Causes of Death in the population affected by the Toxic Oil Syndrome in 2020-2022
Abstract
Background: Toxic Oil Syndrome (TOS) occurred in Spain in 1981 after the ingestion of adulterated rapeseed oil, producing acute and chronic health effects in more than 20,000 people. Since 1995, the TOS cohort has been systematically followed at the Institute for Rare Diseases Research (IIER) to document potential health outcomes. The aim of the study was to assess mortality patterns in the population affected by TOS from 2020 to 2022, during COVID-19 pandemics.
Methods: Causes of Death (CoD) monitoring is part of the of the TOS cohort follow-up. CoD from ICD10 death certificates were validated and extracted from the TOS platform. Standardised mortality ratios (SMR) were obtained for each year of the analysis. Age-adjusted mortality rates per million (AAMR) were calculated by CoD, sex and location for the study period.
Results: From the TOS population alive at the end of 2019 (n = 14,085), 6.5% died between 2020 and 2022 (n = 929), and, in those years, the mortality was higher in the TOS cohort compared to the Spanish population (SMR=1.4; CI95%:1.2-1.6). Most deaths occurred in Madrid (61%, n = 570) and in women (61%, n = 573). COVID-19 accounted for 15% of the CoD (n = 142), followed by heart failure (4%, n = 37) and unspecified dementia (4%, n = 36). Almost all CoD causes were more frequent in women except for COVID-19 (AAMRMen:15.8 vs. AAMRWomen:10.9). The ICD-10 groups with the highest proportions were diseases of the circulatory system (I00–I99; 25%, n = 235), malignant neoplasms (C00–C96; 19%, n = 182), and new diseases of uncertain etiology (U00–U85; 15%, n = 142), which comprised exclusively COVID-19 cases.
Conclusions: Our results shown an excess mortality in the TOS cohort compared to the Spanish population in the study period, which might have been related to COVID-19. Further studies should explore comorbidity and other risk factors in the TOS population to confirm these findings.
Key messages: • An excess mortality was observed in the TOS cohort in the study period.
• COVID-19 was the leading cause of death in the TOS cohort from 2020 to 2022.
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BibTeX
@article{sarmiento2026causes,
title = {{Causes of Death in the population affected by the Toxic Oil Syndrome in 2020-2022}},
author = {R Sarmiento and G Sánchez Díaz and D Lopez de la Iglesia and A Villaverde Hueso and E Gallego and V Alonso Ferreira and E Bermejo Sánchez and G Arias Merino},
journal = {The European Journal of Public Health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag169.949},
url = {https://doi.org/10.1093/eurpub/ckag169.949},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Causes of Death in the population affected by the Toxic Oil Syndrome in 2020-2022
AU - R Sarmiento
AU - G Sánchez Díaz
AU - D Lopez de la Iglesia
AU - A Villaverde Hueso
AU - E Gallego
AU - V Alonso Ferreira
AU - E Bermejo Sánchez
AU - G Arias Merino
PY - 2026
DA - 2026/10/01
JO - The European Journal of Public Health
DO - 10.1093/eurpub/ckag169.949
UR - https://doi.org/10.1093/eurpub/ckag169.949
AB - Background: Toxic Oil Syndrome (TOS) occurred in Spain in 1981 after the ingestion of adulterated rapeseed oil, producing acute and chronic health effects in more than 20,000 people. Since 1995, the TOS cohort has been systematically followed at the Institute for Rare Diseases Research (IIER) to document potential health outcomes. The aim of the study was to assess mortality patterns in the population affected by TOS from 2020 to 2022, during COVID-19 pandemics. Methods: Causes of Death (CoD) monitoring is part of the of the TOS cohort follow-up. CoD from ICD10 death certificates were validated and extracted from the TOS platform. Standardised mortality ratios (SMR) were obtained for each year of the analysis. Age-adjusted mortality rates per million (AAMR) were calculated by CoD, sex and location for the study period. Results: From the TOS population alive at the end of 2019 (n = 14,085), 6.5% died between 2020 and 2022 (n = 929), and, in those years, the mortality was higher in the TOS cohort compared to the Spanish population (SMR=1.4; CI95%:1.2-1.6). Most deaths occurred in Madrid (61%, n = 570) and in women (61%, n = 573). COVID-19 accounted for 15% of the CoD (n = 142), followed by heart failure (4%, n = 37) and unspecified dementia (4%, n = 36). Almost all CoD causes were more frequent in women except for COVID-19 (AAMRMen:15.8 vs. AAMRWomen:10.9). The ICD-10 groups with the highest proportions were diseases of the circulatory system (I00–I99; 25%, n = 235), malignant neoplasms (C00–C96; 19%, n = 182), and new diseases of uncertain etiology (U00–U85; 15%, n = 142), which comprised exclusively COVID-19 cases. Conclusions: Our results shown an excess mortality in the TOS cohort compared to the Spanish population in the study period, which might have been related to COVID-19. Further studies should explore comorbidity and other risk factors in the TOS population to confirm these findings. Key messages: • An excess mortality was observed in the TOS cohort in the study period. • COVID-19 was the leading cause of death in the TOS cohort from 2020 to 2022.
SN - 1101-1262
SN - 1464-360X
ER -