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Chughtai AA, He WQ, Liu B. Associations between severe and notifiable respiratory infections during the first trimester of pregnancy and congenital anomalies at birth: a register-based cohort study. BMC Pregnancy Childbirth 2023; 23:203. [PMID: 36964492 PMCID: PMC10037767 DOI: 10.1186/s12884-023-05514-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 03/13/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND Evidence regarding the association between acute respiratory infections during pregnancy and congenital anomalies in babies, is limited and conflicting. The aim of this study was to examine the association between acute respiratory infections during the first trimester of pregnancy and congenital anomalies in babies using record linkage. METHODS We linked a perinatal register to hospitalisation and disease notifications in the Australian state of New South Wales (NSW) between 2001 to 2016. We quantified the risk of congenital anomalies, identified from the babies' linked hospital record in relation to notifiable respiratory and other infections during pregnancy using generalized Estimating Equations (GEE) adjusted for maternal sociodemographic and other characteristics. RESULTS Of 1,453,037 birth records identified from the perinatal register between 2001 and 2016, 11,710 (0.81%) mothers were hospitalised for acute respiratory infection, 2850 (0.20%) had influenza and 1011 (0.07%) had high risk infections (a record of cytomegalovirus, rubella, herpes simplex, herpes zoster, toxoplasmosis, syphilis, chickenpox (varicella) and zika) during the pregnancy. During the first trimester, acute respiratory infection, influenza and high-risk infections were reported by 1547 (0.11%), 399 (0.03%) and 129 (0.01%) mothers. There were 15,644 (1.08%) babies reported with major congenital anomalies, 2242 (0.15%) with cleft lip/ plate, 7770 (0.53%) with all major cardiovascular anomalies and 1746 (0.12%) with selected major cardiovascular anomalies. The rate of selected major cardiovascular anomalies was significantly higher if the mother had an acute respiratory infection during the first trimester of pregnancy (AOR 3.64, 95% CI 1.73 to 7.66). The rates of all major congenital anomalies and all major cardiovascular anomalies were also higher if the mother had an acute respiratory infection during the first trimester of pregnancy, however the difference was no statistically significant. Influenza during the first trimester was not associated with major congenital anomalies, selected major cardiovascular anomalies or all major cardiovascular anomalies in this study. CONCLUSION This large population-based study found severe acute respiratory infection in first trimester of pregnancy was associated with a higher risk of selected major cardiovascular anomalies in babies. These findings support measures to prevent acute respiratory infections in pregnant women including through vaccination.
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Affiliation(s)
- Abrar A Chughtai
- School of Population Health, University of New South Wales, Samuels Building, Kensington Campus, Sydney, NSW, 2052, Australia.
| | - Wen-Qiang He
- School of Population Health, University of New South Wales, Samuels Building, Kensington Campus, Sydney, NSW, 2052, Australia
| | - Bette Liu
- School of Population Health, University of New South Wales, Samuels Building, Kensington Campus, Sydney, NSW, 2052, Australia
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2
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Oni HT, Buultjens M, Mohamed AL, Islam MM. Neonatal Outcomes of Infants Born to Pregnant Women With Substance Use Disorders: A Multilevel Analysis of Linked Data. Subst Use Misuse 2022; 57:1-10. [PMID: 34369268 DOI: 10.1080/10826084.2021.1958851] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE This study examines the associations of substance use disorders in pregnancy with a set of neonatal outcomes. METHODS This is a quantitative retrospective study. Three linked datasets of a 10-year period (2007-2016) from New South Wales, Australia, were examined. Pregnant women were identified positive for substance use disorders when at least one hospital admission during pregnancy or delivery had opioid-, or cannabis-, or stimulant-, or alcohol- or two or more of the four substance groups- related ICD-10-AM diagnostic code. As there was a hierarchical structure in the dataset, the adjusted odds ratio (AOR) was estimated using multilevel logistic regression. FINDINGS Of the 622,640 birth records, 1677 (0.27%) women had opioid-related, 1857 (0.30%) had cannabis-related, 552 (0.09%) had stimulant-related, 595 (0.10%) had alcohol-related and 591 (0.09%) had polysubstance-related ICD-10-AM diagnostic codes. There were significant relationships between opioid use in pregnancy and neonatal health outcomes including preterm birth (AOR 3.2; 95% CI 2.8, 3.7) and admission to the neonatal intensive care unit (NICU) (AOR 10.0; 95% CI 8.8, 11.3). Substance use disorders due to cannabis, stimulants, alcohol or polysubstance were significantly associated with preterm birth, low birthweight, low APGAR score and admission to NICU. Also, alcohol and polysubstance use disorders in pregnancy were found to be significantly associated with stillbirth. CONCLUSION Results demonstrate that substance use disorders in pregnancy are associated with an increased risk of adverse neonatal outcomes. Early identification of substance use disorders through screening and adherence to pharmacotherapy and other psychosocial interventions could improve neonatal outcomes.
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Affiliation(s)
- Helen T Oni
- Department of Public Health, La Trobe University, Bundoora, VIC, Australia
| | - Melissa Buultjens
- Department of Public Health, La Trobe University, Bundoora, VIC, Australia
| | - Abdel-Latif Mohamed
- Department of Public Health, La Trobe University, Bundoora, VIC, Australia.,Canberra Hospital, Canberra Hospital, Garran, ACT, Australia
| | - M Mofizul Islam
- Department of Public Health, La Trobe University, Bundoora, VIC, Australia
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Siddiqui MT, Al-Yaman W, Singh A, Kirby DF. Short-Bowel Syndrome: Epidemiology, Hospitalization Trends, In-Hospital Mortality, and Healthcare Utilization. JPEN J Parenter Enteral Nutr 2021; 45:1441-1455. [PMID: 33233017 PMCID: PMC9254738 DOI: 10.1002/jpen.2051] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 11/16/2020] [Indexed: 08/10/2023]
Abstract
INTRODUCTION Short-bowel syndrome (SBS) is a common cause of chronic intestinal failure and is associated with increased morbidity, mortality, poor quality of life, and an increased burden on healthcare costs. METHODS We used the US Nationwide Inpatient Sample database from 2005 to 2014. We identified adult SBS hospitalizations by using a combination of International Classification of Diseases, Ninth Revision, Clinical Modification codes. We studied the demographics of the patients with SBS and analyzed the trends in the number of hospitalizations, in-hospital mortality, and healthcare costs. We also identified the risk factors associated with in-hospital mortality. RESULTS A total of 53,040 SBS hospitalizations were identified. We found that SBS-related hospitalizations increased by 55% between 2005 (N = 4037) and 2014 (N = 6265). During this period, the in-hospital mortality decreased from 40 per 1000 to 29 per 1000 hospitalizations, resulting in an overall reduction of 27%. Higher mortality was noted in SBS patients with sepsis (6.7%), liver dysfunction (6.2%), severe malnutrition (6.0%), and metastatic cancer (5.4%). The overall mean length of stay (LOS) for SBS-related hospitalizations was 14.7 days, with a mean hospital cost of $34,130. We noted a steady decrease in the LOS, whereas the cost of care remained relatively stable. CONCLUSIONS The national burden of SBS-related hospitalizations continues to rise, and the mortality associated with SBS has substantially decreased. Older SBS patients with sepsis, liver dysfunction, severe malnutrition, and metastatic cancer had the highest risk of mortality. Healthcare utilization in SBS remains high. healthcare utilization; hospitalization trend; mortality; research and diseases; short-bowel syndrome.
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Affiliation(s)
- Mohamed Tausif Siddiqui
- Department of Gastroenterology, Hepatology and Nutrition, Center for Human Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Wael Al-Yaman
- Department of Gastroenterology, Hepatology and Nutrition, Center for Human Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Amandeep Singh
- Department of Gastroenterology, Hepatology and Nutrition, Center for Human Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Donald F Kirby
- Department of Gastroenterology, Hepatology and Nutrition, Center for Human Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Tervonen HE, Chen TYT, Lin E, Boyle FM, Moylan EJ, Della-Fiorentina SA, Beith J, Johnston A, Currow DC. Risk of emergency hospitalisation and survival outcomes following adjuvant chemotherapy for early breast cancer in New South Wales, Australia. Eur J Cancer Care (Engl) 2019; 28:e13125. [PMID: 31222826 DOI: 10.1111/ecc.13125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 05/01/2019] [Accepted: 05/27/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine risk of emergency hospital admission and survival following adjuvant chemotherapy for early breast cancer. METHODS Linked data from New South Wales population-based and clinical cancer registries (2008-2012), hospital admissions, official death records and pharmaceutical benefit claims. Women aged ≥18 years receiving adjuvant chemotherapy for early-stage operable breast cancer in NSW public hospitals were included. Odds ratios (OR) for emergency hospitalisation within 6 months following chemotherapy initiation were estimated using logistic regression and survival using Kaplan-Meier and Cox proportional hazards methods. RESULTS A total of 3,950 women were included and 30.6% were hospitalised. The most common principal diagnosis at admission was neutropenia (30.8%). Women receiving docetaxel/carboplatin/trastuzumab (TCH) and docetaxel/cyclophosphamide (TC) were the most frequently hospitalised. After adjustment for demographic and clinical factors, the increased risk of hospitalisation for TCH and TC remained compared with doxorubicin/cyclophosphamide 3-weekly (OR 1.71, 95% confidence interval [CI] 1.24-2.37 and OR 1.47, 95% CI 1.17-1.85 respectively). Five-year overall survival was similar for women who were (92.2%, 95% CI 90.7-93.8) and were not hospitalised (93.1%, 95% CI 92.1-94.1). CONCLUSION Emergency hospitalisations following chemotherapy for early breast cancer were relatively common, especially following docetaxel-containing protocols. Further examination of reasons for admission is needed to inform actions to improve patient safety.
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Affiliation(s)
| | - Tina Y T Chen
- Cancer Institute NSW, Alexandria, New South Wales, Australia
| | - Enmoore Lin
- Cancer Institute NSW, Alexandria, New South Wales, Australia
| | - Frances M Boyle
- University of Sydney and Mater Hospital, Sydney, New South Wales, Australia
| | | | | | - Jane Beith
- Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Amy Johnston
- Cancer Institute NSW, Alexandria, New South Wales, Australia
| | - David C Currow
- Cancer Institute NSW, Alexandria, New South Wales, Australia
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Daniels B, Tervonen HE, Pearson SA. Identifying incident cancer cases in dispensing claims: A validation study using Australia's Repatriation Pharmaceutical Benefits Scheme (PBS) data. Int J Popul Data Sci 2019; 5:1152. [PMID: 32935055 PMCID: PMC7473293 DOI: 10.23889/ijpds.v5i1.1152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction Dispensing claims are used commonly as proxy measures in pharmacoepidemiological studies; however, their validity is often untested. Objectives To assess the performance of a proxy for identifying cancer cases based on the dispensing of anticancer medicines and estimate the misclassification of cancer status and potential for bias researchers may encounter when using this proxy. Methods We conducted our validation study using Department of Veterans’ Affairs (DVA) client data linked with the New South Wales (NSW) Cancer Registry and Repatriation Pharmaceutical Benefits Scheme data. We included DVA clients aged ≥65 years residing in NSW between July 2004 and December 2012. We matched clients with a cancer diagnosis to clients without a diagnosis based on demographic characteristics and available observation time. We used dispensing claims for anticancer medicines dispensed between July 2004 and December 2013 as a proxy to identify clients with cancer and calculated sensitivity, specificity, positive predictive values and negative predictive values compared with cancer registrations (gold standard), overall and by cancer site. We illustrated misclassification by the proxy in a cohort of people initiating opioid therapy. Using the proxy, we excluded people with cancer from the cohort, in an attempt to delineate people potentially using opioids for cancer rather than chronic non-cancer pain. Results We identified 15,679 new cancer diagnoses in 14,112 DVA clients from the cancer registry and 62,663 clients without a diagnosis. Sensitivity of the proxy based on dispensing claims was 30% for all cancers and around 20% for specific cancers (range: 10-67%). Specificity was above 90% for all cancers. The dispensing proxy correctly identified 26% of people with a cancer diagnosis who initiated opioid therapy and failed to identify 74% those with a cancer diagnosis; the proxy was most robust for clients with breast cancer where 61% were correctly identified by proxy. Conclusions Using dispensing of anticancer medicines to identify people with a cancer diagnosis performed poorly. Excluding patients with evidence of anticancer medicine use from cohort studies may result removal of a disproportionate number of women with breast cancer. Researchers excluding or otherwise using anticancer medicine dispensing to identify people with cancer in pharmacoepidemiological studies should acknowledge the potential biases introduced to their findings. Keywords cancer, diagnosis, proxy, dispensing records, validation study
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Affiliation(s)
- B Daniels
- Medicines Policy Research Unit, Centre for Big Data Research in Health, UNSW, Sydney, Australia
| | - H E Tervonen
- Medicines Policy Research Unit, Centre for Big Data Research in Health, UNSW, Sydney, Australia
| | - S-A Pearson
- Medicines Policy Research Unit, Centre for Big Data Research in Health, UNSW, Sydney, Australia
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Attard TM, Lawson CE. Comparison of the demographic characteristics of pediatric and adult colorectal cancer patients: a national inpatient sample based analysis. World J Pediatr 2019; 15:37-41. [PMID: 30259389 DOI: 10.1007/s12519-018-0187-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 09/03/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Colorectal cancer in children is rare, but characterized by late presentation, unfavorable histology and poor prognosis. Risk factors for colorectal cancer in children overlap with those for adults with greater influence of hereditary syndromes. The epidemiology of colon cancer in children is poorly understood; the aim of this study was to characterize and compare the demographics and relevant clinical characteristics of pediatric and adult colon cancer, using a national inpatient sample. METHODS The AHRQ online resource HCUPnet/KID database was queried for children, under the age of 18 admitted with ICD 9 CM diagnoses relating to colorectal cancer, at the time of discharge. For comparison, the corresponding diagnoses in adult patients were queried for each successive year. Patient demographics including residential type and median income by zip-code, tumor localization; if recorded, and mean hospital charges were all accrued and analyzed. RESULTS Inpatient admissions for pediatric colorectal cancer were more likely male (54%), in the 15-17 years age bracket (57%). They were significantly more likely from Southwestern regions of the Unites States, and were significantly more likely from residential zip-codes identified as at or below the lowest income quartile than adult CRC patients or pediatric patients as a whole. Hospital charges have more than quadrupled over the time period studied (1997-2012). CONCLUSIONS Pediatric colorectal cancer is the most common primary gastrointestinal malignancy in children. Better understanding associated risk factors including those associated with gender, geographic region and social economic status may contribute to future prevention or early detection strategies.
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Affiliation(s)
- Thomas M Attard
- University of Missouri Kansas City, Kansas City, MO, USA. .,Pediatric Gastroenterology, Children's Mercy Hospital, 2401 Gillham Rd, Kansas City, MO, 64108, USA.
| | - Caitlin E Lawson
- Division of Genetics, Children's Mercy Hospital, Kansas City, MO, USA
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Koram N, Delgado M, Stark JH, Setoguchi S, Luise C. Validation studies of claims data in the Asia‐Pacific region: A comprehensive review. Pharmacoepidemiol Drug Saf 2018; 28:156-170. [DOI: 10.1002/pds.4616] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 05/30/2018] [Accepted: 06/11/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Nana Koram
- Epidemiology, Worldwide Safety and Regulatory, Pfizer, Inc. PA USA
| | - Megan Delgado
- Epidemiology, Worldwide Safety and Regulatory, Pfizer, Inc. PA USA
| | - James H. Stark
- Epidemiology, Worldwide Safety and Regulatory, Pfizer, Inc. NY USA
| | - Soko Setoguchi
- Department of Medicine, Rutgers Robert Wood Johnson Medical SchoolInstitute for Health, Rutgers University NJ USA
| | - Cynthia Luise
- Epidemiology, Worldwide Safety and Regulatory, Pfizer, Inc. NY USA
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Assareh H, Achat HM, Levesque JF. Accuracy of inter-hospital transfer information in Australian hospital administrative databases. Health Informatics J 2017; 25:960-972. [PMID: 29254419 DOI: 10.1177/1460458217730866] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Inter-hospital transfers improve care delivery for which sending and receiving hospitals both accountable for patient outcomes. We aim to measure accuracy in recorded patient transfer information (indication of transfer and hospital identifier) over 2 years across 121 acute hospitals in New South Wales, Australia. Accuracy rate for 127,406 transfer-out separations was 87 per cent, with a low variability across hospitals (10% differences); it was 65 per cent for 151,978 transfer-in admissions with a greater inter-hospital variation (36% differences). Accuracy rate varied by departure and arrival pathways; at receiving hospitals, it was lower for transfer-in admission via emergency department (incidence rate ratio = 0.52, 95% confidence interval: 0.51-0.53) versus direct admission. Transfer-out data were more accurate for transfers to smaller hospitals (incidence rate ratio = 1.06, 95% confidence interval: 1.03-1.08) or re-transfers (incidence rate ratio > 1.08). Incorporation of transfer data from sending and receiving hospitals at patient level in administrative datasets and standardisation of documentation across hospitals would enhance accuracy and support improved attribution of hospital performance measures.
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Furuya-Kanamori L, Doi SAR, Smith PN, Bagheri N, Clements ACA, Sedrakyan A. Hospital effect on infections after four major surgical procedures: outlier and volume-outcome analysis using all-inclusive state data. J Hosp Infect 2017; 97:115-121. [PMID: 28576454 DOI: 10.1016/j.jhin.2017.05.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 05/25/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Hospital volume is known to have a direct impact on the outcomes of major surgical procedures. However, it is unclear if the evidence applies specifically to surgical site infections. AIMS To determine if there are procedure-specific hospital outliers [with higher surgical site infection rates (SSIRs)] for four major surgical procedures, and to examine if hospital volume is associated with SSIRs in the context of outlier performance in New South Wales (NSW), Australia. METHODS Adults who underwent one of four surgical procedures (colorectal, joint replacement, spinal and cardiac procedures) at a NSW healthcare facility between 2002 and 2013 were included. The hospital volume for each of the four surgical procedures was categorized into tertiles (low, medium and high). Multi-variable logistic regression models were built to estimate the expected SSIR for each procedure. The expected SSIRs were used to compute indirect standardized SSIRs which were then plotted in funnel plots to identify hospital outliers. FINDINGS One hospital was identified to be an overall outlier (higher SSIRs for three of the four procedures performed in its facilities), whereas two hospitals were outliers for one specific procedure throughout the entire study period. Low-volume facilities performed the best for colorectal surgery and worst for joint replacement and cardiac surgery. One high-volume facility was an outlier for spinal surgery. CONCLUSIONS Surgical site infections seem to be mainly a procedure-specific, as opposed to a hospital-specific, phenomenon in NSW. The association between hospital volume and SSIRs differs for different surgical procedures.
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Affiliation(s)
- L Furuya-Kanamori
- Department of Public Health, College of Health Sciences, Qatar University, Doha, Qatar
| | - S A R Doi
- Research School of Population Health, The Australian National University, Canberra, ACT, Australia; Department of Community Medicine, College of Medicine, Qatar University, Doha, Qatar
| | - P N Smith
- Department of Orthopaedic Surgery, The Canberra Hospital, Canberra, ACT, Australia; Australian National University Medical School, Canberra, ACT, Australia
| | - N Bagheri
- Research School of Population Health, The Australian National University, Canberra, ACT, Australia
| | - A C A Clements
- Research School of Population Health, The Australian National University, Canberra, ACT, Australia
| | - A Sedrakyan
- Research School of Population Health, The Australian National University, Canberra, ACT, Australia; Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY, USA.
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Luo Q, Yu XQ, Smith DP, Goldsbury DE, Cooke-Yarborough C, Patel MI, O'Connell DL. Cancer-related hospitalisations and 'unknown' stage prostate cancer: a population-based record linkage study. BMJ Open 2017; 7:e014259. [PMID: 28077413 PMCID: PMC5253597 DOI: 10.1136/bmjopen-2016-014259] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To identify reasons for prostate cancer stage being recorded as 'unknown' in Australia's largest population-based cancer registry. DESIGN Prospective population-based cohort. SETTING New South Wales (NSW) is the most populous state in Australia, with almost one third of the total national population. PARTICIPANTS NSW Cancer Registry (NSWCR) records for prostate cancer cases diagnosed in 2001-2009 were linked to the NSW Admitted Patient Data Collection (APDC) for 2000-2010. All patients in this study had a minimum of 12 months follow-up in the hospital episode records after their date of diagnosis as recorded by the NSWCR. MAIN OUTCOME MEASURES Incidence of 'unknown' stage prostate cancer and cancer-specific survival. RESULTS Of 50 597 prostate cancer cases, 39.9% were recorded as having 'unknown' stage. Up to 4 months after diagnosis, 77.2% of cases without a hospital-reported cancer diagnosis were recorded as having 'unknown' stage. Among those patients with a hospital-reported cancer diagnosis, stage was 'unknown' for 7.6% of cases who received a radical prostatectomy (RP) and for 34.0% of cases who had procedures other than RP. In the latter group, the factors that were related to having 'unknown' stage were living in disadvantaged areas (adjusted OR (aOR) range: 1.13 to 1.20), attending a private hospital (aOR range: 1.25 to 2.13), having day-only admission for care (aOR=1.23, 95% CI 1.11 to 1.36), or having procedures other than multiple procedures with imaging (eg, biopsy only, aOR range: 1.11 to 1.45). CONCLUSIONS Over half of 'unknown' stage prostate cancer cases did not have a hospital-reported prostate cancer diagnosis within the 4 months after initial diagnosis. We identified differences in the likelihood of cases being recorded as 'unknown' stage based on socioeconomic status and facility type, which suggests that further investigation of reporting practices in relation to diagnostic and treatment pathways is required.
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Affiliation(s)
- Qingwei Luo
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Xue Qin Yu
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - David Paul Smith
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | | | | | - Manish Indravadan Patel
- Discipline of Surgery, University of Sydney, Sydney, New South Wales, Australia
- Department of Urology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Dianne Lesley O'Connell
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
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Creighton N, Walton R, Roder D, Aranda S, Currow D. Validation of administrative hospital data for identifying incident pancreatic and periampullary cancer cases: a population-based study using linked cancer registry and administrative hospital data in New South Wales, Australia. BMJ Open 2016; 6:e011161. [PMID: 27371553 PMCID: PMC4947808 DOI: 10.1136/bmjopen-2016-011161] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Revised: 05/24/2016] [Accepted: 06/03/2016] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES Informing cancer service delivery with timely and accurate data is essential to cancer control activities and health system monitoring. This study aimed to assess the validity of ascertaining incident cases and resection use for pancreatic and periampullary cancers from linked administrative hospital data, compared with data from a cancer registry (the 'gold standard'). DESIGN, SETTING AND PARTICIPANTS Analysis of linked statutory population-based cancer registry data and administrative hospital data for adults (aged ≥18 years) with a pancreatic or periampullary cancer case diagnosed during 2005-2009 or a hospital admission for these cancers between 2005 and 2013 in New South Wales, Australia. METHODS The sensitivity and positive predictive value (PPV) of pancreatic and periampullary cancer case ascertainment from hospital admission data were calculated for the 2005-2009 period through comparison with registry data. We examined the effect of the look-back period to distinguish incident cancer cases from prevalent cancer cases from hospital admission data using 2009 and 2013 as index years. RESULTS Sensitivity of case ascertainment from the hospital data was 87.5% (4322/4939), with higher sensitivity when the cancer was resected (97.9%, 715/730) and for pancreatic cancers (88.6%, 3733/4211). Sensitivity was lower in regional (83.3%) and remote (85.7%) areas, particularly in areas with interstate outflow of patients for treatment, and for cases notified to the registry by death certificate only (9.6%). The PPV for the identification of incident cases was 82.0% (4322/5272). A 2-year look-back period distinguished the majority (98%) of incident cases from prevalent cases in linked hospital data. CONCLUSIONS Pancreatic and periampullary cancer cases and resection use can be ascertained from linked hospital admission data with sufficient validity for informing aspects of health service delivery and system-level monitoring. Limited tumour clinical information and variation in case ascertainment across population subgroups are limitations of hospital-derived cancer incidence data when compared with population cancer registries.
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Affiliation(s)
| | - Richard Walton
- Cancer Institute NSW, Sydney, New South Wales, Australia
| | - David Roder
- Cancer Institute NSW, Sydney, New South Wales, Australia
- Centre for Population Health Research, University of South Australia, Adelaide, South Australia, Australia
| | - Sanchia Aranda
- Cancer Council Australia, Sydney, New South Wales, Australia
| | - David Currow
- Cancer Institute NSW, Sydney, New South Wales, Australia
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Incidence and Variation of Discrepancies in Recording Chronic Conditions in Australian Hospital Administrative Data. PLoS One 2016; 11:e0147087. [PMID: 26808428 PMCID: PMC4726608 DOI: 10.1371/journal.pone.0147087] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Accepted: 12/26/2015] [Indexed: 01/08/2023] Open
Abstract
Diagnostic data routinely collected for hospital admitted patients and used for case-mix adjustment in care provider comparisons and reimbursement are prone to biases. We aim to measure discrepancies, variations and associated factors in recorded chronic morbidities for hospital admitted patients in New South Wales (NSW), Australia. Of all admissions between July 2010 and June 2014 in all NSW public and private acute hospitals, admissions with over 24 hours stay and one or more of the chronic conditions of diabetes, smoking, hepatitis, HIV, and hypertension were included. The incidence of a non-recorded chronic condition in an admission occurring after the first admission with a recorded chronic condition (index admission) was considered as a discrepancy. Poisson models were employed to (i) derive adjusted discrepancy incidence rates (IR) and rate ratios (IRR) accounting for patient, admission, comorbidity and hospital characteristics and (ii) quantify variation in rates among hospitals. The discrepancy incidence rate was highest for hypertension (51% of 262,664 admissions), followed by hepatitis (37% of 12,107), smoking (33% of 548,965), HIV (27% of 1500) and diabetes (19% of 228,687). Adjusted rates for all conditions declined over the four-year period; with the sharpest drop of over 80% for diabetes (47.7% in 2010 vs. 7.3% in 2014), and 20% to 55% for the other conditions. Discrepancies were more common in private hospitals and smaller public hospitals. Inter-hospital differences were responsible for 1% (HIV) to 9.4% (smoking) of variation in adjusted discrepancy incidences, with an increasing trend for diabetes and HIV. Chronic conditions are recorded inconsistently in hospital administrative datasets, and hospitals contribute to the discrepancies. Adjustment for patterns and stratification in risk adjustments; and furthermore longitudinal accumulation of clinical data at patient level, refinement of clinical coding systems and standardisation of comorbidity recording across hospitals would enhance accuracy of datasets and validity of case-mix adjustment.
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Berger RP, Parks S, Fromkin J, Rubin P, Pecora PJ. Assessing the accuracy of the International Classification of Diseases codes to identify abusive head trauma: a feasibility study. Inj Prev 2013; 21:e133-7. [PMID: 24167034 DOI: 10.1136/injuryprev-2013-040924] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To assess the accuracy of an International Classification of Diseases (ICD) code-based operational case definition for abusive head trauma (AHT). METHODS Subjects were children <5 years of age evaluated for AHT by a hospital-based Child Protection Team (CPT) at a tertiary care paediatric hospital with a completely electronic medical record (EMR) system. Subjects were designated as non-AHT traumatic brain injury (TBI) or AHT based on whether the CPT determined that the injuries were due to AHT. The sensitivity and specificity of the ICD-based definition were calculated. RESULTS There were 223 children evaluated for AHT: 117 AHT and 106 non-AHT TBI. The sensitivity and specificity of the ICD-based operational case definition were 92% (95% CI 85.8 to 96.2) and 96% (95% CI 92.3 to 99.7), respectively. All errors in sensitivity and three of the four specificity errors were due to coder error; one specificity error was a physician error. CONCLUSIONS In a paediatric tertiary care hospital with an EMR system, the accuracy of an ICD-based case definition for AHT was high. Additional studies are needed to assess the accuracy of this definition in all types of hospitals in which children with AHT are cared for.
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Affiliation(s)
- Rachel P Berger
- Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
| | - Sharyn Parks
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Janet Fromkin
- Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
| | - Pamela Rubin
- Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
| | - Peter J Pecora
- Casey Family Programs, School of Social Work, University of Washington, Seattle, Washington, USA
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Lee YYC, Roberts CL, Young J, Dobbins T. Using hospital discharge data to identify incident pregnancy-associated cancers: a validation study. BMC Pregnancy Childbirth 2013; 13:37. [PMID: 23398861 PMCID: PMC3598759 DOI: 10.1186/1471-2393-13-37] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Accepted: 02/09/2013] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Pregnancy-associated cancer is associated with maternal morbidities and adverse pregnancy outcomes, and is reported to be increasing. Hospital discharge data have the potential to provide timely information on cancer incidence, which is central to evaluation and improvement of clinical care for women. This study aimed to assess the validity of hospital data for identifying incident pregnancy-associated cancers compared with incident cancers from an Australian population-based statutory cancer registry. METHODS Birth data from 2001-2008, comprised 470,277 women with 679,736 maternities, were linked to cancer registry and hospitalisation records to identify newly diagnosed cancers during pregnancy or within 12 months of delivery. Two hospital-identified cancer groups were examined; "index cancer hospitalisation" - first cancer admission per woman per pregnancy and "all cancer hospitalisations" -the total number of hospitalisations with a cancer diagnosis and women could have multiple hospitalisations during pregnancy. The latter replicates a scenario where identification of individuals is not possible and hospitalisations are used as the unit of analysis. RESULTS The incidence of pregnancy-associated cancer (according to cancer registry) was 145.4/100,000 maternities. Incidence of cancer was substantially over-estimated when using hospitalisations as the unit of analysis (incidence rate ratio, IRR 1.7) and under-estimated when using the individual (IRR 0.8). Overall, the sensitivity of "index cancer hospitalisation" was 60.4%, positive predictive value (PPV) 77.7%, specificity and negative predictive value both 100%. Melanoma ascertainment was only 36.1% and breast cancer 62.9%. For other common cancers sensitivities ranged from 72.1% to 78.6% and PPVs 56.4% to 87.3%. CONCLUSION Although hospital data provide another timely source of cancer identification, the validity is insufficient to obtain cancer incidence estimates for the obstetric population.
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Affiliation(s)
- Yuen Yi Cathy Lee
- Clinical and Population Perinatal Health Research, Kolling Institute of Medical Research, University of Sydney, New South Wales, Australia
| | - Christine L Roberts
- Clinical and Population Perinatal Health Research, Kolling Institute of Medical Research, University of Sydney, New South Wales, Australia
| | - Jane Young
- Cancer Epidemiology and Services Research Group, University of Sydney, New South Wales, Australia
| | - Timothy Dobbins
- Cancer Epidemiology and Services Research Group, University of Sydney, New South Wales, Australia
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