Iñaki Galán’s research while affiliated with Instituto de Salud Carlos III and other places

The aim of this study was to estimate the series of tobacco smoking prevalence year-by-year in Spain, by sex and age group, for the period 1991–2020. Based on smoking prevalence obtained from national surveys and smoking-related auxiliary information from public statistics, we fitted a multinomial logistic mixed model with random area and time effects. Joinpoint regression was used to identify changes in the prevalence series across the period. To analyse the precision of the model-based estimates, we calculated the coefficients of variation. Between 1991 and 2020, the prevalence of smoking in Spain decreased in both sexes. In the 15–24 age group, the prevalence of smokers showed no differences by sex until 2007, after which prevalence in men exceeded that of women. However, in women aged 55 and over prevalence of smoking has been rising since 1991. After applying the model, the precision of smoking prevalence estimates improved. The reconstruction of a detailed series of tobacco smoking prevalence provides insight into the evolution of the tobacco epidemic in Spain. A detailed analysis by sex and age shows different trends in the prevalence of smoking among women that should be considered when control measures are formulated.

The extent to which physical activity (PA) may offset the risks associated with sedentarism is not yet well understood. We evaluated the independent and the combined effects of PA and sitting time (ST) on all-cause mortality in the Spanish population. Prospective study with 31 100 participants aged 18–69 years from the 2011–2012 and 2017 National Health Surveys; data were linked to mortality records through December 2022. ST was categorized as ≤4 h/day, >4–6 h/day, and >6 h/day, and PA was assessed using the International Physical Activity Questionnaire. PA was classified as (i) low, moderate, or high and (ii) adherence to World Health Organization (WHO) recommendations. Relative risks (RR) were estimated using Poisson regression models. The median follow-up time was 5.7 years, recording 1128 deaths. Individuals with ST >6 h/day had an RR (95% confidence interval) of 1.60 (1.34; 1.92) compared to those with ST ≤4 h/day. In contrast, those with high vs. low PA had an RR of 0.63 (0.51; 0.79), and those meeting WHO recommendations had an RR of 0.60 (0.50; 0.73). When analyzed jointly, individuals who met recommendations and had low ST, compared to those with moderate and high ST, had estimated RRs of 1.17 (0.75; 1.85) and 1.30 (0.83; 2.05), respectively. Among those who did not meet recommendations, the RR increased to 1.51 (1.19; 1.92), 2.06 (1.59; 2.68), and 2.65 (2.06; 3.42) for low, moderate, and high ST, respectively. PA and ST are independently associated with mortality. The risk associated with sedentarism can be partially offset by being physically active.

Objectives This study aims to estimate the impact of the co-occurrence of behavioural risk factors on mortality in the Spanish adult population. Design Population-based cohort study based on data from the 2011–2012 Spanish National Health Survey and the 2014 European Health Survey (n=35 053 participants ≥15 years of age) both linked to mortality data as of December 2022. Risk factors included tobacco use, high-risk alcohol consumption, low adherence to the Mediterranean diet, leisure time sedentary lifestyle and body mass index outside the 18.5–24.9 kg/m ² range. Deaths from any cause (n=2784), from diseases of the circulatory system (n=678) and from tumours (n=869) were identified. Standardised rate differences (SRD) and standardised rate ratios (SRR) were estimated using Poisson regression models adjusted for sociodemographic variables. Results Compared with those with no unhealthy behaviours, overall mortality risk increased gradually as the co-occurrence of risk behaviours increased. Individuals with two factors had an SRD of 3.0 deaths per 1000 person-years (95% CI 1.8; 4.3) and an SRR of 1.88 (95% CI 1.35; 2.62). A coexistence of five risk factors increased SRD and SRR to 11.5 (95% CI 7.2; 15.8) and 4.34 (95% CI 2.84; 6.63), respectively. The association was stronger among individuals under 65 years of age, whereas it did not vary by sex and educational level. Those reporting five risk factors had SRRs of 6.35 (95% CI 2.91; 13.83) and 2.57 (95% CI 1.11; 5.98) for tumour-related and cardiovascular disease mortality, respectively. Conclusions The co-occurrence of unhealthy behaviours increases the risk of overall and cause-specific mortality. Targeting multiple risk behaviours should be incorporated into the public health strategy.

Background Sitting time (ST) constitutes a significant aspect of sedentary behavior, and its worldwide escalation raises concerns regarding public health. International guidelines recommend limiting sedentary time and replacing it with physical activity (PA) to reduce the risk of diseases and mortality. This study examines the impact of replacing ST with PA on all-cause, cardiovascular disease (CVD), and cancer mortality in a representative cohort of the population of Spain. Methods We included 30 955 participants aged 15–69 years from two National Health Surveys performed in 2011 and 2017. Data were linked to mortality records as of December 2022. Data on ST, light PA (LPA), and moderate-vigorous PA (MVPA) were collected as part of the International Physical Activity Questionnaire at baseline. Isotemporal substitution analysis from Poisson regression models was used to estimate the relative risk ratio (RR) of replacing ST with LPA or MVPA. Results During a median follow-up of 5.7 years, 957 deaths were reported. The replacement of 1 h per week of ST with 1 h per week of MVPA was significantly associated with a lower risk of all-cause (3.3%), CVD (6.7%), and cancer mortality (3.1%). Similarly, replacing 1 h per week of ST with 1 h per week of LPA was significantly associated with a lower risk of all-cause (1.6%) and cancer mortality (2.1%). Finally, substituting 1 h per week of LPA with 1 h per week of MVPA was significantly associated with a 7.6% lower risk of CVD mortality. Conclusions Substituting one hour per week of ST with an equivalent amount of PA was associated with a lower risk of all-cause, CVD, and cancer mortality.

INTRODUCTION There is no consensus on the questions that should be included in questionnaires to properly ascertain exposure to secondhand tobacco smoke (SHS). The objective of this study is to analyze the questions included in studies which have assessed SHS exposure in Spain. METHODS A scoping review was performed, using PubMed, Embase and Web of Science databases, selecting original articles published in English and Spanish, across the period 2012–2021. We extracted data from each study regarding its design, target population, sample size or geographical scope; we also collected data regarding how studies dealt with exposure to SHS including assessment and intensity of SHS, exposure setting, geographical scope, and the verbatim questions used. RESULTS Finally, 75 studies were identified. In the 23 studies carried out in children, verbatim questions were included in 8 studies, and the setting most studied was the home. SHS exposure was assessed during pregnancy and postnatally by 8 studies, the verbatim questions used were described in 2 studies, being exposure ascertained at home and workplace. In the adult population, 14 of 44 studies described the verbatim questions; the setting most studied was the home. Verbatim questions varied among studies. CONCLUSIONS Questionnaire-based assessment of SHS exposure is highly heterogeneous, hindering comparability between studies. Therefore, it is necessary to set a standard questionnaire to assess exposure to SHS.

Importance Alcohol consumption is a leading cause of morbidity and mortality that may be more important in older adults with socioeconomic or health-related risk factors. Objective To examine the association of alcohol consumption patterns with 12-year mortality and its modification by health-related or socioeconomic risk factors. Design, Setting, and Participants This prospective cohort study used data from the UK Biobank, a population-based cohort. Participants were current drinkers aged 60 years or older. Data were analyzed from September 2023 to May 2024. Exposure According to their mean alcohol intake in grams per day, participants’ drinking patterns were classified as occasional: ≤2.86 g/d), low risk (men: >2.86-20.00 g/d; women: >2.86-10.00 g/d), moderate risk (men: >20.00-40.00 g/d; women: >10.00-20.00 g/d) and high risk (men: >40.00 g/d; women: >20.00 g/d). Main Outcomes and Measures Health-related risk factors were assessed with the frailty index, and socioeconomic risk factors were assessed with the Townsend deprivation index. All-cause and cause-specific mortality were obtained from death certificates held by the national registries. Analyses excluded deaths in the first 2 years of follow-up and adjusted for potential confounders, including drinking patterns and preferences. Results A total of 135 103 participants (median [IQR] age, 64.0 [62.0-67.0] years; 67 693 [50.1%] women) were included. In the total analytical sample, compared with occasional drinking, high-risk drinking was associated with higher all-cause (hazard ratio [HR], 1.33; 95% CI, 1.24-1.42), cancer (HR, 1.39; 95% CI, 1.26-1.53), and cardiovascular (HR, 1.21; 95% CI, 1.04-1.41) mortality; moderate-risk drinking was associated with higher all-cause (HR, 1.10; 95% CI, 1.03-1.18) and cancer (HR, 1.15; 95% CI, 1.05-1.27) mortality, and low-risk drinking was associated with higher cancer mortality (HR, 1.11; 95% CI, 1.01-1.22). While no associations were found for low- or moderate-risk drinking patterns vs occasional drinking among individuals without socioeconomic or health-related risk factors, low-risk drinking was associated with higher cancer mortality (HR, 1.15; 95% CI, 1.01-1.30) and moderate-risk drinking with higher all-cause (HR, 1.10; 95% CI, 1.01-1.19) and cancer (HR, 1.19; 95% CI, 1.05-1.35) mortality among those with health-related risk factors; low-risk and moderate-risk drinking patterns were associated with higher mortality from all causes (low risk: HR, 1.14; 95% CI, 1.01-1.28; moderate risk: HR, 1.17; 95% CI, 1.03-1.32) and cancer (low risk: HR, 1.25; 95% CI, 1.04-1.50; moderate risk: HR, 1.36; 95% CI, 1.13-1.63) among those with socioeconomic risk factors. Wine preference (>80% of alcohol from wine) and drinking with meals showed small protective associations with mortality, especially from cancer, but only in drinkers with socioeconomic or health-related risk factors and was associated with attenuating the excess mortality associated with high-, moderate- and even low-risk drinking. Conclusions and Relevance In this cohort study of older drinkers from the UK, even low-risk drinking was associated with higher mortality among older adults with health-related or socioeconomic risk factors. The attenuation of mortality observed for wine preference and drinking only during meals requires further investigation, as it may mostly reflect the effect of healthier lifestyles, slower alcohol absorption, or nonalcoholic components of beverages.