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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Background</span><p id="par0005" class="elsevierStylePara elsevierViewall">The life expectancy of adults with Down syndrome &#40;DS&#41; has increased drastically over the past few decades&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> Improved surgical techniques&#44; the development of targeted health programs&#44; advances in antimicrobial therapy&#44; larger support networks and social promotion are some of the factors that explain this progressive increase in these patients&#8217; life expectancy&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#8211;12</span></a> As a result&#44; adults with DS are entering a new stage of life that was typically not experienced by previous generations of this population &#40;i&#46;e&#46;&#44; late adulthood&#41;&#46; In fact&#44; due to the premature tissue aging that characterizes this population&#44; this stage could perhaps be equated with old age in the general population&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#8211;16</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">There is a significant lack of knowledge regarding the aging process of adults with DS&#44; given that not all body systems exhibit premature aging&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;13</span></a> For example&#44; people with DS have a surprisingly low incidence of atherosclerotic cardiovascular diseases and solid tumors compared with the general population&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#8211;24</span></a> The results of studies performed to date agree that adults with DS develop different clinical disorders from the general population&#46;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">25&#44;26</span></a> Thus&#44; people with DS have become an increasingly long-lived population with distinctive characteristics that differ from those of both previous generations of adults with this disorder and the general population&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The social and healthcare needs of people with DS change as they age&#44; as they require a greater number of hospital admissions over time&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> Although many of these admissions are expected to take place in internal medicine wards&#44; the most prevalent clinical disorders that lead to these hospitalizations remain unclear&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Our aim is to improve the social and healthcare services received by adults with DS&#46; Hence&#44; the primary purpose of this study was to describe the epidemiological and clinical characteristics of patients with DS who have been admitted to Spanish internal medicine wards in recent years&#46; We also sought to determine the temporal evolution of these admissions and the rate of in-hospital mortality among this population&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">We conducted a retrospective&#44; observational study using the data recorded in the minimum basic dataset &#40;MBDS&#41; of all adult patients with DS who were admitted to the internal medicine wards of hospitals belonging to the Spanish National Health System &#40;SNHS&#41; between 2005 and 2014&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The MBDS is a database that health centers are required to complete and send to the Spanish Ministry of Health&#44; Consumer Affairs&#44; and Social Welfare on a regular basis&#46; This resource compiles data on the type of admission&#44; clinical circumstances of the admission&#44; follow-up data collected from the patients throughout their hospitalization&#44; discharge diagnoses&#44; procedures performed and the patients&#8217; condition at discharge&#46; In the MBDS&#44; each admission is categorized into diagnosis-related groups &#40;DRGs&#41; that classify patients into groups of clinically similar processes for which a similar resource consumption is expected&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">28&#44;29</span></a> The International Classification of Diseases&#44; 9th revision&#44; clinical modification&#44; 5th edition &#40;ICD-9-CM&#41; was employed to code the diagnoses and procedures in the MBDS&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Our study population was selected by consecutive sampling all admissions to internal medicine wards for patients over 18 years of age&#44; with Down syndrome &#40;ICD-9-CM code 758&#46;0&#41; as their primary or secondary diagnosis&#46; No additional selection criteria were applied&#46; The Ministry of Health&#44; Consumer Affairs&#44; and Social Welfare provided the required data and was responsible for redacting any personal identifier in accordance with the applicable Spanish laws&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> All data were processed with the utmost confidentiality and respect&#44; following the Good Clinical Practice guidelines and the principles set out in the Declaration of Helsinki&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">We analyzed the epidemiological &#40;age&#44; sex&#44; and type of admission&#41;&#44; clinical &#40;reason for admission&#44; primary and secondary diagnoses&#44; and comorbidities&#41; and social &#40;discharge destination&#41; variables&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">A cost-estimation process for admissions grouped by the all-patient DRGs for each given year was followed to calculate the mean cost of each DRG&#46; We calculated the weights and costs of the various DRGs for the Spanish NHS by considering the data from a sample of hospitals that estimated the mean costs of the various DRGs for the entire Spanish NHS&#46; In no case do these data reflect the actual overall expenditure of the Spanish NHS for such concepts&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Given that the demographic structure &#40;e&#46;g&#46;&#44; age&#41; of the population of adults with DS differs from that of the general Spanish population and to account for the effect of age on the mortality rates&#44; we calculated the age-adjusted mortality by employing a direct method using as a control group the general population admitted to internal medicines wards over the study period &#40;2005&#8211;2014&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The Charlson index has been validated for analyzing the relationship between comorbidity and mortality at 1&#8239;year in various patient cohorts and for use with administrative databases&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">28&#44;29&#44;31&#8211;33</span></a> Thus&#44; in line with previous studies performed by other research groups&#44; we analyzed this index as a discrete quantitative variable&#44; classifying the patients into the following score categories&#58; 0 points&#44; 1 point&#44; 2 points and more than 2 points&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">32&#44;33</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">We analyzed the qualitative variables with the chi-squared test applying Yates&#8217; correction or&#44; when necessary&#44; Fisher&#8217;s exact test&#46; We analyzed the quantitative variables with Student&#8217;s t-test or&#44; when necessary&#44; an analysis of variance applying Bonferroni&#8217;s correction&#46; We considered all tests bilateral&#44; and results with p&#8239;&#60;&#8239;&#46;05 were considered statistically significant&#46; We employed SPSS software &#40;SPSS 20&#46;0&#46;0&#44; IBM Corp&#46;&#44; Armonk&#44; NY&#44; USA&#41; for all statistical analyses&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Demographic and clinical characteristics of patients with Down syndrome</span><p id="par0065" class="elsevierStylePara elsevierViewall">A total of 19&#44;611 hospital admissions for adults with DS to hospitals belonging to the Spanish NHS were recorded between 2005 and 2014&#44; with 7548 &#40;38&#46;5&#37;&#41; of these cases accounting for admissions to internal medicine wards&#46; Considering that the overall number of admissions to internal medicine wards over this study period was 5&#44;972&#44;018&#44; The admissions of adults with DS to these wards accounted for 0&#46;13&#37; of the total&#46; Our study population had a mean age &#40;&#177;SD&#41; of 47&#8239;&#177;&#8239;12&#46;5 years &#40;age range&#44; 18&#8211;96 years&#41;&#44; of whom 1838 were men &#40;56&#46;6&#37;&#41; with a mean age of 47&#8239;&#177;&#8239;13 years&#44; and 1408 were women &#40;43&#46;3&#37;&#41; with a mean age of 48&#8239;&#177;&#8239;12 years&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Of the 7548 admissions analyzed&#44; 3786 corresponded to first admissions &#40;50&#46;2&#37;&#41; and 3762 &#40;49&#46;8&#37;&#41; to readmissions&#44; with 7276 &#40;96&#46;4&#37;&#41; of the cases accounting for emergency admissions and 272 for scheduled admissions &#40;3&#46;6&#37;&#41;&#46; Regarding the discharge destination&#44; the patients returned to their usual place of residence or nursing home in 6509 &#40;86&#46;2&#37;&#41; of the cases&#44; were transferred to another hospital in 149 &#40;2&#37;&#41; of the cases&#44; were transferred to another healthcare center in 108 &#40;1&#46;4&#37;&#41; of the cases and were discharged voluntarily in 11 &#40;0&#46;1&#37;&#41; of the cases&#44; with no information being recorded in this regard in 56 cases &#40;0&#46;7&#37;&#41;&#46; A total of 715 patients died during the hospitalization &#40;9&#46;5&#37; of all episodes recorded over the study period and 18&#46;9&#37; of all patients in the study population&#41;&#44; thereby accounting for a crude mortality rate of 18&#46;9&#37; for the study population and an age-adjusted mortality rate of 26&#46;6&#37;&#46; The mean hospital stay was 9&#46;6&#8239;&#177;&#8239;12 days&#44; and the mean calculated expenditure per admission over the entire study period was &#1028;4069&#8239;&#177;&#8239;&#1028;4239&#46; With regard to the geographical distribution of the admissions&#44; the autonomous regions that recorded the most admissions were Andalusia &#40;1451&#59; 19&#46;2&#37;&#41;&#44; Madrid &#40;1060&#59; 14&#37;&#41; and Catalonia &#40;947&#59; 12&#46;5&#37;&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Temporal evolution of the admissions over the study period</span><p id="par0075" class="elsevierStylePara elsevierViewall">A total of 7548 hospitalizations of patients with DS were recorded over the study period&#46; <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> shows the annual evolution of the number of admissions&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">The mean patient age at admission increased progressively over the study period&#44; from 43&#8239;&#177;&#8239;12 years in 2005 to 50&#8239;&#177;&#8239;12 years in 2014&#44; following a statistically significant trend &#40;F&#44; 26&#46;35&#59; p&#8239;&#60;&#8239;&#46;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; This increase was also observed in the sex-stratified analysis&#44; with no significant differences between the two sexes&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Reasons for admission and comorbidities of patients with Down syndrome</span><p id="par0085" class="elsevierStylePara elsevierViewall">As shown in <a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#44; the DRGs analysis revealed that the most frequent causes of hospitalization in decreasing order were respiratory diseases &#40;3684&#44; 48&#46;8&#37;&#41;&#44; heart diseases &#40;760&#44; 10&#37;&#41;&#44; and digestive diseases &#40;353&#44; 4&#46;7&#37;&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">The respiratory disease group mainly encompassed the following DRGs&#58; simple pneumonia &#40;1289&#44; 17&#46;1&#37;&#41;&#44; pneumonia with uncomplicated pleural effusion &#40;468&#44; 6&#46;2&#37;&#41;&#44; complicated respiratory infections &#40;452&#44; 6&#37;&#41; and pneumonia with pleural effusion and major complications &#40;373&#44; 4&#46;9&#37;&#41;&#46; The most frequently recorded diagnoses in the analysis by diagnosis were simple pneumonia &#40;1437&#44; 19&#37;&#41;&#44; inhalation pneumonitis &#40;1020&#44; 13&#46;5&#37;&#41;&#44; acute bronchitis &#40;407&#44; 5&#46;4&#37;&#41; and pneumococcal pneumonia &#40;303&#44; 4&#37;&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Admissions for cardiac causes were distributed among the following DRGs&#58; pulmonary edema &#40;359&#44; 4&#46;8&#37;&#41;&#44; heart failure and arrhythmia &#40;168&#44; 2&#46;2&#37;&#41;&#44; heart failure and shock &#40;106&#44; 1&#46;4&#37;&#41;&#44; uncomplicated syncope and collapse &#40;64&#44; 0&#46;84&#37;&#41; and circulatory disorders &#40;63&#44; 0&#46;83&#37;&#41;&#46; The analysis by diagnosis highlighted 687 diagnoses &#40;current or previous&#41; of heart failure&#44; 331 septal defects&#44; 280 valve diseases &#40;including 151 diagnoses of aortic valve disease and 133 diagnoses of mitral valve disease&#41; and Only 21 and 7 cases of chronic ischemic heart disease and acute myocardial infarction&#44; respectively&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">A total of 353 &#40;4&#46;7&#37;&#41; admissions were caused by gastrointestinal diseases&#44; including acute gastroenteritis and abdominal pain without complications &#40;110&#44; 1&#46;5&#37;&#41;&#44; esophagitis and digestive tract disorders &#40;81&#44; 1&#46;1&#37;&#41;&#44; digestive disorders with major complications &#40;56&#44; 0&#46;7&#37;&#41;&#44; gastroenteritis and abdominal pain with major complications &#40;54&#44; 0&#46;7&#37;&#41; and esophagitis and ulcer without complications &#40;52&#44; 0&#46;7&#37;&#41;&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Urological disorders accounted for 280 &#40;3&#46;7&#37;&#41; admissions&#44; including complicated urinary tract infections &#40;103&#44; 1&#46;4&#37;&#41;&#44; urinary tract disorders associated with a secondary complication &#40;91&#44; 1&#46;2&#37;&#41;&#44; and uncomplicated urinary tract infections &#40;86&#44; 1&#46;1&#37;&#41;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">A total of 269 &#40;3&#46;6&#37;&#41; cases of sepsis were identified&#44; with 48 &#40;0&#46;6&#37;&#41; cases corresponding to episodes of sepsis not associated with noninvasive mechanical ventilation and 221 &#40;2&#46;9&#37;&#41; to episodes of sepsis with major complications&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">The primary DRGs of neurological origin &#40;188 admissions&#44; 2&#46;5&#37;&#41; corresponded to 78 &#40;1&#37;&#41; cases of transient ischemic attacks&#44; seizures&#44; and complicated headaches&#59; 65 &#40;0&#46;9&#37;&#41; cases of uncomplicated seizures&#59; and 45 &#40;0&#46;6&#37;&#41; cases of other nervous system disorders&#46; The analysis by diagnosis identified a history of transient ischemic attack or stroke in 56 cases&#44; with 7 admissions due to a diagnosed transient ischemic attack and 2 due to a stroke&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> summarizes the most relevant comorbidities recorded among the population of adults with DS on admission&#44; including Hypothyroidism &#40;27&#46;1&#37;&#41;&#44; epilepsy &#40;24&#46;1&#37;&#41;&#44; dementia &#40;15&#46;4&#37;&#41; and obesity &#40;9&#46;3&#37;&#41;&#44; together with a low prevalence of arterial hypertension &#40;3&#46;2&#37;&#41;&#44; depression &#40;1&#46;5&#37;&#41;&#44; osteoporosis &#40;1&#37;&#41;&#44; cancer &#40;0&#46;7&#37;&#41; and tobacco use &#40;0&#46;7&#37;&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">The Charlson index score was 0 in 5427 &#40;71&#46;9&#37;&#41; of the cases&#44; 1 in 1389 &#40;18&#46;4&#37;&#41; of the cases&#44; 2 in 460 &#40;6&#46;1&#37;&#41; of the cases and &#62;2 in 264 &#40;3&#46;5&#37;&#41; of the cases&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discussion</span><p id="par0130" class="elsevierStylePara elsevierViewall">More than a third of hospitalized adults with DS are admitted to internal medicine wards&#44; with the number of admissions of increasingly older patients with DS to these wards having risen gradually over the past decade&#46; These admissions account for an age-adjusted mortality of 26&#46;6&#37; and are primarily caused by respiratory diseases&#44; with hypothyroidism and epilepsy recorded as the most frequent comorbidities&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Neither the gradual rise in the number of admissions nor the increase in mean age of the population of adults with DS over the study period are surprising considering the known progressive increase in the mean life expectancy of adults with DS &#40;hospitalized or not&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;34&#8211;36</span></a> However&#44; the mean hospital stay and the healthcare expenditure per admission of a Spanish adult with DS recorded in our study differed from those reported in previous studies also performed with this patient population&#46; In fact&#44; the data obtained for these two factors were similar to those described for the general population of patients admitted to Spanish internal medicine wards&#44; except for the remarkable difference in the mean age of the two populations&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">37&#44;38</span></a> Most studies performed to date with patients with DS have reported a greater use of healthcare services by this population compared with the population without DS&#44;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">35&#44;39&#8211;41</span></a> although it is difficult to compare the results obtained in our study with those of historical case series because the latter included pediatric patients&#46; The discrepancy between such data and our current results might be explained by the fact that many hospitalizations of patients in this older age group are related to cardiovascular surgical interventions&#44; which are typically linked to long mean hospital stays&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">The age-adjusted in-hospital mortality among adults with DS was clearly higher than that observed among the general population admitted to Spanish internal medicine wards&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">37</span></a> We were unable to derive hypotheses in this regard based on the current data&#59; Given the relevance of this parameter&#44; however&#44; we believe that a more detailed analysis of the causes and determining factors of these deaths should be performed in future studies&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">With regard to the analysis of comorbidities&#44; the high prevalence of hypothyroidism&#44; epilepsy and dementia observed among our study population was consistent with that described previously in outpatients with DS&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> However&#44; we were particularly surprised by the very low prevalence among our study population of other comorbidities that are frequently associated with patients with DS&#44; such as obstructive sleep apnea-hypopnea syndrome&#44; celiac disease and depression&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">26&#44;42&#44;43</span></a> We believe that this difference could be explained by an underdiagnosis or under-reporting of these conditions considered to be of little relevance in the clinical context of the admission in these patients&#8217; discharge reports&#46; Even so&#44; these data highlight the need for increased awareness among healthcare professionals of the most relevant clinical disorders that affect this population so as to enable the collection of patients&#8217; medical history on admission to serve as an opportunity to detect these conditions&#46; We were also surprised by the high prevalence of chronic obstructive pulmonary disease among our study population&#44; especially considering the low observed prevalence of smoking&#46; The diagnoses of chronic obstructive pulmonary disease reported among our study population could therefore have corresponded to presumptive diagnoses that were not confirmed by functional tests&#44; possibly because of the healthcare professionals&#8217; need to categorize the respiratory disorders observed among this population within a known framework&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Conversely&#44; the low prevalence of classic cardiovascular risk factors &#40;obesity&#44; diabetes mellitus&#44; hypercholesterolemia&#44; arterial hypertension&#44; and smoking habits&#41; among our population with DS was remarkable in comparison with both the general Spanish population<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a> and other populations with intellectual disabilities&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">45&#44;46</span></a> This difference could also be partly related to the lesser clinical relevance of these diseases throughout the hospitalization period&#44; given That the prevalence of weight disorders reported among the outpatient population of adults with DS is close to 65&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#44;25</span></a> In spite of this&#44; several studies have reported a very low prevalence of metabolic syndrome among adults with DS&#44;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#44;45</span></a> and the results of our study support these findings&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Our study also found a very low rate of admissions due to cardiovascular diseases&#44; such as ischemic heart disease&#44; stroke and heart failure&#46; These results support the hypothesis that premature tissue aging occurs unevenly throughout the bodies of patients with DS&#46; Physiopathological hypotheses for this cardiovascular protection include hypoplasia of the sympathetic autonomic nervous system&#44; a different regulation of the renin-angiotensin-aldosterone system and an imbalance in the leptin&#47;adiponectin ratio&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">Despite observing these and other comorbidities among our study sample&#44; the Charlson index score&#44; which is a frequently employed prognostic determinant for the general hospitalized population&#44; was strikingly low in our study population&#44; As almost 3 out of every 4 patients achieved a score of 0&#44; and only 3&#46;5&#37; of all admissions yielded a score of over 2 points&#46; Considering the discrepancy between the mortality rates and the low comorbidity rate calculated by the Charlson index&#44; we suspect that this predictor loses discriminatory power and prognostic capacity with the population analyzed in our study&#46; Thus&#44; further research should be performed to analyze the factors related to mortality among this population&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">We are aware that our analysis has some limitations&#44; including the fact That the use of an administrative database entails a partial loss of information during the writing of discharge reports and their subsequent encoding&#46; Moreover&#44; the under-reporting of some relatively minor diagnoses on admission might have caused the diagnostic differences observed between the inpatient and outpatient population with DS&#46; It should also be noted that the diagnosis of DS in discharge reports is often based on phenotypic expression and is rarely confirmed by a review of previous genetic results&#46; Therefore&#44; our results might have not been able to fully capture the complexity of adult patients with DS&#46; Nevertheless&#44; one of the strengths of our study lies in its sample size&#44; as this was the largest analysis performed to date on the Spanish hospitalized population&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">In conclusion&#44; this study presents the main characteristics of hospital admissions of Spanish patients with DS&#44; Who are currently characterized by a longer life expectancy compared with their previous generations&#46; These patients share numerous similarities with other patient populations admitted to internal medicine wards and have a different comorbidity profile with rates not lower than those of the general population&#46; The progressive increase in these patients&#8217; mean age and the presence of comorbidities on admission entails that internal medicine doctors are probably the best equipped to coordinate multidisciplinary care for this patient population&#46; We hope our study will serve as a starting point for further research that will enable a better understanding of this population&#8217;s aging process&#44; guide the future training of health professionals and thereby facilitate their familiarization with this population with a view to provide better and more efficient health care&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Funding</span><p id="par0175" class="elsevierStylePara elsevierViewall">The present study was funded by the <span class="elsevierStyleGrantSponsor" id="gs0005">Foundation J&#233;r&#244;me Lejeune</span> &#40;Project number 1777 Down-Lejeune-Comorbidity&#41;&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflicts ofinterest</span><p id="par0180" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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          "palabras" => array:3 [
            0 => "Medicina interna"
            1 => "S&#237;ndrome de Down"
            2 => "Hospitalizaci&#243;n"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background and objectives</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The clinical problems of adults with Down syndrome &#40;DS&#41; seem to differ from those of the general population&#46; To better understand these differences&#44; we list the demographic and clinical characteristics of adults with DS admitted to Spanish internal medicine departments during 2005&#8211;2014&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Patients and methods</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">We conducted an observational retrospective study using data collected from the minimum basic data set on hospitalisation episodes of adults with DS in the internal medicine departments of Spain&#8217;s National Health System from 2005 to 2014&#46; We analysed the patients&#8217; epidemiological&#44; clinical and societal data&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A total of 7548 hospitalisation episodes from 3786 patients were recorded&#46; Some 56&#46;6&#37; of the patients were male with a mean age &#40;&#177;SD&#41; of 47&#8239;&#177;&#8239;13 years&#44; and 715 of the patients died &#40;18&#46;9&#37;&#41;&#46; The age-adjusted mortality was 26&#46;6&#37;&#44; and the mean stay was 9&#46;6&#8239;&#177;&#8239;12 days&#46; The hospitalisation was for respiratory disease in 3684 episodes &#40;48&#46;8&#37;&#41; and for cardiac origin in 760 &#40;10&#37;&#41;&#46; The most common comorbidities were hypothyroidism &#40;27&#46;1&#37;&#44; 2043 episodes&#41;&#44; epilepsy &#40;24&#46;1&#37;&#44; 1819 episodes&#41; and dementia &#40;15&#46;4&#37;&#44; 1162 episodes&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">The hospitalisation of adults with DS in internal medicine departments has increased in the past decade&#46; Although the reasons for hospitalisation&#44; mean stay and cost per episode for this population are similar to those of the general population treated by internal medicine departments&#44; the age-adjusted hospital mortality was significantly greater&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Background and objectives"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Patients and 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">Introducci&#243;n y objetivos</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Los problemas cl&#237;nicos de los adultos con s&#237;ndrome de Down &#40;SD&#41; parecen diferir de los de la poblaci&#243;n general&#46; Para entender mejor estas diferencias describimos las caracter&#237;sticas demogr&#225;ficas y cl&#237;nicas de los adultos con SD que ingresaron en los servicios de Medicina Interna espa&#241;oles en el periodo de 2005&#8211;2014&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Pacientes y m&#233;todos</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional retrospectivo sobre datos recogidos en el conjunto m&#237;nimo b&#225;sico de datos &#40;CMBD&#41; de los episodios de ingreso de adultos con SD en los servicios de Medicina Interna del Sistema Nacional de Salud desde 2005 a 2014&#46; Se analizaron variables epidemiol&#243;gicas&#44; cl&#237;nicas y sociales&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Se registraron 7&#46;548 episodios de ingreso de 3&#46;786 pacientes&#46; El 56&#44;6&#37; eran varones con una edad media &#40;&#177; DE&#41; de 47&#8239;&#177;&#8239;13 a&#241;os&#46; Fallecieron 715 pacientes &#40;18&#44;9&#37;&#41;&#46; La mortalidad ajustada a la edad fue 26&#44;6&#37; y su estancia media fue de 9&#44;6&#8239;&#177;&#8239;12 d&#237;as&#46; En 3&#46;684 episodios &#40;48&#44;8&#37;&#41; el ingreso fue por patolog&#237;a respiratoria y en 760 &#40;10&#37;&#41;&#44; de origen cardiol&#243;gico&#46; Las comorbilidades m&#225;s frecuentes fueron el hipotiroidismo &#40;27&#44;1&#37;&#44; 2&#46;043 episodios&#41;&#44; la epilepsia &#40;24&#46;1&#37;&#44; 1&#46;819 episodios&#41; y la demencia &#40;15&#46;4&#37;&#44; 1&#46;162 episodios&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Los ingresos de adultos con SD en los servicios de Medicina Interna han aumentado en la &#250;ltima d&#233;cada&#46; Si bien los motivos de ingreso&#44; estancia media y coste por episodio de esta poblaci&#243;n son similares a los de la poblaci&#243;n general atendida en Medicina Interna&#44; la mortalidad intrahospitalaria ajustada por edad fue significativamente mayor&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Introducci&#243;n y objetivos"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Pacientes y m&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Aparicio P&#44; et al&#46; Caracter&#237;sticas de los adultos con s&#237;ndrome de Down ingresados en los servicios de medicina interna espa&#241;oles en el periodo 2005&#8211;2014&#46; Rev Clin Esp&#46; 2020&#59;220&#58;553&#8211;560&#46;</p>"
      ]
    ]
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      0 => array:8 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 872
            "Ancho" => 1590
            "Tamanyo" => 71976
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        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0005"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Annual change in the number of hospitalizations of adults with Down syndrome in Spanish internal medicine departments&#46;</p>"
        ]
      ]
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        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1048
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            "Tamanyo" => 92851
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        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0010"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Annual change in the mean age at discharge of Adults with Down syndrome&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 1225
            "Ancho" => 2128
            "Tamanyo" => 131002
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        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0015"
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Most common diagnosis-related groups in adult patients with Down syndrome hospitalized in Spanish internal medicine departments &#40;grouped by diagnostic category&#41;&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0020"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">AHT&#44; arterial hypertension&#59; CHF&#44; congestive heart failure&#59; CKD&#44; chronic kidney disease&#59; COPD&#44; chronic obstructive pulmonary disease&#59; GER&#44; gastroesophageal reflux&#59; HBV&#44; hepatitis B virus&#59; HCV&#44; hepatitis C virus&#59; OSAHS&#44; obstructive sleep apnea-hypopnea syndrome&#46;</p>"
          "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="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Comorbidity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Frequency&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Comorbidity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Frequency&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hypothyroidism&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2043 &#40;27&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hypoacusis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">184 &#40;2&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Epilepsy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1819 &#40;24&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Asthma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">148 &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dementia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1162 &#40;15&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Depression&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">116 &#40;1&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Obesity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">701 &#40;9&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SAHS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">109 &#40;1&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Diabetes mellitus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">706 &#40;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HBV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">102 &#40;1&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">COPD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">581 &#40;7&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">GER&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">95 &#40;1&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hypercholesterolemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">506 &#40;6&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Celiac disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">79 &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CHF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">448 &#40;5&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Osteoporosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">76 &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CKD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">368 &#40;4&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HCV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Constipation&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">307 &#40;4&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">66 &#40;0&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">270 &#40;3&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">61 &#40;0&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t  " align="left" valign="\n
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