Hospitalizations for schistosomiasis in Spain by sex: a population-based study using the national hospital discharge database (2016-2023).

BACKGROUND

Schistosomiasis is an emerging imported parasitic disease in Europe, but information on its clinical burden among hospitalized patients in non-endemic countries remains limited.

OBJECTIVE

To describe the epidemiology, clinical characteristics, complications, and outcomes of patients hospitalized with schistosomiasis in Spain using nationwide hospital discharge data, with a focus on sex-related differences.

METHODS

We conducted a retrospective observational study using the Spanish National Hospital Discharge Database (SNHDD). All hospitalizations with schistosomiasis (ICD-10: B65) recorded between 2016 and 2023 were included. Demographic characteristics, country of birth, clinical conditions, complications, and outcomes were analyzed. Urogenital, hepatosplenic, and intestinal complications were identified using ICD-10 codes.

RESULTS

A total of 710 hospitalizations were identified; 550 (77.5%) occurred in men. Women were older than men (median age 46 vs. 34 years; p < 0.001) and had longer hospital stays (9 vs. 7 days; p = 0.041). Urogenital complications were more frequent in men, including bladder cancer (5.1% vs. 0.6%; p = 0.012), hematuria (5.8% vs. 1.3%; p = 0.017), cystitis (6.7% vs. 0.6%; p = 0.003), and obstructive uropathy (5.3% vs. 0%; p = 0.003). Male sex was independently associated with bladder cancer (aOR 16.31, 95% CI 2.12-125; p = 0. 0.007) and cystitis (adjusted OR 9.49, 95% CI 1.28-70; p = 0.028). Age was positively associated with bladder cancer (aOR 1.05, 95% CI 1.043-1.08; p < 0.001), and a lower probability of hematuria. (aOR 0.96, 95% CI 0.93-0.99; p = 0.005. In contrast, hepatosplenic complications were more frequent in women, including portal hypertension (12.5% vs. 4.5%; p < 0.001), esophageal varices (9.4% vs. 1.8%; p < 0.001), splenomegaly (5.6% vs. 1.5%; p = 0.002), and cirrhosis (6.3% vs. 2.7%; p = 0.033). Female sex was independently associated with portal hypertension (aOR 3.10, 95% CI 1.60-5.99), esophageal varices (aOR 7.11, 95% CI 2.92-17.30), and splenomegaly (aOR 5.46, 95% CI 1.88-15.92). ICU admission (8.6%) and in-hospital mortality (1.8%) did not differ significantly by sex. The overall hospitalization rate was 20 per million hospital admissions and was higher in men than in women (32.1 vs. 8.7 per million).

CONCLUSION

Hospitalizations for schistosomiasis in Spain predominantly occur in men and are mainly associated with imported infections. Men more frequently present with urogenital complications, whereas women show a higher burden of hepatosplenic manifestations. These findings highlight the importance of increasing clinical awareness and implementing targeted screening and early diagnostic strategies in at-risk populations in non-endemic settings.