Background/Objectives: Human papillomavirus (HPV) is a recognized cause of cervical cancer and is associated with several other malignancies, including those affecting the vagina, vulva, anus, penis, and head and neck. The introduction of the HPV vaccine has enabled the prevention of HPV-related cancers. This study aimed to determine the HPV vaccination coverage and examine trends in HPV vaccination in Croatia from 2016 to 2023 in the context of the national vaccination program. Methods: This retrospective study analyzed the aggregated school doctors’ data from 2016 to 2023. HPV vaccination coverages within the 2000–2008 birth cohorts were assessed based on the number of doses administrated, sex, and vaccination schedule, while for the trend analysis joinpoint regression was used. The vaccination coverage between sexes was tested using the chi-square test for trends and their ratio was calculated. Results: The HPV full-dose vaccination coverage increased significantly among the observed birth cohorts, from 4.49% in 2000 to 36.88% in 2008, with an APC = 33.97 and 95% CI: 29.37–42.43 (females from 7.74% to 44.98%, males from 1.44% to 29.14%). The highest recorded vaccination coverage was in the one-dose category (2008 female—52.78%). The vaccination coverage of females was significantly higher than that of males (the chi-square for the linear trend = 659.59, p < 0.001) and the female–male ratio decreased from 5.39 in 2000 to 1.54 in 2008. Conclusions: In Croatia, HPV vaccination coverage has increased since the introduction of the national HPV vaccination program. This positive trend was present in both sexes, and the rate ratio between female and male cohorts decreased.
Background/Objectives: This study focused on the sub-national regional heterogeneity in childhood obesity prevalence across five countries in south-east Europe and the correlation between this heterogeneity and socioeconomic differences. Previous studies have mainly observed national or cross-national data but this study used a sub-national regional approach that may be beneficial in the further investigation of childhood obesity. Methods: Nationally representative samples of children from Croatia, Montenegro, North Macedonia, Serbia and Slovenia were selected using the COSI methodology and used to estimate regional childhood obesity prevalence values. The Sub-national Human Development Database provided data on the Sub-national Human Development Index (SHDI). The spatial autocorrelation analysis of childhood obesity prevalence in sub-national regions was performed and its association with sub-national human development was tested with an ordinary least squares regression model. Results: This study found statistically significant differences in childhood obesity prevalence across sub-national regions in Croatia, Slovenia and Serbia, while no such differences were observed in North Macedonia and Montenegro. There was moderate clustering in childhood obesity rates (Moran’s I = 0.337). The results indicated a significant negative association between SHDI and childhood obesity prevalence across the 48 regions (β = −66.63, p < 0.001). Conclusions: Future public health efforts should take into consideration regional differences in childhood obesity prevalence, and more targeted research is essential for understanding the mechanisms of resilience and vulnerability on a sub-national level.
Background: There is a lack of research addressing associations of antidiabetic drug combinations with COVID-19 deaths. We examined whether adding common second-line agents to metformin was associated with COVID-19 mortality risk to inform clinical decision-making when escalating diabetes treatment. Methods: This is a nationwide retrospective analysis covering the years 2020 and 2021. Data from the National Diabetes Registry (CroDiab) were linked to primary healthcare data, Causes of Death Registry data, and the SARS-CoV-2 vaccination database. Multivariate logistic regression models were developed for each of the combinations to compare the combination with metformin monotherapy. To address confounders, inverse probability of treatment weighting (IPTW) analysis as well as analysis with stabilized weights was performed. Results: Of 141014 analyzed patients, 1268 (0.90%) died of COVID-19 in 2 years. Weighted results of the drug combinations that showed statistically significant associations to COVID-19 death in comparison to metformin alone were metformin+DPP-4 inhibitor (OR 1.182, 95% CI 1.016–1.376), metformin+sulfonylurea (OR 1.195, 95% CI 1.015–1.406), and metformin+GLP-1 agonist (OR 2.992, 95% CI 2.117–4.229). Conclusions: Some combinations of metformin with second-line antidiabetic drugs might require caution in the context of chronic diabetes mellitus type 2 therapy and COVID-19 related deaths. Findings should be interpreted as hypothesis-generating signals from real-world data rather than evidence of causal drug effects. Further research is needed, especially for metformin+GLP-1 agonist, as well as head-to-head comparisons of combinations therapies.
Since the European Commission has published a Proposal for a Regulation – The European Health Data Space, Croatia is actively working on the implementation. Public sector bodies including the Croatian Institute of Public Health, Ministry of Health and Croatian Health Insurance Fund play a key role in this process. The establishment of a Health Data Access Body is the main challenge in this effort. Potential challenges and obstacles in this process and projects that follow the efforts are described in this paper.