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Vasquez MS, Mertens E, Berete F, Van der Heyden J, Peñalvo JL, Vandevijvere S. Comparing self-reported health interview survey and pharmacy billing data in determining the prevalence of diabetes, hypertension, and hypercholesterolemia in Belgium. Arch Public Health 2023; 81:121. [PMID: 37391854 DOI: 10.1186/s13690-023-01134-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 06/15/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND Administrative and health surveys are used in monitoring key health indicators in a population. This study investigated the agreement between self-reported disease status from the Belgian Health Interview Survey (BHIS) and pharmaceutical insurance claims extracted from the Belgian Compulsory Health Insurance (BCHI) in ascertaining the prevalence of diabetes, hypertension, and hypercholesterolemia. METHODS Linkage was made between the BHIS 2018 and the BCHI 2018, from which chronic condition was ascertained using the Anatomical Therapeutic Chemical (ATC) classification and defined daily dose. The data sources were compared using estimates of disease prevalence and various measures of agreement and validity. Multivariable logistic regression was performed for each chronic condition to identify the factors associated to the agreement between the two data sources. RESULTS The prevalence estimates computed from the BCHI and the self-reported disease definition in BHIS, respectively, are 5.8% and 5.9% diabetes cases, 24.6% and 17.6% hypertension cases, and 16.2% and 18.1% of hypercholesterolemia cases. The overall agreement and kappa coefficient between the BCHI and the self-reported disease status is highest for diabetes and is equivalent to 97.6% and 0.80, respectively. The disagreement between the two data sources in ascertaining diabetes is associated with multimorbidity and older age categories. CONCLUSION This study demonstrated the capability of pharmacy billing data in ascertaining and monitoring diabetes in the Belgian population. More studies are needed to assess the applicability of pharmacy claims in ascertaining other chronic conditions and to evaluate the performance of other administrative data such as hospital records containing diagnostic codes.
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Affiliation(s)
- Maria Salve Vasquez
- Department of Epidemiology and Public Health, Service of Health Information, Sciensano, Brussels, Belgium.
| | - Elly Mertens
- Unit of Non-Communicable Diseases, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Finaba Berete
- Department of Epidemiology and Public Health, Service of Health Information, Sciensano, Brussels, Belgium
| | - Johan Van der Heyden
- Department of Epidemiology and Public Health, Service of Health Information, Sciensano, Brussels, Belgium
| | - José L Peñalvo
- Unit of Non-Communicable Diseases, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Stefanie Vandevijvere
- Department of Epidemiology and Public Health, Service of Health Information, Sciensano, Brussels, Belgium
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Baek JH, Park YM, Han KD, Moon MK, Choi JH, Ko SH. Comparison of Operational Definition of Type 2 Diabetes Mellitus Based on Data from Korean National Health Insurance Service and Korea National Health and Nutrition Examination Survey. Diabetes Metab J 2023; 47:201-210. [PMID: 36750233 PMCID: PMC10040628 DOI: 10.4093/dmj.2022.0375] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 12/05/2022] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND We evaluated the validity and reliability of the operational definition of type 2 diabetes mellitus (T2DM) based on the Korean National Health Insurance Service (NHIS) database. METHODS Adult subjects (≥40 years old) included in the Korea National Health and Nutrition Examination Survey (KNHANES) from 2008 to 2017 were merged with those from the NHIS health check-up database, producing a cross-sectional dataset. We evaluated the sensitivity, specificity, accuracy, and agreement of the NHIS criteria for defining T2DM by comparing them with the KNHANES criteria as a standard reference. RESULTS In the study population (n=13,006), two algorithms were devised to determine from the NHIS dataset whether the diagnostic claim codes for T2DM were accompanied by prescription codes for anti-diabetic drugs (algorithm 1) or not (algorithm 2). Using these algorithms, the prevalence of T2DM was 14.9% (n=1,942; algorithm 1) and 20.8% (n=2,707; algorithm 2). Good reliability in defining T2DM was observed for both algorithms (Kappa index, 0.73 [algorithm 1], 0.63 [algorithm 2]). However, the accuracy (0.93 vs. 0.89) and specificity (0.96 vs. 0.90) tended to be higher for algorithm 1 than for algorithm 2. The validity (accuracy, ranging from 0.91 to 0.95) and reliability (Kappa index, ranging from 0.68 to 0.78) of defining T2DM by NHIS criteria were independent of age, sex, socioeconomic status, and accompanied hypertension or dyslipidemia. CONCLUSION The operational definition of T2DM based on population-based NHIS claims data, including diagnostic codes and prescription codes, could be a valid tool to identify individuals with T2DM in the Korean population.
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Affiliation(s)
- Jong Ha Baek
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Korea
- Institute of Health Science, Gyeongsang National University, Jinju, Korea
| | - Yong-Moon Park
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Kyung Do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Min Kyong Moon
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Jong Han Choi
- Division of Endocrinology and Metabolism, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Seung-Hyun Ko
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
- Corresponding author: Seung-Hyun Ko https://orcid.org/0000-0003-3703-1479 Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, 93 Jungbu-daero, Paldal-gu, Suwon 16247, Korea E-mail:
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Tai AS, Lin RT, Lin YC, Wang CH, Lin SH, Imoto S. Genome-wide causal mediation analysis identifies genetic loci associated with uterine fibroids mediated by age at menarche. Hum Reprod 2022; 37:2197-2212. [PMID: 35689443 PMCID: PMC10467635 DOI: 10.1093/humrep/deac136] [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: 10/02/2021] [Revised: 03/04/2022] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION Could the direct contribution of genetic variants to the pathophysiology of uterine fibroids and the contribution mediated by age at menarche be different? SUMMARY ANSWER Age at menarche plays a mediation role in the genetic influence on uterine fibroids, and four causal genetic mechanisms underlying the age at menarche-mediated effects of common genetic loci on uterine fibroid development were identified. WHAT IS KNOWN ALREADY Uterine fibroids are common benign tumors developing from uterine smooth muscle. Genome-wide association studies (GWASs) have identified over 30 genetic loci associated with uterine fibroids in different ethnic populations. Several genetic variations in or nearby these identified loci were also associated with early age at menarche, one of the major risk factors of uterine fibroids. Although the results of GWASs reveal how genetic variations affect uterine fibroids, the genetic mechanism of uterine fibroids mediated by age at menarche remains elusive. STUDY DESIGN, SIZE, DURATION In this study, we conducted a genome-wide causal mediation analysis in two cohorts covering a total of 69 552 females of Han Chinese descent from the Taiwan Biobank (TWB). TWB is an ongoing community- and hospital-based cohort aiming to enroll 200 000 individuals from the general Taiwanese population between 30 and 70 years old. It has been enrolling Taiwanese study participants since 2012 and has extensive phenotypic data collected from 148 291 individuals as of May 2021. PARTICIPANTS/MATERIALS, SETTING, METHODS We recruited individuals in two cohorts, with 13 899 females in TWB1 and 55 653 females in TWB2. The two sets of individuals are almost distinct, with only 730 individuals enrolled in both cohorts. Over 99% of the participants are Han Chinese. Approximately 21% of participants developed uterine fibroids. DNA samples from both cohorts were genotyped using two different customized chips (TWB1 and TWB2 arrays). After quality control and genotype imputation, 646 973 TWB1 single-nucleotide polymorphisms (SNPs) and 686 439 TWB2 SNPs were assessed in our analysis. There were 99 939 SNPs which overlapped between the TWB1 and TWB2 arrays, 547 034 TWB1 array-specific SNPs and 586 500 TWB2 array-specific SNPs. We performed GWASs for screening potential risk SNPs for age at menarche and for uterine fibroids. We subsequently identified causal mediation effects of risk SNPs on uterine fibroids mediated by age at menarche. MAIN RESULTS AND THE ROLE OF CHANCE In addition to known loci at LIN28B associated with age at menarche and loci at WNT4 associated with uterine fibroids, we identified 162 SNPs in 77 transcripts that were associated with menarche-mediated causal effects on uterine fibroids via four different causal genetic mechanisms: a both-harmful group with 52 SNPs, a both-protective group with 34 SNPs, a mediator-harmful group with 22 SNPs and a mediator-protective group with 54 SNPs. Among these SNPs, rs809302 in SLK significantly increased the risk of developing uterine fibroids by 3.92% through a mechanism other than age at menarche (P < 10-10), and rs371721345 in HLA-DOB was associated with a 2.70% decreased risk (P < 10-10) in the occurrence of uterine fibroids, mediated by age at menarche. These findings provide insights into the mechanism underlying the effect of genetic loci on uterine fibroids mediated by age at menarche. LIMITATIONS, REASONS FOR CAUTION A potential issue is that the present study relied upon self-reported age at menarche and uterine fibroid information. Due to the experimental design, the consistency between self-reports and medical records for uterine fibroids in Taiwan cannot be checked. Fortunately, the literature support that self-reporting even years later remains a practical means for collecting data on menarche and uterine fibroids. We found that the impact of under-reporting of uterine fibroids is less in our study. In addition, the rate of reporting a diagnosis of uterine fibroids was within the rates of medical diagnosis based on national health insurance data. Future work investigating the consistency between self-reports and medical records in Taiwan can remedy this issue. WIDER IMPLICATIONS OF THE FINDINGS This study is the first to investigate whether and to what extent age at menarche mediates the causal effects of genetic variants on uterine fibroids by using genome-wide causal mediation analysis. By treating age at menarche as a mediator, this report provides an insight into the genetic risk factors for developing uterine fibroids. Thus, this article represents a step forward in deciphering the role of intermediated risk factors in the genetic mechanism of disease. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by the China Medical University, Taiwan (CMU110-ASIA-13 and CMU107-Z-04), the Ministry of Science and Technology, Taiwan (MOST 110-2314-B-039-058) and the International Joint Usage/Research Center, the Institute of Medical Science, the University of Tokyo, Japan (K2104). The authors have no competing interests. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- An-Shun Tai
- Institute of Statistics, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
- Department of Statistics, National Cheng Kung University, Tainan, Taiwan
| | - Ro-Ting Lin
- College of Public Health, China Medical University, Taichung, Taiwan
| | - Yi-Chun Lin
- College of Public Health, China Medical University, Taichung, Taiwan
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chung-Hsing Wang
- Department of Pediatrics, China Medical University Children’s Hospital, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Sheng-Hsuan Lin
- Institute of Statistics, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Seiya Imoto
- Human Genome Center, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
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Lin CMA, Ng N, Orman A, Clement ND, Deehan DJ. Reliability of patient-reported comorbidities: a systematic review and meta-analysis. Postgrad Med J 2021; 99:postgradmedj-2021-140857. [PMID: 34645695 DOI: 10.1136/postgradmedj-2021-140857] [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: 07/17/2021] [Accepted: 09/18/2021] [Indexed: 11/04/2022]
Abstract
Self-reported questionnaires have become a widely adopted method of reviewing patients in clinical practice. This systematic review aimed to determine the reliability of patient-reported comorbidities and to identify which patient factors influence the reliability. Included studies assessed the reliability of at least one patient-reported comorbidity against their medical record or clinical assessment as gold standard. Twenty-four eligible studies were included in the meta-analysis. Only endocrine diseases (Cohen's Kappa Coefficient (CKC) 0.81 (95% CI 0.76 to 0.85)), consisting of diabetes mellitus (CKC 0.83 (95% CI 0.80 to 0.86)) and thyroid disease (CKC 0.68 (95% CI 0.50 to 0.86)), showed good-to-excellent reliability. Factors most frequently reported to influence concordance included age, sex and educational level.This systematic review demonstrated poor-to-moderate reliability for most systems, except for endocrine which showed good-to-excellent reliability. Although patient self-reporting can be a useful guide to clinical management, several patient factors were demonstrated to affect reliability therefore it should be avoided as a standalone measure.
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Affiliation(s)
| | - Nathan Ng
- Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Alexander Orman
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Nicholas D Clement
- Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.,Musculoskeletal Department, Freeman Hospital, Newcastle upon Tyne, UK
| | - David J Deehan
- Musculoskeletal Department, Freeman Hospital, Newcastle upon Tyne, UK
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5
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Breen KM, Finnegan L, Vuckovic KM, Fink AM, Rosamond W, DeVon HA. Multimorbidity phenotypes in patients presenting to the emergency department with possible acute coronary syndrome. Heart Lung 2021; 50:648-653. [PMID: 34098234 DOI: 10.1016/j.hrtlng.2021.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 05/05/2021] [Accepted: 05/06/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Multimorbidity (> 2 conditions) increases the risk of adverse outcomes and challenges health care systems for patients with acute coronary syndrome (ACS). These complications may be partially attributed to ACS clinical care which is driven by single-disease-based practice guidelines; current guidelines do not consider multimorbidity. OBJECTIVES To identify multimorbidity phenotypes (combinations of conditions) with suspected ACS. We hypothesized that: 1) subgroups of patients with similar multimorbidity phenotypes could be identified, 2) classes would differ according to diagnosis, and 3) class membership would differ by sex, age, functional status, family history, and discharge diagnosis. METHODS This was a secondary analysis of data from a large multi-site clinical study of patients with suspected ACS. Conditions were determined by items on the Charlson Comorbidity Index and the ACS Patient Information Questionnaire. Latent class analysis was used to identify phenotypes. RESULTS The sample (n = 935) was predominantly male (68%) and middle-aged (mean= 59 years). Four multimorbidity phenotypes were identified: 1) high multimorbidity (Class 1) included hyperlipidemia, hypertension (HTN), obesity, diabetes, and respiratory disorders (COPD or asthma); 2) low multimorbidity (Class 2) included only obesity; 3) cardiovascular multimorbidity (Class 3) included HTN, hyperlipidemia, and coronary heart disease; and 4) cardio-oncology multimorbidity (Class 4) included HTN, hyperlipidemia, and cancer. Patients ruled-in for ACS primarily clustered in Classes 3 and 4 (OR 2.82, 95% CI 1.95-4.05, p = 0.001 and OR 1.76, 95% CI 1.13-2.74, p = 0.01). CONCLUSION Identifying and understanding multimorbidity phenotypes may assist with risk-stratification and better triage of high-risk patients in the emergency department.
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Affiliation(s)
- Katherine M Breen
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, Atlanta, GA 30322, United States.
| | - Lorna Finnegan
- Loyola University Chicago, Marcella Niehoff School of Nursing, Chicago, IL, United States
| | - Karen M Vuckovic
- University of Illinois at Chicago, College of Nursing, Department of Biobehavioral Health Science, Chicago, IL, United States
| | - Anne M Fink
- University of Illinois at Chicago, College of Nursing, Department of Biobehavioral Health Science, Chicago, IL, United States
| | - Wayne Rosamond
- University of North Carolina, Gillings School of Global Public Health, Chapel Hill, NC, United States
| | - Holli A DeVon
- University of California Los Angeles School of Nursing, Los Angeles, CA, United States
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6
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Chu WM, Ho HE, Yeh CJ, Tsan YT, Lee SH, Lee MC. Late-career unemployment and risk of frailty among older adults in Taiwan: An 8-year population-based cohort study. Geriatr Gerontol Int 2021; 21:353-358. [PMID: 33590668 DOI: 10.1111/ggi.14136] [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: 06/30/2020] [Revised: 11/23/2020] [Accepted: 01/07/2021] [Indexed: 01/11/2023]
Abstract
AIM To evaluate whether late-career unemployment is associated with increased physical frailty among older adults in Taiwan by the design of a population-based cohort study. METHODS Data were retrieved from the Taiwan Longitudinal Study on Aging. The study examined data from the period 1999 to 2007. A total of 652 subjects were included in the final analysis, and they were categorized as normally employed or unemployed depending on their employment status in 1999. Frailty was defined using the Fried criteria. Multiple confounding factors were adjusted in a multilevel analysis. RESULTS The average age of the participants in 1999 was 59.0 years. A total of 491 participants were normally employed, and 161 participants were unemployed. After adjustment for gender, age, level of education, income, marital status, and number of chronic diseases, late-career unemployment was associated with increased frailty [odds ratio (OR) = 1.61; 95% confidence interval (CI) = 1.00-2.59]. The risk of developing frailty was higher for participants who were unemployed during late career and had poor self-rated health [OR = 3.54; 95% CI = 1.37-9.20]. CONCLUSIONS Late-career unemployment is associated with increased frailty, especially for those who also have poor self-rated health. Older adults should be encouraged to maintain normal employment during the later stages of their career before retirement. Employers should apply strategies to prevent possible late-career unemployment, and the government should provide resources and help to unemployed older workers so that they can minimize poor health outcomes in late life. Geriatr Gerontol Int 2021; 21: 353-358.
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Affiliation(s)
- Wei-Min Chu
- Department of Family Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Occupational Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hsin-En Ho
- Department of Family Medicine, Taichung Armed Force General Hospital, Taichung, Taiwan.,Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,National Defense Medical Center, Taipei, Taiwan
| | - Chih-Jung Yeh
- School of Public Health, Chung Shan Medical University, Taichung, Taiwan
| | - Yu-Tse Tsan
- Department of Occupational Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Shu-Hsin Lee
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,School of Nursing, Chung Shan Medical University, Taichung, Taiwan
| | - Meng-Chih Lee
- Department of Family Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan.,Institute of Population Sciences, National Health Research Institutes, Zhunan, Taiwan.,College of Management, Chaoyang University of Technology, Taichung, Taiwan.,Study Group of Integrated Health and Social Care Project, Ministry of Health and Welfare, Taiwan
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7
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Chou CP, Chen CY, Huang KS, Lin SC, Huang CF, Koo M. Factors associated with nonadherence to antihypertensive medication among middle-aged adults with hypertension: findings from the Taiwan National Health Interview Survey. J Int Med Res 2020. [PMCID: PMC7418250 DOI: 10.1177/0300060520936176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objective We aimed to investigate factors associated with nonadherence to
antihypertensive medication among middle-aged Taiwanese adults with
hypertension. Methods We used data from the 2009 Taiwan National Health Interview Survey (NHIS) to
identify adults age 40 to 65 years with hypertension. We used logistic
regression analyses to investigate factors associated with nonadherence to
antihypertensive medication. Results A total 1,256 respondents with hypertension taking antihypertensive
medication were included in this study. Multiple logistic regression
analyses revealed that six factors were significantly and independently
associated with nonadherence to medication: younger age (odds ratio,
[OR] = 1.85), mean monthly personal income < TWD 20,000 (USD 660)
(OR = 1.87), outpatient medical services use in the past month (OR = 0.57),
hospitalization in the past year (OR = 1.70), diabetes or dyslipidemia
(OR = 0.63), and alcohol use in the past month (OR = 2.38). Conclusions This secondary data analysis of the population-based NHIS identified six
factors associated with nonadherence to antihypertensive medication. These
factors should be considered when planning and implementing blood pressure
control interventions among middle-aged adults with hypertension.
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Affiliation(s)
- Chia-Pei Chou
- Department of Family Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City
- Master Program of Long-Term Care in Aging, Kaohsiung Medical University, Kaohsiung City
| | - Chun-Yu Chen
- Department of Family Medicine, Kaohsiung Municipal Gangshan Hospital, Kaohsiung City
| | - Kun-Siang Huang
- Department of Family Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City
| | - Shih-Chun Lin
- Department of Nursing, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chiayi
| | - Chih-Fang Huang
- Department of Family Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City
- Department of Long Term Care and Management, Chung Hwa University of Medical Technology, Tainan City
| | - Malcolm Koo
- Graduate Institute of Long-term Care, Tzu Chi University of Science and Technology, Hualien City, Hualien
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Yan JW, Liu S, Van Aarsen K, Columbus MP, Spaic T. Do Adult Patients With Type 1 or 2 Diabetes Who Present to the Emergency Department With Hyperglycemia Have Improved Outcomes if They Have Access to Specialized Diabetes Care? Can J Diabetes 2020; 45:59-63. [PMID: 32847767 DOI: 10.1016/j.jcjd.2020.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/20/2020] [Accepted: 05/20/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Few studies have examined the effect of specialized care on patients with diabetes who present to the emergency department (ED) visits for acute hyperglycemia. The objective of this study was to characterize ED patients presenting with hyperglycemia and compare the 30-day outcomes of those followed by specialized diabetes clinics with those not followed. We hypothesized that patients followed by specialized clinics would have improved clinical outcomes compared with those who had no specialized follow up. METHODS We conducted this single-centre retrospective cohort study of adults (≥18 years) with an ED visit for hyperglycemia over 1 year (January to December 2014). Data from ED visits were linked to specialized diabetes clinic records, which contained diabetes-specific clinical data not available in ED visit records. Descriptive statistics were summarized and comparisons between groups were performed, when appropriate. RESULTS There were 456 patients (55.0% men; mean age, 47.7 years; 46.3% with type 1 diabetes) with 250 followed by the specialized diabetes clinics. The 206 patients who were not followed by the diabetes clinics (45%) were more likely to have a recurrent hyperglycemia ED visit (32.5% vs 9.6%, p<0.001) and to require hospitalization for hyperglycemia (14.1% vs 5.2%, p=0.001) within 30 days of initial presentation. CONCLUSIONS Patients followed by specialized diabetes clinics had fewer recurrent ED visits and hospital admissions for hyperglycemia at 30 days compared with those not followed, suggesting that greater continuity of care between endocrinology and emergency medicine may help reduce these adverse outcomes for patients with diabetes.
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Affiliation(s)
- Justin W Yan
- Division of Emergency Medicine, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada; Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Lawson Health Research Institute, London, Ontario, Canada.
| | - Selina Liu
- Division of Emergency Medicine, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada; Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Division of Endocrinology and Metabolism, Department of Medicine, St Joseph's Healthcare London, London, Ontario, Canada
| | - Kristine Van Aarsen
- Division of Emergency Medicine, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Melanie P Columbus
- Division of Emergency Medicine, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Tamara Spaic
- Division of Emergency Medicine, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada; Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Division of Endocrinology and Metabolism, Department of Medicine, St Joseph's Healthcare London, London, Ontario, Canada
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