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Seghieri G, Gualdani E, Franconi F, Campesi I, Di Cianni G, Francesconi P. Pregestational exposure to hormonal combined contraceptives and risk of gestational diabetes: an observational retrospective population study. Acta Diabetol 2023; 60:1505-1511. [PMID: 37394532 DOI: 10.1007/s00592-023-02143-7] [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: 02/17/2023] [Accepted: 06/20/2023] [Indexed: 07/04/2023]
Abstract
AIMS To investigate whether pregestational exposure to oral combined hormonal contraception (CHC) is associated with a rise in the risk of gestational diabetes (GDM). METHODS Prevailing GDM was assessed for all pregnancies that occurred in Tuscany, Italy, from years 2010 to 2018, using administrative data coupled with information about CHC prescriptions in the year prior to pregnancy retrieved from the regional registry of drug prescription claims. The relation between exposure to CHC and risk of GDM, expressed as Odds Ratio: OR (95% Confidence Intervals, CI), was calculated separately based on citizenship of mothers using multiple logistic regression analysis models, after adjusting for confounders. RESULTS Among 210,791 pregnancies from 170,126 mothers, GDM was present in 22,166 (10.5%) pregnancies. CHC prescription within 12 months before the index pregnancy was present in 9065 (4.3%) mothers. The risk of GDM was weakly but significantly higher in pregnancies exposed to pregestational CHC only in pregnancies of mothers of Italian citizenship: OR:1.11 (95% CI 1.02-1.21); p = 0.02, after adjusting for age, parity, calendar year and pregestational body-mass index. The CHC-mediated effect was no longer present in pregnancies of mothers at higher risk of GDM, such as pregestational obesity, migrating from countries at higher GDM risk or after adjusting for the entire panel of confounders including employment status, prior spontaneous abortions, and education degree. CONCLUSIONS CHC had a modest effect on GDM risk, which became insignificant when added to basal prevailing risk factors for impaired glucose metabolism in pregnancy, such as pregestational obesity or originating from countries at high GDM risk.
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Affiliation(s)
- Giuseppe Seghieri
- Epidemiology Unit, Regional Health Agency of Tuscany, Via Pietro Dazzi 1, 50141, Florence, Italy.
- Department of Experimental and Clinical Medicine, Faculty of Physiatry, University of Florence, Florence, Italy.
| | - Elisa Gualdani
- Epidemiology Unit, Regional Health Agency of Tuscany, Via Pietro Dazzi 1, 50141, Florence, Italy
| | - Flavia Franconi
- National Laboratory of Sex Gender Medicine, National Institute of Biostructures and Biosystems, Sassari, Italy
| | - Ilaria Campesi
- National Laboratory of Sex Gender Medicine, National Institute of Biostructures and Biosystems, Sassari, Italy
- Department of Biomedical Science, University of Sassari, Sassari, Italy
| | - Graziano Di Cianni
- Diabetes and Metabolic Diseases Unit, Health Local Unit North-West Tuscany, Livorno, Italy
| | - Paolo Francesconi
- Epidemiology Unit, Regional Health Agency of Tuscany, Via Pietro Dazzi 1, 50141, Florence, Italy
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Mannucci M, Fontana V, Campanella D, Filiberti RA, Pronzato P, Rosa A. A Descriptive Study of Repeated Hospitalizations and Survival of Patients with Metastatic Melanoma in the Northern Italian Region during 2004-2019. Curr Oncol 2023; 30:5266-5278. [PMID: 37366883 DOI: 10.3390/curroncol30060400] [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: 04/04/2023] [Revised: 05/17/2023] [Accepted: 05/23/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Survival rates for metastatic melanoma (MM) patients have improved in recent years, leading to major expenses and health resource use. We conducted a non-concurrent prospective study to describe the burden of hospitalization in a real-world setting for patients with MM. METHODS Patients were tracked throughout all hospital stays in 2004-2019 by means of hospital discharges. The number of hospitalizations, the rehospitalization rate, the average time spent in the hospital and the time span between consecutive admissions were evaluated. Relative survival was also calculated. RESULTS Overall, 1570 patients were identified at the first stay (56.5% in 2004-2011 and 43.7% in 2012-2019). A total of 8583 admissions were retrieved. The overall rehospitalization rate was 1.78 per patient/year (95%CI = 1.68-1.89); it increased significantly with the period of first stay (1.51, 95%CI = 1.40-1.64 in 2004-2011 and 2.11, 95%CI = 1.94-2.29 thereafter). The median time span between hospitalizations was lower for patients hospitalized after 2011 (16 vs. 26 months). An improvement in survival for males was highlighted. CONCLUSIONS The hospitalization rate of patients with MM was higher in the last years of the study. Compared with a shorter length of stay, patients were admitted to hospitals with a higher frequency. Knowledge of the burden of MM is essential for planning the allocation of healthcare resources.
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Affiliation(s)
- Matilde Mannucci
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Vincenzo Fontana
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Dalila Campanella
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Rosa Angela Filiberti
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Paolo Pronzato
- Medical Oncology Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Alessandra Rosa
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
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Seghieri G, Gualdani E, Francia P, Campesi I, Franconi F, Di Cianni G, Francesconi P. Metrics of Gender Differences in Mortality Risk after Diabetic Foot Disease. J Clin Med 2023; 12:jcm12093288. [PMID: 37176728 PMCID: PMC10179088 DOI: 10.3390/jcm12093288] [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: 03/19/2023] [Revised: 04/27/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND The aim of this study was to clarify any gender differences in the mortality risk of people with DFD since patients with diabetic foot disease (DFD) are at a high risk of mortality and, at the same time, are more likely to be men. METHODS From regional administrative sources, the survival probability was retrospectively evaluated by the Kaplan-Meier method and using the Cox proportional-hazards model comparing people with DFD to those without DFD across the years 2011-2018 in Tuscany, Italy. Gender difference in mortality was evaluated by the ratio of hazard ratios (RHR) of men to women after initial DFD hospitalizations (n = 11,529) or in a cohort with prior history of DFD hospitalizations (n = 11,246). RESULTS In both cohorts, the survival probability after DFD was lower among women. Compared to those without DFD, after initial DFD hospitalizations, the mortality risk was significantly (18%) higher for men compared to women. This excess risk was particularly high after major amputations but also after ulcers, infections, gangrene, or Charcot, with a lower reduction after revascularization procedures among men. In the cohort that included people with a history of prior DFD hospitalizations, except for the risk of minor amputations being higher for men, there was no gender difference in mortality risk. CONCLUSIONS In people with DFD, the overall survival probability was lower among women. Compared to those without DFD after a first DFD hospitalization, men were at higher risk of mortality. This excess risk disappeared in groups with a history of previous DFD hospitalizations containing a greater percentage of women who were older and probably had a longer duration of diabetes and thus becoming, over time, progressively frailer than men.
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Affiliation(s)
- Giuseppe Seghieri
- Epidemiology Unit, Agenzia Regionale Sanità, 50141 Florence, Italy
- Faculty of Physiatry, University of Florence, 50121 Florence, Italy
| | - Elisa Gualdani
- Epidemiology Unit, Agenzia Regionale Sanità, 50141 Florence, Italy
| | - Piergiorgio Francia
- Department of Information Engineering, University of Florence, 50121 Florence, Italy
| | - Ilaria Campesi
- Laboratorio Nazionale di Farmacologia e Medicina di Genere, Istituto Nazionale Biostrutture Biosistemi, University of Sassari, 07100 Sassari, Italy
| | - Flavia Franconi
- Laboratorio Nazionale di Farmacologia e Medicina di Genere, Istituto Nazionale Biostrutture Biosistemi, University of Sassari, 07100 Sassari, Italy
| | - Graziano Di Cianni
- Diabetes and Metabolic Diseases Unit, Health Local Unit North-West Tuscany, 57121 Livorno, Italy
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Descriptive Epidemiology of Hospitalization of Patients with a Rare Tumor in an Italian Region. Curr Oncol 2022; 29:9711-9721. [PMID: 36547176 PMCID: PMC9776515 DOI: 10.3390/curroncol29120762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/23/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Rare tumors (RT) collectively account for one quarter of all malignancies in Italy. The low frequency and the large heterogeneity in natural history and outcome of individual diseases, together with a scarcity of epidemiological information make them a challenge for clinical practice, as well as for public healthcare organizations. We conducted a retrospective study to quantify the burden of hospitalization in a real-word setting in patients diagnosed with these diseases in an Italian region. METHODS RT patients were tracked along all hospital stays from 2000 to 2019 using hospital discharge records. Frequency of hospitalizations, average time spent in hospital and median timespan between consecutive admissions were considered. Re-hospitalization rates were analyzed through a multivariable negative binomial regression analysis to adjust for confounding and allowing for over-dispersion in count data. RESULTS As a whole, 57,329 patients were identified at first stay for all studied tumors. A total of 183,959 admissions were retrieved, along a median of 3 hospitalizations per patient. Median timespan between hospitalizations shortened in the course of the study years (12.5 months in 2000-2004 to 5.4 months in 2015-2019). The overall re-hospitalization rate increased from 0.92 per patient/year (95% CI = 0.81-1.04) in 2000-2004 to 2.17 (95% CI = 1.90-2.47) in 2015-2019. CONCLUSIONS Overall, the hospitalization rate of patients with a RT increased in the twenty years since the 2000 and particularly doubled starting from 2015. A higher burden of hospitalizations was found for tumors of the central nervous system, thoracic cavity, digestive tract and sarcomas. To the best of our knowledge this is the first paper related to access to Italian healthcare facilities of patients with these tumors.
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Miele L, Grattagliano I, Lapi F, Dajko M, De Magistris A, Liguori A, De Matthaeis N, Rossi A, Gasbarrini A, Cricelli C, Grieco A. Non-alcoholic fatty liver disease and the risk of fibrosis in Italian primary care services: GPS-NAFLD Study: GPS-NAFLD Study. Liver Int 2022; 42:2632-2645. [PMID: 36169605 PMCID: PMC9827935 DOI: 10.1111/liv.15443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND AIMS The prevalence of non-alcoholic fatty liver disease (NAFLD) is increasing globally. This study aimed to determine the prevalence of NAFLD and the probability of liver fibrosis in Italian primary care services. METHODS We carried out a population-based and nested case-control study including all individuals aged 18 years and above registered at Italian primary care services. Data were collected from the general practitioners' network from 2010 to 2017. NAFLD cases were identified via the ICD-9-CM and Hepatic Steatosis Index score > 36 and were matched each up to 10 controls. Other causes of liver diseases were excluded. The risk of fibrosis was assessed using the FIB-4 and NAFLD fibrosis scores (NFS). RESULTS NAFLD was present in 9% of the primary care population with high regional variability. Among NAFLD subjects: 25% had diabetes, 10% had chronic kidney disease, 11% had cardiovascular disease and 28% were obese. Furthermore, 30% had at least two comorbidities and 13% had cirrhosis. Once cirrhosis was excluded, the risk of any degree of fibrosis was 13.8% with NFS and 20.5% with FIB-4 in subjects <65 years. CONCLUSIONS Even if there is an identification gap in primary care, recorded cases with NAFLD have a high frequency of associated comorbidities. Despite regional variability, a close relation between cirrhosis and NAFLD exists (OR: 3.48, 95% CI: 3.23-3.76). Therefore, the use of non-invasive tests should be promoted in primary care as a useful tool for the early identification of fibrosis risk, independently of evidence of steatosis.
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Affiliation(s)
- Luca Miele
- DiSMeC – Department of Scienze Mediche e ChirurgicheFondazione Policlinico Gemelli IRCCSRomeItaly,Department of Medicina e Chirurgia TraslazionaleUniversità Cattolica Del Sacro CuoreRomeItaly
| | | | - Francesco Lapi
- Health SearchItalian College of General Practitioners and Primary CareFlorenceItaly
| | - Marianxhela Dajko
- DiSMeC – Department of Scienze Mediche e ChirurgicheFondazione Policlinico Gemelli IRCCSRomeItaly
| | - Antonio De Magistris
- Department of Medicina e Chirurgia TraslazionaleUniversità Cattolica Del Sacro CuoreRomeItaly
| | - Antonio Liguori
- DiSMeC – Department of Scienze Mediche e ChirurgicheFondazione Policlinico Gemelli IRCCSRomeItaly
| | - Nicoletta De Matthaeis
- DiSMeC – Department of Scienze Mediche e ChirurgicheFondazione Policlinico Gemelli IRCCSRomeItaly
| | - Alessandro Rossi
- SIMGItalian College of General Practitioners and Primary CareFlorenceItaly
| | - Antonio Gasbarrini
- DiSMeC – Department of Scienze Mediche e ChirurgicheFondazione Policlinico Gemelli IRCCSRomeItaly,Department of Medicina e Chirurgia TraslazionaleUniversità Cattolica Del Sacro CuoreRomeItaly
| | - Claudio Cricelli
- SIMGItalian College of General Practitioners and Primary CareFlorenceItaly,Health SearchItalian College of General Practitioners and Primary CareFlorenceItaly
| | - Antonio Grieco
- DiSMeC – Department of Scienze Mediche e ChirurgicheFondazione Policlinico Gemelli IRCCSRomeItaly,Department of Medicina e Chirurgia TraslazionaleUniversità Cattolica Del Sacro CuoreRomeItaly
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Rachas A, Gastaldi-Ménager C, Denis P, Barthélémy P, Constantinou P, Drouin J, Lastier D, Lesuffleur T, Mette C, Nicolas M, Pestel L, Rivière S, Tajahmady A, Gissot C, Fagot-Campagna A. The Economic Burden of Disease in France From the National Health Insurance Perspective: The Healthcare Expenditures and Conditions Mapping Used to Prepare the French Social Security Funding Act and the Public Health Act. Med Care 2022; 60:655-664. [PMID: 35880776 PMCID: PMC9365254 DOI: 10.1097/mlr.0000000000001745] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Identifying the most frequently treated and the costliest health conditions is essential for prioritizing actions to improve the resilience of health systems. OBJECTIVES Healthcare Expenditures and Conditions Mapping describes the annual economic burden of 58 health conditions to prepare the French Social Security Funding Act and the Public Health Act. DESIGN Annual cross-sectional study (2015-2019) based on the French national health database. SUBJECTS National health insurance beneficiaries (97% of the French residents). MEASURES All individual health care expenditures reimbursed by the national health insurance were attributed to 58 health conditions (treated diseases, chronic treatments, and episodes of care) identified by using algorithms based on available medical information (diagnosis coded during hospital stays, long-term diseases, and specific drugs). RESULTS In 2019, €167.0 billion were reimbursed to 66.3 million people (52% women, median age: 42 y). The most prevalent treated diseases were diabetes (6.0%), chronic respiratory diseases (5.5%), and coronary diseases (3.2%). Coronary diseases accounted for 4.6% of expenditures, neurotic and mood disorders 3.7%, psychotic disorders 2.8%, and breast cancer 2.1%. Between 2015 and 2019, the expenditures increased primarily for diabetes (+€906 million) and neurotic and mood disorders (+€861 million) due to the growing number of patients. "Active lung cancer" (+€797 million) represented the highest relative increase (+54%) due to expenditures for the expensive drugs and medical devices delivered at hospital. CONCLUSIONS These results have provided policy-makers, evaluators, and public health specialists with key insights into identifying health priorities and a better understanding of trends in health care expenditures in France.
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Affiliation(s)
- Antoine Rachas
- Direction de la stratégie, des études et des statistiques, Caisse Nationale d’Assurance Maladie, Paris, France
| | - Christelle Gastaldi-Ménager
- Direction de la stratégie, des études et des statistiques, Caisse Nationale d’Assurance Maladie, Paris, France
| | - Pierre Denis
- Direction de la stratégie, des études et des statistiques, Caisse Nationale d’Assurance Maladie, Paris, France
| | - Pauline Barthélémy
- Direction de la stratégie, des études et des statistiques, Caisse Nationale d’Assurance Maladie, Paris, France
| | - Panayotis Constantinou
- Direction de la stratégie, des études et des statistiques, Caisse Nationale d’Assurance Maladie, Paris, France
| | - Jérôme Drouin
- Direction de la stratégie, des études et des statistiques, Caisse Nationale d’Assurance Maladie, Paris, France
| | - Dimitri Lastier
- Direction de la stratégie, des études et des statistiques, Caisse Nationale d’Assurance Maladie, Paris, France
| | - Thomas Lesuffleur
- Direction de la stratégie, des études et des statistiques, Caisse Nationale d’Assurance Maladie, Paris, France
| | - Corinne Mette
- Direction de la stratégie, des études et des statistiques, Caisse Nationale d’Assurance Maladie, Paris, France
| | - Muriel Nicolas
- Direction de la stratégie, des études et des statistiques, Caisse Nationale d’Assurance Maladie, Paris, France
| | - Laurence Pestel
- Direction de la stratégie, des études et des statistiques, Caisse Nationale d’Assurance Maladie, Paris, France
| | - Sébastien Rivière
- Direction de la stratégie, des études et des statistiques, Caisse Nationale d’Assurance Maladie, Paris, France
| | - Ayden Tajahmady
- Direction de la stratégie, des études et des statistiques, Caisse Nationale d’Assurance Maladie, Paris, France
| | - Claude Gissot
- Direction de la stratégie, des études et des statistiques, Caisse Nationale d’Assurance Maladie, Paris, France
| | - Anne Fagot-Campagna
- Direction de la stratégie, des études et des statistiques, Caisse Nationale d’Assurance Maladie, Paris, France
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Profili F, Seghieri G, Francesconi P. Effect of diabetes on short-term mortality and incidence of first hospitalizations for cardiovascular events after recovery from SARS-CoV-2 infection. Diabetes Res Clin Pract 2022; 187:109872. [PMID: 35429573 PMCID: PMC9006403 DOI: 10.1016/j.diabres.2022.109872] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/06/2022] [Accepted: 04/10/2022] [Indexed: 11/16/2022]
Abstract
AIM To evaluate the impact of diabetes and COVID-19 on all-cause-mortality and first hospitalizations for cardiovascular events (CVE): myocardial infarction or stroke, within six months after being tested positive and having recovered from SARS-CoV-2 infection. METHODS Resident population in Tuscany, Italy of age 45-94 yr without prior hospitalization for CVE, tested positive for SARS-CoV-2 by March 1st, 2020 and afterwards recovering from COVID-19 was compared with age, gender and diabetes matched controls without infection, for incidence rate ratio (IRR) of all-cause-deaths or first CVE at six months follow up. RESULTS 46,152 subjects of whom 4,597 with diabetes, tested positive and recovered from SARS-CoV-2 were compared with 1:1 age, gender and diabetes matched controls without infection. COVID-19 was associated with higher all-cause-mortality: IRR:1.92(95 %CI:1.63-2.25) while diabetes with increased risk of first CVE hospitalizations: IRR:2.24(2.18-4.25). Co-presence of COVID-19 and diabetes didn't add any additional excess risk. Being women and statins' use significantly reduced death risk. CONCLUSIONS After recovery from COVID-19, independently of diabetes, all-cause-mortality risk at six months was twofold increased, while risk of first CVE hospitalization remained unmodified. Diabetes, independently of prior COVID-19, resulted in higher six-months risk of first CVE not of death. Female gender and statins' use reduced both excess risks.
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Seghieri G, Di Cianni G, Gualdani E, De Bellis A, Franconi F, Francesconi P. The impact of fetal sex on risk factors for gestational diabetes and related adverse pregnancy outcomes. Acta Diabetol 2022; 59:633-639. [PMID: 35037136 DOI: 10.1007/s00592-021-01836-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/29/2021] [Indexed: 12/18/2022]
Abstract
AIMS To investigate whether fetal sex affects the impact of classical GDM risk factors on the diagnosis of gestational diabetes (GDM) as well as on related adverse pregnancy outcomes. METHODS This retrospective observational study concerned 206,917 singleton live births born to 170,126 women aged 15-45 over the years 2010-2018 in Tuscany, Italy. GDM was identified by administrative data-sources in 21,613 pregnancies (10.5%) by assessing, through multiple logistic models, whether fetal sex modified the risk of GDM driven by maternal risk factors, and whether it modified the risk of adverse outcomes such as prematurity (birth ≤ 37th gestational week), large for gestational age (LGA), unplanned caesarean sections, or 5-min-Apgar-index ≤ 7 in pregnancies with GDM. RESULTS GDM was diagnosed in 21,613 pregnancies (10.5%). Male fetal sex predicted a higher adjusted risk of GDM: OR = 1.05(95% CI: 1.01-1.07); p < 0.0009. In pregnancies with female sex, pre-pregnancy obesity amplified the risk of GDM: OR = 1.09(95% CI: 1.01-1.19); p = 0.04. In pregnancies with GDM, carrying a female fetus increased the risk of LGA associated with pregestational obesity OR = 1.45(95% CI: 1.15-1.81); p = 0.001, and in primiparous pregnancies, it protected mothers from the risk of unplanned caesarean sections OR = 0.80(95%CI: 0.67-0.92); p = 0.001. CONCLUSIONS While male fetal sex is associated with rise in the risk of GDM, giving birth to a girl amplifies the excess GDM risk driven by pregestational obesity, thus increasing the risk of LGA in pregnancies with GDM. Additionally, female fetal sex in pregnancies with GDM seems to protect from the risk of unplanned caesarean sections in primiparous pregnancies.
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Affiliation(s)
- Giuseppe Seghieri
- Epidemiology Unit, Regional Health Agency of Tuscany, Via Pietro Dazzi 1, 50141, Florence, Italy.
| | - Graziano Di Cianni
- Diabetes and Metabolic Diseases Unit, Health Local Unit North-West Tuscany, Livorno, Italy
| | - Elisa Gualdani
- Epidemiology Unit, Regional Health Agency of Tuscany, Via Pietro Dazzi 1, 50141, Florence, Italy
| | - Alessandra De Bellis
- Diabetes and Metabolic Diseases Unit, "San Giovanni di Dio Hospital", Florence, Italy
| | - Flavia Franconi
- Laboratorio Nazionale di Farmacologia e Medicina di Genere, Istituto Nazionale Biostrutture Biosistemi, University of Sassari, Sassari, Italy
| | - Paolo Francesconi
- Epidemiology Unit, Regional Health Agency of Tuscany, Via Pietro Dazzi 1, 50141, Florence, Italy
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Mortality Risk Associated with Diabetic Foot Complications in People with or without History of Diabetic Foot Hospitalizations. J Clin Med 2022; 11:jcm11092454. [PMID: 35566581 PMCID: PMC9105877 DOI: 10.3390/jcm11092454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/17/2022] [Accepted: 04/25/2022] [Indexed: 02/04/2023] Open
Abstract
The aim of this study was to evaluate the risk of death after hospitalizations for diabetic foot (DF) complications, comparing two different cohorts of people with or without a prior history of DF hospitalizations across the years 2011 to 2018 in Tuscany, Italy. The DF complications were categorized by administrative source datasets such as: amputations (both major and minor), gangrene, ulcers, infections, Charcot and revascularizations. A further aim was to present the trend over time of the first ever incidents of diabetic foot hospitalizations in Tuscany. The eight-year-mortality rate was higher in the cohort with prior hospitalizations (n = 6633; 59%) compared with the cohort with first incident DF hospitalizations (n = 5028; 44%). Amputations (especially major ones) and ulcers had the worst effect on survival in people without basal history of DF hospitalizations and respectively in those with a history of prior DF hospitalizations. In both cohorts, revascularization procedures, when compared to ulcers, were associated with a significantly reduced risk of mortality. The prevalence rate of minor amputations showed a slightly rising trend over time. This result agrees with the national trend. Conversely, the progressive increase over time of revascularizations, associated with the fractional decrease in the rate of gangrene, suggests a trend for more proactive behavior by DF care teams in Tuscany.
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Seghieri G, Policardo L, Gualdani E, Francesconi P. Gender Differences in the Risk of Adverse Outcomes After Incident Diabetic Foot Hospitalization: A Population Cohort Study. Curr Diabetes Rev 2022; 18:e270821195904. [PMID: 34455962 DOI: 10.2174/1573399817666210827121937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 05/25/2021] [Accepted: 05/31/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Diabetic Foot Disease (DFD) is more prevalent among males and is associated with an excess risk of cardiovascular events or mortality. AIMS This study aimed at exploring the risk of cardiovascular events, renal failure, and all-cause mortality after incident DFD hospitalizations, separately in males and females, to detect any gender difference in a cohort of 322,140 people with diabetes retrospectively followed up through administrative data sources in Tuscany, Italy, over the years 2011-2018. METHODS The Hazard Ratio (HR) for incident adverse outcomes after first hospitalizations for DFD, categorized as major/minor amputations (No.=449;3.89%), lower limbs' revascularizations (LLR: No.=2854;24.75%), and lower-extremity-arterial-disease (LEAD) with no procedures (LEAD-no proc: No.=6282;54.49%), was compared to the risk of patients having a background of DFD (ulcers, infections, Charcot-neuroarthropathy: No.=1,944;16.86%). RESULTS DFD incidence rate was higher among males compared to females (1.57(95% CI:1.54-1.61) vs. 0.97(0.94-1.00)/100,000p-years]. After DFD, the overall risk of coronary artery disease was significantly associated with the male gender and of stroke with the female gender. LEAD-no proc and LLR were associated with the risk of stroke only in females, whereas they were found to be associated with the risk of coronary artery disease among females to a significantly greater extent compared to males. The incident of renal failure was not associated with any DFD category. Amputations and LEAD-no proc significantly predicted high mortality risk only in females, while LLR showed reduced risk in both genders. Moreover, females had a greater risk of composite outcomes (death or cardiovascular events). Compared to the background of DFD, the risk was found to be 34% higher after amputations (HR: 1.34(1.04-1.72)) and 10% higher after LEAD-no proc (HR:1.10(1.03-1.18)), confirming that after incident DFD associated with vascular pathogenesis, females are at an increased risk of adverse events. CONCLUSION After incident DFD hospitalizations, females with DFD associated with amputations or arterial disease are at a greater risk of subsequent adverse cardiovascular events than those with a DFD background.
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Affiliation(s)
- Giuseppe Seghieri
- Department of Epidemiology Unit, Regional Health Agency of Tuscany, Florence, Italy, Via Pietro Dazzi 1, Italy
| | - Laura Policardo
- Department of Epidemiology Unit, Regional Health Agency of Tuscany, Florence, Italy, Via Pietro Dazzi 1, Italy
| | - Elisa Gualdani
- Department of Epidemiology Unit, Regional Health Agency of Tuscany, Florence, Italy, Via Pietro Dazzi 1, Italy
| | - Paolo Francesconi
- Department of Epidemiology Unit, Regional Health Agency of Tuscany, Florence, Italy, Via Pietro Dazzi 1, Italy
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11
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Lapi F, Domnich A, Marconi E, Rossi A, Grattagliano I, Lagolio E, Medea G, Sessa A, Cricelli I, Icardi G, Cricelli C. Predicting the risk of severe COVID-19 outcomes in primary care: development and validation of a vulnerability index for equitable allocation of effective vaccines. Expert Rev Vaccines 2021; 21:377-384. [PMID: 34913796 DOI: 10.1080/14760584.2022.2019582] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND General practitioners (GPs) need a valid, user-friendly tool to identify patients most vulnerable to COVID-19, especially in the hypothesis of a booster vaccine dose. The aim of this study was to develop and validate a GP-friendly prognostic index able to forecast severe COVID-19 outcomes in primary care. Indeed, no such prognostic score is as yet available in Italy. RESEARCH DESIGN AND METHODS In this retrospective cohort study, a representative sample of 47,868 Italian adults were followed up for 129,000 person-months. The study outcome was COVID-19-related hospitalization and/or death. Candidate predictors were chosen on the basis of systematic evidence and current recommendations. The model was calibrated by using Cox regression. Both internal and external validations were performed. RESULTS Age, sex and several clinical characteristics were significantly associated with severe outcomes. The final multivariable model explained 60% (95%CI 58-63%) of variance for COVID-19-related hospitalizations and/or deaths. The area under the receiver-operator curve (AUC) was 84% (95% CI: 83-85%). On applying the index to an external cohort, the AUC was 94% (95% CI: 93-95%). CONCLUSIONS This index is a reliable prognostic tool that can help GPs to prioritize their patients for preventive and therapeutic interventions.
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Affiliation(s)
- Francesco Lapi
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Alexander Domnich
- Hygiene Unit, San Martino Policlinico Hospital - Irccs for Oncology and Neurosciences, Genoa, Italy
| | - Ettore Marconi
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Alessandro Rossi
- Italian College of General Practitioners and Primary Care, Florence, Italy
| | | | - Erik Lagolio
- Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Gerardo Medea
- Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Aurelio Sessa
- Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Iacopo Cricelli
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Giancarlo Icardi
- Hygiene Unit, San Martino Policlinico Hospital - Irccs for Oncology and Neurosciences, Genoa, Italy.,Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Claudio Cricelli
- Italian College of General Practitioners and Primary Care, Florence, Italy
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12
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Gualdani E, Di Cianni G, Seghieri M, Francesconi P, Seghieri G. Pregnancy outcomes and maternal characteristics in women with pregestational and gestational diabetes: a retrospective study on 206,917 singleton live births. Acta Diabetol 2021; 58:1169-1176. [PMID: 33835261 DOI: 10.1007/s00592-021-01710-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 03/20/2021] [Indexed: 12/27/2022]
Abstract
AIMS To examine risk of adverse pregnancy outcomes, mothers' characteristics and incidence rate over time of pregestational type 1 (T1D), type 2 (T2D) or gestational diabetes (GDM). METHODS The study included all singleton live births born from women aged 15-45 year, in Tuscany, Italy from 2010 to 2018. Pregnancy outcomes were retrieved by certificates of care at delivery compiled by midwives. Pregestational diabetes and GDM were identified by regional administrative databases. Time course of pregestational diabetes and GDM across last decade was assessed by Poisson analysis. Logistic regression analysis was used to calculate adjusted odds ratios (OR; 95% CI) for maternal characteristics or neonatal outcomes. RESULTS Among 206,917 singleton live births, GDM was diagnosed in 21,613 pregnancies (10.46%) and pregestational diabetes in 979, being T2D more prevalent than T1D (606; 0.29% vs. 373; 0.18%). Pregestational T2D incidence progressively decreased over last decade, T1D remained stable while GDM progressively rose. Pre-pregnancy obesity, preterm deliveries or cesarean sections were common characteristics of pregestational diabetes and GDM. Risk of neonatal distress and neonatal malformations was higher in pregestational T1D. Risk of prior spontaneous abortions was higher in GDM and in pregestational T2D (OR: 4.19; 3.30-5.33), mostly treated with metformin. Risk of neonatal macrosomia was increased only in pregestational diabetes. CONCLUSIONS In our population, pregestational T2D was more prevalent than T1D. Neonatal complications were mostly associated with pregestational T1D. Increased risk of previous spontaneous abortions was the hallmark of pregestational T2D. GDM, even if sharing adverse outcomes with pregestational T2D, was unrelated to rise in risk of neonatal macrosomia.
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Affiliation(s)
- Elisa Gualdani
- Epidemiology Unit, Regional Health Agency of Tuscany, Via Pietro Dazzi 1, 50141, Florence, Italy
| | - Graziano Di Cianni
- Diabetes and Metabolic Diseases Unit, Health Local Unit North-West Tuscany, Livorno, Italy
| | - Marta Seghieri
- Diabetes and Metabolic Diseases Unit, "San Giovanni Di Dio" Hospital, Florence, Italy
| | - Paolo Francesconi
- Epidemiology Unit, Regional Health Agency of Tuscany, Via Pietro Dazzi 1, 50141, Florence, Italy
| | - Giuseppe Seghieri
- Epidemiology Unit, Regional Health Agency of Tuscany, Via Pietro Dazzi 1, 50141, Florence, Italy.
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13
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Cascini S, Agabiti N, Davoli M, Uccioli L, Meloni M, Giurato L, Marino C, Bargagli AM. Survival and factors predicting mortality after major and minor lower-extremity amputations among patients with diabetes: a population-based study using health information systems. BMJ Open Diabetes Res Care 2020; 8:8/1/e001355. [PMID: 32690575 PMCID: PMC7371030 DOI: 10.1136/bmjdrc-2020-001355] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 06/01/2020] [Accepted: 06/16/2020] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION The aim of the study was to identify the sociodemographic and clinical factors associated with death after the first lower-extremity amputation (LEA), minor and major separately, using data from regional health administrative databases. RESEARCH DESIGN AND METHODS We carried out a population-based cohort study including patients with diabetes residing in the Lazio region and undergoing a primary amputation in the period 2012-2015. Each individual was followed up for at least 2 years. Kaplan-Meier analysis was used to evaluate long-term survival; Cox proportional regression models were applied to identify factors associated with all-cause mortality. RESULTS The cohort included 1053 patients, 72% were male, 63% aged ≥65 years, and 519 (49%) died by the end of follow-up. Mortality rates at 1 and 4 years were, respectively, 33% and 65% for major LEA and 18% and 45% for minor LEA. Significant risk factors for mortality were age ≥65, diabetes-related cardiovascular complications, and chronic renal disease for patients with minor LEA, and age ≥75 years, chronic renal disease and antidepressant drug consumption for subjects with major LEA. CONCLUSIONS The present study confirms the high mortality rates described in patients with diabetes after non-traumatic LEA. It shows differences between minor and major LEA in terms of mortality rates and related risk factors. The study highlights the role of depression as specific risk factor for death in patients with diabetes after major LEA and suggests including its definition and management in strategies to reduce the high mortality rate observed in this group of patients.
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Affiliation(s)
- Silvia Cascini
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Nera Agabiti
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Marina Davoli
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Luigi Uccioli
- Department of Internal Medicine, University of Rome Tor Vergata, Rome, Lazio, Italy
| | - Marco Meloni
- Department of Internal Medicine, University of Rome Tor Vergata, Rome, Lazio, Italy
| | - Laura Giurato
- Department of Internal Medicine, University of Rome Tor Vergata, Rome, Lazio, Italy
| | - Claudia Marino
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
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14
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Lovestone S. The European medical information framework: A novel ecosystem for sharing healthcare data across Europe. Learn Health Syst 2020; 4:e10214. [PMID: 32313838 PMCID: PMC7156868 DOI: 10.1002/lrh2.10214] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 11/27/2019] [Accepted: 11/29/2019] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION The European medical information framework (EMIF) was an Innovative Medicines Initiative project jointly supported by the European Union and the European Federation of Pharmaceutical Industries and Associations, that generated a common technology and governance framework to identify, assess and (re)use healthcare data, to facilitate real-world data research. The objectives of EMIF included providing a unified platform to support a wide range of studies within two verification programmes-Alzheimer's disease (EMIF-AD), and metabolic consequences of obesity (EMIF-MET). METHODS The EMIF platform was built around two main data-types: electronic health record data and research cohort data, and the platform architecture composed of a set of tools designed to enable data discovery and characterisation. This included the EMIF catalogue, which allowed users to find relevant data sources, including the data-types collected. Data harmonisation via a common data model were central to the project especially for population data sources. EMIF also developed an ethical code of practice to ensure data protection, patient confidentiality and compliance with the European Data Protection Directive, and GDPR. RESULTS Currently 18 population-based disease agnostic and 60 cohort-based Alzheimer's data partners from across 14 countries are contained within the catalogue, and this will continue to expand. The work conducted in EMIF-AD and EMIF-MET includes standardizing cohorts, summarising baseline characteristics of patients, developing diagnostic algorithms, epidemiological studies, identifying and validating novel biomarkers and selecting potential patient samples for pharmacological intervention. CONCLUSIONS EMIF was designed to provide a sustainable model as demonstrated by the sustainability plans for EMIF-AD. Although network-wide studies using EMIF were not conducted during this project to evaluate its sustainability, learning from EMIF will be used in the follow-on IMI-2 project, European Health Data and Evidence Network (EHDEN). Furthermore, EMIF has facilitated collaborations between partners and continues to promote a wider adoption of principles, technology and architecture through some of its continued work.
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Affiliation(s)
- Simon Lovestone
- Neurodegeneration, Janssen R&D, Janssen Pharmaceutica, Beerse, Belgium
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15
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Rucci P, Avaldi VM, Travaglini C, Ugolini C, Berti E, Moro ML, Fantini MP. Medical Costs of Patients with Type 2 Diabetes in a Single Payer System: A Classification and Regression Tree Analysis. PHARMACOECONOMICS - OPEN 2020; 4:181-190. [PMID: 31325148 PMCID: PMC7018859 DOI: 10.1007/s41669-019-0166-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND OBJECTIVES Many studies and systematic reviews have estimated the healthcare costs of diabetes using a cost-of-illness approach. However, in the studies based on this approach patients' heterogeneity is rarely taken into account. The aim of this study was to stratify patients with type 2 diabetes into homogeneous cost groups based on demographic and clinical characteristics. METHODS We conducted a retrospective cost-of-illness study by linking individual data on health services utilization retrieved from the administrative databases of Emilia-Romagna Region (Italy). Direct medical costs (either all-cause or diabetes-related) were calculated from the perspective of the regional health service, using tariffs for hospitalizations and outpatient services and the unit costs of prescriptions for drugs. The determinants of costs identified in a generalized linear regression model were used to characterize subgroups of patients with homogeneous costs in a classification and regression tree analysis. RESULTS The study population consisted of a cohort of 101,334 patients with type 2 diabetes, followed up for 1 year, with a mean age of 70.9 years. Age, gender, complications, comorbidities and living area accounted significantly for cost variability. The classification tree identified ten patient subgroups with different costs, ranging from a median of €483 to €39,578. The two subgroups with highest costs comprised dialysis patients, and the largest subgroup (57.9%) comprised patients aged ≥ 65 years without renal, cardiovascular and cerebrovascular complications. CONCLUSIONS Classification of patients into homogeneous cost subgroups can be used to improve the management of, and budget allocation for, patients with type 2 diabetes.
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Affiliation(s)
- Paola Rucci
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, via san Giacomo 12, 40126, Bologna, Italy
| | - Vera Maria Avaldi
- Advanced School for Healthcare Policies, Alma Mater Studiorum University of Bologna, via San Giacomo 12, 40126, Bologna, Italy.
| | - Claudio Travaglini
- Department of Management, Alma Mater Studiorum University of Bologna, via Capo di Lucca 34, Bologna, Italy
| | - Cristina Ugolini
- Department of Economics and Advanced School for Healthcare Policies, Alma Mater Studiorum University of Bologna, Piazza Scaravilli 2, 40126, Bologna, Italy
| | - Elena Berti
- Regional Agency for Health and Social Care, Viale Aldo Moro 21, 40127, Bologna, Italy
| | - Maria Luisa Moro
- Regional Agency for Health and Social Care, Viale Aldo Moro 21, 40127, Bologna, Italy
| | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, via san Giacomo 12, 40126, Bologna, Italy
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16
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Mitratza M, Kunst AE, Harteloh PPM, Nielen MMJ, Klijs B. Prevalence of diabetes mellitus at the end of life: An investigation using individually linked cause-of-death and medical register data. Diabetes Res Clin Pract 2020; 160:108003. [PMID: 31911247 DOI: 10.1016/j.diabres.2020.108003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 12/12/2019] [Accepted: 12/31/2019] [Indexed: 11/17/2022]
Abstract
AIMS Although diabetes mellitus at the end of life is associated with complex care, its end-of-life prevalence is uncertain. Our aim is to estimate diabetes prevalence in the end-of-life population, to evaluate which medical register has the largest added value to cause-of-death data in detecting diabetes cases, and to assess the extent to which reporting of diabetes as a cause of death is associated with disease severity. METHODS Our study population consisted of deaths in the Netherlands (2015-2016) included in Nivel Primary Care Database (Nivel-PCD; N = 18,162). The proportion of deaths with diabetes (Type 1 or 2) within the last two years of life was calculated using individually linked cause-of-death, general practice, medication, and hospital discharge data. Severity status of diabetes was defined with dispensed medicines. RESULTS According to all data sources combined, 28.7% of the study population had diabetes at the end of life. The estimated end-of-life prevalence of diabetes was 7.7% using multiple cause-of-death data only. Addition of general practice data increased this estimate the most (19.7%-points). Of the cases added by primary care data, 76.3% had a severe or intermediate status. CONCLUSIONS More than one fourth of the Dutch end-of-life population has diabetes. Cause-of-death data are insufficient to monitor this prevalence, even of severe cases of diabetes, but could be enriched particularly with general practice data.
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Affiliation(s)
- Marianna Mitratza
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - Anton E Kunst
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Peter P M Harteloh
- Department of Health and Care, Statistics Netherlands, The Hague, the Netherlands
| | - Markus M J Nielen
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, the Netherlands
| | - Bart Klijs
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Health and Care, Statistics Netherlands, The Hague, the Netherlands
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17
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Gothe H, Rajsic S, Vukicevic D, Schoenfelder T, Jahn B, Geiger-Gritsch S, Brixner D, Popper N, Endel G, Siebert U. Algorithms to identify COPD in health systems with and without access to ICD coding: a systematic review. BMC Health Serv Res 2019; 19:737. [PMID: 31640678 PMCID: PMC6805625 DOI: 10.1186/s12913-019-4574-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 09/30/2019] [Indexed: 02/03/2023] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) causes significant morbidity and mortality worldwide. Estimation of incidence, prevalence and disease burden through routine insurance data is challenging because of under-diagnosis and under-treatment, particularly for early stage disease in health care systems where outpatient International Classification of Diseases (ICD) diagnoses are not collected. This poses the question of which criteria are commonly applied to identify COPD patients in claims datasets in the absence of ICD diagnoses, and which information can be used as a substitute. The aim of this systematic review is to summarize previously reported methodological approaches for the identification of COPD patients through routine data and to compile potential criteria for the identification of COPD patients if ICD codes are not available. Methods A systematic literature review was performed in Medline via PubMed and Google Scholar from January 2000 through October 2018, followed by a manual review of the included studies by at least two independent raters. Study characteristics and all identifying criteria used in the studies were systematically extracted from the publications, categorized, and compiled in evidence tables. Results In total, the systematic search yielded 151 publications. After title and abstract screening, 38 publications were included into the systematic assessment. In these studies, the most frequently used (22/38) criteria set to identify COPD patients included ICD codes, hospitalization, and ambulatory visits. Only four out of 38 studies used methods other than ICD coding. In a significant proportion of studies, the age range of the target population (33/38) and hospitalization (30/38) were provided. Ambulatory data were included in 24, physician claims in 22, and pharmaceutical data in 18 studies. Only five studies used spirometry, two used surgery and one used oxygen therapy. Conclusions A variety of different criteria is used for the identification of COPD from routine data. The most promising criteria set in data environments where ambulatory diagnosis codes are lacking is the consideration of additional illness-related information with special attention to pharmacotherapy data. Further health services research should focus on the application of more systematic internal and/or external validation approaches.
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Affiliation(s)
- Holger Gothe
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Eduard Wallnoefer Zentrum 1, A-6060, Hall i.T., Austria. .,Medical Faculty "Carl Gustav Carus", Technical University Dresden, Loescherstrasse 18, D-01307, Dresden, Germany.
| | - Sasa Rajsic
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Eduard Wallnoefer Zentrum 1, A-6060, Hall i.T., Austria
| | - Djurdja Vukicevic
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Eduard Wallnoefer Zentrum 1, A-6060, Hall i.T., Austria
| | - Tonio Schoenfelder
- Medical Faculty "Carl Gustav Carus", Technical University Dresden, Loescherstrasse 18, D-01307, Dresden, Germany
| | - Beate Jahn
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Eduard Wallnoefer Zentrum 1, A-6060, Hall i.T., Austria
| | - Sabine Geiger-Gritsch
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Eduard Wallnoefer Zentrum 1, A-6060, Hall i.T., Austria
| | - Diana Brixner
- University of Utah, School of Medicine, Salt Lake City, UT, 84132, USA
| | - Niki Popper
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Eduard Wallnoefer Zentrum 1, A-6060, Hall i.T., Austria.,, dwh Gmbh, Neustiftgasse 57-59, A-1070, Vienna, Austria.,TU Wien, Research Unit of Information and Software Engineering, Vienna, Austria
| | - Gottfried Endel
- Evidence-Based Medicine and Health Technology Assessment, Main Association of Austrian Social Insurance Institutions, Kundmanngasse 21, A-1031, Vienna, Austria
| | - Uwe Siebert
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Eduard Wallnoefer Zentrum 1, A-6060, Hall i.T., Austria.,Division of Health Technology Assessment and Bioinformatics, ONCOTYROL - Center for Personalized Cancer Medicine, Innsbruck, Austria.,Center for Health Decision Science, Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, 718 Huntington Ave, Boston, MA, 02115, USA.,Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 101 Merrimac St, Boston, MA, 02114, USA
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18
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Alexander M, Loomis AK, van der Lei J, Duarte-Salles T, Prieto-Alhambra D, Ansell D, Pasqua A, Lapi F, Rijnbeek P, Mosseveld M, Avillach P, Egger P, Dhalwani NN, Kendrick S, Celis-Morales C, Waterworth DM, Alazawi W, Sattar N. Non-alcoholic fatty liver disease and risk of incident acute myocardial infarction and stroke: findings from matched cohort study of 18 million European adults. BMJ 2019; 367:l5367. [PMID: 31594780 PMCID: PMC6780322 DOI: 10.1136/bmj.l5367] [Citation(s) in RCA: 151] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/20/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To estimate the risk of acute myocardial infarction (AMI) or stroke in adults with non-alcoholic fatty liver disease (NAFLD) or non-alcoholic steatohepatitis (NASH). DESIGN Matched cohort study. SETTING Population based, electronic primary healthcare databases before 31 December 2015 from four European countries: Italy (n=1 542 672), Netherlands (n=2 225 925), Spain (n=5 488 397), and UK (n=12 695 046). PARTICIPANTS 120 795 adults with a recorded diagnosis of NAFLD or NASH and no other liver diseases, matched at time of NAFLD diagnosis (index date) by age, sex, practice site, and visit, recorded at six months before or after the date of diagnosis, with up to 100 patients without NAFLD or NASH in the same database. MAIN OUTCOME MEASURES Primary outcome was incident fatal or non-fatal AMI and ischaemic or unspecified stroke. Hazard ratios were estimated using Cox models and pooled across databases by random effect meta-analyses. RESULTS 120 795 patients with recorded NAFLD or NASH diagnoses were identified with mean follow-up 2.1-5.5 years. After adjustment for age and smoking the pooled hazard ratio for AMI was 1.17 (95% confidence interval 1.05 to 1.30; 1035 events in participants with NAFLD or NASH, 67 823 in matched controls). In a group with more complete data on risk factors (86 098 NAFLD and 4 664 988 matched controls), the hazard ratio for AMI after adjustment for systolic blood pressure, type 2 diabetes, total cholesterol level, statin use, and hypertension was 1.01 (0.91 to 1.12; 747 events in participants with NAFLD or NASH, 37 462 in matched controls). After adjustment for age and smoking status the pooled hazard ratio for stroke was 1.18 (1.11 to 1.24; 2187 events in participants with NAFLD or NASH, 134 001 in matched controls). In the group with more complete data on risk factors, the hazard ratio for stroke was 1.04 (0.99 to 1.09; 1666 events in participants with NAFLD, 83 882 in matched controls) after further adjustment for type 2 diabetes, systolic blood pressure, total cholesterol level, statin use, and hypertension. CONCLUSIONS The diagnosis of NAFLD in current routine care of 17.7 million patient appears not to be associated with AMI or stroke risk after adjustment for established cardiovascular risk factors. Cardiovascular risk assessment in adults with a diagnosis of NAFLD is important but should be done in the same way as for the general population.
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Affiliation(s)
- Myriam Alexander
- Real World Evidence and Epidemiology, GlaxoSmithKline, Uxbridge, Middlesex, UK
| | - A Katrina Loomis
- Worldwide Research and Development, Pfizer, Target Sciences, Groton, CT, USA
| | - Johan van der Lei
- Department of Medical Informatics, Erasmus University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Talita Duarte-Salles
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Daniel Prieto-Alhambra
- Pharmaco- and Device Epidemiology, Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK
| | - David Ansell
- IQVIA, Kings Cross, London, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Alessandro Pasqua
- Health Search, Italian College of General Practitioners and Primary Care, Firenze, Italy
| | - Francesco Lapi
- Health Search, Italian College of General Practitioners and Primary Care, Firenze, Italy
| | - Peter Rijnbeek
- Department of Medical Informatics, Erasmus University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Mees Mosseveld
- Department of Medical Informatics, Erasmus University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Paul Avillach
- Department of Medical Informatics, Erasmus University Medical Centre Rotterdam, Rotterdam, Netherlands
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - Peter Egger
- Real World Evidence and Epidemiology, GlaxoSmithKline, Uxbridge, Middlesex, UK
| | | | - Stuart Kendrick
- GlaxoSmithKline, Medicines Research Centre, Stevenage, Hertfordshire, UK
| | - Carlos Celis-Morales
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow G12 8TA, UK
| | | | - William Alazawi
- Barts Liver Centre, Blizard Institute, Queen Mary, University of London, London, UK
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow G12 8TA, UK
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Al-Azazi S, Singer A, Rabbani R, Lix LM. Combining population-based administrative health records and electronic medical records for disease surveillance. BMC Med Inform Decis Mak 2019; 19:120. [PMID: 31266516 PMCID: PMC6604278 DOI: 10.1186/s12911-019-0845-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 06/20/2019] [Indexed: 11/30/2022] Open
Abstract
Background Administrative health records (AHRs) and electronic medical records (EMRs) are two key sources of population-based data for disease surveillance, but misclassification errors in the data can bias disease estimates. Methods that combine information from error-prone data sources can build on the strengths of AHRs and EMRs. We compared bias and error for four data-combining methods and applied them to estimate hypertension prevalence. Methods Our study included rule-based OR and AND methods that identify disease cases from either or both data sources, respectively, rule-based sensitivity-specificity adjusted (RSSA) method that corrects for inaccuracies using a deterministic rule, and probabilistic-based sensitivity-specificity adjusted (PSSA) method that corrects for error using a statistical model. Computer simulation was used to estimate relative bias (RB) and mean square error (MSE) under varying conditions of population disease prevalence, correlation amongst data sources, and amount of misclassification error. AHRs and EMRs for Manitoba, Canada were used to estimate hypertension prevalence using validated case definitions and multiple disease markers. Results The OR method had the lowest RB and MSE when population disease prevalence was 10%, and the RSSA method had the lowest RB and MSE when population prevalence increased to 20%. As the correlation between data sources increased, the OR method resulted in the lowest RB and MSE. Estimates of hypertension prevalence for AHRs and EMRs alone were 30.9% (95% CI: 30.6–31.2) and 24.9% (95% CI: 24.6–25.2), respectively. The estimates were 21.4% (95% CI: 21.1–21.7), for the AND method, 34.4% (95% CI: 34.1–34.8) for the OR method, 32.2% (95% CI: 31.8–32.6) for the RSSA method, and ranged from 34.3% (95% CI: 34.1–34.5) to 35.9% (95% CI, 35.7–36.1) for the PSSA method, depending on the statistical model. Conclusions The OR and AND methods are influenced by correlation amongst the data sources, while the RSSA method is dependent on the accuracy of prior sensitivity and specificity estimates. The PSSA method performed well when population prevalence was high and average correlations amongst disease markers was low. This study will guide researchers to select a data-combining method that best suits their data characteristics. Electronic supplementary material The online version of this article (10.1186/s12911-019-0845-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Saeed Al-Azazi
- Department of Community Health Sciences, University of Manitoba, S113-750 Bannatyne Avenue, Winnipeg, MB, R3E 0W3, Canada.,George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, MB, Canada
| | - Alexander Singer
- Department of Family Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Rasheda Rabbani
- Department of Community Health Sciences, University of Manitoba, S113-750 Bannatyne Avenue, Winnipeg, MB, R3E 0W3, Canada.,George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, MB, Canada
| | - Lisa M Lix
- Department of Community Health Sciences, University of Manitoba, S113-750 Bannatyne Avenue, Winnipeg, MB, R3E 0W3, Canada. .,George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, MB, Canada.
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Alexander M, Loomis AK, van der Lei J, Duarte-Salles T, Prieto-Alhambra D, Ansell D, Pasqua A, Lapi F, Rijnbeek P, Mosseveld M, Waterworth DM, Kendrick S, Sattar N, Alazawi W. Risks and clinical predictors of cirrhosis and hepatocellular carcinoma diagnoses in adults with diagnosed NAFLD: real-world study of 18 million patients in four European cohorts. BMC Med 2019; 17:95. [PMID: 31104631 PMCID: PMC6526616 DOI: 10.1186/s12916-019-1321-x] [Citation(s) in RCA: 181] [Impact Index Per Article: 36.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 04/10/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is a common condition that progresses in some patients to steatohepatitis (NASH), cirrhosis and hepatocellular carcinoma (HCC). Here we used healthcare records of 18 million adults to estimate risk of acquiring advanced liver disease diagnoses in patients with NAFLD or NASH compared to individually matched controls. METHODS Data were extracted from four European primary care databases representing the UK, Netherlands, Italy and Spain. Patients with a recorded diagnosis of NAFLD or NASH (NAFLD/NASH) were followed up for incident cirrhosis and HCC diagnoses. Each coded NAFLD/NASH patient was matched to up to 100 "non-NAFLD" patients by practice site, gender, age ± 5 years and visit recorded within ± 6 months. Hazard ratios (HR) were estimated using Cox models adjusted for age and smoking status and pooled across databases by random effects meta-analyses. RESULTS Out of 18,782,281 adults, we identified 136,703 patients with coded NAFLD/NASH. Coded NAFLD/NASH patients were more likely to have diabetes, hypertension and obesity than matched controls. HR for cirrhosis in patients compared to controls was 4.73 (95% CI 2.43-9.19) and for HCC, 3.51 (95% CI 1.72-7.16). HR for either outcome was higher in patients with NASH and those with high-risk Fib-4 scores. The strongest independent predictor of a diagnosis of HCC or cirrhosis was baseline diagnosis of diabetes. CONCLUSIONS Real-world population data show that recorded diagnosis of NAFLD/NASH increases risk of life-threatening liver outcomes. Diabetes is an independent predictor of advanced liver disease diagnosis, emphasising the need to identify specific groups of patients at highest risk.
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Affiliation(s)
| | - A Katrina Loomis
- Worldwide Research and Development, Pfizer, Genome Sciences and Technologies, New York, USA
| | | | - Talita Duarte-Salles
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Barcelona, Spain
| | | | | | - Alessandro Pasqua
- Health Search, Italian College of General Practitioners and Primary Care, Firenze, Italy
| | - Francesco Lapi
- Health Search, Italian College of General Practitioners and Primary Care, Firenze, Italy
| | - Peter Rijnbeek
- Erasmus Universitair Medisch Centrum, Rotterdam, Netherlands
| | - Mees Mosseveld
- Erasmus Universitair Medisch Centrum, Rotterdam, Netherlands
| | | | | | | | - William Alazawi
- Barts Liver Centre, Blizard Institute, Queen Mary, University of London, London, UK.
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Seghieri G, Policardo L, Gualdani E, Anichini R, Francesconi P. Gender difference in the risk for cardiovascular events or mortality of patients with diabetic foot syndrome. Acta Diabetol 2019; 56:561-567. [PMID: 30725263 DOI: 10.1007/s00592-019-01292-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 01/21/2019] [Indexed: 12/25/2022]
Abstract
AIMS Diabetic foot syndrome (DFS) increases the risk for atherosclerotic cardiovascular disease (ASCVD), chronic kidney disease (CKD), or mortality. The present study aims at ascertaining whether such DFS-related excess risk differs between genders, retrospectively investigating a population with diabetes from Tuscany, Italy, followed-up for 6 years (2011-2016). METHODS People with diabetes living in Tuscany on January 1st 2011 identified by administrative databases, were divided by baseline history of prior DFS hospitalizations, stratified by presence/absence of peripheral vascular disease and evaluating, by Cox regression analysis, whether adjusted DFS-related excess risk of incident ASCVD, CKD or mortality differed between genders. RESULTS In an overall population of 165,650 subjects with diabetes (81,829M/83,821F), basal prevalence of DFS was twice higher among males, who were moreover at a significantly greater risk of all considered outcomes along the 6-year period. On the contrary, baseline DFS significantly increased the hospitalization risk for ASCVD, CKD and mortality equally or at a slightly greater extent in females, while the risk for stroke was significantly associated with DFS only among females (HR: 1.622 (1.314-1.980); p = 0.0001 vs. HR: 1.132 (0.955-1.332); p = NS). This finding was even reinforced in non-vascular DFS, which was associated with a significant raised risk for stroke, heart failure or mortality exclusively in females. CONCLUSIONS In this population, DFS prevalence and overall risk for ASCVD, CKD or mortality were significantly higher among males. Baseline co-presence of DFS, however, conferred a similar adjusted risk for all these outcomes between genders, and in case of non-vascular DFS the risk was significantly increased only among females.
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Affiliation(s)
- Giuseppe Seghieri
- Epidemiology Unit, Agenzia Regionale Sanità Toscana, Via Pietro Dazzi 1, 50141, Florence, Italy.
| | - Laura Policardo
- Epidemiology Unit, Agenzia Regionale Sanità Toscana, Via Pietro Dazzi 1, 50141, Florence, Italy
| | - Elisa Gualdani
- Epidemiology Unit, Agenzia Regionale Sanità Toscana, Via Pietro Dazzi 1, 50141, Florence, Italy
| | | | - Paolo Francesconi
- Epidemiology Unit, Agenzia Regionale Sanità Toscana, Via Pietro Dazzi 1, 50141, Florence, Italy
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Adherence to diabetes care process indicators in migrants as compared to non-migrants with diabetes: a retrospective cohort study. Int J Public Health 2019; 64:595-601. [DOI: 10.1007/s00038-019-01220-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 01/23/2019] [Accepted: 02/13/2019] [Indexed: 02/02/2023] Open
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Roberto G, Barone-Adesi F, Giorgianni F, Pizzimenti V, Ferrajolo C, Tari M, Bartolini C, Da Cas R, Maggini M, Spila-Alegiani S, Francesconi P, Trifirò G, Poluzzi E, Baccetti F, Gini R. Patterns and trends of utilization of incretin-based medicines between 2008 and 2014 in three Italian geographic areas. BMC Endocr Disord 2019; 19:18. [PMID: 30732592 PMCID: PMC6367760 DOI: 10.1186/s12902-019-0334-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 01/09/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The incretin-based medicines GLP1 analogues (GLP1a) and dipeptidyl peptidase-4 inhibitors (DPP4i) are hypoglycaemic agents licensed for the treatment of type 2 diabetes mellitus (T2DM). Although these drugs possess comparable efficacy and low risk of hypoglycaemia, differences in terms of route of administration (subcutaneous versus oral), effect on body weight and gastrointestinal tolerabily can impact their actual use in clinical practice. This study aimed to describe the real-world utilization of incretin-based medicines in the Italian clinical practice. METHODS A multi-database, population-based, descriptive, cohort study was performed using administrative data collected between 2008 and 2014 from three Italian geographic areas. Subjects aged ≥18 were selected. New users were defined as those with ≥1 dispensing of GLP1a or DPP4i during the year of interest and none in the past. Trends of cumulative annual incidence of use in the general adult population were observed. New users of GLP1a or DPP4i were respectively described in terms of demographic characteristics and use of antidiabetic drugs during 1 year before and after the first incretin dispensing. RESULTS The overall study population included 4,943,952 subjects. A total of 7357 new users of GLP1a and 41,907 of DPP4i were identified during the study period. Incidence of use increased between 2008 (0.2‰ for both GLP1a and DPP4i) and 2011 (GLP1a = 0.6‰; DPP4i = 2.5‰) and slightly decreased thereafter. In 2014, 61% of new GLP1a users received once-daily liraglutide while 52% of new DPP4i users received metformin/DPP4i in fixed-dose. The percentage of new DPP4i users older than 65 years of age increased from 30.9 to 62.6% during the study period. Around 12% of new users had not received any antidiabetic before starting an incretin. CONCLUSIONS During the study period, DPP4i rapidly became the most prescribed incretin-based medicine, particularly among older new user. The choice of the specific incretin-based medicine at first prescription appeared to be directed towards those with higher convenience of use (e.g. oral DPP4i rather than subcutaneous GLP1a, once-daily liraglutide rather than twice-daily exenatide). The non-negligibile use of incretin-based medicines as first-line pharmacotherapy for T2DM warrants further effectiveness and safety evaluations to better define their place in therapy.
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Affiliation(s)
- Giuseppe Roberto
- Epidemiology Unit, Agenzia regionale di sanità della Toscana, Florence, Italy
| | | | - Francesco Giorgianni
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Valeria Pizzimenti
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Carmen Ferrajolo
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
- Department of Experimental medicine, Regional Center of Pharmacovigilance and Pharmacoepidemiology of Campania, University of Campania, Naples, Italy
| | | | - Claudia Bartolini
- Epidemiology Unit, Agenzia regionale di sanità della Toscana, Florence, Italy
| | - Roberto Da Cas
- National Centre for Drug Research and Evaluation, National Institute of Health, Rome, Italy
| | - Marina Maggini
- National Centre for Drug Research and Evaluation, National Institute of Health, Rome, Italy
| | | | - Paolo Francesconi
- Epidemiology Unit, Agenzia regionale di sanità della Toscana, Florence, Italy
| | - Gianluca Trifirò
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Elisabetta Poluzzi
- Department of Medical and Surgical Science, University of Bologna, Unit of Pharmacology, Bologna, Italy
| | - Fabio Baccetti
- Unit of DiabetologyLocal, Health Authority of North-West Tuscany, Massa, Italy
| | - Rosa Gini
- Epidemiology Unit, Agenzia regionale di sanità della Toscana, Florence, Italy
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Patterns of Medication Dispensation for Multiple Comorbidities among Older Adults in Australia. PHARMACY 2018; 6:pharmacy6040134. [PMID: 30562992 PMCID: PMC6306834 DOI: 10.3390/pharmacy6040134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 12/14/2018] [Accepted: 12/14/2018] [Indexed: 11/16/2022] Open
Abstract
Background: The increasing burden of chronic (medical) conditions (CCs) is a major issue for healthcare systems across the world. We aimed to examine the changes in the rate of medication dispensation for multiple CCs among Australians aged ≥65 years. Methods: A repeated cross-sectional study was performed using the 2013⁻2016 Pharmaceutical Benefits Scheme (PBS) data on reimbursed prescriptions for a 10% random sample of the Australian population. Twenty-two CCs were identified via the RxRisk-V tool. The yearly changes in the proportion of older adults dispensed medications for ≥2 CCs were determined through Poisson regression modelling using 2013 as the reference year. The occurrence of CC dyads and triads for which medications were dispensed within a 180-day window were characterised, and the observed and expected rate of medication dispensation for each CC dyad or triad were calculated to identify the top 15 combinations. Results: The proportion of older adults dispensed medications for ≥2 CCs remained stable from 2013 to 2016, at >79% in each year. The proportion who were dispensed medications for multiple CCs increased with age. No gender differences in the dispensation of medications for multiple CCs were observed. Over 60% had medications dispensed for ≥3 CCs. The most frequent CC dyad and triad for which medications were dispensed were dyslipidaemia + hypertension (38.6%) and dyslipidaemia + gastroesophageal reflux disease + hypertension (18.7%), respectively. For the majority of CC dyads and all triads examined, the observed rate of medication dispensation exceeded that expected by chance. Conclusions: A high proportion of older Australians are dispensed medications for multiple CCs, suggestive of multimorbidity. The results reiterate the need for increased research into understanding the causal mechanisms of multimorbidity to inform the design of cost-effective interventions.
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Barletta V, Profili F, Gini R, Grilli L, Rampichini C, Matarrese D, Francesconi P. Impact of Chronic Care Model on diabetes care in Tuscany: a controlled before-after study. Eur J Public Health 2018; 27:8-13. [PMID: 28177456 DOI: 10.1093/eurpub/ckw189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | - Rosa Gini
- Regional Health Agency (ARS) of Tuscany, Florence, Italy
| | - Leonardo Grilli
- Department of Statistics, Informatics, Applications "G. Parenti", University of Florence, Florence, Italy
| | - Carla Rampichini
- Department of Statistics, Informatics, Applications "G. Parenti", University of Florence, Florence, Italy
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The Role of European Healthcare Databases for Post-Marketing Drug Effectiveness, Safety and Value Evaluation: Where Does Italy Stand? Drug Saf 2018; 42:347-363. [DOI: 10.1007/s40264-018-0732-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Vaccination of 50+ adults to promote healthy ageing in Europe: The way forward. Vaccine 2018; 36:5819-5824. [PMID: 30143273 DOI: 10.1016/j.vaccine.2018.08.041] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 08/10/2018] [Accepted: 08/15/2018] [Indexed: 02/02/2023]
Abstract
The proportion of the population ≥65 years old is about 17% today and will be about 27% in 2050 worldwide. The problem, however, is not ageing in itself, it is individual disabilities associated with ageing. This manuscript summarizes the consensus points reached during a pan-European meeting on gaps and barriers in making vaccination of adults aged 50+ a reality and on further joint actions in Europe. The shift from childhood to life-long vaccination is essential to prevent disability, morbidity and mortality in the elderly and promote healthy ageing. This vaccination shift is a major challenge in the post-truth, media-based era in countries with dwindling resources for the provision of healthcare. The challenge can be met only by adopting an innovative approach designed to shift the mindset of decision-makers from treatment to prevention. A number of key actions are required and for these actions a European multidisciplinary network including health authorities, medical doctors with different specialties, sociologists, psychologists, pharmaceutical companies and Associations of patients appears mandatory.
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Pacileo G, Tozzi VD, Sotgiu G, Aliberti S, Morando V, Blasi F. Administrative databases and clinical governance: The case of COPD. Int J Health Plann Manage 2018; 34:177-186. [PMID: 30113709 DOI: 10.1002/hpm.2609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 09/12/2017] [Accepted: 07/04/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide. However, COPD is still underdiagnosed, undertreated, and not sufficiently prevented. Health administrative databases provide a powerful way of studying COPD in the population. METHODS This retrospective study used administrative data, collected during 2011 and 2012, retrieved from 3 Italian local health authorities (LHAs). RESULTS The analysis through administrative databases allowed firstly to identify patients with COPD receiving services by the 3 LHAs: The estimated average is ~3% of the population aged ≥40 years. Furthermore, it was also possible to stratify patients by investigating the health consumption in hospitalization for COPD and use of respiratory drugs. In all 3 LHA patients with moderate COPD were the majority of the population with COPD. Finally, it was possible to distinguish patients who made an appropriate use of SABA (76% of the total), patients who had a potentially inappropriate use (20%), and those with an overuse of SABA (4%). CONCLUSION The use of SABA consumption patterns can be a reliable proxy variable to detect subgroups who may necessitate therapy revision. Health administrative databases seem beneficial for planning health care interventions, including the COPD field. They are robust information systems subjected to regular data quality controls remaining the prevalent data source, reliable because of the amount of data and the population coverage, especially in countries with a National Health Service System.
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Affiliation(s)
- Guglielmo Pacileo
- Centre of Research on Health and Social Care Management, SDA Bocconi School of Management (Bocconi University), Milan, Italy
| | - Valeria D Tozzi
- Centre of Research on Health and Social Care Management, SDA Bocconi School of Management (Bocconi University), Milan, Italy
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Stefano Aliberti
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano Head Internal Medicine Department, Respiratory Unit and Adult Cystic Fibrosis Center Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico Milano, Italy
| | - Verdiana Morando
- Centre of Research on Health and Social Care Management, SDA Bocconi School of Management (Bocconi University), Milan, Italy
| | - Francesco Blasi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano Head Internal Medicine Department, Respiratory Unit and Adult Cystic Fibrosis Center Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico Milano, Italy
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Alexander M, Loomis AK, Fairburn-Beech J, van der Lei J, Duarte-Salles T, Prieto-Alhambra D, Ansell D, Pasqua A, Lapi F, Rijnbeek P, Mosseveld M, Avillach P, Egger P, Kendrick S, Waterworth DM, Sattar N, Alazawi W. Real-world data reveal a diagnostic gap in non-alcoholic fatty liver disease. BMC Med 2018; 16:130. [PMID: 30099968 PMCID: PMC6088429 DOI: 10.1186/s12916-018-1103-x] [Citation(s) in RCA: 161] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 06/19/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is the most common cause of liver disease worldwide. It affects an estimated 20% of the general population, based on cohort studies of varying size and heterogeneous selection. However, the prevalence and incidence of recorded NAFLD diagnoses in unselected real-world health-care records is unknown. We harmonised health records from four major European territories and assessed age- and sex-specific point prevalence and incidence of NAFLD over the past decade. METHODS Data were extracted from The Health Improvement Network (UK), Health Search Database (Italy), Information System for Research in Primary Care (Spain) and Integrated Primary Care Information (Netherlands). Each database uses a different coding system. Prevalence and incidence estimates were pooled across databases by random-effects meta-analysis after a log-transformation. RESULTS Data were available for 17,669,973 adults, of which 176,114 had a recorded diagnosis of NAFLD. Pooled prevalence trebled from 0.60% in 2007 (95% confidence interval: 0.41-0.79) to 1.85% (0.91-2.79) in 2014. Incidence doubled from 1.32 (0.83-1.82) to 2.35 (1.29-3.40) per 1000 person-years. The FIB-4 non-invasive estimate of liver fibrosis could be calculated in 40.6% of patients, of whom 29.6-35.7% had indeterminate or high-risk scores. CONCLUSIONS In the largest primary-care record study of its kind to date, rates of recorded NAFLD are much lower than expected suggesting under-diagnosis and under-recording. Despite this, we have identified rising incidence and prevalence of the diagnosis. Improved recognition of NAFLD may identify people who will benefit from risk factor modification or emerging therapies to prevent progression to cardiometabolic and hepatic complications.
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Affiliation(s)
| | | | | | | | - Talita Duarte-Salles
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Barcelona, Spain
| | | | | | - Alessandro Pasqua
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Francesco Lapi
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Peter Rijnbeek
- Erasmus Universitair Medisch Centrum, Rotterdam, The Netherlands
| | - Mees Mosseveld
- Erasmus Universitair Medisch Centrum, Rotterdam, The Netherlands
| | | | | | | | | | - Naveed Sattar
- University of Glasgow, BHF Glasgow Cardiovascular Research Centre, Glasgow, UK
| | - William Alazawi
- Barts Liver Centre, Blizard Institute, Queen Mary, University of London, London, UK.
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Bezzini D, Policardo L, Profili F, Meucci G, Ulivelli M, Bartalini S, Francesconi P, Battaglia MA. Multiple sclerosis incidence in Tuscany from administrative data. Neurol Sci 2018; 39:1881-1885. [DOI: 10.1007/s10072-018-3513-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 07/30/2018] [Indexed: 10/28/2022]
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Corti MC, Avossa F, Schievano E, Gallina P, Ferroni E, Alba N, Dotto M, Basso C, Netti ST, Fedeli U, Mantoan D. A case-mix classification system for explaining healthcare costs using administrative data in Italy. Eur J Intern Med 2018. [PMID: 29514743 DOI: 10.1016/j.ejim.2018.02.035] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND The Italian National Health Service (NHS) provides universal coverage to all citizens, granting primary and hospital care with a copayment system for outpatient and drug services. Financing of Local Health Trusts (LHTs) is based on a capitation system adjusted only for age, gender and area of residence. We applied a risk-adjustment system (Johns Hopkins Adjusted Clinical Groups System, ACG® System) in order to explain health care costs using routinely collected administrative data in the Veneto Region (North-eastern Italy). METHODS All residents in the Veneto Region were included in the study. The ACG system was applied to classify the regional population based on the following information sources for the year 2015: Hospital Discharges, Emergency Room visits, Chronic disease registry for copayment exemptions, ambulatory visits, medications, the Home care database, and drug prescriptions. Simple linear regressions were used to contrast an age-gender model to models incorporating more comprehensive risk measures aimed at predicting health care costs. RESULTS A simple age-gender model explained only 8% of the variance of 2015 total costs. Adding diagnoses-related variables provided a 23% increase, while pharmacy based variables provided an additional 17% increase in explained variance. The adjusted R-squared of the comprehensive model was 6 times that of the simple age-gender model. CONCLUSIONS ACG System provides substantial improvement in predicting health care costs when compared to simple age-gender adjustments. Aging itself is not the main determinant of the increase of health care costs, which is better explained by the accumulation of chronic conditions and the resulting multimorbidity.
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Affiliation(s)
| | | | | | | | - Eliana Ferroni
- Epidemiological System of the Veneto Region, Padua, Italy.
| | | | - Matilde Dotto
- Epidemiological System of the Veneto Region, Padua, Italy
| | - Cristina Basso
- Intermediate Care Unit of The Veneto Region, Venice, Italy
| | | | - Ugo Fedeli
- Epidemiological System of the Veneto Region, Padua, Italy
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Abraha I, Serraino D, Montedori A, Fusco M, Giovannini G, Casucci P, Cozzolino F, Orso M, Granata A, De Giorgi M, Collarile P, Chiari R, Foglietta J, Vitale MF, Stracci F, Orlandi W, Bidoli E. Sensitivity and specificity of breast cancer ICD-9-CM codes in three Italian administrative healthcare databases: a diagnostic accuracy study. BMJ Open 2018; 8:e020627. [PMID: 30037866 PMCID: PMC6059298 DOI: 10.1136/bmjopen-2017-020627] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 04/25/2018] [Accepted: 05/14/2018] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES To assess the accuracy of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes in identifying patients diagnosed with incident carcinoma in situ and invasive breast cancer in three Italian administrative databases. DESIGN A diagnostic accuracy study comparing ICD-9-CM codes for carcinoma in situ (233.0) and for invasive breast cancer (174.x) with medical chart (as a reference standard). Case definition: (1) presence of a primary nodular lesion in the breast and (2) cytological or histological documentation of cancer from a primary or metastatic site. SETTING Administrative databases from Umbria Region, Azienda Sanitaria Locale (ASL) Napoli 3 Sud (NA) and Friuli VeneziaGiulia (FVG) Region. PARTICIPANTS Women with breast carcinoma in situ (n=246) or invasive breast cancer (n=384) diagnosed (in primary position) between 2012 and 2014. OUTCOME MEASURES Sensitivity and specificity for codes 233.0 and 174.x. RESULTS For invasive breast cancer the sensitivities were 98% (95% CI 93% to 99%) for Umbria, 96% (95% CI 91% to 99%) for NA and 100% (95% CI 97% to 100%) for FVG. Specificities were 90% (95% CI 82% to 95%) for Umbria, 91% (95% CI 83% to 96%) for NA and 91% (95% CI 84% to 96%) for FVG.For carcinoma in situ the sensitivities were 100% (95% CI 93% to 100%) for Umbria, 100% (95% CI 95% to 100%) for NA and 100% (95% CI 96% to 100%) for FVG. Specificities were 98% (95% CI 93% to 100%) for Umbria, 86% (95% CI 78% to 92%) for NA and 90% (95% CI 82% to 95%) for FVG. CONCLUSIONS Administrative healthcare databases from Umbria, NA and FVG are accurate in identifying hospitalised news cases of carcinoma of the breast. The proposed case definition is a powerful tool to perform research on large populations of newly diagnosed patients with breast cancer.
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Affiliation(s)
- Iosief Abraha
- Health Planning Service, Regional Health Authority of Umbria, Perugia, Italy
- Innovation and Development, Agenzia Nazionale per i Servizi Sanitari Regionali (Age.Na.S.), Rome, Italy
| | - Diego Serraino
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico Aviano, Aviano, Italy
| | | | - Mario Fusco
- Registro Tumori Regione Campania, ASL Napoli 3 Sud, Brusciano, Italy
| | - Gianni Giovannini
- Health Planning Service, Regional Health Authority of Umbria, Perugia, Italy
| | - Paola Casucci
- Health ICT Service, Regional Health Authority of Umbria, Perugia, Italy
| | - Francesco Cozzolino
- Health Planning Service, Regional Health Authority of Umbria, Perugia, Italy
| | - Massimiliano Orso
- Health Planning Service, Regional Health Authority of Umbria, Perugia, Italy
| | - Annalisa Granata
- Health ICT Service, Regional Health Authority of Umbria, Perugia, Italy
| | | | - Paolo Collarile
- SOC Epidemiologia Oncologica, Centro di Riferimento Oncologico Aviano, Aviano, Italy
| | - Rita Chiari
- Dipartimento di Oncologia, Azienda Ospedaliera Perugia, Perugia, Italy
| | | | | | | | - Walter Orlandi
- Direzione Sanità, Regional Health Authority of Umbria, Perugia, Italy
| | - Ettore Bidoli
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico Aviano, Aviano, Italy
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Orso M, Serraino D, Abraha I, Fusco M, Giovannini G, Casucci P, Cozzolino F, Granata A, Gobbato M, Stracci F, Ciullo V, Vitale MF, Eusebi P, Orlandi W, Montedori A, Bidoli E. Validating malignant melanoma ICD-9-CM codes in Umbria, ASL Napoli 3 Sud and Friuli Venezia Giulia administrative healthcare databases: a diagnostic accuracy study. BMJ Open 2018; 8:e020631. [PMID: 29678984 PMCID: PMC5914898 DOI: 10.1136/bmjopen-2017-020631] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To assess the accuracy of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes in identifying subjects with melanoma. DESIGN A diagnostic accuracy study comparing melanoma ICD-9-CM codes (index test) with medical chart (reference standard). Case ascertainment was based on neoplastic lesion of the skin and a histological diagnosis from a primary or metastatic site positive for melanoma. SETTING Administrative databases from Umbria Region, Azienda Sanitaria Locale (ASL) Napoli 3 Sud (NA) and Friuli Venezia Giulia (FVG) Region. PARTICIPANTS 112, 130 and 130 cases (subjects with melanoma) were randomly selected from Umbria, NA and FVG, respectively; 94 non-cases (subjects without melanoma) were randomly selected from each unit. OUTCOME MEASURES Sensitivity and specificity for ICD-9-CM code 172.x located in primary position. RESULTS The most common melanoma subtype was malignant melanoma of skin of trunk, except scrotum (ICD-9-CM code: 172.5), followed by malignant melanoma of skin of lower limb, including hip (ICD-9-CM code: 172.7). The mean age of the patients ranged from 60 to 61 years. Most of the diagnoses were performed in surgical departments.The sensitivities were 100% (95% CI 96% to 100%) for Umbria, 99% (95% CI 94% to 100%) for NA and 98% (95% CI 93% to 100%) for FVG. The specificities were 88% (95% CI 80% to 93%) for Umbria, 77% (95% CI 69% to 85%) for NA and 79% (95% CI 71% to 86%) for FVG. CONCLUSIONS The case definition for melanoma based on clinical or instrumental diagnosis, confirmed by histological examination, showed excellent sensitivities and good specificities in the three operative units. Administrative databases from the three operative units can be used for epidemiological and outcome research of melanoma.
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Affiliation(s)
- Massimiliano Orso
- Health Planning Service, Regional Health Authority of Umbria, Perugia, Italy
| | - Diego Serraino
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico Aviano, Aviano, Italy
| | - Iosief Abraha
- Health Planning Service, Regional Health Authority of Umbria, Perugia, Italy
- Innovation and development, Agenzia Nazionale per i Servizi Sanitari Regionali (Agenas), Rome, Italy
| | - Mario Fusco
- Registro Tumori Regione Campania, ASL Napoli 3 Sud, Brusciano, Italy
| | - Gianni Giovannini
- Health Planning Service, Regional Health Authority of Umbria, Perugia, Italy
| | - Paola Casucci
- SOC Epidemiologia Oncologica, Centro di Riferimento Oncologico Aviano, Aviano, Italy
| | - Francesco Cozzolino
- Health Planning Service, Regional Health Authority of Umbria, Perugia, Italy
| | - Annalisa Granata
- Registro Tumori Regione Campania, ASL Napoli 3 Sud, Brusciano, Italy
| | - Michele Gobbato
- SOC Epidemiologia Oncologica, Centro di Riferimento Oncologico Aviano, Aviano, Italy
| | | | - Valerio Ciullo
- Registro Tumori Regione Campania, ASL Napoli 3 Sud, Brusciano, Italy
| | | | - Paolo Eusebi
- Health Planning Service, Regional Health Authority of Umbria, Perugia, Italy
| | - Walter Orlandi
- Direzione Regionale Salute, Regional Health Authority of Umbria, Perugia, Italy
| | | | - Ettore Bidoli
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico Aviano, Aviano, Italy
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Profili F, Bellini I, Zuppiroli A, Seghieri G, Barbone F, Francesconi P. Changes in diabetes care introduced by a Chronic Care Model-based programme in Tuscany: a 4-year cohort study. Eur J Public Health 2018; 27:14-19. [PMID: 28177441 DOI: 10.1093/eurpub/ckw181] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background In 2010, Tuscany (Italy) implemented a Chronic Care Model (CCM)-based programme for the management of chronic diseases. The study’s objective was to evaluate its impact on the care of patients with type 2 diabetes. Methods A population-based cohort study was performed on patients with diabetes, identified by an administrative data algorithm, exposed to a CCM-based programme versus patients not exposed (8486 patients in each group). The groups were matched using a propensity score approach and observed from 2011 to 2014. The outcomes measured were: mortality rate and hazard ratio (HR), hospitalisation incidence rate (IR) (all causes and diabetes-related diseases) and incidence rate ratio (IRR), and Guideline Composite Indicator (GCI) as proxy of adherence to guidelines (IR and IRR). Stratified Cox regression analysis and conditional fixed effect Poisson regression analyses were performed to compute HR and IRR. Results A significant improvement was observed for GCI (IRR 1.58; 95% CI 1.53–1.62) and for cardiovascular long-term complications (IRR 1.11; 95% CI 1.04–1.18). A protective effect was observed for neurological long-term complications (IRR 0.85; 95% CI 0.76–0.95), acute cardio-cerebrovascular long-term complications—stroke and ST segment elevation myocardial infarction—(IRR 0.81; 95% CI 0.71–0.92) and mortality (HR 0.88; 95% CI 0.81–0.96). Conclusion The implementation of a CCM-based programme was followed by better management and benefits for the health status of patients. The increase in hospitalisations for cardiovascular long-term complications could engender cost-efficacy issues, but a better integrated care (GPs and specialists) and a more appropriate specialist outpatient services organisation could avoid a part of these, while still maintaining the benefits seen.
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Affiliation(s)
| | - Irene Bellini
- Medical Specialisation School of Hygiene and Preventive Medicine, Florence, Italy
| | | | | | - Fabio Barbone
- Department of Medical Sciences, University of Trieste, Trieste, Italy.,Department of Medical and Biological Sciences, University of Udine, Udine, Italy
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Martinelli D, Fortunato F, Iannazzo S, Cappelli MG, Prato R. Using Routine Data Sources to Feed an Immunization Information System for High-Risk Patients-A Pilot Study. Front Public Health 2018; 6:37. [PMID: 29503815 PMCID: PMC5820309 DOI: 10.3389/fpubh.2018.00037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 01/31/2018] [Indexed: 02/03/2023] Open
Abstract
Background Vaccine-preventable diseases among high-risk patients are a public health priority in high-income countries. Most national immunization programs have included vaccination recommendations for these population groups but they remain hard-to-reach and coverage data are poorly available. In a pilot study, we developed and tested an automated approach for identifying individuals with underlying medical conditions to feed an immunization information system (IIS). Methods We reviewed published recommendations on medical conditions that indicate vaccination against influenza, pneumococcal disease, meningococcal disease, hepatitis A, and hepatitis B. For each medical condition, we identified the International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis and procedure codes, the user fee exempt codes and the Anatomical Therapeutic Chemical Classification System codes and we reported these data in correspondence tables. Using these tables, we extracted three lists of patients recorded in three current data sources between 2001 and 2010 in the Apulia region of Italy: the hospital discharge registry, the user fee exempt registry, and the drug prescription registry. Using a unique personal identification number, we linked these three lists of patients with the regional IIS (2012 database), obtaining a list of patients with chronic diseases eligible for vaccination. We tested completeness, sensitivity, and positive predictive value (PPV) of this approach by asking a sample of 28 general practitioners (GPs) to evaluate the matching between a sublist of patients with clinical recommendations for influenza vaccination and the GPs individual subjects medical records. Results We included a total of 1,204,496 subjects with underlying medical conditions eligible to receive any of the aforementioned vaccinations. Of these, 9% were identified in all three data sources, 18% in two sources, and 73% in one source. The completeness of this automated process in identifying GPs high-risk patients eligible for influenza vaccination was 88.9% [95% confidence intervals (95% CI): 88.1–89.8%], with a sensitivity of 69.2% (95% CI: 67.7–70.6%) and a PPV of 85.7% (95% CI: 84.4–86.8%). Conclusion The high completeness of the methodology used for identifying high-risk patients in current data sources encouraged us to apply this approach for feeding the regional IIS.
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Affiliation(s)
- Domenico Martinelli
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Francesca Fortunato
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Stefania Iannazzo
- Directorate-General of Health Prevention, Ministry of Health, Rome, Italy
| | | | - Rosa Prato
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
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Marocco A, Stanisic S, Fanelli F, Damele F, Colivicchi F. Alirocumab in the management of primary hypercholesterolaemia or mixed dyslipidaemia: A budget impact analysis – Italian perspective. GLOBAL & REGIONAL HEALTH TECHNOLOGY ASSESSMENT 2018. [DOI: 10.1177/2284240318781483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Gini R, Schuemie MJ, Pasqua A, Carlini E, Profili F, Cricelli I, Dazzi P, Barletta V, Francesconi P, Lapi F, Donatini A, Dal Co G, Visca M, Bellentani M, Sturkenboom M, Klazinga N. Monitoring compliance with standards of care for chronic diseases using healthcare administrative databases in Italy: Strengths and limitations. PLoS One 2017; 12:e0188377. [PMID: 29232365 PMCID: PMC5726627 DOI: 10.1371/journal.pone.0188377] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 11/06/2017] [Indexed: 12/04/2022] Open
Abstract
Background A recent comprehensive report on healthcare quality in Italy published by the Organization of Economic Co-operation and Development (OECD) recommended that regular monitoring of quality of primary care by means of compliance with standards of care for chronic diseases is performed. A previous ecological study demonstrated that compliance with standards of care could be reliably estimated on regional level using administrative databases. This study compares estimates based on administrative data with estimates based on GP records for the same persons, to understand whether ecological fallacy played a role in the results of the previous study. Methods We compared estimates of compliance with diagnostic and therapeutic standards of care for type 2 diabetes (T2DM), hypertension and ischaemic heart disease (IHD) from administrative data (IAD) with estimates from medical records (MR) for the same persons registered with 24 GP’s in 2012. Data were linked at an individual level. Results 32,688 persons entered the study, 12,673 having at least one of the three diseases according to at least one data source. Patients not detected by IAD were many, for all three conditions: adding MR increased the number of cases of T2DM, hypertension, and IHD by +40%, +42%, and +104%, respectively. IAD had imperfect sensitivity in detecting population compliance with therapies (adding MR increased the estimate, from +11.5% for statins to +14.7% for antithrombotics), and, more substantially, with diagnostic recommendations (adding MR increased the estimate, from +23.7% in glycated hemoglobin tests, to +50.5% in electrocardiogram). Patients not detected by IAD were less compliant with respect to those that IAD correctly identified (from -4.8 percentage points in proportion of IHD patients compliant with a yearly glycated hemoglobin test, to -40.1 points in the proportion of T2DM patients compliant with the same recommendation). IAD overestimated indicators of compliance with therapeutic standards (significant differences ranged from 3.3. to 3.6 percentage points) and underestimated indicators of compliance with diagnostic standards (significant differences ranged from -2.3 to -14.1 percentage points). Conclusion IAD overestimated the percentage of patients compliant with therapeutic standards by less than 6 percentage points, and underestimated the percentage of patients compliant with diagnostic standards by a maximum of 14 percentage points. Therefore, both discussions at local level between GP's and local health unit managers and discussions at central level between national and regional policy makers can be informed by indicators of compliance estimated by IAD, which, based on those results, have the ability of signalling critical or excellent clusters. However, this study found that estimates are partly flawed, because a high number of patients with chronic diseases are not detected by IAD, patients detected are not representative of the whole population of patients, and some categories of diagnostic tests are markedly underrecorded in IAD (up to 50% in the case of electrocardiograms). Those results call to caution when interpreting IAD estimates. Audits based on medical records, on the local level, and an interpretation taking into account information external to IAD, on the central level, are needed to assess a more comprehensive compliance with standards.
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Affiliation(s)
- Rosa Gini
- Agenzia regionale di sanità della Toscana, Osservatorio di epidemiologia, Florence, Italy
- Department of Medical Informatics, Erasmus Medical Center, Rotterdam, The Netherlands
- * E-mail:
| | - Martijn J. Schuemie
- Janssen Research & Development, Epidemiology, Titusville, New Jersey, United States of America
- Observational Health Data Sciences and Informatics (OHDSI), New York, New York, United States of America
| | - Alessandro Pasqua
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Emanuele Carlini
- Consiglio Nazionale delle Ricerche, Istituto di Scienza e Tecnologie dell'Informazione, Pisa, Italy
| | - Francesco Profili
- Agenzia regionale di sanità della Toscana, Osservatorio di epidemiologia, Florence, Italy
| | | | - Patrizio Dazzi
- Consiglio Nazionale delle Ricerche, Istituto di Scienza e Tecnologie dell'Informazione, Pisa, Italy
| | - Valentina Barletta
- Agenzia regionale di sanità della Toscana, Osservatorio di epidemiologia, Florence, Italy
| | - Paolo Francesconi
- Agenzia regionale di sanità della Toscana, Osservatorio di epidemiologia, Florence, Italy
| | - Francesco Lapi
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | | | - Giulia Dal Co
- Agenzia Nazionale per il Servizi Sanitari Regionali, Rome, Italy
| | - Modesta Visca
- Agenzia Nazionale per il Servizi Sanitari Regionali, Rome, Italy
| | | | - Miriam Sturkenboom
- Agenzia regionale di sanità della Toscana, Osservatorio di epidemiologia, Florence, Italy
| | - Niek Klazinga
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Di Cianni G, Gualdani E, Berni C, Meucci A, Roti L, Lencioni C, Lacaria E, Seghieri G, Francesconi P. Screening for gestational diabetes in Tuscany, Italy. A population study. Diabetes Res Clin Pract 2017; 132:149-156. [PMID: 28863332 DOI: 10.1016/j.diabres.2017.08.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 08/02/2017] [Accepted: 08/08/2017] [Indexed: 11/24/2022]
Abstract
AIMS According to current Italian guidelines, only women at higher risk of gestational diabetes (GDM) are eligible for receiving a glucose tolerance test (OGTT) during pregnancy. This study evaluates the compliance to national guidelines, additionally proposing an algorithm able to identify women with GDM. METHODS The study included 23,270 pregnant women aged >15yr, resident in Tuscany, a region in central Italy, delivering in year 2015, identified by certificates of care at delivery. Eligibility to screening was evaluated by fulfillment to regional guidelines recommending a 2-h-75g-OGTT only in presence of risk factors. Additionally, a validated algorithm is proposed to diagnose GDM from regional administrative databases. RESULTS Glucose tolerance was tested in 79.2% of women. Eligibility criteria were fulfilled in 55.6% of OGTT performers and in 40.2% of those who didn't perform any OGTT. Performers' rate increased with age, body weight, higher education degree and in those followed by a well defined clinical setting. Housewives and students had a lower chance of receiving an OGTT. Algorithm identified GDM in 11% of women, ranging from 14% among eligible and 7% among non-eligible ones. CONCLUSION Selective screening for GDM is not being currently applied in Tuscany. Despite the percentage of eligible women by national guidelines was 55%, the rate of those who performed the screening was about 80%, with a 40% of low risk women continuing to be screened. Moreover, GDM rate, calculated by algorithm, was relatively large (7%) among non-eligible women, suggesting the need of universal glucose screening to adequately capture all GDM cases.
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Affiliation(s)
- Graziano Di Cianni
- Diabetes and Metabolic Diseases Unit, Health Local Unit Nord-West Tuscany, Livorno Hospital, Italy
| | - Elisa Gualdani
- Epidemiology Unit, Agenzia Regionale Sanità, Florence, Italy
| | | | | | - Lorenzo Roti
- Direzione Sanità Regione Toscana, Florence, Italy
| | - Cristina Lencioni
- Diabetes and Metabolic Diseases Unit, Health Local Unit Nord-West Tuscany, Livorno Hospital, Italy
| | - Emilia Lacaria
- Diabetes and Metabolic Diseases Unit, Health Local Unit Nord-West Tuscany, Livorno Hospital, Italy
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Anichini R, Policardo L, Lombardo FL, Salutini E, Tedeschi A, Viti S, Francia P, Brocco E, Maggini M, Seghieri G, De Bellis A. Hospitalization for Charcot neuroarthropathy in diabetes: A population study in Italy. Diabetes Res Clin Pract 2017; 129:25-31. [PMID: 28500867 DOI: 10.1016/j.diabres.2017.03.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 03/28/2017] [Indexed: 01/29/2023]
Abstract
AIMS To provide data on hospitalization and incidence rates of Charcot neuroarthropathy (CN) and its relation to lower limbs' amputations/revascularizations in population with diabetes of Italy as well as of one of its regions (Tuscany). METHODS Hospitalizations with CN diagnosis (codes ICD-9-CM: 7130, 7135, 7138) have been recorded in people with diabetes over years 2003-2013 in Italy and 2008-2015 in Tuscany. Amputations, peripheral vascular disease, revascularizations and infections were likewise evaluated. RESULTS Between 2003 and 2013 CN hospitalizations were very infrequent in Italy ranging between 14×100,000 and 11×100,000 patients with diabetes. In Tuscany they declined to a minimum of 7×100,000 patients in 2015, after a previous increase to a maximum of 22×100,000 (p=NS for both). Yearly CN incidence remained constant in Italy, declining in Tuscany to a minimum of 3.4×100,000 diabetic patients in 2015 (p=0.047). CN patients were younger and with longer length of hospital stay than those with non-Charcot diabetic foot (p<0.05 for both). Amputation and infection rates were manifold higher in CN patients than in those with non-Charcot diabetic foot, while the revascularization rate was similar in both. CONCLUSIONS Over last decade, in Italy and Tuscany yearly CN incidence and hospitalization rates concerned only a small percentage of patients, remaining constant over years and declining in Tuscany in the last couple of years. CN was significantly associated to younger age, longer hospital stay and greater risk of amputations and infections while the need of revascularization was similar to that of non-Charcot diabetic foot.
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Affiliation(s)
- Roberto Anichini
- Diabetes Unit and Diabetes Foot Unit, San Jacopo Hospital, USL Centro-Toscana, Pistoia, Italy
| | | | - Flavia Lucia Lombardo
- National Centre for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Roma, Italy
| | - Elisabetta Salutini
- Diabetes Unit and Diabetes Foot Unit, San Jacopo Hospital, USL Centro-Toscana, Pistoia, Italy
| | - Anna Tedeschi
- Diabetes Unit and Diabetes Foot Unit, San Jacopo Hospital, USL Centro-Toscana, Pistoia, Italy
| | - Secondina Viti
- Diabetes Unit and Diabetes Foot Unit, San Jacopo Hospital, USL Centro-Toscana, Pistoia, Italy
| | - Piergiorgio Francia
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Enrico Brocco
- Regional Referral Center for the Treatment of Diabetic Foot, Policlinico Abano Terme, Padova, Italy
| | - Marina Maggini
- National Centre for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Roma, Italy
| | | | - Alessandra De Bellis
- Diabetes Unit and Diabetes Foot Unit, San Jacopo Hospital, USL Centro-Toscana, Pistoia, Italy
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Policardo L, Seghieri G, Anichini R, Francesconi P. Effect of statins on hospitalization risk of bacterial infections in patients with or without diabetes. Acta Diabetol 2017; 54:669-675. [PMID: 28421335 DOI: 10.1007/s00592-017-0990-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 03/31/2017] [Indexed: 01/09/2023]
Abstract
AIMS To investigate whether statins reduce the risk to first hospitalization of bacterial infections, in patients with or without diabetes taking into account prior or incident comorbidities. METHODS By using administrative databases, the effect of current statin use was measured on the risk of first hospitalizations due to bacterial infections in people living in Tuscany, Italy, in the period January 1, 2011-December 31, 2015, after excluding those with previous statins use. Population was stratified as with (n = 128,207) or without diabetes (n = 3,304,906), and the hospitalization risk was analyzed by a Cox proportional hazards regression analysis after adjusting for age, gender, previous comorbidities, chronic renal failure, and prior or incident cardiovascular diseases. RESULTS During the 5-year follow-up, 31,543 hospitalizations for bacterial infections were observed: 2.08(2.06-2.10) per 1000 person-year in non-diabetic and 5679: 9.13(8.94-9.32) per 1000 person-year in diabetic population. Diabetes conferred a greater risk of hospitalizations, independently from confounders [adjusted HR (95% CI) 2.04 (1.97-2.10); P < 0.0001]. Statin use decreased the risk by about 2.5% for each one month of therapy, at the same extent in subjects with or without diabetes, after adjusting for all covariates. CONCLUSIONS In this population, diabetes was associated by a twofold increase in the 5-year risk of hospitalizations for bacterial infections. Statin use decreased this risk to a same extent in subjects without or with diabetes, after adjusting for main confounders including comorbidities, and previous or incident cardiovascular events.
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Affiliation(s)
- Laura Policardo
- Epidemiology Unit, Agenzia Regionale Sanità Toscana, Via Pietro Dazzi 1, 50141, Florence, Italy
| | - Giuseppe Seghieri
- Epidemiology Unit, Agenzia Regionale Sanità Toscana, Via Pietro Dazzi 1, 50141, Florence, Italy.
| | | | - Paolo Francesconi
- Epidemiology Unit, Agenzia Regionale Sanità Toscana, Via Pietro Dazzi 1, 50141, Florence, Italy
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Cozzolino F, Abraha I, Orso M, Mengoni A, Cerasa MF, Eusebi P, Ambrosio G, Montedori A. Protocol for validating cardiovascular and cerebrovascular ICD-9-CM codes in healthcare administrative databases: the Umbria Data Value Project. BMJ Open 2017; 7:e013785. [PMID: 28360241 PMCID: PMC5372118 DOI: 10.1136/bmjopen-2016-013785] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Administrative healthcare databases can provide a comprehensive assessment of the burden of diseases in terms of major outcomes, such as mortality, hospital readmissions and use of healthcare resources, thus providing answers to a wide spectrum of research questions. However, a crucial issue is the reliability of information gathered. Aim of this protocol is to validate International Classification of Diseases, 9th Revision-Clinical Modification (ICD-9-CM) codes for major cardiovascular diseases, including acute myocardial infarction (AMI), heart failure (HF), atrial fibrillation (AF) and stroke. METHODS AND ANALYSIS Data from the centralised administrative database of the entire Umbria Region (910 000 residents, located in Central Italy) will be considered. Patients with a first hospital discharge for AMI, HF, AF or stroke, between 2012 and 2014, will be identified in the administrative database using the following groups of ICD-9-CM codes located in primary position: (1) 410.x for AMI; (2) 427.31 for AF; (3) 428 for HF; (4) 433.x1, 434 (excluding 434.x0), 436 for ischaemic stroke, 430 and 431 for haemorrhagic stroke (subarachnoid haemorrhage and intracerebral haemorrhage). A random sample of cases, and of non-cases, will be selected, and the corresponding medical charts retrieved and reviewed for validation by pairs of trained, independent reviewers. For each condition considered, case adjudication of disease will be based on symptoms, laboratory and diagnostic tests, as available in medical charts. Divergences will be resolved by consensus. Sensitivity and specificity with 95% CIs will be calculated. ETHICS AND DISSEMINATION Research protocol has been granted approval by the Regional Ethics Committee. Study results will be disseminated widely through peer-reviewed publications and presentations at national and international conferences.
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Affiliation(s)
- Francesco Cozzolino
- Health Planning Service, Regional Health Authority of Umbria, Perugia, Italy
| | - Iosief Abraha
- Health Planning Service, Regional Health Authority of Umbria, Perugia, Italy
| | - Massimiliano Orso
- Health Planning Service, Regional Health Authority of Umbria, Perugia, Italy
| | - Anna Mengoni
- Division of Cardiology, Santa Maria della Misericordia Hospital, University of Perugia School of Medicine, Perugia, Italy
| | - Maria Francesca Cerasa
- Division of Cardiology, Santa Maria della Misericordia Hospital, University of Perugia School of Medicine, Perugia, Italy
| | - Paolo Eusebi
- Health Planning Service, Regional Health Authority of Umbria, Perugia, Italy
| | - Giuseppe Ambrosio
- Division of Cardiology, Santa Maria della Misericordia Hospital, University of Perugia School of Medicine, Perugia, Italy
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Biffi A, Comoretto R, Arfè A, Scotti L, Merlino L, Vaghi A, Pesci A, de Marco R, Corrao G. Can healthcare utilization data reliably capture cases of chronic respiratory diseases? a cross-sectional investigation in Italy. BMC Pulm Med 2017; 17:20. [PMID: 28103865 PMCID: PMC5248488 DOI: 10.1186/s12890-016-0362-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Accepted: 12/29/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Healthcare utilization data are increasingly used for chronic disease surveillance. Nevertheless, no standard criteria for estimating prevalence of high-impact diseases, such as chronic obstructive pulmonary disease (COPD) and asthma, are available. In this study an algorithm for recognizing COPD/asthma cases from HCU data is developed and implemented in the HCU databases of the Italian Lombardy Region (about 10 million residents). The impact of diagnostic misclassification for reliably estimating prevalence was also assessed. METHODS Disease-specificdrug codes, hospital discharges together with co-payment exemptions when available, and a combination of them according with patient's age, were used to create the proposed algorithm. Identified cases were considered for prevalence estimation. An external validation study was also performed in order to evaluate systematic uncertainty of prevalence estimates. RESULTS Raw prevalence of COPD and asthma in 2010 was 3.6 and 3.3% respectively. According to external validation, sensitivity values were 53% for COPD and 39% for asthma. Adjusted prevalence estimates were respectively 6.8 and 8.5% for COPD (among person aged 40 years or older) and asthma (among person aged 40 years or younger). CONCLUSIONS COPD and asthma prevalence may be estimated from HCU data, albeit with high systematic uncertainty. Validation is recommended in this setting.
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Affiliation(s)
- A Biffi
- Laboratory of Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Via Bicocca degli Arcimboldi, 8, Edificio U7, 20126 Milan, Italy
| | - R Comoretto
- Laboratory of Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Via Bicocca degli Arcimboldi, 8, Edificio U7, 20126 Milan, Italy
| | - A Arfè
- Laboratory of Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Via Bicocca degli Arcimboldi, 8, Edificio U7, 20126 Milan, Italy
- Department of Decision Sciences, Bocconi University, Milan, Italy
| | - L Scotti
- Laboratory of Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Via Bicocca degli Arcimboldi, 8, Edificio U7, 20126 Milan, Italy
| | - L Merlino
- Operative Unit of Territorial Health Services, Region Lombardia, Milan, Italy
| | - A Vaghi
- Division of Pneumology, “Guido Salvini” Hospital, Garbagnate Milanese, Italy
| | - A Pesci
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Division of Pneumology, “San Gerardo” Hospital, Monza, Italy
| | - R de Marco
- Unit of Epidemiology and Medical Statistics, University of Verona, Verona, Italy
| | - G Corrao
- Laboratory of Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Via Bicocca degli Arcimboldi, 8, Edificio U7, 20126 Milan, Italy
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Policardo L, Seghieri G, Francesconi P, Anichini R, Franconi F, Del Prato S. Gender difference in diabetes related excess risk of cardiovascular events: When does the 'risk window' open? J Diabetes Complications 2017; 31:74-79. [PMID: 27746087 DOI: 10.1016/j.jdiacomp.2016.09.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 09/23/2016] [Accepted: 09/24/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Women with diabetes have a greater excess risk for cardiovascular diseases (CVD) than men. This study was aimed at clarifying whether this effect is lifelong or more evident in some life-periods. METHODS The effect of diabetes and gender on the risk of first ever hospitalization for acute myocardial infarction (AMI), ischemic stroke (IS), congestive heart failure (CHF), lower extremity amputations (LEA) or any of these major cardiovascular events (MACE) have been evaluated by a Cox-hazard model, over years 2008-2012 querying administrative databases of a cohort living in Tuscany, Italy. RESULTS Comparing subjects with diabetes to those without it the overall age-adjusted excess risk was higher in women than in men for AMI and MACE and higher in men for LEA, with no difference for IS or CHF. In women the excess risk for AMI and MACE started earlier (46yr) and lasted until age of more than 85yr, while 'risk-windows' opened later and had a shorter duration for CHF (56-65yr) and IS (66-75yr). CONCLUSION Diabetic women have a significant diabetes-associated excess of CVD risk, except for LEA, with a 'risk window' opening earlier and lasting longer for AMI and MACE, later and with a shorter duration for IS and CHF.
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Affiliation(s)
| | - Giuseppe Seghieri
- Agenzia Regionale Sanità Toscana, Florence, Italy; Centre of Study for Gender Health, Pistoia, Italy.
| | | | | | - Flavia Franconi
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy and Laboratory of Gender Medicine, National Institute of Biostructures and Biosystems, Osilo, Sassari, Italy
| | - Stefano Del Prato
- Department of Clinical and Experimental Medicine, Section of Metabolic Diseases and Diabetes, University of Pisa, Pisa, Italy
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Gini R, Schuemie MJ, Mazzaglia G, Lapi F, Francesconi P, Pasqua A, Bianchini E, Montalbano C, Roberto G, Barletta V, Cricelli I, Cricelli C, Dal Co G, Bellentani M, Sturkenboom M, Klazinga N. Automatic identification of type 2 diabetes, hypertension, ischaemic heart disease, heart failure and their levels of severity from Italian General Practitioners' electronic medical records: a validation study. BMJ Open 2016; 6:e012413. [PMID: 27940627 PMCID: PMC5168667 DOI: 10.1136/bmjopen-2016-012413] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES The Italian project MATRICE aimed to assess how well cases of type 2 diabetes (T2DM), hypertension, ischaemic heart disease (IHD) and heart failure (HF) and their levels of severity can be automatically extracted from the Health Search/CSD Longitudinal Patient Database (HSD). From the medical records of the general practitioners (GP) who volunteered to participate, cases were extracted by algorithms based on diagnosis codes, keywords, drug prescriptions and results of diagnostic tests. A random sample of identified cases was validated by interviewing their GPs. SETTING HSD is a database of primary care medical records. A panel of 12 GPs participated in this validation study. PARTICIPANTS 300 patients were sampled for each disease, except for HF, where 243 patients were assessed. OUTCOME MEASURES The positive predictive value (PPV) was assessed for the presence/absence of each condition against the GP's response to the questionnaire, and Cohen's κ was calculated for agreement on the severity level. RESULTS The PPV was 100% (99% to 100%) for T2DM and hypertension, 98% (96% to 100%) for IHD and 55% (49% to 61%) for HF. Cohen's kappa for agreement on the severity level was 0.70 for T2DM and 0.69 for hypertension and IHD. CONCLUSIONS This study shows that individuals with T2DM, hypertension or IHD can be validly identified in HSD by automated identification algorithms. Automatic queries for levels of severity of the same diseases compare well with the corresponding clinical definitions, but some misclassification occurs. For HF, further research is needed to refine the current algorithm.
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Affiliation(s)
- Rosa Gini
- Agenzia regionale di sanità della Toscana, Osservatorio di epidemiologia, Florence, Italy
- Department of Medical Informatics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Martijn J Schuemie
- Department of EpidemiologyJanssen Research & Development, Titusville, New Jersey, USA
- Observational Health Data Sciences and Informatics (OHDSI), New York, New York, USA
| | - Giampiero Mazzaglia
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Francesco Lapi
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Paolo Francesconi
- Agenzia regionale di sanità della Toscana, Osservatorio di epidemiologia, Florence, Italy
| | - Alessandro Pasqua
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Elisa Bianchini
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | | | - Giuseppe Roberto
- Agenzia regionale di sanità della Toscana, Osservatorio di epidemiologia, Florence, Italy
| | - Valentina Barletta
- Agenzia regionale di sanità della Toscana, Osservatorio di epidemiologia, Florence, Italy
| | | | - Claudio Cricelli
- Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Giulia Dal Co
- Agenzia Nazionale per il Servizi Sanitari Regionali, Rome, Italy
| | | | - Miriam Sturkenboom
- Department of Medical Informatics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Niek Klazinga
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Policardo L, Barchielli A, Seghieri G, Francesconi P. Does the hospitalization after a cancer diagnosis modify adherence to process indicators of diabetes care quality? Acta Diabetol 2016; 53:1009-1014. [PMID: 27600441 DOI: 10.1007/s00592-016-0898-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 08/08/2016] [Indexed: 11/26/2022]
Abstract
AIMS This study was designed to answer the question whether surgery due to newly diagnosed cancer may modify quality of diabetes' management, as suggested by current guidelines. METHODS Adherence to guideline composite indicator (GCI), a process indicator including one annual assessment of HbA1c and at least two among eye examination, serum lipids measurement and microalbuminuria, was evaluated between years 2011-2012 and 2014-2015 in 158,069 diabetic patients living in Tuscany, Italy, on 1 January 2011 and surviving on 31 December 2015, of whom 661 were hospitalized in index year 2013 for a surgery procedure due to a newly incident cancer. Difference in GCI modification (DELTA_GCI) of these patients was compared with that of diabetic people without cancer, strictly matched for main confounders by means of a propensity score. RESULTS In diabetic patients with cancer, GCI adherence increased by about 8 % between years 2011-2012 and 2014-2015. When compared with controls, DELTA_GCI increased by 6 % in cancer group compared with controls (p < 0.05), but any significance was lost after matching the groups by propensity score (3 %; p = NS). CONCLUSIONS Our study suggests that a hospitalization for a surgical procedure due to a newly diagnosed cancer does not influence the compliance to a quality process indicator of diabetes care such as GCI.
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Affiliation(s)
- Laura Policardo
- Agenzia Regionale Sanità Toscana, Via Pietro Dazzi 1, 50141, Florence, Italy
| | | | - Giuseppe Seghieri
- Agenzia Regionale Sanità Toscana, Via Pietro Dazzi 1, 50141, Florence, Italy.
| | - Paolo Francesconi
- Agenzia Regionale Sanità Toscana, Via Pietro Dazzi 1, 50141, Florence, Italy
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Roberto G, Leal I, Sattar N, Loomis AK, Avillach P, Egger P, van Wijngaarden R, Ansell D, Reisberg S, Tammesoo ML, Alavere H, Pasqua A, Pedersen L, Cunningham J, Tramontan L, Mayer MA, Herings R, Coloma P, Lapi F, Sturkenboom M, van der Lei J, Schuemie MJ, Rijnbeek P, Gini R. Identifying Cases of Type 2 Diabetes in Heterogeneous Data Sources: Strategy from the EMIF Project. PLoS One 2016; 11:e0160648. [PMID: 27580049 PMCID: PMC5006970 DOI: 10.1371/journal.pone.0160648] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 07/23/2016] [Indexed: 11/26/2022] Open
Abstract
Due to the heterogeneity of existing European sources of observational healthcare data, data source-tailored choices are needed to execute multi-data source, multi-national epidemiological studies. This makes transparent documentation paramount. In this proof-of-concept study, a novel standard data derivation procedure was tested in a set of heterogeneous data sources. Identification of subjects with type 2 diabetes (T2DM) was the test case. We included three primary care data sources (PCDs), three record linkage of administrative and/or registry data sources (RLDs), one hospital and one biobank. Overall, data from 12 million subjects from six European countries were extracted. Based on a shared event definition, sixteeen standard algorithms (components) useful to identify T2DM cases were generated through a top-down/bottom-up iterative approach. Each component was based on one single data domain among diagnoses, drugs, diagnostic test utilization and laboratory results. Diagnoses-based components were subclassified considering the healthcare setting (primary, secondary, inpatient care). The Unified Medical Language System was used for semantic harmonization within data domains. Individual components were extracted and proportion of population identified was compared across data sources. Drug-based components performed similarly in RLDs and PCDs, unlike diagnoses-based components. Using components as building blocks, logical combinations with AND, OR, AND NOT were tested and local experts recommended their preferred data source-tailored combination. The population identified per data sources by resulting algorithms varied from 3.5% to 15.7%, however, age-specific results were fairly comparable. The impact of individual components was assessed: diagnoses-based components identified the majority of cases in PCDs (93–100%), while drug-based components were the main contributors in RLDs (81–100%). The proposed data derivation procedure allowed the generation of data source-tailored case-finding algorithms in a standardized fashion, facilitated transparent documentation of the process and benchmarking of data sources, and provided bases for interpretation of possible inter-data source inconsistency of findings in future studies.
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Affiliation(s)
- Giuseppe Roberto
- Regional Agency for Healthcare Services of Tuscany, Epidemiology unit, Florence, Italy
- * E-mail:
| | - Ingrid Leal
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Naveed Sattar
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - A. Katrina Loomis
- Pfizer Worldwide Research and Development, Groton, Connecticut, United States of America
| | - Paul Avillach
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
- Department of Biomedical Informatics, Harvard Medical School & Children’s Hospital Informatics Program, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | - Peter Egger
- GlaxoSmithKline, Worldwide Epidemiology GSK, Stockley Park West, Uxbridge, United Kingdom
| | | | - David Ansell
- The Health Improvement Network, Cegedim Strategic Data Medical Research Ltd, London, United Kingdom
| | - Sulev Reisberg
- Quretec, Software Technology and Applications Competence Center, University of Tartu, Tartu, Estonia
| | - Mari-Liis Tammesoo
- Estonian Genome Center, University of Tartu, Tartu, Estonia
- Tartu University Hospital, Tartu, Estonia
| | - Helene Alavere
- Estonian Genome Center, University of Tartu, Tartu, Estonia
- Tartu University Hospital, Tartu, Estonia
| | - Alessandro Pasqua
- Health Search, Italian College of General Practitioners and Primary Care, Firenze, Italy
| | - Lars Pedersen
- Department of Clinical Epidemiology, Aarhus University Hosptial, Aarhus, Denmark
| | | | - Lara Tramontan
- Arsenàl.IT Consortium, Veneto's Research Centre for eHealth Innovation, Treviso, Italy
| | - Miguel A. Mayer
- Hospital del Mar Medical Research Institute (IMIM) and Universitat Pompeu Fabra, Barcelona, Spain
| | - Ron Herings
- PHARMO Institute for Drug Outcomes Research, Utrecht, Netherlands
| | - Preciosa Coloma
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Francesco Lapi
- Regional Agency for Healthcare Services of Tuscany, Epidemiology unit, Florence, Italy
| | - Miriam Sturkenboom
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Johan van der Lei
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Martijn J. Schuemie
- Janssen Research & Development, Epidemiology, Titusville, New Jersey, United States of America
- Observational Health Data Sciences and Informatics, New York, New York, United States of America
| | - Peter Rijnbeek
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Rosa Gini
- Regional Agency for Healthcare Services of Tuscany, Epidemiology unit, Florence, Italy
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Stanghellini V, Tosetti C, Benedetto E, Condoluci M, De Bastiani R, Cogliandro R, Mastronuzzi T, De Polo M, Di Mita F, Napoli L, Ubaldi E, Nebiacolombo C, Cottone C, Grattagliano I, Zamparella M, Baldi E, Sanna G. Nickel sensitization in patients with gastro-esophageal reflux disease. United European Gastroenterol J 2016; 4:184-90. [PMID: 27087945 PMCID: PMC4804365 DOI: 10.1177/2050640615595917] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Accepted: 06/21/2015] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Gastro-esophageal reflux disease (GERD) leads to frequent medical visits, and available therapies fail in up to 40% of patients. Food allergies may be involved in GERD pathogenesis; however, allergens other than food have received little attention. Nickel allergy is common in the general population and some high-nickel foods are associated with GERD. However, the potential relationship between nickel allergy and GERD remains unaddressed. AIM This study aimed to evaluate the prevalence of nickel sensitization in patients with and without GERD and to compare clinical and demographic features. METHODS This prospective, multicenter study included 210 adult GERD patients and 140 patients without GERD who presented at the general practitioner. All GERD patients had undergone treatment with proton pump inhibitors and upper digestive endoscopy within the previous five years. Demographic and clinical data were collected by questionnaire and patients underwent a nickel patch allergy test. RESULTS Patients with and without GERD presented similar characteristics, with the exception of nickel sensitization, which was significantly more prevalent among GERD patients than controls (39.5% vs. 16.4%; p = 0.001). Nickel-positive GERD patients were more frequently female (90.4% vs. 65.4%, p = 0.003) and asthmatic (18.1% vs. 4.7%; p = 0.038), compared to nickel-negative GERD patients. At six-month follow-up, most of the patients, with or without nickel sensitization, reported improved symptoms without differences in drug prescription. CONCLUSION Nickel sensitization is particularly prevalent in GERD patients seen in general practice. Whether allergies other than food allergy play a role in GERD remains to be elucidated.
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Affiliation(s)
- Vincenzo Stanghellini
- Department of Digestive Diseases and Internal Medicine, University of Bologna, Italy
- Vincenzo Stanghellini University of Bologna Department of Digestive Diseases and Internal Medicine Policlinico S. Orsola-Malpighi Via Massarenti 9 – I-40138, Bologna, Italy.
| | - Cesare Tosetti
- General Practitioner and Gastroenterologist, Italian Group for Primary Care Gastroenterology (GIGA-CP), Italy
| | - Edoardo Benedetto
- Gastroenterologist, Italian Group for Primary Care Gastroenterology (GIGA-CP), Rende, Italy
| | | | - Rudi De Bastiani
- General Practitioner and Gastroenterologist, Italian Group for Primary Care Gastroenterology (GIGA-CP), Italy
| | - Rosanna Cogliandro
- Department of Digestive Diseases and Internal Medicine, University of Bologna, Italy
| | - Tecla Mastronuzzi
- General Practitioner and Gastroenterologist, Italian Group for Primary Care Gastroenterology (GIGA-CP), Italy
| | - Manuela De Polo
- General Practitioner and Gastroenterologist, Italian Group for Primary Care Gastroenterology (GIGA-CP), Italy
| | - Francesco Di Mita
- General Practitioner and Gastroenterologist, Italian Group for Primary Care Gastroenterology (GIGA-CP), Italy
| | - Luigi Napoli
- General Practitioner and Gastroenterologist, Italian Group for Primary Care Gastroenterology (GIGA-CP), Italy
| | - Enzo Ubaldi
- General Practitioner and Gastroenterologist, Italian Group for Primary Care Gastroenterology (GIGA-CP), Italy
| | - Cristina Nebiacolombo
- General Practitioner and Gastroenterologist, Italian Group for Primary Care Gastroenterology (GIGA-CP), Italy
| | - Carmelo Cottone
- General Practitioner and Gastroenterologist, Italian Group for Primary Care Gastroenterology (GIGA-CP), Italy
| | - Ignazio Grattagliano
- General Practitioner and Gastroenterologist, Italian Group for Primary Care Gastroenterology (GIGA-CP), Italy
| | - Maria Zamparella
- General Practitioner and Gastroenterologist, Italian Group for Primary Care Gastroenterology (GIGA-CP), Italy
| | - Elisabetta Baldi
- General Practitioner and Gastroenterologist, Italian Group for Primary Care Gastroenterology (GIGA-CP), Italy
| | - Guido Sanna
- General Practitioner and Gastroenterologist, Italian Group for Primary Care Gastroenterology (GIGA-CP), Italy
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Seghieri G, Policardo L, Profili F, Francesconi P, Anichini R, Del Prato S. Hospital incidental diagnosis of diabetes: A population study. J Diabetes Complications 2016; 30:457-61. [PMID: 26782024 DOI: 10.1016/j.jdiacomp.2015.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Revised: 12/06/2015] [Accepted: 12/09/2015] [Indexed: 01/30/2023]
Abstract
AIMS To identify incidental previously unrecognized diabetes (IPUD) among hospitalized patients and corresponding mortality risk in comparison with individuals with known diabetes (KDM). METHODS Out of 214,991 individuals discharged in year 2011 from all hospitals of Tuscany, Italy we retrospectively identified IPUD as individuals with no known diabetes and/or previous antidiabetic medication, receiving at least two prescriptions of glucose-lowering-drugs over the next 6months after discharge. Two-year (2012-2013) adjusted mortality risk was tested by a Cox-regression-analysis, comparing IPUD and KDM patients with at least one hospital admission in 2011. RESULTS 974 patients with IPUD (375.6×100,000 hospitalized people) have been identified. IPUD risk was associated with aging, male gender and greater burden of co-morbidities, was higher in migrants of non-Italian ancestry and was reduced among patients of family physicians adhering to guidelines resulting in a proactive model of care delivery. In IPUD patients alive at 1st January 2012, (n=865) the adjusted risk of two-year mortality was similar to that of KDM subjects (HR=1.08; 95% CI: 0.92-1.26; p=NS). CONCLUSIONS IPUD occurs more commonly in older male subjects, migrants of non-Italian ancestry, and among patients of physicians non-adhering to a shared diabetes care model. People with IPUD have similar two-year-mortality risk compared with KDM individuals.
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Affiliation(s)
| | | | | | | | - Roberto Anichini
- Diabetes Unit, Department of Internal Medicine, Azienda USL 3, Pistoia, Italy
| | - Stefano Del Prato
- Department of Clinical and Experimental Medicine, Section of Metabolic Diseases and Diabetes, University of Pisa, Pisa, Italy
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Abraha I, Serraino D, Giovannini G, Stracci F, Casucci P, Alessandrini G, Bidoli E, Chiari R, Cirocchi R, De Giorgi M, Franchini D, Vitale MF, Fusco M, Montedori A. Validity of ICD-9-CM codes for breast, lung and colorectal cancers in three Italian administrative healthcare databases: a diagnostic accuracy study protocol. BMJ Open 2016; 6:e010547. [PMID: 27016247 PMCID: PMC4809074 DOI: 10.1136/bmjopen-2015-010547] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 01/31/2016] [Accepted: 02/22/2016] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Administrative healthcare databases are useful tools to study healthcare outcomes and to monitor the health status of a population. Patients with cancer can be identified through disease-specific codes, prescriptions and physician claims, but prior validation is required to achieve an accurate case definition. The objective of this protocol is to assess the accuracy of International Classification of Diseases Ninth Revision-Clinical Modification (ICD-9-CM) codes for breast, lung and colorectal cancers in identifying patients diagnosed with the relative disease in three Italian administrative databases. METHODS AND ANALYSIS Data from the administrative databases of Umbria Region (910,000 residents), Local Health Unit 3 of Napoli (1,170,000 residents) and Friuli--Venezia Giulia Region (1,227,000 residents) will be considered. In each administrative database, patients with the first occurrence of diagnosis of breast, lung or colorectal cancer between 2012 and 2014 will be identified using the following groups of ICD-9-CM codes in primary position: (1) 233.0 and (2) 174.x for breast cancer; (3) 162.x for lung cancer; (4) 153.x for colon cancer and (5) 154.0-154.1 and 154.8 for rectal cancer. Only incident cases will be considered, that is, excluding cases that have the same diagnosis in the 5 years (2007-2011) before the period of interest. A random sample of cases and non-cases will be selected from each administrative database and the corresponding medical charts will be assessed for validation by pairs of trained, independent reviewers. Case ascertainment within the medical charts will be based on (1) the presence of a primary nodular lesion in the breast, lung or colon-rectum, documented with imaging or endoscopy and (2) a cytological or histological documentation of cancer from a primary or metastatic site. Sensitivity and specificity with 95% CIs will be calculated. DISSEMINATION Study results will be disseminated widely through peer-reviewed publications and presentations at national and international conferences.
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Affiliation(s)
- Iosief Abraha
- Health Planning Service, Regional Health Authority of Umbria, Perugia, Italy
| | - Diego Serraino
- Epidemiology and Biostatistic Unit, Centro di Riferimento Oncologico Aviano, Aviano, Italy
| | - Gianni Giovannini
- Health Planning Service, Regional Health Authority of Umbria, Perugia, Italy
| | | | - Paola Casucci
- Health ICT Service, Regional Health Authority of Umbria, Perugia, Italy
| | | | - Ettore Bidoli
- Epidemiology and Biostatistic Unit, Centro di Riferimento Oncologico Aviano, Aviano, Italy
| | - Rita Chiari
- Dipartimento di Oncologia, Azienda Ospedaliera Perugia, Perugia, Italy
| | - Roberto Cirocchi
- Department of Digestive Surgery and Liver Unit, University of Perugia, Perugia, Italy
| | | | - David Franchini
- Health ICT Service, Regional Health Authority of Umbria, Perugia, Italy
| | | | - Mario Fusco
- Registro Tumori Regione Campania, ASL NA3 Sud, Brusciano, Italy
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Buja A, Solinas G, Visca M, Federico B, Gini R, Baldo V, Francesconi P, Sartor G, Bellentani M, Damiani G. Prevalence of Heart Failure and Adherence to Process Indicators: Which Socio-Demographic Determinants are Involved? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:238. [PMID: 26907316 PMCID: PMC4772258 DOI: 10.3390/ijerph13020238] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 01/22/2016] [Accepted: 02/03/2016] [Indexed: 11/19/2022]
Abstract
Interest in chronic conditions reflects their role as the first cause of death and disability in developed countries; improving the management of these conditions is a priority for health care services. The aim of this study was to establish which sociodemographic factors influence adherence to standards of care for chronic heart failure (CHF). A generalized multilevel structural equation model was developed and applied to a sample of patients with CHF obtained from administrative data flows in six Italian regions to ascertain any associations between adherence to standards of care for CHF and sociodemographic variables. Indicators of compliance were adherence to beta-blocker therapy (BB-A) and Angiotensin Convertin Enzime inhibitor/Angiotensin Receptor Blocker therapy (ACE-A), and creatinine and electrolyte testing (CNK-T). All indicators were computed over a one-year follow-up. Among a cohort of 24,997 patients, the BB-A rate was 40.4%, the ACE-A rate 61.1%, and the CNK-T rate 57.0%. Factors found associated with adherence were gender, age, and citizenship. Our study shows an inadequate adherence to standards of care for CHF, particularly associated with certain sociodemographic characteristics. This suggests the need to improve the role of primary care in managing this chronic condition. The measures considered only apply to patients with a reduced Left Ventricular Ejection Fraction, hence a limitation of this analysis is the lack of information on left ventricular ejection.
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Affiliation(s)
- Alessandra Buja
- Laboratory of Public Health and Population Studies, Department of Molecular Medicine, University of Padova, 35122 Padova, Italy.
| | - Giuliana Solinas
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy.
| | - Modesta Visca
- Agenas, National Agency for Health Services, 00187 Rome, Italy.
| | - Bruno Federico
- Department of Human Sciences, Social and Health, University of Cassino and Southern Lazio, 03043 Cassino, Italy.
| | - Rosa Gini
- Regional Health Agency of Tuscany, 50141 Firenze, Italy.
| | - Vincenzo Baldo
- Laboratory of Public Health and Population Studies, Department of Molecular Medicine, University of Padova, 35122 Padova, Italy.
| | | | - Gino Sartor
- Faculty of Medicine, University of Padova, 35122 Padova, Italy.
| | | | - Gianfranco Damiani
- Department of Public Health, Università Cattolica del Sacro Cuore in Rome, 00168 Rome, Italy.
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