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Lopez-de-Andres A, Jimenez-Garcia R, Cuadrado-Corrales N, Carabantes-Alarcon D, Hernandez-Barrera V, de Miguel-Diez J, Jimenez-Sierra A, Zamorano-Leon JJ. Changes in use and hospital outcomes of bariatric surgery in Spain (2016-2022): analysis of the role of type 2 diabetes using propensity score matching. BMJ Open Diabetes Res Care 2024; 12:e004351. [PMID: 39097299 PMCID: PMC11298724 DOI: 10.1136/bmjdrc-2024-004351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 07/22/2024] [Indexed: 08/05/2024] Open
Abstract
INTRODUCTION The objectives of this study were to examine temporal trends in the incidence of bariatric surgery (Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG)) in patients with and without type 2 diabetes mellitus (T2DM). Outcomes of hospitalization and the impact of T2DM on these outcomes were also analyzed. RESEARCH DESIGN AND METHODS We performed an observational study with the Spanish national hospital discharge database. Obese patients with and without T2DM who underwent RYGB and SG between 2016 and 2022 were identified. Propensity score matching (PSM) and logistic regression were used to compare patients with and without T2DM and to evaluate the effect of T2DM and other variables on outcomes of surgery. A variable "severity" was created to cover patients who died in hospital or were admitted to the intensive care unit (ICU). RESULTS A total of 32,176 bariatric surgery interventions were performed (28.86% with T2DM). 31.57% of RYGBs and 25.53% of SG patients had T2DM. The incidence of RYGB and SG increased significantly between 2016 and 2022 (p<0.001), with a higher incidence in those with T2DM than in those without (incidence rate ratio 4.07 (95% CI 3.95 to 4.20) for RYGB and 3.02 (95% CI 2.92 to 3.14) for SG). In patients who underwent SG, admission to the ICU and severity were significantly more frequent in patients with T2DM than in those without (both p<0.001). In the multivariate analysis, having T2DM was associated with more frequent severity in those who received SG (OR 1.23; 95% CI 1.07 to 1.42). CONCLUSIONS Between 2016 and 2022, bariatric surgery procedures performed in Spain increased in patients with and without T2DM. More interventions were performed on patients with T2DM than on patients without T2DM. RYGB was the most common procedure in patients with T2DM. The presence of T2DM was associated with more severity after SG.
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Affiliation(s)
- Ana Lopez-de-Andres
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Rodrigo Jimenez-Garcia
- Department of Public Health & Maternal and Child Health, Universidad Complutense de Madrid, Madrid, Spain
| | | | - David Carabantes-Alarcon
- Department of Public Health & Maternal and Child Health, Universidad Complutense de Madrid, Madrid, Spain
| | - Valentin Hernandez-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Universidad Rey Juan Carlos, Mostoles, Madrid, Spain
| | - Javier de Miguel-Diez
- Respiratory Care Department, Hospital General Universitario Gregorio Maranon, Madrid, Spain
| | | | - José Javier Zamorano-Leon
- Department of Public Health & Maternal and Child Health, Universidad Complutense de Madrid, Madrid, Spain
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García-Villarino M, Lambert C, De la Hera JM, Torre ELM, Rodríguez-Lacín JMF, Delgado-Álvarez E. Use of electronic health records for the management of diabetes and its risk factors in the Principality of Asturias from 2014 to 2018. ENDOCRINOL DIAB NUTR 2024; 71:208-215. [PMID: 38897704 DOI: 10.1016/j.endien.2024.03.017] [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: 11/25/2023] [Revised: 03/04/2024] [Accepted: 03/04/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND In recent years, the implementation of electronic health records across all hospitals and primary care centres within the National Health System has significantly enhanced access to patients' clinical data. This study aims to estimate the prevalence of type 2 diabetes (T2DM) in primary care settings and to outline its associated cardiovascular risk factors (CVRF) and epidemiological characteristics. METHODS An observational cross-sectional study was conducted including 89,679 patients diagnosed with T2DM who attended the primary health care system from 2014 to 2018. Data was provided by the Primary Health Care System of the Principality of Asturias (SESPA). RESULTS The estimated prevalence of diagnosed T2DM was 8.01% (95% Confidence Interval [CI]: 7.96-8.06) of the total population. Additionally, it was more prevalent in males compared to females (9.90% [95% CI: 9.81-9.99] vs. 6.50% [95% CI: 6.44-6.57]) and increased with age in both sexes. People with T2DM had an average age of 74 years, 52.3% were male, and the most frequently associated CVRF were: dyslipidaemia (47.90%) and hypertension (62.20%). Glycaemic control improved during the 2014-2018 period (31.69%), as did lipid control (23.66%). However, the improvement in blood pressure control (9.34%) was less pronounced for the same period. Regarding the multifactorial control of diabetes (measured by LDL-cholesterol, HbA1C and blood pressure) the overall degree of control improved by 11.55% between 2014 and 2018. CONCLUSION In this 5-year retrospective population-based study, the utilisation of data from electronic medical records provides insights into the prevalence of T2DM in a large population, as well as real-time CVRFs. Leveraging this data facilitates the development of targeted health policies.
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Affiliation(s)
- Miguel García-Villarino
- Grupo de Endocrinología, Nutrición, Diabetes y Obesidad (ENDO), Instituto de Investigación Sanitaria del Principado de Asturias (ISPA) and University of Oviedo, Oviedo, Spain.
| | - Carmen Lambert
- Grupo de Endocrinología, Nutrición, Diabetes y Obesidad (ENDO), Instituto de Investigación Sanitaria del Principado de Asturias (ISPA) and University of Oviedo, Oviedo, Spain
| | - Jesús M De la Hera
- Grupo de Endocrinología, Nutrición, Diabetes y Obesidad (ENDO), Instituto de Investigación Sanitaria del Principado de Asturias (ISPA) and University of Oviedo, Oviedo, Spain; Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Edelmiro Luis Menéndez Torre
- Grupo de Endocrinología, Nutrición, Diabetes y Obesidad (ENDO), Instituto de Investigación Sanitaria del Principado de Asturias (ISPA) and University of Oviedo, Oviedo, Spain; Servicio de Endocrinología y Nutrición, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - José María Fernández Rodríguez-Lacín
- Grupo de Cronicidad, Envejecimiento, Fragilidad y Continuidad Asistencial, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Elías Delgado-Álvarez
- Grupo de Endocrinología, Nutrición, Diabetes y Obesidad (ENDO), Instituto de Investigación Sanitaria del Principado de Asturias (ISPA) and University of Oviedo, Oviedo, Spain; Servicio de Endocrinología y Nutrición, Hospital Universitario Central de Asturias, Oviedo, Spain
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Althunian TA, Alrasheed MM, Alnofal FA, Tafish RT, Mira MA, Alroba RA, Kirdas MW, Alshammari TM. Recording type 2 diabetes mellitus in a standardised central Saudi database: a retrospective validation study. BMJ Open 2023; 13:e065468. [PMID: 36944455 PMCID: PMC10032409 DOI: 10.1136/bmjopen-2022-065468] [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] [Indexed: 03/23/2023] Open
Abstract
OBJECTIVES This study was conducted to assess the validity of recording (and the original diagnostic practice) of type 2 diabetes mellitus at a hospital whose records were integrated to a centralised database (the standardised common data model (CDM) of the Saudi National Pharmacoepidemiologic Database (NPED)). DESIGN A retrospective single-centre validation study. SETTINGS Data of the study participants were extracted from the CDM of the NPED (only records of one tertiary care hospital were integrated at the time of the study) between 1 January 2013 and 1 July 2018. PARTICIPANTS A random sample of patients with type 2 diabetes mellitus (≥18 years old and with a code of type 2 diabetes mellitus) matched with a control group (patients without diabetes) based on age and sex. OUTCOME MEASURES The standardised coding of type 2 diabetes in the CDM was validated by comparing the presence of diabetes in the CDM versus the original electronic records at the hospital, the recording in paper-based medical records, and the physician re-assessment of diabetes in the included cases and controls, respectively. Sensitivity, specificity, positive predictive value and negative predictive value were estimated for each pairwise comparison using RStudio V.1.4.1103. RESULTS A total of 437 random sample of patients with type 2 diabetes mellitus was identified and matched with 437 controls. Only 190 of 437 (43.0%) had paper-based medical records. All estimates were above 90% except for sensitivity and specificity of CDM versus paper-based records (54%; 95% CI 47% to 61% and 68%; 95% CI 62% to 73%, respectively). CONCLUSIONS This study provided an assessment to the extent of which only type 2 diabetes mellitus code can be used to identify patients with this disease at a Saudi centralised database. A future multi-centre study would help adding more emphasis to the study findings.
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Affiliation(s)
- Turki Abdulaziz Althunian
- Research Informatics Department, Saudi Food and Drug Authority, Riyadh, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Meshael M Alrasheed
- Executive Department for Research and Studies, Saudi Food and Drug Authority, Riyadh, Saudi Arabia
| | - Fatemah A Alnofal
- Research Informatics Department, Saudi Food and Drug Authority, Riyadh, Saudi Arabia
| | - Rawan T Tafish
- Orthopedic and Spinal Surgery, Kingdom Hospital & Consulting Clinics, Riyadh, Saudi Arabia
| | - Mahmood A Mira
- Orthopedic and Spinal Surgery, Kingdom Hospital & Consulting Clinics, Riyadh, Saudi Arabia
| | - Raseel A Alroba
- Research Informatics Department, Saudi Food and Drug Authority, Riyadh, Saudi Arabia
| | - Mohammed W Kirdas
- Orthopedic and Spinal Surgery, Kingdom Hospital & Consulting Clinics, Riyadh, Saudi Arabia
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Hsu S, Selen DJ, James K, Li S, Camargo CA, Kaimal A, Powe CE. Assessment of the Validity of Administrative Data for Gestational Diabetes Ascertainment. Am J Obstet Gynecol MFM 2023; 5:100814. [PMID: 36396038 PMCID: PMC10071626 DOI: 10.1016/j.ajogmf.2022.100814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Administrative data, including International Classification of Diseases codes and birth certificate records, are often used for retrospective gestational diabetes research investigations to describe associations of gestational diabetes with perinatal complications and long-term outcomes, and to determine gestational diabetes prevalence. Research investigating the validity of using International Classification of Diseases codes and birth certificates for gestational diabetes ascertainment shows varying degrees of reliability. OBJECTIVE This study aimed to evaluate the accuracy of both International Classification of Diseases codes and birth certificate diagnosis for gestational diabetes ascertainment in a large hospital-based cohort of pregnant individuals, using laboratory criteria for gestational diabetes mellitus as the reference. STUDY DESIGN We studied individuals who received prenatal care at an academic hospital and affiliated community health centers between 1998 and 2016. In the setting of universal 2-step screening for gestational diabetes, pregnant individuals were classified as having gestational diabetes if ≥2 oral glucose tolerance test values met or exceeded National Diabetes Data Group thresholds. We calculated the sensitivity, specificity, positive predictive value, and negative predictive value for International Classification of Diseases code and birth certificate ascertainment of gestational diabetes, and their exact binomial 95% confidence intervals. RESULTS In a cohort of 51,059 pregnancies with complete glucose screening, 1303 (2.6%) met National Diabetes Data Group laboratory criteria for gestational diabetes. Gestational diabetes International Classification of Diseases codes had moderate sensitivity of 70.5% (95% confidence interval, 67.9-72.9), high specificity of 99.3% (95% confidence interval, 99.3-99.4), a positive predictive value of 73.3% (95% confidence interval, 70.8-75.8), and a negative predictive value of 99.2% (95% confidence interval, 99.1-99.3). In the 46,512 pregnancies linked to birth certificate data, birth certificate diagnosis had moderate sensitivity (66.3% [95% confidence interval, 63.6-69.0]), high specificity (98.9% [95% confidence interval, 98.8-99.0]), moderate positive predictive value (62.1% [95% confidence interval, 59.8-64.4]), and high negative predictive value (99.1% [95% confidence interval, 99.0-99.2]). CONCLUSION Ascertainment of gestational diabetes using administrative data, including International Classification of Diseases codes or birth certificates, has moderate sensitivity, moderate positive predictive value, high specificity, and high negative predictive value. Our findings provide context for interpreting the validity of studies that depend on administrative data for ascertainment of gestational diabetes and comparing them with prospective studies that use laboratory-based gestational diabetes criteria.
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Affiliation(s)
- Sarah Hsu
- Diabetes Unit, Massachusetts General Hospital, Boston, MA (Ms Hsu and Drs Selen and Powe); Eli and Edythe L. Broad Institute of MIT and Harvard, Cambridge, MA (Ms Hsu and Dr Powe)
| | - Daryl J Selen
- Diabetes Unit, Massachusetts General Hospital, Boston, MA (Ms Hsu and Drs Selen and Powe); Harvard Medical School, Boston, MA (Drs Selen, James, Camargo, Kaimal, and Powe)
| | - Kaitlyn James
- Harvard Medical School, Boston, MA (Drs Selen, James, Camargo, Kaimal, and Powe); Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA (Drs James, Kaimal, and Powe)
| | - Sijia Li
- Department of Medicine, Division of Endocrinology, Warren Alpert Medical School of Brown University, Providence, RI (Dr. Selen), Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA (Ms Li and Dr Camargo)
| | - Carlos A Camargo
- Harvard Medical School, Boston, MA (Drs Selen, James, Camargo, Kaimal, and Powe); Department of Medicine, Division of Endocrinology, Warren Alpert Medical School of Brown University, Providence, RI (Dr. Selen), Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA (Ms Li and Dr Camargo)
| | - Anjali Kaimal
- Harvard Medical School, Boston, MA (Drs Selen, James, Camargo, Kaimal, and Powe); Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA (Drs James, Kaimal, and Powe)
| | - Camille E Powe
- Diabetes Unit, Massachusetts General Hospital, Boston, MA (Ms Hsu and Drs Selen and Powe); Eli and Edythe L. Broad Institute of MIT and Harvard, Cambridge, MA (Ms Hsu and Dr Powe); Harvard Medical School, Boston, MA (Drs Selen, James, Camargo, Kaimal, and Powe); Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA (Drs James, Kaimal, and Powe).
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Tamayo I, Librero-Lopez J, Galbete A, Cambra K, Enguita-Germán M, Forga L, Goñi MJ, Lecea O, Gorricho J, Olazarán Á, Arnedo L, Moreno-Iribas C, Lafita J, Ibañez-Beroiz B. Cohort Profile: CArdiovascular Risk in patients with DIAbetes in NAvarra (CARDIANA cohort). BMJ Open 2023; 13:e066052. [PMID: 36669840 PMCID: PMC9872484 DOI: 10.1136/bmjopen-2022-066052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 01/04/2023] [Indexed: 01/22/2023] Open
Abstract
PURPOSE The CArdiovascular Risk in patients with DIAbetes in Navarra (CARDIANA cohort) cohort was established to assess the effects of sociodemographic and clinical variables on the risk of cardiovascular events in patients with type 1 (T1D) or type 2 (T2D) diabetes, with a special focus on socioeconomic factors, and to validate and develop cardiovascular risk models for these patients. PARTICIPANTS The CARDIANA cohort included all patients with T1D and T2D diabetes registered in the Public Health Service of Navarra with prevalent disease on 1 January 2012. It consisted of 1067 patients with T1D (ages 2-88 years) and 33842 patients with T2D (ages 20-105 years), whose data were retrospectively extracted from the Health and Administrative System Databases. FINDINGS TO DATE The follow-up period for wave 1 was from 1 January 2012 to 31 December 2016. During these 5 years, 9 patients (0.8%; 95% CI (0.4% to 1.6%)) in the T1D cohort developed a cardiovascular disease event, whereas for the T2D cohort, 2602 (7.7%; 95% CI (7.4% to 8.0%)) had an event. For the T2D cohort, physical activity was associated with a reduced risk of cardiovascular events, with adjusted estimated ORs equal to 0.84 (95% CI 0.66 to 1.07) for the partially active group and 0.71 (95% CI 0.56 to 0.91) for the active group, compared with patients in the non-active group. FUTURE PLANS The CARDIANA cohort is currently being used to assess the effect of sociodemographic risk factors on CV risk at 5 years and to externally validate cardiovascular predictive models. A second wave is being conducted in late 2022 and early 2023, to extend the follow-up other 5 years, from 1 January 2016 to 31 December 2021. Periodic data extractions are planned every 5 years.
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Affiliation(s)
- Ibai Tamayo
- Unidad de Metodología, Navarrabiomed-HUN-UPNA, Pamplona, Navarra, Spain
- Instituto de Investigación Biomédica de Navarra (IdISNA), Pamplona, Spain
- Red de Invesitigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Pamplona, Spain
- Red de Investigacion en Servicios de Salud en Enfermedades Cronicas (REDISSEC), Pamplona, Spain
| | - Julian Librero-Lopez
- Unidad de Metodología, Navarrabiomed-HUN-UPNA, Pamplona, Navarra, Spain
- Instituto de Investigación Biomédica de Navarra (IdISNA), Pamplona, Spain
- Red de Invesitigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Pamplona, Spain
- Red de Investigacion en Servicios de Salud en Enfermedades Cronicas (REDISSEC), Pamplona, Spain
| | - Arkaitz Galbete
- Instituto de Investigación Biomédica de Navarra (IdISNA), Pamplona, Spain
- Red de Invesitigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Pamplona, Spain
- Red de Investigacion en Servicios de Salud en Enfermedades Cronicas (REDISSEC), Pamplona, Spain
- Departamento de Estadística, Universidad Pública de Navarra, Pamplona, Spain
| | - Koldo Cambra
- Red de Investigacion en Servicios de Salud en Enfermedades Cronicas (REDISSEC), Pamplona, Spain
- Departamento de Sanidad, Gobierno Vasco, Pamplona, Spain
| | - Mónica Enguita-Germán
- Unidad de Metodología, Navarrabiomed-HUN-UPNA, Pamplona, Navarra, Spain
- Instituto de Investigación Biomédica de Navarra (IdISNA), Pamplona, Spain
- Red de Invesitigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Pamplona, Spain
- Red de Investigacion en Servicios de Salud en Enfermedades Cronicas (REDISSEC), Pamplona, Spain
| | - Luis Forga
- Instituto de Investigación Biomédica de Navarra (IdISNA), Pamplona, Spain
- Servicio de Endocrinología y Nutrición - HUN, Servicio Navarro de Salud - Osasunbidea, Pamplona, Spain
| | - María José Goñi
- Instituto de Investigación Biomédica de Navarra (IdISNA), Pamplona, Spain
- Servicio de Endocrinología y Nutrición - HUN, Servicio Navarro de Salud - Osasunbidea, Pamplona, Spain
| | - Oscar Lecea
- Red de Invesitigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Pamplona, Spain
- Atención Primaria, Servicio Navarro de Salud - Osasunbidea, Pamplona, Spain
| | - Javier Gorricho
- Red de Investigacion en Servicios de Salud en Enfermedades Cronicas (REDISSEC), Pamplona, Spain
- Servicio de Evaluación y Difusión de resultados en Salud, Servicio Navarro de Salud - Osasunbidea, Pamplona, Spain
| | - Álvaro Olazarán
- Servicio Tecnologías de la Salud, Departamento de Universidad, Innovación y Transformación, Pamplona, Spain
| | - Laura Arnedo
- Instituto de Estadística de Navarra, Pamplona, Spain
| | - Conchi Moreno-Iribas
- Instituto de Investigación Biomédica de Navarra (IdISNA), Pamplona, Spain
- Red de Investigacion en Servicios de Salud en Enfermedades Cronicas (REDISSEC), Pamplona, Spain
- Instituto de Salud Pública y Laboral de Navarra, Pamplona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Pamplona, Spain
| | - Javier Lafita
- Red de Invesitigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Pamplona, Spain
- Servicio de Efectividad y Seguridad Asistencial, Servicio Navarro de Salud - Osasunbidea, Pamplona, Spain
| | - Berta Ibañez-Beroiz
- Unidad de Metodología, Navarrabiomed-HUN-UPNA, Pamplona, Navarra, Spain
- Instituto de Investigación Biomédica de Navarra (IdISNA), Pamplona, Spain
- Red de Invesitigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Pamplona, Spain
- Red de Investigacion en Servicios de Salud en Enfermedades Cronicas (REDISSEC), Pamplona, Spain
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Paul SK, Ling J, Samanta M, Montvida O. Robustness of Multiple Imputation Methods for Missing Risk Factor Data from Electronic Medical Records for Observational Studies. JOURNAL OF HEALTHCARE INFORMATICS RESEARCH 2022; 6:385-400. [PMID: 36744084 PMCID: PMC9892403 DOI: 10.1007/s41666-022-00119-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/26/2022] [Accepted: 08/18/2022] [Indexed: 02/07/2023]
Abstract
Evaluating appropriate methodologies for imputation of missing outcome data from electronic medical records (EMRs) is crucial but lacking for observational studies. Using US EMR in people with type 2 diabetes treated over 12 and 24 months with dipeptidyl peptidase 4 inhibitors (DPP-4i, n = 38,483) and glucagon-like peptide 1 receptor agonists (GLP-1RA, n = 8,977), predictors of missingness of disease biomarker (HbA1c) were explored. Robustness of multiple imputation (MI) by chained equations, two-fold MI (MI-2F) and MI with Monte Carlo Markov Chain were compared to complete case analyses for drawing inferences. Compared to younger people (age quartile Q1), those in age quartile Q3 and Q4 were less likely to have missing HbA1c by 25-32% (range of OR CI: 0.55-0.88) at 6-month follow-up and by 26-39% (range of OR CI: 0.50-0.80) at 12-month follow-up. People with HbA1c ≥ 7.5% at baseline were 12% (OR CI: 0.83, 0.93) and 14% (OR CI: 0.77, 0.97) less likely to have missing data at 6-month follow-up in the DPP-4i and GLP-1RA groups, respectively. All imputation methods provided similar HbA1c distributions during follow-up as observed with complete case analyses. The clinical inferences based on absolute change in HbA1c and by proportion of people reducing HbA1c to a clinically acceptable level (≤ 7%) were also similar between imputed data and complete case analyses. MI-2F method provided marginally smaller mean difference between observed and imputed data with relatively smaller standard error of difference, compared to other methods, while evaluating for consistency through artificial within-sample analyses. The established MI techniques can be reliably employed for missing outcome data imputations in large EMR-based relational databases, leading to efficiently designing and drawing robust clinical inferences in pharmaco-epidemiological studies. Supplementary Information The online version contains supplementary material available at 10.1007/s41666-022-00119-w.
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Affiliation(s)
- Sanjoy K. Paul
- Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, Australia
| | - Joanna Ling
- Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, Australia
- Royal Melbourne Institute of Technology, Melbourne, Australia
| | - Mayukh Samanta
- Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, Australia
| | - Olga Montvida
- Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, Australia
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7
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Fernandez-Lazaro CI, Sayon-Orea C, Toledo E, Moreno-Iribas C, Guembe MJ. Association of ideal cardiovascular health with cardiovascular events and risk advancement periods in a Mediterranean population-based cohort. BMC Med 2022; 20:232. [PMID: 35787272 PMCID: PMC9254604 DOI: 10.1186/s12916-022-02417-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 05/26/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The American Heart Association recommends Life's Simple 7 as ideal cardiovascular health (ICVH) to reduce cardiovascular risk. Rate advancement period (RAP), a useful tool to quantify and communicate exposure impact on risks, may enhance communication about the benefits of achieving ICVH. We aimed to examine whether greater adherence to ICVH metrics was associated with reduced incidence of cardiovascular risk in a population-based cohort and estimate its impact on the timing of occurrence using RAP. METHODS Prospective analyses of 3826 participants, initially free from cardiovascular disease at baseline, enrolled in the Vascular Risk in Navarra Study (RIVANA), a Mediterranean population-based cohort of Spanish adults. ICVH metrics were defined using participants' baseline information as follows: never-smoker or quitting > 12 months ago, body mass index < 25 kg/m2, ≥ 150 min/week of moderate physical activity or equivalent, healthy dietary pattern (≥ 9 points on a validated 14-item Mediterranean diet adherence screener), untreated cholesterol < 200 mg/dL, untreated blood pressure < 120/80 mmHg, and untreated fasting blood glucose < 100 mg/dL. Participants were assigned 1 point for each achieved metric and were grouped according to their number of accumulated metrics in ≤ 2, 3, 4, and ≥ 5. The primary endpoint was major cardiovascular events (composite of myocardial infarction, stroke, or death from cardiovascular causes). Cox proportional hazard ratios (HRs) and RAPs with their corresponding 95% confidence intervals (95% CI) adjusted for potential confounders were calculated. RESULTS During a median follow-up of 12.8 years (interquartile range 12.3-13.1), a total of 194 primary endpoints were identified. Compared to participants with ≤ 2 ideal metrics, HR (95% CI) for major cardiovascular events among participants meeting ≥ 5 metrics was 0.32 (0.17-0.60) with RAP (95% CI) of - 14.4 years (- 22.9, - 5.9). CONCLUSIONS Greater adherence to ICVH metrics was associated with lower cardiovascular risk among Spanish adults of the RIVANA cohort. Adherence to ideal metrics may substantially delay cardiovascular risk.
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Affiliation(s)
- Cesar I Fernandez-Lazaro
- Department of Health, Government of Navarre, Vascular Risk in Navarre Investigation Group, Pamplona, Spain. .,Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, C/Irunlarrea 1, 31008, Pamplona, Spain. .,IdiSNA, Navarra Institute for Health Research, Pamplona, Spain. .,Navarrabiomed-Miguel Servet Foundation, Pamplona, Spain.
| | - Carmen Sayon-Orea
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, C/Irunlarrea 1, 31008, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, Pamplona, Spain.,Navarra Public Health Institute, Pamplona, Spain
| | - Estefania Toledo
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, C/Irunlarrea 1, 31008, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, Pamplona, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Conchi Moreno-Iribas
- Department of Health, Government of Navarre, Vascular Risk in Navarre Investigation Group, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, Pamplona, Spain.,Navarra Public Health Institute, Pamplona, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Institute of Health Carlos III, Madrid, Spain
| | - María J Guembe
- Department of Health, Government of Navarre, Vascular Risk in Navarre Investigation Group, Pamplona, Spain.,Servicio de Apoyo a la Gestión Clínica y Continuidad Asistencial, Complejo Hospitalario de Navarra, Pamplona, Spain.,Dirección General de Salud del Gobierno de Navarra, Servicio de Planificación, Evaluación Y Gestión del Cono-cimiento, Pamplona, Spain
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8
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Enguita-Germán M, Librero J, Leache L, Gutiérrez-Valencia M, Tamayo I, Jericó C, Gorricho J, García-Erce JA. Role of the AB0 blood group in COVID-19 infection and complications: A population-based study. Transfus Apher Sci 2022; 61:103357. [PMID: 35148968 PMCID: PMC8762836 DOI: 10.1016/j.transci.2022.103357] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/05/2022] [Accepted: 01/15/2022] [Indexed: 12/16/2022]
Abstract
Since the beginning of the COVID-19 pandemic, the ABO blood group has been described as a possible biological marker of susceptibility for the disease. This study evaluates the role of ABO group on the risk of SARS-CoV-2 infection and related complications in a population-based cohort including 87,090 subjects from the Navarre population (Northern Spain) with no history of SARS-CoV-2 infection and with known ABO blood group, after one year of the pandemic (May 2020 - May 2021). The risk of infection, hospitalization, Intensive Care Unit (ICU) admission and death was analyzed using multivariate logistic regression, adjusting for possible confounding variables. A lower risk of infection was observed in group 0 vs non-0 groups [OR 0.94 (95 %CI 0.90-0.99)], a higher risk of infection in group A vs non-A groups [OR 1.09 (95 %CI 1.04-1.15)] and a higher risk of infection in group A vs group 0 [OR 1.08 (95CI 1.03-1.14)] (when the 4 groups are analyzed separately). No association was observed between blood groups and hospitalization, ICU admission, or death in SARS-CoV-2 infected subjects. Regarding the risk of SARS-CoV-2 infection, we observed a protective role of group O and a greater risk in the A group.
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Affiliation(s)
- Mónica Enguita-Germán
- Unidad de Metodología. Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain; Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), Bilbao, Spain.
| | - Julián Librero
- Unidad de Metodología. Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain; Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), Bilbao, Spain.
| | - Leire Leache
- Sección de Innovación y Organización, Servicio Navarro de Salud-Osasunbidea, Spain.
| | | | - Ibai Tamayo
- Unidad de Metodología. Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain; Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), Bilbao, Spain.
| | - Carlos Jericó
- Department of Internal Medicine, Hospital Sant Joan Despí-Moisès Broggi, Consorci Sanitari Integral, Sant Joan Despí, Barcelona, Spain.
| | - Javier Gorricho
- Servicios de Evaluación y Difusión de Resultados, Servicio Navarro de Salud-Osasunbidea, Spain.
| | - José Antonio García-Erce
- Banco de Sangre y Tejidos de Navarra, Servicio Navarro de Salud, Osasunbidea, Pamplona, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Instituto Aragonés de Ciencias de la Salud, Zaragoza, Spain; Grupo idiPAZ de «Investigación en PBM», Madrid, Spain.
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9
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Cárdenas-Robledo S, Otero-Romero S, Passarell-Bacardit MA, Carbonell-Mirabent P, Sastre-Garriga J, Montalban X, Tintoré M. Multiple sclerosis is associated with higher comorbidity and health care resource use: A population-based, case-control study in a western Mediterranean region. Eur J Neurol 2021; 28:4124-4134. [PMID: 34293826 DOI: 10.1111/ene.15030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 07/19/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Comorbidities are common in multiple sclerosis (MS), and have been associated with worse outcomes and increased health care resource usage. We studied the frequency of comorbidities and adverse health behaviors (AHBs) in MS patients in the Mediterranean region of Catalonia. METHODS This population-based, case-control study used primary health care information covering 80% of Catalonia's population. Cases were matched by age/sex with randomly chosen controls (ratio = 1:5). Demographic information, comorbidities, AHBs, annual visits, sick leave days, and medication dispensing were studied. The association of comorbidities with MS and the profile of comorbidities according to sex within MS cases were assessed with multivariate logistic regression models, after adjusting for confounding variables. Health care resource usage was analyzed in MS cases compared to controls, and within MS cases in those with compared to those without comorbidities. RESULTS Five thousand five hundred forty-eight MS cases and 27,710 controls (70% female, mean age = 48.3 years) were included. Stroke (odds ratio [OR] = 1.54, 95% confidence interval [CI] = 1.17-1.99), epilepsy (OR = 2.46, 95% CI = 1.94-3.10), bipolar disorder (OR = 1.67, 95% CI = 1.17-2.36), and depression (OR = 1.83, 95% CI = 1.70-1.98) were more frequent in MS. Cases were more prone to smoking but less to alcohol intake. Among cases, psychiatric comorbidities were more frequent in women, whereas cardiovascular diseases and AHBs were more frequent in men. MS patients, particularly with comorbidities, had higher health care resource usage than controls. CONCLUSIONS Psychiatric comorbidities, stroke, epilepsy, and AHBs are more common in MS patients than in the general population in the western Mediterranean region of Catalonia. The presence of comorbidities increases the health care resource usage in MS patients.
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Affiliation(s)
- Simón Cárdenas-Robledo
- Neurology-Neuroimmunology Service, Multiple Sclerosis Center of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Department of Neurology, Multiple Sclerosis Center (CEMHUN), Hospital Universitario Nacional de Colombia, Bogotá, Colombia
| | - Susana Otero-Romero
- Neurology-Neuroimmunology Service, Multiple Sclerosis Center of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Preventive Medicine and Epidemiology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Maria Angels Passarell-Bacardit
- Atención Primaria / IDIAP Jordi Gol Primary Care Research Institute, Institut Catalá de la Salut, Catalunya Central, Barcelona, Spain
| | - Pere Carbonell-Mirabent
- Neurology-Neuroimmunology Service, Multiple Sclerosis Center of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Jaume Sastre-Garriga
- Neurology-Neuroimmunology Service, Multiple Sclerosis Center of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Xavier Montalban
- Neurology-Neuroimmunology Service, Multiple Sclerosis Center of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Mar Tintoré
- Neurology-Neuroimmunology Service, Multiple Sclerosis Center of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Barcelona, Spain
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10
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Martínez-Baz I, Navascués A, Portillo ME, Casado I, Fresán U, Ezpeleta C, Castilla J. Effect of Influenza Vaccination in Preventing Laboratory-Confirmed Influenza Hospitalization in Patients With Diabetes Mellitus. Clin Infect Dis 2021; 73:107-114. [PMID: 32412600 DOI: 10.1093/cid/ciaa564] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 05/08/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND People with diabetes are at high risk of severe influenza complications. The influenza vaccination effect among diabetic patients remains inconclusive. We estimated the average effect of influenza vaccination status in the current and prior seasons in preventing laboratory-confirmed influenza hospitalization in diabetic patients. METHODS Patients attended in hospitals and primary healthcare centers with influenza-like illness were tested for influenza from the 2013-2014 to 2018-2019 seasons in Navarre, Spain. A test-negative case-control design in diabetic inpatients compared the influenza vaccination status in the current and 5 prior seasons between laboratory-confirmed influenza cases and negative controls. Vaccination status of influenza-confirmed cases was compared between diabetic inpatients and outpatients. Influenza vaccination effect was compared between diabetic patients and older (≥ 60 years) or chronic nondiabetic patients. RESULTS Of 1670 diabetic inpatients tested, 569 (34%) were confirmed for influenza and 1101 were test-negative controls. The average effect in preventing influenza hospitalization was 46% (95% confidence interval [CI], 28%-59%) for current-season vaccination and 44% (95% CI, 20%-61%) for vaccination in prior seasons only in comparison to unvaccinated patients in the current and prior seasons. Among diabetic patients with confirmed influenza, current-season vaccination reduced the probability of hospitalization (adjusted odds ratio, 0.35; 95% CI, .15-.79). In diabetic patients, vaccination effect against influenza hospitalizations was not inferior to that in older or chronic nondiabetic patients. CONCLUSIONS On average, influenza vaccination of diabetic population reduced by around half the risk of influenza hospitalization. Vaccination in prior seasons maintained a notable protective effect. These results reinforce the recommendation of influenza vaccination for diabetic patients.
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Affiliation(s)
- Iván Martínez-Baz
- Instituto de Salud Pública de Navarra - IdiSNA, Pamplona, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Ana Navascués
- Clinical Microbiology Department, Complejo Hospitalario de Navarra - IdiSNA, Pamplona, Spain
| | - María Eugenia Portillo
- Clinical Microbiology Department, Complejo Hospitalario de Navarra - IdiSNA, Pamplona, Spain
| | - Itziar Casado
- Instituto de Salud Pública de Navarra - IdiSNA, Pamplona, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Ujué Fresán
- Instituto de Salud Pública de Navarra - IdiSNA, Pamplona, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Carmen Ezpeleta
- Clinical Microbiology Department, Complejo Hospitalario de Navarra - IdiSNA, Pamplona, Spain
| | - Jesús Castilla
- Instituto de Salud Pública de Navarra - IdiSNA, Pamplona, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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11
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Paul SK, Montvida O, Best JH, Gale S, Pethö-Schramm A, Sarsour K. Association of biological antirheumatic therapy with risk for type 2 diabetes: a retrospective cohort study in incident rheumatoid arthritis. BMJ Open 2021; 11:e042246. [PMID: 34135030 PMCID: PMC8211068 DOI: 10.1136/bmjopen-2020-042246] [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] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To explore possible associations of treatment with biological disease-modifying antirheumatic drugs (bDMARDs), including T-cell-based and interleukin-6 inhibition (IL-6i)-based therapies, and the risk for type 2 diabetes mellitus (T2DM) in patients with rheumatoid arthritis (RA). STUDY DESIGN, SETTING AND PARTICIPANTS Five treatment groups were selected from a United States Electronic Medical Records database of 283 756 patients with RA (mean follow-up, 5 years): never received bDMARD (No bDMARD, n=125 337), tumour necrosis factor inhibitors (TNFi, n=34 873), IL-6i (n=1884), T-cell inhibitors (n=5935) and IL-6i+T cell inhibitor abatacept (n=1213). Probability and risk for T2DM were estimated with adjustment for relevant confounders. RESULTS In the cohort of 169 242 patients with a mean 4.5 years of follow-up and a mean 641 200 person years of follow-up, the adjusted probability of developing T2DM was significantly lower in the IL-6i (probability, 1%; 95% CI 0.6 to 2.0), T-cell inhibitor (probability, 3%; 95% CI 2.3 to 3.3) and IL-6i+T cell inhibitor (probability, 2%; 95% CI 0.1 to 2.9) groups than in the No bDMARD (probability, 5%; 95% CI 4.6 to 4.9) and TNFi (probability, 4%; 95% CI 3.7 to 4.7) groups. Compared with No bDMARD, the IL-6i and IL-6i+T cell inhibitor groups had 37% (95% CI of HR 0.42 to 0.96) and 34% (95% CI of HR 0.46 to 0.93) significantly lower risk for T2DM, respectively; there was no significant difference in risk in the TNFi (HR 0.99; 95% CI 0.93 to 1.06) and T-cell inhibitor (HR 0.96; 95% CI 0.82 to 1.12) groups. CONCLUSIONS Treatment with IL-6i, with or without T-cell inhibitors, was associated with reduced risk for T2DM compared with TNFi or No bDMARDs; a less pronounced association was observed for the T-cell inhibitor abatacept.
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Affiliation(s)
- Sanjoy K Paul
- Melbourne EpiCentre, University of Melbourne and Melbourne Health, Parkville, Victoria, Australia
| | - Olga Montvida
- Melbourne EpiCentre, University of Melbourne and Melbourne Health, Parkville, Victoria, Australia
| | - Jennie H Best
- Pharmaceuticals Division, Genentech, South San Francisco, California, USA
| | - Sara Gale
- Pharmaceuticals Division, Genentech, South San Francisco, California, USA
| | - Attila Pethö-Schramm
- Pharmaceuticals Division, F Hoffmann-La Roche AG, Basel, Basel-Stadt, Switzerland
| | - Khaled Sarsour
- Pharmaceuticals Division, Genentech, South San Francisco, California, USA
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12
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Risk Factors of Infection, Hospitalization and Death from SARS-CoV-2: A Population-Based Cohort Study. J Clin Med 2021; 10:jcm10122608. [PMID: 34199198 PMCID: PMC8231921 DOI: 10.3390/jcm10122608] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/08/2021] [Accepted: 06/10/2021] [Indexed: 12/11/2022] Open
Abstract
We conducted a prospective population-based cohort study to assess risk factors for infection, hospitalization, and death from SARS-CoV-2. The study comprised the people covered by the Health Service of Navarre, Spain. Sociodemographic variables and chronic conditions were obtained from electronic healthcare databases. Confirmed infections, hospitalizations, and deaths from SARS-CoV-2 were obtained from the enhanced epidemiological surveillance during the second SARS-CoV-2 epidemic surge (July–December 2020), in which diagnostic tests were widely available. Among 643,757 people, 5497 confirmed infections, 323 hospitalizations, 38 intensive care unit admissions, and 72 deaths from SARS-CoV-2 per 100,000 inhabitants were observed. A higher incidence of confirmed infection was associated with people aged 15–29 years, nursing home residents, healthcare workers, people born in Latin America or Africa, as well as in those diagnosed with diabetes, cardiovascular disease, chronic obstructive pulmonary disease (COPD), chronic kidney disease, dementia, severe obesity, hypertension and functional dependence. The risk of hospitalization in the population was associated with males, higher age, nursing home residents, Latin American or African origin, and those diagnosed with immunodeficiency, diabetes, cardiovascular disease, COPD, asthma, kidney disease, cerebrovascular disease, cirrhosis, dementia, severe obesity, hypertension and functional dependence. The risk of death was associated with males, higher age, nursing home residents, Latin American origin, low income level, immunodeficiency, diabetes, cardiovascular disease, COPD, kidney disease, dementia, and functional dependence. This study supports the prioritization of the older population, nursing home residents, and people with chronic conditions and functional dependence for SARS-CoV-2 prevention and vaccination, and highlights the need for additional preventive support for immigrants.
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13
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Fresán U, Guevara M, Trobajo-Sanmartín C, Burgui C, Ezpeleta C, Castilla J. Hypertension and Related Comorbidities as Potential Risk Factors for COVID-19 Hospitalization and Severity: A Prospective Population-Based Cohort Study. J Clin Med 2021; 10:jcm10061194. [PMID: 33809217 PMCID: PMC8000595 DOI: 10.3390/jcm10061194] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/02/2021] [Accepted: 03/09/2021] [Indexed: 01/10/2023] Open
Abstract
The independent role of hypertension for COVID-19 outcomes in the population remains unclear. We aimed to estimate the independent effect of hypertension and hypertension-related conditions, i.e., cardiovascular, cerebrovascular and chronic kidney diseases, as potential risk factors for COVID-19 hospitalization and severe COVID-19 (i.e., intensive care unit admission or death) in the population. The risk for severe COVID-19 among hospitalized patients was also evaluated. A Spanish population-based cohort of people aged 25-79 years was prospectively followed from March to May 2020 to identify hospitalizations for laboratory-confirmed COVID-19. Poisson regression was used to estimate the adjusted relative risk (aRR) for COVID-19 hospitalization and severe COVID-19 among the whole cohort, and for severe COVID-19 among hospitalized patients. Of 424,784 people followed, 1106 were hospitalized by COVID-19 and 176 were severe cases. Hypertension was not independently associated with a higher risk of hospitalization (aRR 0.96, 95% CI 0.83-1.12) nor severe COVID-19 (aRR 1.12, 95% CI 0.80-1.56) in the population. Persons with cardiovascular, cerebrovascular and chronic kidney diseases were at higher risk for COVID-19 hospitalization (aRR 1.33, 95% CI 1.13-1.58; aRR 1.41, 95% CI 1.04-1.92; and aRR 1.52, 95% CI 1.21-1.91; respectively) and severe COVID-19 (aRR 1.61, 95% CI 1.13-2.30; aRR 1.91, 95% CI 1.13-3.25; and aRR 1.78, 95% CI 1.14-2.76; respectively). COVID-19 hospitalized patients with cerebrovascular diseases were at higher risk of mortality (aRR 1.80, 95% CI 1.00-3.23). The current study shows that, in the general population, persons with cardiovascular, cerebrovascular and chronic kidney diseases, but not those with hypertension only, should be considered as high-risk groups for COVID-19 hospitalization and severe COVID-19.
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Affiliation(s)
- Ujué Fresán
- Instituto de Salud Pública de Navarra, 31003 Pamplona, Spain; (M.G.); (C.B.); (J.C.)
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain; (C.T.-S.); (C.E.)
- e-Health Group, Instituto de Salud Global Barcelona (ISGlobal), 08003 Barcelona, Spain
- Correspondence:
| | - Marcela Guevara
- Instituto de Salud Pública de Navarra, 31003 Pamplona, Spain; (M.G.); (C.B.); (J.C.)
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain; (C.T.-S.); (C.E.)
| | - Camino Trobajo-Sanmartín
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain; (C.T.-S.); (C.E.)
- Servicio de Microbiología Clínica, Complejo Hospitalario de Navarra, 31008 Pamplona, Spain
| | - Cristina Burgui
- Instituto de Salud Pública de Navarra, 31003 Pamplona, Spain; (M.G.); (C.B.); (J.C.)
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain; (C.T.-S.); (C.E.)
| | - Carmen Ezpeleta
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain; (C.T.-S.); (C.E.)
- Servicio de Microbiología Clínica, Complejo Hospitalario de Navarra, 31008 Pamplona, Spain
| | - Jesús Castilla
- Instituto de Salud Pública de Navarra, 31003 Pamplona, Spain; (M.G.); (C.B.); (J.C.)
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain; (C.T.-S.); (C.E.)
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14
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Lee S, Doktorchik C, Martin EA, D'Souza AG, Eastwood C, Shaheen AA, Naugler C, Lee J, Quan H. Electronic Medical Record-Based Case Phenotyping for the Charlson Conditions: Scoping Review. JMIR Med Inform 2021; 9:e23934. [PMID: 33522976 PMCID: PMC7884219 DOI: 10.2196/23934] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 11/20/2020] [Accepted: 12/05/2020] [Indexed: 12/16/2022] Open
Abstract
Background Electronic medical records (EMRs) contain large amounts of rich clinical information. Developing EMR-based case definitions, also known as EMR phenotyping, is an active area of research that has implications for epidemiology, clinical care, and health services research. Objective This review aims to describe and assess the present landscape of EMR-based case phenotyping for the Charlson conditions. Methods A scoping review of EMR-based algorithms for defining the Charlson comorbidity index conditions was completed. This study covered articles published between January 2000 and April 2020, both inclusive. Embase (Excerpta Medica database) and MEDLINE (Medical Literature Analysis and Retrieval System Online) were searched using keywords developed in the following 3 domains: terms related to EMR, terms related to case finding, and disease-specific terms. The manuscript follows the Preferred Reporting Items for Systematic reviews and Meta-analyses extension for Scoping Reviews (PRISMA) guidelines. Results A total of 274 articles representing 299 algorithms were assessed and summarized. Most studies were undertaken in the United States (181/299, 60.5%), followed by the United Kingdom (42/299, 14.0%) and Canada (15/299, 5.0%). These algorithms were mostly developed either in primary care (103/299, 34.4%) or inpatient (168/299, 56.2%) settings. Diabetes, congestive heart failure, myocardial infarction, and rheumatology had the highest number of developed algorithms. Data-driven and clinical rule–based approaches have been identified. EMR-based phenotype and algorithm development reflect the data access allowed by respective health systems, and algorithms vary in their performance. Conclusions Recognizing similarities and differences in health systems, data collection strategies, extraction, data release protocols, and existing clinical pathways is critical to algorithm development strategies. Several strategies to assist with phenotype-based case definitions have been proposed.
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Affiliation(s)
- Seungwon Lee
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Alberta Health Services, Calgary, AB, Canada.,Data Intelligence for Health Lab, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Chelsea Doktorchik
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Elliot Asher Martin
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Alberta Health Services, Calgary, AB, Canada
| | - Adam Giles D'Souza
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Alberta Health Services, Calgary, AB, Canada
| | - Cathy Eastwood
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Abdel Aziz Shaheen
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Christopher Naugler
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Joon Lee
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Data Intelligence for Health Lab, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Hude Quan
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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15
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Wikström K, Lamidi ML, Rautiainen P, Tirkkonen H, Kivinen P, Laatikainen T. The effect of the integration of health services on health care usage among patients with type 2 diabetes in North Karelia, Finland. BMC Health Serv Res 2021; 21:65. [PMID: 33441132 PMCID: PMC7805148 DOI: 10.1186/s12913-021-06059-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 01/02/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The need to improve the care of people with complex care requirements has been driving the reforms integrating care processes. This study examines the effect of the integration of health services on health care usage and the processes and outcomes of care among type 2 diabetes patients. METHODS Data include all type 2 diabetes patients who lived in North Karelia, Finland, between 2014 and 2018. Health care contacts and glycated haemoglobin (HbA1c) measurements were obtained from the electronic health records. Logistic, Poisson and linear models with generalised estimating equations and the Friedman test were used to study the differences between years. RESULTS The health care usage was highest in 2017, the first year of a new organisation, and smallest in the following year. Before the new organisation, the health care usage was lowest in 2014, being slightly higher compared with 2018. Between the last two years, the mean number of contacts per person declined from 3.25 to 2.88 (-0.37, p < 0.001). The decreasing pattern seen in total health care usage was most obvious among contacts with primary health care nurses. The number of contacts increased only among specialised care nurses between the last two years. The number of HbA1c measurements was also in its lowest in 2018 but in its highest in 2015. Between the years 2014 and 2018, the difference in the mean number of contacts was - 0.05 (p = 0.011) for those not measured, -0.02 (p = 0.225) for those measured and within the target level of HbA1c, and 0.12 (p = 0.001) for those measured and not at the target level of HbA1c. CONCLUSIONS Health care integration first increased the health care usage but then brought it to a slightly lower level than before. The changes were most obvious in primary health care nurses' appointments, and no decline was observed in secondary-level care. Even though the numbers of HbA1c measurements and the proportion measured declined, measurements increased among those with poor glycaemic control. The observed changes might reflect the better targeting and more concordant services in different service units.
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Affiliation(s)
- Katja Wikström
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, PO Box 1627, 70211, Kuopio, Finland. .,Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland.
| | - Marja-Leena Lamidi
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, PO Box 1627, 70211, Kuopio, Finland
| | - Päivi Rautiainen
- Joint Municipal Authority for North Karelia Social and Health Services, Joensuu, Finland
| | - Hilkka Tirkkonen
- Joint Municipal Authority for North Karelia Social and Health Services, Joensuu, Finland
| | - Petri Kivinen
- Joint Municipal Authority for North Karelia Social and Health Services, Joensuu, Finland
| | - Tiina Laatikainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, PO Box 1627, 70211, Kuopio, Finland.,Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland.,Joint Municipal Authority for North Karelia Social and Health Services, Joensuu, Finland
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16
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Dibato JE, Montvida O, Zaccardi F, Sargeant JA, Davies MJ, Khunti K, Paul SK. Association of Cardiometabolic Multimorbidity and Depression With Cardiovascular Events in Early-Onset Adult Type 2 Diabetes: A Multiethnic Study in the U.S. Diabetes Care 2021; 44:231-239. [PMID: 33177170 DOI: 10.2337/dc20-2045] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 10/12/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate the temporal patterns of cardiometabolic multimorbidity (CM) and depression in White Caucasians (WCs) and African Americans (AAs) with early-onset type 2 diabetes and their impact on long-term atherosclerotic cardiovascular disease (ASCVD). RESEARCH DESIGN AND METHODS From U.S. electronic medical records, 101,104 AA and 505,336 WC subjects with type 2 diabetes diagnosed between 2000 and 2017 were identified (mean follow-up 5.3 years). Among those without ASCVD at diagnosis, risk of ASCVD and three-point major adverse cardiovascular events (MACE-3) (heart failure, myocardial infarction, or stroke) was evaluated between ethnicities by age-groups. RESULTS The proportion of patients diagnosed at <50 years of age increased during 2012-2017 (AA 34-38%, WC 26-29%). Depression prevalence increased during 2000-2017 (AA 15-23%, WC 20-34%), with an increasing trend for CM at diagnosis in both groups. Compared with WC, the adjusted MACE-3 risk was significantly higher in AA across all age-groups, more pronounced in the 18-39-year age-group (hazard ratio 95% CI 1.42, 1.88), and in patients with and without depression. AAs had a 17% (1.05, 1.31) significantly higher adjusted ASCVD risk in the 18-39-year age-group only. Depression was independently associated with ASCVD and MACE-3 risk in both ethnic groups across all age-groups. Other comorbidities were independently associated with ASCVD and MACE-3 risk only among WCs. CONCLUSIONS AAs have higher cardiovascular risk compared with WCs, particularly in early-onset type 2 diabetes. CM and depression at diabetes diagnosis have been increasing over the past two decades in both ethnic groups. Strategies for screening and optimal management of CM and depression, particularly in early-onset type 2 diabetes, may result in a lower cardiovascular risk.
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Affiliation(s)
- John Epoh Dibato
- Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, Victoria, Australia
| | - Olga Montvida
- Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, Victoria, Australia
| | - Francesco Zaccardi
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, U.K
| | - Jack Alistair Sargeant
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, U.K.,Leicester NIHR Biomedical Research Centre, Leicester, U.K
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, U.K.,Leicester NIHR Biomedical Research Centre, Leicester, U.K
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, U.K.,Leicester NIHR Biomedical Research Centre, Leicester, U.K
| | - Sanjoy K Paul
- Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, Victoria, Australia
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17
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Fresán U, Guevara M, Elía F, Albéniz E, Burgui C, Castilla J. Independent Role of Severe Obesity as a Risk Factor for COVID-19 Hospitalization: A Spanish Population-Based Cohort Study. Obesity (Silver Spring) 2021; 29:29-37. [PMID: 32885905 DOI: 10.1002/oby.23029] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/24/2020] [Accepted: 09/02/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES This study analyzed the association between severe obesity and coronavirus disease 2019 (COVID-19) hospitalization and severe disease. METHODS The incidence of hospitalization for laboratory-confirmed COVID-19 was evaluated in a prospective population-based cohort of 433,995 persons aged 25 to 79 years in Spain during March and April of 2020. Persons with and without class 3 obesity were compared using Poisson regression to estimate the adjusted relative risk (aRR) from class 3 obesity of COVID-19 hospitalization and of severe disease (intensive care unit admission or death). Differences in the effect by age, sex, and chronic conditions were evaluated. RESULTS Individuals with class 3 obesity had a higher risk of hospitalization (aRR = 2.20, 95% CI: 1.66-2.93) and developing severe COVID-19 (aRR = 2.30, 95% CI: 1.20-4.40). In people younger than 50 years, these effects were more pronounced (aRR = 5.02, 95% CI: 3.19-7.90 and aRR = 13.80, 95% CI: 3.11-61.17, respectively), whereas no significant effects were observed in those aged 65 to 79 years (aRR = 1.22, 95% CI: 0.70-2.12 and aRR = 1.42, 95% CI: 0.52-3.88, respectively). Sex and chronic conditions did not modify the effect of class 3 obesity in any of the outcomes. CONCLUSIONS Severe obesity is a relevant risk factor for COVID-19 hospitalization and severity in young adults, having a magnitude similar to that of aging. Tackling the current obesity pandemic could alleviate the impact of chronic and infectious diseases.
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Affiliation(s)
- Ujué Fresán
- Navarre Public Health Institute, Pamplona, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Pamplona, Spain
- Navarre Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Marcela Guevara
- Navarre Public Health Institute, Pamplona, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Pamplona, Spain
- Navarre Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Fernando Elía
- Navarre Institute for Health Research (IdiSNA), Pamplona, Spain
- Primary Health Care Directorate, Navarre Health Service, Pamplona, Spain
| | - Esther Albéniz
- Navarre Institute for Health Research (IdiSNA), Pamplona, Spain
- Primary Health Care Directorate, Navarre Health Service, Pamplona, Spain
| | - Cristina Burgui
- Navarre Public Health Institute, Pamplona, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Pamplona, Spain
- Navarre Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Jesús Castilla
- Navarre Public Health Institute, Pamplona, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Pamplona, Spain
- Navarre Institute for Health Research (IdiSNA), Pamplona, Spain
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18
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Montvida O, Verma S, Shaw JE, Paul SK. Cardiometabolic risk factor control in black and white people in the United States initiating sodium-glucose co-transporter-2 inhibitors: A real-world study. Diabetes Obes Metab 2020; 22:2384-2397. [PMID: 32744394 DOI: 10.1111/dom.14164] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/19/2020] [Accepted: 07/29/2020] [Indexed: 01/08/2023]
Abstract
AIMS To explore cardiometabolic risk profiles, the probability of sustainable control, and the effectiveness of treatment with sodium-glucose co-transporter-2 (SGLT2) inhibitors in black and white adults in the United States with type 2 diabetes. MATERIALS AND METHODS Using nationally representative US electronic medical records, 72 690 white and 10 004 black adults diagnosed with type 2 diabetes initiating SGLT2 inhibitors during the period 2013 to 2018, continuing it for ≥6 months, and with follow-up of ≥12 months, were identified. Glycated haemoglobin (HbA1c), body weight, systolic blood pressure (SBP) and lipid changes at 6 months, and sustainability of control over 18 months post SGLT2 inhibitor initiation were explored, separately in those with and without atherosclerotic cardiovascular disease (ASCVD). RESULTS The white group was older (58 years) with lower mean HbA1c (8.5%), compared to the black group (age 54 years, HbA1c 9.0%). Body mass index distribution was similar. The proportions of people with uncontrolled SBP, LDL cholesterol, non-HDL cholesterol and triglyceride levels were 24%, 42%, 51% and 62%, respectively, in white patients, and 31%, 51%, 49% and 32%, respectively, in black patients. At 6-month follow-up white and black patients had similar adjusted reductions in HbA1c (1.1%), SBP (8-10 mmHg), LDL cholesterol (0.26 - 0.34 mmol / L) and body weight (1.1-1.4 kg). However, over 18 months' follow-up, compared to white patients, black patients were significantly less likely to achieve sustainable control in HbA1c (odds ratio [OR] 0.67, 95% confidence interval [CI] 0.63-0.72), body weight (OR 0.81, 95% CI 0.72-0.91), SBP (OR 0.67, 95% CI 0.61-0.74) and LDL cholesterol (OR 0.77, 95% CI 0.67-0.89). Triglyceride control was significantly better among black patients. Black patients had a significantly higher risk factor burden, irrespective of ASCVD status. CONCLUSIONS While the effectiveness of SGLT2 inhibitors was similar among black and white patients, irrespective of ASCVD status, black patients continued to have worse cardiometabolic risk factor burden after SGLT2 inhibitor initiation.
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Affiliation(s)
- Olga Montvida
- Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, Victoria, Australia
| | - Subodh Verma
- Division of Cardiac Surgery, University of Toronto, St. Michael' Hospital, Toronto, Canada
| | | | - Sanjoy K Paul
- Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, Victoria, Australia
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19
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Risk for cardiovascular disease associated with metabolic syndrome and its components: a 13-year prospective study in the RIVANA cohort. Cardiovasc Diabetol 2020; 19:195. [PMID: 33222691 PMCID: PMC7680587 DOI: 10.1186/s12933-020-01166-6] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/31/2020] [Indexed: 12/19/2022] Open
Abstract
Background We aimed to investigate the association of metabolic syndrome (MetS) and its single components with cardiovascular risk and estimated their impact on the prematurity of occurrence of cardiovascular events using rate advancement periods (RAPs). Methods We performed prospective analyses among 3976 participants (age range: 35–84, 55% female) in the Vascular Risk in Navarre (RIVANA) Study, a Mediterranean population-based cohort. MetS was defined based on the modified criteria of the American Heart Association/National Heart, Lung, and Blood Institute and the International Diabetes Federation. The primary endpoint was major cardiovascular event (a composite of myocardial infarction, stroke, or mortality from cardiovascular causes). Secondary endpoints were incidence of non-fatal myocardial infarction and non-fatal stroke, cardiovascular mortality, and all-cause mortality. Cox proportional hazards models, adjusted for potential confounders, were fitted to evaluate the association between MetS and its single components at baseline with primary and secondary endpoints. Results During a median follow-up of 12.8 years (interquartile range, 12.5–13.1), we identified 228 primary endpoint events. MetS was associated with higher risk of incidence of major cardiovascular event, cardiovascular and all-cause mortality, but was neither associated with higher risk of myocardial infarction nor stroke. Compared with participants without MetS, the multivariable hazard ratio (95% confidence interval [CI]) among participants with MetS was 1.32 (1.01–1.74) with RAP (95% CI) of 3.23 years (0.03, 6.42) for major cardiovascular event, 1.64 (1.03–2.60) with RAP of 3.73 years (0.02, 7.45) for cardiovascular mortality, and 1.45 (1.17–1.80) with RAP of 3.24 years (1.21, 5.27) for all-cause mortality. The magnitude of the associations of the single components of MetS was similar than the predicted by MetS. Additionally, for each additional trait of MetS, incidence of major cardiovascular event relatively increased by 22% (1.22, 95% CI 1.09–1.36) with RAP of 2.31 years (0.88, 3.74). Conclusions MetS was independently associated with CVD risk, cardiovascular and all-cause mortality. Components of the MetS were associated with similar magnitude of increased CVD, which suggests that MetS was not in excess of the level explained by the presence of its single components. Further research should explore the association of different combinations of the components of MetS with CVD.
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20
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Hall ES, McAllister JM, Wexelblatt SL. Developmental Disorders and Medical Complications Among Infants with Subclinical Intrauterine Opioid Exposures. Popul Health Manag 2019; 22:19-24. [PMID: 29893624 PMCID: PMC6386081 DOI: 10.1089/pop.2018.0016] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The objective was to compare diagnosis rates representing developmental outcomes and medical complications between infants with intrauterine opioid exposures who did not receive pharmacologic treatment for neonatal abstinence syndrome at the time of birth and infants for whom no exposure to substances of abuse were detected. This retrospective, descriptive study included approximately 95% of Hamilton County, Ohio resident births in 2014 and 2015. Universal maternal drug test results, performed at the time of birth, were documented and linked to electronic health records representing pediatric primary and subspecialty follow-up care as well as urgent care, emergency care, and inpatient services provided by Cincinnati Children's Hospital Medical Center through 2017, when all children were at least 24 months old. Diagnosis rates were compared between drug exposure groups using chi-square tests. Among infants born at >34 weeks gestation and without other complex clinical conditions, infants with subclinical opioid exposures (N = 473) were more likely than infants with no drug exposures (N = 14,933) to be diagnosed with behavioral or emotional disorders (3.0% vs 1.1%, P = 0.0008), developmental delay (15.6% vs 7.6%, P < 0.0001), speech disorder (10.1% vs 6.5%, P = 0.001), or strabismus (3.4% vs 1.0%, P < 0.0001), and more likely to be exposed to the hepatitis C virus (6.8% vs 0.1%, P < 0.0001). Increased diagnosis rates among all opioid exposed infants, regardless of withdrawal severity, may warrant the additional allocation of resources for screening and follow-up. Awareness of the increased risk for certain developmental delays and medical conditions is critical to early intervention and treatment supporting improved outcomes.
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Affiliation(s)
- Eric S. Hall
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jennifer M. McAllister
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Scott L. Wexelblatt
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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21
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Wikström K, Toivakka M, Rautiainen P, Tirkkonen H, Repo T, Laatikainen T. Electronic Health Records as Valuable Data Sources in the Health Care Quality Improvement Process. Health Serv Res Manag Epidemiol 2019; 6:2333392819852879. [PMID: 31211180 PMCID: PMC6545647 DOI: 10.1177/2333392819852879] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 05/02/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In North Karelia, Finland, the regional electronic health records (EHRs) enable flexible data retrieval and area-level analyses. The aim of this study was to assess the early detection of type 2 diabetes (T2D) in the region and to evaluate the performed activities in order to improve the processes between the years 2012 and 2017. METHODS Patients with T2D were identified from the EHRs using the ICD-10 codes registered during any visit to either primary or specialized care. The prevalence of T2D was calculated for the years 2012, 2015, and 2017 on the municipality level. The number of people found in the EHRs with diabetes was compared with the number found in the national register of medication reimbursement rights. RESULTS In 2012, the age-adjusted prevalence of T2D in North Karelia varied considerably between municipalities (5.5%-8.6%). These differences indicate variation in the processes of early diagnosis. The findings were discussed in the regional network of health professionals treating patients with T2D, resulting in sharing experiences and best practices. In 2017, the differences had notably diminished, and in most municipalities, the prevalence exceeded 8%. The regional differences in the prevalence and their downward trend were observed both in the EHRs and in the medication reimbursement rights register. CONCLUSION Clear differences in the prevalence of T2D were detected between municipalities. After visualizing these differences and providing information for the professionals, the early detection of T2D improved and the regional differences decreased. The EHRs are a valuable data source for knowledge-based management and quality improvement.
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Affiliation(s)
- Katja Wikström
- Institute of Public Health and Clinical Nutrition, University of Eastern
Finland, Kuopio, Finland
- Department of Public Health Solutions, National Institute for Health and
Welfare, Helsinki, Finland
| | - Maija Toivakka
- Department of Geographical and Historical Studies, University of Eastern
Finland, Joensuu, Finland
| | - Päivi Rautiainen
- Joint Municipal Authority for North Karelia Social and Health Services (Siun
sote), Joensuu, Finland
| | - Hilkka Tirkkonen
- Joint Municipal Authority for North Karelia Social and Health Services (Siun
sote), Joensuu, Finland
| | - Teppo Repo
- Department of Geographical and Historical Studies, University of Eastern
Finland, Joensuu, Finland
| | - Tiina Laatikainen
- Institute of Public Health and Clinical Nutrition, University of Eastern
Finland, Kuopio, Finland
- Department of Public Health Solutions, National Institute for Health and
Welfare, Helsinki, Finland
- Joint Municipal Authority for North Karelia Social and Health Services (Siun
sote), Joensuu, Finland
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22
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Moulis G, Ibañez B, Palmaro A, Aizpuru F, Millan E, Lapeyre-Mestre M, Sailler L, Cambra K. Cross-national health care database utilization between Spain and France: results from the EPICHRONIC study assessing the prevalence of type 2 diabetes mellitus. Clin Epidemiol 2018; 10:863-874. [PMID: 30100760 PMCID: PMC6067780 DOI: 10.2147/clep.s151890] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
AIM The EPICHRONIC (EPIdemiology of CHRONIC diseases) project investigated the possibility of developing common procedures for French and Spanish electronic health care databases to enable large-scale pharmacoepidemiological studies on chronic diseases. A feasibility study assessed the prevalence of type 2 diabetes mellitus (T2DM) in Navarre and the Basque Country (Spain) and the Midi-Pyrénées region (France). PATIENTS AND METHODS We described and compared database structures and the availability of hospital, outpatient, and drug-dispensing data from 5.9 million inhabitants. Due to differences in database structures and recorded data, we could not develop a common procedure to estimate T2DM prevalence, but identified an algorithm specific to each database. Patients were identified using primary care diagnosis codes previously validated in Spanish databases and a combination of primary care diagnosis codes, hospital diagnosis codes, and data on exposure to oral antidiabetic drugs from the French database. RESULTS Spanish and French databases (the latter termed Système National d'Information Inter-Régimes de l'Assurance Maladie [SNIIRAM]) included demographic, primary care diagnoses, hospital diagnoses, and outpatient drug-dispensing data. Diagnoses were encoded using the International Classification of Primary Care (version 2) and the International Classification of Diseases, version 9 and version 10 (ICD-9 and ICD-10) in the Spanish databases, whereas the SNIIRAM contained ICD-10 codes. All data were anonymized before transferring to researchers. T2DM prevalence in the population over 20 years was estimated to be 6.6-7.0% in the Spanish regions and 6.3% in the Midi-Pyrénées region with ~2% higher estimates for males in the three regions. CONCLUSION Tailored procedures can be designed to estimate the prevalence of T2DM in population-based studies from Spanish and French electronic health care records.
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Affiliation(s)
- Guillaume Moulis
- Department of Internal Medicine, Toulouse University Hospital, Toulouse, France,
- UMR1027 INSERM, University of Toulouse, Toulouse, France,
- Clinical Investigation Center 1436, Toulouse University Hospital, Toulouse, France,
| | - Berta Ibañez
- Navarrabiomed, Health Department, Public University of Navarra, Pamplona, Spain
- IdiSNA, Pamplona, Spain
- Health Service Research on Chronic Patients Network (REDISSEC), Pamplona, Spain
| | - Aurore Palmaro
- UMR1027 INSERM, University of Toulouse, Toulouse, France,
- Clinical Investigation Center 1436, Toulouse University Hospital, Toulouse, France,
| | - Felipe Aizpuru
- Health Service Research on Chronic Patients Network (REDISSEC), Pamplona, Spain
- Research Unit Araba (BioAraba), Osakidetza-Basque Health Department, Vitoria-Gasteiz, Spain
- Healthcare Services Sub-directorate, Osakidetza-Basque Health Service, Araba, Spain
| | - Eduardo Millan
- Health Service Research on Chronic Patients Network (REDISSEC), Pamplona, Spain
- Healthcare Services Sub-directorate, Osakidetza-Basque Health Service, Araba, Spain
| | - Maryse Lapeyre-Mestre
- UMR1027 INSERM, University of Toulouse, Toulouse, France,
- Clinical Investigation Center 1436, Toulouse University Hospital, Toulouse, France,
- Department of Medical and Clinical Pharmacology, Toulouse University Hospital, Toulouse, France
| | - Laurent Sailler
- Department of Internal Medicine, Toulouse University Hospital, Toulouse, France,
- UMR1027 INSERM, University of Toulouse, Toulouse, France,
- Clinical Investigation Center 1436, Toulouse University Hospital, Toulouse, France,
| | - Koldo Cambra
- IdiSNA, Pamplona, Spain
- Health Service Research on Chronic Patients Network (REDISSEC), Pamplona, Spain
- Institute of Public Health and Labour Health of Navarra, Pamplona, Spain
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