Original article
Analysis of hospitalizations by cardiovascular disease in the population with diabetes in Spain
Análisis de las hospitalizaciones por enfermedad cardiovascular en población diabética en España
A. Zapatero-Gaviriaa,
, R. Gómez-Huelgasb, J. Canora-Lebratoa, J. Ena-Muñozc, M. Romero-Sáncheza, M. Mendez-Bailónd, J. Marco-Martínezd, R. Barba-Martíne
Corresponding author
a Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
b Departamento de Medicina Interna, Hospital Regional Universitario de Málaga, Málaga, Spain
c Servicio de Medicina Interna, Hospital Marina Baixa, Villajoyosa, Alicante, Spain
d Servicio de Medicina Interna, Hospital Clínico Universitario San Carlos, Madrid, Spain
e Servicio de Medicina Interna, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain
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"apellidos" => "Barba-Martín" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Medicina Interna, Hospital Regional Universitario de Málaga, Málaga, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Marina Baixa, Villajoyosa, Alicante, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Clínico Universitario San Carlos, Madrid, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Análisis de las hospitalizaciones por enfermedad cardiovascular en población diabética en España" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Background</span><p id="par0005" class="elsevierStylePara elsevierViewall">Recent studies have indicated that the prevalence of diabetes mellitus (DM) in the adult Spanish population is 14%, with a trend toward doubling in the coming decades.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">There is evidence that patients with DM have a greater risk of hospitalization than patients without diabetes<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">2,3</span></a> and that the presence of diabetes is one of the main determinants of increased hospitalization costs, hospital readmissions and mortality.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In Spain, the prevalence of DM in patients hospitalized in internal medicine departments varies between 18.4% and 27%.<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">5,6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Cardiovascular diseases (CVDs) represent the main associated comorbidity in patients hospitalized with DM in Spain.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">7</span></a> According to data published by the American Diabetes Association, CVDs represent the largest healthcare cost in hospitalized patients.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">8</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">A recent Spanish study, based on more than 5 million hospitalizations between 1997 and 2010, revealed that the hospitalization rate for patients with diabetes doubled during this period, due mostly to a marked increase in hospitalizations for heart failure and malignancies, which were probably related to the progressive aging of the population with diabetes.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">9</span></a> The study also observed a stabilization in the number of hospitalizations for coronary artery disease, which was probably related to improved control of cardiovascular risk factors in patients with diabetes.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">9</span></a> This tendency toward a reduction in hospitalizations for coronary syndrome and stroke has also been observed in the United States.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">10</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">An important aspect that has not been studied is the distribution and characteristics of hospitalizations for CVD in patients with DM in the various hospital departments.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The objective of the present study was to analyze all the causes of hospitalization for CVD (coronary artery disease, cerebrovascular disease, peripheral arterial disease and congestive heart failure [CHF]) in patients with DM in Spain and their distribution by department.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><p id="par0040" class="elsevierStylePara elsevierViewall">In this study, we analyzed data from the minimum basic data set (MBDS) of patients discharged in 2015 from hospitals of the Spanish National Health System (NHS), provided by the Ministry of Health and Consumer Affairs, who were diagnosed with diabetes (ICD-9-CM: 250.xx). and is a database that must be filled in by the management of all hospital centers and sent annually to the Ministry of Health of their autonomous community and to the Ministry of Health and Consumer Affairs. The aim of the MBDS is to determine the country's standard, a group of indicators that define the operation of the hospitals in the Spanish NHS regarding hospitalization episodes, after classification by diagnosis-related group (DRG) in the current version for the analyzed year. To code the diagnoses and procedures, we employed the International Classification of Diseases, 9th Clinical Modification, 5th edition. ICD-9-CM: We employed the patient classification system All Patient (AP) DRG version 27.0 and All Patient Refined (APR) DRG version 32 to group the discharges by process. Each APR-DRG has an assigned disease severity subclass (degree of physiological decompensation or loss of organ system function) from 1 to 4 (minor, moderate, major and extreme).</p><p id="par0045" class="elsevierStylePara elsevierViewall">The data collected in the MBDS included the hospital size classification (group 1, fewer than 200 beds; group 2, 200–500 beds; group 3, 501–1000 beds; group 4, more than 1000 beds); circumstances of the hospitalization (1, emergency; 2, scheduled); circumstances of the discharge (1, home; 2, transfer to hospital, 3, voluntary discharge, 4, death); and primary diagnosis, encoded using the ICD-9-CM and considered that which, after studying the patient, was established as the cause of the hospital admission according to the criteria of the clinical department or physician who treated the patient. This diagnosis remains primary throughout the patient's stay, despite the onset of significant complications and even other independent conditions that are assigned as secondary diagnoses. Diagnostic and therapeutic procedures, which included up to 20 per episode, are classified using the ICD-9-CM procedure classification, which consists of 16 structured chapters, the first 15 by anatomical location. Chapter 16 includes therapeutic, diagnostic and nonsurgical prophylactic procedures.</p><p id="par0050" class="elsevierStylePara elsevierViewall">To determine the patient comorbidity, we employed the Charlson index,<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">11</span></a> which was developed in 1987 and has shown the relationship between comorbidity and mortality at 1 year in various patient cohorts. The index, which has been adapted for use with administrative databases,<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">12</span></a> assesses the presence of 19 medical conditions, with a weight of 1–6 and a total score of 0–37. A score >2 is related to a mortality rate >50% at 1 year.</p><p id="par0055" class="elsevierStylePara elsevierViewall">We selected hospitalization episodes with a diagnosis of diabetes (ICD-9-CM: 250.xx) for patients older than 18 years, excluding pregnant women. We considered that the patients presented CVD if they had at least 1 of the following comorbidities in the primary or secondary diagnoses: heart failure (ICD-9-CM: 398.91, 404*, 402.11, 402.91, 428–428.9), ischemic heart disease (ICD-9-CM codes: 410–410.9), cerebrovascular disease (ICD-9-CM: 430–438) and peripheral arterial disease (ICD-9-CM: 440–448).</p><p id="par0060" class="elsevierStylePara elsevierViewall">We performed a descriptive data analysis and compared the demographic variables between the patients who had been hospitalized in internal medicine departments, surgery departments or other medical departments (other than internal medicine). We employed the chi-squared test for categorical variables for the dichotomous variables and the analysis of variance test for the quantitative variables. For the statistical analysis, we employed the SPSS 13.0 program.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0065" class="elsevierStylePara elsevierViewall">In 2015, 3,727,583 hospital discharges were registered in Spain, 619,188 (16.7%) of which corresponded to patients older than 18 years with DM.</p><p id="par0070" class="elsevierStylePara elsevierViewall">The distribution by department is presented in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. The internal medicine departments were responsible for 34.2% of the episodes (212,013), followed by cardiology (9.5%) and 3 surgical specialties: general surgery (8.9%), trauma (6.9%) and urology (4.8%).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">The overall number of patients with DM hospitalized in internal medicine departments (34.2%) was similar to that treated by the rest of the medical departments (36.7%) and higher than those hospitalized in surgery departments (29.1%).</p><p id="par0080" class="elsevierStylePara elsevierViewall">The overall mean age of the hospitalized patients with DM was 73.24<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>12.57 years, with a predominance of men (56.8%). In most cases (76.6%), the hospitalization was an emergency compared with 23.2% of scheduled hospitalizations. The overall mean stay was 8.24 days, and the readmission rate at 30 days was 14%. Eighty-seven percent of the patients were discharged to their home, 2.1% were referred to public health centers, and the overall mortality rate was 6.8%.</p><p id="par0085" class="elsevierStylePara elsevierViewall">The patients hospitalized in internal medicine departments were older, had longer mean stays and higher mortality than the patients hospitalized in other medical services and surgery departments. The comorbidity measured by the Charlson index was higher for the patients with DM hospitalized in internal medicine departments (Charlson score<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>2 for 42% of the patients vs. 39% for those hospitalized in other medical departments and 21% in surgery departments) (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">Some 40.8% of the hospitalized patients with DM (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>253,712) presented CVD distributed as follows: congestive heart failure [CHF], 20.1%; stroke, 10.3%; ischemic heart disease, 9.4%; and peripheral arterial disease, 9.1%. The prevalence of CVD among the hospitalized patients with DM varied widely among the various departments: vascular surgery (80.8%), neurology (78.7%), cardiology (73.6%), internal medicine (50.7%), heart surgery (52.3%), nephrology (40.1%) general surgery (13.9%), urology (13.3%), endocrinology (12.3%) and trauma (11.9%).</p><p id="par0095" class="elsevierStylePara elsevierViewall">The most common CVD was CHF. Of the 253,712 patients with CVD, 49.3% presented CHF, 25.3% presented cerebrovascular disease, 22.9% presented ischemic heart disease, and 22.4% presented peripheral vascular disease (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">The internal medicine departments discharged a higher number of patients with DM and CVD (42.3%) than the other medical services (41.8%) and the collection of surgery departments (15.8%) (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). In particular, the internal medicine departments accumulated 55.6% of hospitalizations for patients with DM and CHF, 40.8% with cerebrovascular disease, 28.9% with ischemic heart disease and 28.6% with peripheral arterial disease (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).</p><p id="par0105" class="elsevierStylePara elsevierViewall">The clinical severity measured by APR-DRG is presented in <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>. Some 41.9% of the patients with diabetes hospitalized in internal medicine had a degree of severity of 3–4 compared with 31.6% of the medical patients (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.01) and 11.2% of the surgical patients (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.01).</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0110" class="elsevierStylePara elsevierViewall">The present study describes for the first time the hospital map for CVD in patients with DM in Spain and its distribution by department. It is worth noting that internal medicine departments treat more than a third of patients with DM hospitalized for any cause and more than 40% of hospitalized patients with DM and CVD. The patients hospitalized in internal medicine departments are older and have greater clinical complexity than those admitted to other medical or surgical departments.</p><p id="par0115" class="elsevierStylePara elsevierViewall">It is also worth noting that CHF represents the most common CVD in hospitalized patients with DM and that most of these patients are admitted to internal medicine departments.</p><p id="par0120" class="elsevierStylePara elsevierViewall">These data illustrate the weight of internal medicine in Spain in caring for the population with diabetes hospitalized in general and with CVD in particular.</p><p id="par0125" class="elsevierStylePara elsevierViewall">In our analysis, 1 of every 6 adult patients hospitalized in Spain for any cause had DM. The presence of DM is known to increase the likelihood of hospital admission by 2–6-fold.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">13</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">The US National Health and Nutrition Examination Survey (NHANES) of 6265 adults with diabetes between the ages of 45 and 75 years estimated that the risk of hospitalization for patients with DM was 51% greater than that of patients without diabetes, after adjusting for other risk factors.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">14</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">According to our data, more than 40% of the patients hospitalized with DM had CVD, half of whom presented CHF (49.3%), followed by cerebrovascular disease (24.9%), ischemic heart disease (22.9%) and peripheral arterial vascular disease (22.4%).</p><p id="par0140" class="elsevierStylePara elsevierViewall">DM is a well-known major risk factor for developing CVD and worsens the prognosis of CVD, especially in women.<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">15</span></a> DM doubles the risk of coronary artery disease, stroke and cardiovascular death attributed to other vascular causes,<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">14</span></a> and ischemic heart disease associated with DM presents more severe forms.<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">16,17</span></a> DM also represents a major risk factor for developing CHF. In the Reduction of Atherothrombosis for Continued Health (REACH) registry, the presence of DM increased the risk of hospitalization and death by CHF by 33%.<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">16</span></a> This prognosis of CHF in patients with DM has been confirmed by other authors.<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">18</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">In recent years, there has been a trend toward decreasing CVD mortality, both in the general population and in patients with DM, which has been related to better control of cardiovascular risk factors and improved interventions in acute phases of CVD. From 1998 to 2012, Sweden observed a reduction in hospitalizations and CVD mortality, especially for ischemic heart disease, which was more pronounced in patients with type 1 DM than with type 2 DM.<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">19</span></a> In the United States, there has also been a significant reduction in hospitalizations for coronary artery disease and stroke, both ischemic and hemorrhagic, from 1998 to 2014.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">10</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">In Spain, De Miguel-Yanes et al.<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">20</span></a> (using the MBDS from 2002 to 2014) also observed a reduction in hospitalizations for ischemic heart disease in patients with diabetes; however, they recorded an increase in hospitalizations for stroke.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">21</span></a> Another Spanish study, this time by Perez-Belmonte et al.,<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">9</span></a> also analyzed the MBDS from 1997 to 2010 and concluded that hospital admissions of patients with diabetes doubled in absolute terms during the study period. The authors stated that this increase was due mainly to an increase in hospitalizations for CHF and malignancies, while hospitalizations for cerebrovascular disease and coronary artery disease tended to stabilize.</p><p id="par0155" class="elsevierStylePara elsevierViewall">Our data show that internal medicine departments have a highly relevant role in managing hospitalized patients with diabetes and that the departments treat most hospitalized patients with CVD, especially those hospitalized with CHF.</p><p id="par0160" class="elsevierStylePara elsevierViewall">It is also noteworthy the high prevalence of DM in the surgical departments that, as a whole, treat almost a third of hospitalized patients with DM and CVD. It is important to emphasize that the vascular surgery departments had a high prevalence of CVD and a high prevalence of peripheral arterial disease in our study, which reached rates similar to those of coronary artery and cerebrovascular disease. Peripheral arterial disease has been identified as one of the comorbidities with the greatest impact on the length of stay and hospital costs.<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">20</span></a> These data are important for highlighting the growing importance that consulting tasks in surgery departments have for internal medicine departments, in the shared care of patients with a significant comorbidity burden, including clinical support for patients with diabetes hospitalized in surgery departments. The need for comprehensive clinical support for this population is justified by the presence of multiple comorbidities in more than 90% of patients with DM hospitalized in Spain.<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">22,23</span></a></p><p id="par0165" class="elsevierStylePara elsevierViewall">In medical departments other than internal medicine, the incidence rate of CVD varies according to the following specialty: neurology (78.7%), cardiology (73.6%), geriatric medicine (54.6%), nephrology (40.1%), gastrointestinal (17.4%) and endocrinology with the lowest rate (12.3%). These data probably reflect the fact that patients with diabetes hospitalized in cardiology departments are admitted mainly for ischemic heart disease and heart failure and that those admitted to neurology departments are for stroke. Those admitted to endocrinology departments are there for reasons other than cardiovascular complications.</p><p id="par0170" class="elsevierStylePara elsevierViewall">In terms of the study limitations, we used an administrative database (MBDS) that has shown its capacity to present the current situation in a hospital center. However, there are known limitations in working with this type of registry, which depend especially on the quality of the discharge reports. We know that some diagnoses are under-reported and that risk factors are not always coded. However, the considerable number of cases included in these databases help us determine, with decent reliability, the reality of care.</p><p id="par0175" class="elsevierStylePara elsevierViewall">In conclusion, we would like to highlight that 1 of every 6 hospitalized patients in Spain has DM, more than 40% of whom also have CVD, with CHF the main cause of hospitalization. The internal medicine departments in Spain assume a significant part of the care for the hospitalized population with diabetes and treat most hospitalized patients with DM and CHF. Almost a third of hospitalized patients with DM are admitted to surgical departments. The figure of internist consultant, under the formula of shared care, could therefore contribute to a better management of these patients.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflicts of interest</span><p id="par0180" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1171500" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1095900" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1171501" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1095899" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Background" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Materials and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflicts of interest" ] 9 => array:2 [ "identificador" => "xack400271" "titulo" => "Acknowledgements" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-06-08" "fechaAceptado" => "2018-09-18" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1095900" "palabras" => array:4 [ 0 => "Diabetes mellitus" 1 => "Cardiovascular disease" 2 => "Hospitalized patients" 3 => "Internal medicine" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1095899" "palabras" => array:4 [ 0 => "Diabetes mellitus" 1 => "Enfermedad cardiovascular" 2 => "Hospitalizados" 3 => "Medicina interna" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Diabetes mellitus is associated with a marked increase in cardiovascular disease. In this study, we analyzed the prevalence of diabetes mellitus in hospitalised patients in Spain in 2015 and the burden of associated cardiovascular disease.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">By analysing the 2015 minimum basic data set (MBDS) of the Spanish Ministry of Health, we included all patients discharged with a diagnosis of diabetes mellitus. We describe the epidemiological characteristics, distribution by the various hospital departments and the presence of cardiovascular disease.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">In 2015, there was 3,727,583 hospital discharges in Spain, 619,188 of which involved patients with diabetes (16.7%), 56.8% of whom were men and with a mean age of 73.2 years. The prevalence of cardiovascular disease was 40.8%, distributed among congestive heart failure (20.1%), cerebrovascular disease (10.3%), coronary artery disease (9.4%) and peripheral arterial disease (9.1%). Most of the patients were admitted to internal medicine (34.2%), cardiology (9.5%) and general surgery (8.9%) departments. The mean overall stay was 8.2 days, the readmission rate at 30 days was 14%, and the mortality rate was 6.8%. The patients hospitalized in internal medicine had higher severity levels (3–4) than those hospitalized in other medical departments (41.9% vs. 31.6%, respectively; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.01) and those hospitalized in surgical departments (11.2%; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.01).</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Diabetes mellitus is a significant comorbidity for patients hospitalized in internal medicine. A significant proportion of these patients present cardiovascular disease, mostly heart failure.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Diabetes mellitus se asocia con un marcado incremento de enfermedad cardiovascular. En el presente estudio analizamos la prevalencia de diabetes mellitus en pacientes hospitalizados en España en 2015 y la carga de enfermedad cardiovascular asociada.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Mediante el análisis del conjunto mínimo básico de datos (CMBD) del Ministerio de Sanidad del año 2015, se incluyen todos los pacientes dados de alta con diagnóstico de diabetes mellitus. Se describen las características epidemiológicas, la distribución por los diferentes servicios hospitalarios y la presencia de enfermedad cardiovascular.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">En el año 2015 hubo 3.727.583 altas en España; de ellas, 619.188 correspondían a diabéticos (16,7%); el 56,8% eran varones y la edad media era de 73,2 años. La prevalencia de enfermedad cardiovascular fue del 40,8%, distribuida en insuficiencia cardiaca congestiva (20,1%), enfermedad cerebrovascular (10,3%), enfermedad coronaria (9,4%) y enfermedad arterial periférica (9,1%). La mayor parte de pacientes ingresaron en los servicios de medicina interna (34,2%), cardiología (9,5%) y cirugía general (8,9%). La estancia media global fue de 8,2 días y los reingresos a 30<span class="elsevierStyleHsp" style=""></span>días alcanzaron el 14%. La mortalidad fue del 6,8%. Los pacientes ingresados en medicina interna tienen un grado de severidad más alto (3-4), 41,9% vs 31,6%, que los ingresados en otros servicios médicos (p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,01) y que los ingresados en servicios quirúrgicos (11,2%) (p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,01).</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La diabetes mellitus es una comorbilidad importante de los pacientes ingresados en medicina interna. Una proporción significativa de estos pacientes presenta enfermedad cardiovascular, y la más frecuente es la insuficiencia cardíaca.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Please cite this article as: Zapatero-Gaviria A, Gómez-Huelgas R, Canora-Lebrato J, Ena-Muñoz J, Romero-Sánchez M, Mendez-Bailón M, et al. Análisis de las hospitalizaciones por enfermedad cardiovascular en población diabética en España. Rev Clin Esp. 2019;219:124–129.</p>" ] ] "multimedia" => array:4 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Department \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Number \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Internal medicine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">212,013 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cardiology \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58,051 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">General and gastrointestinal surgery \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">54,844 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Trauma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">42,635 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Urology \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29,848 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pulmonology \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28,351 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gastrointestinal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27,700 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Neurology \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23,151 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Vascular surgery \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19,217 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Nephrology \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13,596 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Geriatrics \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12,633 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Oncology \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11,510 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Others \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">85,639 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1999328.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Hospitalizations for patients with type 2 diabetes in Spain (2015). Distribution by department.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Internal medicine \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Other medical services \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Surgical departments \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age, years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">77.4<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>11.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">71.6<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>13.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">70.4<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>12.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">73.2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>12.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sex (male) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">51.2% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">60.5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">58.9% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">56.8% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mean stay, days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8.6<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>8.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8.1<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>10.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7.9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>10.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8.2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>9.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Charlson score >2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">42.4% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">39.0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">21.0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">34.9% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mortality \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7.5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.1% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6.8% \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1999330.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.001 for all comparisons.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Hospitalizations for patients with type 2 diabetes in Spain (2015). Descriptive analysis grouped by internal medicine departments and other medical and surgical departments.<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a></p>" ] ] 2 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Internal medicine (212,013)</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Other medical services (227,271)</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Surgery departments (179,904)</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cardiovascular disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">107,428 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">42.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">106,160 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41.8<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">*</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40,124 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15.8<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">*</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ischemic heart disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16,792 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34,163 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58.8<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">*</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7164 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.3<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">*</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Congestive heart failure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">69,709 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">55.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">47,077 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37.5<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">*</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8596 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.9<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">*</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cerebrovascular disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26,248 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29,878 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">46.4<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">*</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8216 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.8<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">*</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Peripheral arterial disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16,320 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28.6<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">**</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18,226 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">32.0<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">**</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22,435 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">39.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1999331.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "*" "nota" => "<p class="elsevierStyleNotepara" id="npar0010"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.01 for the comparison with internal medicine.</p>" ] 1 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "**" "nota" => "<p class="elsevierStyleNotepara" id="npar0015"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.01 for the comparison with surgical departments.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Hospitalizations for patients with type 2 diabetes and cardiovascular disease in Spain (2015). Analysis grouped by internal medicine departments and other medical and surgical departments.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="6" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Severity</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">0 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">1 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">3 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">4 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Surgical \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.1% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">45.8% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">43.0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.2% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Medical \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.1% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19.7% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">48.6% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28.1% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Internal medicine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.1% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.1% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">47.9% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38.3% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.6% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100% \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1999329.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0020" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0020">41.9% of the internal medicine patients had a degree of severity of 3–4 compared with 31.6% of the medical patients (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.01) and 11.2% of the surgical patients (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.01).</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Hospitalizations for patients with type 2 diabetes and cardiovascular disease in Spain (2015). 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2023 March | 6 | 4 | 10 |
| 2020 September | 0 | 1 | 1 |
| 2018 December | 2 | 4 | 6 |
