全科医学杂志

Secular Trend throughout 30 Years of Chronic Diseases in a Family Medicine Office in Toledo, Spain: 1985-1995-2016

Abstract

Jose Luis Turabian

Objective: To compare the frequencies of chronic diseases in three cross-sectional investigations corresponding to 1985, 1995, and 2016, in order to detect the secular variations of chronic health problems.

Methodology: We compare the results of three cross-sectional studies previously published, conducted in the same Family Medicine office in Toledo, Spain, by the same principal investigator: in 1985 and 1995, on the total number of patients enrolled in the consultation, and a cross-sectional study, from a secondary analysis of an existing dataset, based on a random sample of patients from the same consultation, in 2016, with a similar methodology and identical or compatible classifications.

Results: We included 1356 patients in 1985 with 56% of female patients, 1677 patients in 1995, with 55% females in 1995, and 300 patients, with 57% in 2016 (χ2=0.575, p=0.750148, not significant at p<0.05). But in 2016 more patients older than 65 years were included: 11%>65 years in 1985, 12% in 1995, and 28% in 2016 (χ2=73.71, p<0.00001). Secular variation of the diseases in this series of 30 years shows an uneven behavior of the different groups: 1) A group with increase (Circulatory system, Endocrine, Mental, and Musculo-skeletal), but not of the expected magnitude if the trend until 1995 had continued; 2) A group with only small increase (Respiratory system and Neoplasms); 3) A group with stagnation of the prevalence (Genitourinary, Infectious and Nervous and senses); And 4) A group with decrease of the prevalence (Diseases of the skin, and Digestive system). There is also an increase in the number of chronic diseases per patient, from 0.9 in 1985, to 2.0 in 1995, and to 2.4 in 2016, but their variation is not uniform either, and in several age groups and sex there is a slight decrease in the last 20 years.

Conclusions: The comparison of consistent, comparable and stable series between 1985, 1995 and 2016 in our context shows that although not all disease groups behave the same, there is a general trend of secular variation of chronic diseases of increasing prevalence of chronic diseases from 1985 to 1995, and a reduction or slowdown in prevalence growth from that date to 2016: there is only a clear increase in Circulatory system, Endocrine, Mental, and Musculo-skeletal, but not of the expected magnitude, and in all other groups the increase is weak, or there is no or there is a decrease in prevalence. This knowledge can help to plan the needs of community health resources in our environment in the near future.