BACKGROUND: Men present higher overall rates of substance use and abuse than women; yet, evidence suggests that an increase of substance use by the younger cohorts of women in recent decades is narrowing this gap in western societies. Moreover, younger cohorts may also be reporting earlier initiation of substance use, representing an increased risk for developing substance-related problems. With this study we intend to identify changes in the patterns of substance use of men and women in Spain for public health policy, planning and intervention. METHODS: Sex differences in the cumulative incidence of alcohol, tobacco, cannabis and cocaine were examined by birth cohort using a combined sample of individuals aged 15-64 years from eight editions of the Spanish National Survey on Drugs (1995-2009). RESULTS: Initiation of substance use in Spain is progressively taking place at younger ages, particularly among women. The gender-gap of life-time occurrence of substance use is narrowing (cannabis and cocaine) almost closing (alcohol) and even reversing (tobacco) in the youngest cohort. CONCLUSION: These results reflect the particular evolution and trends of Spanish society regarding substance use. Women's increased use of substances and the earlier age of initiation of substance use by both sexes present particular challenges for prevention and treatment of future substance-related problems. The trends registered for legal and illegal substances would require re-evaluation of existing prevention policies. ; This work was supported by the Delegación del Gobierno para el Plan Nacional sobre Drogas of the Ministerio de Salud y Política Social, grant numbers: PNSD 2007/I044 and 2011/I073; FIS-Redes/nde investigación cooperativa, grant number: RD06/0001/1018; and AGAUR, grant number: 2009 SGR 00718. Albert Sánchez-Niubò was supported by Instituto de Salud Carlos III, grant number: CA08/00214. The work was partially developed within the framework of the EU project JUST/2010/DPIP/AG/1410: New methodological tools for/npolicy and programme evaluation
Background: Little evidence on the validity of simple and widely applicable tools to predict mortality in patients with chronic obstructive pulmonary disease (COPD) exists. Objective: To conduct a large international study to validate the ADO index that uses age, dyspnoea and FEV1 to predict 3-year mortality and to update it in order to make prediction of mortality in COPD patients as generalisable as possible. Design: Individual subject data analysis of 10 European and American cohorts (n=13 914). Setting: Population-based, primary, secondary and tertiary care. Patients: COPD GOLD stages I–IV. Measurements: We validated the original ADO index. We then obtained an updated ADO index in half of our cohorts to improve its predictive accuracy, which in turn was validated comprehensively in the remaining cohorts using discrimination, calibration and decision curve analysis and a number of sensitivity analyses. Results: 1350 (9.7%) of all subjects with COPD (60% male, mean age 61 years, mean FEV1 66% predicted) had died at 3 years. The original ADO index showed high discrimination but poor calibration (p<0.001 for difference between predicted and observed risk). The updated ADO index (scores from 0 to 14) preserved excellent discrimination (area under curve 0.81, 95% CI 0.80 to 0.82) but showed much improved calibration with predicted 3-year risks from 0.7% (95% CI 0.6% to 0.9%, score of 0) to 64.5% (61.2% to 67.7%, score of 14). The ADO index showed higher net benefit in subjects at low-to-moderate risk of 3-year mortality than FEV1 alone. Interpretation: The updated 15-point ADO index accurately predicts 3-year mortality across the COPD severity spectrum and can be used to inform patients about their prognosis, clinical trial study design or benefit harm assessment of medical interventions. ; The Barmelweid cohort (Switzerland) was funded by the Swiss National Science Foundation (grant number 3233B0-115216) and by the Klinik Barmelweid. Basque study (Spain): No external funding. The Cardiovascular Health Study is supported by NHLBI Grant/Contract numbers N01-HC-85239, N01-HC-85079 through N01-HC-85086; N01-HC-35129, N01 HC-15103, N01 HC-55222, N01-HC-75150, N01-HC-45133; HL080295, HL-075366; NIA Grant/Contract numbers AG-023269, AG-15928, AG-20098, and AG-027058; University of Pittsburgh Claude. D. Pepper Older Americans Independence Center grant number P30-AG-024827; with additional contribution from NINDS. See also http://www.chs-nhlbi.org/pi.htm The Copenhagen City Heart City study (Denmark) was supported by grants from The Danish Heart Foundation, The Danish Lung Association and Danish Medical Research Council. The Jackson Heart Study (JHS) is a collaborative study supported by the National Institutes of Health and the National Center on Minority Health and Health Disparities (study ID numbers: 5001; N01 HC95170; N01 HC95171; N01 HC95172) in partnership with Jackson State University, Tougaloo College, and University of Mississippi Medical Center. The Lung Health Study (USA) was supported by contract NIH/N01-HR-46002 from the National Heart, Lung and Blood Institute (NHLBI). The National Emphysema Treatment Trial (USA) is funded by the National Heart, Lung and Blood Institute, the Centers for Medicare and Medicaid Services, and the Agency for Healthcare Research and Quality. The PAC-COPD Study is funded by grants from Fondo de Investigación Sanitaria (FIS PI020541), Ministry of Health, Spain; Agència d'Avaluació de Tecnologia i Recerca Mèdiques (AATRM 035/20/02), Catalonia Government; Spanish Society of Pneumology and Thoracic Surgery (SEPAR 2002/137); Catalan Foundation of Pneumology (FUCAP 2003 Beca Marià Ravà); Red RESPIRA (RTIC C03/11); Red RCESP (RTIC C03/09), Fondo de Investigación Sanitaria (PI052486); Fondo de Investigación Sanitaria (PI052302); Fundació La Marató de TV3 (num. 041110); DURSI (2005SGR00392); and an unrestricted educational grant from Novartis Farmacèutica, Spain. CIBERESP and CIBERES are funded by the Instituto de Salud Carlos III, Ministry of Health, Spain. PLATINO study was funded by ALAT (Associacion Latino Americana del Tórax); Boehringer Ingelheim GmbH (BI), and GlaxoSmithKline (GSK). The SEPOC study (Spain) was supported by grants from Fondo de Investigación Sanitaria 99/0690 and CIRIT 1999SGR00240. Judith Garcia-Aymerich has a researcher contract from the Instituto de Salud Carlos III (CP05/00118), Ministry of Health, Spain. Karel G.M. Moons receives funding from the Netherlands Organisation for Scientific Research (project 9120.8004 and 918.10.615).
