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Buawangpong N, Phinyo P, Angkurawaranon C, Soontornpun A, Jiraporncharoen W, Sirikul W, Pinyopornpanish K. External Validation of the Charlson Comorbidity Index-based Model for Survival Prediction in Thai Patients Diagnosed with Dementia. BMC Geriatr 2024; 24:675. [PMID: 39134981 PMCID: PMC11318235 DOI: 10.1186/s12877-024-05238-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 07/22/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND The Charlson Comorbidity Index (CCI) is commonly employed for predicting mortality. Nonetheless, its performance has rarely been evaluated in patients with dementia. This study aimed to examine the predictive capability of the CCI-based model for survival prediction in Thai patients diagnosed with dementia. METHODS An external validation study was conducted using retrospective data from adults with dementia who had visited the outpatient departments at Maharaj Nakorn Chiang Mai Hospital between 2006 and 2012. The data obtained from electronic medical records included age, gender, date of dementia diagnosis and death, types of dementia, and comorbidities at the time of dementia diagnosis. The discriminative ability and calibration of the CCI-based model were estimated using Harrell's C Discrimination Index and visualized with calibration plot. As the initial performance did not meet satisfaction, model updating and recalibration were performed. RESULTS Of 702 patients, 56.9% were female. The mean age at dementia diagnosis was 75.22 (SD 9.75) year-old. During external validation, Harrell's C-statistic of the CCI-based model was 0.58 (95% CI, 0.54-0.61). The model showed poor external calibration. Model updating was subsequently performed. All updated models demonstrated a modest increase in Harrell's C-statistic. Temporal recalibration did not significantly improve the calibration of any of the updated models. CONCLUSION The CCI-based model exhibited fair discriminative ability and poor calibration for predicting survival in Thai patients diagnosed with dementia. Despite attempts at model updating, significant improvements were not achieved. Therefore, it is important to consider the incorporation of other influential prognostic factors.
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Affiliation(s)
- Nida Buawangpong
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Inthawarorot Rd., Chiang Mai, 50200, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Phichayut Phinyo
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Inthawarorot Rd., Chiang Mai, 50200, Thailand
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
- Musculoskeletal Science and Translational Research (MSTR), Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Chaisiri Angkurawaranon
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Inthawarorot Rd., Chiang Mai, 50200, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Atiwat Soontornpun
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Wichuda Jiraporncharoen
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Inthawarorot Rd., Chiang Mai, 50200, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Wachiranun Sirikul
- Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Kanokporn Pinyopornpanish
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Inthawarorot Rd., Chiang Mai, 50200, Thailand.
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, 50200, Thailand.
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McConnell ML, Marshall EG, Stock D, Trenaman SC, Andrew MK. Is Dementia Related to a Longer Wait Time to be Assigned a New Primary Care Provider? An Analysis of the Nova Scotia Need a Family Practice Registry Derived from the PUPPY-Study. Can Geriatr J 2023; 26:502-510. [PMID: 38045885 PMCID: PMC10684307 DOI: 10.5770/cgj.26.681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Abstract
Background Access to Primary Care Providers (PCPs) is limited for many Canadians. "Unattached patients" are persons who do not have a PCP. Older adults living with dementia may face greater challenges seeking attachment. This study investigated whether older adults living with dementia experience differential wait times for PCPs compared to those without a diagnosis of dementia. Methods This was an observational descriptive study of the centralized wait-list data from the Nova Scotia (NS) Need a Family Practice Registry (NaFPR). Time on provider wait-list by dementia diagnosis and age were compared. Number of days on the registry across these measures was estimated. Multivariable proportional hazards regression was used to compare hazards of remaining on the registry over time. Results Unattached older adults living with dementia were on the NaFPR for less time compared to those without dementia (381.4 vs. 428.8 days, respectively). After adjusting for age, self-reported gender, comorbidity, rurality, income quintiles, and overall deprivation, older adults with dementia had a 1.13-fold (95% CI: 1.04-1.24) increase in the likelihood of leaving the NaFPR. Potential contributors to this small difference could be placement in Long Term Care (LTC) and subsequent facility PCP attachment. Conclusions Analysis of the NaFPR exhibited similarly time to PCP attachment despite a diagnosis of dementia. This represented an effective equality model of health care utilized in NS. Future studies should investigate whether an equity model with priority attachment for vulnerable patients would reduce hospitalization and LTC institutionalization.
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Affiliation(s)
- Miranda L. McConnell
- Primary Care Research Unit, Dalhousie Departments of Family Medicine, Dalhousie University, Halifax
| | - Emily Gard Marshall
- Primary Care Research Unit, Dalhousie Departments of Family Medicine, Dalhousie University, Halifax
| | - David Stock
- Primary Care Research Unit, Dalhousie Departments of Family Medicine, Dalhousie University, Halifax
| | - Shanna C. Trenaman
- Department of Medicine (College of Pharmacy), Dalhousie University, Halifax
| | - Melissa K. Andrew
- Department of Medicine (Geriatrics), Dalhousie University, Halifax, NS
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Co M, Mueller C, Mayston R, Das-Munshi J, Prina M. Ethnicity and survival after a dementia diagnosis: a retrospective cohort study using electronic health record data. Alzheimers Res Ther 2023; 15:67. [PMID: 36991518 PMCID: PMC10052806 DOI: 10.1186/s13195-022-01135-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 12/05/2022] [Indexed: 03/31/2023]
Abstract
BACKGROUND Individuals from minority ethnic groups in the UK are thought to be at higher risk of developing dementia while facing additional barriers to receiving timely care. However, few studies in the UK have examined if there are ethnic disparities in survival once individuals receive a dementia diagnosis. METHODS We conducted a retrospective cohort study using electronic health record data of individuals diagnosed with dementia from a large secondary mental healthcare provider in London. Patients from Black African, Black Caribbean, South Asian, White British, and White Irish ethnic backgrounds were followed up for a 10-year period between 01 January 2008 and 31 December 2017. Data were linked to death certificate data from the Office of National Statistics to determine survival from dementia diagnosis. Standardised mortality ratios were calculated to estimate excess deaths in each ethnicity group as compared to the gender- and age-standardised population of England and Wales. We used Cox regression models to compare survival after dementia diagnosis across each ethnicity group. RESULTS Mortality was elevated at least twofold across all ethnicity groups with dementia compared to the general population in England and Wales. Risk of death was lower in Black Caribbean, Black African, White Irish, and South Asian groups as compared to the White British population, even after adjusting for age, gender, neighbourhood-level deprivation, indicators of mental and physical comorbidities. Risk of death remained lower after additionally accounting for those who emigrated out of the cohort. CONCLUSIONS While mortality in dementia is elevated across all ethnic groups as compared to the general population, reasons for longer survival in minority ethnic groups in the UK as compared to the White British group are unclear and merit further exploration. Implications of longer survival, including carer burden and costs, should be considered in policy and planning to ensure adequate support for families and carers of individuals with dementia.
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Affiliation(s)
- Melissa Co
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neurosciences, King's College London, David Goldberg Centre, De Crespigny Park, London, SE5 8AF, UK.
| | - Christoph Mueller
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Rosie Mayston
- Department of Global Health & Social Medicine, Faculty of Social Science & Public Policy, King's College London, London, UK
| | - Jayati Das-Munshi
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Matthew Prina
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neurosciences, King's College London, David Goldberg Centre, De Crespigny Park, London, SE5 8AF, UK
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
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Buawangpong N, Pinyopornpanish K, Phinyo P, Jiraporncharoen W, Angkurawaranon C, Soontornpun A. Effect of Comorbidities on Ten-Year Survival in Patients with Dementia. J Alzheimers Dis 2023; 94:163-175. [PMID: 37212105 DOI: 10.3233/jad-221259] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND There is a verified association between comorbidity and survival in patients with dementia. OBJECTIVE To describe the ten-year survival probability of patients with dementia and to identify the impact of comorbidity. METHODS The prognostic retrospective cohort study was conducted using data from adults with dementia who had visited the outpatient departments at Maharaj Nakorn Chiang Mai hospital between 2006 and 2012. Dementia was verified in accordance with standard practice guidelines. Secondary data detailing about patient age, gender, date of dementia diagnosis and death, types of dementia, and comorbidities at the time of dementia diagnosis was obtained from electronic medical records. The association between comorbidity, patients' underlying disease at dementia diagnosis, and overall survival were analyzed using a multivariable Cox proportional hazard model adjusted for age, gender, types of dementia, and other comorbidities. RESULTS Of the 702 patients, 56.9% were female. Alzheimer's disease (39.6%) was the most prevalent type of dementia. Median overall survival was 6.0 years (95% CI 5.5- 6.7). The comorbidities associated with a high risk of mortality included liver disease (aHR 2.70, 95% CI 1.46- 5.00), atrial fibrillation (aHR 2.15, 95% CI 1.29- 3.58), myocardial infarction (aHR 1.55, 95% CI 1.07- 2.26), and type 2 diabetes mellitus (aHR 1.40, 95% CI 1.13- 1.74). CONCLUSION Overall survival rate of patients with dementia in Thailand was comparable to previous studies. Several comorbidities were associated with a ten-year survival. The prognosis of patients with dementia may be improved by appropriate care of comorbidities.
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Affiliation(s)
- Nida Buawangpong
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand
| | - Kanokporn Pinyopornpanish
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand
| | - Phichayut Phinyo
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Musculoskeletal Science and Translational Research (MSTR), Chiang Mai University, Chiang Mai, Thailand
| | - Wichuda Jiraporncharoen
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand
| | - Chaisiri Angkurawaranon
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand
| | - Atiwat Soontornpun
- Department of Internal Medicine, Division of Neurology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Meng Z, Cheng L, Hu X, Chen Q. Risk factors for in-hospital death in elderly patients over 65 years of age with dementia: A retrospective cross-sectional study. Medicine (Baltimore) 2022; 101:e29737. [PMID: 35777004 PMCID: PMC9239669 DOI: 10.1097/md.0000000000029737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
As the population continues to age, dementia is becoming a huge social, economic, and healthcare burden. However, the risk factors for in-hospital death in elderly patients over 65 years of age with dementia are not well understood. Identifying factors that affect their prognosis could help clinicians with scientific decision-making. To examine the risk factors for in-hospital death in elderly patients over 65 years of age with dementia in the Geriatric Department of West China Hospital. In this retrospective, cross-sectional study, we analyzed inpatients aged ≥65 years with dementia between 2010 and 2016 using electronic medical records from the Information Center of West China Hospital. The risk factors for death were assessed using multivariable logistic regression. Out of a total of 2986 inpatients with dementia, 3.4% died. Patient deaths were related to digestive diseases, respiratory diseases, circulatory diseases, urinary diseases, and chronic obstructive pulmonary disease, whereas patient survival was associated with osteoporosis and Parkinson disease. Patients with a mean length of hospital stay of ≥60 days had an increased risk of death (all P <.05). In the multiple logistic regression analysis, age ≥80 years, digestive diseases, respiratory diseases, urinary diseases, diabetes, chronic obstructive pulmonary disease, and ≥7 comorbidities were risk factors for death. Mortality in hospitalized older patients with dementia is low, but some risk factors may be easily ignored. These findings could raise awareness among clinicians and caregivers about risk factors in hospitalized older patients, particularly hospitalized elderly patients with multiple comorbidities. Therefore, to reduce mortality, early prevention and management of potential risks are necessary.
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Affiliation(s)
- Zhangmin Meng
- Department of Geriatrics, West China Hospital, West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Linan Cheng
- West China School of Nursing, Sichuan University/Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, China
| | - Xiuying Hu
- Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Qian Chen
- Department of Geriatrics, West China Hospital, West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
- *Correspondence: Qian Chen, Department of Geriatrics, West China Hospital/West China School of Nursing, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan 610041, China (e-mail: )
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Chen Y, Crimmins E, Ferido P, Zissimopoulos JM. Racial/Ethnic Disparities in Length of Life after Dementia Diagnosis: an 18-Year Follow-up Study of Medicare Beneficiaries. THE LANCET REGIONAL HEALTH - AMERICAS 2022; 8. [PMID: 35814361 PMCID: PMC9264371 DOI: 10.1016/j.lana.2021.100179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background Methods Findings Interpretation
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7
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Li W, Chen D, Ruan W, Peng Y, Lu Z, Wang D. Associations of depression, sleep disorder with total and cause-specific mortality: A prospective cohort study. J Affect Disord 2022; 298:134-141. [PMID: 34763200 DOI: 10.1016/j.jad.2021.10.131] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/25/2021] [Accepted: 10/28/2021] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Evidence on the association of depression and sleep disorder with mortality is limited. We aimed to evaluate the relationship of depression and sleep disorder with mortality. METHODS A total of 25,978 participants from the National health and Nutrition Examination Surveys (NHANES 2005∼2014) were included in the present study. Cox proportional hazards models were used to explore the associations of depression and sleep disorder with total and cause-specific mortality. RESULTS A total of 1,864 deaths occurred among 25,978 participants during a median follow-up of 5.67 years, including 301 deaths from cardiovascular diseases (CVD) and 415 deaths from cancer. We observed significant positive relationship between depression and total and CVD mortality, the multiple adjusted hazard rations (HRs) and 95% confidence intervals (CIs) were 1.56 (1.31-1.85) and 2.11 (1.36-3.30), respectively. Sleep disorder was only significantly associated with total mortality, and the HR and 95% CI was 1.49 (1.28-1.72). Sleep disorder was associated with total mortality in male (HR=1.64, 95% CI 1.29-2.08), excessive sleep time increased the risk of total mortality in elders (1.31, 1.05-1.63). No joint effect of depression and sleep disorder on total mortality was observed. A dose-response relationship of depression score and sleep time with total mortality was observed. CONCLUSIONS Depression and sleep disorder are associated with increased risks of total and specific-cause mortality, and differences in sex, age and BMI were observed. More studies should be conducted to examine these relationships and to explore mechanisms.
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Affiliation(s)
- Wenzhen Li
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China.
| | - Dajie Chen
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Wenyu Ruan
- Shangluo Central Hospital, Shangluo, Shaanxi 726000, China
| | - Ying Peng
- Wuhan Center for Disease Control and Prevention, Wuhan, Hubei 430000, China
| | - Zuxun Lu
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Dongming Wang
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, Hubei 430030, China; Key Laboratory of Environment and Health, Ministry of Education and Ministry of Environmental Protection and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China.
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8
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Co M, Couch E, Gao Q, Martinez A, Das-Munshi J, Prina M. Differences in survival and mortality in minority ethnic groups with dementia: A systematic review and meta-analysis. Int J Geriatr Psychiatry 2021; 36:1640-1663. [PMID: 34324226 DOI: 10.1002/gps.5590] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 06/12/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Although there are disparities in both risk of developing dementia and accessibility of dementia services for certain minority ethnic groups in the United States and United Kingdom, disparities in survival after a dementia diagnosis are less well-studied. Our objective was to systematically review the literature to investigate racial/ethnic differences in survival and mortality in dementia. METHODS We searched Embase, Ovid MEDLINE, Global Health and PsycINFO from inception to November 2018 for studies comparing survival or mortality over time in at least two race/ethnicity groups. Studies from any country were included but analysed separately. We used narrative synthesis and random-effects meta-analysis to synthesise findings. The Newcastle-Ottawa Scale was used to assess quality and risk of bias in individual studies. RESULTS We identified 22 articles, most from the United States (n = 17), as well as the United Kingdom (n = 3) and the Netherlands (n = 1). In a meta-analysis of US studies, hazard of mortality was lower in Black/African American groups (Pooled Hazard Ratio = 0.86, 95% CI = 0.82-0.91, I2 = 17%, from four studies) and Hispanic/Latino groups (Pooled HR = 0.65, 95% CI = 0.50-0.84, I2 = 86%, from four studies) versus comparison groups. However, study quality was mixed, and in particular, quality of reporting of race/ethnicity was inconsistent. CONCLUSION Literature indicates that Black/African American and Hispanic/Latino groups may experience lower mortality in dementia versus comparison groups in the United States, but further research, using clearer and more and consistent reporting of race/ethnicity, is necessary to understand what drives these patterns and their implications for policy and practice.
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Affiliation(s)
- Melissa Co
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Elyse Couch
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Qian Gao
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Andrea Martinez
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Jayati Das-Munshi
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Trust, London, UK
| | - Matthew Prina
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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9
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Campbell P, Rathod-Mistry T, Marshall M, Bailey J, Chew-Graham CA, Croft P, Frisher M, Hayward R, Negi R, Singh S, Tantalo-Baker S, Tarafdar S, Babatunde OO, Robinson L, Sumathipala A, Thein N, Walters K, Weich S, Jordan KP. Markers of dementia-related health in primary care electronic health records. Aging Ment Health 2021; 25:1452-1462. [PMID: 32578454 DOI: 10.1080/13607863.2020.1783511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Identifying routinely recorded markers of poor health in patients with dementia may help treatment decisions and evaluation of earlier outcomes in research. Our objective was to determine whether a set of credible markers of dementia-related health could be identified from primary care electronic health records (EHR). METHODS The study consisted of (i) rapid review of potential measures of dementia-related health used in EHR studies; (ii) consensus exercise to assess feasibility of identifying these markers in UK primary care EHR; (iii) development of UK EHR code lists for markers; (iv) analysis of a regional primary care EHR database to determine further potential markers; (v) consensus exercise to finalise markers and pool into higher domains; (vi) determination of 12-month prevalence of domains in EHR of 2328 patients with dementia compared to matched patients without dementia. RESULTS Sixty-three markers were identified and mapped to 13 domains: Care; Home Pressures; Severe Neuropsychiatric; Neuropsychiatric; Cognitive Function; Daily Functioning; Safety; Comorbidity; Symptoms; Diet/Nutrition; Imaging; Increased Multimorbidity; Change in Dementia Drug. Comorbidity was the most prevalent recorded domain in dementia (69%). Home Pressures were the least prevalent domain (1%). Ten domains had a statistically significant higher prevalence in dementia patients, one (Comorbidity) was higher in non-dementia patients, and two (Home Pressures, Diet/Nutrition) showed no association with dementia. CONCLUSIONS EHR captures important markers of dementia-related health. Further research should assess if they indicate dementia progression. These markers could provide the basis for identifying individuals at risk of faster progression and outcome measures for use in research.
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Affiliation(s)
- Paul Campbell
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, UK.,Midlands Partnership NHS Foundation Trust, St. George's Hospital, Stafford, UK
| | - Trishna Rathod-Mistry
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, UK
| | - Michelle Marshall
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, UK
| | - James Bailey
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, UK
| | - Carolyn A Chew-Graham
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, UK.,Midlands Partnership NHS Foundation Trust, St. George's Hospital, Stafford, UK
| | - Peter Croft
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, UK
| | - Martin Frisher
- School of Pharmacy and Bioengineering, Keele University, Keele, Staffordshire, UK
| | - Richard Hayward
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, UK
| | - Rashi Negi
- Midlands Partnership NHS Foundation Trust, St. George's Hospital, Stafford, UK
| | - Swaran Singh
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Shula Tantalo-Baker
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, UK
| | - Suhail Tarafdar
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, UK
| | - Opeyemi O Babatunde
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, UK.,Centre for Prognosis Research, Keele University, Keele, Staffordshire, UK
| | - Louise Robinson
- Institute of Health and Society and Newcastle University Institute for Ageing, Newcastle upon Tyne, UK
| | - Athula Sumathipala
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, UK.,Midlands Partnership NHS Foundation Trust, St. George's Hospital, Stafford, UK
| | - Nwe Thein
- Midlands Partnership NHS Foundation Trust, St. George's Hospital, Stafford, UK
| | - Kate Walters
- Research Department of Primary Care & Population Health, University College London, Royal Free Campus, London, UK
| | - Scott Weich
- Mental Health Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Kelvin P Jordan
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, UK.,Centre for Prognosis Research, Keele University, Keele, Staffordshire, UK
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10
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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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11
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Rathod-Mistry T, Marshall M, Campbell P, Bailey J, Chew-Graham CA, Croft P, Frisher M, Hayward R, Negi R, Robinson L, Singh S, Sumathipala A, Thein N, Walters K, Weich S, Jordan KP. Indicators of dementia disease progression in primary care: An electronic health record cohort study. Eur J Neurol 2021; 28:1499-1510. [PMID: 33378599 DOI: 10.1111/ene.14710] [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: 07/23/2020] [Revised: 12/17/2020] [Accepted: 12/20/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE The objectives were to assess the feasibility and validity of using markers of dementia-related health as indicators of dementia progression in primary care, by assessing the frequency with which they are recorded and by testing the hypothesis that they are associated with recognised outcomes of dementia. The markers, in 13 domains, were derived previously through literature review, expert consensus, and analysis of regional primary care records. METHODS The study population consisted of patients with a recorded dementia diagnosis in the Clinical Practice Research Datalink, a UK primary care database linked to secondary care records. Incidence of recorded domains in the 36 months after diagnosis was determined. Associations of recording of domains with future hospital admission, palliative care, and mortality were derived. RESULTS There were 30,463 people with diagnosed dementia. Incidence of domains ranged from 469/1000 person-years (Increased Multimorbidity) to 11/1000 (Home Pressures). An increasing number of domains in which a new marker was recorded in the first year after diagnosis was associated with hospital admission (hazard ratio for ≥4 domains vs. no domains = 1.24; 95% confidence interval = 1.15-1.33), palliative care (1.87; 1.62-2.15), and mortality (1.57; 1.47-1.67). Individual domains were associated with outcomes with varying strengths of association. CONCLUSIONS Feasibility and validity of potential indicators of progression of dementia derived from primary care records are supported by their frequency of recording and associations with recognised outcomes. Further research should assess whether these markers can help identify patients with poorer prognosis to improve outcomes through stratified care and targeted support.
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Affiliation(s)
| | | | - Paul Campbell
- School of Medicine, Keele University, Keele, UK.,Midlands Partnership NHS Foundation Trust, Stafford, UK
| | | | - Carolyn A Chew-Graham
- School of Medicine, Keele University, Keele, UK.,Midlands Partnership NHS Foundation Trust, Stafford, UK
| | - Peter Croft
- School of Medicine, Keele University, Keele, UK
| | - Martin Frisher
- School of Pharmacy and Bioengineering, Keele University, Keele, UK
| | | | - Rashi Negi
- Midlands Partnership NHS Foundation Trust, Stafford, UK
| | - Louise Robinson
- Institute of Health and Society and Newcastle University Institute for Ageing, Newcastle Upon Tyne, UK
| | - Swaran Singh
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Athula Sumathipala
- School of Medicine, Keele University, Keele, UK.,Midlands Partnership NHS Foundation Trust, Stafford, UK
| | - Nwe Thein
- Midlands Partnership NHS Foundation Trust, Stafford, UK
| | - Kate Walters
- Research Department of Primary Care & Population Health, University College London, London, UK
| | - Scott Weich
- Mental Health Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Kelvin P Jordan
- School of Medicine, Keele University, Keele, UK.,Centre for Prognosis Research, Keele University, Keele, UK
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12
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Lunghi C, Zongo A, Tardif I, Demers É, Diendéré JDR, Guénette L. Depression but not non-persistence to antidiabetic drugs is associated with mortality in type 2 diabetes: A nested case-control study. Diabetes Res Clin Pract 2021; 171:108566. [PMID: 33271227 DOI: 10.1016/j.diabres.2020.108566] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/09/2020] [Accepted: 11/16/2020] [Indexed: 01/06/2023]
Abstract
AIMS To measure the effect of depression on mortality of individuals newly treated with antidiabetic drugs, accounting for non-persistence to treatment. METHODS We conducted a nested case-control study within a cohort of newly treated individuals with diabetes. Using Quebec administrative data, we identified all-cause, diabetes-related, cardiovascular-related and major cardiovascular event deaths during a maximum follow-up of eight years. Each case was matched with up to 10 controls by age, sex, follow-up, and comorbidity index. We used conditional logistic regressions to estimate the effect of depression on mortality, adjusting for non-persistence to antidiabetic drug treatment, and other variables. RESULTS We retrieved 13,558 deaths, of which 3,652 were related to cardiovascular diseases, 2,112 to major cardiovascular events, and 311 to diabetes. Depression was associated with an increased risk of all-cause and cardiovascular-related deaths, with adjusted odds ratios (ORs) ranging from 1.32 (95% CI: 1.21-1.45) to 1.72 (95% CI: 1.57-1.88) depending on the model, but not with diabetes-related mortality. CONCLUSION Depression is independently associated with all-cause and cardiovascular-related mortality in individuals with type 2 diabetes, even when adjusting for non-persistence to antidiabetic drug treatment. Identifying risk factors for depression and implementing a screening and proper treatment for depression may help reducing mortality.
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Affiliation(s)
- Carlotta Lunghi
- Department of Health Sciences, Université du Québec à Rimouski, 1595 boulevard Alphonse-Desjardins, Lévis (QC), Canada; Axe Santé des Populations et Pratiques Optimales en Santé (SP-POS), Centre de recherche du CHU de Quebec, 1050 chemin Ste-Foy, Quebec City (QC) Canada; Faculty of Pharmacy, 1050 avenue de la Médecine, Université Laval, Quebec City (QC) Canada.
| | - Arsène Zongo
- Axe Santé des Populations et Pratiques Optimales en Santé (SP-POS), Centre de recherche du CHU de Quebec, 1050 chemin Ste-Foy, Quebec City (QC) Canada; Faculty of Pharmacy, 1050 avenue de la Médecine, Université Laval, Quebec City (QC) Canada
| | - Isabelle Tardif
- Faculty of Medicine, 1050 avenue de la Médecine, Université Laval, Quebec City (QC) Canada
| | - Éric Demers
- Axe Santé des Populations et Pratiques Optimales en Santé (SP-POS), Centre de recherche du CHU de Quebec, 1050 chemin Ste-Foy, Quebec City (QC) Canada
| | - Joël Désiré Relwende Diendéré
- Axe Santé des Populations et Pratiques Optimales en Santé (SP-POS), Centre de recherche du CHU de Quebec, 1050 chemin Ste-Foy, Quebec City (QC) Canada; Faculty of Pharmacy, 1050 avenue de la Médecine, Université Laval, Quebec City (QC) Canada
| | - Line Guénette
- Axe Santé des Populations et Pratiques Optimales en Santé (SP-POS), Centre de recherche du CHU de Quebec, 1050 chemin Ste-Foy, Quebec City (QC) Canada; Faculty of Pharmacy, 1050 avenue de la Médecine, Université Laval, Quebec City (QC) Canada
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13
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Cullum S, Varghese C, Coomarasamy C, Whittington R, Hadfield L, Rajay A, Yeom B, Liu B, Christie M, Appleton K, Yates S, Cheung G. Predictors of mortality in Māori, Pacific Island, and European patients diagnosed with dementia at a New Zealand Memory Service. Int J Geriatr Psychiatry 2020; 35:516-524. [PMID: 31957058 DOI: 10.1002/gps.5266] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 12/21/2019] [Indexed: 11/11/2022]
Abstract
BACKGROUND As the economic impact of dementia on health and social care increases, governments require disease-specific epidemiological data that will help inform spending and policy decisions. The aim of this study is to examine predictors of mortality in dementia in consecutive referrals to a New Zealand (NZ) memory service that includes Māori, Pacific Islander, and NZ European patients. METHODS Date of birth, sex, ethnicity, living situation, cognitive function, dementia subtype, dementia severity, physical comorbidity, and medication data were collected from electronic health records. The resulting data set was linked to administrative data on mortality and last hospital contact dates to allow time-dependent survival analyses. RESULTS The risk of death in people with dementia was increased by age (adjusted HR per year 1.08, 95%CI:1.05-1.12) and lower cognitive score at baseline (adjusted HR for severe impairment:2.54, 95% CI:1.25-5.16), and was reduced by cholinesterase inhibitors (adjusted HR:0.54, 95% CI:0.34-0.88). Compared to NZ Europeans (HR:1.19, 95% CI:0.63-2.25), antipsychotics increased the risk of death three-fold in Māori (adjusted HR:3.62, 95% CI:0.79-16.7) and Pacific Islanders (adjusted HR:2.54, 95%CI:1.10-5.85). CONCLUSIONS Further research is required to elucidate the mechanisms underlying the survival rates in Māori and Pacific Islanders living with dementia in NZ,and their increased risk of death if antipsychotics are used.
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Affiliation(s)
- Sarah Cullum
- Department of Psychological Medicine School of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.,Mental Health and Addictions Services, Counties Manukau Health Board, Auckland, New Zealand
| | - Chris Varghese
- Department of Psychological Medicine School of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | | | - Rosie Whittington
- Health Intelligence and Informatics, Counties Manukau Health Board, Auckland, New Zealand
| | - Laura Hadfield
- School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Aakash Rajay
- Department of Psychological Medicine School of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Brian Yeom
- Department of Psychological Medicine School of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Bonnie Liu
- Department of Psychological Medicine School of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Madeline Christie
- School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | | | - Susan Yates
- Department of Psychological Medicine School of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Gary Cheung
- Department of Psychological Medicine School of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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14
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CSF level of β-amyloid peptide predicts mortality in Alzheimer's disease. ALZHEIMERS RESEARCH & THERAPY 2019; 11:29. [PMID: 30922415 PMCID: PMC6440001 DOI: 10.1186/s13195-019-0481-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 03/08/2019] [Indexed: 12/31/2022]
Abstract
Objective Alzheimer’s disease (AD) is the sixth leading cause of death, with an average survival estimated between 5 and 10 years after diagnosis. Despite recent advances in diagnostic criteria of AD, few studies have used biomarker-based diagnostics to determine the prognostic factors of AD. We investigate predictors of death and institutionalization in a population of AD patients with high probability of AD physiopathology process assessed by positivity of three CSF biomarkers. Methods Three hundred twenty-one AD patients with abnormal values for CSF beta-amyloid peptide (Aβ42), tau, and phosphorylated tau levels were recruited from a memory clinic-based registry between 2008 and 2017 (Lariboisiere hospital, Paris, France) and followed during a median period of 3.9 years. We used multivariable Cox models to estimate the hazard ratio (HR) of death and institutionalization for baseline clinical data, genotype of the apolipoprotein E (APOE), and levels of CSF biomarkers. Results A total of 71 (22%) patients were institutionalized and 57 (18%) died during the follow-up. Greater age, male sex, lower MMSE score, and lower CSF Aβ42 level were associated with an increased risk of mortality. One standard deviation lower CSF Aβ42 (135 pg/mL) was associated with a 89% increased risk of death (95% CI = 1.25–2.86; p = 0.002). This association was not modified by age, sex, education, APOE ε4, and disease severity. There was no evidence of an association of tau CSF biomarkers with mortality. None of the CSF biomarkers were associated with institutionalization. Conclusions Lower CSF Aβ42 is a strong prognostic marker of mortality in AD patients, independently of age or severity of the disease. Whether drugs targeting beta-amyloid peptide could have an effect on mortality of AD patients should be investigated in future clinical trials.
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