Letter to the Editor
Increasing trend in mortality from systemic lupus erythematosus in Latin America as an expression of social disparities in health
Tendencia creciente en la mortalidad por lupus eritematoso sistémico en América Latina como expresión de las desigualdades sociales en salud
Read
2055
Timeswas read the article
761
Total PDF
1294
Total HTML
Share statistics
array:23 [ "pii" => "S2173574321000599" "issn" => "21735743" "doi" => "10.1016/j.reumae.2020.07.005" "estado" => "S300" "fechaPublicacion" => "2022-03-01" "aid" => "1452" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "copyrightAnyo" => "2020" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Reumatol Clin. 2022;18:189-90" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S1699258X20301649" "issn" => "1699258X" "doi" => "10.1016/j.reuma.2020.07.004" "estado" => "S300" "fechaPublicacion" => "2022-03-01" "aid" => "1452" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Reumatol Clin. 2022;18:189-90" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta al Editor</span>" "titulo" => "Tendencia creciente en la mortalidad por lupus eritematoso sistémico en América Latina como expresión de las desigualdades sociales en salud" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "189" "paginaFinal" => "190" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Increasing Trend in Mortality From Systemic Lupus Erythematosus in Latin America as an Expression of Social Disparities in Health" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Halbert Hernández-Negrín, David Padilla-Cueto, Onan Martínez Morales" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Halbert" "apellidos" => "Hernández-Negrín" ] 1 => array:2 [ "nombre" => "David" "apellidos" => "Padilla-Cueto" ] 2 => array:2 [ "nombre" => "Onan" "apellidos" => "Martínez Morales" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173574321000599" "doi" => "10.1016/j.reumae.2020.07.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574321000599?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X20301649?idApp=UINPBA00004M" "url" => "/1699258X/0000001800000003/v1_202203030655/S1699258X20301649/v1_202203030655/es/main.assets" ] ] "itemAnterior" => array:19 [ "pii" => "S2173574320301519" "issn" => "21735743" "doi" => "10.1016/j.reumae.2020.04.008" "estado" => "S300" "fechaPublicacion" => "2022-03-01" "aid" => "1422" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Reumatol Clin. 2022;18:188-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Efficacy and Safety of Baricitinib in Patients with Rheumatoid Arthritis and Inadequate Response to Conventional Synthetic DMARDs and/or Biological DMARDs: Data from a Local Registry" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "188" "paginaFinal" => "189" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Eficacia y seguridad de baricitinib en pacientes con artritis reumatoide y respuesta inadecuada a FAME convencionales sintéticos o biológicos: datos de un registro local" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "José Rosas, José Miguel Senabre-Gallego, Gregorio Santos-Soler, José Antonio Bernal, Ana Pons Bas" "autores" => array:6 [ 0 => array:2 [ "nombre" => "José" "apellidos" => "Rosas" ] 1 => array:2 [ "nombre" => "José Miguel" "apellidos" => "Senabre-Gallego" ] 2 => array:2 [ "nombre" => "Gregorio" "apellidos" => "Santos-Soler" ] 3 => array:2 [ "nombre" => "José" "apellidos" => "Antonio Bernal" ] 4 => array:2 [ "nombre" => "Ana" "apellidos" => "Pons Bas" ] 5 => array:1 [ "colaborador" => "Grupo Aire-Mb" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1699258X20300887" "doi" => "10.1016/j.reuma.2020.04.011" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X20300887?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574320301519?idApp=UINPBA00004M" "url" => "/21735743/0000001800000003/v1_202203090817/S2173574320301519/v1_202203090817/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Increasing trend in mortality from systemic lupus erythematosus in Latin America as an expression of social disparities in health" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "189" "paginaFinal" => "190" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Halbert Hernández-Negrín, David Padilla-Cueto, Onan Martínez Morales" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Halbert" "apellidos" => "Hernández-Negrín" "email" => array:1 [ 0 => "halberthn@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "David" "apellidos" => "Padilla-Cueto" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Onan" "apellidos" => "Martínez Morales" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Universidad de Ciencias Médicas de Villa Clara, Santa Clara, Villa Clara, Cuba" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Hospital Universitario Arnaldo Milián, Santa Clara, Villa Clara, Cuba" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "IPS Asistir Salud, Bogotá, Colombia" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tendencia creciente en la mortalidad por lupus eritematoso sistémico en América Latina como expresión de las desigualdades sociales en salud" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Despite the fact that in the last two decades diagnostic, therapeutic and preventative strategies regarding systemic lupus erythematosus (SLE) have improved, their impact on specific mortality from this disease is as yet unknown.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> This has led to the use of data from mortality records to undertake cost-effective research studies with a standardised method on the epidemiological behaviour of mortality by SLE at a population level and over long periods of time.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,3–5</span></a> The resulting evidence of these studies has helped to enhance the understanding of this disease and its recognition as a major health problem for healthcare authorities of several governments.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,5,6</span></a> However, Latin America is experiencing a very different reality in political material and health reports regarding SLE.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Recently, Scherlinger M et al. published the worldwide trends on mortality from systemic autoimmune diseases during the period from 2001 to 2014 in the journal “<span class="elsevierStyleItalic">Autoimmunity Reviews”</span>. For this they used the mortality database from the World health Organisation.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Their main conclusion was the standardised rate of mortality by SLE in Latin America was 5 times greater than that of Europe, a phenomenon which was not observed in the other systemic autoimmune diseases studied. Furthermore, during the 2003–2014 period, in Latin America and Asia, there was a significantly growing trend in standardised rates of mortality by SLE, whilst in Europe, North America and Oceania they demonstrated there was a decreasing trend and in Africa rates remained stable.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Posterior analysis by the same authors established an inverse correlation between countries’ wealth and the standardized rate of SLE mortality.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> These research studies confirmed the findings from 3 previous studies on this matter which were based on mortality records, with a similar methodology.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,7,8</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Inequality dominates the American continent.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Against this backdrop, much discussion has arisen as to whether the greater severity and mortality observed in Latin American patients with SLE is a consequence of genetic factors or the expression of the influence on health of social determinants in which this patient group lives. The great majority of studies conclude that the main cause of these adverse findings are from the inequalities that affect minority groups where individual factors combine (poverty, malnutrition, lack of treatment compliance, adverse perception and non-adaptive behaviour related to the disease); factors affecting the health system (lack of access to specialised services, geographical isolation) and those caused by society (lack of social support, inadequate public policies and low gross domestic product).<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,10,11</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">It is important to underline that the research studies mentioned share the inherent limitations of the mortality statistics of each country and do not offer information on the causes of death, disease activity or accumulated organ damage. Despite these methodological limitations, their findings are relevant because they identify the tip of the iceberg of this health problem in the region, and urge the Latin American scientific community to recognise and prioritise it.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Low regional evidence on the extension of the problem, its associated factors and the possible effective interventions to address it, are barriers which impede the right decisions being taken and increase the divide between healthcare results for Latin American patients with SLE and the rest of the world.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Over more than a decade has passed since the report by the Commission on Social Determinants of health from the World Health Organisation: <span class="elsevierStyleItalic">Closing the gap in a generation.</span> Research and action on individual and contextual determinants which mould health inequalities has been consolidated.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9,12</span></a> This argument increasingly dictates that only an ecological approach from the perspective of social epidemiology will lead to the disentanglement of the <span class="elsevierStyleItalic">causes of the causes</span> of this epidemiological trend in the region and will open the doors to multi-level strategies which lead to its control.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0035" class="elsevierStylePara elsevierViewall">This research study did not receive any specific grants from public, commercial sector or not-for-profit agencies.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Hernández-Negrín H, Padilla-Cueto D, Martínez Morales O. Tendencia creciente en la mortalidad por lupus eritematoso sistémico en América Latina como expresión de las desigualdades sociales en salud. Reumatol Clin. 2022;18:189–190.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:12 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Worldwide trends in all-cause mortality of auto-immune systemic diseases between 2001 and 2014" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Scherlinger" 1 => "P. Mertz" 2 => "F. Sagez" 3 => "A. Meyer" 4 => "A. Felten" 5 => "E. Chatelus" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/lupus-2020-eurolupus.19" "Revista" => array:5 [ "tituloSerie" => "Lupus Sci Med" "fecha" => "2020" "volumen" => "7" "paginaInicial" => "A1" "paginaFinal" => "A131" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Update on lupus epidemiology: advancing health disparities research through the study of minority populations" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C. Drenkard" 1 => "S.S. Lim" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/BOR.0000000000000646" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Rheumatol" "fecha" => "2019" "volumen" => "31" "paginaInicial" => "689" "paginaFinal" => "696" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31436582" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Worldwide trends in all-cause mortality of auto-immune systemic diseases between 2001 and 2014" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Scherlinger" 1 => "P. Mertz" 2 => "F. Sagez" 3 => "A. Meyer" 4 => "A. Felten" 5 => "E. Chatelus" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.autrev.2020.102531" "Revista" => array:5 [ "tituloSerie" => "Autoimmun Rev" "fecha" => "2020" "volumen" => "19" "paginaInicial" => "102531" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32234406" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Uptrend in mortality from systemic connective tissue diseases: A joinpoint regression analysis among the general population of Brazil, 1996–2016" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R. Rezende" 1 => "C. Vieira" 2 => "R. Gismondi" 3 => "E. Klumb" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jbspin.2019.03.010" "Revista" => array:6 [ "tituloSerie" => "Joint Bone Spine" "fecha" => "2019" "volumen" => "86" "paginaInicial" => "800" "paginaFinal" => "802" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30981869" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lupus – an unrecognized leading cause of death in young women: population-based study using nationwide death certificates, 2000–2015" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "E.Y. Yen" 1 => "R.R. Singh" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/art.40512" "Revista" => array:7 [ "tituloSerie" => "Arthritis Rheumatol" "fecha" => "2018" "volumen" => "70" "numero" => "8" "paginaInicial" => "1251" "paginaFinal" => "1255" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29671279" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Global consensus building and prioritisation of fundamental lupus challenges: the ALPHA project" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Manzi" 1 => "S. Raymond" 2 => "K. Tse" 3 => "Y. Peña" 4 => "A. Anderson" 5 => "K. Arntsen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/lupus-2019-000342" "Revista" => array:3 [ "tituloSerie" => "Lupus Sci Med" "fecha" => "2019" "volumen" => "6" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tendencias en la mortalidad por enfermedades autoinmunes sistémicas en Cuba, 2001–2014. [Tesis]" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "H. Hernández Negrín" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2020" "editorial" => "Universidad de Ciencias Médicas de Villa Clara" "editorialLocalizacion" => "Villa Clara" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mortality rate and premature mortality due to systemic erythematosus lupus in Latin America, US and England and Wales" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C.R. Soares" 1 => "K. Viana" 2 => "F. Moraes-Santos" 3 => "C.L. Vieira" 4 => "F. Lamarão" 5 => "M. Iglesias-Rodriguez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Value Health" "fecha" => "2015" "volumen" => "18" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sociedades justas: equidad en la salud y vida digna" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Comisión de la Organización Panamericana de la Salud sobre Equidad y Desigualdades en Salud en las Américas" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:4 [ "titulo" => "Informe de la Comisión de la Organización Panamericana de la Salud sobre Equidad y Desigualdades en Salud en las Américas" "fecha" => "2019" "editorial" => "OPS" "editorialLocalizacion" => "Washington, D.C" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Challenges for lupus management in emerging countries" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Z. Tazi Mezalek" 1 => "W. Bono" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.lpm.2014.04.002" "Revista" => array:5 [ "tituloSerie" => "La Presse Med" "fecha" => "2014" "volumen" => "43" "paginaInicial" => "e209" "paginaFinal" => "e220" ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The global burden of SLE: prevalence, health disparities and socioeconomic impact" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "E.E. Carter" 1 => "S.G. Barr" 2 => "A.E. Clarke" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/nrrheum.2016.137" "Revista" => array:6 [ "tituloSerie" => "Nat Rev Rheumatol" "fecha" => "2016" "volumen" => "12" "paginaInicial" => "605" "paginaFinal" => "620" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27558659" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Subsanar las desigualdades en una generación: alcanzar la equidad sanitaria actuando sobre los determinantes sociales de la salud: Informe final de la Comisión de Determinantes Sociales de la Salud" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Organización Mundial de la Salud" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2009" "editorial" => "OMS" "editorialLocalizacion" => "Washington D.C" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735743/0000001800000003/v1_202203090817/S2173574321000599/v1_202203090817/en/main.assets" "Apartado" => array:4 [ "identificador" => "8400" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735743/0000001800000003/v1_202203090817/S2173574321000599/v1_202203090817/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574321000599?idApp=UINPBA00004M" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 36 | 31 | 67 |
| 2024 September | 49 | 10 | 59 |
| 2024 August | 69 | 31 | 100 |
| 2024 July | 40 | 30 | 70 |
| 2024 June | 51 | 27 | 78 |
| 2024 May | 48 | 14 | 62 |
| 2024 April | 32 | 24 | 56 |
| 2024 March | 48 | 22 | 70 |
| 2024 February | 32 | 28 | 60 |
| 2024 January | 83 | 32 | 115 |
| 2023 December | 34 | 28 | 62 |
| 2023 November | 38 | 31 | 69 |
| 2023 October | 39 | 43 | 82 |
| 2023 September | 77 | 43 | 120 |
| 2023 August | 54 | 11 | 65 |
| 2023 July | 44 | 26 | 70 |
| 2023 June | 31 | 27 | 58 |
| 2023 May | 39 | 34 | 73 |
| 2023 April | 34 | 7 | 41 |
| 2023 March | 56 | 31 | 87 |
| 2023 February | 39 | 33 | 72 |
| 2023 January | 68 | 20 | 88 |
| 2022 December | 73 | 44 | 117 |
| 2022 November | 55 | 36 | 91 |
| 2022 October | 54 | 40 | 94 |
| 2022 September | 67 | 56 | 123 |
| 2022 August | 2 | 1 | 3 |
| 2022 April | 2 | 1 | 3 |
Show all
