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que incluye cuatro &#225;reas b&#225;sicas de salud &#40;ABS&#41; semirrurales&#44; el Hospital de Palam&#243;s como hospital comarcal del Baix Empord&#224; y el centro sociosanitario Palam&#243;s Gent Gran&#44; en la provincia de Girona&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Poblaci&#243;n</span><p id="par0050" class="elsevierStylePara elsevierViewall">Residentes en las ABS gestionadas por SSIBE en los a&#241;os 2006 &#40;91&#46;347&#41; y 2007 &#40;93&#46;577&#41;&#44; seg&#250;n la base de datos corporativa de SSIBE&#46; El modelo se desarroll&#243; con las personas que estuvieron presentes en ambos a&#241;os &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>88&#46;795&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Variables</span><p id="par0055" class="elsevierStylePara elsevierViewall">Se obtuvieron datos de 2006 y 2007 de las siguientes variables y fuentes&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8211;</span><p id="par0060" class="elsevierStylePara elsevierViewall">Datos demogr&#225;ficos del registro de poblaci&#243;n de SSIBE&#58; edad y sexo&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8211;</span><p id="par0065" class="elsevierStylePara elsevierViewall">Datos de actividad asistencial y consumos sanitarios en todas las unidades asistenciales de SSIBE&#44; obtenidos de su base de datos corporativa&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8211;</span><p id="par0070" class="elsevierStylePara elsevierViewall">Morbilidad atendida&#58; obtenida a partir de la codificaci&#243;n mediante la CIE-9-MC de la actividad asistencial del a&#241;o previo&#44; agrupada seg&#250;n los <span class="elsevierStyleItalic">clinical risk groups</span> &#40;CRG&#41; en su versi&#243;n 1&#46;6&#46;1<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#44;20</span></a> siguiendo un procedimiento previamente validado<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a>&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#8211;</span><p id="par0075" class="elsevierStylePara elsevierViewall">Gasto de recetas de farmacia&#44; seg&#250;n ficheros de facturaci&#243;n facilitados por Catsalut&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">&#8211;</span><p id="par0080" class="elsevierStylePara elsevierViewall">Coste sanitario individual&#44; calculado mediante una metodolog&#237;a previamente desarrollada sobre costes reales&#44; que incluye el de todos los servicios prestados por SSIBE y el de las recetas de farmacia dispensadas<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#44;22</span></a>&#46;</p></li></ul></p><p id="par0085" class="elsevierStylePara elsevierViewall">Para el desarrollo del modelo se consider&#243; como variable dependiente el coste sanitario superior al percentil 95 &#40;P95&#41; del coste sanitario total del conjunto de la poblaci&#243;n en el a&#241;o 2007 &#40;s&#237;&#47;no&#41;&#46; Se escogi&#243; como punto de corte el P95 sobre an&#225;lisis previos de concentraci&#243;n y persistencia del gasto sanitario<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a>&#44; y considerando que el 5&#37; de la poblaci&#243;n correspond&#237;a a un n&#250;mero de personas asequible para realizar estrategias proactivas&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Para la selecci&#243;n de las variables predictoras&#44; anticipando la utilizaci&#243;n pr&#225;ctica del modelo&#44; se parti&#243; de la premisa de que pudieran estar disponibles al principio de cada a&#241;o&#44; incluyendo tres grupos de variables&#58;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">a&#41;</span><p id="par0095" class="elsevierStylePara elsevierViewall">Demogr&#225;ficas&#58; sexo y grupo de edad en a&#241;os &#40;&#60;1&#44; 1-14&#44; 15-24&#44; 25-34&#44; 35-44&#44; 45-54&#44; 55-64&#44; 65-74&#44; 75-84 y &#8805;85&#41; al iniciar el a&#241;o 2007&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">b&#41;</span><p id="par0100" class="elsevierStylePara elsevierViewall">Morbilidad&#58; se calcul&#243; con la informaci&#243;n de diagn&#243;sticos y procedimientos del a&#241;o 2006&#44; utilizando las categor&#237;as ACRG3 <span class="elsevierStyleItalic">&#40;aggregated CRG level 3&#41;&#46;</span> Se consider&#243; que este nivel&#44; con 44 categor&#237;as&#44; aportaba una significaci&#243;n cl&#237;nica suficiente y discriminaba niveles de gravedad&#46; La categor&#237;a 11&#44; <span class="elsevierStyleItalic">Sanos no usuarios</span>&#44; se modific&#243; a la categor&#237;a 10&#44; <span class="elsevierStyleItalic">Sanos</span>&#44; si inclu&#237;a personas con coste sanitario positivo&#46; As&#237;&#44; todos los clasificados como no usuarios tienen coste cero&#46;</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">c&#41;</span><p id="par0105" class="elsevierStylePara elsevierViewall">Utilizaci&#243;n durante el a&#241;o 2006&#58; se eligieron por su relaci&#243;n con el coste total elevado&#44; seg&#250;n estudios previos efectuados en el mismo &#225;mbito<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a>&#44; seg&#250;n el coste superior al P95 de la aportaci&#243;n p&#250;blica de recetas de farmacia del conjunto de la poblaci&#243;n &#40;s&#237;&#47;no&#41;&#44; la medicaci&#243;n hospitalaria de dispensaci&#243;n ambulatoria &#40;MHDA&#59; s&#237;&#47;no&#41; y la hospitalizaci&#243;n &#40;s&#237;&#47;no&#41;&#46;</p></li></ul></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">An&#225;lisis estad&#237;stico</span><p id="par0110" class="elsevierStylePara elsevierViewall">Se efectu&#243; un an&#225;lisis univariado&#44; mediante frecuencias y porcentajes para variables categ&#243;ricas&#44; y media&#44; mediana y rango intercuart&#237;lico &#40;Q1-Q3&#41; para variables cuantitativas&#46; Para la construcci&#243;n del modelo de regresi&#243;n log&#237;stica s&#243;lo se incluyeron las personas presentes ambos a&#241;os del estudio&#44; y se distribuyeron aleatoriamente en dos grupos&#46; El primero incluy&#243; el 70&#37; de la poblaci&#243;n y se utiliz&#243; para estimarlo con un nivel de confianza &#40;IC&#41; del 95&#37;&#59; el 30&#37; restante se utiliz&#243; para validarlo&#46; La bondad del ajuste del modelo se evalu&#243; mediante el pseudoestad&#237;stico R<span class="elsevierStyleSup">2</span> de Nagelkerke &#40;versi&#243;n ajustada de R<span class="elsevierStyleSup">2</span> de Cox y Snell&#41;&#44; que determina la proporci&#243;n de varianza explicada por el modelo en la variable dependiente&#46; El modelo se evalu&#243; mediante la sensibilidad&#44; la especificidad&#44; el valor predictivo positivo &#40;VPP&#41; y el &#225;rea bajo la curva ROC &#40;AUC&#41; con su IC&#46; Para ello se construy&#243; una tabla 2 <span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>2 con las variables alto coste real &#40;observado en el a&#241;o 2007&#41; y predicho seg&#250;n el modelo&#46; Se consider&#243; que el modelo identificaba un individuo como de alto coste si su probabilidad predicha era superior al P95 de la distribuci&#243;n de probabilidad del conjunto de la poblaci&#243;n<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">23&#44;24</span></a>&#46; Se utiliz&#243; el programa PASW statistics 18&#46;0 &#40;SPSS Inc&#46;&#44; an IBM Co&#46; Chigago&#44; Illinois&#44; Estados Unidos&#41;&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Aspectos &#233;ticos</span><p id="par0115" class="elsevierStylePara elsevierViewall">El proyecto del estudio fue aprobado por el Comit&#233; de Investigaci&#243;n Cl&#237;nica de SSIBE&#46; Dada la metodolog&#237;a del estudio&#44; basado en una revisi&#243;n retrospectiva de registros cl&#237;nico-administrativos&#44; no se solicit&#243; consentimiento informado&#46; La extracci&#243;n de datos fue efectuada por un profesional de SSIBE y su manejo se efectu&#243; de manera an&#243;nima&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Resultados</span><p id="par0120" class="elsevierStylePara elsevierViewall">Las caracter&#237;sticas sociodemogr&#225;ficas y de morbilidad de la poblaci&#243;n incluida&#44; presente en los 2 a&#241;os del estudio &#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>88&#46;795&#41;&#44; se reflejan en la <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a>&#46; La edad media fue de 39&#44;5 a&#241;os &#40;desviaci&#243;n est&#225;ndar &#91;DE&#93;&#58; 24&#44;5 a&#241;os&#41;&#44; y la proporci&#243;n de mujeres &#40;49&#44;5&#37;&#41; y hombres fue similar&#46; En cada estrato de edad y sexo se incluy&#243; la distribuci&#243;n de morbilidad utilizando los estados de salud de los CRG&#46; Dado que el estado 1-<span class="elsevierStyleItalic">Sanos</span> contiene dos grupos de personas diferenciados&#44; los que contactan con el sistema sanitario y los que no contactan&#44; correspondientes al ACRG3 11-<span class="elsevierStyleItalic">Sanos no usuarios</span>&#44; los pacientes clasificados en este ACRG3 11 se a&#241;adieron como un estado de salud m&#225;s&#46; Este desdoblamiento permite apreciar que aparecen en ambos sexos y en todos los grupos de edad&#44; aunque son m&#225;s numerosos entre los 15 y los 55 a&#241;os&#46; Hasta los 55 a&#241;os de edad&#44; m&#225;s del 60&#37; de los pacientes en cada grupo se incluyen en el estado de salud <span class="elsevierStyleItalic">Sanos</span> &#40;usuarios y no usuarios&#41;&#46; A partir de esta edad la proporci&#243;n disminuye por debajo del 50&#37;&#44; conforme se incrementa la proporci&#243;n de pacientes con diferentes combinaciones de enfermedades cr&#243;nicas de diferente gravedad&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">En el c&#225;lculo del coste sanitario medio y el del P95 se incluy&#243; toda la poblaci&#243;n residente cada uno de los a&#241;os&#46; El coste sanitario total medio fue de 625&#44;8 &#8364; &#40;DE&#58; 2283&#44;0 &#8364;&#41; en 2006 y de 685&#44;5 &#8364; &#40;DE&#58; 2250&#44;9 &#8364;&#41; en 2007&#46; El P95 fue 2400&#44;0 &#8364; en 2006 y 2673&#44;0 &#8364; en 2007&#46; De las 88&#46;795 personas presentes los 2 a&#241;os&#44; 82&#46;258 &#40;92&#44;6&#37;&#41; tuvieron ambos a&#241;os del estudio un coste inferior o igual al P95&#44; y 2129 &#40;2&#44;4&#37;&#41; tuvieron un coste superior al P95&#46; El resto de la poblaci&#243;n &#40;4408 personas&#44; 5&#37;&#41; fueron de alto coste s&#243;lo uno de los 2 a&#241;os del estudio&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> se muestra la distribuci&#243;n de la poblaci&#243;n y el coste sanitario incurrido seg&#250;n morbilidad &#40;estratificada seg&#250;n los ACRG3&#41; para dos subgrupos&#58; el de coste inferior o igual al P95 y el de coste superior al P95&#44; referidos al a&#241;o 2006&#46; Los datos que se muestran en la tabla se refieren tan s&#243;lo a las personas presentes en los 2 a&#241;os del estudio&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">Se observa que hay pacientes de alto coste en cualquiera de los ACRG3&#44; y que en cada una de las categor&#237;as de ACRG3 el coste medio de los pacientes de alto coste es al menos tres veces mayor que el de los pacientes clasificados en el grupo de menor coste&#46; La proporci&#243;n de casos que son de alto coste dentro de un mismo ACRG3 var&#237;a considerablemente&#44; aumentando conforme aumenta la carga de morbilidad&#46; El conjunto de pacientes de alto coste representa el 44&#37; del coste sanitario total&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">En t&#233;rminos de utilizaci&#243;n de servicios sanitarios&#44; la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> muestra que pertenecer al grupo de alto coste multiplica por cuatro el n&#250;mero de visitas en atenci&#243;n primaria&#44; por nueve el n&#250;mero de visitas en atenci&#243;n especializada&#44; por cinco el n&#250;mero de visitas a urgencias hospitalarias&#44; por 90 el de estancias de hospitalizaci&#243;n de agudos&#44; por m&#225;s de cinco el n&#250;mero de pruebas diagn&#243;sticas&#44; y copan la casi totalidad de las estancias en el &#225;mbito sociosanitario&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0145" class="elsevierStylePara elsevierViewall">La relaci&#243;n del coste elevado con la morbilidad y el consumo de recursos sanitarios se muestra en la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#44; donde se presenta la distribuci&#243;n del consumo de farmacia&#44; tanto de prescripciones ambulatorias &#40;recetas&#41; como de MHDA&#44; y de los d&#237;as de estancia en hospitalizaci&#243;n de agudos&#44; para cada estado de salud de los CRG y comparando los casos de alto coste con el resto&#46; En conjunto&#44; los pacientes del grupo de alto coste acumulan el 39&#37; del coste de recetas de farmacia&#44; el 99&#37; del coste de MHDA y el 82&#37; de las estancias hospitalarias&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0150" class="elsevierStylePara elsevierViewall">El c&#225;lculo del modelo determin&#243; que las variables edad&#44; ACRG3&#44; gasto de recetas de farmacia superior al percentil 95&#44; consumo de MHDA y hospitalizaci&#243;n eran estad&#237;sticamente significativas como variables predictoras&#44; pero no as&#237; el sexo&#46; La varianza explicada por el modelo final utilizado fue del 38&#44;2&#37; &#40;R<span class="elsevierStyleSup">2</span> de Nagelkerke<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;382&#41;&#46; En la <a class="elsevierStyleCrossRef" href="#sec0090">tabla I del Ap&#233;ndice en la versi&#243;n online</a> de este art&#237;culo se aportan los detalles del modelo desarrollado&#46; Las <a class="elsevierStyleCrossRefs" href="#fig0010">figuras 2 y 3</a> muestran las <span class="elsevierStyleItalic">odds-ratio</span> de cada una de las categor&#237;as de las variables introducidas finalmente en el modelo&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0155" class="elsevierStylePara elsevierViewall">Para evaluar la capacidad de identificaci&#243;n de las personas clasificadas en el grupo de alto coste se realiz&#243; un an&#225;lisis de la capacidad discriminante del modelo elegido&#46; La sensibilidad fue del 48&#44;4&#37; &#40;IC&#58; 46&#44;9&#37;-49&#44;8&#37;&#41;&#44; la especificidad fue del 97&#44;2&#37; &#40;IC&#58; 97&#44;0&#37;-97&#44;3&#37;&#41; y el valor predictivo positivo fue del 46&#44;5&#37; &#40;IC&#58; 45&#44;0&#37;-47&#44;9&#37;&#41;&#46; El &#225;rea bajo la curva ROC fue de 0&#44;897 &#40;IC&#58; 0&#44;892-0&#44;902&#41;&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discusi&#243;n</span><p id="par0160" class="elsevierStylePara elsevierViewall">Los resultados de este estudio muestran que&#44; mediante t&#233;cnicas de modelizaci&#243;n aplicadas a una poblaci&#243;n definida&#44; puede predecirse de manera suficientemente v&#225;lida el riesgo individual de efectuar un consumo sanitario elevado&#44; considerando las caracter&#237;sticas sociodemogr&#225;ficas&#44; de morbilidad y de utilizaci&#243;n previa de recursos como factores predictivos&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Orueta et al&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> incluyen toda la poblaci&#243;n del Pa&#237;s Vasco y utilizan tres sistemas de ajuste de riesgo diferentes&#44; uno de ellos los CRG&#44; para evaluar su capacidad explicativa del gasto sanitario e identificar los pacientes de m&#225;s alto coste &#40;5&#37; de la poblaci&#243;n&#41;&#46; Nuestro estudio incorpora datos de una mayor amplitud de servicios sanitarios &#40;estimamos que se incluye el 82&#37; del coste total&#44; frente al 72&#37;&#41;&#44; y adem&#225;s est&#225; basado en una metodolog&#237;a de coste real frente a una de utilizaci&#243;n de tarifas&#44; aunque en una poblaci&#243;n sensiblemente inferior&#46; A pesar de estas diferencias&#44; los valores del AUC para la identificaci&#243;n de los casos de alto coste en ambos estudios para los CRG son similares &#40;0&#44;897 en nuestro estudio y 0&#44;848 en el vasco&#41;&#46; Haas et al&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> utilizan seis sistemas de ajuste de riesgo&#44; aunque no los CRG&#44; como medida de la morbilidad para predecir diferentes resultados &#40;hospitalizaciones y reingresos a 30 d&#237;as&#44; visitas a urgencias&#44; coste total&#41; en una poblaci&#243;n de tama&#241;o similar a la de nuestro estudio&#44; y no se encuentran diferencias entre ellos&#46; En su caso identifican el 10&#37; de la poblaci&#243;n de m&#225;s alto coste con AUC alrededor de 0&#44;75&#44; pero no utilizan los datos de consumo previo como predictores&#44; lo que justifica que nuestros resultados sean ligeramente mejores&#46; Meenan et al&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> muestran valores similares de sensibilidad a los obtenidos por nosotros para cinco modelos de ajuste de riesgo&#44; incluyendo 1&#44;5 millones de personas y centr&#225;ndose en el 1&#37; de la poblaci&#243;n de mayor coste&#46; Otros autores<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">28&#44;29</span></a> obtienen resultados similares con ligeras variaciones metodol&#243;gicas&#46; En todos estos trabajos se consideran otras variables &#40;no utilizadas en nuestro estudio&#41;&#44; tales como el &#237;ndice de deprivaci&#243;n MEDEA o el estado de salud autopercibida&#44; como variables predictoras que en general aportan poco valor explicativo a los modelos utilizados&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">La aproximaci&#243;n que se ha empleado en este estudio es diferente a la de Billing et al&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> y L&#243;pez-Aguil&#225; et al&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>&#44; ya que en estos casos el inter&#233;s del modelo estaba centrado en la identificaci&#243;n de pacientes con alto riesgo de reingreso hospitalario&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">El modelo desarrollado cumple tres condiciones relevantes para facilitar su aplicaci&#243;n pr&#225;ctica&#46; Por una parte&#44; utiliza un nivel de agrupaci&#243;n con suficiente significaci&#243;n cl&#237;nica para que sea &#250;til y comprensible a los profesionales asistenciales&#46; El segundo aspecto a considerar es que el tama&#241;o de la poblaci&#243;n seleccionada&#44; fijado en un 5&#37; del total&#44; ser&#237;a el m&#225;ximo asumible por los equipos sanitarios para un abordaje proactivo&#46; Finalmente&#44; las variables predictoras utilizadas pueden estar disponibles con un retraso m&#237;nimo para su uso&#46; Puede considerase razonable que durante el primer mes del a&#241;o est&#233;n disponibles tanto el c&#225;lculo de la morbilidad como los datos de hospitalizaci&#243;n y farmacia del a&#241;o previo&#44; para actualizar el modelo y aplicarlo en el a&#241;o en curso&#46; Por otro lado&#44; su utilidad radica en la identificaci&#243;n de pacientes con elevadas necesidades de cuidados&#44; donde se supone que la atenci&#243;n proactiva puede mejorar la eficiencia de los cuidados y la calidad de vida de estos pacientes<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a>&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Como limitaci&#243;n&#44; debe tenerse en cuenta que los costes asociados con cada paciente responden a la realidad de la organizaci&#243;n donde se ha desarrollado el estudio &#40;validez interna&#41;&#46; Adem&#225;s&#44; al introducir el consumo de productos farmac&#233;uticos como elemento predictivo se incorpora el estilo de pr&#225;ctica prescriptora de los profesionales de SSIBE&#44; que puede ser distinto en otra organizaci&#243;n<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a>&#46; Por ello&#44; cualquier posible extrapolaci&#243;n a otros &#225;mbitos debe hacerse con mucha precauci&#243;n&#44; y requerir&#237;a una validaci&#243;n y una calibraci&#243;n con datos propios &#40;validez externa&#41;&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Otra limitaci&#243;n rese&#241;able es que no se han incluido variables socioecon&#243;micas por falta de disponibilidad sistem&#225;tica individual&#46; Sin embargo&#44; otros autores que las utilizan se&#241;alan su poca aportaci&#243;n a la capacidad predictiva de los modelos utilizados<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a>&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">La sensibilidad y el valor predictivo positivo obtenidos son los habituales en este tipo de an&#225;lisis&#44; y se consideran suficientes para la finalidad que se persigue&#46; En definitiva&#44; un modelo predictivo de riesgo deber&#237;a tener una aplicaci&#243;n pr&#225;ctica prudente&#44; similar a la que pueda tener un instrumento de cribado&#58; permite detectar las personas con m&#225;s alta probabilidad de efectuar una elevada utilizaci&#243;n de recursos&#44; pero no la asegura&#46; Antes de aplicar una intervenci&#243;n sanitaria determinada&#44; es preciso evaluar de manera individual cada uno de los casos identificados&#44; sea mediante consulta de registros cl&#237;nicos o presencialmente&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">Aunque la variable dependiente del modelo desarrollado tenga una dimensi&#243;n econ&#243;mica&#44; su utilidad va m&#225;s all&#225; de la gesti&#243;n financiera&#46; El riesgo de consumo sanitario total elevado se relaciona con la presencia de condiciones cl&#237;nicas cr&#243;nicas y su nivel de complejidad&#46; Por ello&#44; los individuos clasificados como de alto riesgo corresponden a personas con enfermedades cr&#243;nicas complejas&#44; tributarias de un abordaje asistencial de gesti&#243;n de casos&#46; En definitiva&#44; un modelo basado en la edad&#44; la morbilidad y la utilizaci&#243;n previa permite identificar la poblaci&#243;n diana de una estrategia de atenci&#243;n proactiva a pacientes cr&#243;nicos complejos&#46;<elsevierMultimedia ident="tb0005"></elsevierMultimedia></p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Editora responsable del art&#237;culo</span><p id="par0210" class="elsevierStylePara elsevierViewall">Clara Berm&#250;dez-Tamayo&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Contribuciones de autor&#237;a</span><p id="par0215" class="elsevierStylePara elsevierViewall">Todos los autores participaron en el dise&#241;o y el desarrollo del estudio previo&#44; as&#237; como en la revisi&#243;n del manuscrito&#44; del cual aprueban su versi&#243;n final&#46; J&#46; Coderch dirigi&#243; el estudio previo y ha coordinado la elaboraci&#243;n del manuscrito y su correcci&#243;n final&#46; <span class="elsevierStyleSmallCaps">I</span>&#46; S&#225;nchez realiz&#243; las t&#233;cnicas estad&#237;sticas para la construcci&#243;n y la validaci&#243;n del modelo predictivo&#46; P&#46; Ibern ha supervisado todo el proceso&#44; aportando espec&#237;ficamente la visi&#243;n de experiencias internacionales&#46; M&#46; Carreras efectu&#243; el an&#225;lisis de costes sanitarios individual&#46; <span class="elsevierStyleSmallCaps">X</span>&#46; P&#233;rez-Berruezo ha desarrollado los aspectos relacionados con la aplicabilidad en los procesos asistenciales&#46; J&#46;M&#46; Inoriza realiz&#243; el an&#225;lisis de actividad y morbilidad&#44; elabor&#243; el informe sobre el estudio previo y efectu&#243; la revisi&#243;n bibliogr&#225;fica&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Financiaci&#243;n</span><p id="par0220" class="elsevierStylePara elsevierViewall">Art&#237;culo elaborado en el marco del proyecto PI12&#47;01355&#44; <span class="elsevierStyleItalic">Efectividad e impacto econ&#243;mico de un programa de atenci&#243;n proactiva a pacientes cr&#243;nicos complejos identificados mediante un modelo predictivo basado en la morbilidad</span> &#40;ATENPRO&#41;&#44; financiado por el Instituto de Salud Carlos <span class="elsevierStyleSmallCaps">III</span>&#44; en la convocatoria 2012 de ayudas del Subprograma de Proyectos de Investigaci&#243;n en Salud&#44; cofinanciado por el Fondo Europeo de Desarrollo Regional &#40;FEDER&#41; de la Uni&#243;n Europea&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Conflictos de intereses</span><p id="par0225" class="elsevierStylePara elsevierViewall">Ninguno&#46;</p></span></span>"
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              "titulo" => "Variables"
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    "fechaRecibido" => "2013-11-11"
    "fechaAceptado" => "2014-03-04"
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          "palabras" => array:8 [
            0 => "Modelos predictivos"
            1 => "Ajuste de riesgo"
            2 => "Morbilidad"
            3 => "Enfermedad cr&#243;nica"
            4 => "Anciano fr&#225;gil"
            5 => "Modelos log&#237;sticos"
            6 => "Costos de la atenci&#243;n en salud"
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            0 => "Forecasting"
            1 => "Risk adjustment"
            2 => "Morbidity"
            3 => "Chronic disease"
            4 => "Frail elderly"
            5 => "Logistic models"
            6 => "Health care costs"
            7 => "Integrated health care systems"
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    "resumen" => array:2 [
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        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Construir y validar un modelo predictivo del riesgo de consumo de recursos sanitarios elevado&#44; y evaluar su capacidad para identificar pacientes cr&#243;nicos complejos&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio transversal realizado en una organizaci&#243;n sanitaria integrada sobre datos individuales de residentes 2 a&#241;os consecutivos &#40;88&#46;795 personas&#41;&#46; Variable dependiente&#58; coste sanitario real superior al percentil 95 &#40;P95&#41;&#44; incluyendo todos los servicios de la organizaci&#243;n sanitaria integrada y las recetas de farmacia&#46; Variables predictoras&#58; edad&#44; sexo&#44; morbilidad &#40;seg&#250;n los <span class="elsevierStyleItalic">clinical risk groups</span> &#91;CRG&#93;&#41; y datos seleccionados de utilizaci&#243;n previa &#40;uso de hospitalizaci&#243;n&#44; uso de medicaci&#243;n hospitalaria ambulatoria&#44; gasto en recetas de farmacia&#41;&#46; An&#225;lisis univariado descriptivo&#46; Construcci&#243;n de un modelo de regresi&#243;n log&#237;stica con nivel de confianza del 95&#37;&#59; an&#225;lisis de validez mediante sensibilidad&#44; especificidad&#44; valor predictivo positivo &#40;VPP&#41; y &#225;rea bajo la curva ROC &#40;AUC&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Las personas con coste &#62;P95 acumulan el 44&#37; del coste sanitario total y se concentran en las categor&#237;as ACRG3 &#40;<span class="elsevierStyleItalic">aggregated CRG level 3</span>&#41; de enfermedades cr&#243;nicas m&#250;ltiples o graves&#46; La carga de morbilidad aumenta con la edad&#46; En el modelo&#44; todas las variables fueron estad&#237;sticamente significativas excepto el sexo&#46; Se obtuvo una sensibilidad del 48&#44;4&#37; &#40;intervalo de confianza &#91;IC&#93;&#58; 46&#44;9&#37;-49&#44;8&#37;&#41;&#44; una especificidad del 97&#44;2&#37; &#40;IC&#58; 97&#44;0&#37;-97&#44;3&#37;&#41;&#44; un VPP del 46&#44;5&#37; &#40;IC&#58; 45&#44;0&#37;-47&#44;9&#37;&#41; y un AUC de 0&#44;897 &#40;IC&#58; 0&#44;892-0&#44;902&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">El consumo sanitario elevado se relaciona con la morbilidad cr&#243;nica compleja&#46; Un modelo basado en la edad&#44; la morbilidad y la utilizaci&#243;n previa es v&#225;lido para predecir el riesgo de alto consumo&#44; y as&#237; identificar la poblaci&#243;n diana de estrategias de atenci&#243;n proactiva para pacientes cr&#243;nicos complejos&#46;</p>"
      ]
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To develop a predictive model for the risk of high consumption of healthcare resources&#44; and assess the ability of the model to identify complex chronic patients&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A cross-sectional study was performed within a healthcare management organization by using individual data from 2 consecutive years &#40;88&#44;795 people&#41;&#46; The dependent variable consisted of healthcare costs above the 95th percentile &#40;P95&#41;&#44; including all services provided by the organization and pharmaceutical consumption outside of the institution&#46; The predictive variables were age&#44; sex&#44; morbidity&#8212;based on clinical risk groups &#40;CRG&#41;&#8212;and selected data from previous utilization &#40;use of hospitalization&#44; use of high-cost drugs in ambulatory care&#44; pharmaceutical expenditure&#41;&#46; A univariate descriptive analysis was performed&#46; We constructed a logistic regression model with a 95&#37; confidence level and analyzed sensitivity&#44; specificity&#44; positive predictive values &#40;PPV&#41;&#44; and the area under the ROC curve &#40;AUC&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Individuals incurring costs &#62;P95 accumulated 44&#37; of total healthcare costs and were concentrated in ACRG3 &#40;aggregated CRG level 3&#41; categories related to multiple chronic diseases&#46; All variables were statistically significant except for sex&#46; The model had a sensitivity of 48&#46;4&#37; &#40;CI&#58; 46&#46;9&#37;-49&#46;8&#37;&#41;&#44; specificity of 97&#46;2&#37; &#40;CI&#58; 97&#46;0&#37;-97&#46;3&#37;&#41;&#44; PPV of 46&#46;5&#37; &#40;CI&#58; 45&#46;0&#37;-47&#46;9&#37;&#41;&#44; and an AUC of 0&#46;897 &#40;CI&#58; 0&#46;892 to 0&#46;902&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">High consumption of healthcare resources is associated with complex chronic morbidity&#46; A model based on age&#44; morbidity&#44; and prior utilization is able to predict high-cost risk and identify a target population requiring proactive care&#46;</p>"
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            "titulo" => "Material suplementario"
            "identificador" => "sec0090"
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          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Poblaci&#243;n residente en los a&#241;os 2006 y 2007&#58; distribuci&#243;n por sexo&#44; grupo de edad y morbilidad atendida en el a&#241;o 2006 &#40;estado de salud seg&#250;n <span class="elsevierStyleItalic">clinical risk groups</span> &#8211;CRG&#8211;&#41;&#46;</p>"
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          "es" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Odds ratio</span> de las variables predictoras&#58; edad&#44; consumo de farmacia y hospitalizaci&#243;n de agudos&#46;</p>"
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Coste total a&#241;o 2006<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>percentil 95</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">Aggregated Clinical Risk Grup 3</span> &#40;ACRG3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Personas&nbsp;\t\t\t\t\t\t\n
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                  \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">&#37; fila&nbsp;\t\t\t\t\t\t\n
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                  \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">Media&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
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                  \t\t\t\t" style="border-bottom: 2px solid black">Mediana&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">P25&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">P75&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">Personas&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">&#37; fila&nbsp;\t\t\t\t\t\t\n
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                  \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">Media&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">Mediana&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">P25&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">P75&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
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                  \t\t\t\t">10 Sanos &#40;usuarios&#41;&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">11 Sanos &#40;no usuarios&#41;&nbsp;\t\t\t\t\t\t\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">12 Embarazo con parto sin otras enfermedades significativas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">14 Embarazo sin parto sin otras enfermedades significativas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">15 Diagn&#243;sticos cr&#243;nicos significativos sin otras enfermedades significativas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">20 Historia de enfermedad cr&#243;nica menor &#250;nica&nbsp;\t\t\t\t\t\t\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">22 Embarazo con parto con otras enfermedades significativas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">75&#44;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;389&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">3&#46;833&nbsp;\t\t\t\t\t\t\n
                  \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">24 Embarazo sin parto con otras enfermedades significativas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">87&#44;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">61&nbsp;\t\t\t\t\t\t\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">25 Diagn&#243;sticos cr&#243;nicos significativos con otras enfermedades significativas&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">31 Enfermedad cr&#243;nica menor &#250;nica nivel-1&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">32 Enfermedad cr&#243;nica menor &#250;nica nivel-2&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">41 Enfermedad cr&#243;nica menor en varios &#243;rganos nivel-1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">42 Enfermedad cr&#243;nica menor en varios &#243;rganos nivel-2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">43 Enfermedad cr&#243;nica menor en varios &#243;rganos nivel-3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">44 Enfermedad cr&#243;nica menor en varios &#243;rganos nivel-4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">51 Enfermedad cr&#243;nica dominante &#250;nica nivel-1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">52 Enfermedad cr&#243;nica dominante &#250;nica nivel-2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">53 Enfermedad cr&#243;nica dominante &#250;nica nivel-3&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">54 Enfermedad cr&#243;nica dominante &#250;nica nivel-4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">67&#44;4&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  " align="char" valign="\n
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                  \t\t\t\t">1&#46;263&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">848&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">1&#46;665&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">32&#44;6&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">55 Enfermedad cr&#243;nica dominante &#250;nica nivel-5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">69&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">68&#44;3&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">1&#46;125&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">867&nbsp;\t\t\t\t\t\t\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
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                  \t\t\t\t">56 Enfermedad cr&#243;nica dominante &#250;nica nivel-6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;591&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">28&#44;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#46;938&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">61 Dos enfermedades cr&#243;nicas dominantes nivel-1&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">657&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">4&#46;976&nbsp;\t\t\t\t\t\t\n
                  \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">62 Dos enfermedades cr&#243;nicas dominantes nivel-2&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">550&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">978&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">395&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#46;019&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">5&#46;870&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">63 Dos enfermedades cr&#243;nicas dominantes nivel-3&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">232&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">47&#44;5&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">1&#46;471&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">1&#46;479&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">1&#46;930&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">256&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">52&#44;5&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">5&#46;579&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">4&#46;224&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;144&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">6&#46;550&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">64 Dos enfermedades cr&#243;nicas dominantes nivel-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">75&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">29&#44;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;548&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="char" valign="\n
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                  \t\t\t\t">1&#46;619&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="char" valign="\n
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                  \t\t\t\t">1&#46;138&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="char" valign="\n
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                  \t\t\t\t">1&#46;924&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="char" valign="\n
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                  \t\t\t\t">181&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="char" valign="\n
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                  \t\t\t\t">70&#44;7&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">6&#46;321&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">4&#46;694&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;320&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">7&#46;048&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">65 Dos enfermedades cr&#243;nicas dominantes nivel-5&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">18&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#44;3&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;498&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="char" valign="\n
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                  \t\t\t\t">1&#46;575&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="char" valign="\n
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                  \t\t\t\t">1&#46;061&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">1&#46;937&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">108&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="char" valign="\n
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                  \t\t\t\t">85&#44;7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6&#46;736&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#46;283&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="char" valign="\n
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                  \t\t\t\t">3&#46;746&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="char" valign="\n
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                  \t\t\t\t">8&#46;376&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">66 Dos enfermedades cr&#243;nicas dominantes nivel-6&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&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="char" valign="\n
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                  \t\t\t\t">16&#44;7&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;087&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="char" valign="\n
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                  \t\t\t\t">2&#46;215&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">1&#46;726&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">2&#46;320&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">15&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">83&#44;3&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">7&#46;049&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">6&#46;676&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="char" valign="\n
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                  \t\t\t\t">4&#46;288&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="char" valign="\n
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                  \t\t\t\t">8&#46;839&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">71 Tres enfermedades cr&#243;nicas dominantes nivel-1&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">66&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="char" valign="\n
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                  \t\t\t\t">52&#44;4&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="char" valign="\n
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                  \t\t\t\t">1&#46;469&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">1&#46;481&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">1&#46;036&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">1&#46;938&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">60&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">47&#44;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#46;780&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="char" valign="\n
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                  \t\t\t\t">3&#46;473&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;963&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">5&#46;274&nbsp;\t\t\t\t\t\t\n
                  \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">72 Tres enfermedades cr&#243;nicas dominantes nivel-2&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">20&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">21&#44;3&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">1&#46;758&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">1&#46;945&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;500&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#46;160&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">74&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">78&#44;7&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">7&#46;663&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">3&#46;677&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="char" valign="\n
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                  \t\t\t\t">8&#46;558&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">73 Tres enfermedades cr&#243;nicas dominantes nivel-3&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">7&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="char" valign="\n
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                  \t\t\t\t">9&#44;2&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">1&#46;599&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">1&#46;609&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">1&#46;149&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">2&#46;111&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">69&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">90&#44;8&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">7&#46;655&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">6&#46;134&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="char" valign="\n
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                  \t\t\t\t">4&#46;305&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">9&#46;433&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">74 Tres enfermedades cr&#243;nicas dominantes nivel-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">2&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&#44;1&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;740&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">1&#46;740&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="char" valign="\n
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                  \t\t\t\t">1&#46;303&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="char" valign="\n
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                  \t\t\t\t">2&#46;178&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">20&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">90&#44;9&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">6&#46;869&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">5&#46;581&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="char" valign="\n
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                  \t\t\t\t">4&#46;111&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">9&#46;453&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">75 Tres enfermedades cr&#243;nicas dominantes nivel-5&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&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="char" valign="\n
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                  \t\t\t\t">6&#44;3&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;088&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">1&#46;088&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="char" valign="\n
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                  \t\t\t\t">1&#46;088&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">15&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">93&#44;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9&#46;874&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="char" valign="\n
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                  \t\t\t\t">8&#46;795&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="char" valign="\n
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                  \t\t\t\t">6&#46;190&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="char" valign="\n
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                  \t\t\t\t">13&#46;475&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">76 Tres enfermedades cr&#243;nicas dominantes nivel-6&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&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&#44;0&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&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="char" valign="\n
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                  \t\t\t\t">-&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="char" valign="\n
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                  \t\t\t\t">-&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="char" valign="\n
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                  \t\t\t\t">4&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="char" valign="\n
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                  \t\t\t\t">100&#44;0&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="char" valign="\n
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                  \t\t\t\t">11&#46;630&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="char" valign="\n
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                  \t\t\t\t">13&#46;392&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;705&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="char" valign="\n
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                  \t\t\t\t">16&#46;556&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">81 Enfermedad neopl&#225;sica dominante&#44; metast&#225;sica o complicada nivel-1&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">17&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="char" valign="\n
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                  \t\t\t\t">65&#44;4&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;085&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">760&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="char" valign="\n
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                  \t\t\t\t">655&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="char" valign="\n
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                  \t\t\t\t">1&#46;593&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="char" valign="\n
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                  \t\t\t\t">9&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="char" valign="\n
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                  \t\t\t\t">34&#44;6&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="char" valign="\n
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                  \t\t\t\t">9&#46;783&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="char" valign="\n
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                  \t\t\t\t">6&#46;064&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;712&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">7&#46;304&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">82 Enfermedad neopl&#225;sica dominante&#44; metast&#225;sica o complicada nivel-2&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">49&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">52&#44;1&nbsp;\t\t\t\t\t\t\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">83 Enfermedad neopl&#225;sica dominante&#44; metast&#225;sica o complicada nivel-3&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">3&#46;524&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">7&#46;548&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">84 Enfermedad neopl&#225;sica dominante&#44; metast&#225;sica o complicada nivel-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
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                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">22&#44;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;656&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;767&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">77&#44;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#46;029&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="char" valign="\n
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                  \t\t\t\t">9&#46;749&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">85 Enfermedad neopl&#225;sica dominante&#44; metast&#225;sica o complicada nivel-5&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">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">50&#44;0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;018&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#46;018&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#46;018&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6&#46;404&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">6&#46;404&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="char" valign="\n
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                  \t\t\t\t">6&#46;404&nbsp;\t\t\t\t\t\t\n
                  \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">91 Condiciones catastr&#243;ficas nivel-1&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">8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">44&#44;4&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">955&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">935&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">499&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">4&#46;825&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">3&#46;243&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">6&#46;328&nbsp;\t\t\t\t\t\t\n
                  \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">92 Condiciones catastr&#243;ficas nivel-2&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  " align="char" valign="\n
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                  \t\t\t\t">26&#44;5&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">898&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">943&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">418&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#46;252&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">93 Condiciones catastr&#243;ficas nivel-3&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">94 Condiciones catastr&#243;ficas nivel-4&nbsp;\t\t\t\t\t\t\n
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                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab516067.png"
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          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tblfn0005"
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Se incluye s&#243;lo la poblaci&#243;n presente ambos a&#241;os del estudio&#46;</p>"
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        "descripcion" => array:1 [
          "es" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Coste sanitario total en el a&#241;o 2006 distribuido seg&#250;n morbilidad<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a></p>"
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                0 => """
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                  \t\t\t\t" style="border-bottom: 2px solid black">Poblaci&#243;n de coste total 2006 &#8804; percentil 95</td><td class="td" title="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Poblaci&#243;n de coste total 2006<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>Percentil 95</td></tr><tr title="table-row"><td class="td" title="\n
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                  \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">Total&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">&#37; total&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">Media&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">Mediana&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">Total&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">&#37; total&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">Media&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">Mediana&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">Atenci&#243;n primaria &#40;visitas&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">455&#46;716&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">82&#44;6&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&#44;25&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&#44;0&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">95&#46;911&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">17&#44;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">21&#44;00&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">15&#44;0&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">Atenci&#243;n especializada &#40;visitas&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&#46;292&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">69&#44;1&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&#44;63&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&#44;0&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">24&#46;255&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">30&#44;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">5&#44;31&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&#44;0&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">Urgencias &#40;episodios&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#46;778&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">80&#44;5&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&#44;30&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&#44;0&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">6&#46;231&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">19&#44;5&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&#44;36&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&#44;0&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">Hospital agudos &#40;d&#237;as ingreso&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;537&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">18&#44;2&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&#44;04&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&#44;0&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">15&#46;944&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">81&#44;8&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&#44;77&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&#44;0&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">Hospital sociosanitario &#40;d&#237;as ingreso&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">166&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&#44;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">0&#44;00&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&#44;0&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">24&#46;468&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">99&#44;3&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&#44;36&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&#44;0&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">Pruebas diagn&#243;sticas &#40;estudios&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">123&#46;448&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&#44;2&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&#44;42&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&#44;0&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">52&#46;407&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&#44;8&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">11&#44;48&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&#44;0&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">Actividad sanitaria total &#40;contactos&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">688&#46;901&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">74&#44;3&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&#44;15&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&#44;0&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">238&#46;536&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">25&#44;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">56&#44;43&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">44&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab516068.png"
              ]
            ]
          ]
          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Se incluye s&#243;lo la poblaci&#243;n presente ambos a&#241;os del estudio&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
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            0 => array:2 [
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                  \t\t\t\t" style="border-bottom: 2px solid black">Coste total a&#241;o 2006 &#8804; percentil 95</td><td class="td" title="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Coste total a&#241;o 2006<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>percentil 95</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Personas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Mediana&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Recetas aportaci&#243;n p&#250;blica &#40;&#8364;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>MHDA &#40;&#8364;&#41;&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">-&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\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\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
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hospital agudos &#40;d&#237;as estancia&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Sanos &#40;usuarios&#41;</span></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"><span class="elsevierStyleHsp" style=""></span>Recetas aportaci&#243;n p&#250;blica &#40;&#8364;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">40&#46;715&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">48&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">5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">259&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">914&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">62&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;807&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"><span class="elsevierStyleHsp" style=""></span>MHDA &#40;&#8364;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hospital agudos &#40;d&#237;as estancia&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="11" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="11" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Historia de enfermedad aguda significativa</span></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"><span class="elsevierStyleHsp" style=""></span>Recetas aportaci&#243;n p&#250;blica &#40;&#8364;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \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">18&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">152&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"><span class="elsevierStyleHsp" style=""></span>MHDA &#40;&#8364;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">111&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \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"><span class="elsevierStyleHsp" style=""></span>Hospital agudos &#40;d&#237;as estancia&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
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                  \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">7&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  " colspan="11" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="11" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Enfermedad cr&#243;nica menor &#250;nica</span></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"><span class="elsevierStyleHsp" style=""></span>Recetas aportaci&#243;n p&#250;blica &#40;&#8364;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">6&#46;135&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">49&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1&#46;005&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1&#46;489&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"><span class="elsevierStyleHsp" style=""></span>MHDA &#40;&#8364;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \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"><span class="elsevierStyleHsp" style=""></span>Hospital agudos &#40;d&#237;as estancia&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Enfermedades cr&#243;nicas menores en diferentes &#243;rganos</span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Recetas aportaci&#243;n p&#250;blica &#40;&#8364;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>MHDA &#40;&#8364;&#41;&nbsp;\t\t\t\t\t\t\n
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