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Lambert J, Sandhu H, Kean E, Xavier T, Brokman A, Steckler Z, Park L, Stromberg A. A strategy to identify event specific hospitalizations in large health claims databases. BMC Health Serv Res 2022; 22:705. [PMID: 35619126 PMCID: PMC9133593 DOI: 10.1186/s12913-022-08107-x] [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] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 05/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health insurance claims data offer a unique opportunity to study disease distribution on a large scale. Challenges arise in the process of accurately analyzing these raw data. One important challenge to overcome is the accurate classification of study outcomes. For example, using claims data, there is no clear way of classifying hospitalizations due to a specific event. This is because of the inherent disjointedness and lack of context that typically come with raw claims data. METHODS In this paper, we propose a framework for classifying hospitalizations due to a specific event. We then tested this framework in a private health insurance claims database (Symphony) with approximately 4 million US adults who tested positive with COVID-19 between March and December 2020. Our claims specific COVID-19 related hospitalizations proportion is then compared to nationally reported rates from the Centers for Disease Control by age. RESULTS Across all ages (18 +) the total percentage of Symphony patients who met our definition of hospitalized due to COVID-19 was 7.3% which was similar to the CDC's estimate of 7.5%. By age group, defined by the CDC, our estimates vs. the CDC's estimates were 18-49: 2.7% vs. 3%, 50-64: 8.2% vs. 9.2%, and 65 + : 14.6% vs. 28.1%. CONCLUSIONS The proposed methodology is a rigorous way to define event specific hospitalizations in claims data. This methodology can be extended to many different types of events and used on a variety of different types of claims databases.
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Affiliation(s)
- Joshua Lambert
- College of Nursing, University of Cincinnati, Procter Hall, Cincinnati, OH, 45219, USA.
| | - Harpal Sandhu
- Department of Bioengineering, University of Louisville Speed School of Engineering, Eastern Pkwy, Louisville, USA
| | - Emily Kean
- College of Nursing, University of Cincinnati, Procter Hall, Cincinnati, OH, 45219, USA
| | - Teenu Xavier
- College of Nursing, University of Cincinnati, Procter Hall, Cincinnati, OH, 45219, USA
| | - Aviv Brokman
- Dr. Bing Zhang Department of Statistics, University of Kentucky, Lexington, USA
| | - Zachary Steckler
- Dr. Bing Zhang Department of Statistics, University of Kentucky, Lexington, USA
| | - Lee Park
- Dr. Bing Zhang Department of Statistics, University of Kentucky, Lexington, USA
| | - Arnold Stromberg
- Dr. Bing Zhang Department of Statistics, University of Kentucky, Lexington, USA
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Landscape of Living Multiorgan Donation in the United States: A Registry-Based Cohort Study. Transplantation 2019; 102:1148-1155. [PMID: 29952925 DOI: 10.1097/tp.0000000000002082] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The donation of multiple allografts from a single living donor is a rare practice, and the patient characteristics and outcomes associated with these procedures are not well described. METHODS Using the Scientific Registry of Transplant Recipients, we identified 101 living multiorgan donors and their 133 recipients. RESULTS The 49 sequential (donations during separate procedures) multiorgan donors provided grafts to 81 recipients: 21 kidney-then-liver, 15 liver-then-kidney, 5 lung-then-kidney, 3 liver-then-intestine, 3 kidney-then-pancreas, 1 lung-then-liver, and 1 pancreas-then-kidney. Of these donors, 38% donated 2 grafts to the same recipient and 15% donated 2 grafts as non-directed donors. Compared to recipients from first-time, single organ living donors, recipients from second-time living donors had similar graft and patient survival. The 52 simultaneous (multiple donations during one procedure) multiorgan donors provided 2 grafts to 1 recipient each: 48 kidney-pancreas and 4 liver-intestine. Donors had median of 13.4 years (interquartile range, 8.3-18.5 years) of follow-up. There was one reported death of a sequential donor (2.5 years after second donation). Few postdonation complications were reported over a median of 116 days (interquartile range, 0-295 days) of follow-up; however, routine living donor follow-up data were sparse. Recipients of kidneys from second-time living donors had similar graft (P = 0.2) and patient survival (P = 0.4) when compared with recipients from first-time living donors. Similarly, recipients of livers from second-time living donors had similar graft survival (P = 0.9) and patient survival (P = 0.7) when compared with recipients from first-time living donors. CONCLUSIONS Careful documentation of outcomes is needed to ensure ethical practices in selection, informed consent, and postdonation care of this unique donor community.
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Abstract
β cell replacement with either pancreas or islet transplantation has progressed immensely over the last decades with current 1- and 5-year insulin independence rates of approximately 85% and 50%, respectively. Recent advances are largely attributed to improvements in immunosuppressive regimen, donor selection, and surgical technique. However, both strategies are compromised by a scarce donor source. Xenotransplantation offers a potential solution by providing a theoretically unlimited supply of islets, but clinical application has been limited by concerns for a potent immune response against xenogeneic tissue. β cell clusters derived from embryonic or induced pluripotent stem cells represent another promising unlimited source of insulin producing cells, but clinical application is pending further advances in the function of the β cell like clusters. Exciting developments and rapid progress in all areas of β cell replacement prompted a lively debate by members of the young investigator committee of the International Pancreas and Islet Transplant Association at the 15th International Pancreas and Islet Transplant Association Congress in Melbourne and at the 26th international congress of The Transplant Society in Hong Kong. This international group of young investigators debated which modality of β cell replacement would predominate the landscape in 10 years, and their arguments are summarized here.
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Bonnet-Serrano F, Diedisheim M, Mallone R, Larger E. Decreased α-cell mass and early structural alterations of the exocrine pancreas in patients with type 1 diabetes: An analysis based on the nPOD repository. PLoS One 2018; 13:e0191528. [PMID: 29352311 PMCID: PMC5774815 DOI: 10.1371/journal.pone.0191528] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 01/05/2018] [Indexed: 01/21/2023] Open
Abstract
Background and aims Abnormal glucagon secretion and functional alterations of the exocrine pancreas have been described in patients with type 1 diabetes (T1D), but their respective anatomical substrata have seldom been investigated. Our aim was to develop an automated morphometric analysis process to characterize the anatomy of α-cell and exocrine pancreas in patients with T1D, using the publicly available slides of the Network for Pancreatic Organ Donors (nPOD). Materials and methods The ratio of β- and α-cell area to total tissue area were quantified in 75 patients with T1D (thereafter patients) and 66 control subjects (thereafter controls), on 2 insulin-stained and 4 glucagon-stained slides from both the head and the tail of the pancreas. The β- and α-cell masses were calculated in the 66 patients and the 50 controls for which the pancreas weight was available. Non-exocrine-non-endocrine tissue area (i.e. non-acinar, non-insular tissue) to total tissue area ratio was evaluated on both insulin- and glucagon-stained slides. Results were expressed as mean ±SD. Results An automated quantification method was set up using the R software and was validated by quantification of β-cell mass, a well characterized parameter. β-cell mass was 29.6±112 mg in patients and 628 ±717 mg in controls (p<0.0001). α-cell mass was 181±176 mg in patients and 349 ±241mg in controls (p<0.0001). Non-exocrine-non-endocrine area to total tissue area ratio was 39±9% in patients and 29± 10% in controls (p<0.0001) and increased with age in both groups, with no correlation with diabetes duration in patients. Conclusion The absolute α-cell mass was lower in patients compared to controls, in proportion to the decrease in pancreas weight observed in patients. Non-exocrine-non-endocrine area to total tissue area ratio increased with age in both groups but was higher in patients at all ages.
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Affiliation(s)
- Fidéline Bonnet-Serrano
- Assistance Publique Hôpitaux de Paris, Hôpital Cochin, UF d’Hormonologie, DHU « AUTHORS », Paris, France
- Assistance Publique Hôpitaux de Paris, Hôpital Cochin, Service de diabétologie, DHU « AUTHORS », Paris, France
| | - Marc Diedisheim
- Assistance Publique Hôpitaux de Paris, Hôpital Cochin, Service de diabétologie, DHU « AUTHORS », Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- INSERM, U1016 and CNRS UMR8104, Cochin Institute, Paris, France
| | - Roberto Mallone
- Assistance Publique Hôpitaux de Paris, Hôpital Cochin, Service de diabétologie, DHU « AUTHORS », Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- INSERM, U1016 and CNRS UMR8104, Cochin Institute, Paris, France
| | - Etienne Larger
- Assistance Publique Hôpitaux de Paris, Hôpital Cochin, Service de diabétologie, DHU « AUTHORS », Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- INSERM, U1016 and CNRS UMR8104, Cochin Institute, Paris, France
- * E-mail:
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Kasiske BL, Asrani SK, Dew MA, Henderson ML, Henrich C, Humar A, Israni AK, Lentine KL, Matas AJ, Newell KA, LaPointe Rudow D, Massie AB, Snyder JJ, Taler SJ, Trotter JF, Waterman AD. The Living Donor Collective: A Scientific Registry for Living Donors. Am J Transplant 2017; 17:3040-3048. [PMID: 28520316 DOI: 10.1111/ajt.14365] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 04/20/2017] [Accepted: 05/07/2017] [Indexed: 01/25/2023]
Abstract
In the setting of an overall decline in living organ donation and new questions about long-term safety, a better understanding of outcomes after living donation has become imperative. Adequate information on outcomes important to donors may take many years to ascertain and may be evident only by comparing large numbers of donors with suitable controls. Previous studies have been unable to fully answer critical questions, primarily due to lack of appropriate controls, inadequate sample size, and/or follow-up duration that is too short to allow detection of important risks attributable to donation. The Organ Procurement and Transplantation Network does not follow donors long term and has no prospective control group with which to compare postdonation outcomes. There is a need to establish a national living donor registry and to prospectively follow donors over their lifetimes. In addition, there is a need to better understand the reasons many potential donors who volunteer to donate do not donate and whether the reasons are justified. Therefore, the US Health Resources and Services Administration asked the Scientific Registry of Transplant Recipients to establish a national registry to address these important questions. Here, we discuss the efforts, challenges, and opportunities inherent in establishing the Living Donor Collective.
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Affiliation(s)
- B L Kasiske
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN.,Department of Medicine, Hennepin County Medical Center, Minneapolis, MN
| | - S K Asrani
- Transplant Hepatology, Baylor University Medical Center, Dallas, TX
| | - M A Dew
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - M L Henderson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - C Henrich
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN
| | - A Humar
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - A K Israni
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN.,Department of Medicine, Hennepin County Medical Center, Minneapolis, MN
| | - K L Lentine
- Department of Medicine, Saint Louis University, St. Louis, MO
| | - A J Matas
- Department of Surgery, University of Minnesota, Minneapolis, MN
| | - K A Newell
- Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - D LaPointe Rudow
- Recanati Miller Transplantation Institute, Mount Sinai Hospital, New York, NY
| | - A B Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - J J Snyder
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN
| | - S J Taler
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - J F Trotter
- Transplant Hepatology, Baylor University Medical Center, Dallas, TX
| | - A D Waterman
- David Geffen School of Medicine at UCLA, Kidney Transplant Program, Los Angeles, CA
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Sengupta B, Serrano OK, Sutherland DER, Kandaswamy R. Living Donor Pancreas Transplants: Donor Selection and Risk Minimization. CURRENT TRANSPLANTATION REPORTS 2017. [DOI: 10.1007/s40472-017-0152-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Highlights in Clinical Science. Transplantation 2017; 101:1121-1124. [PMID: 28538651 DOI: 10.1097/tp.0000000000001803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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