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The provision for days 1&#8211;3 depends on the type of affiliation and labor agreements&#46; TD process starts and ends at the primary care physician level&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Although there are some studies&#44;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a> no information was found on the cost of TD due to MD or its variability by Region &#40;CC&#46; AA&#46;&#41; or payer&#46; For this reason&#44; we decided to perform this study aimed at estimating the annual cost of TD caused by MD in Spain and its variability between CC&#46; AA&#46; and payers&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methodology</span><p id="par0015" class="elsevierStylePara elsevierViewall">This was a descriptive study of cost estimation of TD caused by MD in Spain&#44; using secondary data from INSS&#46; The INSS provided a table for each Spanish province which consisted the number of TD processes&#44; the number of total days of TD and the mean duration of the process&#44; by sex and age of TD processes regarding common diseases in 2007&#46; The INSS classifies a process as MD parting from an official evaluation as part of ICD-9-CM coding&#46; In the absence of data on TD due to MD&#44; the number of processes and their duration were estimated as the ratios of affiliation&#44; incidence and duration in each other with respect to INSS<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&#46; To estimate costs&#44; we considered the amount of the benefit and the days of TD paid by the INSS or mutual&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;6&#44;7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The additional part paid for by the employer varies with the type of collective agreement&#46; Given the variability of the agreements&#44; it was assumed that&#44; on average&#44; companies pay 80&#37; of the employee&#39;s salary the first 3 days&#44; completing what is paid for by the INSS or mutual to 80&#37; from day 4 to 20&#44; and even 90&#37; from day 21 onwards&#46; To estimate the costs by type of affiliation&#44; we considered the proportion of workers belonging to each regime&#58; General Regime &#40;RG&#41;&#44; Special Scheme for Self-Employed &#40;RETA&#41;&#44; Special Agricultural Self-paid Scheme&#44; Special Agricultural Scheme paid by the employer&#44; Home makers regime &#40;REEH&#41;&#44; Special Scheme for Coal Mining &#40;REMC&#41; and Special Scheme for Sea workers&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> The average daily INSS contribution base for the affiliate scheme was adjusted for changes in salary by gender and CC&#46; AA&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Information on employed persons and GDP and for the CC&#46; AA&#46; was obtained from the National Statistics Institute&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#8211;11</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0025" class="elsevierStylePara elsevierViewall">MDs were the leading cause of TD in Spain&#44; producing 908<span class="elsevierStyleHsp" style=""></span>781 TD processes &#40;18&#37; of all processes&#41;&#44; 39<span class="elsevierStyleHsp" style=""></span>342<span class="elsevierStyleHsp" style=""></span>857 lost work days &#40;23&#37; of days lost per TD&#41; and a cost of 1702 million euros &#40;23&#37; of the cost of all TD l&#41;&#46; TD processes of longer duration were caused by mental illness&#44; which accounted for 11&#37; of TD costs&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The average cost of an episode of TD due to MD was 1873 &#8364;&#46; In all&#44; 57&#37; of the processes and 53&#37; of the cost of TD due to MD occurred in women&#46; However&#44; the average cost of TD was lower in women than in men&#58; 1746 &#8364; vs 2040 &#8364;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Of the TD processes&#44; 18&#37; is caused by MD&#44; but in Galicia this was 24&#37;&#44; while in Catalonia it was 10&#37;&#46; The average duration of an absence due to MD in Spain is 43 days&#44; but varies between a maximum of 54 days in Asturias and a minimum of 35 days in La Rioja&#46; The annual number of TD processes due to MD per 1000 employed persons was 44&#46;6 in Spain&#44; ranging from a high of 70 in the Basque Country&#44; Navarra and Canarias &#40;except Ceuta and Melilla&#41; to a minimum of 28 in Catalonia&#46; The mean cost of a TD process due to MD in Spain was 1873 &#8364;&#44; with a maximum value in the Basque Country &#40;2429 &#8364;&#41; and a minimum in La Rioja &#40;1391 &#8364;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">The average cost per TD due to MD per employed person in Spain was 83&#46;6 &#8364;&#59; the Basque Country had the highest &#40;169 &#8364;&#41;&#44; while Murcia &#40;54 &#8364;&#41; had the lowest cost per employee&#46; The cost of TD due to MD in Spain represented 1&#46;62 &#8364; per 1000 &#8364; of GDP&#46; The Basque Country &#40;2&#46;58 &#8364;&#41; had the highest TD costs due to MD per 1000 &#8364; of GDP and Catalonia &#40;0&#46;98 &#8364;&#41;&#44; the lowest &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Schemes with a higher proportion of unionized workers are the RG &#40;76&#46;87&#37;&#41; and RETA &#40;16&#46;22&#37;&#41;&#44; and consequently are schemes in which the higher costs occur in absolute terms&#58; 88&#37; &#40;1 &#46;498 million&#41; of costs occurred in the RG members&#44; followed by those from RETA &#40;8&#46;5&#37; of costs&#41;&#46; Members of the REMC had the lowest absolute cost&#44; but a higher cost per member &#40;0&#46;10&#37; of costs and 0&#46;05&#37; of members&#41;&#46; In all&#44; 39&#37; of the costs are borne by the INSS&#44; 35&#37; from mutual and 26&#37; is paid by companies &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0050" class="elsevierStylePara elsevierViewall">MDs were the leading cause of TD in Spain in 2007&#44; representing 18&#37; of processes&#44; 23&#37; of days lost and 23&#37; of the cost of TD caused by all diseases&#46; The mean duration per TD process due to MD is approximately one and one-half months &#40;43 days&#41;&#46; The proportion of TD processes due to MD in Spain was higher in women than in men&#44; consistent with the fact that the MDs are more common in women&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> However&#44; the average cost per episode for TD was lower in women than in men&#44; perhaps due to the different distributions of the type of employment and wages between the genders&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The observed variability in the number of processes&#44; duration and costs between CC&#46; AA&#46; is consistent with previous studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a> However&#44; in our study the proportion of TD due to MD in Catalonia &#40;10&#37;&#41; was lower than that of a 2009 study&#44; where MDs were the second cause of TD &#40;19&#37; of total&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> One possible explanation for this difference could be the improvement in diagnostic coding in Catalonia&#44; as in the Catalonia INSS data for 2007&#44; 42&#37; of TD processes were not diagnosed&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Variability in TD length between CC&#46; AA&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> had been previously explored&#44; referring to the factors influencing return to work after TD&#44; which were the CC&#46; AA&#46;&#44; age&#44; gender and economic activity of the patient&#46; It is difficult to find an explanation for the differences in the number of TD processes due to MD between CC&#46; AA&#46; after adjusting for the employed population&#46; They could be due to structural factors&#44; for example&#44; the different compositions of the working population&#44; but could also be due to organizational aspects&#44; such as differences in the control of sick leave between CC&#46; AA&#46; factors&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The cost per procedure varies widely depending on the type of affiliation&#46; For example&#44; the average cost of a TD process due to MD in REMC is 3776&#44; twice the average and 5 times higher than that in REEH&#46; This is due&#44; among other reasons&#44; to the fact that the average contribution base of REMC is much higher than in REEH &#40;82&#46;86 &#8364; vs 22&#46;18 &#8364;&#41;&#46; According to the affiliate scheme and the entity that pays the TD&#44; the INSS &#40;39&#37;&#41; and mutual &#40;35&#37;&#41; bear most of the cost of TD due to MD&#44; and the employer &#40;26&#37;&#41; comes in third&#46; Payment for TD is a little lower in mutual &#40;35&#37; vs INSS 39&#37;&#41;&#44; because&#44; although for each worker covered by the INSS there are 1&#46;35 covered by mutual&#44; prevalence and the duration of TD processes are 20&#37; lower in mutual compared to that in INSS&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">One limitation of the study is that the information relates to the year 2007 and the findings must be interpreted in the context of the economic situation and the Spanish health system at that date&#46; Another limitation could be that the data provided by the INSS may have a misclassification bias&#44; since the data come from the &#8220;official reports&#8221; given by doctors&#44; who might assign the process of TD to a given condition when a patient has more than one&#46; This and other potential limitations of the study come primarily from the limited information available for research&#46; Consequently&#44; it is crucial to improve information systems and research projects that contribute to produce knowledge on the indirect costs of disease in Spain&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">In conclusion&#44; MDs were the leading cause of TD in Spain in 2007&#44; producing more than 900<span class="elsevierStyleHsp" style=""></span>000 episodes of TD&#44; 39 million days off work and a considerable cost to the INSS&#44; and mutual companies&#44; which together amounted to 1<span class="elsevierStyleHsp" style=""></span>700<span class="elsevierStyleHsp" style=""></span>000<span class="elsevierStyleHsp" style=""></span>000 euros&#46; There is a wide variability in CC&#46; AA&#46; on different indicators analyzed and membership schemes&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">This article is an abridged version of the &#8220;Cost of temporary disability due to musculoskeletal diseases in Spain&#8221; report&#46; This report can be obtained at <a id="intr0010" class="elsevierStyleInterRef" href="http://www.taiss.com/publi/absful/informe-coste-incapacidad-temporal-enfermedades-musculo-esqueleticas-taiss.pdf">http&#58;&#47;&#47;www&#46;taiss&#46;com&#47;publi&#47;absful&#47;informe-coste-incapacidad-temporal-enfermedades-musculo-esqueleticas-taiss&#46;pdf</a>&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Ethical Responsibilities</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Protection of people and animals</span><p id="par0085" class="elsevierStylePara elsevierViewall">The authors declare that no experiments have been performed on humans or animals&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Data confidentiality</span><p id="par0090" class="elsevierStylePara elsevierViewall">The authors state that no patient data appear in this article&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Right to privacy and informed consent</span><p id="par0095" class="elsevierStylePara elsevierViewall">The authors state that no patient data appear in this article&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Funding</span><p id="par0100" class="elsevierStylePara elsevierViewall">This study was funded by the Abbott Foundation&#44; which was not involved in the analysis or in drafting the manuscript&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflicts of Interest</span><p id="par0105" class="elsevierStylePara elsevierViewall">The authors declare no conflicts of interest&#46;</p></span></span>"
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              "titulo" => "Protection of people and animals"
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              "titulo" => "Data confidentiality"
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              "identificador" => "sec0040"
              "titulo" => "Right to privacy and informed consent"
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          "titulo" => "Funding"
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          "titulo" => "Acknowledgements"
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          "titulo" => "References"
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    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2013-04-10"
    "fechaAceptado" => "2013-07-04"
    "PalabrasClave" => array:2 [
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec307730"
          "palabras" => array:4 [
            0 => "Musculoskeletal diseases"
            1 => "Work leaves"
            2 => "Indirect costs"
            3 => "Variability"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec307731"
          "palabras" => array:4 [
            0 => "Enfermedades musculoesquel&#233;ticas"
            1 => "Bajas laborales"
            2 => "Costes indirectos"
            3 => "Variabilidad"
          ]
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    "resumen" => array:2 [
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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To estimate the annual cost of temporary work disability &#40;TWD&#41; caused by musculoskeletal diseases &#40;MDs&#41; in Spain and its variations between regions &#40;autonomous communities&#58; ACs&#41; and paying institutions&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">Method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Descriptive study of the costs of MD-related TWD in ACs in 2007&#46; The Spanish National Institute of Social Security &#40;NISS&#41; provided aggregate data&#46; Extrapolations to the rest of the TWD payers &#40;mutual societies and employers&#41; were used&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">MDs were the leading cause of TWD in Spain in 2007&#44; causing 908<span class="elsevierStyleHsp" style=""></span>781 episodes of TWD &#40;18&#37; of the total&#41;&#44; 39<span class="elsevierStyleHsp" style=""></span>342<span class="elsevierStyleHsp" style=""></span>857 lost working days &#40;23&#37;&#41;&#44; and a cost of 1702 million euros &#40;23&#37;&#41;&#46; The annual incidence of TWD episodes per 1000 employed was 45&#46; The cost per TWD process was 1873 &#8364;&#44; ranging from 1391 &#8364; &#40;La Rioja&#41; to 2429 &#8364; &#40;The Basque Country&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">MDs produce annually in Spain over 39 million days lost by TWD with a cost of over 1700 million euros&#46; Regions observed wide variations of the TWD cost&#46;</p>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Estimar el coste anual de la incapacidad temporal &#40;IT&#41; ocasionada por las enfermedades musculoesquel&#233;ticas &#40;EME&#41; en Espa&#241;a y su variabilidad entre comunidades aut&#243;nomas &#40;CC&#46; AA&#46;&#41; y entidades pagadoras&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio descriptivo de costes por IT debida a EME en las CC&#46; AA&#46; en el 2007&#46; Se utilizaron datos agregados del Instituto Nacional de Seguridad Social &#40;INSS&#41; y extrapolaciones a las entidades que realizan el pago de la IT &#40;INSS&#44; mutuas y empresas&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Las EME fueron la primera causa de IT en Espa&#241;a en 2007&#44; produciendo 908&#46;781 episodios de IT &#40;18&#37; del total&#41;&#44; 39&#46;342&#46;857 d&#237;as de baja &#40;23&#37;&#41; y 1&#46;702 millones de euros de coste &#40;23&#37;&#41;&#46; La incidencia anual de procesos de IT por EME por cada 1&#46;000 personas ocupadas fue de 45&#46; El coste por proceso de IT fue de 1&#46;873 oscilando entre un m&#237;nimo de 1&#46;391 &#8364; &#40;La Rioja&#41; y un m&#225;ximo de 2&#46;429 &#8364; &#40;Pa&#237;s Vasco&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Las EME producen anualmente en Espa&#241;a m&#225;s de 39 millones de d&#237;as de baja por IT&#44; con un coste superior a 1&#46;700 millones de euros&#46; El coste de la IT tiene una amplia variabilidad entre CC&#46; AA&#46;</p>"
      ]
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; L&#225;zaro P&#44; Parody E&#44; Garc&#237;a-Vicu&#241;a R&#44; Gabriele G&#44; Jover J&#193;&#44; Sevilla J&#46; Coste de la incapacidad temporal debida a enfermedades musculoesquel&#233;ticas en Espa&#241;a&#46; Reumatol Clin&#46; 2014&#59;10&#58;109&#8211;112&#46;</p>"
      ]
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        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">CC&#46; AA&#46;&#44; autonomous community&#59; MD&#44; musculoskeletal disease&#59; TD&#44; temporary disability&#59; GDP&#44; gross domestic product&#46;</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">In bold the average for Spain is represented&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td 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">CC&#46; AA&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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">Ratio TD processes due to MD&#47;total disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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">Time spent by TD process due to MD &#40;days&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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">TD processes due to MD per 1000 persons employed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Cost of TD due to MD &#40;&#8364;&#41;</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Average cost per TD process&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Cost per subject occupied&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Cost per &#36; 1000 of GDP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><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">Andaluc&#237;a&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;21&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&#46;16&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&#46;4&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1513&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&#46;20&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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">Aragon&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;17&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
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                  \t\t\t\t">Asturias&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Baleares&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Canary Islands&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Extremadura&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Galicia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">1886&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">94&#46;92&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Rioja&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1391&nbsp;\t\t\t\t\t\t\n
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                  """
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Company&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">INSS&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Mutual&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">INSS&#43;Mutual&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Total&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">76&#46;87&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">427<span class="elsevierStyleHsp" style=""></span>424<span class="elsevierStyleHsp" style=""></span>946&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">556<span class="elsevierStyleHsp" style=""></span>875<span class="elsevierStyleHsp" style=""></span>540&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">514<span class="elsevierStyleHsp" style=""></span>082<span class="elsevierStyleHsp" style=""></span>600&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1<span class="elsevierStyleHsp" style=""></span>070<span class="elsevierStyleHsp" style=""></span>958<span class="elsevierStyleHsp" style=""></span>140&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1<span class="elsevierStyleHsp" style=""></span>498<span class="elsevierStyleHsp" style=""></span>383<span class="elsevierStyleHsp" style=""></span>086&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">88&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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">Self-employed&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#46;22&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">OR&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">76<span class="elsevierStyleHsp" style=""></span>572<span class="elsevierStyleHsp" style=""></span>384&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68<span class="elsevierStyleHsp" style=""></span>583<span class="elsevierStyleHsp" style=""></span>976&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">145<span class="elsevierStyleHsp" style=""></span>156<span class="elsevierStyleHsp" style=""></span>360&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">145<span class="elsevierStyleHsp" style=""></span>156<span class="elsevierStyleHsp" style=""></span>360&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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">Agricultural own account&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;29&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">OR&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4<span class="elsevierStyleHsp" style=""></span>926<span class="elsevierStyleHsp" style=""></span>647&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4<span class="elsevierStyleHsp" style=""></span>159<span class="elsevierStyleHsp" style=""></span>820&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9<span class="elsevierStyleHsp" style=""></span>086<span class="elsevierStyleHsp" style=""></span>467&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9<span class="elsevierStyleHsp" style=""></span>086<span class="elsevierStyleHsp" style=""></span>467&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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">Agricultural other account&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;76&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">8<span class="elsevierStyleHsp" style=""></span>400<span class="elsevierStyleHsp" style=""></span>243&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12<span class="elsevierStyleHsp" style=""></span>273<span class="elsevierStyleHsp" style=""></span>694&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8<span class="elsevierStyleHsp" style=""></span>935<span class="elsevierStyleHsp" style=""></span>064&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21<span class="elsevierStyleHsp" style=""></span>208<span class="elsevierStyleHsp" style=""></span>758&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29<span class="elsevierStyleHsp" style=""></span>609<span class="elsevierStyleHsp" style=""></span>001&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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">Domestic employees&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;44&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">1<span class="elsevierStyleHsp" style=""></span>668<span class="elsevierStyleHsp" style=""></span>275&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4<span class="elsevierStyleHsp" style=""></span>186<span class="elsevierStyleHsp" style=""></span>766&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4<span class="elsevierStyleHsp" style=""></span>154<span class="elsevierStyleHsp" style=""></span>609&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8<span class="elsevierStyleHsp" style=""></span>341<span class="elsevierStyleHsp" style=""></span>375&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10<span class="elsevierStyleHsp" style=""></span>009<span class="elsevierStyleHsp" style=""></span>650&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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">Coal and mining&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;05&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">468<span class="elsevierStyleHsp" style=""></span>022&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">754<span class="elsevierStyleHsp" style=""></span>840&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">523<span class="elsevierStyleHsp" style=""></span>715&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1<span class="elsevierStyleHsp" style=""></span>278<span class="elsevierStyleHsp" style=""></span>555&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1<span class="elsevierStyleHsp" style=""></span>746<span class="elsevierStyleHsp" style=""></span>577&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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">Special sea&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;37&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">2<span class="elsevierStyleHsp" style=""></span>267<span class="elsevierStyleHsp" style=""></span>246&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3<span class="elsevierStyleHsp" style=""></span>302<span class="elsevierStyleHsp" style=""></span>539&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2<span class="elsevierStyleHsp" style=""></span>548<span class="elsevierStyleHsp" style=""></span>386&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5<span class="elsevierStyleHsp" style=""></span>850<span class="elsevierStyleHsp" style=""></span>925&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8<span class="elsevierStyleHsp" style=""></span>118<span class="elsevierStyleHsp" style=""></span>171&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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">All schemes&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&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">440<span class="elsevierStyleHsp" style=""></span>228<span class="elsevierStyleHsp" style=""></span>733&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">658<span class="elsevierStyleHsp" style=""></span>892<span class="elsevierStyleHsp" style=""></span>410&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">602<span class="elsevierStyleHsp" style=""></span>988<span class="elsevierStyleHsp" style=""></span>171&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1<span class="elsevierStyleHsp" style=""></span>261<span class="elsevierStyleHsp" style=""></span>880<span class="elsevierStyleHsp" style=""></span>581&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1<span class="elsevierStyleHsp" style=""></span>702<span class="elsevierStyleHsp" style=""></span>109<span class="elsevierStyleHsp" style=""></span>314&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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">&#37; total cost&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="" valign="\n
                  \t\t\t\t\ttop\n
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Brief Report
Cost of Temporary Work Disability Due to Musculoskeletal Diseases in Spain
Coste de la incapacidad temporal debida a enfermedades musculoesqueléticas en España
Pablo Lázaroa,
Corresponding author
plazaro@taiss.com

Corresponding author.
, Elizabeth Parodya, Rosario García-Vicuñab, Giovanna Gabrielec, Juan Ángel Joverd, Jordi Sevillae
a Técnicas Avanzadas de Investigación en Servicios de Salud, Madrid, Spain
b Servicio de Reumatología, Instituto de Investigación Sanitaria La Princesa, Hospital Universitario de la Princesa, Madrid, Spain
c Fundación Josep Laporte, Universidad Autónoma de Barcelona, Barcelona, Spain
d Servicio de Reumatología, Hospital Clínico San Carlos, Madrid, Spain
e PricewaterhouseCoopers, Madrid, Spain
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The provision for days 1&#8211;3 depends on the type of affiliation and labor agreements&#46; TD process starts and ends at the primary care physician level&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Although there are some studies&#44;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a> no information was found on the cost of TD due to MD or its variability by Region &#40;CC&#46; AA&#46;&#41; or payer&#46; For this reason&#44; we decided to perform this study aimed at estimating the annual cost of TD caused by MD in Spain and its variability between CC&#46; AA&#46; and payers&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methodology</span><p id="par0015" class="elsevierStylePara elsevierViewall">This was a descriptive study of cost estimation of TD caused by MD in Spain&#44; using secondary data from INSS&#46; The INSS provided a table for each Spanish province which consisted the number of TD processes&#44; the number of total days of TD and the mean duration of the process&#44; by sex and age of TD processes regarding common diseases in 2007&#46; The INSS classifies a process as MD parting from an official evaluation as part of ICD-9-CM coding&#46; In the absence of data on TD due to MD&#44; the number of processes and their duration were estimated as the ratios of affiliation&#44; incidence and duration in each other with respect to INSS<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&#46; To estimate costs&#44; we considered the amount of the benefit and the days of TD paid by the INSS or mutual&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;6&#44;7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The additional part paid for by the employer varies with the type of collective agreement&#46; Given the variability of the agreements&#44; it was assumed that&#44; on average&#44; companies pay 80&#37; of the employee&#39;s salary the first 3 days&#44; completing what is paid for by the INSS or mutual to 80&#37; from day 4 to 20&#44; and even 90&#37; from day 21 onwards&#46; To estimate the costs by type of affiliation&#44; we considered the proportion of workers belonging to each regime&#58; General Regime &#40;RG&#41;&#44; Special Scheme for Self-Employed &#40;RETA&#41;&#44; Special Agricultural Self-paid Scheme&#44; Special Agricultural Scheme paid by the employer&#44; Home makers regime &#40;REEH&#41;&#44; Special Scheme for Coal Mining &#40;REMC&#41; and Special Scheme for Sea workers&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> The average daily INSS contribution base for the affiliate scheme was adjusted for changes in salary by gender and CC&#46; AA&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Information on employed persons and GDP and for the CC&#46; AA&#46; was obtained from the National Statistics Institute&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#8211;11</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0025" class="elsevierStylePara elsevierViewall">MDs were the leading cause of TD in Spain&#44; producing 908<span class="elsevierStyleHsp" style=""></span>781 TD processes &#40;18&#37; of all processes&#41;&#44; 39<span class="elsevierStyleHsp" style=""></span>342<span class="elsevierStyleHsp" style=""></span>857 lost work days &#40;23&#37; of days lost per TD&#41; and a cost of 1702 million euros &#40;23&#37; of the cost of all TD l&#41;&#46; TD processes of longer duration were caused by mental illness&#44; which accounted for 11&#37; of TD costs&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The average cost of an episode of TD due to MD was 1873 &#8364;&#46; In all&#44; 57&#37; of the processes and 53&#37; of the cost of TD due to MD occurred in women&#46; However&#44; the average cost of TD was lower in women than in men&#58; 1746 &#8364; vs 2040 &#8364;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Of the TD processes&#44; 18&#37; is caused by MD&#44; but in Galicia this was 24&#37;&#44; while in Catalonia it was 10&#37;&#46; The average duration of an absence due to MD in Spain is 43 days&#44; but varies between a maximum of 54 days in Asturias and a minimum of 35 days in La Rioja&#46; The annual number of TD processes due to MD per 1000 employed persons was 44&#46;6 in Spain&#44; ranging from a high of 70 in the Basque Country&#44; Navarra and Canarias &#40;except Ceuta and Melilla&#41; to a minimum of 28 in Catalonia&#46; The mean cost of a TD process due to MD in Spain was 1873 &#8364;&#44; with a maximum value in the Basque Country &#40;2429 &#8364;&#41; and a minimum in La Rioja &#40;1391 &#8364;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">The average cost per TD due to MD per employed person in Spain was 83&#46;6 &#8364;&#59; the Basque Country had the highest &#40;169 &#8364;&#41;&#44; while Murcia &#40;54 &#8364;&#41; had the lowest cost per employee&#46; The cost of TD due to MD in Spain represented 1&#46;62 &#8364; per 1000 &#8364; of GDP&#46; The Basque Country &#40;2&#46;58 &#8364;&#41; had the highest TD costs due to MD per 1000 &#8364; of GDP and Catalonia &#40;0&#46;98 &#8364;&#41;&#44; the lowest &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Schemes with a higher proportion of unionized workers are the RG &#40;76&#46;87&#37;&#41; and RETA &#40;16&#46;22&#37;&#41;&#44; and consequently are schemes in which the higher costs occur in absolute terms&#58; 88&#37; &#40;1 &#46;498 million&#41; of costs occurred in the RG members&#44; followed by those from RETA &#40;8&#46;5&#37; of costs&#41;&#46; Members of the REMC had the lowest absolute cost&#44; but a higher cost per member &#40;0&#46;10&#37; of costs and 0&#46;05&#37; of members&#41;&#46; In all&#44; 39&#37; of the costs are borne by the INSS&#44; 35&#37; from mutual and 26&#37; is paid by companies &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0050" class="elsevierStylePara elsevierViewall">MDs were the leading cause of TD in Spain in 2007&#44; representing 18&#37; of processes&#44; 23&#37; of days lost and 23&#37; of the cost of TD caused by all diseases&#46; The mean duration per TD process due to MD is approximately one and one-half months &#40;43 days&#41;&#46; The proportion of TD processes due to MD in Spain was higher in women than in men&#44; consistent with the fact that the MDs are more common in women&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> However&#44; the average cost per episode for TD was lower in women than in men&#44; perhaps due to the different distributions of the type of employment and wages between the genders&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The observed variability in the number of processes&#44; duration and costs between CC&#46; AA&#46; is consistent with previous studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a> However&#44; in our study the proportion of TD due to MD in Catalonia &#40;10&#37;&#41; was lower than that of a 2009 study&#44; where MDs were the second cause of TD &#40;19&#37; of total&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> One possible explanation for this difference could be the improvement in diagnostic coding in Catalonia&#44; as in the Catalonia INSS data for 2007&#44; 42&#37; of TD processes were not diagnosed&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Variability in TD length between CC&#46; AA&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> had been previously explored&#44; referring to the factors influencing return to work after TD&#44; which were the CC&#46; AA&#46;&#44; age&#44; gender and economic activity of the patient&#46; It is difficult to find an explanation for the differences in the number of TD processes due to MD between CC&#46; AA&#46; after adjusting for the employed population&#46; They could be due to structural factors&#44; for example&#44; the different compositions of the working population&#44; but could also be due to organizational aspects&#44; such as differences in the control of sick leave between CC&#46; AA&#46; factors&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The cost per procedure varies widely depending on the type of affiliation&#46; For example&#44; the average cost of a TD process due to MD in REMC is 3776&#44; twice the average and 5 times higher than that in REEH&#46; This is due&#44; among other reasons&#44; to the fact that the average contribution base of REMC is much higher than in REEH &#40;82&#46;86 &#8364; vs 22&#46;18 &#8364;&#41;&#46; According to the affiliate scheme and the entity that pays the TD&#44; the INSS &#40;39&#37;&#41; and mutual &#40;35&#37;&#41; bear most of the cost of TD due to MD&#44; and the employer &#40;26&#37;&#41; comes in third&#46; Payment for TD is a little lower in mutual &#40;35&#37; vs INSS 39&#37;&#41;&#44; because&#44; although for each worker covered by the INSS there are 1&#46;35 covered by mutual&#44; prevalence and the duration of TD processes are 20&#37; lower in mutual compared to that in INSS&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">One limitation of the study is that the information relates to the year 2007 and the findings must be interpreted in the context of the economic situation and the Spanish health system at that date&#46; Another limitation could be that the data provided by the INSS may have a misclassification bias&#44; since the data come from the &#8220;official reports&#8221; given by doctors&#44; who might assign the process of TD to a given condition when a patient has more than one&#46; This and other potential limitations of the study come primarily from the limited information available for research&#46; Consequently&#44; it is crucial to improve information systems and research projects that contribute to produce knowledge on the indirect costs of disease in Spain&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">In conclusion&#44; MDs were the leading cause of TD in Spain in 2007&#44; producing more than 900<span class="elsevierStyleHsp" style=""></span>000 episodes of TD&#44; 39 million days off work and a considerable cost to the INSS&#44; and mutual companies&#44; which together amounted to 1<span class="elsevierStyleHsp" style=""></span>700<span class="elsevierStyleHsp" style=""></span>000<span class="elsevierStyleHsp" style=""></span>000 euros&#46; There is a wide variability in CC&#46; AA&#46; on different indicators analyzed and membership schemes&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">This article is an abridged version of the &#8220;Cost of temporary disability due to musculoskeletal diseases in Spain&#8221; report&#46; This report can be obtained at <a id="intr0010" class="elsevierStyleInterRef" href="http://www.taiss.com/publi/absful/informe-coste-incapacidad-temporal-enfermedades-musculo-esqueleticas-taiss.pdf">http&#58;&#47;&#47;www&#46;taiss&#46;com&#47;publi&#47;absful&#47;informe-coste-incapacidad-temporal-enfermedades-musculo-esqueleticas-taiss&#46;pdf</a>&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Ethical Responsibilities</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Protection of people and animals</span><p id="par0085" class="elsevierStylePara elsevierViewall">The authors declare that no experiments have been performed on humans or animals&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Data confidentiality</span><p id="par0090" class="elsevierStylePara elsevierViewall">The authors state that no patient data appear in this article&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Right to privacy and informed consent</span><p id="par0095" class="elsevierStylePara elsevierViewall">The authors state that no patient data appear in this article&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Funding</span><p id="par0100" class="elsevierStylePara elsevierViewall">This study was funded by the Abbott Foundation&#44; which was not involved in the analysis or in drafting the manuscript&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflicts of Interest</span><p id="par0105" class="elsevierStylePara elsevierViewall">The authors declare no conflicts of interest&#46;</p></span></span>"
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            4 => "Conclusi&#243;n"
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          "titulo" => "Palabras clave"
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          "titulo" => "Discussion"
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          "identificador" => "sec0025"
          "titulo" => "Ethical Responsibilities"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Protection of people and animals"
            ]
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              "titulo" => "Data confidentiality"
            ]
            2 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Right to privacy and informed consent"
            ]
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          "identificador" => "sec0045"
          "titulo" => "Funding"
        ]
        10 => array:2 [
          "identificador" => "sec0050"
          "titulo" => "Conflicts of Interest"
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        11 => array:2 [
          "identificador" => "xack77313"
          "titulo" => "Acknowledgements"
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        12 => array:1 [
          "titulo" => "References"
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      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2013-04-10"
    "fechaAceptado" => "2013-07-04"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec307730"
          "palabras" => array:4 [
            0 => "Musculoskeletal diseases"
            1 => "Work leaves"
            2 => "Indirect costs"
            3 => "Variability"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec307731"
          "palabras" => array:4 [
            0 => "Enfermedades musculoesquel&#233;ticas"
            1 => "Bajas laborales"
            2 => "Costes indirectos"
            3 => "Variabilidad"
          ]
        ]
      ]
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    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To estimate the annual cost of temporary work disability &#40;TWD&#41; caused by musculoskeletal diseases &#40;MDs&#41; in Spain and its variations between regions &#40;autonomous communities&#58; ACs&#41; and paying institutions&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">Method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Descriptive study of the costs of MD-related TWD in ACs in 2007&#46; The Spanish National Institute of Social Security &#40;NISS&#41; provided aggregate data&#46; Extrapolations to the rest of the TWD payers &#40;mutual societies and employers&#41; were used&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">MDs were the leading cause of TWD in Spain in 2007&#44; causing 908<span class="elsevierStyleHsp" style=""></span>781 episodes of TWD &#40;18&#37; of the total&#41;&#44; 39<span class="elsevierStyleHsp" style=""></span>342<span class="elsevierStyleHsp" style=""></span>857 lost working days &#40;23&#37;&#41;&#44; and a cost of 1702 million euros &#40;23&#37;&#41;&#46; The annual incidence of TWD episodes per 1000 employed was 45&#46; The cost per TWD process was 1873 &#8364;&#44; ranging from 1391 &#8364; &#40;La Rioja&#41; to 2429 &#8364; &#40;The Basque Country&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">MDs produce annually in Spain over 39 million days lost by TWD with a cost of over 1700 million euros&#46; Regions observed wide variations of the TWD cost&#46;</p>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Estimar el coste anual de la incapacidad temporal &#40;IT&#41; ocasionada por las enfermedades musculoesquel&#233;ticas &#40;EME&#41; en Espa&#241;a y su variabilidad entre comunidades aut&#243;nomas &#40;CC&#46; AA&#46;&#41; y entidades pagadoras&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio descriptivo de costes por IT debida a EME en las CC&#46; AA&#46; en el 2007&#46; Se utilizaron datos agregados del Instituto Nacional de Seguridad Social &#40;INSS&#41; y extrapolaciones a las entidades que realizan el pago de la IT &#40;INSS&#44; mutuas y empresas&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Las EME fueron la primera causa de IT en Espa&#241;a en 2007&#44; produciendo 908&#46;781 episodios de IT &#40;18&#37; del total&#41;&#44; 39&#46;342&#46;857 d&#237;as de baja &#40;23&#37;&#41; y 1&#46;702 millones de euros de coste &#40;23&#37;&#41;&#46; La incidencia anual de procesos de IT por EME por cada 1&#46;000 personas ocupadas fue de 45&#46; El coste por proceso de IT fue de 1&#46;873 oscilando entre un m&#237;nimo de 1&#46;391 &#8364; &#40;La Rioja&#41; y un m&#225;ximo de 2&#46;429 &#8364; &#40;Pa&#237;s Vasco&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Las EME producen anualmente en Espa&#241;a m&#225;s de 39 millones de d&#237;as de baja por IT&#44; con un coste superior a 1&#46;700 millones de euros&#46; El coste de la IT tiene una amplia variabilidad entre CC&#46; AA&#46;</p>"
      ]
    ]
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      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; L&#225;zaro P&#44; Parody E&#44; Garc&#237;a-Vicu&#241;a R&#44; Gabriele G&#44; Jover J&#193;&#44; Sevilla J&#46; Coste de la incapacidad temporal debida a enfermedades musculoesquel&#233;ticas en Espa&#241;a&#46; Reumatol Clin&#46; 2014&#59;10&#58;109&#8211;112&#46;</p>"
      ]
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        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">CC&#46; AA&#46;&#44; autonomous community&#59; MD&#44; musculoskeletal disease&#59; TD&#44; temporary disability&#59; GDP&#44; gross domestic product&#46;</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">In bold the average for Spain is represented&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td 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">CC&#46; AA&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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">Ratio TD processes due to MD&#47;total disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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">Time spent by TD process due to MD &#40;days&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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">TD processes due to MD per 1000 persons employed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Cost of TD due to MD &#40;&#8364;&#41;</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Average cost per TD process&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Cost per subject occupied&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Cost per &#36; 1000 of GDP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><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">Andaluc&#237;a&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;21&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&#46;16&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&#46;4&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1513&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&#46;20&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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">Aragon&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;17&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&#46;27&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&#46;9&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1583&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">75&#46;85&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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">Asturias&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;20&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53&#46;64&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&#46;7&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2374&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">129&#46;93&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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">Baleares&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;21&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="char" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t">Canary Islands&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Murcia&nbsp;\t\t\t\t\t\t\n
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                  """
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                  \t\t\t\t" style="border-bottom: 2px solid black">INSS&#43;Mutual&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Agricultural own account&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">OR&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Agricultural other account&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="char" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  """
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      "titulo" => "References"
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                    0 => array:2 [
                      "titulo" => "The burden of muskuloskeletal conditions at the start of the new millenium"
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                          "colaboracion" => "WHO"
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                      "titulo" => "Caracter&#237;sticas de la incapacidad temporal de origen musculoesqu&#233;letico en la Comunidad Aut&#243;noma de Madrid durante un a&#241;o"
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