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Okoli GN, Righolt CH, Zhang G, Alessi-Severini S, Van Caeseele P, Kuo IF, Mahmud SM. Socioeconomic, health-related, and primary care physician characteristics associated with adherence to seasonal influenza vaccination in Manitoba, Canada: A population-wide record-linkage cohort study. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2024; 115:585-598. [PMID: 38806938 PMCID: PMC11382643 DOI: 10.17269/s41997-024-00893-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 04/26/2024] [Indexed: 05/30/2024]
Abstract
OBJECTIVE There is a lack of published evidence on factors associated with adherence (maintenance of cumulative vaccination) to seasonal influenza vaccination (SIV) in Manitoba, Canada. We sought to assess the associations. METHODS A cohort study utilizing Manitoba administrative health databases. Participants received SIV in 2010/11 influenza season, remained registered Manitoba residents and received at least one SIV during the 2011/12‒2019/20 seasons. We dichotomized adherence into "more adherent" (6‒9 SIVs) and "less adherent" (1‒5 SIVs) and used multivariable adjusted generalized estimating equation logistic regression models to assess association between adherence and socioeconomic, health-related, and primary care physician (PCP) characteristics, stratified by age group (< 5, 5‒17, 18‒44, 45‒64, ≥ 65) and sex. Results are adjusted odds ratios with 95% confidence intervals. RESULTS There were 152,493 participants. Males had lower odds of being more adherent except among ≥ 65-year-olds (1.03, 95% CI 1.01‒1.05). Compared with the lowest income quintile, those in higher income quintiles had higher odds of being more adherent. The odds mostly increased with increase in income quintile. Those with more contact with their PCP/hospitalization one year prior had higher odds of being more adherent. The odds increased with increased contact among those 18‒44, 45‒64 and ≥ 65 years old. Those who had PCP with more years of practice had higher odds of being more adherent. The odds increased as years of practice increased. These observations were mostly consistent irrespective of sex. CONCLUSION Female gender, having higher income, having more contact with the health system, and having an experienced PCP may determine increased adherence to SIV in Manitoba. These findings require attention.
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Affiliation(s)
- George N Okoli
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
- Vaccine and Drug Evaluation Centre, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
- George and Fay Yee Centre for Healthcare Innovation, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
| | - Christiaan H Righolt
- Vaccine and Drug Evaluation Centre, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Geng Zhang
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Vaccine and Drug Evaluation Centre, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Silvia Alessi-Severini
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Paul Van Caeseele
- Departments of Medical Microbiology and Infectious Diseases, and Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Cadham Provincial Public Health Laboratories, Manitoba Health and Seniors Care, Winnipeg, MB, Canada
| | - I Fan Kuo
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Optimal Use and Evaluation, Ministry of Health, Government of British Columbia, Vancouver, BC, Canada
| | - Salaheddin M Mahmud
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Vaccine and Drug Evaluation Centre, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
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Hinds A, Suárez Aguilar B, Berrio YD, Ospina Galeano D, Gómez Vargas JH, Ruiz VE, Mignone J. Consistency Between Administrative Health Records and Self-Reported Health Status and Health Care Use Among Indigenous Wayuu Health Insurance Enrollees: La Guajira, Colombia. Eval Health Prof 2024:1632787241263370. [PMID: 38884607 DOI: 10.1177/01632787241263370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
The objective of the study was to assess the consistency between self-reported demographic characteristics, health conditions, and healthcare use, and administrative healthcare records, in a sample of enrollees of an Indigenous health organization in Colombia. We conducted a phone survey of a random sample of 2113 enrollees September-2020/February-2021. Administrative health records were obtained for the sample. Using ICD-10 diagnostic codes, we identified individuals who had healthcare visits for diabetes, hypertension, and/or pregnancy. Using unique identifiers, we linked their survey data to the administrative dataset. Agreement percentages and Cohen's Kappa coefficients were calculated. Logistic regressions were performed for each health condition/state. Results showed high degree of agreement between data sources for sex and age, similar rates for diabetes and hypertension, 10% variation for pregnancy. Kappa statistics were in the moderate range. Age was significantly associated with agreement between data sources. Sex, language, and self-rated health were significant for diabetes. This is the first study with data from an Indigenous population assessing the consistency between self-reported data and administrative health records. Survey and administrative data produced similar results, suggesting that Anas Wauu can be confident in using their data for planning and research purposes, as part of the movement toward data sovereignty.
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Gaddoury MA, Armenian HK. Epidemiology of Hajj pilgrimage mortality: Analysis for potential intervention. J Infect Public Health 2024; 17 Suppl 1:49-61. [PMID: 37336690 DOI: 10.1016/j.jiph.2023.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 04/24/2023] [Accepted: 05/18/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND The Saudi Vision 2030 predicts the attendance of 30 million pilgrims each year by 2030. Cost-effective healthcare services during the Hajj are important to manage this increase in the number of pilgrims. Little is known about the impact of the existing chronic diseases on morbidity and mortality during the Hajj. Furthermore, the quality of services provided by Hajj hospitals warrants further study. This study aims to describe patterns of inpatient, all-cause mortality during the Hajj and the relationship between mortality and preexisting chronic diseases as well as the services provided in Hajj hospitals. METHODS The population included pilgrims who were admitted to Hajj hospitals in Makkah and sacred sites between 2012 and 2017, excluding 2015. A retrospective, matched, case-control study design was utilized. 2237 cases of mortality were matched to 4474 control cases based on age and gender. The data were extracted from hospital admissions offices and medical records. Hierarchical, logistic regression models were used to examine the medical services. The effect measure modification of the copresence of more than one chronic disease was also examined. RESULTS The rate of inpatient all-cause mortality was higher in Makkah hospitals compared to sacred site hospitals. Inpatient, all-cause mortality was significantly associated with diabetes, hypertension, and cardiovascular diseases. Effect measure modification was present between diabetes and cardiovascular diseases, hypertension, and cardiovascular diseases, but not between diabetes and hypertension. Patients who received medical services were more likely to die during their hospital stay compared to patients not receiving services. CONCLUSION The current focus on public health issues during the Hajj should be equally distributed between communicable and non-communicable diseases. Although advanced services are provided by Hajj hospitals, interventions to address the increased risks, including mortality, faced by pilgrims with preexisting, chronic diseases should be further investigated and considered.
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Affiliation(s)
- Mahmoud A Gaddoury
- King Abdulaziz University, Faculty of Medicine, Saudi Arabia; University of California, Los Angeles, USA.
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Okoli GN, Righolt CH, Zhang G, Van Caeseele P, Kuo IF, Alessi-Severini S, Mahmud SM. A population-based, province-wide, record-linkage interrupted time series analysis of impact of the universal seasonal influenza vaccination policy on seasonal influenza vaccine uptake among 5-64-year-olds in the province of Manitoba, Canada. Vaccine 2024; 42:1571-1581. [PMID: 38360473 DOI: 10.1016/j.vaccine.2024.01.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/17/2024]
Abstract
INTRODUCTION Universal seasonal influenza vaccination policy (USIVP) was introduced in Manitoba, Canada in 2010. Its impact on seasonal influenza vaccine (SIV) uptake remains underexplored. METHODS We used population-wide data from Manitoba to assess the impact of the USIVP on SIV uptake. The study covered twenty influenza seasons (2000/01-2019/20). We summarized SIV uptake for influenza seasons before and after the USIVP. Utilizing a single-group interrupted time series analysis and appropriately accounting for autocorrelation, we estimated absolute change and annual trend in SIV uptake percentages among 5-17-, 18-44-, and 45-64-year-olds across strata of certain population socioeconomic and health-related characteristics following the USIVP. RESULTS Average SIV uptake percentage in all age groups was significantly higher after compared with before the USIVP. Following the USIVP, there was no significant absolute change in SIV uptake percentage among 18-44- and 45-64-year-olds overall; however, a significant decrease was observed among 18-44-year-old males in the higher income quintiles, across healthcare utilization, and in some regions of residence. A significant increase was observed among 5-17-year-olds in the lowest income quintiles, in Northern Manitoba, and among those with less healthcare utilization, and no chronic disease. Overall, there was mostly no significant annual trend in SIV uptake percentage among 18-44-year-olds, and while a significant upward and downward trend was observed among 5-17-year-olds and 45-64-year-olds, respectively, a significant downward trend was observed across all strata of population characteristics within all age groups in Northern Manitoba. CONCLUSIONS The USIVP in Manitoba was followed by an absolute increase in SIV uptake percentage only in some socioeconomically disadvantaged subpopulations among 5-17-year-olds. While there was mostly an upward annual trend in SIV uptake percentage among 5-17-year-olds, a downward trend was observed among 45-64-year-olds and across all age groups and subpopulations in socioeconomically disadvantaged Northern Manitoba. These findings are novel for Manitoba and require investigation and public health attention.
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Affiliation(s)
- George N Okoli
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Vaccine and Drug Evaluation Centre, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; George and Fay Yee Centre for Healthcare Innovation, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Christiaan H Righolt
- Vaccine and Drug Evaluation Centre, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Geng Zhang
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Vaccine and Drug Evaluation Centre, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Paul Van Caeseele
- Departments of Medical Microbiology and Infectious Diseases, and Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Cadham Provincial Public Health Laboratories, Manitoba Health and Seniors Care, Winnipeg, Manitoba, Canada
| | - I Fan Kuo
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Optimal Use and Evaluation, Ministry of Health, Government of British Columbia, Vancouver, British Columbia, Canada
| | - Silvia Alessi-Severini
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Salaheddin M Mahmud
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Vaccine and Drug Evaluation Centre, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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McAndrew EN, Graham J, Dufault B, Desautels DN, Kim CA. Long-term Survival Among Patients With De Novo Human Epidermal Growth Receptor 2-Positive Metastatic Breast Cancer in Manitoba. Am J Clin Oncol 2024; 47:122-127. [PMID: 38047455 DOI: 10.1097/coc.0000000000001068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
OBJECTIVES Although metastatic breast cancer (MBC) is considered incurable, human epidermal growth receptor 2 (HER2)-directed therapy has improved outcomes significantly, with some patients experiencing durable responses to treatment. The aim of this study was to identify potential predictors of long-term survival (LTS) among patients with de novo HER2-positive MBC who received HER2-directed treatment. METHODS Eligible patients from 2008 to 2018 were identified using the Manitoba Cancer Registry. LTS was defined as survival ≥5 years from the time of diagnosis. Univariate logistic regression models were performed to assess variables of clinical interest and the odds of LTS. Overall survival (OS) was defined as the time from diagnosis of MBC to death of any cause. OS was estimated using the Kaplan-Meier method with log-rank comparative analyses as a univariate analysis. A Cox proportional hazards model was used for OS estimates in a univariate analysis. RESULTS A total of 62 patients were diagnosed with de novo HER2-positive MBC and received HER2-directed therapy. Eighteen (29%) achieved LTS. The median OS of the whole cohort was 50.2 months (95% CI: 28.6-not reached). Radiographic response to first-line treatment was associated with LTS; complete and partial responses were both associated with higher odds of LTS (odds ratio: 28.33 [95% CI: 2.47-4006.71, P = 0.0043] and odds ratio: 7.80 [95% CI: 0.7317-1072.00, P = 0.0972], respectively). The best radiographic response was associated with improved OS. CONCLUSIONS Radiographic response to first-line HER2-directed therapy is a predictor for LTS in patients with de novo HER2-positive MBC. Larger studies are needed to identify patients who can safely discontinue HER2-targeted therapy.
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Affiliation(s)
- Erin N McAndrew
- Department of Internal Medicine, Rady Faculty of Health Sciences
| | - Jeffrey Graham
- Department of Internal Medicine, Rady Faculty of Health Sciences
- Department of Internal Medicine, Section of Medical Oncology and Hematology, Rady Faculty of Health Sciences, University of Manitoba
- Paul Albrechtsen Research Institute CancerCare Manitoba
| | - Brenden Dufault
- George and Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
| | - Danielle N Desautels
- Department of Internal Medicine, Rady Faculty of Health Sciences
- Department of Internal Medicine, Section of Medical Oncology and Hematology, Rady Faculty of Health Sciences, University of Manitoba
- Paul Albrechtsen Research Institute CancerCare Manitoba
| | - Christina A Kim
- Department of Internal Medicine, Rady Faculty of Health Sciences
- Department of Internal Medicine, Section of Medical Oncology and Hematology, Rady Faculty of Health Sciences, University of Manitoba
- Paul Albrechtsen Research Institute CancerCare Manitoba
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Okoli GN, Righolt CH, Zhang G, Alessi-Severini S, Van Caeseele P, fan Kuo I, Mahmud SM. Characteristics and determinants of seasonal influenza vaccination in Manitoba, Canada: A population-wide record-linkage study. Vaccine X 2024; 17:100435. [PMID: 38299203 PMCID: PMC10825609 DOI: 10.1016/j.jvacx.2024.100435] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 01/03/2024] [Accepted: 01/08/2024] [Indexed: 02/02/2024] Open
Abstract
Background Seasonal influenza vaccine (SIV) uptake (receipt of vaccine) in Manitoba, Canada is consistently low notwithstanding vaccine availability and free-of-charge vaccination. Despite, there is a lack of published evidence on the determinants of uptake of the vaccine. We sought to assess the association between SIV uptake and certain population and primary care physician (PCP) characteristics in Manitoba. Methods We conducted a longitudinal study utilizing Manitoba administrative health databases. We summarized SIV uptake from 2000/01-2019/20 influenza seasons across subpopulations defined by socioeconomic, health-related and PCP characteristics. Utilizing multivariable generalized estimating equation logistic regression models, we assessed the association between SIV uptake and the socioeconomic, health-related and PCP characteristics, stratified by age group (<5-, 5-17-, 18-44-, 45-64-, ≥65-year-olds) and sex. Results are adjusted odds ratios with associated 95 % confidence intervals. Results SIV uptake percentage increased over time with 4.4 %, 13.1 %, 17.5 % and 21.7 % of < 5-year-olds, 2 %, 4.9 %, 9.7 % and 13.1 % of 5-17-year-olds, 5.4 %, 8.8 %, 10.7 % and 13.5 % of 18-44-year-olds, 16.8 %, 21.3 %, 23.6 % and 24.6 % of 45-64-year-olds receiving the SIV in 2000-2004, 2005-2009, 2010-2014 and 2015-2019, respectively. There was a decline among ≥ 65-year-olds from 58.5 % to 53.5 %. We observed a similar pattern across subpopulations. There were significantly increased odds of SIV uptake among females within the age groups ≥ 18 years, in higher income quintiles, mostly with increased contact with a PCP/hospitalization within age groups ≥ 18 years, among those who had older or female PCPs (the opposite observation among ≥ 65-year-olds) and whose PCP administered at least one SIV in prior influenza season. These observations were largely consistent irrespective of sex. Conclusion SIV uptake in Manitoba appears to increase with age, and many socioeconomic, health-related and PCP characteristics appear to be associated with it. These findings may inform targeted vaccination programs to optimize influenza vaccination in Manitoba and similar Canadian jurisdictions.
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Affiliation(s)
- George N. Okoli
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Vaccine and Drug Evaluation Centre, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- George and Fay Yee Centre for Healthcare Innovation, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Christiaan H. Righolt
- Vaccine and Drug Evaluation Centre, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Geng Zhang
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Vaccine and Drug Evaluation Centre, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Silvia Alessi-Severini
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Paul Van Caeseele
- Departments of Medical Microbiology and Infectious Diseases, and Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Cadham Provincial Public Health Laboratories, Manitoba Health and Seniors Care, Winnipeg, Manitoba, Canada
| | - I fan Kuo
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Optimal Use and Evaluation, Ministry of Health, Government of British Columbia, Vancouver, British Columbia, Canada
| | - Salaheddin M. Mahmud
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Vaccine and Drug Evaluation Centre, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Rittberg R, Decker K, Lambert P, Bravo J, St John P, Turner D, Czaykowski P, Dawe DE. Impact of age, comorbidity, and polypharmacy on receipt of systemic therapy in advanced cancers: A retrospective population-based study. J Geriatr Oncol 2024; 15:101689. [PMID: 38219331 DOI: 10.1016/j.jgo.2023.101689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 11/18/2023] [Accepted: 12/12/2023] [Indexed: 01/16/2024]
Abstract
INTRODUCTION Cancer incidence, comorbidity, and polypharmacy increase with age, but the interplay between these factors on receipt of systemic therapy (ST) in advanced cancer has rarely been studied. MATERIALS AND METHODS A retrospective cohort study was conducted including patients aged ≥18 years diagnosed from 2004 to 2015 with multiple myeloma (MM) (all stages), lung cancer (stage IV), and stage III-IV non-Hodgkin's lymphoma (NHL), breast, colorectal (CRC), prostate, or ovarian cancer in Manitoba, Canada. Clinical and administrative health data were used to determine demographic and cancer characteristics, treatment history, comorbidity (Charlson Comorbidity Index [CCI] and Resource Utilization Band [RUB]), and polypharmacy (≥6 medications). Multivariable logistic regression was used to evaluate variable associations with receipt of ST and interaction with age. RESULTS In total, 17,228 patients were diagnosed with advanced cancer. Ages were distributed as follows: 7% <50 years, 16% 50-59 years, 26% 60-69, 26% 70-79, 24% ≥80 years. ST was administered to 50% of patients. Increased age, polypharmacy, and comorbidity each independently decreased the likelihood of receiving ST. Significant interaction effects were found between age at diagnosis with stage of cancer and cancer type. Differences in probability of ST by cancer stage converged as age increased. In multivariable analysis, adjusting for covariates, patients with MM had the highest odds and lung cancer the lowest odds to receive ST. The impact of comorbidity and polypharmacy did not differ meaningfully with increasing age. DISCUSSION Increased age, polypharmacy, and comorbidity were each independently associated with decreased receipt of ST in people with advanced cancers. The impact of comorbidity and polypharmacy did not differ meaningfully with increasing age, while age meaningfully interacted with stage and cancer type.
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Affiliation(s)
- Rebekah Rittberg
- Department of Internal Medicine, University of Manitoba, Winnipeg, Canada; Department of Medical Oncology, BC Cancer, Vancouver, Canada
| | - Kathleen Decker
- CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, Canada; Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, Canada
| | - Pascal Lambert
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, Canada
| | - Jen Bravo
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, Canada
| | - Philip St John
- Section of Geriatric Medicine, Department of Internal Medicine, University of Manitoba, Winnipeg, Canada; Centre on Aging, University of Manitoba, Winnipeg, Canada
| | - Donna Turner
- CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, Canada; Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, Canada
| | - Piotr Czaykowski
- Department of Internal Medicine, University of Manitoba, Winnipeg, Canada; Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, Canada
| | - David E Dawe
- Department of Internal Medicine, University of Manitoba, Winnipeg, Canada; CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, Canada; Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, Canada.
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Decker KM, Musto G, Bucher O, Czaykowski P, Hebbard P, Kim JO, Singh H, Thiessen M, Feely A, Galloway K, Lambert P. Examining the Association Between the COVID-19 Pandemic and the Rate of Diagnostic Tests for Breast, Cervical, and Colorectal Cancer in Manitoba, Canada. Technol Cancer Res Treat 2024; 23:15330338241263616. [PMID: 39053019 PMCID: PMC11282542 DOI: 10.1177/15330338241263616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 05/02/2024] [Accepted: 05/28/2024] [Indexed: 07/27/2024] Open
Abstract
Background: Strategies to minimize the impact of the COVID-19 pandemic led to a reduction in diagnostic testing. It is important to assess the magnitude and duration of this impact to plan ongoing care and avoid long-lasting impacts of the pandemic. Objective: We examined the association between the COVID-19 pandemic and the rate of diagnostic tests for breast, cervical, and colorectal cancer in Manitoba, Canada. Design and Participants: A population-based, cross-sectional study design with an interrupted time series analysis was used that included diagnostic tests from January 1, 2015 until August 31, 2022. Setting: Manitoba, Canada. Main Outcomes: Outcomes included mammogram, breast ultrasound, colposcopy, and colonoscopy rates per 100,000. Cumulative and percent cumulative differences between the fitted and counterfactual number of tests were estimated. Mean, median, and 90th percentile number of days from referral to colonoscopy date by referral type (elective, semiurgent, urgent) were determined. Results: In April 2020, following the declaration of the COVID-19 public health emergency, bilateral mammograms decreased by 77%, unilateral mammograms by 70%, breast ultrasounds by 53%, colposcopies by 63%, and colonoscopies by 75%. In Winnipeg (the largest urban center in the province), elective and semiurgent colonoscopies decreased by 76% and 39%, respectively. There was no decrease in urgent colonoscopies. As of August 2022, there were an estimated 7270 (10.7%) fewer bilateral mammograms, 2722 (14.8%) fewer breast ultrasounds, 836 (3.3%) fewer colposcopies, and 11 600 (13.8%) fewer colonoscopies than expected in the absence of COVID-19. As of December 2022, in Winnipeg, there were an estimated 6030 (23.9%) fewer elective colonoscopies, 313 (2.6%) fewer semiurgent colonoscopies, and 438 (27.3%) more urgent colonoscopies. Conclusions: In Manitoba, the COVID-19 pandemic was associated with sizable decreases in diagnostic tests for breast, colorectal, and cervical cancer. Two and a half years later, there remained large cumulative deficits in bilateral mammograms, breast ultrasounds, and colonoscopies.
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Affiliation(s)
- Kathleen M. Decker
- Paul Albrechtsen Research Institute CancerCare Manitoba, Winnipeg, MB, Canada
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Grace Musto
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Oliver Bucher
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Piotr Czaykowski
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Pamela Hebbard
- Department of Surgery, Section of General Surgery, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Julian O. Kim
- Paul Albrechtsen Research Institute CancerCare Manitoba, Winnipeg, MB, Canada
- Department of Radiology, Section of Radiation Oncology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Radiation Oncology, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Harminder Singh
- Paul Albrechtsen Research Institute CancerCare Manitoba, Winnipeg, MB, Canada
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Maclean Thiessen
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Allison Feely
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Katie Galloway
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Pascal Lambert
- Paul Albrechtsen Research Institute CancerCare Manitoba, Winnipeg, MB, Canada
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, MB, Canada
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Okoli GN, Righolt CH, Zhang G, Alessi-Severini S, Van Caeseele P, Kuo IF, Mahmud SM. Impact of the universal seasonal influenza vaccination policy in the province of Manitoba, Canada: A population-based, province-wide record-linkage study. Vaccine 2023; 41:6679-6689. [PMID: 37778900 DOI: 10.1016/j.vaccine.2023.09.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/20/2023] [Accepted: 09/22/2023] [Indexed: 10/03/2023]
Abstract
INTRODUCTION In 2010, the government of the province of Manitoba, Canada introduced universal seasonal influenza vaccination policy (USIVP), providing free-of-charge vaccination to all registered residents of the province at least six months of age. Impact of the policy on seasonal influenza vaccine (SIV) uptake (receipt of vaccine) in Manitoba remains unclear, as there is a lack of published evaluations. METHODS We conducted an ecological study, utilizing population-wide data from several linked de-identified Manitoba Health and Seniors Care administrative health databases. The study period was from 2000/01-2019/20 influenza seasons. The primary exposure was USIVP (five influenza seasons pre-policy [2005/06-2009/10] compared with post-policy [2010/11-2014/15]). The outcome was SIV uptake. We conducted pre/post logistic regression analysis stratified by age group (<5-, 5-17-, 18-44-, 45-64-, ≥65-year-olds) and certain population socioeconomic and health-related characteristics. Results are adjusted odds ratios with associated 95 % confidence intervals. RESULTS We observed significantly increased adjusted odds of SIV uptake post-policy relative to pre-policy in all age groups except ≥65-year-olds already covered from inception of the vaccination programme. The adjusted odds ratios ranged from 0.76 (0.75-0.76) among ≥65-year-olds to 2.15 (2.13-2.18) among 5-17-year-olds, and were largely homogeneous within age groups across sex, income quintiles, regions of residence, and categories of number of visits to primary care physician/hospitalization one year prior to an influenza season except among <5- and 5-17-year-olds. These findings were mostly consistent irrespective of sex and region of residence although there was variability across income quintiles in Northern Manitoba region. CONCLUSIONS Introduction of the USIVP in Manitoba was followed by a significant increase in SIV uptake in the five years post policy among <65-year-olds, with similar increased relative odds of vaccination observed within age groups across subpopulations. The observed variations in the relative odds of vaccination across income quintiles in Northern Manitoba region requires administrative attention.
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Affiliation(s)
- George N Okoli
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Vaccine and Drug Evaluation Centre, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; George and Fay Yee Centre for Healthcare Innovation, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Christiaan H Righolt
- Vaccine and Drug Evaluation Centre, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Geng Zhang
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Vaccine and Drug Evaluation Centre, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Silvia Alessi-Severini
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Paul Van Caeseele
- Departments of Medical Microbiology and Infectious Diseases, and Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Cadham Provincial Public Health Laboratories, Manitoba Health and Seniors Care, Winnipeg, Manitoba, Canada
| | - I Fan Kuo
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Optimal Use and Evaluation, Ministry of Health, Government of British Columbia, Vancouver, British Columbia, Canada
| | - Salaheddin M Mahmud
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Vaccine and Drug Evaluation Centre, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Ferro MA, Elgie M, Dol M, Basque D. Measurement invariance of the 12-item self-administered World Health Organization Disability Assessment Schedule (WHODAS) 2.0 across early and late adolescents in Canada. Disabil Rehabil 2023; 45:3118-3124. [PMID: 36082846 DOI: 10.1080/09638288.2022.2118867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 08/11/2022] [Accepted: 08/25/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE This study examined whether the 12-item self-administered World Health Organization Disability Assessment Schedule (WHODAS) 2.0 demonstrated measurement invariance between young adolescents aged 10-16 years with a physical illness and older adolescents aged 15-19 years from the general population. MATERIALS AND METHODS Young adolescent data come from the baseline wave of the Multimorbidity in Youth across the Life-course study (n = 117) and older adolescent data come from the Canadian Community Health Survey-Mental Health (n = 1851). Multiple-group confirmatory factor analysis was used to test measurement invariance. WHODAS 2.0 scores were compared across morbidity subgroups using multiple regression. RESULTS Measurement invariance of the WHODAS 2.0 was demonstrated: (χ2=635.2(144), p<.001; RMSEA = 0.059 (0.054, 0.064); CFI = 0.967; TLI = 0.970; and, SRMR = 0.068). Adjusting for data source, sex, race, immigrant status, and household income, WHODAS 2.0 scores were associated with morbidity status in a dose-response manner: physical illness only (B = 1.50, p<.001), mental illness only (B = 2.92, p<.001), and physical-mental comorbidity (B = 4.44, p<.001). CONCLUSIONS Measurement invariance of the WHODAS 2.0 suggests that young adolescents interpret the items and disability construct similarly to older adolescents - a group that previously demonstrated measurement invariance with an adult sample. The 12-item self-administered WHODAS 2.0 may be used to measure disability across the life-course. IMPLICATIONS FOR REHABILITATIONThe 12-item self-administered WHODAS 2.0 is one of the most widely used measures of disability and functioning.Measurement invariance of the WHODAS 2.0 suggests that young adolescents interpret the items and disability construct similarly to older adolescents and adults in Canada.Researchers and health professionals can be confident that differences in 12-item self-administered WHODAS 2.0 scores are real and meaningful.The 12-item self-administered WHODAS 2.0 may be used to measure disability across the life-course.
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Affiliation(s)
- Mark A Ferro
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Melissa Elgie
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Megan Dol
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Dominique Basque
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
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11
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Galloway K, Lambert P, Bow EJ, Czaykowski P, Fatoye T, Goldenberg B, Kristjanson M, Singh H, Bucher O, Decker K. Evaluation of the Impact of the Urgent Cancer Care Clinic on Emergency Department Visits, Primary Care Clinician Visits, and Hospitalizations in Winnipeg, Manitoba. Curr Oncol 2023; 30:6771-6785. [PMID: 37504356 PMCID: PMC10378500 DOI: 10.3390/curroncol30070496] [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: 05/23/2023] [Revised: 07/12/2023] [Accepted: 07/16/2023] [Indexed: 07/29/2023] Open
Abstract
The urgent cancer care (UCC) clinic at CancerCare Manitoba (CCMB) opened in 2013 to provide care to individuals diagnosed with cancer and serious blood disorders experiencing complications from the underlying disorder or its treatment. This study examined the impact of the UCC clinic on other health care utilization in Winnipeg, Manitoba, Canada. An interrupted time series study design was used to compare the rates of emergency department (ED) visits, primary care clinician (PCC) visits, and hospitalizations from 1 January 2010 to 31 December 2015. Rates of ED visits were also stratified by ED location, severity, and cancer type. We found a 6% (95% CI 1.00-1.13, p-value = 0.0389) increase in PCC visits, a 7% (95% CI 0.99-1.15, p-value = 0.0737) increase in hospitalizations, a 4% (95% CI 0.86-1.08, p-value = 0.5053) decrease in the rate of ED visits, and a 3% (95% CI 0.92-1.17, p-value = 0.5778) increase in the rate of ED visits during the UCC clinic hours after the UCC clinic opened. The implementation of the UCC clinic had minimal impact on health care utilization. Future work should examine the impact of the UCC clinic on other aspects of healthcare utilization (e.g., number of tests ordered and time spent waiting in CCMB's main clinics) and patient quality of life and patient and health care provider experience.
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Affiliation(s)
- Katie Galloway
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada
- Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, 750 Bannatyne Avenue, Winnipeg, MB R3E 0W2, Canada
| | - Pascal Lambert
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada
- Paul Albrechtsen Research Institute CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada
| | - Eric J Bow
- Department of Medical Oncology and Hematology, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada
- Department of Internal Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, 820 Sherbrook Street, Winnipeg, MB R3A 1R9, Canada
- Department of Medical Microbiology and Infectious Diseases, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, 745 Bannatyne Avenue, Winnipeg, MB R3E 0J9, Canada
| | - Piotr Czaykowski
- Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, 750 Bannatyne Avenue, Winnipeg, MB R3E 0W2, Canada
- Department of Medical Oncology and Hematology, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada
- Department of Internal Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, 820 Sherbrook Street, Winnipeg, MB R3A 1R9, Canada
| | - Tunji Fatoye
- Department of Primary Care Oncology, Cancer Care Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada
- Department of Family Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, 750 Bannatyne Avenue, Winnipeg, MB R3E 0W2, Canada
| | - Benjamin Goldenberg
- Department of Medical Oncology and Hematology, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada
- Department of Internal Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, 820 Sherbrook Street, Winnipeg, MB R3A 1R9, Canada
| | - Mark Kristjanson
- Department of Primary Care Oncology, Cancer Care Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada
| | - Harminder Singh
- Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, 750 Bannatyne Avenue, Winnipeg, MB R3E 0W2, Canada
- Paul Albrechtsen Research Institute CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada
- Department of Internal Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, 820 Sherbrook Street, Winnipeg, MB R3A 1R9, Canada
| | - Oliver Bucher
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada
| | - Kathleen Decker
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada
- Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, 750 Bannatyne Avenue, Winnipeg, MB R3E 0W2, Canada
- Paul Albrechtsen Research Institute CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada
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12
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Bishop L, Charlton RA, McLean KJ, McQuaid GA, Lee NR, Wallace GL. Cardiovascular disease risk factors in autistic adults: The impact of sleep quality and antipsychotic medication use. Autism Res 2023; 16:569-579. [PMID: 36490360 PMCID: PMC10023317 DOI: 10.1002/aur.2872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 11/25/2022] [Indexed: 12/13/2022]
Abstract
Approximately 40% of American adults are affected by cardiovascular disease (CVD) risk factors (e.g., high blood pressure, high cholesterol, diabetes, and overweight or obesity), and risk among autistic adults may be even higher. Mechanisms underlying the high prevalence of CVD risk factors in autistic people may include known correlates of CVD risk factors in other groups, including high levels of perceived stress, poor sleep quality, and antipsychotic medication use. A sample of 545 autistic adults without intellectual disability aged 18+ were recruited through the Simons Foundation Powering Autism Research, Research Match. Multiple linear regression models examined the association between key independent variables (self-reported perceived stress, sleep quality, and antipsychotic medication use) and CVD risk factors, controlling for demographic variables (age, sex assigned at birth, race, low-income status, autistic traits). Overall, 73.2% of autistic adults in our sample had an overweight/obesity classification, 45.3% had high cholesterol, 39.4% had high blood pressure, and 10.3% had diabetes. Older age, male sex assigned at birth, and poorer sleep quality were associated with a higher number of CVD risk factors. Using antipsychotic medications was associated with an increased likelihood of having diabetes. Poorer sleep quality was associated with an increased likelihood of having an overweight/obesity classification. Self-reported CVD risk factors are highly prevalent among autistic adults. Both improving sleep quality and closely monitoring CVD risk factors among autistic adults who use antipsychotic medications have the potential to reduce risk for CVD.
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Okunseri C, Frantsve-Hawley J, Thakkar-Samtani M, Okunev II, Heaton LJ, Tranby EP. Estimation of oral disease burden from claims and self-reported data. J Public Health Dent 2023; 83:51-59. [PMID: 36224115 DOI: 10.1111/jphd.12550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 04/21/2022] [Accepted: 07/11/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the use of Medicaid and commercial claims data with self-reported survey data in estimating the prevalence of oral disease burden. METHODS We analyzed 2018 Medicaid claims from the IBM Watson Medicaid Marketscan database, commercial claims from the IBM Dental Database, and Medical Expenditure Panel Survey (MEPS) data. The estimate of oral disease burden was based on standard metrics using periodontal and caries-related Current Dental Terminology (CDT) procedure codes. A direct comparison between the data sets was also done. RESULTS Unweighted Medicaid and commercial enrollees were 11.6 and 10.5 million, respectively. The weighted proportion from MEPS for Medicaid and commercial plans ranged from 80 to 208 million people. Estimates of caries-related treatments were calculated from IBM Watson and MEPS data for Medicaid enrollees (13% vs. 12%, respectively) and commercial claims (25% vs. 17%, respectively). Prevalence of periodontal related treatments for those with a dental visit was estimated for IBM Watson and MEPS enrollees for Medicaid (0.7% vs. 0.5%, respectively) and commercial claims (7% vs. 1.6%, respectively). Dental disease estimates were higher in individuals with at least one dental visit across cohorts. Prevalence of disease for those with a dental visit based on specific procedures were higher in commercial plans than in Medicaid. CONCLUSIONS Claims data has the potential to serve as a proxy measure for the estimate of dental disease burden in a population.
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Affiliation(s)
- Christopher Okunseri
- Department of Clinical Services, School of Dentistry, Marquette University Milwaukee Wisconsin, Milwaukee, Wisconsin, USA
| | | | | | - IIya Okunev
- CareQuest Institute for Oral Health, Boston, Massachusetts, USA
| | - Lisa J Heaton
- CareQuest Institute for Oral Health, Boston, Massachusetts, USA
| | - Eric P Tranby
- CareQuest Institute for Oral Health, Boston, Massachusetts, USA
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Zhang M, Shi Y, Zhou B, Huang Z, Zhao Z, Li C, Zhang X, Han G, Peng K, Li X, Wang Y, Ezzati M, Wang L, Li Y. Prevalence, awareness, treatment, and control of hypertension in China, 2004-18: findings from six rounds of a national survey. BMJ 2023; 380:e071952. [PMID: 36631148 PMCID: PMC10498511 DOI: 10.1136/bmj-2022-071952] [Citation(s) in RCA: 42] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/24/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To assess the recent trends in prevalence and management of hypertension in China, nationally and by population subgroups. DESIGN Six rounds of a national survey, China. SETTING China Chronic Disease and Risk Factors Surveillance, 2004-18. PARTICIPANTS 642 523 community dwelling adults aged 18-69 years (30 501 in 2004, 47 353 in 2007, 90 491 in 2010, 156 836 in 2013, 162 293 in 2015, and 155 049 in 2018). MAIN OUTCOME MEASURES Hypertension was defined as a blood pressure of ≥140/90 mm Hg or taking antihypertensive drugs. The main outcome measures were hypertension prevalence and proportion of people with hypertension who were aware of their hypertension, who were treated for hypertension, and whose blood pressure was controlled below 140/90 mm Hg. RESULTS The standardised prevalence of hypertension in adults aged 18-69 years in China increased from 20.8% (95% confidence interval 19.0% to 22.5%) in 2004 to 29.6% (27.8% to 31.3%) in 2010, then decreased to 24.7% (23.2% to 26.1%) in 2018. During 2010-18, the absolute annual decline in prevalence of hypertension among women was more than twice that among men (-0.83 percentage points (95% confidence interval -1.13 to -0.52) v -0.40 percentage points (-0.73 to -0.07)). Despite modest improvements in the awareness, treatment, and control of hypertension since 2004, rates remained low in 2018, at 38.3% (36.3% to 40.4%), 34.6% (32.6% to 36.7%), and 12.0% (10.6% to 13.4%). Of 274 million (95% confidence interval 238 to 311 million) adults aged 18-69 years with hypertension in 2018, control was inadequate in an estimated 240 million (215 to 264 million). Across all surveys, women with low educational attainment had higher prevalence of hypertension than those with higher education, but the finding was mixed for men. The gap in hypertension control between urban and rural areas persisted, despite larger improvements in diagnosis and control in rural than in urban areas. CONCLUSIONS The prevalence of hypertension in China has slightly declined since 2010, but treatment and control remain low. The findings highlight the need for improving detection and treatment of hypertension through the strengthening of primary care in China, especially in rural areas.
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Affiliation(s)
- Mei Zhang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Yu Shi
- National Clinical Research Center for Cardiovascular Diseases, Heart Failure Ward, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, Guangdong Province, China
| | - Bin Zhou
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
- The Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, London, UK
| | - Zhengjing Huang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Zhenping Zhao
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Chun Li
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Xiao Zhang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Guiyuan Han
- National Clinical Research Center for Cardiovascular Diseases, Heart Failure Ward, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, Guangdong Province, China
| | - Ke Peng
- National Clinical Research Center for Cardiovascular Diseases, Heart Failure Ward, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, Guangdong Province, China
| | - Xinhua Li
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
- People's Medical Publishing House, Beijing, China
| | - Youfa Wang
- Global Health Institute, School of Public Health, Xi'an Jiaotong University, Xi'an, China
| | - Majid Ezzati
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
- The Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, London, UK
| | - Limin Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Yichong Li
- National Clinical Research Center for Cardiovascular Diseases, Heart Failure Ward, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, Guangdong Province, China
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15
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Righolt CH, Zhang G, Gibson SB, Johnston JB, Banerji V, Mahmud SM. Patterns and predictors of referral to the specialized chronic lymphocytic leukemia clinic in Manitoba, Canada. Cancer Epidemiol 2022; 81:102279. [PMID: 36279643 DOI: 10.1016/j.canep.2022.102279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/26/2022] [Accepted: 10/11/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Better CLL patient survival has been reported for specialized CLL clinics/hematologists (compared to other CLL patients). It is possible that improved survival is driven by a better prognosis of referred patients. METHODS We used logistic regression to calculate the odds ratios (ORs) and 95 % confidence intervals 95 %CIs) of the association between patient characteristics and CLL referral of all persons diagnosed in 2005-2016 with a pathologically-confirmed CLL or SLL. RESULTS Two-thirds of 1293 patients were referred to the CLL clinic. Referred patients were younger (16 % vs 44 % were 80 +) and in better health (47 % vs 56 % with a chronic diseases) than non-referred patients. Referral increased over time: in 2005-2010, about 60 % of patients were referred; in 2011-2016, this increased to 76 %. Gender did not affect referral (the OR for females is 1.0, 95 %CI 0.8-1.2), but age played a major role; CLL patients diagnosed at age 80 + were less likely to be referred than patients diagnosed < 60, 0.2 (0.1-0.3). CONCLUSION Because referral to Manitoba's specialized CLL clinic is associated with age and the patient's overall health before referral, one should be careful in interpreting differences in outcomes between CLL patients based on referral status alone.
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MESH Headings
- Aged, 80 and over
- Female
- Humans
- Canada
- Chronic Disease
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/epidemiology
- Leukemia, Lymphocytic, Chronic, B-Cell/therapy
- Manitoba/epidemiology
- Referral and Consultation/statistics & numerical data
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Affiliation(s)
- Christiaan H Righolt
- Vaccine and Drug Evaluation Centre, Department of Community Health Sciences, University of Manitoba, 337-750 McDermot Avenue, Winnipeg, MB, Canada R3E 0T5
| | - Geng Zhang
- Vaccine and Drug Evaluation Centre, Department of Community Health Sciences, University of Manitoba, 337-750 McDermot Avenue, Winnipeg, MB, Canada R3E 0T5
| | - Spencer B Gibson
- Research Institute of Oncology and Hematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada; Department of Hematology and Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - James B Johnston
- Research Institute of Oncology and Hematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada; Department of Hematology and Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada; Department Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Versha Banerji
- Research Institute of Oncology and Hematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada; Department of Hematology and Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada; Department Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Salaheddin M Mahmud
- Vaccine and Drug Evaluation Centre, Department of Community Health Sciences, University of Manitoba, 337-750 McDermot Avenue, Winnipeg, MB, Canada R3E 0T5.
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Are grandchildren good for you? Well-being and health effects of becoming a grandparent. Soc Sci Med 2022; 313:115392. [PMID: 36215928 DOI: 10.1016/j.socscimed.2022.115392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 09/19/2022] [Accepted: 09/21/2022] [Indexed: 01/26/2023]
Abstract
Older individuals commonly go through a few major life transitions which can impact their health and well-being. While transitions like that into retirement have been extensively investigated, little research focused on the transition into grandparenthood. Understanding effects of this highly common event is not only important from a descriptive viewpoint, but is also informative for the active aging policies that are increasingly pursued to deal with aging populations. Using data from ten Western European countries, we show that grandparenthood on average leads to a reduction in well-being while hardly impacting physical, cognitive and mental health. The effect is heterogeneous by family closeness, though. Grandparenthood reduces well-being for those having relatively little family contact and not providing child care. But it leaves well-being unaffected while improving health along some dimensions among those with the opposite profile. The only exception to the latter are grandmothers providing daily child care, for whom grandparenthood appears to be burdensome. This pattern of results suggests that involving grandparents non-intensively in child care may lead to beneficial side-effects. Becoming a grandparent induces people to retire, but retirement seems no relevant channel for well-being and health effects.
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Hypertension and cognition are minimally associated in late life. Hypertens Res 2022; 45:1622-1631. [PMID: 35787658 DOI: 10.1038/s41440-022-00970-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 05/07/2022] [Accepted: 05/18/2022] [Indexed: 01/13/2023]
Abstract
Hypertension impacts approximately 65% of persons over 60 years of age. Although previous studies have proposed an association between mid-life hypertension and late-life cognition, reports of associations between late-life hypertension and cognition have been mixed in the direction and magnitude of the observed associations and in the cognitive domains that may be affected. This study contrasted older adults with and without self-reported hypertension at two time points in late life (MBaseline age = 64.3 years, SD1 = 0.7; MFollow-up age = 71.2 years, SD2 = 0.9), separated by approximately seven years. Participants included 4314 1957 high school graduates from the Wisconsin Longitudinal Study who were followed longitudinally until 2011. Cognitive, demographic, and health variables from the 2003-2005 and 2011 data collection waves were used. Cognitive measures included letter and category fluency, digit ordering, similarities, and immediate and delayed recall. Bayesian independent t tests and regressions examined the association between self-reported hypertension status and cognition at baseline and follow-up. Persons with self-reported hypertension over seven years showed slightly worse letter fluency and digit ordering performance at follow-up than persons without self-reported hypertension. No baseline cognitive differences were observed between groups. Participants with self-reported hypertension showed no improvement in letter fluency or digit ordering compared to persons without self-reported hypertension. After controlling for cardiovascular risk factors, hypertension was associated only with a slight decline in letter fluency. Finally, hypertension duration was not associated with cognitive performance. Self-reported hypertension was associated with minimal to no effects on cognition in older adults. Controlling for cardiovascular risk factors eliminated virtually all associations between self-reported hypertension and cognition.
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Incidence of anogenital warts after the introduction of the quadrivalent HPV vaccine program in Manitoba, Canada. PLoS One 2022; 17:e0267646. [PMID: 35472093 PMCID: PMC9041799 DOI: 10.1371/journal.pone.0267646] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 04/12/2022] [Indexed: 11/19/2022] Open
Abstract
Background
The incidence of anogenital warts (AGW) decreased after the introduction of the quadrivalent human papillomavirus (qHPV) vaccine in multiple jurisdictions. We studied how comparing AGW incidence rates with different outcomes affects the interpretation of the qHPV vaccination program. To do this, we replicated multiple study designs within a single jurisdiction (Manitoba).
Methods
We measured the incidence rates of AGW, AGW-related prescriptions, chlamydia, and gonorrhea (the latter two as sham outcomes) between 2001 and 2017 using several clinical and administrative health databases from Manitoba. We then used incidence rate ratios (IRRs) to compare, for each outcome, the rate for the 1997–1998 birth cohort (the first cohorts eligible for the publicly funded qHPV vaccination program) and the older 1995–1996 birth cohort.
Results
AGW incidence in Manitoba dropped 72% (95% confidence interval 54–83%) among 16–18 year-old girls and 51% (14–72%) among boys after the introduction of the female-only qHPV vaccination program. Trends in AGW-related prescriptions were different from trends in AGW diagnoses as these prescriptions peaked shortly after the introduction of the publicly funded qHPV vaccine program. Chlamydia and gonorrhea incidence rates also decreased 12% (5–18%) and 16% (-1-30%), respectively, for 16–18 year-old girls.
Conclusions
The publicly funded school-based qHPV vaccine program reduced AGW incidence in Manitoba by three-quarters in young females. AGW-related prescriptions are a poor proxy for medically attended AGW after the introduction of the publicly funded qHPV vaccination program. Different sexual habits in adolescents are, at most, responsible for a small portion of the reduction in AGW incidence.
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The impact of the modified frailty index on clinical outcomes for patients with stage IV non-small cell lung cancer receiving chemotherapy. J Geriatr Oncol 2022; 13:654-661. [DOI: 10.1016/j.jgo.2022.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 12/23/2021] [Accepted: 02/23/2022] [Indexed: 01/20/2023]
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20
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Young MA, Anang P, Gavalova A. Pediatric Chronic Pain, Resilience and Psychiatric Comorbidity in Canada: A Retrospective, Comparative Analysis. FRONTIERS IN HEALTH SERVICES 2022; 2:852322. [PMID: 36925848 PMCID: PMC10012762 DOI: 10.3389/frhs.2022.852322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 04/11/2022] [Indexed: 11/13/2022]
Abstract
Objective Chronic pain compromises child and adolescent well-being and development. This study aimed to identify risk factors for chronic pain and exploration of how young people negotiate such risks and express resilience. We hypothesized children and youth with chronic pain would report greater prevalence of mental health disorders than the general population; and those demonstrating greater resilience would demonstrate less psychiatric comorbidity. Method A retrospective chart review was conducted for all patients (ages 7-17) attending the sole pediatric chronic pain clinic in Manitoba, from 2015 to 2019 (N = 116). Patients' demographic information and psychiatric illness burden were compared to provincial epidemiological data using Chi-Square tests. Pain sites, family history, psychiatric illness, psychosocial functioning, treatment history and treatment recommendations were explored. Results The sample was predominantly female (74%; N = 114). Sixty-eight percent of patients reported a family history of chronic pain. Thirty-seven percent of the patients (vs. 14.0% anticipated; N = 326 260) reported comorbid psychiatric disorder, X2 (1, N = 114) = 53.00, p < 0.001. Thirty-two percent reported diagnosis of mood and/or anxiety disorder (vs. 7.3%), X2 (1, N = 114) = 99.34, p < 0.001. Children and youth demonstrating resilience through engagement in more prosocial behaviors reported fewer psychiatric symptoms (rs = -0.292, N = 114, p = 0.002, Spearman's correlation). Conclusions Female sex, family history, and lower socioeconomic status were associated with chronic pain. Psychiatric conditions were more prevalent in chronic pain patients than in the general population. Approaching chronic pain from a mind-body perspective, while building on patients' strengths, is central to informing treatment.
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Affiliation(s)
- Megan A Young
- Department of Psychiatry, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Polina Anang
- Department of Psychiatry, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Anna Gavalova
- Department of Neuroscience, Faculty of Science, University of Winnipeg, Winnipeg, MB, Canada
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21
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Treatment Patterns, Toxicity, and Outcomes of Older Adults With Advanced Pancreatic Cancer Receiving First-line Palliative Chemotherapy. Am J Clin Oncol 2021; 45:55-60. [DOI: 10.1097/coc.0000000000000882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Tolonen H, Reinikainen J, Koponen P, Elonheimo H, Palmieri L, Tijhuis MJ. Cross-national comparisons of health indicators require standardized definitions and common data sources. Arch Public Health 2021; 79:208. [PMID: 34819157 PMCID: PMC8614034 DOI: 10.1186/s13690-021-00734-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 11/10/2021] [Indexed: 11/13/2022] Open
Abstract
Background Health indicators are used to monitor the health status and determinants of health of the population and population sub-groups, identify existing or emerging health problems which would require prevention and health promotion activities, help to target health care resources in the most adequate way as well as for evaluation of the success of public health actions both at the national and international level. The quality and validity of the health indicator depends both on available data and used indicator definition. In this study we will evaluate existing knowledge about comparability of different data sources for definition of health indicators, compare how selected health indicators presented in different international databases possibly differ, and finally, present the results from a case study from Finland on comparability of health indicators derived from different data sources at national level. Methods For comparisons, four health indicators were selected that were commonly available in international databases and available for the Finnish case study. These were prevalence of obesity, hypertension, diabetes, and asthma in the adult populations. Our evaluation has three parts: 1) a scoping review of the latest literature, 2) comparison of the prevalences presented in different international databases, and 3) a case study using data from Finland. Results Literature shows that comparability of estimated outcomes for health indicators using different data sources such as self-reported questionnaire data from surveys, measured data from surveys or data from administrative health registers, varies between indicators. Also, the case study from Finland showed that diseases which require regular health care visits such as diabetes, comparability is high while for health outcomes which can remain asymptomatic for a long time such as hypertension, comparability is lower. In different international health related databases, country specific results differ due to variations in the used data sources but also due to differences in indicator definitions. Conclusions Reliable comparison of the health indicators over time and between regions within a country or across the countries requires common indicator definitions, similar data sources and standardized data collection methods.
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Affiliation(s)
- Hanna Tolonen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland.
| | - Jaakko Reinikainen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Päivikki Koponen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Hanna Elonheimo
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Luigi Palmieri
- Department of Cardiovascular, Endocrine-metabolic Diseases and Ageing, Istituto Superiore di Sanità (ISS), Roma, Italy
| | - Mariken J Tijhuis
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
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Hara K, Kobayashi Y, Tomio J, Ito Y, Svensson T, Ikesu R, Chung UI, Svensson AK. Claims-based algorithms for common chronic conditions were efficiently constructed using machine learning methods. PLoS One 2021; 16:e0254394. [PMID: 34570785 PMCID: PMC8476042 DOI: 10.1371/journal.pone.0254394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 06/25/2021] [Indexed: 11/29/2022] Open
Abstract
Identification of medical conditions using claims data is generally conducted with algorithms based on subject-matter knowledge. However, these claims-based algorithms (CBAs) are highly dependent on the knowledge level and not necessarily optimized for target conditions. We investigated whether machine learning methods can supplement researchers' knowledge of target conditions in building CBAs. Retrospective cohort study using a claims database combined with annual health check-up results of employees' health insurance programs for fiscal year 2016-17 in Japan (study population for hypertension, N = 631,289; diabetes, N = 152,368; dyslipidemia, N = 614,434). We constructed CBAs with logistic regression, k-nearest neighbor, support vector machine, penalized logistic regression, tree-based model, and neural network for identifying patients with three common chronic conditions: hypertension, diabetes, and dyslipidemia. We then compared their association measures using a completely hold-out test set (25% of the study population). Among the test cohorts of 157,822, 38,092, and 153,608 enrollees for hypertension, diabetes, and dyslipidemia, 25.4%, 8.4%, and 38.7% of them had a diagnosis of the corresponding condition. The areas under the receiver operating characteristic curve (AUCs) of the logistic regression with/without subject-matter knowledge about the target condition were .923/.921 for hypertension, .957/.938 for diabetes, and .739/.747 for dyslipidemia. The logistic lasso, logistic elastic-net, and tree-based methods yielded AUCs comparable to those of the logistic regression with subject-matter knowledge: .923-.931 for hypertension; .958-.966 for diabetes; .747-.773 for dyslipidemia. We found that machine learning methods can attain AUCs comparable to the conventional knowledge-based method in building CBAs.
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Affiliation(s)
- Konan Hara
- Department of Public Health, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Yasuki Kobayashi
- Department of Public Health, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Jun Tomio
- Department of Public Health, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Yuki Ito
- Department of Economics, University of California, Berkeley, Berkeley, California, United States of America
| | - Thomas Svensson
- Precision Health, Department of Bioengineering, Graduate School of Engineering, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
- Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
- School of Health Innovation, Kanagawa University of Human Services, Kawasaki-shi, Kanagawa, Japan
| | - Ryo Ikesu
- Department of Public Health, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
- Precision Health, Department of Bioengineering, Graduate School of Engineering, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Ung-il Chung
- Precision Health, Department of Bioengineering, Graduate School of Engineering, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
- School of Health Innovation, Kanagawa University of Human Services, Kawasaki-shi, Kanagawa, Japan
- Clinical Biotechnology, Center for Disease Biology and Integrative Medicine, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Akiko Kishi Svensson
- Precision Health, Department of Bioengineering, Graduate School of Engineering, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
- Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
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Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. Lancet 2021; 398:957-980. [PMID: 34450083 PMCID: PMC8446938 DOI: 10.1016/s0140-6736(21)01330-1] [Citation(s) in RCA: 1076] [Impact Index Per Article: 358.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/01/2021] [Accepted: 06/03/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. METHODS We used data from 1990 to 2019 on people aged 30-79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. FINDINGS The number of people aged 30-79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306-359) million women and 317 (292-344) million men in 1990 to 626 (584-668) million women and 652 (604-698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55-62) of women and 49% (46-52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43-51) of women and 38% (35-41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20-27) for women and 18% (16-21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. INTERPRETATION Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings. FUNDING WHO.
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25
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Lambert P, Pitz M, Singh H, Decker K. Evaluation of algorithms using administrative health and structured electronic medical record data to determine breast and colorectal cancer recurrence in a Canadian province : Using algorithms to determine breast and colorectal cancer recurrence. BMC Cancer 2021; 21:763. [PMID: 34210266 PMCID: PMC8252227 DOI: 10.1186/s12885-021-08526-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 06/21/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Algorithms that use administrative health and electronic medical record (EMR) data to determine cancer recurrence have the potential to replace chart reviews. This study evaluated algorithms to determine breast and colorectal cancer recurrence in a Canadian province with a universal health care system. METHODS Individuals diagnosed with stage I-III breast or colorectal cancer diagnosed from 2004 to 2012 in Manitoba, Canada were included. Pre-specified and conditional inference tree algorithms using administrative health and structured EMR data were developed. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) correct classification, and scaled Brier scores were measured. RESULTS The weighted pre-specified variable algorithm for the breast cancer validation cohort (N = 1181, 167 recurrences) demonstrated 81.1% sensitivity, 93.2% specificity, 61.4% PPV, 97.4% NPV, 91.8% correct classification, and scaled Brier score of 0.21. The weighted conditional inference tree algorithm demonstrated 68.5% sensitivity, 97.0% specificity, 75.4% PPV, 95.8% NPV, 93.6% correct classification, and scaled Brier score of 0.39. The weighted pre-specified variable algorithm for the colorectal validation cohort (N = 693, 136 recurrences) demonstrated 77.7% sensitivity, 92.8% specificity, 70.7% PPV, 94.9% NPV, 90.1% correct classification, and scaled Brier score of 0.33. The conditional inference tree algorithm demonstrated 62.6% sensitivity, 97.8% specificity, 86.4% PPV, 92.2% NPV, 91.4% correct classification, and scaled Brier score of 0.42. CONCLUSIONS Algorithms developed in this study using administrative health and structured EMR data to determine breast and colorectal cancer recurrence had moderate sensitivity and PPV, high specificity, NPV, and correct classification, but low accuracy. The accuracy is similar to other algorithms developed to classify recurrence only (i.e., distinguished from second primary) and inferior to algorithms that do not make this distinction. The accuracy of algorithms for determining cancer recurrence only must improve before replacing chart reviews.
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Affiliation(s)
- Pascal Lambert
- CancerCare Manitoba Research Institute, 675 McDermot Avenue, Winnipeg, Manitoba, R3E 0V9, Canada
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, Manitoba, R3E 0V9, Canada
| | - Marshall Pitz
- CancerCare Manitoba Research Institute, 675 McDermot Avenue, Winnipeg, Manitoba, R3E 0V9, Canada
- Department of Medical Oncology, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, Manitoba, R3E 0V9, Canada
- Department of Internal Medicine, University of Manitoba, 820 Sherbrook Street, Winnipeg, Manitoba, R3A 1R9, Canada
- Department of Community Health Sciences, University of Manitoba, 750 Bannatyne Avenue, Winnipeg, Manitoba, R3E 0W3, Canada
| | - Harminder Singh
- CancerCare Manitoba Research Institute, 675 McDermot Avenue, Winnipeg, Manitoba, R3E 0V9, Canada
- Department of Internal Medicine, University of Manitoba, 820 Sherbrook Street, Winnipeg, Manitoba, R3A 1R9, Canada
- Department of Community Health Sciences, University of Manitoba, 750 Bannatyne Avenue, Winnipeg, Manitoba, R3E 0W3, Canada
| | - Kathleen Decker
- CancerCare Manitoba Research Institute, 675 McDermot Avenue, Winnipeg, Manitoba, R3E 0V9, Canada.
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, Manitoba, R3E 0V9, Canada.
- Department of Community Health Sciences, University of Manitoba, 750 Bannatyne Avenue, Winnipeg, Manitoba, R3E 0W3, Canada.
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Predictors of Urgent Cancer Care Clinic and Emergency Department Visits for Individuals Diagnosed with Cancer. CURRENT ONCOLOGY (TORONTO, ONT.) 2021; 28:1773-1789. [PMID: 34066855 PMCID: PMC8161790 DOI: 10.3390/curroncol28030165] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 04/29/2021] [Accepted: 05/04/2021] [Indexed: 01/30/2023]
Abstract
In 2013, CancerCare Manitoba (CCMB) launched an urgent cancer care clinic (UCC) to meet the needs of individuals diagnosed with cancer experiencing acute complications of cancer or its treatment. This retrospective cohort study compared the characteristics of individuals diagnosed with cancer that visited the UCC to those who visited an emergency department (ED) and determined predictors of use. Multivariable logistic mixed models were run to predict an individual’s likelihood of visiting the UCC or an ED. Scaled Brier scores were calculated to determine how greatly each predictor impacted UCC or ED use. We found that UCC visits increased up to 4 months after eligibility to visit and then decreased. ED visits were highest immediately after eligibility and then decreased. The median number of hours between triage and discharge was 2 h for UCC visits and 9 h for ED visits. Chemotherapy had the strongest association with UCC visits, whereas ED visits prior to diagnosis had the strongest association with ED visits. Variables related to socioeconomic status were less strongly associated with UCC or ED visits. Future studies would be beneficial to planning service delivery and improving clinical outcomes and patient satisfaction.
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de Boer AW, Blom JW, de Waal MWM, Rippe RCA, de Koning EJP, Jazet IM, Rosendaal FR, den Heijer M, Numans ME, de Mutsert R. Coded diagnoses from general practice electronic health records are a feasible and valid alternative to self-report to define diabetes cases in research. Prim Care Diabetes 2021; 15:234-239. [PMID: 32888897 DOI: 10.1016/j.pcd.2020.08.011] [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: 01/02/2020] [Revised: 08/17/2020] [Accepted: 08/18/2020] [Indexed: 11/21/2022]
Abstract
AIMS To examine the feasibility and validity of obtaining International Classification of Primary Care (ICPC)-coded diagnoses of diabetes mellitus (DM) from general practice electronic health records for case definition in epidemiological studies, as alternatives to self-reported DM. METHODS The Netherlands Epidemiology of Obesity study is a population-based cohort study of 6671 persons aged 45-65 years at baseline, included between 2008-2012. Data from electronic health records were collected between 2012-2014. We defined a reference standard using diagnoses, prescriptions and consultation notes and investigated its agreement with ICPC-coded diagnoses of DM and self-reported DM. RESULTS After a median follow-up of 1.8 years, data from 6442 (97%) participants were collected. With the reference standard, 506 participants (79/1000 person-years) were classified with prevalent DM at baseline and 131 participants (11/1000 person-years) were classified with incident DM during follow-up. The agreement of prevalent DM between self-report and the reference standard was 98% (kappa 0.86), the agreement between ICPC-coded diagnoses and the reference standard was 99% (kappa 0.95). The agreement of incident DM between ICPC-coded diagnoses and the reference standard was >99% (kappa 0.92). CONCLUSIONS ICPC-coded diagnoses of DM from general practice electronic health records are a feasible and valid alternative to self-reported diagnoses of DM.
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Affiliation(s)
- A W de Boer
- Department of Clinical Epidemiology, Leiden University Medical Center (LUMC), Leiden, The Netherlands; Department of Public Health and Primary Care, LUMC, Leiden, The Netherlands.
| | - J W Blom
- Department of Public Health and Primary Care, LUMC, Leiden, The Netherlands
| | - M W M de Waal
- Department of Public Health and Primary Care, LUMC, Leiden, The Netherlands
| | - R C A Rippe
- Centre for Child and Family Science, Leiden University, Leiden, The Netherlands
| | - E J P de Koning
- Department of Internal Medicine, LUMC, Leiden, The Netherlands
| | - I M Jazet
- Department of Internal Medicine, LUMC, Leiden, The Netherlands
| | - F R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - M den Heijer
- Department of Clinical Epidemiology, Leiden University Medical Center (LUMC), Leiden, The Netherlands; Department of Internal Medicine, VU Medical Center, Amsterdam, The Netherlands
| | - M E Numans
- Department of Public Health and Primary Care, LUMC, Leiden, The Netherlands
| | - R de Mutsert
- Department of Clinical Epidemiology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
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Chou CY, Chiu CJ, Chang CM, Wu CH, Lu FH, Wu JS, Yang YC. Disease-related disability burden: a comparison of seven chronic conditions in middle-aged and older adults. BMC Geriatr 2021; 21:201. [PMID: 33757452 PMCID: PMC7986023 DOI: 10.1186/s12877-021-02137-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 03/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although previous studies have explored the effect of chronic conditions on physical disability, little is known about the levels and rates of change in physical disability after a chronic condition diagnosis in middle-aged and older adults in the Asian population. The aim of this study is to ascertain the average levels and rates of change in the development of disability after disease diagnosis, as well as to determine the influences of sociodemographic and health-related correlates in the development of disability. METHODS This is a retrospective cohort study analyzing data of nationally representative participants aged 50 and over with a chronic condition or having developed one during follow-ups based on data from the 1996-2011 Taiwan Longitudinal Study on Aging (TLSA) (n = 5131). Seven chronic conditions were examined. Covariates included age at initial diagnosis, gender, education level, number of comorbidities, and depression status. Physical disability was measured by combining self-reported ADL, IADL, and strength and mobility activities with 17 total possible points, further analyzed with multilevel modeling. RESULTS The results showed that (1) physical disability was highest for stroke, followed by cancer and diabetes at the time of the initial disease diagnosis. (2) The linear rate of change was highest for stroke, followed by lung disease and heart disease, indicating that these diseases led to higher steady increases in physical disability after the disease diagnosis. (3) The quadratic rate of change was highest in diabetes, followed by cancer and hypertension, indicating that these diseases had led to higher increments of physical disability in later stage disease. After controlling for sociodemographic and comorbidity, depression status accounted for 39.9-73.6% and 37.9-100% of the variances in the physical disability intercept and change over time, respectively. CONCLUSIONS Despite the fact that a comparison across conditions was not statistically tested, an accelerated increase in physical disabilities was found as chronic conditions progressed. While stroke and cancer lead to disability immediately, conditions such as diabetes, cancer, and hypertension give rise to higher increments of physical disability in later stage disease. Mitigating depressive symptoms may be beneficial in terms of preventing disability development in this population.
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Affiliation(s)
- Chieh-Ying Chou
- Institute of Gerontology, College of Medicine, National Cheng Kung University, No. 1, University Road, 70101, Tainan, Taiwan.,Department of Family Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Ching-Ju Chiu
- Institute of Gerontology, College of Medicine, National Cheng Kung University, No. 1, University Road, 70101, Tainan, Taiwan.
| | - Chia-Ming Chang
- Institute of Gerontology, College of Medicine, National Cheng Kung University, No. 1, University Road, 70101, Tainan, Taiwan.,Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Division of Geriatrics and Gerontology, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Chih-Hsing Wu
- Institute of Gerontology, College of Medicine, National Cheng Kung University, No. 1, University Road, 70101, Tainan, Taiwan.,Department of Family Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.,Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Feng-Hwa Lu
- Institute of Gerontology, College of Medicine, National Cheng Kung University, No. 1, University Road, 70101, Tainan, Taiwan.,Department of Family Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.,Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jin-Shang Wu
- Department of Family Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.,Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Ching Yang
- Department of Family Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.,Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Eitner A, Culvenor AG, Wirth W, Schaible HG, Eckstein F. Impact of Diabetes Mellitus on Knee Osteoarthritis Pain and Physical and Mental Status: Data From the Osteoarthritis Initiative. Arthritis Care Res (Hoboken) 2021; 73:540-548. [PMID: 32105401 DOI: 10.1002/acr.24173] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 02/18/2020] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Diabetes mellitus (DM) appears to increase osteoarthritic knee pain, which may be related to greater adiposity and more advanced disease status often observed in individuals with osteoarthritis (OA) and DM. We aimed to assess whether OA knee pain and health status are worse in individuals with OA and DM, independent of these potential confounders. METHODS We included 202 OA participants with DM and 2,279 without DM from the Osteoarthritis Initiative. Knee pain was evaluated using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and a numeric rating scale (NRS). Physical and mental status were assessed by the Medical Outcomes Study Short Form 12 (SF-12) questionnaire, physical component summary (PCS) score and mental component summary (MCS) score, and by the Center for Epidemiologic Studies Depression Scale (CES-D). Linear regression models assessed the influence of DM, adjusted for age, sex, body mass index (BMI), and radiographic severity. RESULTS OA participants with DM reported worse knee pain and greater physical and mental issues compared with participants without DM. Individuals with DM had worse KOOS pain (β = -4.72 [95% confidence interval (95% CI) -7.22, -2.23]) and worse NRS pain (β = 0.42 [95% CI 0.04, 0.80]) independent of BMI, OA severity, age, and sex. The negative influence of DM was also apparent for SF-12 PCS (β = -3.49 [95% CI -4.73, -2.25]), SF-12 MCS (β = -1.42 [95% CI -2.57, -0.26]), and CES-D (β = 1.08 [95% CI 0.08, 2.08]). CONCLUSION Individuals with knee OA experience on average higher pain intensity and a worse physical and mental health status if they have DM. Linear regression models show that DM is a risk factor for higher pain, in addition to and independent of greater BMI and radiographic OA severity.
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Affiliation(s)
- Annett Eitner
- University Hospital Jena and Friedrich Schiller University, Jena, Germany
| | - Adam G Culvenor
- Paracelsus Medical University Salzburg and Nuremberg, Salzburg, Austria, and La Trobe University, Bundoora, Victoria, Australia
| | - Wolfgang Wirth
- Chondrometrics GmbH, Ainring, Germany, and Paracelsus Medical University, Salzburg, Austria
| | | | - Felix Eckstein
- Chondrometrics GmbH, Ainring, Germany, and Paracelsus Medical University, Salzburg, Austria
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Righolt CH, Pabla G, Donelle J, Brna P, Deeks SL, Wilson SE, Smith B, Wilson K, Mahmud SM, Top KA, Hawken S. Vaccine coverage among children with epilepsy in two Canadian provinces: A Canadian immunization research network study. Vaccine 2021; 39:2117-2123. [PMID: 33722410 DOI: 10.1016/j.vaccine.2021.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 02/25/2021] [Accepted: 03/02/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Children with epilepsy are at increased risk of complications from vaccine-preventable infections, yet information on vaccine coverage in these children is scarce. We aimed to compare vaccine coverage among children with epilepsy to children without epilepsy. STUDY DESIGN We conducted a retrospective cohort study including all 2005-2013 births in Manitoba and Ontario, Canada, creating two cohorts: 2-year-olds and 7-year-olds (followed to age 2 and 7 years). We split each cohort into epilepsy and non-epilepsy subcohorts. We assessed vaccination coverage based on provincial schedules and determined timeliness of MMR (measles, mumps, rubella) dose 1 (recommended at 12 months) and DTaP (diphtheria, tetanus, pertussis) dose 4 (recommended at 18 months). We used logistic regression to calculate adjusted odds ratios (aORs) of the association between epilepsy and vaccination, combining both provincial estimates using random effects meta-analysis. RESULTS We included 16,558 2-year-olds (Manitoba, 653; Ontario, 15,905) and 13,004 7-year-olds (Manitoba, 483; Ontario, 12,521) with epilepsy. At age 2 years, the aOR for up-to-date vaccination among children with versus without epilepsy was 0.9 (95% confidence interval 0.8-1.1); at age 7 years it was 1.0 (0.9-1.1). Infants diagnosed with epilepsy before age 6 months were less likely to be up-to-date at age 2 years (0.9; 0.8-0.9), although this difference disappeared by age 7 years. Vaccine timeliness was similar between children with and without epilepsy for MMR dose 1 and DTaP dose 4. CONCLUSIONS Overall, this study suggests that children with epilepsy are not significantly under-vaccinated compared to their peers without epilepsy. As children with epilepsy are at a higher risk of complications from vaccine-preventable diseases, vaccination in children with epilepsy should be optimized, especially early in life, as these children may not be able to rely on herd protection.
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Affiliation(s)
- Christiaan H Righolt
- Vaccine and Drug Evaluation Centre, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
| | - Gurpreet Pabla
- Vaccine and Drug Evaluation Centre, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Jessy Donelle
- Institute for Clinical Evaluative Sciences, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Paula Brna
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Shelley L Deeks
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Public Health Ontario, Toronto, ON, Canada
| | | | - Bruce Smith
- Department of Mathematics and Statistics, Dalhousie University, Halifax, NS, Canada
| | - Kumanan Wilson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Salaheddin M Mahmud
- Vaccine and Drug Evaluation Centre, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Karina A Top
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada; Department of Community Health & Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Steven Hawken
- Institute for Clinical Evaluative Sciences, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada
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Righolt CH, Zhang G, Mahmud SM. Classification of drug use patterns. Pharmacol Res Perspect 2020; 8:e00687. [PMID: 33280248 PMCID: PMC7719192 DOI: 10.1002/prp2.687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 10/24/2020] [Indexed: 01/02/2023] Open
Abstract
Characterizing long‐term prescription data is challenging due to the time‐varying nature of drug use. Conventional approaches summarize time‐varying data into categorical variables based on simple measures, such as cumulative dose, while ignoring patterns of use. The loss of information can lead to misclassification and biased estimates of the exposure‐outcome association. We introduce a classification method to characterize longitudinal prescription data with an unsupervised machine learning algorithm. We used administrative databases covering virtually all 1.3 million residents of Manitoba and explicitly designed features to describe the average dose, proportion of days covered (PDC), dose change, and dose variability, and clustered the resulting feature space using K‐means clustering. We applied this method to metformin use in diabetes patients. We identified 27,786 metformin users and showed that the feature distributions of their metformin use are stable for varying the lengths of follow‐up and that these distributions have clear interpretations. We found six distinct metformin user groups: patients with intermittent use, decreasing dose, increasing dose, high dose, and two medium dose groups (one with stable dose and one with highly variable use). Patients in the varying and decreasing dose groups had a higher chance of progression of diabetes than other patients. The method presented in this paper allows for characterization of drug use into distinct and clinically relevant groups in a way that cannot be obtained from merely classifying use by quantiles of overall use.
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Affiliation(s)
- Christiaan H Righolt
- Vaccine and Drug Evaluation Centre, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Geng Zhang
- Vaccine and Drug Evaluation Centre, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Salaheddin M Mahmud
- Vaccine and Drug Evaluation Centre, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
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Matthews G, Yousfi S, Schmidt‐Rathjens C, Amelang M. Personality variable differences between disease clusters. EUROPEAN JOURNAL OF PERSONALITY 2020. [DOI: 10.1002/per.476] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Previous studies of personality and health have focused mainly on the influence of psychological factors on single diseases such as cancer and coronary heart disease (CHD), thereby neglecting the problem of comorbidity (i.e. the combination of different diseases). The main focus of the present study was the discrimination between single‐ and multiple‐disease conditions on the basis of personality traits. An extensive battery of personality scales implicated in health was administered to a sample of n=5133 individuals of both genders between the ages of 40 and 65. Subjects also reported their health or illness status. A factor analysis of the personality scales yielded five dimensions clearly interpretable as “Emotional Lability”, “Type A Behaviour”, “Behavioural Control”, “Locus of Control over Diseases”, and “Psychoticism”. Hierarchical cluster analyses of the subsample of participants who reported suffering from more than one disease led to eight clusters representing individuals with different combinations of diseases. Generally, there were very few significant differences between healthy and single‐disease participants with regard to personality. However, mean factor scores calculated for “Emotional Lability” were higher across the multiple‐disease groups than in the healthy and single‐disease groups. No other personality factor showed this trend. In general the results reported here show the important role negative affectivity (e.g. Emotional Lability, Neuroticism, Depression) plays in differentiating between single and multiple diseases. Copyright © 2003 John Wiley & Sons, Ltd.
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Shaffer SR, Nugent Z, Walkty A, Yu BN, Lix LM, Targownik LE, Bernstein CN, Singh H. Time trends and predictors of laboratory-confirmed recurrent and severe Clostridioides difficile infections in Manitoba: a population-based study. CMAJ Open 2020; 8:E737-E746. [PMID: 33199507 PMCID: PMC7676992 DOI: 10.9778/cmajo.20190191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Many previous studies of Clostridioides difficile infection (CDI) epidemiology have used hospital discharge data codes, which can have limited accuracy. We used a data set of laboratory-confirmed cases of CDI in the province of Manitoba, Canada, to describe the epidemiology of CDI over a decade. METHODS We conducted a population-based historical cohort study using Manitoba Health's population-wide laboratory-based CDI data set linked to administrative health databases. All individuals living in Manitoba and experiencing a CDI episode between 2005 and 2015 were included (n = 8471) and followed up from CDI diagnosis. We assessed time trends of CDI, incidence and predictors of recurrence and severe outcomes, and health care encounters after CDI diagnosis. CDI episodes were stratified by community versus hospital site of acquiring CDI. RESULTS Between 2005 and 2009, overall CDI diagnoses decreased by an average of 12.6% per year (95% confidence interval [CI] -4.4 to -20.0), with no statistically significant change from 2010 to 2015. In stratified analysis, incident and recurrent CDI had a similar decrease in the initial study time period and then stabilized. The proportion of community-associated CDI cases increased by an average of 4.8% per year (95% CI 2.8 to 6.8) during the study period. CDI acquired in a health care facility had a higher recurrence rate and more severe outcomes. Recurrence of CDI increased the likelihood of admission to hospital. INTERPRETATION Between 2005 and 2015, the rates of overall laboratory-confirmed CDI, incident CDI, recurrent CDI and severe outcomes following CDI initially decreased before stabilizing, and an increasing proportion of CDI cases were community-associated. There is an increasing need to test for CDI among outpatients with diarrhea and to increase efforts to prevent recurrent CDI.
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Affiliation(s)
- Seth R Shaffer
- Internal Medicine (Shaffer, Nugent, Walkty, Bernstein, Singh), University of Manitoba, Winnipeg, Man.; Inflammatory Bowel Disease Centre (Shaffer), University of Chicago Medicine, Chicago, Ill.; CancerCare Manitoba, Research Institute (Nugent, Singh); Community Health Sciences (Yu, Lix, Singh), University of Manitoba, Winnipeg, Man.; Division of Epidemiology and Population Health (Yu), BC Centre for Excellence in HIV/AIDS, Vancouver, BC; Division of Gastroenterology (Targownik), Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - Zoann Nugent
- Internal Medicine (Shaffer, Nugent, Walkty, Bernstein, Singh), University of Manitoba, Winnipeg, Man.; Inflammatory Bowel Disease Centre (Shaffer), University of Chicago Medicine, Chicago, Ill.; CancerCare Manitoba, Research Institute (Nugent, Singh); Community Health Sciences (Yu, Lix, Singh), University of Manitoba, Winnipeg, Man.; Division of Epidemiology and Population Health (Yu), BC Centre for Excellence in HIV/AIDS, Vancouver, BC; Division of Gastroenterology (Targownik), Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - Andrew Walkty
- Internal Medicine (Shaffer, Nugent, Walkty, Bernstein, Singh), University of Manitoba, Winnipeg, Man.; Inflammatory Bowel Disease Centre (Shaffer), University of Chicago Medicine, Chicago, Ill.; CancerCare Manitoba, Research Institute (Nugent, Singh); Community Health Sciences (Yu, Lix, Singh), University of Manitoba, Winnipeg, Man.; Division of Epidemiology and Population Health (Yu), BC Centre for Excellence in HIV/AIDS, Vancouver, BC; Division of Gastroenterology (Targownik), Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - B Nancy Yu
- Internal Medicine (Shaffer, Nugent, Walkty, Bernstein, Singh), University of Manitoba, Winnipeg, Man.; Inflammatory Bowel Disease Centre (Shaffer), University of Chicago Medicine, Chicago, Ill.; CancerCare Manitoba, Research Institute (Nugent, Singh); Community Health Sciences (Yu, Lix, Singh), University of Manitoba, Winnipeg, Man.; Division of Epidemiology and Population Health (Yu), BC Centre for Excellence in HIV/AIDS, Vancouver, BC; Division of Gastroenterology (Targownik), Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - Lisa M Lix
- Internal Medicine (Shaffer, Nugent, Walkty, Bernstein, Singh), University of Manitoba, Winnipeg, Man.; Inflammatory Bowel Disease Centre (Shaffer), University of Chicago Medicine, Chicago, Ill.; CancerCare Manitoba, Research Institute (Nugent, Singh); Community Health Sciences (Yu, Lix, Singh), University of Manitoba, Winnipeg, Man.; Division of Epidemiology and Population Health (Yu), BC Centre for Excellence in HIV/AIDS, Vancouver, BC; Division of Gastroenterology (Targownik), Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - Laura E Targownik
- Internal Medicine (Shaffer, Nugent, Walkty, Bernstein, Singh), University of Manitoba, Winnipeg, Man.; Inflammatory Bowel Disease Centre (Shaffer), University of Chicago Medicine, Chicago, Ill.; CancerCare Manitoba, Research Institute (Nugent, Singh); Community Health Sciences (Yu, Lix, Singh), University of Manitoba, Winnipeg, Man.; Division of Epidemiology and Population Health (Yu), BC Centre for Excellence in HIV/AIDS, Vancouver, BC; Division of Gastroenterology (Targownik), Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - Charles N Bernstein
- Internal Medicine (Shaffer, Nugent, Walkty, Bernstein, Singh), University of Manitoba, Winnipeg, Man.; Inflammatory Bowel Disease Centre (Shaffer), University of Chicago Medicine, Chicago, Ill.; CancerCare Manitoba, Research Institute (Nugent, Singh); Community Health Sciences (Yu, Lix, Singh), University of Manitoba, Winnipeg, Man.; Division of Epidemiology and Population Health (Yu), BC Centre for Excellence in HIV/AIDS, Vancouver, BC; Division of Gastroenterology (Targownik), Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - Harminder Singh
- Internal Medicine (Shaffer, Nugent, Walkty, Bernstein, Singh), University of Manitoba, Winnipeg, Man.; Inflammatory Bowel Disease Centre (Shaffer), University of Chicago Medicine, Chicago, Ill.; CancerCare Manitoba, Research Institute (Nugent, Singh); Community Health Sciences (Yu, Lix, Singh), University of Manitoba, Winnipeg, Man.; Division of Epidemiology and Population Health (Yu), BC Centre for Excellence in HIV/AIDS, Vancouver, BC; Division of Gastroenterology (Targownik), Mount Sinai Hospital, University of Toronto, Toronto, Ont.
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Niraula S, Biswanger N, Hu P, Lambert P, Decker K. Incidence, Characteristics, and Outcomes of Interval Breast Cancers Compared With Screening-Detected Breast Cancers. JAMA Netw Open 2020; 3:e2018179. [PMID: 32975573 PMCID: PMC7519419 DOI: 10.1001/jamanetworkopen.2020.18179] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
IMPORTANCE Breast cancer comprises a highly heterogeneous group of diseases. Many breast cancers, particularly the more lethal ones, may not satisfy the assumptions about biology and natural history of breast cancer necessary for screening mammography to be effective. OBJECTIVES To compare tumor characteristics of breast cancers diagnosed within 2 years of a normal screening mammogram (interval breast cancer [IBC]) with those of screen-detected breast cancers (SBC) and to compare breast cancer-specific mortality of IBC with SBC. DESIGN, SETTING, AND PARTICIPANTS In this registry-based cohort study, we collected data about relevant tumor- and patient-related variables on women diagnosed with breast cancer between January 2004 and June 2010 who participated in the population-based screening program in Manitoba, Canada, and those diagnosed with breast cancer outside the screening program in the province. We performed multinomial logistic regression analysis to assess tumor and patient characteristics associated with a diagnosis of IBC compared with SBC. Competing risk analysis was performed to examine risk of death by cancer detection method. EXPOSURES Breast cancer diagnosis. MAIN OUTCOMES AND MEASURES Differences in tumor characteristics and breast cancer-specific mortality. RESULTS A total of 69 025 women aged 50 to 64 years had 212 screening mammograms during the study period. There were 1687 breast cancer diagnoses (705 SBC, 206 IBC, 275 were noncompliant, and 501 were detected outside the screening program), and 225 deaths (170 breast cancer-specific deaths). Interval cancers were more likely than SBC to be of high grade and estrogen receptor negative (odds ratio [OR], 6.33; 95% CI, 3.73-10.75; P < .001; and OR, 2.88; 95% CI, 2.01-4.13; P < .001, respectively). After a median follow-up of 7 years, breast cancer-specific mortality was significantly higher for IBC compared with SBC cancers (hazard ratio [HR] 3.55; 95% CI, 2.01-6.28; P < .001), for a sojorn time of 2 years. Non-breast cancer mortality was similar between IBC and SBC (HR, 1.33; 95% CI, 0.43-4.15). CONCLUSIONS AND RELEVANCE In this cohort study, interval cancers were highly prevalent in women participating in population screening, represented a worse biology, and had a hazard for breast cancer death more than 3-fold that for SBC. Strategies beyond current mammographic screening practices are needed to reduce incidence, improve detection, and reduce deaths from these potentially lethal breast cancers.
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Affiliation(s)
- Saroj Niraula
- Section of Medical Oncology and hematology, University of Manitoba, Winnipeg, Manitoba, Canada
- Research Institute of Oncology and Hematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Natalie Biswanger
- Cancer Screening program, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - PingZhao Hu
- Department of Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Pascal Lambert
- Research Institute of Oncology and Hematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Kathleen Decker
- Research Institute of Oncology and Hematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Rittberg R, Zhang H, Lambert P, Kudlovich R, Kim CA, Dawe DE. Utility of the modified frailty index in predicting toxicity and cancer outcomes for older adults with advanced pancreatic cancer receiving first-line palliative chemotherapy. J Geriatr Oncol 2020; 12:112-117. [PMID: 32798212 DOI: 10.1016/j.jgo.2020.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/25/2020] [Accepted: 07/06/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pancreatic cancer primarily affects older adults and is associated with a high morbidity and mortality. Identifying frail patients with advanced pancreatic cancer (APC) helps to mitigate the risks of chemotherapy (CT). The modified Frailty Index (mFI) is an 11-point deficit measure used to identify frail patients. Although validated in surgical fields, it has not been assessed in an APC population. METHODS A retrospective cohort study evaluated consecutive patients, aged ≥65 years, diagnosed with APC from 2011 to 2016 and treated with first line palliative-intent CT. mFI was categorized as: 0, 1, 2 and ≥ 3. Descriptive analysis was completed comparing patient characteristics, CT toxicity, response to treatment, and overall survival (OS) by mFI score. RESULTS 87 patients with APC received palliative CT. Median age was 71 (65-88), 54% male. A mFI score of 0, 1, 2, and ≥ 3 occurred for 20 (23%), 28 (32.2%), 25 (28.7%) and 14 (16.1%) patients respectively. Patients with mFI scores of 0-1 were more likely to receive: 5-fluorouracil, irinotecan and oxaliplatin. CT toxicity, emergency room (ED) and urgent cancer clinic (UCC) presentation, and hospitalization length did not differ by mFI. Longer OS was associated with better ECOG and receipt of combination CT. CONCLUSION This is the first assessment of the mFI in an APC population receiving CT. The mFI score did not correlate with toxicity, ED/UCC visits, hospitalization length or OS. Ongoing assessment of tools that accurately identify frailty in patients with APC is critical to help better select candidates for aggressive CT.
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Affiliation(s)
- Rebekah Rittberg
- Department of Internal Medicine, University of Manitoba, 820 Sherbrook St, R3A 1R9 Winnipeg, MB, Canada; CancerCare Manitoba, Department of Hematology and Medical Oncology, 675 McDermot Ave, R3E 0V9 Winnipeg, MB, Canada.
| | - Hanbo Zhang
- Cross Cancer Institute, Department of Oncology, 8440 112 St. NW, T6G 2R7 Edmonton, AB, Canada.
| | - Pascal Lambert
- CancerCare Manitoba, Department of Epidemiology, 675 McDermot Ave, R3E 0V9 Winnipeg, MB, Canada.
| | - Robert Kudlovich
- Department of Internal Medicine, University of Manitoba, 820 Sherbrook St, R3A 1R9 Winnipeg, MB, Canada.
| | - Christina A Kim
- Department of Internal Medicine, University of Manitoba, 820 Sherbrook St, R3A 1R9 Winnipeg, MB, Canada; CancerCare Manitoba, Department of Hematology and Medical Oncology, 675 McDermot Ave, R3E 0V9 Winnipeg, MB, Canada; Research Institute in Oncology and Hematology, CancerCare Manitoba, 675 McDermot Ave, R3E 0V9 Winnipeg, MB, Canada.
| | - David E Dawe
- Department of Internal Medicine, University of Manitoba, 820 Sherbrook St, R3A 1R9 Winnipeg, MB, Canada; CancerCare Manitoba, Department of Hematology and Medical Oncology, 675 McDermot Ave, R3E 0V9 Winnipeg, MB, Canada; Research Institute in Oncology and Hematology, CancerCare Manitoba, 675 McDermot Ave, R3E 0V9 Winnipeg, MB, Canada.
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RAGHUNATHAN TRIVELLORE, GHOSH KAUSHIK, ROSEN ALLISON, IMBRIANO PAUL, STEWART SUSAN, BONDARENKO IRINA, MESSER KASSANDRA, BERGLUND PATRICIA, SHAFFER JAMES, CUTLER DAVID. COMBINING INFORMATION FROM MULTIPLE DATA SOURCES TO ASSESS POPULATION HEALTH. JOURNAL OF SURVEY STATISTICS AND METHODOLOGY 2020; 9:598-625. [PMID: 34337089 PMCID: PMC8324014 DOI: 10.1093/jssam/smz047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Information about an extensive set of health conditions on a well-defined sample of subjects is essential for assessing population health, gauging the impact of various policies, modeling costs, and studying health disparities. Unfortunately, there is no single data source that provides accurate information about health conditions. We combine information from several administrative and survey data sets to obtain model-based dummy variables for 107 health conditions (diseases, preventive measures, and screening for diseases) for elderly (age 65 and older) subjects in the Medicare Current Beneficiary Survey (MCBS) over the fourteen-year period, 1999-2012. The MCBS has prevalence of diseases assessed based on Medicare claims and provides detailed information on all health conditions but is prone to underestimation bias. The National Health and Nutrition Examination Survey (NHANES), on the other hand, collects self-reports and physical/laboratory measures only for a subset of the 107 health conditions. Neither source provides complete information, but we use them together to derive model-based corrected dummy variables in MCBS for the full range of existing health conditions using a missing data and measurement error model framework. We create multiply imputed dummy variables and use them to construct the prevalence rate and trend estimates. The broader goal, however, is to use these corrected or modeled dummy variables for a multitude of policy analysis, cost modeling, and analysis of other relationships either using them as predictors or as outcome variables.
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Affiliation(s)
- TRIVELLORE RAGHUNATHAN
- Address correspondence to Trivellore Raghunathan, Department of Biostatistics, 1415 Washington Heights, University of Michigan, Ann Arbor, MI 48109, USA;
| | - KAUSHIK GHOSH
- National Bureau of Economic Research (NBER), 1050 Massachusetts Ave, Cambridge, MA 02138
| | - ALLISON ROSEN
- Department of Quantitative Health Sciences University of Massachusetts Medical School 368 Plantation Street, AS9-1083, Worcester, MA 01655; NBER
| | - PAUL IMBRIANO
- Department of Biostatistics, 1415 Washington Heights, University of Michigan, Ann Arbor, MI 48109
| | - SUSAN STEWART
- National Bureau of Economic Research (NBER), 1050 Massachusetts Ave, Cambridge, MA 02138
| | - IRINA BONDARENKO
- Department of Biostatistics, 1415 Washington Heights, University of Michigan, Ann Arbor, MI 48109
| | - KASSANDRA MESSER
- Survey Research Center, Institute for Social Research, 426 Thompson Street, University of Michigan, Ann Arbor, MI 48106
| | - PATRICIA BERGLUND
- Survey Research Center, Institute for Social Research, 426 Thompson Street, University of Michigan, Ann Arbor, MI 48106
| | | | - DAVID CUTLER
- Department of Economics, Harvard University, 1805 Cambridge St, Cambridge, MA 02138; NBER
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Bernstein CN, Nugent Z, Targownik LE, Singh H, Snider C, Witt J. The Cost of Use of the Emergency Department by Persons With Inflammatory Bowel Disease Living in a Canadian Health Region: A Retrospective Population-Based Study. J Can Assoc Gastroenterol 2020; 3:135-140. [PMID: 32395688 PMCID: PMC7204788 DOI: 10.1093/jcag/gwz001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 02/14/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND We aimed to determine the costs of emergency department (ED) attendance by persons with inflammatory bowel disease (IBD) not admitted to hospital from the ED. METHODS This was a population-based administrative database study linking the University of Manitoba IBD Epidemiology Database with the Winnipeg Regional Health Authority (WRHA) ED Information Service database. We identified persons with IBD who presented to the ED and were not admitted between January 1, 2009 and March 31, 2012. We then applied costs in Canadian dollars for these visits including an average ED visit cost plus 26% for overhead (total = $508), an average estimated cost of laboratory investigations ($50), and costs for each of radiographic imaging, lower endoscopy and consultation with an internist/gastroenterologist or a surgeon. We tallied the costs of each unique ED presentation. We determined average costs for visits associated with specific consultations or investigations. RESULTS One thousand six hundred and eighty-two persons with IBD (4,853 individual visits) attended the ED and did not get hospitalized. The average cost per ED visit by a person with IBD who did not get hospitalized was $650. This resulted in a total expenditure of $3,152,227 on these persons for their ED attendance or $969,916 per year. The visits with the highest mean costs were those associated with an abdominal computerized tomography scan ($979), those associated with surgical consultation ($1019), and those associated with an internist/gastroenterologist consultation ($942). CONCLUSION Better strategies for management of acute issues for persons with IBD that can reduce the use of an ED are needed and can be considerably cost saving.
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Affiliation(s)
- Charles N Bernstein
- The University of Manitoba Inflammatory Bowel Disease Clinical and Research Centre, Winnipeg, Manitoba, Canada
- Department of Internal Medicine, Rady College of Medicine, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Zoann Nugent
- The University of Manitoba Inflammatory Bowel Disease Clinical and Research Centre, Winnipeg, Manitoba, Canada
| | - Laura E Targownik
- The University of Manitoba Inflammatory Bowel Disease Clinical and Research Centre, Winnipeg, Manitoba, Canada
- Department of Internal Medicine, Rady College of Medicine, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Harminder Singh
- The University of Manitoba Inflammatory Bowel Disease Clinical and Research Centre, Winnipeg, Manitoba, Canada
- Department of Internal Medicine, Rady College of Medicine, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Carolyn Snider
- Department of Emergency Medicine, Rady College of Medicine, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Julia Witt
- The University of Manitoba Inflammatory Bowel Disease Clinical and Research Centre, Winnipeg, Manitoba, Canada
- Department of Economics, Rady College of Medicine, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Decker KM, Lambert P, Nugent Z, Biswanger N, Samadder J, Singh H. Time Trends in the Diagnosis of Colorectal Cancer With Obstruction, Perforation, and Emergency Admission After the Introduction of Population-Based Organized Screening. JAMA Netw Open 2020; 3:e205741. [PMID: 32453385 PMCID: PMC7251446 DOI: 10.1001/jamanetworkopen.2020.5741] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE Up to 30% of patients with a diagnosis of colorectal cancer (CRC) present as an emergency (an intestinal obstruction, perforation, or emergency hospital admission) (OPE). There are limited data about the association of organized, population-based colorectal cancer screening with the rate of emergency presentations. OBJECTIVE To examine the association of CRC screening with OPE at cancer diagnosis and time trends in the rate of OPE after the start of organized CRC screening using a highly sensitive fecal occult blood test. DESIGN, SETTING, AND PARTICIPANTS A historical cohort study was conducted among 1861 individuals 52 to 74 years of age with a diagnosis of CRC from January 1, 2007, to December 31, 2015, who lived in Winnipeg, Manitoba, a province with universal health care and an organized CRC screening program. Statistical analysis was performed from January 22, 2019, to February 26, 2020. EXPOSURES Variables included prior CRC screening, era of diagnosis, cancer stage at diagnosis, tumor site in the colon, area level mean household income, primary care continuity of care, and comorbidity. MAIN OUTCOMES AND MEASURES The primary outcomes were defined as an OPE. Logistic regression was used to evaluate factors associated with OPE at CRC diagnosis. Trends over time were calculated using Joinpoint Regression. RESULTS From 2007 to 2015, 1861 individuals 52 to 74 years of age (1133 men; median age, 65.1 years [interquartile range, 60.0-70.3 years]) received a diagnosis of CRC in Winnipeg. Most individuals had good continuity of care and moderate comorbidities. Overall, 345 individuals (18.5%) had an OPE. The rate of emergency hospital admissions decreased significantly from 2007 (the start of the organized, province-wide CRC screening program) to 2015 (annual change, -7.1%; 95% CI, -11.3% to -2.8%; P = .01). There was no change in the rate of obstructions or perforations or stage IV CRCs. Individuals who were up to date for CRC screening were significantly less likely to receive a diagnosis of an OPE (odds ratio, 0.38; 95% CI, 0.28-0.50; P < .001). The results were similar after adding emergency department visits and stage IV CRC at diagnosis to the outcome. CONCLUSIONS AND RELEVANCE This study suggests that the rate of emergency hospital admissions decreased over time for individuals who underwent CRC screening, but there was no change in the rate of obstructions and perforations. Individuals who were up to date for CRC screening were less likely to have a CRC diagnosis with an OPE.
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Affiliation(s)
- Kathleen M. Decker
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba
- Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, Manitoba
- Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, Manitoba
| | - Pascal Lambert
- Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, Manitoba
| | - Zoann Nugent
- Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, Manitoba
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba
| | - Natalie Biswanger
- Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, Manitoba
| | - Jewel Samadder
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Phoenix, Arizona
- Department of Medicine, University of Utah, Salt Lake City
| | - Harminder Singh
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba
- Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, Manitoba
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba
- Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, Manitoba
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Singal D, Chateau D, Struck S, Lee JB, Dahl M, Derksen S, Katz LY, Ruth C, Hanlon-Dearman A, Brownell M. In Utero Antidepressants and Neurodevelopmental Outcomes in Kindergarteners. Pediatrics 2020; 145:peds.2019-1157. [PMID: 32341177 DOI: 10.1542/peds.2019-1157] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/11/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To determine if in utero selective serotonin reuptake inhibitor (SSRI) or selective serotonin norepinephrine inhibitor (SNRI) exposure is associated with developmental vulnerability in kindergarten among children whose mothers were diagnosed with prenatal mood or anxiety disorder. METHODS Linkable administrative data were used to create a population-based cohort of 266 479 mother-child dyads of children born in Manitoba, Canada, between 1996 and 2014, with follow-up through 2015. The sample was restricted to mothers who had a mood or anxiety disorder diagnosis between 90 days before conception (N = 13 818). Exposed women had ≥2 SSRI or SNRI dispensations during pregnancy (n = 2055); unexposed mothers did not have a dispensation of an SSRI or SNRI during pregnancy (n = 10 017). The Early Development Instrument (EDI) was used to assess developmental health in kindergarten children. The EDI is a 104-component kindergarten teacher-administered questionnaire, encompassing 5 developmental domains. RESULTS Of the 3048 children included in the study who met inclusion criteria and had an EDI, 21.43% of children in the exposed group were assessed as vulnerable on 2 or more domains versus 16.16% of children in the unexposed group (adjusted odds ratio = 1.43; 95% confidence interval 1.08-1.90). Children in the exposed group also had a significant risk of being vulnerable in language and/or cognition (adjusted odds ratio = 1.40; 95% confidence interval 1.03-1.90). CONCLUSIONS Exposure to SSRIs or SNRIs during pregnancy was associated with an increased risk of developmental vulnerability and an increased risk of deficits in language and/or cognition. Replication of results is necessary before clinical implications can be reached.
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Affiliation(s)
- Deepa Singal
- Department of Community Health Sciences, Manitoba Centre for Health Policy, and
| | - Dan Chateau
- Department of Community Health Sciences, Manitoba Centre for Health Policy, and
| | - Shannon Struck
- Department of Community Health Sciences, Manitoba Centre for Health Policy, and
| | - Janelle Boram Lee
- Department of Community Health Sciences, Manitoba Centre for Health Policy, and
| | - Matthew Dahl
- Department of Community Health Sciences, Manitoba Centre for Health Policy, and
| | - Shelly Derksen
- Department of Community Health Sciences, Manitoba Centre for Health Policy, and
| | - Laurence Y Katz
- Department of Psychiatry, Child and Adolescent Psychiatry Health Sciences Centre, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Chelsea Ruth
- Section of Neonatology, Department of Pediatrics and Child Health
| | - Ana Hanlon-Dearman
- Section of Developmental Pediatrics, Department of Pediatrics and Child Health Policy, and
| | - Marni Brownell
- Department of Community Health Sciences, Manitoba Centre for Health Policy, and
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Saarinen AIL, Keltikangas-Järvinen L, Hintsa T, Pulkki-Råback L, Ravaja N, Lehtimäki T, Raitakari O, Hintsanen M. Does Compassion Predict Blood Pressure and Hypertension? The Modifying Role of Familial Risk for Hypertension. Int J Behav Med 2020; 27:527-538. [PMID: 32347444 PMCID: PMC7497423 DOI: 10.1007/s12529-020-09886-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background This study investigated (i) whether compassion is associated with blood pressure or hypertension in adulthood and (ii) whether familial risk for hypertension modifies these associations. Method The participants (N = 1112–1293) came from the prospective Young Finns Study. Parental hypertension was assessed in 1983–2007; participants’ blood pressure in 2001, 2007, and 2011; hypertension in 2007 and 2011 (participants were aged 30–49 years in 2007–2011); and compassion in 2001. Results High compassion predicted lower levels of diastolic and systolic blood pressure in adulthood. Additionally, high compassion was related to lower risk for hypertension in adulthood among individuals with no familial risk for hypertension (independently of age, sex, participants’ and their parents’ socioeconomic factors, and participants’ health behaviors). Compassion was not related to hypertension in adulthood among individuals with familial risk for hypertension. Conclusion High compassion predicts lower diastolic and systolic blood pressure in adulthood. Moreover, high compassion may protect against hypertension among individuals without familial risk for hypertension. As our sample consisted of comparatively young participants, our findings provide novel implications for especially early-onset hypertension. Electronic supplementary material The online version of this article (10.1007/s12529-020-09886-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Aino I L Saarinen
- Research Unit of Psychology, University of Oulu, P.O. Box 2000 (Erkki Koiso-Kanttilan katu 1), 90014, Oulu, Finland.,Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | | | - Taina Hintsa
- Department of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland
| | - Laura Pulkki-Råback
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Niklas Ravaja
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Fimlab Laboratories and Finnish Cardiovascular Research Center-Tampere, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Olli Raitakari
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.,Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland.,Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Mirka Hintsanen
- Research Unit of Psychology, University of Oulu, P.O. Box 2000 (Erkki Koiso-Kanttilan katu 1), 90014, Oulu, Finland.
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Gruneir A, Griffith LE, Fisher K, Perez R, Favotto L, Patterson C, Markle-Reid M, Ploeg J, Upshur R. Measuring multimorbidity series. An overlooked complexity - Comparison of self-report vs. administrative data in community-living adults: Paper 3. Agreement across data sources and implications for estimating associations with health service use. J Clin Epidemiol 2020; 124:173-182. [PMID: 32353402 DOI: 10.1016/j.jclinepi.2020.04.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 02/03/2020] [Accepted: 04/22/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The objective of this study is to describe agreement between administrative and self-report data on the number and type of chronic conditions (CCs) and determine whether associations between CC count and health service use differ by data source. STUDY DESIGN AND SETTING We linked Canadian Community Health Survey and administrative data for a cohort of adults aged 45+ years in Ontario and identified 12 CCs from both data sources. Agreement was described by count and constituent CCs. We estimated associations between CC count (self-report and administrative data) and health service use (administrative data only) over 1 year. RESULTS Among 71,317 adults, 26.9% showed agreement on both count and constituent CCs but agreement declined with increasing CCs. Health service use increased with CC count but the association was stronger when CCs were measured with administrative data. For example, when measured with administrative data, the odds of a general practitioner visit for 5+ CCs vs. none was 20.3 (95% CI 20.0-20.5) but when using self-report data, the estimate was 8.0 (95% CI 7.8-8.2). CONCLUSION Agreement on the number of CCs was low and resulted in different estimates on the association with health service use, illustrating the challenges in CC measurement and the ability to interpret the effects on outcomes.
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Affiliation(s)
- Andrea Gruneir
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada; ICES, Toronto, Ontario, Canada; Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.
| | - Lauren E Griffith
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Kathryn Fisher
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Richard Perez
- ICES McMaster, McMaster University, Hamilton, Ontario, Canada
| | - Lindsay Favotto
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; ICES McMaster, McMaster University, Hamilton, Ontario, Canada
| | | | - Maureen Markle-Reid
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Jenny Ploeg
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Ross Upshur
- Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Bridgepoint Collaboratory for Research and Innovation, Sinai Health System, Toronto, Ontario, Canada
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Griffith LE, Gruneir A, Fisher KA, Upshur R, Patterson C, Perez R, Favotto L, Markle-Reid M, Ploeg J. Measuring multimorbidity series-an overlooked complexity comparison of self-report vs. administrative data in community-living adults: paper 2. Prevalence estimates depend on the data source. J Clin Epidemiol 2020; 124:163-172. [PMID: 32353403 DOI: 10.1016/j.jclinepi.2020.04.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 02/01/2020] [Accepted: 04/22/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The objective of the study was to compare multimorbidity prevalence using self-reported and administrative data and identify factors associated with agreement between data sources. STUDY DESIGN AND SETTING Self-reported cross-sectional data from four Canadian Community Health Survey waves were linked to administrative data in Ontario, Canada. Multimorbidity prevalence was examined using two definitions, 2+ and 3+ chronic conditions (CCs). Agreement between data sources was assessed using Kappa and Phi statistics. Logistic regression was used to estimate associations between agreement and sociodemographic, health behavior, and health status variables for each multimorbidity definition. RESULTS Regardless of multimorbidity definition, prevalence was higher using administrative data (2+ CCs: 55.5% vs. 47.1%; 3+ CCs: 30.0% vs. 24.2%). Agreement between data sources was moderate (2+ CCs K = 0.482; 3+ CCs K = 0.442), and while associated with sociodemographic, health behavior, and health status factors, the magnitude and sometimes direction of association differed by multimorbidity definition. CONCLUSION A better understanding is needed of what factors influence individuals' reporting of CCs and how they align with what is in administrative data as policy makers need a solid evidence base on which to make decisions for health planning. Our results suggest that data sources may need to be triangulated to provide accurate estimates of multimorbidity for health services planning and policy.
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Affiliation(s)
- Lauren E Griffith
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
| | - Andrea Gruneir
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada; ICES, Toronto, Ontario, Canada; Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Kathryn A Fisher
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Ross Upshur
- Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Bridgepoint Collaboratory for Research and Innovation, Sinai Health System, Toronto, Ontario, Canada
| | | | - Richard Perez
- ICES, McMaster University, Hamilton, Ontario, Canada
| | - Lindsay Favotto
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; ICES, McMaster University, Hamilton, Ontario, Canada
| | - Maureen Markle-Reid
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Jenny Ploeg
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
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van der Leek AP, Bahreinian S, Chartier M, Dahl ME, Azad MB, Brownell MD, Kozyrskyj AL. Maternal Distress During Pregnancy and Recurrence in Early Childhood Predicts Atopic Dermatitis and Asthma in Childhood. Chest 2020; 158:57-67. [PMID: 32173490 DOI: 10.1016/j.chest.2020.01.052] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 01/20/2020] [Accepted: 01/23/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Early-life stress is becoming an important determinant of immune system programming. Maternal prenatal distress is found to be associated with atopic disease in offspring but the separate effects of postnatal distress are not well-studied. RESEARCH QUESTION Does the likelihood of asthma and atopic dermatitis in children increase when they are exposed to maternal distress pre- and postnatally in a sex-specific manner? STUDY DESIGN AND METHODS Using data from a provincial newborn screen and health-care database for 12,587 children born in 2004, maternal distress (depression or anxiety) was defined as prenatal, self-limiting, recurrent, or late-onset postpartum. Atopic dermatitis (AD) and asthma at ages 5 years and 7 years of age were diagnosed by using hospitalization, physician visit, or prescription records. Associations between maternal distress and childhood asthma and AD were determined by using multiple logistic regression. RESULTS After adjusting for risk factors, a significant association between maternal prenatal (OR, 1.27; 95% CI, 1.11-1.46), recurrent postpartum (OR, 1.28; 95% CI, 1.11-1.48), and late-onset postpartum (OR, 1.19, 95% CI, 1.06-1.34) distress was found with AD at age 5 years. Asthma at age 7 years was also associated with maternal prenatal distress (OR, 1.57; 95% CI, 1.29-1.91) and late-onset postnatal distress (OR, 1.22; 95% CI, 1.01-1.46). Self-limiting postnatal distress was not found to be a risk factor for either atopic condition. Associations with AD or asthma were of a similar magnitude in boys and girls; the exception was recurrent postnatal distress, which increased risk for asthma in boys only. INTERPRETATION This population-based study provides evidence for sex-specific associations between maternal prenatal and postnatal distress, as well as the development of AD and asthma. The findings support recommendations for greater psychosocial support of mothers during pregnancy and early childhood to prevent childhood atopic disease.
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Affiliation(s)
| | - Salma Bahreinian
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Mariette Chartier
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
| | - Matthew E Dahl
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
| | - Meghan B Azad
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Marni D Brownell
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
| | - Anita L Kozyrskyj
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada; School of Public Health, University of Alberta, Edmonton, AB, Canada.
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Lee DC, Feldman JM, Osorio M, Koziatek CA, Nguyen MV, Nagappan A, Shim CJ, Vinson AJ, Thorpe LE, McGraw NA. Improving the geographical precision of rural chronic disease surveillance by using emergency claims data: a cross-sectional comparison of survey versus claims data in Sullivan County, New York. BMJ Open 2019; 9:e033373. [PMID: 31740475 PMCID: PMC6887089 DOI: 10.1136/bmjopen-2019-033373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 10/31/2019] [Accepted: 10/31/2019] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Some of the most pressing health problems are found in rural America. However, the surveillance needed to track and prevent disease in these regions is lacking. Our objective was to perform a comprehensive health survey of a single rural county to assess the validity of using emergency claims data to estimate rural disease prevalence at a sub-county level. DESIGN We performed a cross-sectional study of chronic disease prevalence estimates using emergency department (ED) claims data versus mailed health surveys designed to capture a substantial proportion of residents in New York's rural Sullivan County. SETTING Sullivan County, a rural county ranked second-to-last for health outcomes in New York State. PARTICIPANTS Adult residents of Sullivan County aged 25 years and older who responded to the health survey in 2017-2018 or had at least one ED visit in 2011-2015. OUTCOME MEASURES We compared age and gender-adjusted prevalence of hypertension, hyperlipidaemia, diabetes, cancer, asthma and chronic obstructive pulmonary disease/emphysema among nine sub-county areas. RESULTS Our county-wide mailed survey obtained 6675 completed responses for a response rate of 30.4%. This sample represented more than 12% of the estimated 53 020 adults in Sullivan County. Using emergency claims data, we identified 34 576 adults from Sullivan County who visited an ED at least once during 2011-2015. At a sub-county level, prevalence estimates from mailed surveys and emergency claims data correlated especially well for diabetes (r=0.90) and asthma (r=0.85). Other conditions were not well correlated (range: 0.23-0.46). Using emergency claims data, we created more geographically detailed maps of disease prevalence using geocoded addresses. CONCLUSIONS For select conditions, emergency claims data may be useful for tracking disease prevalence in rural areas and providing more geographically detailed estimates. For rural regions lacking robust health surveillance, emergency claims data can inform how to geographically target efforts to prevent chronic disease.
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Affiliation(s)
- David C Lee
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York City, New York, USA
- Department of Population Health, New York University School of Medicine, New York City, New York, USA
| | - Justin M Feldman
- Department of Population Health, New York University School of Medicine, New York City, New York, USA
| | - Marcela Osorio
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York City, New York, USA
| | - Christian A Koziatek
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York City, New York, USA
| | - Michael V Nguyen
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York City, New York, USA
| | - Ashwini Nagappan
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York City, New York, USA
| | - Christopher J Shim
- California Northstate University College of Medicine, Elk Grove, California, USA
| | - Andrew J Vinson
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York City, New York, USA
| | - Lorna E Thorpe
- Department of Population Health, New York University School of Medicine, New York City, New York, USA
| | - Nancy A McGraw
- Sullivan County Public Health Services, Liberty, New York, USA
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Singh H, Nugent Z, Walkty A, Yu BN, Lix LM, Targownik LE, Bernstein CN, Witt J. Direct cost of health care for individuals with community associated Clostridium difficile infections: A population-based cohort study. PLoS One 2019; 14:e0224609. [PMID: 31703080 PMCID: PMC6839863 DOI: 10.1371/journal.pone.0224609] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 10/17/2019] [Indexed: 12/12/2022] Open
Abstract
Background Even though the incidence of community-acquired Clostridium difficile infection (CDI) is reported to be increasing, few studies have reported on the healthcare costs of community-acquired CDI. We estimated cost of care for individuals with community-associated CDI and compared with that for matched controls without CDI in the time period of six months before to one year after CDI. Methods All individuals in the province of Manitoba, diagnosed with CDI between July 2005 and March 2015 were matched up to 4 individuals without CDI. Health care utilization and direct costs resulting from hospitalizations, physician reimbursement claims and prescriptions were determined from the population based provincial databases. Quantile regressions were performed to determine predictors of cost of individuals with community associated CDI. Results Of all CDIs, 30–40% in each period of the study had community-associated CDI; of which 12% were recurrent CDIs. The incremental median and 90th percentile cost of care for individuals with community-associated CDI was $800 and $16,000 respectively in the six months after CDI diagnosis. After adjustment for age, co-morbidities, sex, socioeconomic status and magnitude of health care utilization prior to CDI, the median incremental cost for recurrent CDI was $1,812 and that for a subsequent episode of CDI was $3,139 compared to those with a single community-associated CDI episode. The median cost for a prescription of Vancomycin was $316 (IQR 209–489). Conclusions Health care costs of an episode of community-associated CDI have been much more than the cost of antibiotic treatment. Our study provides population-based data for formal cost effectiveness analysis for use of newer treatments for community-associated CDI.
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Affiliation(s)
- Harminder Singh
- University of Manitoba IBD Clinical and Research Center, Winnipeg, Manitoba, Canada
- Department of Internal Medicine, University of Manitoba, Max Rady College of Medicine, Winnipeg, Manitoba, Canada
- CancerCare Manitoba, Research Institute, Winnipeg, Manitoba, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- * E-mail:
| | - Zoann Nugent
- University of Manitoba IBD Clinical and Research Center, Winnipeg, Manitoba, Canada
- CancerCare Manitoba, Research Institute, Winnipeg, Manitoba, Canada
| | - A Walkty
- Department of Internal Medicine, University of Manitoba, Max Rady College of Medicine, Winnipeg, Manitoba, Canada
| | - B Nancy Yu
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Public Health Branch, Manitoba Health, Seniors and Active Living, Winnipeg, Manitoba, Canada
| | - Lisa M. Lix
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Laura E. Targownik
- University of Manitoba IBD Clinical and Research Center, Winnipeg, Manitoba, Canada
- Department of Internal Medicine, University of Manitoba, Max Rady College of Medicine, Winnipeg, Manitoba, Canada
| | - Charles N. Bernstein
- University of Manitoba IBD Clinical and Research Center, Winnipeg, Manitoba, Canada
- Department of Internal Medicine, University of Manitoba, Max Rady College of Medicine, Winnipeg, Manitoba, Canada
| | - Julia Witt
- Department of Economics, University of Manitoba, Winnipeg, Manitoba, Canada
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A nested case-control study measuring pertussis vaccine effectiveness and duration of protection in Manitoba, Canada, 1992–2015: A Canadian Immunization Research Network Study. Vaccine 2019; 37:7132-7137. [DOI: 10.1016/j.vaccine.2019.09.064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 09/05/2019] [Accepted: 09/19/2019] [Indexed: 11/23/2022]
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Richard L, Hwang SW, Forchuk C, Nisenbaum R, Clemens K, Wiens K, Booth R, Azimaee M, Shariff SZ. Validation study of health administrative data algorithms to identify individuals experiencing homelessness and estimate population prevalence of homelessness in Ontario, Canada. BMJ Open 2019; 9:e030221. [PMID: 31594882 PMCID: PMC6797366 DOI: 10.1136/bmjopen-2019-030221] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES To validate case ascertainment algorithms for identifying individuals experiencing homelessness in health administrative databases between 2007 and 2014; and to estimate homelessness prevalence trends in Ontario, Canada, between 2007 and 2016. DESIGN A population-based retrospective validation study. SETTING Ontario, Canada, from 2007 to 2014 (validation) and 2007 to 2016 (estimation). PARTICIPANTS Our reference standard was the known housing status of a longitudinal cohort of housed (n=137 200) and homeless or vulnerably housed (n=686) individuals. Two reference standard definitions of homelessness were adopted: the housing episode and the annual housing experience (any homelessness within a calendar year). MAIN OUTCOME MEASURES Sensitivity, specificity, positive and negative predictive values and positive likelihood ratios of 30 case ascertainment algorithms for detecting homelessness using up to eight health service databases. RESULTS Sensitivity estimates ranged from 10.8% to 28.9% (housing episode definition) and 18.5% to 35.6% (annual housing experience definition). Specificities exceeded 99% and positive likelihood ratios were high using both definitions. The most optimal algorithm estimates that 59 974 (95% CI 55 231 to 65 208) Ontarians (0.53% of the adult population) experienced homelessness in 2016, a 67.3% increase from 2007. CONCLUSIONS In Ontario, case ascertainment algorithms for identifying homelessness had low sensitivity but very high specificity and positive likelihood ratio. The use of health administrative databases may offer opportunities to track individuals experiencing homelessness over time and inform efforts to improve housing and health status in this vulnerable population.
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Affiliation(s)
| | | | - Cheryl Forchuk
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
| | - Rosane Nisenbaum
- St Michael's Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Kristin Clemens
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Kathryn Wiens
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Richard Booth
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
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48
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Radnaabaatar M, Kim Y, Go D, Jung Y, Jung J, Yoon S. Burden of dental caries and periodontal disease in South Korea: An analysis using the national health insurance claims database. Community Dent Oral Epidemiol 2019; 47:513-519. [DOI: 10.1111/cdoe.12493] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 08/07/2019] [Accepted: 08/08/2019] [Indexed: 01/26/2023]
Affiliation(s)
| | - Young‐Eun Kim
- Department of Preventive Medicine Korea University College of Medicine Seoul Korea
| | - Dun‐Sol Go
- Department of Public Health, Graduate School Korea University Seoul Korea
| | - Yunsun Jung
- Department of Public Health, Graduate School Korea University Seoul Korea
| | - Jaehun Jung
- Department of Preventive Medicine Gachon University College of Medicine Incheon Korea
| | - Seok‐Jun Yoon
- Department of Preventive Medicine Korea University College of Medicine Seoul Korea
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49
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Righolt CH, Lagace-Wiens P, Mahmud SM. Prevalence, predictors, and consequences of inappropriate empiric antimicrobial therapy for complicated urinary tract and intra-abdominal infections in Winnipeg hospitals. Diagn Microbiol Infect Dis 2019; 96:114891. [PMID: 31668828 DOI: 10.1016/j.diagmicrobio.2019.114891] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 08/23/2019] [Accepted: 08/24/2019] [Indexed: 12/20/2022]
Abstract
Information on inappropriate empiric antimicrobial therapy (ET) in Canadian hospitals is scarce. All Manitobans 18 years of age and over who were admitted to a hospital in Winnipeg with a complicated urinary tract infection (cUTI) or complicated intra-abdominal infection (cIAI) from January 2006 to December 2014 were eligible for inclusion in this cohort study. The prevalence of inappropriate ET was 11% for cUTI patients and 9% for cIAI patients. The risk of receiving inappropriate ET was higher for older patients (cUTI patients 65 or older had 2-fold increased risk compared to younger patients; odds ratio 2.1, 95% confidence interval 1.3-3.6; this was 1.6 [0.7-3.5] for cIAI patients) and those hospitalized in the previous year: 1.5 (1.0-2.4) in cUTIs and 1.5 (0.6-3.4) in cIAIs. The risk for a hospital stay over 3 weeks was increased for inappropriate ET in cUTI patients, 2.3 (1.4-3.7), but not in cIAI patients, 0.9 (0.4-2.1).
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Affiliation(s)
- Christiaan H Righolt
- Vaccine and Drug Evaluation Centre, Department of Community Health Sciences, University of Manitoba, 337-750 McDermot Avenue, Winnipeg, MB, R3E 0T5, Canada
| | - Philippe Lagace-Wiens
- Diagnostic Services, Shared Health, Clinical Microbiology, Saint-Boniface Hospital, L4025-409 Taché Avenue, Winnipeg, MB, R2H 2A6
| | - Salaheddin M Mahmud
- Vaccine and Drug Evaluation Centre, Department of Community Health Sciences, University of Manitoba, 337-750 McDermot Avenue, Winnipeg, MB, R3E 0T5, Canada.
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50
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Ye X, Monchka BA, Righolt CH, Mahmud SM. Maternal use of antibiotics and cancer incidence risk in offspring: A population-based cohort study in Manitoba, Canada. Cancer Med 2019; 8:5367-5372. [PMID: 31310456 PMCID: PMC6718549 DOI: 10.1002/cam4.2412] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 06/26/2019] [Accepted: 06/27/2019] [Indexed: 12/12/2022] Open
Abstract
Several epidemiological studies have found an association between maternal antibiotics use during pregnancy and increased risk of certain cancer types, although conclusions differ between studies. We examined this association in a cohort study including 262 116 mother‐child pairs of Manitoba births between 1996 and 2013. Maternal antibiotics use during prepregnancy (6 months prior to pregnancy) and pregnancy periods was assessed. Children's cancer incidence was tracked up to the end of the follow‐up period (December 2015). We calculated incidence rate and used Cox regression to estimate adjusted hazard ratios (HRs). Antibiotics use during pregnancy was not associated with overall cancer (HR = 1.1, 95% confidence interval 0.9‐1.4), leukemias (1.3, 0.9‐1.8), or acute lymphocytic leukemia (1.1, 0.7‐1.6). The association between antibiotics use and overall cancer risk differed by trimester: 1.5 (1.1‐1.9) in the first, 0.8 (0.6‐1.0) in the second, and 1.1 (0.8‐1.5) in the third trimester. Further research is necessary to confirm the association between first‐trimester exposure and cancer risk after a better controlling of confounding factors.
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Affiliation(s)
- Xibiao Ye
- Vaccine and Drug Evaluation Centre, University of Manitoba, Winnipeg, Manitoba, Canada.,School of Health Information Science, University of Victoria, British Columbia, Canada
| | - Barret A Monchka
- Vaccine and Drug Evaluation Centre, University of Manitoba, Winnipeg, Manitoba, Canada.,George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Christiaan H Righolt
- Vaccine and Drug Evaluation Centre, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Salaheddin M Mahmud
- Vaccine and Drug Evaluation Centre, University of Manitoba, Winnipeg, Manitoba, Canada.,College of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada.,George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada
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