No Evidence of Morbidity Compression in Spain a Time Series Study Based on National

No evidence of morbidity compression in Spain – a time series study based on national hospitalization records.

Stefan Walter, Hiram Beltrán-Sánchez, Enrique Regidor, Carlos Gomez-Martin, Jose Luis del Barrio, Angel Gil de Miguel, Subu V Subramanian, Ruth Gil Prieto

corresponding author:

Stefan Walter

Dept. of Epidemiology and Biostatistics

University of California San Francisco

Email:

Table of Contents

Online Resource 1 Rates of hospitalization incidence (per 100,000) for major chronic disease stratified by gender and period standardized to the European Standard Population from 1976, Spain 1997-2000 and 2007-2010.

Online Resource 2 Age- and sex-specific hospitalization incidence (per 100,000) for ICD-9 410: Myocardial Infarction, Spain 1997-2000 and 2007-2010.

Online Resource 3 Age- and sex-specific hospitalization incidence (per 100,000) for ICD-9 418: Heart Failure, Spain 1997-2000 and 2007-2010.

Online Resource 4 Age- and sex-specific hospitalization incidence (per 100,000) for ICD-9 430-438: Cerebrovascular Disease, Spain 1997-2000 and 2007-2010.

Online Resource 5 Age- and sex-specific hospitalization incidence (per 100,000) for ICD-9 188: Bladder Cancer, Spain 1997-2000 and 2007-2010.

Online Resource 6 Age- and sex-specific hospitalization incidence (per 100,000) for ICD-9 185: Prostate Cancer, Spain 1997-2000 and 2007-2010.

Online Resource 7 Age- and sex-specific hospitalization incidence (per 100,000) for ICD-9 174-175: Breast Cancer, Spain 1997-2000 and 2007-2010.

Online Resource 8 Age- and sex-specific hospitalization incidence (per 100,000) for ICD-9 162: Lung Cancer, Spain 1997-2000 and 2007-2010.

Online Resource 9 Age- and sex-specific hospitalization incidence (per 100,000) for ICD-9 153: Colon Cancer, Spain 1997-2000 and 2007-2010.

Online Resource 10 Population of Spain used for Incidence Rates and Calculations

Online Resource 11 European Standard Population 1976

Online Resource 1 Rates of hospitalization incidence (per 100,000) for major chronic disease stratified by gender and period standardized to the European Standard Population from 1976, Spain 1997-2000 and 2007-2010.

1997 - 2000 / 2007-2010
Rate* / 95%-CI** / Rate* / 95%-CI**
Men
CVD
MyocardialInfarction / 340.66 / (338.33, 343.00) / 360.80 / (358.62, 362.99)
HeartFailure / 262.16 / (260.21, 264.13) / 316.53 / (314.63, 318.44)
Cerebrovascular Disease / 524.55 / (521.74, 527.38) / 515.76 / (513.24, 518.29)
CANCER
BladderCancer / 161.44 / (159.87, 163.01) / 202.31 / (200.71, 203.91)
Prostate Cancer / 97.70 / (96.49, 98.92) / 155.39 / (153.93, 156.85)
Breast Cancer / -- / -- / -- / --
Lung Cancer / 215.66 / (213.81, 217.52) / 206.93 / (205.28, 208.59)
Colon Cancer / 84.73 / (83.61, 85.87) / 121.61 / (120.39, 122.85)
Women
CVD
Myocardial Infarction / 105.22 / (104.12, 106.33) / 114.40 / (113.40, 115,48)
Heart Failure / 204.03 / (202.59, 205.47) / 238.48 / (237.10, 239.86)
Cerebrovascular Disease / 321.35 / (319.45, 323.25) / 308.49 / (306.78, 310.20)
CANCER
Bladder Cancer / 18.51 / (18.04, 19.00) / 26.31 / (25.78, 26.85)
Prostate Cancer / -- / -- / -- / --
Breast Cancer / 158.31 / (156.75, 159.88) / 175.60 / (174.45, 177.48)
Lung Cancer / 16.63 / (16.16, 17.12) / 30.18 / (29.56, 30.81)
Colon Cancer / 64.73 / (63.8, 65.67) / 84.18 / (83.21, 85.16)

*Rate – Incidence Rate of First Hospitalization per 100.000 Inhabitants
** 95%-CI – 95% Confidence Interval

Online Resource 2 Age- and sex-specific hospitalization incidence (per 100,000) for ICD-9 410: Myocardial Infarction, Spain 1997-2000 and 2007-2010.

MALES / FEMALES
Time Period / Group of Age / IR / LL / UL / IR / LL / UL
1997-2000 / 50-54 / 201.78 / 197.7 / 205.86 / 22.71 / 21.36 / 24.06
55-59 / 258.99 / 253.91 / 264.08 / 42.52 / 40.5 / 44.54
60-64 / 346.57 / 340.73 / 352.4 / 77.33 / 74.7 / 79.96
65-69 / 418.46 / 412.01 / 424.91 / 128.54 / 125.2 / 131.89
70-74 / 494.12 / 486.28 / 501.96 / 197.54 / 193.11 / 201.97
75-79 / 531.28 / 521.4 / 541.15 / 271.1 / 265.26 / 276.95
80-84 / 544.08 / 530.57 / 557.59 / 317.45 / 309.79 / 325.11
85+ / 416.9 / 403.27 / 430.53 / 284.17 / 276.59 / 291.76
2007-2010 / 50-54 / 231.34 / 227.43 / 235.25 / 35.54 / 34.01 / 37.06
55-59 / 295.44 / 290.71 / 300.17 / 52.97 / 51 / 54.95
60-64 / 340.44 / 335.13 / 345.76 / 75.38 / 72.96 / 77.8
65-69 / 390.37 / 383.99 / 396.76 / 121.39 / 118.01 / 124.78
70-74 / 489.72 / 482.33 / 497.11 / 195.34 / 191.09 / 199.6
75-79 / 569.49 / 560.84 / 578.13 / 279.32 / 274.09 / 284.55
80-84 / 640.98 / 629.49 / 652.48 / 362.06 / 355.22 / 368.91
85+ / 558.34 / 544.95 / 571.73 / 381.9 / 374.48 / 389.33

ICD-9= International Codification of Diseases, IR = Incidence Rate, 95%CILOWER= 95% Confidence Interval lower bound, 95% CIUPPER= 95% Confidence Interval upper bound.

Online Resource 3 Age- and sex-specific hospitalization incidence (per 100,000) for ICD-9 418: Heart Failure, Spain 1997-2000 and 2007-2010.

MALES / FEMALES
Time Period / Group of Age / IR / LL / UL / IR / LL / UL
1997-2000 / 50-54 / 57.86 / 55.68 / 60.05 / 25.13 / 23.7 / 26.55
55-59 / 95.79 / 92.7 / 98.89 / 49.02 / 46.85 / 51.18
60-64 / 173.73 / 169.6 / 177.86 / 103.82 / 100.77 / 106.87
65-69 / 274.47 / 269.24 / 279.69 / 188.41 / 184.36 / 192.45
70-74 / 443.24 / 435.81 / 450.67 / 334.64 / 328.88 / 340.41
75-79 / 663.49 / 652.45 / 674.52 / 561.93 / 553.52 / 570.35
80-84 / 931.41 / 913.74 / 949.09 / 920.72 / 907.68 / 933.76
85+ / 1068.29 / 1046.5 / 1090.1 / 1125.53 / 1110.44 / 1140.62
2007-2010 / 50-54 / 58.44 / 56.48 / 60.41 / 24.09 / 22.83 / 25.34
55-59 / 103.15 / 100.36 / 105.94 / 43.91 / 42.11 / 45.7
60-64 / 164.62 / 160.92 / 168.31 / 82.8 / 80.27 / 85.34
65-69 / 281.04 / 275.62 / 286.46 / 174.68 / 170.62 / 178.74
70-74 / 510.61 / 503.06 / 518.16 / 378.59 / 372.67 / 384.51
75-79 / 828.7 / 818.28 / 839.13 / 683.16 / 674.98 / 691.34
80-84 / 1288.14 / 1271.8 / 1304.4 / 1154.12 / 1141.9 / 1166.34
85+ / 1726.85 / 1703.3 / 1750.4 / 1714.86 / 1699.12 / 1730.6

ICD-9= International Codification of Diseases, IR = Incidence Rate, 95%CILOWER= 95% Confidence Interval lower bound, 95% CIUPPER= 95% Confidence Interval upper bound

Online Resource 4 Age- and sex-specific hospitalization incidence (per 100,000) for ICD-9 430-438: Cerebrovascular Disease, Spain 1997-2000 and 2007-2010.

MALES / FEMALES
Time Period / Group of Age / IR / LL / UL / IR / LL / UL
1997-2000 / 50-54 / 181.28 / 177.42 / 185.15 / 77.47 / 74.98 / 79.97
55-59 / 280.17 / 274.88 / 285.46 / 121.96 / 118.55 / 125.38
60-64 / 453.61 / 446.94 / 460.29 / 210.48 / 206.14 / 214.82
65-69 / 641.64 / 633.65 / 649.63 / 343.73 / 338.26 / 349.19
70-74 / 896.76 / 886.19 / 907.32 / 561.17 / 553.7 / 568.64
75-79 / 1136.3 / 1121.9 / 1150.8 / 855.52 / 845.14 / 865.91
80-84 / 1320.75 / 1299.7 / 1341.8 / 1144.42 / 1129.88 / 1158.96
85+ / 1143.71 / 1121.1 / 1166.3 / 1078.65 / 1063.88 / 1093.43
2007-2010 / 50-54 / 180.08 / 176.64 / 183.53 / 83.31 / 80.97 / 85.64
55-59 / 276.97 / 272.39 / 281.55 / 117.73 / 114.79 / 120.67
60-64 / 400.32 / 394.55 / 406.08 / 178.65 / 174.93 / 182.38
65-69 / 585.26 / 577.44 / 593.08 / 298.53 / 293.22 / 303.83
70-74 / 865.05 / 855.22 / 874.88 / 512.17 / 505.28 / 519.05
75-79 / 1146.69 / 1134.4 / 1159 / 796.02 / 787.19 / 804.85
80-84 / 1380.79 / 1363.9 / 1397.7 / 1123.63 / 1111.57 / 1135.69
85+ / 1422.73 / 1401.4 / 1444.1 / 1317.05 / 1303.26 / 1330.85

ICD-9= International Codification of Diseases, IR = Incidence Rate, 95%CILOWER= 95% Confidence Interval lower bound, 95% CIUPPER= 95% Confidence Interval upper bound

Online Resource 5 Age- and sex-specific hospitalization incidence (per 100,000) for ICD-9 188: Bladder Cancer, Spain 1997-2000 and 2007-2010.

MALES / FEMALES
Time Period / Group of Age / IR / LL / UL / IR / LL / UL
1997-2000 / 50-54 / 58.9 / 56.69 / 61.1 / 6.05 / 5.35 / 6.74
55-59 / 90.04 / 87.04 / 93.04 / 8.49 / 7.59 / 9.39
60-64 / 150.6 / 146.75 / 154.45 / 14.93 / 13.78 / 16.09
65-69 / 213.78 / 209.16 / 218.39 / 21.57 / 20.21 / 22.94
70-74 / 292.25 / 286.22 / 298.29 / 33.65 / 31.82 / 35.48
75-79 / 333.34 / 325.52 / 341.17 / 41.85 / 39.55 / 44.14
80-84 / 341.43 / 330.73 / 352.12 / 52.88 / 49.76 / 56.01
85+ / 236.12 / 225.86 / 246.38 / 45.09 / 42.07 / 48.11
2007-2010 / 50-54 / 67.22 / 65.12 / 69.33 / 13 / 12.08 / 13.92
55-59 / 120.87 / 117.84 / 123.89 / 15.16 / 14.1 / 16.21
60-64 / 189.03 / 185.07 / 192.99 / 19.7 / 18.46 / 20.94
65-69 / 256.44 / 251.26 / 261.62 / 29.82 / 28.14 / 31.5
70-74 / 354.35 / 348.06 / 360.64 / 40.5 / 38.56 / 42.44
75-79 / 411.35 / 404 / 418.69 / 57.09 / 54.73 / 59.46
80-84 / 450.89 / 441.25 / 460.53 / 68.81 / 65.82 / 71.79
85+ / 363.65 / 352.84 / 374.45 / 58.88 / 55.97 / 61.8

ICD-9= International Codification of Diseases, IR = Incidence Rate, 95%CILOWER= 95% Confidence Interval lower bound, 95% CIUPPER= 95% Confidence Interval upper bound

Online Resource 6 Age- and sex-specific hospitalization incidence (per 100,000) for ICD-9 185: Prostate Cancer, Spain 1997-2000 and 2007-2010.

MALES / FEMALES
Time Period / Group of Age / IR / LL / UL / IR / LL / UL
1997-2000 / 50-54 / 19.21 / 17.95 / 20.47
55-59 / 49.04 / 46.83 / 51.26
60-64 / 108.5 / 105.24 / 111.77
65-69 / 163.24 / 159.21 / 167.27
70-74 / 165.9 / 161.35 / 170.44
75-79 / 180.49 / 174.73 / 186.24
80-84 / 196.11 / 188 / 204.22
85+ / 154.2 / 145.91 / 162.5
2007-2010 / 50-54 / 46.36 / 44.61 / 48.11
55-59 / 126.21 / 123.12 / 129.3
60-64 / 224.03 / 219.72 / 228.34
65-69 / 286.18 / 280.71 / 291.65
70-74 / 207.54 / 202.73 / 212.35
75-79 / 140.62 / 136.33 / 144.92
80-84 / 133.86 / 128.61 / 139.11
85+ / 121.8 / 115.55 / 128.05

ICD-9= International Codification of Diseases, IR = Incidence Rate, 95%CILOWER= 95% Confidence Interval lower bound, 95% CIUPPER= 95% Confidence Interval upper bound

Online Resource 7 Age- and sex-specific hospitalization incidence (per 100,000) for ICD-9 174-175: Breast Cancer, Spain 1997-2000 and 2007-2010.

MALES / FEMALES
Time Period / Group of Age / IR / LL / UL / IR / LL / UL
1997-2000 / 50-54 / 0.43 / 0.24 / 0.62 / 148.59 / 145.13 / 152.05
55-59 / 0.86 / 0.57 / 1.15 / 166.03 / 162.04 / 170.01
60-64 / 1.2 / 0.86 / 1.54 / 182.41 / 178.36 / 186.45
65-69 / 1.76 / 1.34 / 2.18 / 161.29 / 157.55 / 165.03
70-74 / 2.43 / 1.88 / 2.98 / 164 / 159.96 / 168.03
75-79 / 2.72 / 2.02 / 3.43 / 153.31 / 148.91 / 157.71
80-84 / 1.66 / 0.91 / 2.4 / 122.93 / 118.17 / 127.7
85+ / 1.62 / 0.77 / 2.48 / 76.01 / 72.09 / 79.93
2007-2010 / 50-54 / 0.81 / 0.58 / 1.04 / 165.36 / 162.07 / 168.64
55-59 / 1.06 / 0.78 / 1.35 / 177 / 173.4 / 180.6
60-64 / 2.05 / 1.64 / 2.47 / 196.31 / 192.4 / 200.22
65-69 / 2.45 / 1.94 / 2.95 / 193.87 / 189.6 / 198.15
70-74 / 2.7 / 2.15 / 3.25 / 174.56 / 170.54 / 178.58
75-79 / 3.59 / 2.9 / 4.27 / 182.85 / 178.61 / 187.08
80-84 / 3.54 / 2.69 / 4.4 / 151.9 / 147.47 / 156.34
85+ / 3.26 / 2.24 / 4.28 / 85.01 / 81.51 / 88.52

ICD-9= International Codification of Diseases, IR = Incidence Rate, 95%CILOWER= 95% Confidence Interval lower bound, 95% CIUPPER= 95% Confidence Interval upper bound

Online Resource 8 Age- and sex-specific hospitalization incidence (per 100,000) for ICD-9 162: Lung Cancer, Spain 1997-2000 and 2007-2010.

MALES / FEMALES
Time Period / Group of Age / IR / LL / UL / IR / LL / UL
1997-2000 / 50-54 / 109.33 / 106.32 / 112.33 / 10.29 / 9.37 / 11.2
55-59 / 164.24 / 160.19 / 168.29 / 12.25 / 11.17 / 13.33
60-64 / 243.36 / 238.47 / 248.25 / 17.17 / 15.93 / 18.42
65-69 / 300.76 / 295.29 / 306.23 / 22.23 / 20.84 / 23.62
70-74 / 352.82 / 346.2 / 359.45 / 25.29 / 23.7 / 26.87
75-79 / 327.94 / 320.18 / 335.7 / 25.4 / 23.61 / 27.19
80-84 / 238.44 / 229.5 / 247.38 / 21.35 / 19.36 / 23.33
85+ / 130.88 / 123.24 / 138.52 / 14.06 / 12.38 / 15.75
2007-2010 / 50-54 / 96.04 / 93.52 / 98.56 / 28.27 / 26.91 / 29.63
55-59 / 157.17 / 153.72 / 160.62 / 28.52 / 27.07 / 29.97
60-64 / 219.75 / 215.48 / 224.02 / 28.78 / 27.29 / 30.28
65-69 / 274.34 / 268.99 / 279.7 / 31.02 / 29.31 / 32.73
70-74 / 339.04 / 332.89 / 345.19 / 37.13 / 35.27 / 38.98
75-79 / 348.72 / 341.96 / 355.48 / 35.68 / 33.81 / 37.55
80-84 / 293.69 / 285.91 / 301.47 / 32.58 / 30.53 / 34.64
85+ / 181.32 / 173.69 / 188.95 / 22.9 / 21.08 / 24.72

ICD-9= International Codification of Diseases, IR = Incidence Rate, 95%CILOWER= 95% Confidence Interval lower bound, 95% CIUPPER= 95% Confidence Interval upper bound

Online Resource 9 Age- and sex-specific hospitalization incidence (per 100,000) for ICD-9 153: Colon Cancer, Spain 1997-2000 and 2007-2010.

MALES / FEMALES
Time Period / Group of Age / IR / LL / UL / IR / LL / UL
1997-2000 / 50-54 / 27.16 / 25.66 / 28.66 / 22.8 / 21.44 / 24.15
55-59 / 45.92 / 43.78 / 48.06 / 33.24 / 31.45 / 35.02
60-64 / 77.34 / 74.59 / 80.1 / 49.94 / 47.82 / 52.05
65-69 / 112.65 / 109.3 / 116 / 64.41 / 62.04 / 66.77
70-74 / 152.09 / 147.74 / 156.44 / 86.19 / 83.26 / 89.12
75-79 / 186.17 / 180.33 / 192.02 / 108.61 / 104.91 / 112.31
80-84 / 195.24 / 187.15 / 203.33 / 123.41 / 118.64 / 128.19
85+ / 130.42 / 122.79 / 138.04 / 92.39 / 88.07 / 96.71
2007-2010 / 50-54 / 36.96 / 35.4 / 38.52 / 27.78 / 26.43 / 29.13
55-59 / 64.52 / 62.31 / 66.73 / 41.48 / 39.74 / 43.23
60-64 / 104.92 / 101.97 / 107.87 / 59.02 / 56.88 / 61.16
65-69 / 156.66 / 152.61 / 160.7 / 84.53 / 81.71 / 87.35
70-74 / 226.74 / 221.71 / 231.77 / 112.97 / 109.73 / 116.2
75-79 / 275.47 / 269.46 / 281.48 / 142.58 / 138.84 / 146.31
80-84 / 288.54 / 280.83 / 296.25 / 159.92 / 155.37 / 164.47
85+ / 209.99 / 201.78 / 218.21 / 123.67 / 119.44 / 127.89

ICD-9= International Codification of Diseases, IR = Incidence Rate, 95%CILOWER= 95% Confidence Interval lower bound, 95% CIUPPER= 95% Confidence Interval upper bound

Online Resource 10 Population of Spain used for Incidence Rates and Calculations

Males / YEAR / YEAR
Age / 1997 / 1998 / 1999 / 2000 / 2007 / 2008 / 2009 / 2010
50-54 / 1108142 / 1146079 / 1190403 / 1209382 / 1375021 / 1428323 / 1479446 / 1536718
55-59 / 915957 / 907636 / 971681 / 1048441 / 1242516 / 1272124 / 1274182 / 1285336
60-64 / 1019348 / 1009875 / 973379 / 909760 / 1103542 / 1147908 / 1179734 / 1197171
65-69 / 935449 / 954669 / 982881 / 987568 / 869763 / 876799 / 927927 / 1000448
70-74 / 741352 / 757017 / 786249 / 801060 / 903112 / 887791 / 850628 / 800240
75-79 / 471716 / 502910 / 542704 / 574802 / 702395 / 727351 / 743934 / 754755
80-84 / 278085 / 282597 / 289817 / 295286 / 444039 / 457022 / 472930 / 489865
85+ / 194050 / 202937 / 244567 / 220287 / 270564 / 289338 / 308196 / 328123
Females
Age / YEAR / YEAR
50-54 / 1135390 / 1173955 / 1219331 / 1235455 / 1387797 / 1442050 / 1496562 / 1551812
55-59 / 966050 / 950705 / 1012603 / 1087489 / 1284711 / 1312332 / 1314789 / 1326540
60-64 / 1115148 / 1106164 / 1066151 / 997972 / 1176897 / 1224696 / 1262077 / 1280561
65-69 / 1079090 / 1096171 / 1121993 / 1124572 / 969665 / 972081 / 1027416 / 1105186
70-74 / 933904 / 949145 / 983772 / 996686 / 1090612 / 1069151 / 1024570 / 963726
75-79 / 708636 / 740822 / 780304 / 817036 / 949641 / 975967 / 994307 / 1003603
80-84 / 504486 / 512524 / 528424 / 534570 / 717031 / 728723 / 752263 / 769695
85+ / 431521 / 453302 / 510160 / 503498 / 614884 / 648568 / 680599 / 715523

Online Resource 11 European Standard Population 1976

Age / N
50-54 / 7000
55-59 / 6000
60-64 / 5000
65-69 / 4000
70-74 / 3000
75-79 / 2000
80-84 / 1000
85+ / 1000