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Randall S, Brown A, Ferrante A, Boyd J, Robinson S. Implementing privacy preserving record linkage: Insights from Australian use cases. Int J Med Inform 2024; 191:105582. [PMID: 39096591 DOI: 10.1016/j.ijmedinf.2024.105582] [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: 04/21/2024] [Revised: 07/15/2024] [Accepted: 07/29/2024] [Indexed: 08/05/2024]
Abstract
OBJECTIVE To describe the use of privacy preserving linkage methods operationally in Australia, and to present insights and key learnings from their implementation. METHODS Privacy preserving record linkage (PPRL) utilising Bloom filters provides a unique practical mechanism that allows linkage to occur without the release of personally identifiable information (PII), while still ensuring high accuracy. RESULTS The methodology has received wide uptake within Australia, with four state linkage units with privacy preserving capability. It has enabled access to general practice and private pathology data amongst other, both much sought after datasets previous inaccessible for linkage. CONCLUSION The Australian experience suggests privacy preserving linkage is a practical solution for improving data access for policy, planning and population health research. It is hoped interest in this methodology internationally continues to grow.
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Affiliation(s)
- Sean Randall
- Deakin Health Economics, Institute for Health Transformation, Deakin University. Burwood Hwy, Burwood, VIC 3125, Australia.
| | - Adrian Brown
- Centre for Data Linkage, School of Population Health, Curtin University. Kent St, Bentley, WA 6102, Australia.
| | - Anna Ferrante
- Centre for Data Linkage, School of Population Health, Curtin University. Kent St, Bentley, WA 6102, Australia.
| | - James Boyd
- Department of Public Health, La Trobe University, Plenty Rd, Bundoora, VIC 3086, Australia.
| | - Suzanne Robinson
- Deakin Health Economics, Institute for Health Transformation, Deakin University. Burwood Hwy, Burwood, VIC 3125, Australia.
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Shirinbakhshmasoleh M, Aboulatta L, Leong C, Riel H, Liu K, Delaney JC, Bolton JM, Falk J, Alessi-Severini S, Eltonsy S, Kowalec K. The impact of COVID-19 public health measures on the utilization of antipsychotics in schizophrenia in Manitoba - A population-based study. Schizophr Res 2024; 272:69-76. [PMID: 39197318 DOI: 10.1016/j.schres.2024.08.004] [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: 05/23/2024] [Revised: 08/13/2024] [Accepted: 08/14/2024] [Indexed: 09/01/2024]
Abstract
PURPOSE During the COVID-19 pandemic, public health measures were implemented, yet it is unknown whether these measures affected medication access in those with schizophrenia (SCZ). This study aimed to assess whether the antipsychotic utilization in SCZ changed during the pandemic. METHODS We used dispensed prescription drug data from the Canadian province of Manitoba in individuals with SCZ using linked administrative data from the Manitoba Population Research Data Repository. The quarterly incident and prevalent dispensation of antipsychotics at two periods were compared with the expected trend (April 1, 2015 to April 1, 2020 and 2021) using linear autoregression. We stratified the primary results by age and sex and examined multiple subgroups. RESULTS There were 9045 individuals with SCZ in the first fiscal quarter of 2020. The prevalent use of the most common antipsychotics were: olanzapine (206.7/1000), risperidone (190.8/1000), quetiapine (174.4/1000), and clozapine (100.9/1000). The overall prevalent use of antipsychotics remained stable during the pandemic compared with the expected trend. A significant decrease in the incident use in April-June 2020 (estimate: -1.3, 95%CI:-2.2,-0.3) was noted compared with the expected. A significantly higher incidence of atypical antipsychotics (estimate: 1.4, 95%CI: 0.2,2.5) and risperidone separately (estimate: 1.8, 95%CI: 0.2,3.3) was noted in 2021 compared with expected. CONCLUSION This study found a decline in the receipt of antipsychotics for people with SCZ during the initial implementation of COVID-19 public health measures, particularly on the overall incidence. Future work on investigating the impact of these trends on SCZ outcomes is needed to inform future pandemic-related policies.
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Affiliation(s)
| | - Laila Aboulatta
- College of Pharmacy, University of Manitoba, Winnipeg, Canada
| | - Christine Leong
- College of Pharmacy, University of Manitoba, Winnipeg, Canada; Department of Psychiatry, College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Hayley Riel
- College of Pharmacy, University of Manitoba, Winnipeg, Canada
| | - Kun Liu
- Manitoba Center for Health Policy, Winnipeg, Canada
| | - Joseph C Delaney
- College of Pharmacy, University of Manitoba, Winnipeg, Canada; Department of Epidemiology, University of Washington, Seattle, USA
| | | | - Jamison Falk
- College of Pharmacy, University of Manitoba, Winnipeg, Canada
| | | | - Sherif Eltonsy
- College of Pharmacy, University of Manitoba, Winnipeg, Canada; Children's Hospital Research Institute of Manitoba, Winnipeg, Canada
| | - Kaarina Kowalec
- College of Pharmacy, University of Manitoba, Winnipeg, Canada; Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.
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3
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Shahbaz M, Harding JE, Milne B, Walters A, von Randow M, Gamble GD. Effect of utilizing either a self-reported questionnaire or administrative data alone or in combination on the findings of a randomized controlled trial of the long-term effects of antenatal corticosteroids. PLoS One 2024; 19:e0308414. [PMID: 39110714 PMCID: PMC11305536 DOI: 10.1371/journal.pone.0308414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 07/23/2024] [Indexed: 08/10/2024] Open
Abstract
INTRODUCTION A combination of self-reported questionnaire and administrative data could potentially enhance ascertainment of outcomes and alleviate the limitations of both in follow up studies. However, it is uncertain how access to only one of these data sources to assess outcomes impact study findings. Therefore, this study aimed to determine whether the study findings would be altered if the outcomes were assessed by different data sources alone or in combination. METHODS At 50-year follow-up of participants in a randomized trial, we assessed the effect of antenatal betamethasone exposure on the diagnosis of diabetes, pre-diabetes, hyperlipidemia, hypertension, mental health disorders, and asthma using a self-reported questionnaire, administrative data, a combination of both, or any data source, with or without adjudication by an expert panel of five clinicians. Differences between relative risks derived from each data source were calculated using the Bland-Altman approach. RESULTS There were 424 participants (46% of those eligible, aged 49 years, SD 1, 50% male). There were no differences in study outcomes between participants exposed to betamethasone and those exposed to placebo when the outcomes were assessed using different data sources. When compared to the study findings determined using adjudicated outcomes, the mean difference (limits of agreement) in relative risks derived from other data sources were: self-reported questionnaires 0.02 (-0.35 to 0.40), administrative data 0.06 (-0.32 to 0.44), both questionnaire and administrative data 0.01 (-0.41 to 0.43), and any data source, 0.01 (-0.08 to 0.10). CONCLUSION Utilizing a self-reported questionnaire, administrative data, both questionnaire and administrative data, or any of these sources for assessing study outcomes had no impact on the study findings compared with when study outcomes were assessed using adjudicated outcomes.
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Affiliation(s)
- Mohammad Shahbaz
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Jane E. Harding
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Barry Milne
- Centre of Methods and Policy Application in Social Sciences, University of Auckland, Auckland, New Zealand
| | - Anthony Walters
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Martin von Randow
- Centre of Methods and Policy Application in Social Sciences, University of Auckland, Auckland, New Zealand
| | - Greg D. Gamble
- Liggins Institute, The University of Auckland, Auckland, New Zealand
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Shah VN, Leslie WD, Lautatzis ME, Liu K, Prior HJ, Wicklow B. Maternal diabetes and fracture risk in offspring: a population-based analysis. J Bone Miner Res 2024; 39:683-687. [PMID: 38547399 PMCID: PMC11472174 DOI: 10.1093/jbmr/zjae052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/20/2024] [Accepted: 03/25/2024] [Indexed: 04/04/2024]
Abstract
Factors affecting intrauterine environment exerts influence on skeletal health and fracture risk in later life. Diabetes during pregnancy is known to influence birth weight and is associated with fetal overgrowth. However, the effects of maternal diabetes on fracture risk in offspring is unknown. This study was aimed to evaluate the association between maternal diabetes and fracture risk in offspring. Using population-based administrative health data for Manitoba, Canada, we identified deliveries complicated by gestational diabetes and type 2 diabetes between April 1, 1980, and March 31, 2020. The cohort was followed for a median of 15.8 yr. The primary outcome was any incident fracture in offspring. Secondary outcomes were long bone upper extremity fracture, long bone lower extremity fracture, vertebral fracture, and any non-trauma fractures. Cox proportional hazard regression models were used to estimate fracture risk in offspring by maternal diabetes status adjusted for relevant covariates. Of the 585 176 deliveries, 26 397 offspring were born to women with diabetes (3.0% gestational diabetes and 1.5% type 2 diabetes), and 558 779 were born to women without diabetes. The adjusted risk for any fracture was 7% (hazard ratio, 1.07; 95% CI, 2.7-11.5%) higher in the offspring of mothers with diabetes than offspring of mothers without diabetes. Types of fractures were similar between the 2 groups with a predominance of long bone upper extremity fractures. In conclusion, maternal diabetes was associated with a modest increase in fracture risk in offspring. Longitudinal prospective studies are needed to understand intrauterine and postnatal factors that may influence fracture risk in the offspring of mothers with diabetes.
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Affiliation(s)
- Viral N Shah
- Indiana University School of Medicine, Indianapolis, IN 46202, United States
| | - William D Leslie
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, R2H 2A6, Canada
| | - Maria-Elena Lautatzis
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, MB R3A 1S1, Canada
| | - Kun Liu
- Manitoba Centre for Health Policy, Manitoba, R3E 3P5, Canada
| | - Heather J Prior
- Manitoba Centre for Health Policy, Manitoba, R3E 3P5, Canada
| | - Brandy Wicklow
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, MB R3A 1S1, Canada
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5
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Salman MS, Ruth CA, Yogendran MS, Zrinyi A, Morris M. Gastroschisis and septo-optic-pituitary dysplasia: Is there an association? J Paediatr Child Health 2024; 60:294-298. [PMID: 38780070 DOI: 10.1111/jpc.16568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/22/2023] [Accepted: 05/12/2024] [Indexed: 05/25/2024]
Abstract
AIM There are several case reports describing patients with both optic nerve hypoplasia/septo-optic-pituitary dysplasia (ONH/SOD) and gastroschisis (GS). Our aim was to investigate whether ONH/SOD is associated with GS. METHODS A retrospective population-based study was undertaken using the Population Research Data Repository at the Manitoba Center for Health Policy in Manitoba, Canada to investigate if any patient with ONH/SOD also had GS. In addition, Winnipeg's Surgical Database of Outcomes and Management (WiSDOM), a hospital-based paediatric surgical database, was searched to ascertain if any of the patients with GS also have ONH/SOD. RESULTS Cases were 124 patients with ONH/SOD diagnosed during 1990-2019. None had GS. The surgical database had 188 patients from Manitoba with GS during 1991-2019. None had ONH/SOD. CONCLUSION There does not appear to be an association between ONH/SOD and GS in our cohorts of patients with these two disorders.
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Affiliation(s)
- Michael S Salman
- Section of Pediatric Neurology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Chelsea A Ruth
- Section of Neonatology, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Marina S Yogendran
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Anna Zrinyi
- Section of Pediatric Surgery, Department of Surgery, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Melanie Morris
- Section of Pediatric Surgery, Department of Surgery, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Marquis S, Lunsky Y, McGrail KM, Baumbusch J. Population Level Mental Health Diagnoses for Youth with Intellectual/Developmental Disabilities Compared to Youth without Intellectual/Developmental Disabilities. Res Child Adolesc Psychopathol 2024; 52:1147-1156. [PMID: 38329685 DOI: 10.1007/s10802-024-01174-0] [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] [Accepted: 01/29/2024] [Indexed: 02/09/2024]
Abstract
There is evidence in the literature that youth with intellectual/developmental disabilities (IDD) experience mental health issues to a greater extent compared to youth without IDD. In addition, transition from pediatric to adult services may be a period of increased anxiety and mental health problems for these youth. This study used a retrospective cohort design using population level administrative health data to compare mental health diagnoses between youth with IDD and youth without IDD; particularly examining the period when youth transition from pediatric health services to adult health services. In addition, this study compared the mental health of youth with various types of IDD (Down syndrome, autism, fetal alcohol syndrome and other rarer diagnoses). Results showed that at the population level youth with IDD have greater odds of anxiety/depression or psychotic illness than youth without IDD. Adjusted odds of anxiety/depression or psychotic illness also varied with age, income level, sex, and type of IDD. Youth with fetal alcohol syndrome had the greatest odds of both anxiety/depression and a psychotic illness. Odds of anxiety/depression increased from age 15-19 years old. Odds of a psychotic illness increased from age 15 to age 24 years old.
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Affiliation(s)
- Sandra Marquis
- School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.
| | - Yona Lunsky
- Azrieli Adult Neurodevelopmental Centre, Campbell Family Mental Health Research Institute, CAMH, 1025 Queen St West, Toronto, ON, M6J 1H4, Canada
| | - Kimberlyn M McGrail
- Centre for Health Services and Policy Research, The University of British Columbia, 201-2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Jennifer Baumbusch
- School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.
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Louis D, Akil H, Oberoi S, Sirski M, Alvaro R, Seshia M, Moddemann D, Lix LM, Ruth C, Garland A. Grade 7 school performance of children born preterm: a retrospective Canadian Cohort study. J Perinatol 2024; 44:827-834. [PMID: 38438788 DOI: 10.1038/s41372-024-01911-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/31/2024] [Accepted: 02/13/2024] [Indexed: 03/06/2024]
Abstract
IMPORTANCE Data on the middle school outcomes of preterm children are limited and have methodologic issues. OBJECTIVE To study the association between preterm birth and grade 7 school performance. METHODS A retrospective population-based cohort study of children born in Manitoba, Canada between 1994 and 2006 using their grade 7 school performance data. A secondary sibling cohort was created comprising children born preterm and their full-term siblings. Primary exposure was preterm birth categorized as <28, 28-33 and 34-36 weeks gestation. The two co-primary grade 7 outcome measures were: not meeting the mathematics competencies, and not meeting the student engagement competencies. Multivariable logistic regression models tested the association between preterm birth and both co-primary outcomes; adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated. RESULTS 7653 preterm (gestational age median [IQR]: 35 weeks [34,36]) and 110,313 term (40 [39,40]) were included. 43% of < 28 weeks, 18% of 28-33 weeks and 17% of 34-36 weeks had the mathematics co-primary outcome compared to 13% of term children. The corresponding % for the student engagement outcome were 42%, 24%, 24% and 24% respectively. Preterm birth was associated with the mathematics (<28 weeks: 5.48, 3.89-7.70; 28-33 weeks: 1.47, 1.27-1.70; 34-36 weeks: 1.26, 1.16-1.35) and student engagement outcomes (<28 weeks: 2.49, 1.76-3.51; 28-33 weeks: 1.21, 1.06-1.39; 34-36 weeks: 1.09, 1.01-1.16). However, there was no difference in outcomes among the sibling cohort. CONCLUSIONS AND RELEVANCE Children born preterm had lower grade 7 performance compared to children born term in this population-based cohort. Screening and supports for them in their middle school years are warranted.
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Affiliation(s)
- Deepak Louis
- Section of Neonatology, Department of Pediatrics and Child Health, Rady Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada.
| | - Hammam Akil
- Section of Neonatology, Department of Pediatrics and Child Health, Rady Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Sapna Oberoi
- Division of Pediatric Hematology-Oncology, Department of Pediatrics and Child Health, Rady Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Monica Sirski
- Data analyst, Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
| | - Ruben Alvaro
- Section of Neonatology, Department of Pediatrics and Child Health, Rady Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Mary Seshia
- Section of Neonatology, Department of Pediatrics and Child Health, Rady Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Diane Moddemann
- Neonatal Follow-up Program, Department of Pediatrics and Child Health, Rady Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Lisa M Lix
- Department of Community Health Sciences, Rady Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
| | - Chelsea Ruth
- Section of Neonatology, Department of Pediatrics and Child Health, Rady Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
| | - Allan Garland
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
- Department of Medicine, Rady Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada
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Gus E, Wang SM, Malic C, Zuccaro J. Routinely collected burn clinical data in Canada: Determining the knowledge gap. Burns 2024; 50:1101-1115. [PMID: 38429127 DOI: 10.1016/j.burns.2024.02.009] [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: 10/26/2023] [Revised: 01/17/2024] [Accepted: 02/08/2024] [Indexed: 03/03/2024]
Abstract
Unlike other developed countries that hold national burn registries to monitor burn injury and care, Canada relies on single-centre secondary datasets and administrative databases as surveillance mechanisms. The objective of this study was to determine the knowledge gap faced in Canada for not having a dedicated burn registry. A comprehensive scoping review was conducted to identify the burn literature that has arisen from secondary datasets in Canada. Literature of all study designs was included with the exception of case reports and cases series. Once data extraction was concluded, a thematic framework was constructed based on the information that arose from nations that hold national burn registries. Eighty-eight studies were included. Twelve studies arose from national datasets, and 18 from provincial databases, most of which were from Ontario and British Columbia. Only seven studies were conducted using a combination of Canadian units' single-centre datasets. The majority of included studies (58%) resulted from non-collaborative use of single-centre secondary datasets. Research efforts were predominantly conducted by burn units in Ontario, British Columbia, Manitoba and Alberta. A significant number of the included studies were outdated and several provinces/territories had no published burn data whatsoever. Efforts should be made towards the development of systems to surveil burn injury and care in Canada. This study supports the development of a nation-wide burn registry to bridge this knowledge gap.
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Affiliation(s)
- Eduardo Gus
- Division of Plastic, Reconstructive & Aesthetic Surgery, The Hospital for Sick Children, Toronto, Canada; Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Canada.
| | - Sabrina M Wang
- Temerty Faculty of Medicine, University of Toronto, Canada
| | - Claudia Malic
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Ottawa, Ontario, Canada; Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Jennifer Zuccaro
- Division of Plastic, Reconstructive & Aesthetic Surgery, The Hospital for Sick Children, Toronto, Canada
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Chartier MJ, Brownell M, Star L, Murdock N, Campbell R, Phillips-Beck W, Horton M, Meade C, Au W, Schultz J, Bowes JM, Cochrane B. The Mental Health of First Nations Children in Manitoba: A Population-Based Retrospective Cohort Study Using Linked Administrative Data: La santé mentale des enfants des Premières Nations au Manitoba : une étude de cohorte rétrospective dans la population, à l'aide de données administratives liées. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2024; 69:404-414. [PMID: 38343025 PMCID: PMC11107444 DOI: 10.1177/07067437241226998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/04/2024]
Abstract
OBJECTIVE First Nations children face a greater risk of experiencing mental disorders than other children from the general population because of family and societal factors, yet there is little research examining their mental health. This study compares diagnosed mental disorders and suicidal behaviours of First Nations children living on-reserve and off-reserve to all other children living in Manitoba. METHOD The research team, which included First Nations and non-First Nations researchers, utilized population-based administrative data that linked de-identified individual-level records from the 2016 First Nations Research File to health and social information for children living in Manitoba. Adjusted rates and rate ratios of mental disorders and suicide behaviours were calculated using a generalized linear modelling approach to compare First Nations children (n = 40,574) and all other children (n = 197,109) and comparing First Nations children living on- and off-reserve. RESULTS Compared with all other children, First Nations children had a higher prevalence of schizophrenia (adjusted rate ratio (aRR): 4.42, 95% confidence interval (CI), 3.36 to 5.82), attention-deficit hyperactivity disorder (ADHD; aRR: 1.21, 95% CI, 1.09 to 1.33), substance use disorders (aRR: 5.19; 95% CI, 4.25 to 6.33), hospitalizations for suicide attempts (aRR: 6.96; 95% CI, 4.36 to 11.13) and suicide deaths (aRR: 10.63; 95% CI, 7.08 to 15.95). The prevalence of ADHD and mood/anxiety disorders was significantly higher for First Nations children living off-reserve compared with on-reserve; in contrast, hospitalization rates for suicide attempts were twice as high on-reserve than off-reserve. When the comparison cohort was restricted to only other children in low-income areas, a higher prevalence of almost all disorders remained for First Nations children. CONCLUSION Large disparities were found in mental health indicators between First Nations children and other children in Manitoba, demonstrating that considerable work is required to improve the mental well-being of First Nations children. Equitable access to culturally safe services is urgently needed and these services should be self-determined, planned, and implemented by First Nations people.
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Affiliation(s)
- Mariette J Chartier
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba; Winnipeg, Canada
| | - Marni Brownell
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba; Winnipeg, Canada
| | - Leona Star
- First Nations Health and Social Secretariat of Manitoba, Winnipeg, Canada
| | - Nora Murdock
- Manitoba First Nations Education Resource Centre, Winnipeg, Canada
| | - Rhonda Campbell
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | | | - Mabel Horton
- Advisory Working Group, First Nations Health and Social Secretariat of Manitoba, Winnipeg, Canada
| | - Chelsey Meade
- Manitoba First Nations Education Resource Centre, Winnipeg, Canada
| | - Wendy Au
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba; Winnipeg, Canada
| | - Jennifer Schultz
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba; Winnipeg, Canada
| | - John-Michael Bowes
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba; Winnipeg, Canada
| | - Brooke Cochrane
- College of Medicine, Rady Faculty of Health Sciences, University of Manitoba. Winnipeg, Canada
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Marquis S, Marquis NE, Lunsky Y, McGrail KM, Baumbusch J. A retrospective cohort study of prescription drug use among youth with intellectual/developmental disabilities in British Columbia. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2024. [PMID: 38773818 DOI: 10.1111/jir.13147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/22/2024] [Accepted: 04/24/2024] [Indexed: 05/24/2024]
Abstract
BACKGROUND People with intellectual/developmental disabilities (IDD) are known to have high rates of prescription drug use, particularly for psychotropic medications. This is of concern due to the many side effects associated with these medications and because of the risks of polypharmacy. In this paper we compare the most commonly dispensed drugs and all psychotropic medications for youth with IDD compared with youth without IDD. METHODS Using population-level administrative health data over a 10-year period, this study examined medications dispensed to youth with an IDD aged 15-24 years compared with youth without an IDD. The most common medications dispensed and the number of youth they were dispensed to were determined. As well a wide variety of psychotropic medications were examined. RESULTS There were a total of 20 591 youth with IDD and 1 293 791 youth without IDD identified. Youth with IDD had higher odds of being dispensed pain medications, amoxicillin, salbutamol, levothyroxine and all the psychotropic medications (antidepressants, antipsychotics, anxiolytics, anti-adrenergic agents, mood stabilisers and stimulants). For youth with IDD, 6558 (31.85%) were dispensed two or more different psychotropic medications within a year, compared with 75 963 (5.87%) of youth without IDD. DISCUSSION Compared to youth without IDD, youth with IDD had significantly higher odds of being dispensed most of the prescription medications studied, including all of the psychotropic medications. They were also twice as likely to be dispensed two or more medications from different classes of psychotropic drugs within the same year. These findings have important implications for the health of people with IDD and for their health care providers.
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Affiliation(s)
- S Marquis
- School of Nursing, Faculty of Applied Science, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Y Lunsky
- Azrieli Adult Neurodevelopmental Centre, Campbell Family Mental Health Research Institute, CAMH, Toronto, Ontario, Canada
| | - K M McGrail
- Centre for Health Services and Policy Research, The University of British Columbia, Vancouver, British Columbia, Canada
| | - J Baumbusch
- School of Nursing, Faculty of Applied Science, University of British Columbia, Vancouver, British Columbia, Canada
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11
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Kim JW, Choi H, Lim HJ, Oh M, Ahn JJ. Evaluating Linkage Quality of Population-Based Administrative Data for Health Service Research. J Korean Med Sci 2024; 39:e127. [PMID: 38622936 PMCID: PMC11018984 DOI: 10.3346/jkms.2024.39.e127] [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: 08/31/2023] [Accepted: 03/11/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND To overcome the limitations of relying on data from a single institution, many researchers have studied data linkage methodologies. Data linkage includes errors owing to legal issues surrounding personal information and technical issues related to data processing. Linkage errors affect selection bias, and external and internal validity. Therefore, quality verification for each connection method with adherence to personal information protection is an important issue. This study evaluated the linkage quality of linked data and analyzed the potential bias resulting from linkage errors. METHODS This study analyzed claims data submitted to the Health Insurance Review and Assessment Service (HIRA DATA). The linkage errors of the two deterministic linkage methods were evaluated based on the use of the match key. The first deterministic linkage uses a unique identification number, and the second deterministic linkage uses the name, gender, and date of birth as a set of partial identifiers. The linkage error included in this deterministic linkage method was compared with the absolute standardized difference (ASD) of Cohen's according to the baseline characteristics, and the linkage quality was evaluated through the following indicators: linked rate, false match rate, missed match rate, positive predictive value, sensitivity, specificity, and F1-score. RESULTS For the deterministic linkage method that used the name, gender, and date of birth as a set of partial identifiers, the true match rate was 83.5 and the missed match rate was 16.5. Although there was bias in some characteristics of the data, most of the ASD values were less than 0.1, with no case greater than 0.5. Therefore, it is difficult to determine whether linked data constructed with deterministic linkages have substantial differences. CONCLUSION This study confirms the possibility of building health and medical data at the national level as the first data linkage quality verification study using big data from the HIRA. Analyzing the quality of linkages is crucial for comprehending linkage errors and generating reliable analytical outcomes. Linkers should increase the reliability of linked data by providing linkage error-related information to researchers. The results of this study will serve as reference data to increase the reliability of multicenter data linkage studies.
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Affiliation(s)
- Ji-Woo Kim
- Big Data Linkage Division, Health Insurance Review & Assessment Service, Wonju, Korea
| | - Hyojung Choi
- Digital Medical Technology Listing Division, Health Insurance Review & Assessment Service, Wonju, Korea
| | - Hyun Jeung Lim
- DRG Administration Division, Health Insurance Review & Assessment Service, Wonju, Korea
| | - Miae Oh
- Center for Research on Big Data Information, Korea Institute for Health and Social Affairs, Sejong, Korea
| | - Jae Joon Ahn
- Division of Data Science, Yonsei University, Wonju, Korea.
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Seghieri C, Tortù C, Tricò D, Leonetti S. Learning prevalent patterns of co-morbidities in multichronic patients using population-based healthcare data. Sci Rep 2024; 14:2186. [PMID: 38272953 PMCID: PMC10810806 DOI: 10.1038/s41598-024-51249-7] [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: 09/12/2023] [Accepted: 01/02/2024] [Indexed: 01/27/2024] Open
Abstract
The prevalence of longstanding chronic diseases has increased worldwide, along with the average age of the population. As a result, an increasing number of people is affected by two or more chronic conditions simultaneously, and healthcare systems are facing the challenge of treating multimorbid patients effectively. Current therapeutic strategies are suited to manage each chronic condition separately, without considering the whole clinical condition of the patient. This approach may lead to suboptimal clinical outcomes and system inefficiencies (e.g. redundant diagnostic tests and inadequate drug prescriptions). We develop a novel methodology based on the joint implementation of data reduction and clustering algorithms to identify patterns of chronic diseases that are likely to co-occur in multichronic patients. We analyse data from a large adult population of multichronic patients living in Tuscany (Italy) in 2019 which was stratified by sex and age classes. Results demonstrate that (i) cardio-metabolic, endocrine, and neuro-degenerative diseases represent a stable pattern of multimorbidity, and (ii) disease prevalence and clustering vary across ages and between women and men. Identifying the most common multichronic profiles can help tailor medical protocols to patients' needs and reduce costs. Furthermore, analysing temporal patterns of disease can refine risk predictions for evolutive chronic conditions.
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Affiliation(s)
- Chiara Seghieri
- Management and Healthcare Laboratory, Institute of Management and Department EMbeDS, Sant'Anna School of Advanced Studies, Piazza Martiri della Libertà 33, 56127, Pisa, Italy
| | - Costanza Tortù
- Management and Healthcare Laboratory, Institute of Management and Department EMbeDS, Sant'Anna School of Advanced Studies, Piazza Martiri della Libertà 33, 56127, Pisa, Italy
| | - Domenico Tricò
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56126, Pisa, Italy
| | - Simone Leonetti
- Management and Healthcare Laboratory, Interdisciplinary Research Center "Health Science", Sant'Anna School of Advanced Studies, Piazza Martiri della Libertà 33, 56127, Pisa, Italy.
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13
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Giunta DH, Karlsson P, Younus M, Berglind IA, Kieler H, Reutfors J. Validation of diagnoses of liver disorders in users of systemic azole antifungal medication in Sweden. BMC Gastroenterol 2024; 24:21. [PMID: 38182992 PMCID: PMC10770890 DOI: 10.1186/s12876-023-03110-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 12/28/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Liver disorders are important adverse effects associated with antifungal drug treatment. However, the accuracy of Clinical International Classification of Diseases (ICD)-10 codes in identifying liver disorders for register based research is not well-established. This study aimed to determine the positive predictive value (PPV) of the ICD-10 codes for identifying patients with toxic liver disease, hepatic failure, and jaundice among patients with systemic antifungal treatment. METHODS Data from the Swedish Prescribed Drug Register and the National Patient Register were utilized to identify adult patients who received systemic azole antifungal drugs and had a recorded diagnosis of toxic liver disease (K71.0, K71.1, K71.2, K71.6, K71.8, K71.9), hepatic failure (K72.0, K72.9), or jaundice (R17) between 2005 and 2016. The medical records of all included patients were reviewed. Prespecified criteria were used to re-evaluate and confirm each diagnosis, serving as the gold standard to calculate PPVs with 95% confidence intervals (95% CI) for each diagnostic group. RESULTS Among the 115 included patients, 26 were diagnosed with toxic liver disease, 58 with hepatic failure, and 31 with jaundice. Toxic liver disease was confirmed in 14 out of 26 patients, yielding a PPV of 53.8% (95% CI 33.4-73.4%). Hepatic failure was confirmed in 26 out of 38 patients, resulting in a PPV of 62.1% (95% CI 48.4-74.5%). The highest PPV was found in jaundice, with 30 confirmed diagnoses out of 31, yielding a PPV of 96.8% (95% CI 83.3-99.9%). CONCLUSION Among patients who received azole antifungal treatment and were subsequently diagnosed with a liver disorder, the PPV for the diagnosis of jaundice was high, while the PPVs for toxic liver disease and hepatic failure were lower.
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Affiliation(s)
- Diego Hernan Giunta
- Centre for Pharmacoepidemiology, Karolinska Institutet, Karolinska University Hospital T2:02, 171 76, Stockholm, Sweden.
| | - Pär Karlsson
- Centre for Pharmacoepidemiology, Karolinska Institutet, Karolinska University Hospital T2:02, 171 76, Stockholm, Sweden
| | - Muhammad Younus
- Safety Surveillance Research, Worldwide Medical and Safety, Pfizer Inc, Collegeville, PA, USA
| | - Ina Anveden Berglind
- Centre for Pharmacoepidemiology, Karolinska Institutet, Karolinska University Hospital T2:02, 171 76, Stockholm, Sweden
- Center for Occupational and Environmental Medicine, Stockholm Region, Stockholm, Sweden
| | - Helle Kieler
- Centre for Pharmacoepidemiology, Karolinska Institutet, Karolinska University Hospital T2:02, 171 76, Stockholm, Sweden
| | - Johan Reutfors
- Centre for Pharmacoepidemiology, Karolinska Institutet, Karolinska University Hospital T2:02, 171 76, Stockholm, Sweden
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Salman MS, Ruth CA, Yogendran MS, Rozovsky K, Lix LM. Risk factors in children with optic nerve hypoplasia and septo-optic dysplasia. Dev Med Child Neurol 2024; 66:106-116. [PMID: 37394738 DOI: 10.1111/dmcn.15678] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 05/22/2023] [Accepted: 05/24/2023] [Indexed: 07/04/2023]
Abstract
AIM To identify the risk factors for optic nerve hypoplasia (ONH) and septo-optic dysplasia (SOD). METHOD A retrospective, population-based study with case-control design was undertaken using the Population Research Data Repository at the Manitoba Center for Health Policy in Manitoba, Canada. Cases were 111 patients (63 males, 48 females; age range 1-35 years [mean 11 years 6 months, SD 7 years 2 months]) with ONH and SOD diagnosed from 1990 to 2019, matched to 555 unrelated population-based controls (315 males, 240 females; age range 1-35 years [mean 11 years 6 months, SD 7 years 2 months]) on year of birth, sex, and area of residence. Additionally, 75 cases (46 males, 29 females; age range 2-35 years [mean 12 years 6 months, SD 7 years 2 months]) with ONH and SOD were matched one-on-one with sibling controls (40 males, 35 females; age range 0-33 years [mean 11 years 7 months, SD 7 years 10 months], the rest did not have siblings). Several antenatal maternal risk factors associated with ONH and SOD were tested for their association with case and control group membership using adjusted odds ratios (ORs) and 95% confidence intervals (CIs) from a multivariate conditional logistic regression model. The outcome was the risk of developing ONH and SOD. RESULTS Maternal age at conception (OR = 0.91, 95% CI = 0.86-0.96), primigravida (OR = 3.39, 95% CI = 1.92-6.01), and smoking (OR = 2.86, 95% CI = 1.61-5.05) were independently associated with ONH and SOD in the cohort matched to unrelated controls (p < 0.001). In the sibling cohort, smoking was an important risk factor (OR = 3.65, 95% CI = 1.2-11.1, p = 0.02). INTERPRETATION Unmodifiable and modifiable antenatal maternal risk factors are associated with ONH and SOD. Our investigation suggests that several risk factors reported in previous studies may have been due to confounding bias and that maternal smoking during pregnancy is the main modifiable risk factor associated with ONH and SOD. WHAT THIS PAPER ADDS Historically, many antenatal risk factors have been associated with optic nerve hypoplasia (ONH) and septo-optic dysplasia (SOD). Population-based data with matched controls for potential confounding bias are lacking. Young maternal age at conception, primigravida, and smoking during pregnancy are the main risk factors for ONH and SOD using a population-based, case-control design.
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Affiliation(s)
- Michael S Salman
- Section of Pediatric Neurology, Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Chelsea A Ruth
- Section of Neonatology, Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Marina S Yogendran
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Katya Rozovsky
- Section of Pediatric Radiology, Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lisa M Lix
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Berete F, Demarest S, Charafeddine R, De Ridder K, Van Oyen H, Van Hoof W, Bruyère O, Van der Heyden J. Linking health survey data with health insurance data: methodology, challenges, opportunities and recommendations for public health research. An experience from the HISlink project in Belgium. Arch Public Health 2023; 81:198. [PMID: 37968754 PMCID: PMC10648729 DOI: 10.1186/s13690-023-01213-0] [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: 03/24/2023] [Accepted: 11/03/2023] [Indexed: 11/17/2023] Open
Abstract
In recent years, the linkage of survey data to health administrative data has increased. This offers new opportunities for research into the use of health services and public health. Building on the HISlink use case, the linkage of Belgian Health Interview Survey (BHIS) data and Belgian Compulsory Health Insurance (BCHI) data, this paper provides an overview of the practical implementation of linking data, the outcomes in terms of a linked dataset and of the studies conducted as well as the lessons learned and recommendations for future links.Individual BHIS 2013 and 2018 data was linked to BCHI data using the national register number. The overall linkage rate was 92.3% and 94.2% for HISlink 2013 and HISlink 2018, respectively. Linked BHIS-BCHI data were used in validation studies (e.g. self-reported breast cancer screening; chronic diseases, polypharmacy), in policy-driven research (e.g., mediation effect of health literacy in the relationship between socioeconomic status and health related outcomes, and in longitudinal study (e.g. identifying predictors of nursing home admission among older BHIS participants). The linkage of both data sources combines their strengths but does not overcome all weaknesses.The availability of a national register number was an asset for HISlink. Policy-makers and researchers must take initiatives to find a better balance between the right to privacy of respondents and society's right to evidence-based information to improve health. Researchers should be aware that the procedures necessary to implement a link may have an impact on the timeliness of their research. Although some aspects of HISlink are specific to the Belgian context, we believe that some lessons learned are useful in an international context, especially for other European Union member states that collect similar data.
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Affiliation(s)
- Finaba Berete
- Department of Epidemiology and Public Health, Sciensano, Juliette Wytsmanstraat 14, Brussels, 1050, Belgium.
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium.
| | - Stefaan Demarest
- Department of Epidemiology and Public Health, Sciensano, Juliette Wytsmanstraat 14, Brussels, 1050, Belgium
| | - Rana Charafeddine
- Department of Epidemiology and Public Health, Sciensano, Juliette Wytsmanstraat 14, Brussels, 1050, Belgium
| | - Karin De Ridder
- Department of Epidemiology and Public Health, Sciensano, Juliette Wytsmanstraat 14, Brussels, 1050, Belgium
| | - Herman Van Oyen
- Department of Epidemiology and Public Health, Sciensano, Juliette Wytsmanstraat 14, Brussels, 1050, Belgium
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Wannes Van Hoof
- Department of Epidemiology and Public Health, Sciensano, Juliette Wytsmanstraat 14, Brussels, 1050, Belgium
| | - Olivier Bruyère
- WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Ageing, Research Unit in Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - Johan Van der Heyden
- Department of Epidemiology and Public Health, Sciensano, Juliette Wytsmanstraat 14, Brussels, 1050, Belgium
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Scheibner J, Kroesche N, Wakefield L, Cockburn T, McPhail SM, Richards B. Does Legislation Impede Data Sharing in Australia Across Institutions and Jurisdictions? A Scoping Review. J Med Syst 2023; 47:116. [PMID: 37962613 DOI: 10.1007/s10916-023-02009-z] [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: 08/10/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023]
Abstract
In Australia, regulations governing data, including formal legislation and policies promulgated by private and public agencies, are often seen as a barrier to data sharing. This sharing can include between institutions, as well as across jurisdictional borders in a federated jurisdiction such as Australia. In some cases, these regulations place a barrier to sharing data across borders or between institutions without a prerequisite requirement. In other cases, these regulations may be perceived as a justification not to share data. The objective of this review was to analyse published literature from Australia to see what regulations were used to justify not sharing data, along with any other factors that might discourage data sharing. We searched PubMed, Scopus and Web of Science for empirical and policy articles discussing data sharing in Australia. We then filtered these results via abstract and conducted a full text assessment to include 33 articles for analysis. Although there are a few areas of notable regulatory divergence with respect to legislation governing health data, most regulations in Australia are relatively consistent. Further, the absence of uniform ethics approval between sites in different states was frequently cited as a barrier to data sharing.
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Affiliation(s)
- James Scheibner
- College of Business, Government and Law, Flinders University, Adelaide, Australia.
| | - Nicole Kroesche
- Australian Centre for Health Law Research (ACHLR), School of Law, Faculty of Business and Law, Queensland University of Technology, Brisbane, Australia
| | - Luke Wakefield
- Australian Centre for Health Law Research (ACHLR), School of Law, Faculty of Business and Law, Queensland University of Technology, Brisbane, Australia
| | - Tina Cockburn
- Australian Centre for Health Law Research (ACHLR), School of Law, Faculty of Business and Law, Queensland University of Technology, Brisbane, Australia
| | - Steven M McPhail
- Australian Centre for Health Services Innovation (AusHSI) and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
- Digital Health and Informatics Directorate, Metro South Health, Brisbane, Australia
| | - Bernadette Richards
- Associate Professor of Ethics and Professionalism, Medical School, Academy for Medical Education, University of Queensland, Brisbane, Australia
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Emerson SD, McLinden T, Sereda P, Lima VD, Hogg RS, Kooij KW, Yonkman AM, Salters KA, Moore D, Toy J, Wong J, Consolacion T, Montaner JSG, Barrios R. Identification of people with low prevalence diseases in administrative healthcare records: A case study of HIV in British Columbia, Canada. PLoS One 2023; 18:e0290777. [PMID: 37651428 PMCID: PMC10470893 DOI: 10.1371/journal.pone.0290777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 08/16/2023] [Indexed: 09/02/2023] Open
Abstract
INTRODUCTION Case-finding algorithms can be applied to administrative healthcare records to identify people with diseases, including people with HIV (PWH). When supplementing an existing registry of a low prevalence disease, near-perfect specificity helps minimize impacts of adding in algorithm-identified false positive cases. We evaluated the performance of algorithms applied to healthcare records to supplement an HIV registry in British Columbia (BC), Canada. METHODS We applied algorithms based on HIV-related diagnostic codes to healthcare practitioner and hospitalization records. We evaluated 28 algorithms in a validation sub-sample of 7,124 persons with positive HIV tests (2,817 with a prior negative test) from the STOP HIV/AIDS data linkage-a linkage of healthcare, clinical, and HIV test records for PWH in BC, resembling a disease registry (1996-2020). Algorithms were primarily assessed based on their specificity-derived from this validation sub-sample-and their impact on the estimate of the total number of PWH in BC as of 2020. RESULTS In the validation sub-sample, median age at positive HIV test was 37 years (Q1: 30, Q3: 46), 80.1% were men, and 48.9% resided in the Vancouver Coastal Health Authority. For all algorithms, specificity exceeded 97% and sensitivity ranged from 81% to 95%. To supplement the HIV registry, we selected an algorithm with 99.89% (95% CI: 99.76% - 100.00%) specificity and 82.21% (95% CI: 81.26% - 83.16%) sensitivity, requiring five HIV-related healthcare practitioner encounters or two HIV-related hospitalizations within a 12-month window, or one hospitalization with HIV as the most responsible diagnosis. Upon adding PWH identified by this highly-specific algorithm to the registry, 8,774 PWH were present in BC as of March 2020, of whom 333 (3.8%) were algorithm-identified. DISCUSSION In the context of an existing low prevalence disease registry, the results of our validation study demonstrate the value of highly-specific case-finding algorithms applied to administrative healthcare records to enhance our ability to estimate the number of PWH living in BC.
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Affiliation(s)
- Scott D. Emerson
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Taylor McLinden
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Paul Sereda
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Viviane D. Lima
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Robert S. Hogg
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Katherine W. Kooij
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Amanda M. Yonkman
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Kate A. Salters
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - David Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Junine Toy
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Jason Wong
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Theodora Consolacion
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Julio S. G. Montaner
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rolando Barrios
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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Suerungruang S, Sornlorm K, Laohasiriwong W, Mahato RK. Spatial association and modelling of under-5 mortality in Thailand, 2020. GEOSPATIAL HEALTH 2023; 18. [PMID: 37667901 DOI: 10.4081/gh.2023.1220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 08/07/2023] [Indexed: 09/06/2023]
Abstract
Under-5 mortality rate (U5MR) is a key indicator of child health and overall development. In Thailand, despite significant steps made in child health, disparities in U5MR persist across different provinces. We examined various socio-economic variables, health service availability and environmental factors impacting U5MR in Thailand to model their influences through spatial analysis. Global and Local Moran's I statistics for spatial autocorrelation of U5MR and its related factors were used on secondary data from the Ministry of Public Health, National Centers for Environmental Information, National Statistical Office, and the Office of the National Economic and Social Development Council in Thailand. The relationships between U5MR and these factors were modelled using ordinary least squares (OLS) estimation, spatial lag model (SLM) and spatial error model (SEM). There were significant spatial disparities in U5MR across Thailand. Factors such as low birth weight, unemployment rate, and proportion of land use for agricultural purposes exhibited significant positive spatial autocorrelation, directly influencing U5MR, while average years of education, community organizations, number of beds for inpatients per 1,000 population, and exclusive breastfeeding practices acted as protective factors against U5MR (R2 of SEM = 0.588).The findings underscore the need for comprehensive, multi-sectoral strategies to address the U5MR disparities in Thailand. Policy interventions should consider improving socioeconomic conditions, healthcare quality, health accessibility, and environmental health in high U5M areas. Overall, this study provides valuable insights into the spatial distribution of U5MR and its associated factors, which highlights the need for tailored and localized health policies and interventions.
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Zenesini C, Belotti LMB, Baccari F, Baldin E, Ridley B, Calandra-Buonaura G, Cortelli P, D'Alessandro R, Nonino F, Vignatelli L. Validation of Administrative Health Data Algorithms for Identifying Persons with Parkinson's Disease and the 10-Year Prevalence Trend in Bologna, Italy. Neuroepidemiology 2023; 57:336-344. [PMID: 37549643 DOI: 10.1159/000533362] [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: 05/09/2023] [Accepted: 07/27/2023] [Indexed: 08/09/2023] Open
Abstract
INTRODUCTION Health administrative databases are widely used for the estimation of the prevalence of Parkinson's disease (PD). Few in general, and none used in Italy, have been validated by testing their diagnostic accuracy. The primary objective was to validate two algorithms for the identification of persons with PD using clinical diagnosis as the reference standard on an Italian sample of people with PD. The second objective was to estimate 10-year trends in PD prevalence in the Bologna Local Health Trust from 2010 to 2019. METHODS Two algorithms (index tests) applied to health administrative databases (hospital discharge, drug prescriptions, exemptions for medical costs) were validated against clinical diagnosis of PD by an expert neurologist (reference standard) in a cohort of consecutive outpatients. Sensitivity and specificity with relative 95% confidence intervals (CIs) were calculated. The prevalence of PD in a specific year was estimated as the ratio between the number of subjects fulfilling any criteria of the algorithm with better diagnostic accuracy and the total population in the same year (×1,000), stratified by age, sex, and district of residence. RESULTS The two algorithms showed high accuracy for identifying patients with PD: one with greater sensitivity of 94.2% (CI: 88.4-97.6) and the other with greater specificity of 98.1% (CI: 97.7-98.5). For the estimation of prevalence, we chose the most specific algorithm with the fewest total number of misclassified cases. We identified 3,798 people with PD as of December 31, 2019, corresponding to a prevalence of 4.3 per 1,000 inhabitants (CI: 4.2-4.4). Prevalence was higher in males (4.7, CI: 4.5-5.0) than females (3.8, CI: 3.7-4.0) and increased with age. The crude prevalence over time was slightly elevated as it followed a progressive aging of the population. When stratifying the prevalence for age groups, we did not observe a trend except in the 45-64 year category where we observed an increasing trend over time. CONCLUSION Algorithms based on administrative data are accurate when detecting people with PD in the Italian public health system. In a large northern Italian population, increased prevalence of about 10% was observed in the decade 2010-2019 and is explained by increased life expectancy. These data may be useful in planning the allocation of health care resources for people with PD.
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Affiliation(s)
- Corrado Zenesini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | | | - Flavia Baccari
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Elisa Baldin
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Ben Ridley
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Giovanna Calandra-Buonaura
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Dipartimento di Scienze Biomediche e NeuroMotorie, Università Degli Studi di Bologna, Bologna, Italy
| | - Pietro Cortelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Dipartimento di Scienze Biomediche e NeuroMotorie, Università Degli Studi di Bologna, Bologna, Italy
| | | | - Francesco Nonino
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Luca Vignatelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
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Lu CH, Jette G, Falls Z, Jacobs DM, Gibson W, Bednarczyk EM, Kuo TY, Lape-Newman B, Leonard KE, Elkin PL. A cohort of patients in New York State with an alcohol use disorder and subsequent treatment information - A merging of two administrative data sources. J Biomed Inform 2023; 144:104443. [PMID: 37455008 PMCID: PMC11178131 DOI: 10.1016/j.jbi.2023.104443] [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: 03/17/2023] [Revised: 07/05/2023] [Accepted: 07/08/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE Despite the high prevalence of alcohol use disorder (AUD) in the United States, limited research is focused on the associations among AUD, pain, and opioids/benzodiazepine use. In addition, little is known regarding individuals with a history of AUD and their potential risk for pain diagnoses, pain prescriptions, and subsequent misuse. Moreover, the potential risk of pain diagnoses, prescriptions, and subsequent misuse among individuals with a history of AUD is not well known. The objective was to develop a tailored dataset by linking data from 2 New York State (NYS) administrative databases to investigate a series of hypotheses related to AUD and painful medical disorders. METHODS Data from the NYS Office of Addiction Services and Supports (OASAS) Client Data System (CDS) and Medicaid claims data from the NYS Department of Health Medicaid Data Warehouse (MDW) were merged using a stepwise deterministic method. Multiple patient-level identifier combinations were applied to create linkage rules. We included patients aged 18 and older from the OASAS CDS who initially entered treatment with a primary substance use of alcohol and no use of opioids between January 1, 2003, and September 23, 2019. This cohort was then linked to corresponding Medicaid claims. RESULTS A total of 177,685 individuals with a primary AUD problem and no opioid use history were included in the dataset. Of these, 37,346 (21.0%) patients had an OUD diagnosis, and 3,365 (1.9%) patients experienced an opioid overdose. There were 121,865 (68.6%) patients found to have a pain condition. CONCLUSION The integrated database allows researchers to examine the associations among AUD, pain, and opioids/benzodiazepine use, and propose hypotheses to improve outcomes for at-risk patients. The findings of this study can contribute to the development of a prognostic prediction model and the analysis of longitudinal outcomes to improve the care of patients with AUD.
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Affiliation(s)
- Chi-Hua Lu
- Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, NY, USA.
| | - Gail Jette
- Division of Outcomes, Management, and Systems Information, Office of Addiction Services and Supports, Albany, NY, USA
| | - Zackary Falls
- Department of Biomedical Informatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - David M Jacobs
- Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Walter Gibson
- Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Edward M Bednarczyk
- Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Tzu-Yin Kuo
- Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, NY, USA
| | | | - Kenneth E Leonard
- Clinical and Research Institute on Addictions, University at Buffalo, Buffalo, NY, USA
| | - Peter L Elkin
- Department of Biomedical Informatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA; Faculty of Engineering, University of Southern Denmark, Denmark; U.S. Department of Veterans Affairs, WNY VA, Buffalo, NY, USA
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21
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Marquis S, Lunsky Y, McGrail KM, Baumbusch J. Population-level use of gynecological health services by female youth with intellectual/developmental disabilities in British Columbia Canada. Disabil Health J 2023:101478. [PMID: 37142456 DOI: 10.1016/j.dhjo.2023.101478] [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: 01/20/2023] [Revised: 03/18/2023] [Accepted: 04/11/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND There is evidence that female youth with intellectual/developmental disabilities (IDD) experience poorer gynecological care compared to female youth without disabilities. OBJECTIVE The objective of this study was to obtain baseline data on visits to a health care provider for a gynecological issue for females with IDD and compare that information to the experiences of female youth without IDD. METHODS This study is a retrospective cohort study using population-level administrative health data from 2010 to 2019 for females aged 15-24 years, with and without IDD. RESULTS 6452 female youth with IDD and 637,627 female youth without IDD were identified in the data. Over the ten-year period, 53.77% of youth with IDD and 53.68% of youth without IDD had a visit to a physician for a gynecological issue. However, as females with IDD aged, the number of people seeing a physician for a gynecological issue decreased. In the group aged 20-24 years, 15.25% of females with IDD and 24.47% of females without IDD (p < 0.0001) had a Pap test done at any time; 25.94% of females with IDD had a visit for contraception management and 28.38% of females (p < 0.0001) without IDD had a visit for contraception management. Gynecological care also varied by type of IDD. CONCLUSIONS Females with IDD had a similar number of visits for a gynecological issue as female youth without IDD. However, the reasons for visits and the age at which visits occurred differed between youth with and without IDD. As females with IDD transition into adulthood, gynecological care must be maintained and improved.
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Affiliation(s)
- Sandra Marquis
- School of Nursing University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.
| | - Yona Lunsky
- Azrieli Adult Neurodevelopmental Centre, Campbell Family Mental Health Research Institute, CAMH, 1025 Queen St West, Toronto, ONT, M6J 1H4, Canada.
| | - Kimberlyn M McGrail
- Centre for Health Services and Policy Research, The University of British Columbia, 201-2206 East Mall, Vancouver, BC, V6T 1Z3, Canada.
| | - Jennifer Baumbusch
- School of Nursing University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.
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22
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Ghebreab L, Kool B, Lee A, Morton S. Comparing primary caregivers' reported injury data with routinely recorded injury data to assess predictors of childhood injury. BMC Med Res Methodol 2023; 23:91. [PMID: 37041484 PMCID: PMC10088216 DOI: 10.1186/s12874-023-01900-0] [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: 08/23/2022] [Accepted: 03/23/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND Linking self-reported data collected from longitudinal studies with administrative health records is timely and cost-effective, provides the opportunity to augment information contained in each and can offset some of the limitations of both data sources. The aim of this study was to compare maternal-reported child injury data with administrative injury records and assess the level of agreement. METHODS A deterministic linkage was undertaken to link injury-related data from the Growing up in New Zealand (GUiNZ) study to routinely collected injury records from New Zealand's Accident Compensation Corporation (ACC) for preschool children. The analyses compared: (i) the characteristics of mothers with linked data vs. those without, (ii) injury incidences from maternal recall with those recorded in ACC injury claims, and (iii) the demographic characteristics of concordant and discordant injury reports, including the validity and reliability of injury records from both data sources. RESULTS Of all mothers who responded to the injury questions in the GUiNZ study (n = 5836), more than 95% (n = 5637) agreed to have their child's record linked to routine administrative health records. The overall discordance in injury reports showed an increasing trend as children grew older (9% at 9 M to 29% at 54 M). The mothers of children with discordance between maternal injury reports and ACC records were more likely to be younger, of Pacific ethnicity, with lower educational attainment, and live in areas of high deprivation (p < 0.001). The level of agreement between maternal injury recall and ACC injury record decreased (κ = 0.83 to κ = 0.42) as the cohort moved through their preschool years. CONCLUSIONS In general, the findings of this study identified that there was underreporting and discordance of the maternal injury recall, which varied by the demographic characteristics of mothers and their child's age. Therefore, linking the routinely gathered injury data with maternal self-report child injury data has the potential to augment longitudinal birth cohort study data to investigate risk or protective factors associated with childhood injury.
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Affiliation(s)
- Luam Ghebreab
- Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, 507-1001, 22-30 Park Ave, Auckland, New Zealand.
| | - Bridget Kool
- Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, 507-1001, 22-30 Park Ave, Auckland, New Zealand
| | - Arier Lee
- Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, 507-1001, 22-30 Park Ave, Auckland, New Zealand
| | - Susan Morton
- Department of Social and Community Health, School of Population Health, University of Auckland, Auckland, New Zealand
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23
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Brogly SB, Bowie AC, Li W, Camden A, Velez MP, Guttmann A, Werler MM. Safety of prenatal opioid analgesics: Do results differ between public health insurance beneficiary and population-based cohorts? Birth Defects Res 2023; 115:555-562. [PMID: 36628593 DOI: 10.1002/bdr2.2147] [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: 09/09/2022] [Revised: 12/13/2022] [Accepted: 12/15/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Pregnant patients with particular types of health insurance may have distinct demographic and medical characteristics that have a biologic effect on associations between opioid analgesics and congenital anomalies (CA). METHODS We followed 199,884 pregnant prescription beneficiaries in Ontario, Canada (1996-2018). Opioid analgesics dispensed in the first trimester and CA were identified from universal-access administrative health records. We estimated propensity score adjusted risk ratios (RR) between first trimester exposure and CA (any, major, minor, specific). RRs were compared to those published from an Ontario population-based cohort (N = 599,579, 2013-2018). RESULTS 15,724 (7.9%) were exposed to first trimester opioid analgesics, mainly codeine (58.1%) or oxycodone (21.3%); CA prevalence in exposed was 3.1%. RRs in the beneficiary cohort appeared higher than the population-based cohort for any CA with hydromorphone (RR = 2.34, 95% CI: 1.65, 3.30) and oxycodone (RR = 1.73, 95% CI: 1.46, 2.05) and major CA with hydromorphone (RR = 2.74, 95% CI: 1.91, 3.94) and oxycodone (RR = 1.72, 95% CI: 1.42, 2.08). Other RRs that appeared higher in the beneficiary cohort included cardiovascular (codeine, oxycodone), gastrointestinal (oxycodone), musculoskeletal (any, hydromorphone, oxycodone), CNS (oxycodone), chromosomal (codeine), and neoplasm and tumor (oxycodone) anomalies. The beneficiary cohort had higher opioid doses, was younger, had lower socioeconomic status, and greater comorbidities. CONCLUSIONS Increased risks of CA after first trimester opioid analgesics were observed in low-income prescription beneficiaries, and some estimates were higher than a population-based cohort from the same setting. Biological differences associated with younger age, lower socioeconomic status and greater comorbidity may affect generalizability of results from pregnant low-income beneficiaries.
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Affiliation(s)
- Susan B Brogly
- Department of Surgery, Queen's University, Kingston, Canada.,ICES, Toronto, Canada
| | - Alexa C Bowie
- Department of Public Health Sciences, Queen's University, Kingston, Canada
| | | | - Andi Camden
- ICES, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,The Hospital for Sick Children, Toronto, Canada
| | - Maria P Velez
- ICES, Toronto, Canada.,Department of Obstetrics and Gynaecology, Queen's University, Kingston, Canada
| | - Astrid Guttmann
- ICES, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,The Hospital for Sick Children, Toronto, Canada
| | - Martha M Werler
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
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24
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Field E, Strathearn M, Boyd-Skinner C, Dyda A. Usefulness of linked data for infectious disease events: a systematic review. Epidemiol Infect 2023; 151:e46. [PMID: 36843485 PMCID: PMC10052405 DOI: 10.1017/s0950268823000316] [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: 10/13/2022] [Revised: 01/20/2023] [Accepted: 02/10/2023] [Indexed: 02/28/2023] Open
Abstract
Surveillance is a key public health function to enable early detection of infectious disease events and inform public health action. Data linkage may improve the depth of data for response to infectious disease events. This study aimed to describe the uses of linked data for infectious disease events. A systematic review was conducted using Pubmed, CINAHL and Web of Science. Studies were included if they used data linkage for an acute infectious disease event (e.g. outbreak of disease). We summarised the event, study aims and designs; data sets; linkage methods; outcomes reported; and benefits and limitations. Fifty-four studies were included. Uses of linkage for infectious disease events included assessment of severity of disease and risk factors; improved case finding and contact tracing; and vaccine uptake, safety and effectiveness. The ability to conduct larger scale population level studies was identified as a benefit, in particular for rarer exposures, risk factors or outcomes. Limitations included timeliness, data quality and inability to collect additional variables. This review demonstrated multiple uses of data linkage for infectious disease events. As infectious disease events occur without warning, there is a need to establish pre-approved protocols and the infrastructure for data-linkage to enhance information available during an event.
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Affiliation(s)
- Emma Field
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Melanie Strathearn
- School of Population Health, University of Queensland, Brisbane, Australia
| | | | - Amalie Dyda
- School of Population Health, University of Queensland, Brisbane, Australia
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25
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Soliman A, Rajasekaran S, Toman P, Ravishanker N. A fast privacy-preserving patient record linkage of time series data. Sci Rep 2023; 13:3292. [PMID: 36841850 PMCID: PMC9968283 DOI: 10.1038/s41598-023-29132-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 01/31/2023] [Indexed: 02/26/2023] Open
Abstract
Recent advances in technology have led to an explosion of data in virtually all domains of our lives. Modern biomedical devices can acquire a large number of physical readings from patients. Often, these readings are stored in the form of time series data. Such time series data can form the basis for important research to advance healthcare and well being. Due to several considerations including data size, patient privacy, etc., the original, full data may not be available to secondary parties or researchers. Instead, suppose that a subset of the data is made available. A fast and reliable record linkage algorithm enables us to accurately match patient records in the original and subset databases while maintaining privacy. The problem of record linkage when the attributes include time series has not been studied much in the literature. We introduce two main contributions in this paper. First, we propose a novel, very efficient, and scalable record linkage algorithm that is employed on time series data. This algorithm is 400× faster than the previous work. Second, we introduce a privacy preserving framework that enables health institutions to safely release their raw time series records to researchers with bare minimum amount of identifying information.
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Affiliation(s)
- Ahmed Soliman
- Computer Science and Engineering Department, University of Connecticut, Storrs, CT, 06269, USA
| | - Sanguthevar Rajasekaran
- Computer Science and Engineering Department, University of Connecticut, Storrs, CT, 06269, USA.
| | - Patrick Toman
- Department of Statistics, University of Connecticut, Storrs, CT, 06269, USA
| | - Nalini Ravishanker
- Department of Statistics, University of Connecticut, Storrs, CT, 06269, USA
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26
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Soneson E, Das S, Burn AM, van Melle M, Anderson JK, Fazel M, Fonagy P, Ford T, Gilbert R, Harron K, Howarth E, Humphrey A, Jones PB, Moore A. Leveraging Administrative Data to Better Understand and Address Child Maltreatment: A Scoping Review of Data Linkage Studies. CHILD MALTREATMENT 2023; 28:176-195. [PMID: 35240863 PMCID: PMC9806482 DOI: 10.1177/10775595221079308] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
BACKGROUND This scoping review aimed to overview studies that used administrative data linkage in the context of child maltreatment to improve our understanding of the value that data linkage may confer for policy, practice, and research. METHODS We searched MEDLINE, Embase, PsycINFO, CINAHL, and ERIC electronic databases in June 2019 and May 2020 for studies that linked two or more datasets (at least one of which was administrative in nature) to study child maltreatment. We report findings with numerical and narrative summary. RESULTS We included 121 studies, mainly from the United States or Australia and published in the past decade. Data came primarily from social services and health sectors, and linkage processes and data quality were often not described in sufficient detail to align with current reporting guidelines. Most studies were descriptive in nature and research questions addressed fell under eight themes: descriptive epidemiology, risk factors, outcomes, intergenerational transmission, predictive modelling, intervention/service evaluation, multi-sector involvement, and methodological considerations/advancements. CONCLUSIONS Included studies demonstrated the wide variety of ways in which data linkage can contribute to the public health response to child maltreatment. However, how research using linked data can be translated into effective service development and monitoring, or targeting of interventions, is underexplored in terms of privacy protection, ethics and governance, data quality, and evidence of effectiveness.
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Affiliation(s)
- Emma Soneson
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Shruti Das
- University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Anne-Marie Burn
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Marije van Melle
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | | | - Mina Fazel
- Department of Psychiatry, Warneford Hospital, University of Oxford, Headington, Oxford, UK
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Ruth Gilbert
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Katie Harron
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Emma Howarth
- School of Psychology, University of East London, London, UK
| | - Ayla Humphrey
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Peter B. Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Anna Moore
- Department of Psychiatry, University of Cambridge, Cambridge, UK
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27
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Li S, Wang Y, Ying Y, Gong Q, Lou G, Liu Y, Liu S, Li H. Independent and Joint Associations of BMI and Waist Circumference With the Onset of Type 2 Diabetes Mellitus in Chinese Adults: Prospective Data Linkage Study. JMIR Public Health Surveill 2023; 9:e39459. [PMID: 36630180 PMCID: PMC9878373 DOI: 10.2196/39459] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 11/19/2022] [Accepted: 11/26/2022] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND General obesity and abdominal obesity, typically measured by BMI and waist circumference (WC), respectively, are associated with an increased risk of type 2 diabetes mellitus (T2DM). However, the magnitude of the association of these two obesity indicators and their joint association with the onset of T2DM remain controversial. OBJECTIVE The aim of this study was to investigate the associations between these two obesity indicators and T2DM among the Chinese population to contribute scientific evidence for appropriate T2DM interventions. METHODS A cohort of 3001 eligible participants was selected from the Ningbo Adult Chronic Disease Surveillance Project running since 2015. Based on BMI, individuals were categorized into groups of underweight or normal, overweight, and obesity. Based on WC, individuals were categorized in groups of normal, precentral obesity, and central obesity. Follow-up was performed by linking data of the baseline data set with the diabetes registry data set and the vital registry data set (both from the Ningbo Municipal Integrated Noncommunicable Disease Collaborative Management System), mainly using the participants' identity numbers. Follow-up was completed when a participant was diagnosed with T2DM. The associations were estimated with multivariate Cox proportional hazard regression. RESULTS In the cohort, 90 of 3001 participants developed T2DM (incidence density: 6.483/1000 person-years) with a median 4.72 years of follow-up. After controlling for age, sex, hypertension, dyslipidemia, smoking status, and family history of diabetes, the multivariate adjusted hazard ratios (HRs) across underweight/normal, overweight, and obesity BMI categories were 1.000, 1.653 (95% CI 1.030-2.654), and 2.375 (95% CI 1.261-4.473), respectively. The multivariate adjusted HRs across the normal, precentral obesity, and central obesity WC categories were 1.000, 1.215 (95% CI 0.689-2.142), and 1.663 (95% CI 1.016-2.723), respectively. Compared with the reference group (normal WC with an underweight/normal BMI), the multivariate adjusted HR for participants with both central obesity according to WC and obesity according to BMI was 2.489 (95% CI 1.284-4.825). CONCLUSIONS Both elevated BMI and WC at baseline increased the risk of T2DM. Compared with WC, BMI as an obesity indicator was more strongly associated with the onset of T2DM.
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Affiliation(s)
- Sixuan Li
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo, China
| | - Yong Wang
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo, China
| | - Yanyan Ying
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo, China
| | - Qinghai Gong
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo, China
| | - Ge Lou
- Center for Disease Control and Prevention of Chaoyang District, Beijing, China
| | - Yang Liu
- Shanghai Pudong New Area Center for Disease Control and Prevention, Pudong Institute of Preventive Medicine, Fudan University, Shanghai, China
| | - Shiwei Liu
- Chinese Center for Disease Control and Prevention, Bejing, China
| | - Hui Li
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo, China
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28
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Louis D, Oberoi S, Ricci FM, Pylypjuk C, Alvaro R, Seshia M, de Cabo C, Moddemann D, Sirski M, Lix LM, Garland A, Ruth CA. Grade 3 school performance among children born preterm: a population-based cohort study. Arch Dis Child Fetal Neonatal Ed 2022; 108:286-293. [PMID: 36456174 DOI: 10.1136/archdischild-2022-324746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 11/17/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVE To study the association between prematurity and grade 3 school performance in a contemporary cohort of children. METHODS Population-based retrospective cohort study in Manitoba, Canada. Children born between 1999 and 2011 who had their grade 3 school performance data available were eligible. Preterm birth (<37 weeks) was the exposure of interest assessed using multivariable logistic regression models. Our primary outcomes were 'needs ongoing help' or 'outside the range' in at least two of each of the (1) four numeracy and (2) three reading competencies. RESULTS Of the 186 956 eligible children, 101 436 children (7187 preterm (gestational age, median (IQR) 35 weeks (34, 36)) and 94 249 term (40 weeks (39,40)) were included. Overall, 19% of preterm and 14% of term children had the numeracy outcome (adjusted OR (aOR) 1.38; 95% CI 1.29 to 1.47, p<0.001), while 19% and 13% had the reading outcome (aOR 1.38; 1.29 to 1.48, p<0.001). These differences showed a gestational age gradient. Gestational age (for numeracy, <28 weeks aOR 4.93 (3.45 to 7.03), 28-33 weeks 1.72 (1.50 to 1.98), 34-36 weeks 1.24 (1.15 to 1.34); for reading, <28 weeks 3.51 (2.40 to 5.14), 28-33 weeks 1.72 (1.49 to 1.98), 34-36 weeks 1.24 (1.17-1.37)), male sex, small for gestational age and maternal medical and sociodemographic factors were associated with the numeracy and reading outcomes in this cohort. CONCLUSIONS AND RELEVANCE Children born preterm had poorer performance in grade 3 numeracy and reading proficiencies than children born full term. All children born preterm, not just those born extremely preterm, should be screened for reading and numeracy performance in school and strategies implemented to address any deficits.
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Affiliation(s)
- Deepak Louis
- Section of Neonatology, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sapna Oberoi
- Division of Pediatric Hematology-Oncology, Department of Pediatrics and Child Health, University of Manitoba, Winipeg, Manitoba, Canada
| | - Florencia M Ricci
- Section of Neonatology, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Christy Pylypjuk
- Department of Obstetrics and Gynecology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ruben Alvaro
- Section of Neonatology, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mary Seshia
- Section of Neonatology, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Cecilia de Cabo
- Section of Neonatology, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Diane Moddemann
- Neonatal Follow up program, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Monica Sirski
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lisa M Lix
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Allan Garland
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Chelsea Anastasia Ruth
- Section of Neonatology, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada.,Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
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29
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Milne BJ, D'Souza S, Andersen SH, Richmond-Rakerd LS. Use of Population-Level Administrative Data in Developmental Science. ANNUAL REVIEW OF DEVELOPMENTAL PSYCHOLOGY 2022; 4:447-468. [PMID: 37284522 PMCID: PMC10241456 DOI: 10.1146/annurev-devpsych-120920-023709] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Population-level administrative data-data on individuals' interactions with administrative systems (e.g., health, criminal justice, and education)-have substantially advanced our understanding of life-course development. In this review, we focus on five areas where research using these data has made significant contributions to developmental science: (a) understanding small or difficult-to-study populations, (b) evaluating intergenerational and family influences, (c) enabling estimation of causal effects through natural experiments and regional comparisons, (d) identifying individuals at risk for negative developmental outcomes, and (e) assessing neighborhood and environmental influences. Further advances will be made by linking prospective surveys to administrative data to expand the range of developmental questions that can be tested; supporting efforts to establish new linked administrative data resources, including in developing countries; and conducting cross-national comparisons to test findings' generalizability. New administrative data initiatives should involve consultation with population subgroups including vulnerable groups, efforts to obtain social license, and strong ethical oversight and governance arrangements.
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Affiliation(s)
- Barry J Milne
- School of Social Sciences and Centre of Methods and Policy Application in the Social Sciences (COMPASS), University of Auckland, Auckland, New Zealand
| | - Stephanie D'Souza
- School of Social Sciences and Centre of Methods and Policy Application in the Social Sciences (COMPASS), University of Auckland, Auckland, New Zealand
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30
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Louis D, Akil H, Bolton JM, Bacchini F, Netzel K, Oberoi S, Pylypjuk C, Flaten L, Cheung K, Lix LM, Ruth C, Garland A. Mental Disorders Among Mothers of Children Born Preterm: A Population-Based Cohort Study in Canada. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022; 68:338-346. [PMID: 36412096 DOI: 10.1177/07067437221138237] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Our aim was to examine the association between preterm delivery and incident maternal mental disorders using a population-based cohort of mothers in Canada. METHODS Retrospective matched cohort study using Manitoba Centre for Health Policy (MCHP) administrative data in Manitoba. Mothers who delivered preterm babies (<37 weeks gestational age) between 1998 and 2013 were matched 1:5 to mothers of term babies using socio-demographic variables. Primary outcome was any incident mental disorder within 5 years of delivery defined as any of (a) mood and anxiety disorders, (b) psychotic disorders, (c) substance use disorders, and (d) suicide or suicide attempts. Multivariable Poisson regression model was used to estimate the 5-year adjusted incidence rate ratios (IRRs). RESULTS Mothers of preterm children (N = 5,361) had similar incidence rates of any mental disorder (17.4% vs. 16.6%, IRR = 0.99, 95% CI, 0.91 to 1.07) compared to mothers of term children (N = 24,932). Mothers of term children had a higher rate of any mental disorder in the first year while mothers of preterm children had higher rates from 2 to 5 years. Being the mother of a child born <28 week (IRR = 1.5, 95% CI, 1.14 to 2.04), but not 28-33 weeks (IRR = 1.03, 95% CI, 0.86 to 1.19) or 34-36 weeks (IRR = 0.96, 95% CI, 0.88 to 1.05), was associated with any mental disorder. INTERPRETATION Mothers of preterm and term children had similar rates of incident mental disorders within 5-years post-delivery. Extreme prematurity was a risk factor for any mental disorder. Targeted screening and support of this latter group may be beneficial.
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Affiliation(s)
- Deepak Louis
- Section of Neonatology, Department of Pediatrics and Child Health, Rady Faculty of Medicine, 8664University of Manitoba, Winnipeg, Canada
| | - Hammam Akil
- Section of Neonatology, Department of Pediatrics and Child Health, Rady Faculty of Medicine, 8664University of Manitoba, Winnipeg, Canada
| | - James M Bolton
- Department of Psychiatry, Rady Faculty of Medicine, 8664University of Manitoba, Winnipeg, Canada.,Manitoba Centre for Health Policy, 8664University of Manitoba, Winnipeg, Canada
| | | | - Karen Netzel
- Neonatal Intensive Care Unit, Women's Hospital, Winnipeg, Canada
| | - Sapna Oberoi
- Department of Pediatric Hematology Oncology, Rady Faculty of Medicine, 8664University of Manitoba, Winnipeg, Canada
| | - Christy Pylypjuk
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Rady Faculty of Medicine, 8664University of Manitoba, Winnipeg, Canada
| | - Lisa Flaten
- Manitoba Centre for Health Policy, 8664University of Manitoba, Winnipeg, Canada
| | - Kristene Cheung
- Department of Clinical Health Psychology, Rady Faculty of Medicine, 8664University of Manitoba, Winnipeg, Canada
| | - Lisa M Lix
- Manitoba Centre for Health Policy, 8664University of Manitoba, Winnipeg, Canada.,Department of Community Health Sciences, Rady Faculty of Medicine, 8664University of Manitoba, Winnipeg, Canada
| | - Chelsea Ruth
- Section of Neonatology, Department of Pediatrics and Child Health, Rady Faculty of Medicine, 8664University of Manitoba, Winnipeg, Canada.,Manitoba Centre for Health Policy, 8664University of Manitoba, Winnipeg, Canada
| | - Allan Garland
- Manitoba Centre for Health Policy, 8664University of Manitoba, Winnipeg, Canada.,Department of Medicine, Rady Faculty of Medicine, 8664University of Manitoba, Winnipeg, Canada
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Nickel NC, Enns JE, Freier A, McCulloch SC, Chartier M, Casidsid HJM, Balogun OD, Mulhall D, Dragan R, Sarkar J, Bolton J, Konrad G, Phillips-Beck W, Sanguins J, Shimmin C, McDonald N, Mignone J, Hinds A. Characterising methamphetamine use to inform health and social policies in Manitoba, Canada: a protocol for a retrospective cohort study using linked administrative data. BMJ Open 2022; 12:e062127. [PMID: 36261234 PMCID: PMC9582321 DOI: 10.1136/bmjopen-2022-062127] [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] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Rising use of methamphetamine is causing significant public health concern in Canada. The biological and behavioural effects of methamphetamine range from wakefulness, vigour and euphoria to adverse physical health outcomes like myocardial infarction, haemorrhagic stroke, arrhythmia and seizure. It can also cause severe psychological complications such as psychosis. National survey data point to increasing rates of methamphetamine use, as well as increasing ease of access and serious methamphetamine-related harms. There is an urgent need for evidence to address knowledge gaps, provide direction to harm reduction and treatment efforts and inform health and social policies for people using methamphetamine. This protocol describes a study that aims to address this need for evidence. METHODS The study will use linked, whole population, de-identified administrative data from the Manitoba Population Research Data Repository. The cohort will include individuals in the city of Winnipeg, Manitoba, who came into contact with the health system for reasons related to methamphetamine use from 2013 to 2021 and a comparison group matched on age, sex and geography. We will describe the cohort's sociodemographic characteristics, calculate incidence and prevalence of mental disorders associated with methamphetamine use and examine rates of health and social service use. We will evaluate the use of olanzapine pharmacotherapy in reducing adverse emergency department outcomes. In partnership with Indigenous co-investigators, outcomes will be stratified by First Nations and Métis identity. ETHICS AND DISSEMINATION The study was approved by the University of Manitoba Health Research Ethics Board, and access datasets have been granted by all data providers. We also received approval from the First Nations Health and Social Secretariat of Manitoba's Health Information Research Governance Committee and the Manitoba Métis Federation. Dissemination will be guided by an 'Evidence 2 Action' group of public rightsholders, service providers and knowledge users who will ensure that the analyses address the critical issues.
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Affiliation(s)
- Nathan C Nickel
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Manitoba Inuit Association, Winnipeg, Manitoba, Canada
| | - Jennifer E Enns
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Amy Freier
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Scott C McCulloch
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mariette Chartier
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Hera J M Casidsid
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Drew Mulhall
- Department of Orthopedic Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Roxana Dragan
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Joykrishna Sarkar
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James Bolton
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Geoffrey Konrad
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Wanda Phillips-Beck
- First Nations Health and Social Secretariat of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Carolyn Shimmin
- George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada
| | - Neil McDonald
- Winnipeg Fire Paramedic Service, Winnipeg, Manitoba, Canada
| | - Javier Mignone
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Aynslie Hinds
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Gonzalez JJ, Dziwis J, Patel YA, Tapper EB. Identifying Ascites in Patients with Cirrhosis Using Administrative Codes and Diuretic Use: A Multicenter Study. Dig Dis Sci 2022; 67:4695-4701. [PMID: 35088187 PMCID: PMC11289723 DOI: 10.1007/s10620-021-07367-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 12/12/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Ascites is associated with significantly increased morbidity, mortality, and health care costs. Large population studies are necessary to determine the burden and impact of ascites; however, ascites ICD-10 codes perform poorly in the identification of patients. METHODS We utilized three independent retrospective cohorts at the University of Michigan (cohorts 1 and 2) and Duke University (cohort 3). Cohort 1: Child A5-6 patients followed up to 10 years (n = 150); cohort 2: Child A5-B7 patients with portal hypertension followed for up to 1 year (n = 65); cohort 3: cross-sectional cohort of patients evaluated for liver transplant (n = 100). We computed performance characteristics for ascites-related ICD-10 codes (K70.31, K70.11, K71.51, R18.8), as well as loop and/or potassium-sparing diuretics. RESULTS A total of 315 patients were included across three cohorts. Algorithms including any ascites code provided better sensitivity and equivalent specificity to R18.8 alone for all cohorts. In cohort 2, we found that loop diuretics, potassium-sparing diuretics, and a combination of both with a cirrhosis code were highly sensitive (82.3% for each) and specific (89.1-93.5%). In contrast, ascites codes were insensitive. In patients with moderate-severe ascites, a combination of recorded diuretics showed high sensitivity and specificity (95.2% and 86.8%). In Cohort 3's transplant evaluation patients, we found that loop diuretics, potassium-sparing diuretics, and a combination of both with a cirrhosis code were highly sensitive (90.4%, 78.8% and 75.0%, respectively) and specific (85.0%, 90.0% and 95.0%, respectively). For moderate-severe cirrhosis, loop diuretics and R18.8 showed higher sensitivity (77.8%) and specificity (88.9%), respectively. CONCLUSION Diuretic records with a cirrhosis code improve the identification of ascites. This method for identifying ascites should be used in future large dataset studies.
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Affiliation(s)
- Juan J Gonzalez
- Division of Hospital Medicine, Department of Internal Medicine, University of Michigan Medical School, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA.
| | - Jennifer Dziwis
- Department of Internal Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Yuval A Patel
- Division of Gastroenterology, Department of Internal Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Elliot B Tapper
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
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Yamamoto JM, Pylypjuk C, Sellers E, McLeod L, Wicklow B, Sirski M, Prior H, Ruth C. Maternal and neonatal outcomes in pregnancies with type 2 diabetes in First Nation and other Manitoban people: a population-based study. CMAJ Open 2022; 10:E930-E936. [PMID: 36280248 PMCID: PMC9640167 DOI: 10.9778/cmajo.20220025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND First Nation people living in Canada experience a high prevalence of type 2 diabetes in pregnancy. In this study, we aimed to describe maternal and neonatal outcomes in First Nation and all other females with type 2 diabetes living in Manitoba, Canada. METHODS This was a population-level retrospective cohort study using linked administrative data from Manitoba (2012-2017). We compared First Nation females with type 2 diabetes with all other Manitoban females with type 2 diabetes, using relative risks (RRs) and 95% confidence intervals (CIs). RESULTS A total of 2181 females with type 2 diabetes were included, and 1218 (55.8%) were First Nation. First Nation females with type 2 diabetes were significantly more likely to experience stillbirth (RR 2.14, 95% CI 1.11-4.13) and perinatal death (RR 2.39, 95% CI 1.37-4.17) than all other Manitoban females with type 2 diabetes. Offspring of First Nation females with type 2 diabetes had a higher risk of most neonatal complications than offspring of all other Manitoban females with type 2 diabetes, including a higher risk of congenital malformations (RR 1.97, 95% CI 1.30-2.99), but First Nation people did not have a higher risk of most maternal complications. INTERPRETATION First Nation pregnant individuals living with type 2 diabetes experienced a higher risk for adverse pregnancy outcomes than all other Manitoban females with type 2 diabetes. Additional studies are needed to identify both high-risk and protective factors for pregnancy complications in First Nation people living with type 2 diabetes in pregnancy.
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Affiliation(s)
- Jennifer M Yamamoto
- Department of Internal Medicine (Yamamoto), University of Manitoba; Children's Hospital Research Institute of Manitoba (Yamamoto, Pylypjuk, Sellers, Wicklow); Departments of Obstetrics, Gynecology and Reproductive Sciences (Pylypjuk), and Pediatrics and Child Health (Sellers, Wicklow, Ruth), University of Manitoba; First Nations Health and Social Secretariat of Manitoba (McLeod); Manitoba Centre for Health Policy (Sirski, Prior, Ruth), University of Manitoba, Winnipeg, Man
| | - Christy Pylypjuk
- Department of Internal Medicine (Yamamoto), University of Manitoba; Children's Hospital Research Institute of Manitoba (Yamamoto, Pylypjuk, Sellers, Wicklow); Departments of Obstetrics, Gynecology and Reproductive Sciences (Pylypjuk), and Pediatrics and Child Health (Sellers, Wicklow, Ruth), University of Manitoba; First Nations Health and Social Secretariat of Manitoba (McLeod); Manitoba Centre for Health Policy (Sirski, Prior, Ruth), University of Manitoba, Winnipeg, Man
| | - Elizabeth Sellers
- Department of Internal Medicine (Yamamoto), University of Manitoba; Children's Hospital Research Institute of Manitoba (Yamamoto, Pylypjuk, Sellers, Wicklow); Departments of Obstetrics, Gynecology and Reproductive Sciences (Pylypjuk), and Pediatrics and Child Health (Sellers, Wicklow, Ruth), University of Manitoba; First Nations Health and Social Secretariat of Manitoba (McLeod); Manitoba Centre for Health Policy (Sirski, Prior, Ruth), University of Manitoba, Winnipeg, Man
| | - Lorraine McLeod
- Department of Internal Medicine (Yamamoto), University of Manitoba; Children's Hospital Research Institute of Manitoba (Yamamoto, Pylypjuk, Sellers, Wicklow); Departments of Obstetrics, Gynecology and Reproductive Sciences (Pylypjuk), and Pediatrics and Child Health (Sellers, Wicklow, Ruth), University of Manitoba; First Nations Health and Social Secretariat of Manitoba (McLeod); Manitoba Centre for Health Policy (Sirski, Prior, Ruth), University of Manitoba, Winnipeg, Man
| | - Brandy Wicklow
- Department of Internal Medicine (Yamamoto), University of Manitoba; Children's Hospital Research Institute of Manitoba (Yamamoto, Pylypjuk, Sellers, Wicklow); Departments of Obstetrics, Gynecology and Reproductive Sciences (Pylypjuk), and Pediatrics and Child Health (Sellers, Wicklow, Ruth), University of Manitoba; First Nations Health and Social Secretariat of Manitoba (McLeod); Manitoba Centre for Health Policy (Sirski, Prior, Ruth), University of Manitoba, Winnipeg, Man
| | - Monica Sirski
- Department of Internal Medicine (Yamamoto), University of Manitoba; Children's Hospital Research Institute of Manitoba (Yamamoto, Pylypjuk, Sellers, Wicklow); Departments of Obstetrics, Gynecology and Reproductive Sciences (Pylypjuk), and Pediatrics and Child Health (Sellers, Wicklow, Ruth), University of Manitoba; First Nations Health and Social Secretariat of Manitoba (McLeod); Manitoba Centre for Health Policy (Sirski, Prior, Ruth), University of Manitoba, Winnipeg, Man
| | - Heather Prior
- Department of Internal Medicine (Yamamoto), University of Manitoba; Children's Hospital Research Institute of Manitoba (Yamamoto, Pylypjuk, Sellers, Wicklow); Departments of Obstetrics, Gynecology and Reproductive Sciences (Pylypjuk), and Pediatrics and Child Health (Sellers, Wicklow, Ruth), University of Manitoba; First Nations Health and Social Secretariat of Manitoba (McLeod); Manitoba Centre for Health Policy (Sirski, Prior, Ruth), University of Manitoba, Winnipeg, Man
| | - Chelsea Ruth
- Department of Internal Medicine (Yamamoto), University of Manitoba; Children's Hospital Research Institute of Manitoba (Yamamoto, Pylypjuk, Sellers, Wicklow); Departments of Obstetrics, Gynecology and Reproductive Sciences (Pylypjuk), and Pediatrics and Child Health (Sellers, Wicklow, Ruth), University of Manitoba; First Nations Health and Social Secretariat of Manitoba (McLeod); Manitoba Centre for Health Policy (Sirski, Prior, Ruth), University of Manitoba, Winnipeg, Man.
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Stewart-Tufescu A, Struck S, Taillieu T, Salmon S, Fortier J, Brownell M, Chartier M, Yakubovich AR, Afifi TO. Adverse Childhood Experiences and Education Outcomes among Adolescents: Linking Survey and Administrative Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11564. [PMID: 36141833 PMCID: PMC9517426 DOI: 10.3390/ijerph191811564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 09/05/2022] [Accepted: 09/09/2022] [Indexed: 06/16/2023]
Abstract
It is well established that adverse childhood experiences (ACEs) are associated with detrimental health outcomes in adulthood. Less is known about the relationships between ACEs and education outcomes and among adolescents. The aim of this study was to examine the associations between ACEs and adolescents' self-reported education outcomes and provincial education assessments among adolescents in Manitoba, Canada. Data were gathered from 1002 adolescents who participated in the Well-Being and Experiences (WE) Study. A subsample of the adolescents (84%) consented to having their WE survey data linked to administrative education databases. Binary and multinomial logistic regression models were computed to examine associations between ACE history and self-reported education outcomes and provincial education assessments, adjusting for sociodemographic variables. Adolescents with an ACE history had significantly increased likelihood of having ever been suspended from school (adjusted odds ratio (aOR) = 3.33, 95% CI 1.60-6.92), of lower grades (adjusted relative risk ratio (aRRR) = 3.21, 95% CI 1.42-7.29), and of chronic school absenteeism (aRRR = 2.45, 95% CI 1.28-4.68) compared with adolescents without an ACE history after adjusting for sociodemographic variables. Findings from this study illuminate the important relationship between childhood adversity and poor education outcomes assessed directly by adolescents. Increasing awareness of the public health risk associated with ACEs and education outcomes may inform education policy and school-based interventions.
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Affiliation(s)
- Ashley Stewart-Tufescu
- Faculty of Social Work and Children’s Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
| | - Shannon Struck
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB R3E 0W3, Canada
| | - Tamara Taillieu
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB R3E 0W3, Canada
| | - Samantha Salmon
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB R3E 0W3, Canada
| | - Janique Fortier
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB R3E 0W3, Canada
| | - Marni Brownell
- Department of Community Health Sciences, Manitoba Centre for Health Policy, and Children’s Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
| | - Mariette Chartier
- Department of Community Health Sciences, Manitoba Centre for Health Policy, and Children’s Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
| | - Alexa R. Yakubovich
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, NS B3H 1V7, Canada
| | - Tracie O. Afifi
- Departments of Community Health Sciences and Psychiatry, Children’s Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
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Chikwava F, O’Donnell M, Ferrante A, Pakpahan E, Cordier R. Patterns of homelessness and housing instability and the relationship with mental health disorders among young people transitioning from out-of-home care: Retrospective cohort study using linked administrative data. PLoS One 2022; 17:e0274196. [PMID: 36054257 PMCID: PMC9439254 DOI: 10.1371/journal.pone.0274196] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 08/23/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives The study examined the relationship between mental health, homelessness and housing instability among young people aged 15–18 years old who transitioned from out-of-home in 2013 to 2014 in the state of Victoria, Australia with follow-up to 2018. We determined the various mental health disorders and other predictors that were associated with different levels of homelessness risk, including identifying the impact of dual diagnosis of mental health and substance use disorder on homelessness. Methodology Using retrospective de-identified linked administrative data from various government departments we identified various dimensions of homelessness which were mapped from the European Topology of Homelessness (ETHOS) framework and associated mental health variables which were determined from the WHO ICD-10 codes. We used ordered logistic regression and Poisson regression analysis to estimate the impact of homelessness and housing instability respectively. Results A total homelessness prevalence of 60% was determined in the care-leaving population. After adjustment, high risk of homelessness was associated with dual diagnosis of mental health and substance use disorder, intentional self-harm, anxiety, psychotic disorders, assault and maltreatment, history of involvement with the justice system, substance use prior to leaving care, residential and home-based OHC placement and a history of staying in public housing. Conclusions There is clearly a need for policy makers and service providers to work together to find effective housing pathways and integrated health services for this heterogeneous group of vulnerable young people with complex health and social needs. Future research should determine longitudinally the bidirectional relationship between mental health disorders and homelessness.
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Affiliation(s)
- Fadzai Chikwava
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Melissa O’Donnell
- Australian Centre for Child Protection, University of South Australia, Adelaide, South Australia, Australia
- Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - Anna Ferrante
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Eduwin Pakpahan
- Department of Mathematics, Physics & Electrical Engineering, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Reinie Cordier
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, United Kingdom
- * E-mail:
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Premature mortality in people affected by co-occurring homelessness, justice involvement, opioid dependence, and psychosis: a retrospective cohort study using linked administrative data. THE LANCET PUBLIC HEALTH 2022; 7:e733-e743. [PMID: 35907410 PMCID: PMC9433331 DOI: 10.1016/s2468-2667(22)00159-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/01/2022] [Accepted: 06/20/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Homelessness, opioid dependence, justice involvement, and psychosis are each associated with an increased risk of poor health and commonly co-occur in the same individuals. Most existing studies of mortality associated with this co-occurrence rely on active follow-up methods prone to selection and retention bias, and focus on a limited set of specific exposures rather than taking a population-based approach. To address these limitations, we did a retrospective cohort study using linked administrative data. METHODS In this retrospective cohort study, we linked a population register of adults resident in Glasgow, UK, to administrative datasets from homelessness and criminal justice services; community pharmacies; and a clinical psychosis registry with data from April 1, 2010 to March 31, 2014. Linkage to death registrations from April 1, 2014 to March 31, 2019 provided follow-up data on premature mortality (age <75 years) from all causes, non-communicable diseases, and causes considered potentially avoidable through health-care or public health intervention. We estimated hazard ratios (HR) using Poisson regression, adjusting for age, gender, socioeconomic deprivation, and calendar time. FINDINGS Of 536 653 cohort members, 11 484 (2·1%) died during follow-up. All-cause premature mortality was significantly higher among people with multiple exposures than among people with single exposures, and among people with any exposure than among people with none (eg, homelessness plus other exposures vs no exposures: HR 8·4 [95% CI 7·3-9·5]; homelessness alone vs no exposures: HR 2·2 [1·9-2·5]). Avoidable premature mortality was highest among those with multiple exposures (eg, imprisonment plus other exposures vs no exposures: HR 10·5 [9·1-12·3]; imprisonment alone vs no exposures: HR 3·8 [3·0-4·8]). Premature mortality from non-communicable disease was higher among those with any exposures than among those with none, despite accounting for a lower proportion of deaths in the exposed group; although in some cases there was little difference between estimates for single versus multiple exposures. INTERPRETATION The co-occurrence of at least two of homelessness, opioid dependence, justice involvement, or psychosis is associated with very high rates of premature mortality, particularly from avoidable causes of death, including non-communicable disease. Responding to these findings demands wide-ranging efforts across health-care provision, public health, and social policy. Future work should examine the timing and sequencing of exposures to better understand the causal pathways underlying excess mortality. FUNDING Chief Scientist Office, Medical Research Council, NHS Research Scotland.
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Chartier MJ, Bolton JM, Ekuma O, Mota N, Hensel JM, Nie Y, McDougall C. Suicidal Risk and Adverse Social Outcomes in Adulthood Associated with Child and Adolescent Mental Disorders. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022; 67:512-523. [PMID: 34796744 PMCID: PMC9234896 DOI: 10.1177/07067437211055417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The life course of children and adolescents with mental disorders is an important area of investigation, yet it remains understudied. This study provides a first-ever comprehensive examination of the relationship between child and adolescent mental disorders and subsequent suicidal and adverse social outcomes in early adulthood using population-based data. METHODS De-identified administrative databases were used to create a birth cohort of 60,838 residents of Manitoba born between April 1980 to March 1985 who were followed until March 2015. Unadjusted and adjusted hazard ratios (aHRs) and odds ratios (aORs) were calculated to determine associations between physician-diagnosed mental disorders in childhood or adolescence and a range of adverse early adulthood (ages 18 to 35) outcomes. RESULTS Diagnoses of mood/anxiety disorders, attention-deficit hyperactivity disorder, substance use disorder, conduct disorder, psychotic disorder, personality disorders in childhood or adolescence were associated with having the same diagnoses in adulthood. These mental disorder diagnoses in childhood/adolescence were strongly associated with an increased risk of suicidal behaviors and adverse adult social outcomes in adulthood. Similarly, suicide attempts in adolescence conferred an increased risk in adulthood of suicide death (aHR: 3.6; 95% confidence interval [CI]: 1.9-6.9), suicide attempts (aHR: 6.2; CI: 5.0-7.6), social housing use (aHR: 1.7; CI 1.4-2.1), income assistance (aHR: 1.8; CI 1.6-2.1), criminal accusation (aHR: 2.2; CI 2.0-2.5), criminal victimization (aHR:2.5; CI 2.2-2.7), and not completing high school (aOR: 3.1; CI: 2.5-3.9). CONCLUSION Mental disorders diagnosed in childhood and adolescence are important risk factors not only for mental disorders in adulthood but also for a range of early adult adversity. These findings provide an evidence-based prognosis of children's long-term well-being and a rationale for ensuring timely access to mental health services. Better population-level mental health promotion and early intervention for children and adolescents with mental disorders are promising for improving future adult outcomes.
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Affiliation(s)
- Mariette J. Chartier
- Department of Community Health
Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- Mariette J. Chartier PhD, Manitoba Centre
for Health Policy, University of Manitoba, 408-727 McDermot Avenue, Winnipeg,
Manitoba, R3E 3P5, Canada.
| | - James M. Bolton
- Department of Psychiatry and Community Health Sciences, Rady Faculty
of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Okechukwu Ekuma
- Department of Community Health Sciences, Rady Faculty of Health
Sciences, University of Manitoba, Winnipeg, Canada
| | - Natalie Mota
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Canada
| | - Jennifer M. Hensel
- Department of Psychiatry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Yao Nie
- Department of Community Health Sciences, Rady Faculty of Health
Sciences, University of Manitoba, Winnipeg, Canada
| | - Chelsey McDougall
- Department of Community Health Sciences, Rady Faculty of Health
Sciences, University of Manitoba, Winnipeg, Canada
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International Classification of Diseases Codes are Useful in Identifying Cirrhosis in Administrative Databases. Dig Dis Sci 2022; 67:2107-2122. [PMID: 34091800 DOI: 10.1007/s10620-021-07076-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/24/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Health administrative databases are essential to define patient populations, make socioeconomic predictions, and facilitate medical research and healthcare planning. The accuracy of this data is dependent on valid codes/coding algorithms. AIMS The aim of this study was to systematically identify and summarize the validity of International Classification of Diseases (ICD) codes for identifying patients with cirrhosis in administrative data. METHODS Electronic databases, MEDLINE (via Ovid), EMBASE (via Ovid), the Web of Science, and CINAHL (via EBSCOhost), were searched for validation studies which compared ICD codes related to cirrhosis to a clinical reference standard, and reported statistical measures of performance. RESULTS Fourteen studies were included in the review. There was a large variation in the algorithms used to validate ICD codes to diagnose cirrhosis. Despite the variation, the positive predictive value (PPV) was greater than 84% and the specificity was greater than 75% in the majority of the studies. The negative predictive value (NPV) was lower, but still was associated with values greater than 70% in the majority of studies. Sensitivity data varied significantly with values ranging from 0.27 to 99%. CONCLUSIONS Evaluated ICD codes for cirrhosis, including codes for chronic liver disease, cirrhosis-specific codes, and cirrhosis-related complications, have demonstrated variable sensitivity and reasonable specificity for the identification of cirrhosis. Additional research is needed to maximize the identification of persons with cirrhosis to avoid underestimating the burden of disease.
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Mah SM, Dasgupta K, Akbari A, Ross NA, Fry R. An international comparative study of active living environments and hospitalization for Wales and Canada. SSM Popul Health 2022; 18:101048. [PMID: 35372657 PMCID: PMC8965167 DOI: 10.1016/j.ssmph.2022.101048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 01/14/2022] [Accepted: 02/14/2022] [Indexed: 11/26/2022] Open
Abstract
Rationale: Previous studies indicate active living environments (ALEs) are associated with higher physical activity levels across different geographic contexts, and could lead to reductions in hospital burden. Both Wales UK and Canada have advanced data infrastructure that allows record linkage between survey data and administrative health information. Objective To assess the relationship between ALEs and hospitalization in Wales and Canada. Methods We performed a population-based comparison using individual-level survey data from the Welsh Health Survey (N = 9968) linked to the Patient Episode Database for Wales, and the Canadian Community Health Survey (N = 40,335) linked to the Discharge Abstract Database. Using equivalent protocols and open-source data for street networks, destinations, and residential density, we derived 5-class measures of the ALE for Wales and Canada (classed 1 through 5, considered least favourable to most favourable for active living, respectively). We evaluated relationships of ALEs to health, behaviours and hospitalization using multivariate regression (reference group was the lowest ALE class 1, considered least favourable for active living). Results For Canada, those living in the highest ALE class 5 had lower odds of all-cause hospitalization (OR 0.66, 95% CI 0.54 to 0.81; as compared to the lowest ALE class 1). In contrast, those living in the highest ALE class 5 in Wales had higher odds of all-cause hospitalization (OR 1.37, 95% CI 1.04 to 1.80). The relationship between ALEs and cardiometabolic hospitalization was inconclusive for Canada (OR 0.75, 95% CI 0.50 to 1.12), but we observed higher odds of cardiometabolic hospitalization for respondents living in higher ALE classes for Wales (OR 1.46, 95% CI 1.10 to 1.78; comparing ALE class 4 to ALE class 1). Conclusion Canadian respondents living in high ALE neighbourhoods that are understood to be favourable for active living had lower odds of all-cause hospitalization, whereas Welsh respondents living in high ALEs that were deemed favourable for active living exhibited higher odds of all-cause hospitalization. Environments which promote physical activity in one geographic context may not do so in another. There remains a need to identify relevant context-specific factors that encourage active living.
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Affiliation(s)
- Sarah M Mah
- Department of Geography, McGill University, 705-805 Sherbrooke Street West, Montreal, Quebec, H3A 0B9, Canada.,Dalla Lana School of Public Health, University of Toronto, Health Sciences Building 155 College Street, 6th Floor Toronto, ON M5T 3M7, Canada
| | - Kaberi Dasgupta
- Divisions of Internal Medicine, Divisions of Clinical Epidemiology, Divisions of Endocrinology and Metabolism. McGill University Health Centre, 1001 Decarie Boulevard, D02.3312, Montreal, Quebec, H4A 3J1, Canada
| | - Ashley Akbari
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Nancy A Ross
- Department of Geography, McGill University, 705-805 Sherbrooke Street West, Montreal, Quebec, H3A 0B9, Canada.,Department of Public Health Sciences, School of Medicine, Queen's University, Carruthers Hall, 62 Fifth Field Company Lane, Kingston, ON, K7L 3N6, Canada
| | - Richard Fry
- Population Data Science, Swansea University Medical School, Swansea, UK
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Holland ML, Taylor RM, Condon E, Rinne GR, Bleicher S, Seldin ML, Sadler LS, Li C. Using probabilistic record linkage and propensity-score matching to identify a community-based comparison population. Res Nurs Health 2022; 45:390-400. [PMID: 35388528 PMCID: PMC9064948 DOI: 10.1002/nur.22226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 03/03/2022] [Accepted: 03/15/2022] [Indexed: 11/06/2022]
Abstract
In retrospective cohort studies of interventions disseminated to communities, it is challenging to find comparison groups with high-quality data for evaluation. We present one methodological approach as part of our study of birth outcomes of second-born children in a home visiting (HV) program targeting first-time mothers. We used probabilistic record linkage to link Connecticut's Nurturing Families Network (NFN) HV program and birth-certificate data for children born from 2005 to 2015. We identified two potential comparison groups: a propensity-score-matched group from the remaining birth certificate sample and eligible-but-unenrolled families. An analysis of interpregnancy interval (IPI) is presented to exemplify the approach. We identified the birth certificates of 4822 NFN families. The propensity-score-matched group had 14,219 families (3-to-1 matching) and we identified 1101 eligible-but-unenrolled families. Covariates were well balanced for the propensity-score-matched group, but poorly balanced for the eligible-but-unenrolled group. No program effect on IPI was found. By combining propensity-score matching and probabilistic record linkage, we were able to retrospectively identify relatively large comparison groups for quasi-experimental research. Using birth certificate data, we accessed outcomes for all of these individuals from a single data source. Multiple comparison groups allow us to confirm findings when each method has some limitations. Other researchers seeking community-based comparison groups could consider a similar approach.
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Affiliation(s)
- Margaret L Holland
- Child Study Center, Yale School of Medicine, Yale School of Nursing, Yale University, New Haven, Connecticut, USA
| | - Rose M Taylor
- Yale School of Nursing, Yale University, New Haven, Connecticut, USA
| | - Eileen Condon
- Yale School of Nursing, Yale University, New Haven, Connecticut, USA
| | - Gabrielle R Rinne
- Yale School of Nursing, Yale University, New Haven, Connecticut, USA
| | - Sarah Bleicher
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Margaret L Seldin
- Yale School of Nursing, Yale University, New Haven, Connecticut, USA
| | - Lois S Sadler
- Child Study Center, Yale School of Medicine, Yale School of Nursing, Yale University, New Haven, Connecticut, USA
- Yale School of Nursing, Yale University, New Haven, Connecticut, USA
| | - Connie Li
- Yale School of Public Health, Yale University, New Haven, Connecticut, USA
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Yi SE, Harish V, Gutierrez J, Ravaut M, Kornas K, Watson T, Poutanen T, Ghassemi M, Volkovs M, Rosella LC. Predicting hospitalisations related to ambulatory care sensitive conditions with machine learning for population health planning: derivation and validation cohort study. BMJ Open 2022; 12:e051403. [PMID: 35365510 PMCID: PMC8977821 DOI: 10.1136/bmjopen-2021-051403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 02/28/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To predict older adults' risk of avoidable hospitalisation related to ambulatory care sensitive conditions (ACSC) using machine learning applied to administrative health data of Ontario, Canada. DESIGN, SETTING AND PARTICIPANTS A retrospective cohort study was conducted on a large cohort of all residents covered under a single-payer system in Ontario, Canada over the period of 10 years (2008-2017). The study included 1.85 million Ontario residents between 65 and 74 years old at any time throughout the study period. DATA SOURCES Administrative health data from Ontario, Canada obtained from the (ICES formely known as the Institute for Clinical Evaluative Sciences Data Repository. MAIN OUTCOME MEASURES Risk of hospitalisations due to ACSCs 1 year after the observation period. RESULTS The study used a total of 1 854 116 patients, split into train, validation and test sets. The ACSC incidence rates among the data points were 1.1% for all sets. The final XGBoost model achieved an area under the receiver operating curve of 80.5% and an area under precision-recall curve of 0.093 on the test set, and the predictions were well calibrated, including in key subgroups. When ranking the model predictions, those at the top 5% of risk as predicted by the model captured 37.4% of those presented with an ACSC-related hospitalisation. A variety of features such as the previous number of ambulatory care visits, presence of ACSC-related hospitalisations during the observation window, age, rural residence and prescription of certain medications were contributors to the prediction. Our model was also able to capture the geospatial heterogeneity of ACSC risk in Ontario, and especially the elevated risk in rural and marginalised regions. CONCLUSIONS This study aimed to predict the 1-year risk of hospitalisation from ambulatory-care sensitive conditions in seniors aged 65-74 years old with a single, large-scale machine learning model. The model shows the potential to inform population health planning and interventions to reduce the burden of ACSC-related hospitalisations.
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Affiliation(s)
- Seung Eun Yi
- Layer6 AI, Toronto, Ontario, Canada
- Department of Computer Science, University of Toronto, Toronto, Ontario, Canada
| | - Vinyas Harish
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Temerty Centre for Artificial Intelligence Research and Education in Medicine, University of Toronto, Toronto, Ontario, Canada
- Vector Institute, Toronto, Ontario, Canada
| | | | - Mathieu Ravaut
- School of Computer Science and Engineering, Nanyang Technological University, Singapore
| | - Kathy Kornas
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Tristan Watson
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | | | - Marzyeh Ghassemi
- Department of Computer Science, University of Toronto, Toronto, Ontario, Canada
- Vector Institute, Toronto, Ontario, Canada
| | | | - Laura C Rosella
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Temerty Centre for Artificial Intelligence Research and Education in Medicine, University of Toronto, Toronto, Ontario, Canada
- Vector Institute, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
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Crockett LK, Ruth CA, Heaman MI, Brownell MD. Education Outcomes of Children Born Late Preterm: A Retrospective Whole-Population Cohort Study. Matern Child Health J 2022; 26:1126-1141. [PMID: 35301671 DOI: 10.1007/s10995-022-03403-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Early life exposures can have an impact on a child's developmental trajectory and children born late preterm (34-36 weeks gestational age) are increasingly recognized to have health and developmental setbacks that extend into childhood. OBJECTIVES The purpose of this study was to assess whether late preterm birth was associated with poorer developmental and educational outcomes in the early childhood period, after controlling for health and social factors. METHODS We conducted a retrospective cohort study using administrative databases housed at the Manitoba Centre for Health Policy, including all children born late preterm (34-36 weeks gestational age (GA)) and at full-term (39-41 weeks GA) between 2000 and 2005 in urban Manitoba (N = 28,100). Logistic regression was used to examine the association between gestational age (GA) and outcomes, after adjusting for covariates. RESULTS Adjusted analyses demonstrated that children born late preterm had a higher prevalence of attention deficit hyperactivity disorder (ADHD) (aOR = 1.25, 95% CI [1.03, 1.51]), were more likely to be vulnerable in the language and cognitive (aOR = 1.29, 95% CI [1.06, 1.57]), communication and general knowledge (aOR = 1.24, 95% CI [1.01, 1.53]), and physical health and well-being (aOR = 1.27, 95% CI [1.04, 1.53]) domains of development at kindergarten, and were more likely to repeat kindergarten or grade 1 (aOR = 1.52, 95% CI [1.03, 2.25]) compared to children born at term. They did not differ in receipt of special education funding, in social maturity or emotional development at kindergarten, and in reading and numeracy assessments in the third grade. CONCLUSIONS Given that the late preterm population makes up 75% of the preterm population, their poorer outcomes have implications at the population level. This study underscores the importance of recognizing the developmental vulnerability of this population and adequately accounting for the social differences between children born late preterm and at term.
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Affiliation(s)
- L K Crockett
- Department of Community Health Sciences, Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, 374(1) - 753 McDermot Avenue, Winnipeg, MB, R3E 0T6, Canada.
| | - C A Ruth
- Manitoba Centre for Health Policy, University of Manitoba, 408 - 727 McDermot Avenue, Winnipeg, MB, R3E 3P5, Canada.,Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - M I Heaman
- College of Nursing, Rady Faculty of Health Sciences, Helen Glass Centre for Nursing, University of Manitoba, 89 Curry Place, Winnipeg, MB, R3T 2N2, Canada
| | - M D Brownell
- Department of Community Health Sciences, Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, 374(1) - 753 McDermot Avenue, Winnipeg, MB, R3E 0T6, Canada.,Manitoba Centre for Health Policy, University of Manitoba, 408 - 727 McDermot Avenue, Winnipeg, MB, R3E 3P5, Canada
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Galsklint J, Kold S, Kristensen SR, Severinsen MT, Gade IL. Validation of Postsurgical Venous Thromboembolism Diagnoses of Patients Undergoing Lower Limb Orthopedic Surgery in the Danish National Patient Registry. Clin Epidemiol 2022; 14:191-199. [PMID: 35210866 PMCID: PMC8860350 DOI: 10.2147/clep.s345293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/13/2022] [Indexed: 11/23/2022] Open
Abstract
Background Healthcare databases can be a valuable source of epidemiological research regarding postoperative venous thromboembolism (VTE), ie, deep vein thrombosis (DVT) and pulmonary embolism (PE), following orthopedic procedures, but only if the diagnoses are valid. We examined the validity of VTE diagnosis codes in the Danish National Patient Registry (DNPR) by calculating their positive predictive value (PPV) and negative predictive value (NPV) versus actual medical records. Methods We identified patients who had undergone lower limb surgery during the period 2009–2019 at a hospital in the North Denmark Region. Of these, 420 patients had at least one VTE diagnosis registered in the DNPR within 180 days after lower limb surgery. Each patient with a VTE diagnosis was matched with two patients on age and sex, as well as type, location and period of surgery. The entire medical record and diagnostic imaging were reviewed to confirm VTE diagnosis. Results The overall PPVs was 85.2% (95% CI: 81.5–88.5%) for first time VTE diagnosis following lower limb surgery, 82.6% (95% CI: 77.5–82.8%) for DVT, and 90.3% (95% CI: 84.3–94.6%) for PE. We found improvement in PPV during the study period when stratifying for three periods of the whole period. There were no significant differences when stratifying for sex, age, or surgery site. All negative predictive values were higher than 99%. A total of 113 additional VTE diagnoses were registered among 88 VTE patients during follow-up. Only four of the suspected recurrent VTEs were confirmed to be true recurrent VTEs. Conclusion The VTE diagnosis codes in the DNPR after lower limb orthopedic surgery were highly valid against the actual medical records, and we observed better PPV over recent years.
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Affiliation(s)
- Josephine Galsklint
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
| | - Søren Kold
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Orthopedic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Søren Risom Kristensen
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Marianne Tang Severinsen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Hematology and Clinical Cancer Research, Aalborg University Hospital, Aalborg, Denmark
- Correspondence: Marianne Tang Severinsen, Department of Hematology, University Hospital, Aalborg, Denmark, Email
| | - Inger Lise Gade
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Hematology and Clinical Cancer Research, Aalborg University Hospital, Aalborg, Denmark
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
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Andrew E, Cox S, Smith K. Linking Ambulance Records with Hospital and Death Index Data to Evaluate Patient Outcomes. Int J Gen Med 2022; 15:567-572. [PMID: 35046714 PMCID: PMC8763257 DOI: 10.2147/ijgm.s328149] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 11/15/2021] [Indexed: 12/02/2022] Open
Abstract
Objective Linkage of electronic administrative datasets is becoming increasingly common, offering a powerful resource for research and analysis. However, routine linkage of prehospital data with emergency department (ED) presentation and hospital admission datasets is rare. We describe a methodology used to link ambulance data with hospital ED presentations, admissions, and death records, and examine potential biases between matched and unmatched patients. Methods Iterative deterministic linkage methodologies were employed to link clinical, operational, and secondary triage ambulance data to ED presentations, hospital admissions, and death records in Victoria, Australia. Descriptive analyses and standardised differences were used to examine potential biases between matched and unmatched patients. Results A total of 2,813,913 ambulance records were available for linkage. Of the patients that were transported to a public ED (n=1,753,268), 83.3% matched with an ED record. Only small differences were observed between matched and unmatched patients for sex, year, time of day and attending crew type. The data elements with the largest standardised differences were patient age (0.25) and paramedic diagnosis (0.25). Matched patients were older (mean ± standard deviation: 55.6±25.7 vs 49.0±26.0 years) and more likely to have a paramedic-suspected cardiac, respiratory, neurological, or gastrointestinal/genitourinary condition, suspected infection/sepsis, or pain. Conclusion This linked dataset will facilitate a large body of research into prehospital care and patient outcomes. Although future analysis of matched patients should acknowledge the linkage error rate, our findings suggest that results are likely to be generalisable to the broader ambulance population.
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Affiliation(s)
- Emily Andrew
- Centre for Research and Evaluation, Ambulance Victoria, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia
- Correspondence: Emily Andrew Email
| | - Shelley Cox
- Centre for Research and Evaluation, Ambulance Victoria, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia
| | - Karen Smith
- Centre for Research and Evaluation, Ambulance Victoria, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia
- Department of Paramedicine, Monash University, Victoria, Australia
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Nickel NC, Enns JE, Sanguins J, O'Conaill C, Chateau D, Driedger SM, Taylor C, Detillieux G, Deh MT, Brownell E, Chartrand AF, Katz A. Patterns of prescription opioid dispensing among Red River Métis in Manitoba, Canada: a retrospective longitudinal cross-sectional study. CMAJ Open 2022; 10:E288-E295. [PMID: 35351781 PMCID: PMC9259467 DOI: 10.9778/cmajo.20210025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Amid rising concern about opioid use across Canada, Métis leaders in Manitoba are seeking information on prescription opioid dispensing in Red River Métis populations to assist with planning and implementing appropriate evidence-based harm-reduction strategies in their communities. We examined patterns of prescription opioid dispensing among Red River Métis and compared them to those among other residents of Manitoba. METHODS We conducted a population-based retrospective cross-sectional study for fiscal years 2006/07-2018/19 using administrative data from the Manitoba Population Research Data Repository and a study designed in partnership with researchers from the Manitoba Métis Federation. We compared age- and sex-adjusted rates of prescription opioid dispensing and mean morphine equivalents (MEQ) between Red River Métis and all other Manitobans aged 10 years or older, in accordance with Indigenous data sovereignty principles. To better understand what was driving any differences in patterns of prescription opioid dispensing between the 2 groups, we stratified the groups by age, sex, urbanicity, number of comorbidities, income quintile and opioid type, and compared patterns in MEQ/person. RESULTS The 2018/19 cohort included 76 755 Red River Métis and 1 117 854 other Manitobans. Other Manitobans were more likely than Red River Métis to be in higher income quintiles and to live in urban areas, and were less likely to have been diagnosed with a mood or anxiety disorder or a substance use disorder in the previous 5 years. The rate of prescription opioid dispensing and the opioid-associated MEQ/person were consistently higher among Red River Métis than among other Manitobans in each study year (p < 0.001). The rate of prescription opioid dispensing declined and the MEQ/person rose among other Manitobans over the study period but did not change among Red River Métis. INTERPRETATION The rate of prescription opioid dispensing and the potency of prescribed opioids were higher among Red River Métis in Manitoba than among other Manitobans. Further investigation into the different dispensing patterns between the 2 groups and the potential opioid-related harms they may herald is warranted.
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Affiliation(s)
- Nathan C Nickel
- Manitoba Centre for Health Policy (Nickel, Enns, Chateau, Taylor, Detillieux, Tso Deh, Brownell, Katz), Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba; Departments of Community Health Sciences (Nickel, O'Conaill, Chateau, Driedger) and Family Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba; National Centre for Epidemiology and Population Health (Chateau), Australian National University, Canberra, Australia; Health and Wellness Department (Sanguins) and Early Learning and Child Care Department (Chartrand), Manitoba Métis Federation, Winnipeg, Man.
| | - Jennifer E Enns
- Manitoba Centre for Health Policy (Nickel, Enns, Chateau, Taylor, Detillieux, Tso Deh, Brownell, Katz), Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba; Departments of Community Health Sciences (Nickel, O'Conaill, Chateau, Driedger) and Family Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba; National Centre for Epidemiology and Population Health (Chateau), Australian National University, Canberra, Australia; Health and Wellness Department (Sanguins) and Early Learning and Child Care Department (Chartrand), Manitoba Métis Federation, Winnipeg, Man
| | - Julianne Sanguins
- Manitoba Centre for Health Policy (Nickel, Enns, Chateau, Taylor, Detillieux, Tso Deh, Brownell, Katz), Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba; Departments of Community Health Sciences (Nickel, O'Conaill, Chateau, Driedger) and Family Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba; National Centre for Epidemiology and Population Health (Chateau), Australian National University, Canberra, Australia; Health and Wellness Department (Sanguins) and Early Learning and Child Care Department (Chartrand), Manitoba Métis Federation, Winnipeg, Man.
| | - Carrie O'Conaill
- Manitoba Centre for Health Policy (Nickel, Enns, Chateau, Taylor, Detillieux, Tso Deh, Brownell, Katz), Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba; Departments of Community Health Sciences (Nickel, O'Conaill, Chateau, Driedger) and Family Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba; National Centre for Epidemiology and Population Health (Chateau), Australian National University, Canberra, Australia; Health and Wellness Department (Sanguins) and Early Learning and Child Care Department (Chartrand), Manitoba Métis Federation, Winnipeg, Man
| | - Dan Chateau
- Manitoba Centre for Health Policy (Nickel, Enns, Chateau, Taylor, Detillieux, Tso Deh, Brownell, Katz), Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba; Departments of Community Health Sciences (Nickel, O'Conaill, Chateau, Driedger) and Family Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba; National Centre for Epidemiology and Population Health (Chateau), Australian National University, Canberra, Australia; Health and Wellness Department (Sanguins) and Early Learning and Child Care Department (Chartrand), Manitoba Métis Federation, Winnipeg, Man
| | - S Michelle Driedger
- Manitoba Centre for Health Policy (Nickel, Enns, Chateau, Taylor, Detillieux, Tso Deh, Brownell, Katz), Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba; Departments of Community Health Sciences (Nickel, O'Conaill, Chateau, Driedger) and Family Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba; National Centre for Epidemiology and Population Health (Chateau), Australian National University, Canberra, Australia; Health and Wellness Department (Sanguins) and Early Learning and Child Care Department (Chartrand), Manitoba Métis Federation, Winnipeg, Man
| | - Carole Taylor
- Manitoba Centre for Health Policy (Nickel, Enns, Chateau, Taylor, Detillieux, Tso Deh, Brownell, Katz), Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba; Departments of Community Health Sciences (Nickel, O'Conaill, Chateau, Driedger) and Family Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba; National Centre for Epidemiology and Population Health (Chateau), Australian National University, Canberra, Australia; Health and Wellness Department (Sanguins) and Early Learning and Child Care Department (Chartrand), Manitoba Métis Federation, Winnipeg, Man
| | - Gilles Detillieux
- Manitoba Centre for Health Policy (Nickel, Enns, Chateau, Taylor, Detillieux, Tso Deh, Brownell, Katz), Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba; Departments of Community Health Sciences (Nickel, O'Conaill, Chateau, Driedger) and Family Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba; National Centre for Epidemiology and Population Health (Chateau), Australian National University, Canberra, Australia; Health and Wellness Department (Sanguins) and Early Learning and Child Care Department (Chartrand), Manitoba Métis Federation, Winnipeg, Man
| | - Miyosha Tso Deh
- Manitoba Centre for Health Policy (Nickel, Enns, Chateau, Taylor, Detillieux, Tso Deh, Brownell, Katz), Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba; Departments of Community Health Sciences (Nickel, O'Conaill, Chateau, Driedger) and Family Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba; National Centre for Epidemiology and Population Health (Chateau), Australian National University, Canberra, Australia; Health and Wellness Department (Sanguins) and Early Learning and Child Care Department (Chartrand), Manitoba Métis Federation, Winnipeg, Man
| | - Emily Brownell
- Manitoba Centre for Health Policy (Nickel, Enns, Chateau, Taylor, Detillieux, Tso Deh, Brownell, Katz), Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba; Departments of Community Health Sciences (Nickel, O'Conaill, Chateau, Driedger) and Family Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba; National Centre for Epidemiology and Population Health (Chateau), Australian National University, Canberra, Australia; Health and Wellness Department (Sanguins) and Early Learning and Child Care Department (Chartrand), Manitoba Métis Federation, Winnipeg, Man
| | - A Frances Chartrand
- Manitoba Centre for Health Policy (Nickel, Enns, Chateau, Taylor, Detillieux, Tso Deh, Brownell, Katz), Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba; Departments of Community Health Sciences (Nickel, O'Conaill, Chateau, Driedger) and Family Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba; National Centre for Epidemiology and Population Health (Chateau), Australian National University, Canberra, Australia; Health and Wellness Department (Sanguins) and Early Learning and Child Care Department (Chartrand), Manitoba Métis Federation, Winnipeg, Man
| | - Alan Katz
- Manitoba Centre for Health Policy (Nickel, Enns, Chateau, Taylor, Detillieux, Tso Deh, Brownell, Katz), Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba; Departments of Community Health Sciences (Nickel, O'Conaill, Chateau, Driedger) and Family Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba; National Centre for Epidemiology and Population Health (Chateau), Australian National University, Canberra, Australia; Health and Wellness Department (Sanguins) and Early Learning and Child Care Department (Chartrand), Manitoba Métis Federation, Winnipeg, Man
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Uncertainty in geospatial health: challenges and opportunities ahead. Ann Epidemiol 2021; 65:15-30. [PMID: 34656750 DOI: 10.1016/j.annepidem.2021.10.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 09/29/2021] [Accepted: 10/04/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE Uncertainty is not always well captured, understood, or modeled properly, and can bias the robustness of complex relationships, such as the association between the environment and public health through exposure, estimates of geographic accessibility and cluster detection, to name a few. METHODS We review current challenges and future opportunities as geospatial data and analyses are applied to the field of public health. We are particularly interested in the sources of uncertainty in geospatial data and how this uncertainty may propagate in spatial analysis. RESULTS We present opportunities to reduce the magnitude and impact of uncertainty. Specifically, we focus on (1) the use of multiple reference data sources to reduce geocoding errors, (2) the validity of online geocoders and how confidentiality (e.g., HIPAA) may be breached, (3) use of multiple reference data sources to reduce geocoding errors, (4) the impact of geoimputation techniques on travel estimates, (5) residential mobility and how it affects accessibility metrics and clustering, and (6) modeling errors in the American Community Survey. Our paper discusses how to communicate spatial and spatiotemporal uncertainty, and high-performance computing to conduct large amounts of simulations to ultimately increase statistical robustness for studies in public health. CONCLUSIONS Our paper contributes to recent efforts to fill in knowledge gaps at the intersection of spatial uncertainty and public health.
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Lee JH, Kang SY, Yoo Y, An J, Park SY, Lee JH, Lee SE, Kim MH, Kanemitsu Y, Chang YS, Song WJ. Epidemiology of adult chronic cough: disease burden, regional issues, and recent findings. Asia Pac Allergy 2021; 11:e38. [PMID: 34786368 PMCID: PMC8563099 DOI: 10.5415/apallergy.2021.11.e38] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 12/12/2022] Open
Abstract
Chronic cough is a common medical condition that has a significant impact on patients' quality of life. Although it was previously considered a symptom of other disorders, it is now regarded as a pathologic state that is characterized by a deviation from the intrinsic protective functions of the cough reflex, especially in adults. There are several factors that may underlie the cough reflex hypersensitivity and its persistence, such as age, sex, comorbidities, viral infection, exposure to irritants or environmental pollutants, and their interactions may determine the epidemiology of chronic cough in different countries. With a deeper understanding of disease pathophysiology and advanced research methodology, there are more attempts to investigate cough epidemiology using a large cohort of healthcare population data. This is a narrative overview of recent findings on the disease burden, risk factors, Asia-Pacific issues, and longitudinal outcomes in adults with chronic cough. This paper also discusses the approaches utilizing routinely collected data in cough research.
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Affiliation(s)
- Ji-Hyang Lee
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung-Yoon Kang
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Youngsang Yoo
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Gangneung Asan Hospital, Gangneung, Korea
| | - Jin An
- Department of Allergy, Pulmonary and Critical Care Medicine, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Korea
| | - So-Young Park
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Ji-Ho Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Seung-Eun Lee
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Min-Hye Kim
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Yoshihiro Kanemitsu
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | - Yoon-Seok Chang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Woo-Jung Song
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Doetsch JN, Dias V, Indredavik MS, Reittu J, Devold RK, Teixeira R, Kajantie E, Barros H. Record linkage of population-based cohort data from minors with national register data: a scoping review and comparative legal analysis of four European countries. OPEN RESEARCH EUROPE 2021; 1:58. [PMID: 37645179 PMCID: PMC10445839 DOI: 10.12688/openreseurope.13689.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/20/2021] [Indexed: 08/31/2023]
Abstract
Background: The GDPR was implemented to build an overarching framework for personal data protection across the EU/EEA. Linkage of data directly collected from cohort participants, potentially serving as a prominent tool for health research, must respect data protection rules and privacy rights. Our objective was to investigate law possibilities of linking cohort data of minors with routinely collected education and health data comparing EU/EEA member states. Methods: A legal comparative analysis and scoping review was conducted of openly accessible published laws and regulations in EUR-Lex and national law databases on GDPR's implementation in Portugal, Finland, Norway, and the Netherlands and its connected national regulations purposing record linkage for health research that have been implemented up until April 30, 2021. Results: The GDPR does not ensure total uniformity in data protection legislation across member states offering flexibility for national legislation. Exceptions to process personal data, e.g., public interest and scientific research, must be laid down in EU/EEA or national law. Differences in national interpretation caused obstacles in cross-national research and record linkage: Portugal requires written consent and ethical approval; Finland allows linkage mostly without consent through the national Social and Health Data Permit Authority; Norway when based on regional ethics committee's approval and adequate information technology safeguarding confidentiality; the Netherlands mainly bases linkage on the opt-out system and Data Protection Impact Assessment. Conclusions: Though the GDPR is the most important legal framework, national legislation execution matters most when linking cohort data with routinely collected health and education data. As national interpretation varies, legal intervention balancing individual right to informational self-determination and public good is gravely needed for health research. More harmonization across EU/EEA could be helpful but should not be detrimental in those member states which already opened a leeway for registries and research for the public good without explicit consent.
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Affiliation(s)
- Julia Nadine Doetsch
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, 4050-600, Portugal
- EPIUnit, Instituto de Saúde Pública da, Universidade do Porto (ISPUP), Porto, 4050-600, Portugal
| | - Vasco Dias
- INESC TEC -Institute for Systems and Computer Engineering, Technology and Science, Campus da Faculdade de Engenharia da Universidade do Porto, Porto, 4050-091, Portugal
| | - Marit S. Indredavik
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU – Norwegian University of Science and Technology, Trondheim, NO-7491, Norway
| | - Jarkko Reittu
- Finnish Institute for Health and Welfare, Legal Services, Helsinki, Finland
- University of Helsinki, Faculty of Law, Helsinki, Finland
| | - Randi Kallar Devold
- Faculty of Medicine and Health Sciences, NTNU – Norwegian University of Science and Technology, Trondheim, NO-7491, Norway
| | - Raquel Teixeira
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, 4050-600, Portugal
- EPIUnit, Instituto de Saúde Pública da, Universidade do Porto (ISPUP), Porto, 4050-600, Portugal
| | - Eero Kajantie
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU – Norwegian University of Science and Technology, Trondheim, NO-7491, Norway
- Finnish Institute for Health and Welfare, Population Health Unit, Helsinki and Oulu, Finland
- PEDEGO Research Unit, MRC Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
- Children’s Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Henrique Barros
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, 4050-600, Portugal
- EPIUnit, Instituto de Saúde Pública da, Universidade do Porto (ISPUP), Porto, 4050-600, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto (FMUP), Porto, Portugal
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Kendell C, Levy AR, Porter G, Gibson E, Urquhart R. Factors affecting access to administrative health data for research in Canada: a study protocol. Int J Popul Data Sci 2021; 6:1653. [PMID: 34632104 PMCID: PMC8477899 DOI: 10.23889/ijpds.v6i1.1653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION In Canada, most provinces have established administrative health data repositories to facilitate access to these data for research. Anecdotally, researchers have described delays and substantial inter-provincial variations in the timeliness of data access approvals and receipt of data. Currently, the reasons for these delays and variations in timeliness are not well understood. This paper provides a study protocol for (1) identifying the factors affecting access to administrative health data for research within select Canadian provinces, and (2) comparing factors across provinces to assess whether and how they contribute to inter-provincial variations in access to administrative health data for research. METHODS A qualitative, multiple-case study research design will be used. Three cases will be included, representing three different provinces. For each case, data will be collected from documents and interviews. Specifically, interviews will be carried out with (1) research stakeholders, and (2) regulatory stakeholders (10 individuals/group * 2 groups/province * 3 provinces = 60). During within-case analysis, interview data for each stakeholder group will be analyzed separately using constant comparative analysis. Document analysis will occur iteratively, and will inform interview guide adaptation, and supplement interview data. Cross-case analysis will involve systematic comparison of findings across cases. DISCUSSION This study represents the first in-depth examination of access to administrative health data in Canada. The main outcome will be an overarching mid-range theory explaining inter-provincial variations in access to administrative health data in Canada. This theory will be strengthened by the inclusion of the perspectives of both researchers and those involved in the regulation of data access. The findings from this study may be used to improve equitable and timely access to administrative health data across provinces, and may be transferable to other jurisdictions where barriers to access to administrative health data have been reported.
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Affiliation(s)
- Cynthia Kendell
- Interdisciplinary PhD Program, Dalhousie University, Halifax, Nova Scotia, B3H 4H6
- Department of Surgery, Nova Scotia Health, Halifax, Nova Scotia, B3H 2Y9
| | - Adrian R Levy
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, B3H 1V7
| | - Geoff Porter
- Department of Surgery, Nova Scotia Health, Halifax, Nova Scotia, B3H 2Y9
| | - Elaine Gibson
- Schulich School of Law, Health Law Institute, Dalhousie University, Halifax, Nova Scotia, B3H 4R2
| | - Robin Urquhart
- Department of Surgery, Nova Scotia Health, Halifax, Nova Scotia, B3H 2Y9
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, B3H 1V7
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Nickel NC, Clark W, Phillips-Beck W, Sanguins J, Enns JE, Lavoie JG, Romanescu R, Katz A, Mahar AL, Brownell M, Lix L, Urquia M, Tso Deh M, O'Conaill C, Durksen A, Brownell E. Diagnostic testing and vaccination for COVID-19 among First Nations, Metis and Inuit in Manitoba, Canada: protocol for a nations-based cohort study using linked administrative data. BMJ Open 2021; 11:e052936. [PMID: 34521679 PMCID: PMC8441222 DOI: 10.1136/bmjopen-2021-052936] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Decades of research demonstrate that First Nations, Metis and Inuit (FN/M/I) populations have differential access to diagnostic and therapeutic healthcare. Emerging evidence shows that this continues to be the case during the SARS-CoV-2 pandemic. In an effort to rectify these differences in access to care, our team, which is co-led by FN/M/I partners, will generate and distribute evidence on COVID-19 diagnostic testing and vaccination in high-priority FN/M/I populations in Manitoba, with the goal of identifying system-level and individual-level factors that act as barriers to equitable care and thereby informing Indigenous-led public health responses. METHODS AND ANALYSIS Our nations-based approach focuses on FN/M/I populations with separate study arms for each group. Linked administrative health data on COVID-19 diagnostic testing and vaccinations are available on a weekly basis. We will conduct surveillance to monitor trends in testing and vaccination among each FN/M/I population and all other Manitobans, map the geographic distribution of these outcomes by health region and tribal council, and identify barriers to testing and vaccination to inform public health strategies. We will follow the course of the pandemic starting from January 2020 and report findings quarterly. ETHICS AND DISSEMINATION Ethics approvals have been granted by the University of Manitoba Research Ethics Board and from each of our FN/M/I partners' organisations. Our team is committed to engaging in authentic relationship-based research that follows First Nations, Metis and Inuit research ethics principles. Our FN/M/I partners will direct the dissemination of new information to leadership in their communities (health directors, community health organisations) and to decision-makers in the provincial Ministry of Health. We will also publish in open-access journals. The study will create ongoing capacity to monitor Manitoba's pandemic response and ensure potential health inequities are minimised, with learnings applicable to other jurisdictions where detailed administrative data may not be available.
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Affiliation(s)
- Nathan C Nickel
- Department of Community Health Sciences, University of Manitoba Faculty of Health Sciences, Winnipeg, Manitoba, Canada
| | - Wayne Clark
- Manitoba Inuit Association, Winnipeg, Manitoba, Canada
| | - Wanda Phillips-Beck
- First Nations Health and Social Secretariat of Manitoba, Winnipeg, Manitoba, Canada
- College of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Jennifer Emily Enns
- Department of Community Health Sciences, University of Manitoba Faculty of Health Sciences, Winnipeg, Manitoba, Canada
| | - Josée G Lavoie
- Department of Community Health Sciences, University of Manitoba Faculty of Health Sciences, Winnipeg, Manitoba, Canada
| | - Razvan Romanescu
- Biostatistics, University of Manitoba Faculty of Health Sciences, Winnipeg, Manitoba, Canada
| | - Alan Katz
- Department of Community Health Sciences, University of Manitoba Faculty of Health Sciences, Winnipeg, Manitoba, Canada
- Department of Family Medicine, University of Manitoba Faculty of Health Sciences, Winnipeg, Manitoba, Canada
| | - Alyson L Mahar
- Department of Community Health Sciences, University of Manitoba Faculty of Health Sciences, Winnipeg, Manitoba, Canada
| | - Marni Brownell
- Department of Community Health Sciences, University of Manitoba Faculty of Health Sciences, Winnipeg, Manitoba, Canada
| | - Lisa Lix
- Department of Community Health Sciences, University of Manitoba Faculty of Health Sciences, Winnipeg, Manitoba, Canada
| | - Marcelo Urquia
- Department of Community Health Sciences, University of Manitoba Faculty of Health Sciences, Winnipeg, Manitoba, Canada
| | - Miyosha Tso Deh
- Department of Community Health Sciences, University of Manitoba Faculty of Health Sciences, Winnipeg, Manitoba, Canada
| | - Carrie O'Conaill
- Department of Community Health Sciences, University of Manitoba Faculty of Health Sciences, Winnipeg, Manitoba, Canada
| | - Anita Durksen
- Department of Community Health Sciences, University of Manitoba Faculty of Health Sciences, Winnipeg, Manitoba, Canada
| | - Emily Brownell
- Department of Community Health Sciences, University of Manitoba Faculty of Health Sciences, Winnipeg, Manitoba, Canada
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