, adultos-jóvenes y adultos) y las diferencias demográficas entre comunidades es algo menor que en el caso de los ancianos.

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    Co-authorship of the text in Spanish: María José Amorín Calzada. See the list of members engaged


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    Bibliography



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    You can download the complete publication The COVID-19 pandemic in Spain. First wave: from the first cases to the end of June 2020 in Libros Digitales del ANE site.

    Categoría:La pandemia COVID-19 en España

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