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Luo Y, Luo CL, Meislin R, Yang E, Zhang X. Psychological comorbidities are more prevalent amongst pregnant and postpartum patients with irritable bowel syndrome. Neurogastroenterol Motil 2024; 36:e14800. [PMID: 38622838 DOI: 10.1111/nmo.14800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 02/26/2024] [Accepted: 04/03/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND There is a lack of data on the epidemiology of IBS in pregnant and postpartum patients in the United States. METHODS A retrospective claims analysis was conducted in a cohort of 1,618,379 patients with ≥1 delivery hospitalization between 2013-2019 utilizing ICD-9 and ICD-10 codes after merging inpatient and outpatient claims. Obstetric, psychological, and other medical comorbidities were also examined. KEY RESULTS The prevalence of IBS in our cohort was 1.38%. Pregnant and postpartum patients with IBS were more likely to have psychological comorbidities including depression (OR 2.93, CI 2.83-3.03), postpartum depression (OR 3.00, CI 2.91-3.09), and anxiety (OR 3.74, CI 3.64-3.84). They were also more likely to have migraines (OR 3.04, CI 2.94-3.15) and connective tissue disease or autoimmune disease (OR 3.54, CI 3.22-3.89). CONCLUSION The prevalence of IBS in pregnant and postpartum patients in a large claims database was 1.38%. Pregnant and postpartum patients with IBS have a higher odd of psychological comorbidities in addition to medical comorbidities such as migraines, connective tissue, and autoimmune disease. Future studies should focus on validating and characterizing the impact and directionality of co-existing comorbidities on IBS severity and the development of new-onset IBS during pregnancy and the postpartum period.
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Affiliation(s)
- Yuying Luo
- Mount Sinai Center for Gastrointestinal Physiology and Motility, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Christie Lee Luo
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rachel Meislin
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Eunyoung Yang
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Xiaotao Zhang
- Mount Sinai Center for Gastrointestinal Physiology and Motility, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Kim JH, Lee E, Ha EK, Lee GC, Shin J, Baek HS, Choi SH, Shin YH, Han MY. Infant Feeding Pattern Clusters Are Associated with Childhood Health Outcomes. Nutrients 2023; 15:3065. [PMID: 37447391 DOI: 10.3390/nu15133065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 07/15/2023] Open
Abstract
(1) Background: Feeding behavior habits have a pattern with a certain tendency during infancy. We aimed to identify the associations between feeding patterns in infancy and the subsequent 10-year childhood disease burden. (2) Methods: Data from 236,372 infants were obtained from the national health insurance and screening program records in South Korea. Parent-administered questionnaires during infancy provided details on the feeding type and types/frequency of complementary food for analyzing feeding patterns. The outcomes were all-cause hospitalization and the development of 15 representative childhood diseases until the age of 10 years. Anthropometric measurements obtained at 6 years of age were analyzed. To estimate outcome risks while considering multiple risk factors, we employed a Cox proportional hazard and modified Poisson regression. (3) Results: Three clusters were identified: high prevalence of breastfeeding with regular exposure to a variety of solid foods (n = 116,372, cluster 1), similar prevalence of breastfeeding and formula feeding with less exposure to solid foods (n = 108,189, cluster 2), and similar prevalence of breastfeeding and formula feeding with the least exposure to solid foods in infancy (n = 11,811, cluster 3). Compared with cluster 1, children in clusters 2 and 3 had increased risks of all-cause hospitalization (hazard ratio (HR), (95% confidence interval (CI)), 1.04 (1.03-1.06) and 1.08 (1.05-1.11), respectively). Children in clusters 2 and 3 had an increased risk of upper respiratory infection, pneumonia, and gastroenteritis, as well as neurobehavioral diseases. Overweight/obesity at the age of 6 years was associated with clusters 2 and 3. (4) Conclusions: Feeding patterns in infancy were associated with an increased risk of childhood disease burden.
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Affiliation(s)
- Ju Hee Kim
- Department of Pediatrics, Kyung Hee University Medical Center, Seoul 02447, Republic of Korea
| | - Eun Lee
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju 61469, Republic of Korea
| | - Eun Kyo Ha
- Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital, Seoul 07441, Republic of Korea
| | - Gi Chun Lee
- Department of Computer Science and Engineering, Konkuk University, Seoul 05029, Republic of Korea
| | - Jeewon Shin
- Department of Pediatrics, Bundang CHA Medical Center, CHA University School of Medicine, 59, Yatap-ro, Seongnam 13496, Republic of Korea
| | - Hey-Sung Baek
- Department of Pediatrics, Hallym University Kangdong Sacred Heart Hospital, Seoul 05355, Republic of Korea
| | - Sun-Hee Choi
- Department of Pediatrics, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul 05278, Republic of Korea
| | - Youn Ho Shin
- Department of Pediatrics, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul 07345, Republic of Korea
| | - Man Yong Han
- Department of Pediatrics, Bundang CHA Medical Center, CHA University School of Medicine, 59, Yatap-ro, Seongnam 13496, Republic of Korea
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Wu S, Yang Z, Liu S, Zhang Q, Zhang S, Zhu S. Frailty status and risk of irritable bowel syndrome in middle-aged and older adults: A large-scale prospective cohort study. EClinicalMedicine 2023; 56:101807. [PMID: 36593792 PMCID: PMC9803645 DOI: 10.1016/j.eclinm.2022.101807] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/09/2022] [Accepted: 12/09/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Frailty is a public health problem for ageing society, however, evidence is lacking regarding its impact on intestinal functions. We aimed to examine prospective relationships of frailty and pre-frailty in middle-aged and older adults with incident irritable bowel syndrome (IBS) in a large-scale population-based cohort. METHODS Participants (aged 37-73 years) free of IBS, coeliac disease, inflammatory bowel disease and any cancer at baseline were included, using data from the UK Biobank (collected 2006-2010, 22 assessment centres). Participants without available primary care data were excluded. Frailty status was assessed using Fried phenotype including five criteria (weight loss, exhaustion, low grip strength, low physical activity, slow walking pace). Participants who met at least three criteria were defined as frail, and those who fulfilled one or two criteria were defined as pre-frail. Primary outcome was incident IBS. Cox proportional hazard model was conducted to examine the associated risk of incident IBS. FINDINGS Among 176,423 participants (mean age 56.19 years), 7994 (4.5%) and 78,957 (44.8%) were frail and pre-frail at baseline. During a median of 13.2-year follow-up, 4155 cases of incident IBS were identified. Compared with non-frail individuals, those with frail (HR = 1.80, 95% CI: 1.59-2.04) and pre-frail (HR = 1.21, 1.14-1.30) showed significantly higher risk of developing IBS after multivariable adjustment (Ptrend < 0.001). Specifically, the positive association was not only observed in older adults (HR = 1.69, 1.37-2.08 for frail; 1.24, 1.12-1.39 for pre-frail), but also in middle-aged adults (HR = 1.90, 1.62-2.22 for frail; 1.19, 1.10-1.30 for pre-frail), both with Ptrend < 0.001. Further sensitivity analysis and subgroup analysis indicated similar results. INTERPRETATION Frailty and pre-frailty in middle-aged and older adults are associated with increased risk of incident clinical diagnosis of IBS. FUNDING National Natural Science Foundation of China (No. 82070550) & National Key Research and Development Program of China (2022YFC2504002, 2022YFC2504003).
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Affiliation(s)
- Shanshan Wu
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Disease, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Disease, Beijing 100050, China
| | - Zhirong Yang
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
- Primary Care Unit, Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge CB18RN, UK
| | - Si Liu
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Disease, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Disease, Beijing 100050, China
| | - Qian Zhang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Disease, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Disease, Beijing 100050, China
| | - Shutian Zhang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Disease, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Disease, Beijing 100050, China
| | - Shengtao Zhu
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Disease, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Disease, Beijing 100050, China
- Corresponding author.
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Kim JH, Lee SW, Kwon Y, Ha EK, An J, Cha HR, Jeong SJ, Han MY. Infantile Colic and the Subsequent Development of the Irritable Bowel Syndrome. J Neurogastroenterol Motil 2022; 28:618-629. [PMID: 36250369 DOI: 10.5056/jnm21181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 12/03/2022] [Accepted: 05/07/2022] [Indexed: 11/20/2022] Open
Abstract
Background/Aims Little is known about the association between infantile colic and the later onset of irritable bowel syndrome (IBS). Methods This study examined all 917 707 children who were born in Korea between 2007 and 2008. Infantile colic was defined with 1 or more diagnoses of ICD-10 code R10.4 or R68.1 at the age of 5 weeks to 4 months, and infants with a diagnosis of infantile colic and without were allocated into the infantile colic group and the control group. IBS was defined as 2 or more diagnoses of ICD-10 code K58.X after 4 years of age. Each child was traced until 2017. The risk of IBS with infantile colic was evaluated using a Cox proportional hazards model with propensity score inverse probability of treatment weighting (IPTW). Results After IPTW, 363 528 and 359 842 children were allocated to the control group and the infantile colic group, respectively. The infantile colic group had a higher risk of developing IBS in childhood (hazard ratio [95% CI], 1.12 [1.10 to 1.13]) than the control group. Moreover, the subgroup analyses according to the feeding status, birth weight, sex, or economic status, showed that the risk of IBS with former infantile colic remained statistically significant. Conclusions Children with a diagnosis of infantile colic during the infant period had a significant risk of developing IBS after 4 years of age. Understanding the pathogenesis of infantile colic in the neonatal period may reduce the prevalence and severity of functional gastrointestinal disorders from childhood to adolescence to adulthood.
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Affiliation(s)
- Ju Hee Kim
- Department of Pediatrics, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Seung Won Lee
- Department of Precision Medicine, Sungkyunkwan University School of Medicine, Suwon, Gyeonggi-do, Korea
| | - Yoowon Kwon
- Department of Pediatrics, Chungnam National University Sejong Hospital, Sejong, Korea
| | - Eun Kyo Ha
- Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Jaewoo An
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Gyeonggi-do, Korea
| | - Hye Ryeong Cha
- Department of Comuputer Science and Engineering, Sungkyunkwan University, Suwon, Gyeonggi-do, Korea
| | - Su Jin Jeong
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Gyeonggi-do, Korea
| | - Man Yong Han
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Gyeonggi-do, Korea
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Satisfaction With Telehealth Among Patients With Irritable Bowel Syndrome During COVID-19: Cross-Sectional Survey Findings. Clin Transl Gastroenterol 2022; 13:e00515. [PMID: 35981244 PMCID: PMC9524970 DOI: 10.14309/ctg.0000000000000515] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 06/27/2022] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Coronavirus disease 2019 rapidly shifted health care toward telehealth. We assessed satisfaction with and preferences for telehealth among patients with irritable bowel syndrome (IBS). METHODS We conducted a cross-sectional survey in an integrated healthcare system in Southern California with members aged 18-90 years with an International Classification of Diseases 9 and 10 codes for IBS from office-based encounters between June 1, 2018, and June 1, 2020. Eligible patients were emailed a survey assessing telehealth satisfaction overall and by patient-related factors, IBS characteristics, health and technologic literacy, utilization, and coronavirus disease 2019 perceptions. We identified perceived telehealth benefits and challenges. Multivariable logistic regression identified predictors of telehealth dissatisfaction. RESULTS Of 44,789 surveys sent, 5,832 (13.0%) patients responded and 1,632 (3.6%) had Rome IV IBS. Among 1,314 (22.5%) patients with IBS and prior telehealth use (mean age 52.6 years [17.4]; 84.9% female; and 59.4% non-Hispanic White, 29.0% Hispanic, and 5.6% non-Hispanic Black), 898 (68.3%) were satisfied, 130 (9.9%) were dissatisfied, and 286 (21.8%) felt neutral. In addition, 78.6% would use telehealth again. Independent predictors of telehealth dissatisfaction include social media use of once a week or less (adjusted odds ratio [OR] = 2.1; 1.3-3.5), duration of IBS for <1 year (adjusted OR = 8.2; 1.9-35.8), and willingness to travel 60 plus minutes for face-to-face visits (adjusted OR = 2.6; 1.4-3.7). Patients' main concern with telehealth was a lack of physical examination. DISCUSSION Most of the patients with IBS are satisfied with telehealth. Shorter duration of IBS diagnosis, comfort with technology, and increased willingness to travel were associated with telehealth dissatisfaction. These predictors may help identify a target population for a focused IBS-telehealth program.
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Shah ED, Brenner DM, Chen VL. Baseline Predictors of Discontinuation of Prescription Drug Therapy for IBS-C: Cohort Analysis at an Integrated Healthcare System. Dig Dis Sci 2022; 67:1213-1221. [PMID: 33779879 PMCID: PMC8478965 DOI: 10.1007/s10620-021-06963-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 03/16/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Effective prescription drug treatment of constipation-predominant irritable bowel syndrome (IBS-C) requires patients to remain on daily therapy, yet predictive factors to optimize treatment selection are unknown. AIMS We assessed whether common comorbidities including chronic overlapping pain conditions (COPCs), mood disorders, or concurrent medications influence the risk of discontinuing IBS-C prescription drug therapy. METHODS We included all IBS-C patients who initiated treatment with the secretagogues linaclotide or lubiprostone across the Michigan Medicine healthcare system between 2012 and 2016. A Cox proportional hazards model was constructed to model time-to-treatment discontinuation as a valid, quantifiable measure of IBS medication persistence using hazards ratios (HR) with 95% confidence intervals (CI). RESULTS Our cohort included 225 patients on linaclotide and 492 on lubiprostone (mean age 48.3 years, 86.9% women, 46.6% with at least one COPC, 60.3% with at least one mood disorder) with an average follow-up of 2.1 years. Patients with at least one COPC (HR = 0.566; 95%CI = 0.371-0.863) and also women (HR = 0.535; 95%CI = 0.307-0.934) had a lower risk of discontinuing linaclotide, while COPCs predicted a trend toward increased discontinuation of lubiprostone (HR = 1.254; 95%CI = 0.997-1.576). Age, comorbid mood disorders, and baseline use of narcotics or benzodiazepines did not significantly mediate the risk of treatment discontinuation; our findings remained stable in univariate and multivariable analyses. CONCLUSIONS COPCs and sex appear to influence the likelihood of discontinuation of two commonly prescribed secretagogues, while mood disorders, narcotics, and benzodiazepines may not. Routine assessment for comorbid COPCs prior to initiating therapy may optimize IBS-C treatment selection and outcomes in practice.
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Affiliation(s)
- Eric D. Shah
- Center for Gastrointestinal Motility, Esophageal, and Swallowing Disorders, Division of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03766, USA,Division of Gastroenterology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Darren M. Brenner
- Division of Gastroenterology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Vincent L. Chen
- Division of Gastroenterology, Michigan Medicine, Ann Arbor, MI, USA
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Association of Consuming Tap Water or Purified Water during Infancy with Irritable Bowel Syndrome in Children. CHILDREN 2022; 9:children9020135. [PMID: 35204856 PMCID: PMC8869972 DOI: 10.3390/children9020135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/30/2021] [Accepted: 01/15/2022] [Indexed: 11/23/2022]
Abstract
Objective: The objective of this study was to analyze the effect of consuming formula powder prepared with tap water or purified water during the first 4 to 6 months of life on the subsequent development of irritable bowel syndrome (IBS). Study design and setting: A total of 917,707 children who were born in Korea between 2007 and 2008 were analyzed. All children were followed up until they lost eligibility for health care services or until 2017. Data on the water used to prepare formula powder were from questionnaires answered by the parents when the child was 4 to 6 months old. IBS was defined as two or more diagnoses of IBS after the age of 4 years. Inverse probability of treatment weighting (IPTW) using the propensity score was used to balance the two groups. The risk of IBS was evaluated using a Cox proportional hazards model. Results: After weighting, there were 73,355 children in the tap water group and 73,351 in the purified water group. The purified water group had a higher risk of IBS (HR: 1.05; 95% CI: 1.01, 1.09). This relationship was also present after the subgroup analyses of males and females and the sensitivity analysis that used different definitions of IBS. Conclusions: Drinking formula powder prepared with purified water rather than tap water during the first 4 to 6 months of age was found to be associated with IBS.
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Foley HE, Knight JC, Ploughman M, Asghari S, Audas R. Association of chronic pain with comorbidities and health care utilization: a retrospective cohort study using health administrative data. Pain 2021; 162:2737-2749. [PMID: 33902092 DOI: 10.1097/j.pain.0000000000002264] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 03/09/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT Health administrative data provide a potentially robust information source regarding the substantial burden chronic pain exerts on individuals and the health care system. This study aimed to use health administrative data to estimate comorbidity prevalence and annual health care utilization associated with chronic pain in Newfoundland and Labrador, Canada. Applying the validated Chronic Pain Algorithm to provincial Fee-for-Service Physician Claims File data (1999-2009) established the Chronic Pain (n = 184,580) and No Chronic Pain (n = 320,113) comparator groups. Applying the Canadian Chronic Disease Surveillance System coding algorithms to Claims File and Provincial Discharge Abstract Data (1999-2009) determined the prevalence of 16 comorbidities. The 2009/2010 risk and person-year rate of physician and diagnostic imaging visits and hospital admissions were calculated and adjusted using the robust Poisson model with log link function (risks) and negative binomial model (rates). Results indicated a significantly higher prevalence of all comorbidities and up to 4 times the odds of multimorbidity in the Chronic Pain Group (P-value < 0.001). Chronic Pain Group members accounted for 58.8% of all physician visits, 57.6% of all diagnostic imaging visits, and 54.2% of all hospital admissions in 2009/2010, but only 12% to 16% of these were for pain-related conditions as per recorded diagnostic codes. The Chronic Pain Group had significantly higher rates of physician visits and high-cost hospital admission/diagnostic imaging visits (P-value < 0.001) when adjusted for demographics and comorbidities. Observations made using this methodology supported that people identified as having chronic pain have higher prevalence of comorbidities and use significantly more publicly funded health services.
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Affiliation(s)
- Heather E Foley
- Centre for Pain and Disability Management, Adult Rehabilitation, Geriatrics and Palliative Care Program, Eastern Regional Health Authority, St. John's, NL, Canada
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - John C Knight
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
- Analytics and Information Services Department, Newfoundland and Labrador Centre for Health Information, St. John's, NL, Canada
| | - Michelle Ploughman
- Division of Biomedical Sciences, Physical Medicine and Rehabilitation, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Shabnam Asghari
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
- Discipline of Family Medicine, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Richard Audas
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
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Foley HE, Knight JC, Ploughman M, Asghari S, Audas R. Identifying cases of chronic pain using health administrative data: A validation study. CANADIAN JOURNAL OF PAIN-REVUE CANADIENNE DE LA DOULEUR 2020; 4:252-267. [PMID: 33987504 PMCID: PMC7967902 DOI: 10.1080/24740527.2020.1820857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Most prevalence estimates of chronic pain are derived from surveys and vary widely, both globally (2%–54%) and in Canada (6.5%–44%). Health administrative data are increasingly used for chronic disease surveillance, but their validity as a source to ascertain chronic pain cases is understudied. Aim The aim of this study was to derive and validate an algorithm to identify cases of chronic pain as a single chronic disease using provincial health administrative data. Methods A reference standard was developed and applied to the electronic medical records data of a Newfoundland and Labrador general population sample participating in the Canadian Primary Care Sentinel Surveillance Network. Chronic pain algorithms were created from the administrative data of patient populations with chronic pain, and their classification performance was compared to that of the reference standard via statistical tests of selection accuracy. Results The most performant algorithm for chronic pain case ascertainment from the Medical Care Plan Fee-for-Service Physicians Claims File was one anesthesiology encounter ever recording a chronic pain clinic procedure code OR five physician encounter dates recording any pain-related diagnostic code in 5 years with more than 183 days separating at least two encounters. The algorithm demonstrated 0.703 (95% confidence interval [CI], 0.685–0.722) sensitivity, 0.668 (95% CI, 0.657–0.678) specificity, and 0.408 (95% CI, 0.393–0.423) positive predictive value. The chronic pain algorithm selected 37.6% of a Newfoundland and Labrador provincial cohort. Conclusions A health administrative data algorithm was derived and validated to identify chronic pain cases and estimate disease burden in residents attending fee-for-service physician encounters in Newfoundland and Labrador.
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Affiliation(s)
- Heather E Foley
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - John C Knight
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada.,Primary Health Care Research Unit, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Michelle Ploughman
- Physical Medicine & Rehabilitation, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Shabnam Asghari
- Discipline of Family Medicine, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Rick Audas
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
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Lacasse A, Cauvier Charest E, Dault R, Cloutier AM, Choinière M, Blais L, Vanasse A. Validity of Algorithms for Identification of Individuals Suffering from Chronic Noncancer Pain in Administrative Databases: A Systematic Review. PAIN MEDICINE (MALDEN, MASS.) 2020; 21:1825-1839. [PMID: 32142130 PMCID: PMC7553015 DOI: 10.1093/pm/pnaa004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Secondary analysis of health administrative databases is indispensable to enriching our understanding of health trajectories, health care utilization, and real-world risks and benefits of drugs among large populations. OBJECTIVES This systematic review aimed at assessing evidence about the validity of algorithms for the identification of individuals suffering from nonarthritic chronic noncancer pain (CNCP) in administrative databases. METHODS Studies reporting measures of diagnostic accuracy of such algorithms and published in English or French were searched in the Medline, Embase, CINAHL, AgeLine, PsycINFO, and Abstracts in Social Gerontology electronic databases without any dates of coverage restrictions up to March 1, 2018. Reference lists of included studies were also screened for additional publications. RESULTS Only six studies focused on commonly studied CNCP conditions and were included in the review. Some algorithms showed a ≥60% combination of sensitivity and specificity values (back pain disorders in general, fibromyalgia, low back pain, migraine, neck/back problems studied together). Only algorithms designed to identify fibromyalgia cases reached a ≥80% combination (without replication of findings in other studies/databases). CONCLUSIONS In summary, the present investigation informs us about the limited amount of literature available to guide and support the use of administrative databases as valid sources of data for research on CNCP. Considering the added value of such data sources, the important research gaps identified in this innovative review provide important directions for future research. The review protocol was registered with PROSPERO (CRD42018086402).
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Affiliation(s)
- Anaïs Lacasse
- Département des Sciences de la Santé, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, Québec, Canada
| | - Elizabeth Cauvier Charest
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Roxanne Dault
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Anne-Marie Cloutier
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Manon Choinière
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, Québec, Canada
- Département d'Anesthésiologie et de Médecine de la Douleur, Faculté de Médecine, Université de Montréal, Montréal, Québec, Canada
| | - Lucie Blais
- Faculté de Pharmacie, Université de Montréal, Montréal, Québec, Canada
| | - Alain Vanasse
- Faculté de Pharmacie, Université de Montréal, Montréal, Québec, Canada
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), Sherbrooke, Québec, Canada
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Evaluating When and Why Patients Discontinue Chronic Therapy for Irritable Bowel Syndrome With Constipation and Chronic Idiopathic Constipation. Am J Gastroenterol 2020; 115:596-602. [PMID: 32022721 PMCID: PMC7565170 DOI: 10.14309/ajg.0000000000000530] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION To inform the patient-centered discussion regarding comparative outcomes with irritable bowel syndrome/chronic idiopathic constipation pharmacotherapy, we evaluated reasons and timing of discontinuation of FDA-approved pharmacotherapy for irritable bowel syndrome and chronic idiopathic constipation in a large observational real-world cohort. METHODS We identified patients initiating lubiprostone or linaclotide within the University of Michigan Electronic Medical Record (2012-2016). Medication start and stop dates were determined in manual chart review including detailed review of all documentation including office notes and telephone encounters. A Cox model was constructed to predict the hazard of discontinuation. RESULTS On multivariate analysis of 1,612 patients, linaclotide users had a lower risk of discontinuing therapy than lubiprostone users for any reason (hazard ratio [HR] = 0.6, 95% confidence interval [CI] 0.5-0.8). At 3 and 12 months, the overall discontinuation rates were 23% and 43% for lubiprostone compared with 14% and 24% for linaclotide. Over the first year of therapy, more than half of discontinuations due to intolerance occurred in the first 3 months for both drugs. Linaclotide users were more likely to discontinue due to intolerance (HR = 1.6 [95% CI, 1.2-2.3]) but less likely to discontinue due to insufficient efficacy of therapy (HR = 0.5 [95% CI, 0.4-0.8]). IBS diagnosis increased the hazard of discontinuation of lubiprostone relative to linactolide (HR = 1.4, 95% CI, 1.1-1.6). Loss of prescription drug coverage remained a common reason for discontinuation over the first year of therapy. DISCUSSION Individuals appear more likely to discontinue lubiprostone than linaclotide overall, but more likely to discontinue linaclotide compared with lubiprostone due to intolerance (mostly diarrhea). Most discontinuations due to intolerance occur in the first 3 months. These results may be useful in individualized treatment selection and enhancing patient knowledge regarding long-term outcomes.
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Higher odds of irritable bowel syndrome among hospitalized patients using cannabis: a propensity-matched analysis. Eur J Gastroenterol Hepatol 2019; 31:756-765. [PMID: 30807448 DOI: 10.1097/meg.0000000000001382] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The endogenous cannabinoid system modulates many brain-gut and gut-brain physiologic pathways, which are postulated to be dysfunctional in irritable bowel syndrome (IBS). Herein, we examine the relationship between cannabis use disorder (CUD) and having IBS. PATIENTS AND METHODS After selecting patients aged 18 years and above from the 2014 Nationwide Inpatient Survey, we used the International Classification of Diseases, 9th ed. codes to identify individuals with CUD, IBS, and the established risk factors for IBS. We then estimated the crude and adjusted odds ratios of having a diagnosis of IBS with CUD and assessed for the interactions of CUD with other risk factors (SAS 9.4). We confirmed our findings in two ways: conducting a similar analysis on a previous Nationwide Inpatient Survey data (2012); and using a greedy algorithm to design a propensity-scored case-control (1 : 10) study, approximating a pseudorandomized clinical trial. RESULTS Out of 4 709 043 patients evaluated, 0.03% had a primary admission for IBS and 1.32% had CUD. CUD was associated with increased odds of IBS [adjusted odds ratio: 2.03; 95% confidence interval (CI): 1.53-2.71]. CUD was related to higher odds for IBS among males compared with females (3.48; 1.98-6.12 vs. 1.48; 0.88-2.50), and Hispanics and Caucasians compared with Blacks (5.28; 1.77-15.76, 1.80; 1.02-3.18 vs. 1.80; 0.65-5.03). On propensity-matching, CUD was associated with 80% increased odds for IBS (1.82; 1.27-2.60). CONCLUSION Our findings suggest that CUD is significantly associated with IBS among the general population. Males, Caucasians, and Hispanics might be more impacted by CUD associated IBS. Additional biomedical studies are required to elucidate this relationship.
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Adegbala O, Adejumo AC, Olakanmi O, Akinjero A, Akintoye E, Alliu S, Edo-Osagie E, Chatterjee A. Relation of Cannabis Use and Atrial Fibrillation Among Patients Hospitalized for Heart Failure. Am J Cardiol 2018; 122:129-134. [PMID: 29685570 DOI: 10.1016/j.amjcard.2018.03.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 02/26/2018] [Accepted: 03/01/2018] [Indexed: 12/19/2022]
Abstract
Left ventricular dysfunction triggers the activation of the sympathetic nervous system, providing inotropic support to the failing heart and concomitantly increasing the risk of atrial fibrillation (AF). The cardiovascular effects of cannabis have been characterized as biphasic on the autonomic nervous system with an increased sympathetic effect at low doses and an inhibitory sympathetic activity at higher doses. It is unknown if the autonomic effect of cannabis impacts the occurrence of AF in patients with heart failure (HF). We used data from the Healthcare Cost and Utilization Project-National Inpatient Sample for patients admitted with a diagnosis of HF in 2014. The outcome variable was the diagnosis of AF, with the main exposure being cannabis use. We identified a cannabis user group and a 1:1 propensity-matched non-cannabis user group, each having 3,548 patients. We then estimated the odds of AF diagnosis in cannabis users. An estimated 3,950,392 patients were admitted with a diagnosis of HF in the United States in 2014. Among these, there were 17,755 (0.45%) cannabis users. In the matched cohort, cannabis users were less likely to have AF (19.08% vs 21.39%; AOR 0.87 [0.77 to 0.98]). In conclusion, cannabis users have lower odds of AF when compared with nonusers, which was not explained by co-morbid conditions, age, insurance type, and socioeconomic status.
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Affiliation(s)
- Oluwole Adegbala
- Department of Internal Medicine, Englewood Hospital and Medical Center, Seton Hall University-Hackensack Meridian School of Medicine, Englewood, New Jersey.
| | | | - Olagoke Olakanmi
- Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois
| | - Akintunde Akinjero
- Department of Internal Medicine, Englewood Hospital and Medical Center, Seton Hall University-Hackensack Meridian School of Medicine, Englewood, New Jersey
| | - Emmanuel Akintoye
- Division of Cardiology, Wayne State University/Detroit Medical Center, Detroit, Michigan
| | - Samson Alliu
- Division of Cardiology, Maimonides Medical Centre, Brooklyn, New York
| | - Eseosa Edo-Osagie
- Department of Internal Medicine, Englewood Hospital and Medical Center, Seton Hall University-Hackensack Meridian School of Medicine, Englewood, New Jersey
| | - Arka Chatterjee
- Division of Cardiology, University of Alabama at Birmingham, Birmingham, Alabama
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Beer KD, Collier SA, Du F, Gargano JW. Giardiasis Diagnosis and Treatment Practices Among Commercially Insured Persons in the United States. Clin Infect Dis 2018; 64:1244-1250. [PMID: 28207070 DOI: 10.1093/cid/cix138] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 02/08/2017] [Indexed: 11/14/2022] Open
Abstract
Background Giardiasis, the most common enteric parasitic infection in the United States, causes an estimated 1.2 million episodes of illness annually. Published clinical recommendations include readily available Giardia-specific diagnostic testing and antiparasitic drugs. We investigated sequences of giardiasis diagnostic and treatment events using MarketScan, a large health insurance claims database. Methods We created a longitudinal cohort of 2995 persons diagnosed with giardiasis (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] code 007.1) from 2006 to 2010, and analyzed claims occurring 90 days before to 90 days after initial diagnosis. We evaluated differences in number and sequence of visits, diagnostic tests, and prescriptions by age group (children 1-17 years, adults 18-64 years) using χ2 tests and data visualization software. Results Among 2995 patients (212433 claims), 18% had a Giardia-specific test followed by or concurrent with an effective antiparasitic drug, without ineffective antibiotics. Almost two-thirds of patients had an antiparasitic and 27% had an antibiotic during the study window. Compared with children, adults more often had ≥3 visits before diagnosis (19% vs 15%; P = .02). Adults were also less likely to have a Giardia-specific diagnostic test (48% vs 58%; P < .001) and more likely to have an antibiotic prescription (28% vs 25%; P = .04). When Giardia-specific tests and antiparasitic and antibiotic prescriptions were examined, pediatric clinical event sequences most frequently began with a Giardia-specific test, whereas adult sequences most frequently began with an antiparasitic prescription. Conclusions Giardiasis care infrequently follows all aspects of clinical recommendations. Multiple differences between pediatric and adult care, despite age-agnostic recommendations, suggest opportunities for provider education or tailored guidance.
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Affiliation(s)
- Karlyn D Beer
- Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sarah A Collier
- Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Fan Du
- Human-Computer Interaction Lab, University of Maryland, College Park, USA
| | - Julia W Gargano
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Nakao JH, Collier SA, Gargano JW. Giardiasis and Subsequent Irritable Bowel Syndrome: A Longitudinal Cohort Study Using Health Insurance Data. J Infect Dis 2017; 215:798-805. [PMID: 28329069 DOI: 10.1093/infdis/jiw621] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 12/13/2016] [Indexed: 12/19/2022] Open
Abstract
Background Giardia intestinalis is the most commonly reported human intestinal parasite in the United States. Increased incidence of chronic gastrointestinal complaints has been reported after some giardiasis outbreaks. We examined the relationship between giardiasis diagnosis and irritable bowel syndrome (IBS) diagnosis. Methods We used the 2006-2010 MarketScan commercial insurance database. Persons with at least 1 giardiasis diagnosis were individually matched on age group, sex, and enrollment length in months to 5 persons without a giardiasis diagnosis. Persons diagnosed with IBS before the date of study entry were excluded. We calculated crude incidence rates (IRs) and developed Cox proportional hazards models. Results The matched cohort included 3935 persons with giardiasis and 19663 persons without giardiasis. One-year incidence of IBS was higher in persons with giardiasis (IR = 37.7/1000 person-years vs 4.4/1000 person-years). The unadjusted hazard ratio was 4.8 (95% confidence interval [CI] = 3.6-6.4), attenuated slightly to 3.9 (95% CI = 2.9-5.4) after adjusting for anxiety, depression, and healthcare utilization. Conclusions In a large insurance database, individuals diagnosed with giardiasis were more likely to have a subsequent IBS diagnosis, despite accounting for confounders. Future research on risk factors for IBS among giardiasis patients and the pathophysiology of postinfectious IBS is needed.
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Affiliation(s)
- Jolene H Nakao
- Epidemic Intelligence Service, Epidemiology Workforce Branch, Division of Scientific Education And Professional Development, Center For Surveillance, Epidemiology And Laboratory Services, Office of Public Health Scientific Services, Centers for Disease Control and Prevention, Atlanta, GA, USA.,Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sarah A Collier
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Julia W Gargano
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Lacasse A, Ware MA, Dorais M, Lanctôt H, Choinière M. Is the Quebec provincial administrative database a valid source for research on chronic non-cancer pain? Pharmacoepidemiol Drug Saf 2015; 24:980-90. [DOI: 10.1002/pds.3820] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 05/27/2015] [Accepted: 05/28/2015] [Indexed: 12/17/2022]
Affiliation(s)
- Anaïs Lacasse
- Département des sciences de la santé; Université du Québec en Abitibi-Témiscamingue; Rouyn-Noranda Québec Canada
- Centre de recherche du Centre hospitalier de l'Université de Montréal; Montréal Québec Canada
| | - Mark A. Ware
- Alan Edwards Pain Management Unit; McGill University Health Centre; Montréal Québec Canada
| | - Marc Dorais
- StatSciences Inc.; Notre-Dame-de-l'Île-Perrot Québec Canada
| | - Hélène Lanctôt
- Centre de recherche du Centre hospitalier de l'Université de Montréal; Montréal Québec Canada
| | - Manon Choinière
- Centre de recherche du Centre hospitalier de l'Université de Montréal; Montréal Québec Canada
- Département d'anesthésiologie, Faculté de médecine; Université de Montréal; Montréal Québec Canada
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Cutrona SL, Toh S, Iyer A, Foy S, Daniel GW, Nair VP, Ng D, Butler MG, Boudreau D, Forrow S, Goldberg R, Gore J, McManus D, Racoosin JA, Gurwitz JH. Validation of acute myocardial infarction in the Food and Drug Administration's Mini-Sentinel program. Pharmacoepidemiol Drug Saf 2013; 22:40-54. [PMID: 22745038 PMCID: PMC3601831 DOI: 10.1002/pds.3310] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Revised: 05/15/2012] [Accepted: 05/29/2012] [Indexed: 11/11/2022]
Abstract
PURPOSE To validate an algorithm based upon International Classification of Diseases, 9(th) revision, Clinical Modification (ICD-9-CM) codes for acute myocardial infarction (AMI) documented within the Mini-Sentinel Distributed Database (MSDD). METHODS Using an ICD-9-CM-based algorithm (hospitalized patients with 410.x0 or 410.x1 in primary position), we identified a random sample of potential cases of AMI in 2009 from four Data Partners participating in the Mini-Sentinel Program. Cardiologist reviewers used information abstracted from hospital records to assess the likelihood of an AMI diagnosis based on criteria from the Joint European Society of Cardiology and American College of Cardiology Global Task Force. Positive predictive values (PPVs) of the ICD-9-based algorithm were calculated. RESULTS Of the 153 potential cases of AMI identified, hospital records for 143 (93%) were retrieved and abstracted. Overall, the PPV was 86.0% (95% confidence interval; 79.2%, 91.2%). PPVs ranged from 76.3% to 94.3% across the four Data Partners. CONCLUSIONS The overall PPV of potential AMI cases, as identified using an ICD-9-CM-based algorithm, may be acceptable for safety surveillance; however, PPVs do vary across Data Partners. This validation effort provides a contemporary estimate of the reliability of this algorithm for use in future surveillance efforts conducted using the Food and Drug Administration's MSDD.
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Affiliation(s)
- Sarah L Cutrona
- Meyers Primary Care Institute-Fallon Community Health Plan, Reliant Medical Group, and University of Massachusetts Medical School, Worcester, MA, USA.
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Marrie RA, Yu BN, Leung S, Elliott L, Caetano P, Warren S, Wolfson C, Patten SB, Svenson LW, Tremlett H, Fisk J, Blanchard JF. The Utility of Administrative Data for Surveillance of Comorbidity in Multiple Sclerosis: A Validation Study. Neuroepidemiology 2012; 40:85-92. [DOI: 10.1159/000343188] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 08/30/2012] [Indexed: 12/25/2022] Open
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Li X, Hilsden R, Hossain S, Fleming J, Winget M. Validation of administrative data sources for endoscopy utilization in colorectal cancer diagnosis. BMC Health Serv Res 2012; 12:358. [PMID: 23062117 PMCID: PMC3508878 DOI: 10.1186/1472-6963-12-358] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 10/05/2012] [Indexed: 11/25/2022] Open
Abstract
Background Validation of administrative data is important to assess potential sources of bias in outcome evaluation and to prevent dissemination of misleading or inaccurate information. The purpose of the study was to determine the completeness and accuracy of endoscopy data in several administrative data sources in the year prior to colorectal cancer diagnosis as part of a larger project focused on evaluating the quality of pre-diagnostic care. Methods Primary and secondary data sources for endoscopy were collected from the Alberta Cancer Registry, cancer medical charts and three different administrative data sources. 1672 randomly sampled patients diagnosed with invasive colorectal cancer in years 2000–2005 in Alberta, Canada were included. A retrospective validation study of administrative data for endoscopy in the year prior to colorectal cancer diagnosis was conducted. A gold standard dataset was created by combining all the datasets. Number and percent identified, agreement and percent unique to a given data source were calculated and compared across each dataset and to the gold standard with respect to identifying all patients who underwent endoscopy and all endoscopies received by those patients. Results The combined administrative data and physician billing data identified as high or higher percentage of patients who had one or more endoscopy (84% and 78%, respectively) and total endoscopy procedures (89% and 81%, respectively) than the chart review (78% for both). Conclusions Endoscopy data has a high level of completeness and accuracy in physician billing data alone. Combined with hospital in/outpatient data it is more complete than chart review alone.
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Affiliation(s)
- Xue Li
- Division of Community Oncology, Cancer Care, Alberta Health Services, Edmonton, Alberta, Canada
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Lindfors P, Unge P, Nyhlin H, Ljótsson B, Björnsson ES, Abrahamsson H, Simrén M. Long-term effects of hypnotherapy in patients with refractory irritable bowel syndrome. Scand J Gastroenterol 2012; 47:414-20. [PMID: 22339617 DOI: 10.3109/00365521.2012.658858] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Gut-directed hypnotherapy is considered to be an effective treatment in irritable bowel syndrome (IBS) but few studies report the long-term effects. This retrospective study aims to evaluate the long-term perceived efficacy of gut-directed hypnotherapy given outside highly specialized hypnotherapy centers. METHODS 208 patients, who all had received gut-directed hypnotherapy, were retrospectively evaluated. The Subjective Assessment Questionnaire (SAQ) was used to measure changes in IBS symptoms, and patients were classified as responders and non-responders. Patients were also asked to report changes in health-care seeking, use of drugs for IBS symptoms, use of alternative non-pharmacological treatments, and if they still actively used hypnotherapy. RESULTS Immediately after hypnotherapy, 103 of 208 patients (49%) were responders and 75 of these (73%) had improved further at the follow-up 2-7 years after hypnotherapy (mean 4 years). A majority of the responders still used hypnotherapy on a regular basis at follow-up (73%), and the responders reported a greater reduction in health-care seeking than non-responders. A total of 87% of all patients reported that they considered gut-directed hypnotherapy to be worthwhile, and this differed between responders and non-responders (100% vs. 74%; p < 0.0001). CONCLUSION This long-term follow-up study indicates that gut-directed hypnotherapy in refractory IBS is an effective treatment option with long-lasting effects, also when given outside highly specialized hypnotherapy centers. Apart from the clinical benefits, the reduction in health-care utilization has the potential to reduce the health-care costs.
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Affiliation(s)
- Perjohan Lindfors
- Department of Internal medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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Grodzinsky E, Hallert C, Faresjö T, Bergfors E, Faresjö AO. Could gastrointestinal disorders differ in two close but divergent social environments? Int J Health Geogr 2012; 11:5. [PMID: 22309613 PMCID: PMC3330019 DOI: 10.1186/1476-072x-11-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Accepted: 02/06/2012] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Many public health problems in modern society affect the gastrointestinal area. Knowledge of the disease occurrence in populations is better understood if viewed in a psychosocial context including indicators of the social environment where people spend their lives. The general aim of this study was to estimate the occurrence in the population and between sexes of common gastrointestinal conditions in two neighborhood cities representing two different social environments defined as a "white-collar" and a "blue-collar" city. METHODS We conducted a retrospective register study using data of diagnosed gastrointestinal disorders (cumulative incidence rates) derived from an administrative health care register based on medical records assigned by the physicians at hospitals and primary care. RESULTS Functional gastrointestinal diseases and peptic ulcers were more frequent in the white-collar city, while diagnoses in the gallbladder area were significantly more frequent in the blue-collar city. Functional dyspepsia, irritable bowel syndrome, and unspecified functional bowel diseases, and celiac disease, were more frequent among women while esophageal reflux, peptic ulcers, gastric and rectal cancers were more frequent among men regardless of social environment. CONCLUSIONS Knowledge of the occurrence of gastrointestinal problems in populations is better understood if viewed in a context were the social environment is included. Indicators of the social environment should therefore also be considered in future studies of the occurrence of gastrointestinal problems.
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Affiliation(s)
- Ewa Grodzinsky
- Dept of Medicine and Health Sciences, Linköping University, SE-581 83 Linköping, Sweden
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Chaudhary A, Tiwari N, Jain V, Singh R. Microporous bilayer osmotic tablet for colon-specific delivery. Eur J Pharm Biopharm 2011; 78:134-40. [DOI: 10.1016/j.ejpb.2011.01.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Revised: 01/01/2011] [Accepted: 01/11/2011] [Indexed: 12/18/2022]
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Porter CK, Gormley R, Tribble DR, Cash BD, Riddle MS. The Incidence and gastrointestinal infectious risk of functional gastrointestinal disorders in a healthy US adult population. Am J Gastroenterol 2011; 106:130-8. [PMID: 20859264 DOI: 10.1038/ajg.2010.371] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Functional gastrointestinal disorders (FGDs) are recognized sequelae of infectious gastroenteritis (IGE). Within the active duty military population, a group with known high IGE rates, the population-based incidence, risk factors, and attributable burden of care referable to FGD after IGE are poorly defined. METHODS Using electronic medical encounter data (1999-2007) on active duty US military, a matched, case-control study describing the epidemiology and risk determinants of FGD (irritable bowel syndrome (IBS), functional constipation (FC), functional diarrhea (FD), dyspepsia (D)) was conducted. Incidence rates and duration of FGD-related medical care were estimated, and conditional logistic regression was utilized to evaluate FGD risk after IGE. RESULTS A total of 31,866 cases of FGD identified were distributed as follows: FC 55% (n=17,538), D 21.2% (n=6,750), FD 2.1% (n=674), IBS 28.5% (n=9,091). Previous IGE episodes were distributed as follows: specific bacterial pathogen (n=65, 1.2%), bacterial, with no pathogen specified (n=2155, 38.9%), protozoal (n=38, 0.7%), viral (n=3431, 61.9%). A significant association between IGE and all FGD (odds ratio (OR) 2.64; P<0.001) was seen, with highest risk for FD (OR 6.28, P<0.001) and IBS (OR 3.72, P<0.001), and moderate risk for FC (2.15, P<0.001) and D (OR 2.39, P<0.001). Risk generally increased with temporal proximity to, and bacterial etiology of, exposure. Duration of FGD-related care was prolonged with 22.7% having FGD-associated medical encounters 5 years after diagnosis. CONCLUSIONS FGD are common in this population at high risk for IGE. When considering effective countermeasures and mitigation strategies, attention directed toward prevention as well as the acute and chronic sequelae of these infections is needed.
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Affiliation(s)
- Chad K Porter
- Enteric Diseases Department, Naval Medical Research Center, Silver Spring, Maryland 20910-7500, USA
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Lix LM, Yogendran MS, Shaw SY, Targownick LE, Jones J, Bataineh O. Comparing administrative and survey data for ascertaining cases of irritable bowel syndrome: a population-based investigation. BMC Health Serv Res 2010; 10:31. [PMID: 20113531 PMCID: PMC2824664 DOI: 10.1186/1472-6963-10-31] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2009] [Accepted: 02/01/2010] [Indexed: 12/15/2022] Open
Abstract
Background Administrative and survey data are two key data sources for population-based research about chronic disease. The objectives of this methodological paper are to: (1) estimate agreement between the two data sources for irritable bowel syndrome (IBS) and compare the results to those for inflammatory bowel disease (IBD); (2) compare the frequency of IBS-related diagnoses in administrative data for survey respondents with and without self-reported IBS, and (3) estimate IBS prevalence from both sources. Methods This retrospective cohort study used linked administrative and health survey data for 5,134 adults from the province of Manitoba, Canada. Diagnoses in hospital and physician administrative data were investigated for respondents with self-reported IBS, IBD, and no bowel disorder. Agreement between survey and administrative data was estimated using the κ statistic. The χ2 statistic tested the association between the frequency of IBS-related diagnoses and self-reported IBS. Crude, sex-specific, and age-specific IBS prevalence estimates were calculated from both sources. Results Overall, 3.0% of the cohort had self-reported IBS, 0.8% had self-reported IBD, and 95.3% reported no bowel disorder. Agreement was poor to fair for IBS and substantially higher for IBD. The most frequent IBS-related diagnoses among the cohort were anxiety disorders (34.4%), symptoms of the abdomen and pelvis (26.9%), and diverticulitis of the intestine (10.6%). Crude IBS prevalence estimates from both sources were lower than those reported previously. Conclusions Poor agreement between administrative and survey data for IBS may account for differences in the results of health services and outcomes research using these sources. Further research is needed to identify the optimal method(s) to ascertain IBS cases in both data sources.
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Affiliation(s)
- Lisa M Lix
- School of Public Health, University of Saskatchewan, Saskatoon, Canada.
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