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Ringshausen FC, Rademacher J, Pink I, de Roux A, Hickstein L, Ploner T, Welte T, Diel R. Increasing bronchiectasis prevalence in Germany, 2009-2017: a population-based cohort study. Eur Respir J 2019; 54:13993003.00499-2019. [PMID: 31467114 DOI: 10.1183/13993003.00499-2019] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 08/13/2019] [Indexed: 11/05/2022]
Affiliation(s)
- Felix C Ringshausen
- Dept of Respiratory Medicine, Hannover Medical School, Hannover, Germany .,Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Jessica Rademacher
- Dept of Respiratory Medicine, Hannover Medical School, Hannover, Germany.,Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Isabell Pink
- Dept of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Andrés de Roux
- Pneumologische Praxis am Schloss Charlottenburg, Berlin, Germany
| | - Lennart Hickstein
- InGef - Institute for Applied Health Research Berlin GmbH, Berlin, Germany
| | - Tina Ploner
- InGef - Institute for Applied Health Research Berlin GmbH, Berlin, Germany
| | - Tobias Welte
- Dept of Respiratory Medicine, Hannover Medical School, Hannover, Germany.,Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Roland Diel
- Institute for Epidemiology, University Medical Center Schleswig-Holstein, Kiel, Germany.,LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany.,Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services (BGW), Hamburg, Germany
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Jacob J, Schmedt N, Hickstein L, Galetzka W, Walker J, Enders D. Comparison of Approaches to Select a Propensity Score Matched Control Group in the Absence of an Obvious Start of Follow Up for this Group: An Example Study on the Economic Impact of the DMP Bronchial Asthma. Gesundheitswesen 2019; 82:S151-S157. [PMID: 31645071 DOI: 10.1055/a-0948-5356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Claims data are a valuable data source to investigate the economic impact of new health care services. While the date of enrollment into the new service is an obvious start of follow-up for participants, the strategy to select potential controls is not straightforward due to a missing start of follow-up to ascertain possible confounders. The aim of this study was to compare different approaches to select controls via Propensity Score Matching (PSM) using the disease management program (DMP) bronchial asthma (BA) as an example. METHODS We conducted a retrospective cohort study of BA patients between 2013 and 2016 to examine total one-year health care costs and all-cause mortality. We implemented different scenarios regarding the selection of potential controls: I) allotment of a random index date with subsequent PSM, II) calendar year-based PSM (landmark analysis) and III) calendar quarter-based PSM. In scenario I, we applied 2 approaches to assign a random index date: a) assign random index date among all quarters with a BA diagnosis and b) assign random index date and thereafter examine if a BA diagnosis was documented in that quarter. RESULTS No significant differences in total one-year health care costs between DMP BA participants and non-participants were observed in any of the scenarios. This could to some extent be explained by the higher mortality in the control groups in all scenarios. CONCLUSION If the loss of potential controls can be compensated, scenario Ib is a pragmatic option to select a control group. If that is not the case, scenario III is the more sophisticated approach, with the limitation that baseline characteristics prior PSM cannot be depicted and computational time or memory size needed to conduct the analysis need to be sufficient.
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Affiliation(s)
| | | | - Lennart Hickstein
- InGef - Institut für angewandte Gesundheitsforschung Berlin GmbH, Berlin
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Viniol A, Ploner T, Hickstein L, Haasenritter J, Klein KM, Walker J, Donner-Banzhoff N, Becker A. Prescribing practice of pregabalin/gabapentin in pain therapy: an evaluation of German claim data. BMJ Open 2019; 9:e021535. [PMID: 30928920 PMCID: PMC6475154 DOI: 10.1136/bmjopen-2018-021535] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES To analyse the prevalence and incidence of pregabalin and gabapentin (P/G) prescriptions, typical therapeutic uses of P/G with special attention to pain-related diagnoses and discontinuation rates. DESIGN Secondary data analysis. SETTING Primary and secondary care in Germany. PARTICIPANTS Four million patients in the years 2009-2015 (anonymous health insurance data). INTERVENTION None. PRIMARY AND SECONDARY OUTCOME MEASURES P/G prescribing rates, P/G prescribing rates associated with pain therapy, analysis of pain-related diagnoses leading to new P/G prescriptions and the discontinuation rate of P/G. RESULTS In 2015, 1.6% of insured persons received P/G prescriptions. Among the patients with pain first treated with P/G, as few as 25.7% were diagnosed with a typical neuropathic pain disorder. The remaining 74.3% had either not received a diagnosis of neuropathic pain or showed a neuropathic component that was pathophysiologically conceivable but did not support the prescription of P/G. High discontinuation rates were observed (85%). Among the patients who had discontinued the drug, 61.1% did not receive follow-up prescriptions within 2 years. CONCLUSION The results show that P/G is widely prescribed in cases of chronic pain irrespective of neuropathic pain diagnoses. The high discontinuation rate indicates a lack of therapeutic benefits and/or the occurrence of adverse effects.
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Affiliation(s)
- Annika Viniol
- Department of General Medicine, Preventive and Rehabilitation Medicine, University of Marburg, Marburg, Germany
| | - Tina Ploner
- Institute for Applied Health Research Berlin, InGef, Berlin, Germany
| | - Lennart Hickstein
- Institute for Applied Health Research Berlin, InGef, Berlin, Germany
- University Medicine Greifswald, Greifswald, Germany
| | - Jörg Haasenritter
- Department of General Medicine, Preventive and Rehabilitation Medicine, University of Marburg, Marburg, Germany
| | - Karl Martin Klein
- Epilepsy Centre Frankfurt Rhein-Main, University Hospital Frankfurt, University of Frankfurt, Frankfurt, Hessen, Germany
- Departments of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Jochen Walker
- Institute for Applied Health Research Berlin, InGef, Berlin, Germany
| | - Norbert Donner-Banzhoff
- Department of General Medicine, Preventive and Rehabilitation Medicine, University of Marburg, Marburg, Germany
| | - Annette Becker
- Department of General Medicine, Preventive and Rehabilitation Medicine, University of Marburg, Marburg, Germany
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Mayerhoff L, Lehne M, Hickstein L, Salimullah T, Prieur S, Thomas SK, Zhang J. Cost associated with hematopoietic stem cell transplantation: a retrospective claims data analysis in Germany. J Comp Eff Res 2018; 8:121-131. [PMID: 30517020 DOI: 10.2217/cer-2018-0100] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
AIM Quantify hematopoietic stem cell transplantation (HSCT) costs in German patients with acute lymphoblastic leukemia (ALL), diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma (FL). METHODS The primary outcome was direct and indirect costs in patients with ALL/DLBCL/FL who received HSCT between 2010 and 2014. Costs were evaluated two to four quarters before to eight quarters after HSCT. RESULTS Among 258 patients with HSCT, direct costs were €290,125/patient (pediatric ALL), €246,266/patient (adult ALL), €230,399/patient (DLBCL/FL allogeneic) and €107,457/patient (DLBCL/FL autologous). Indirect costs with HSCT were €52,939/patient (adult ALL), €20,285/patient (DLBCL/FL allogeneic) and €29,881/patient (DLBCL/FL autologous). CONCLUSION Direct and indirect costs associated with HSCT are substantial for patients with ALL, DLBCL and FL. Novel therapies that reduce HSCT use could reduce medical costs.
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Affiliation(s)
| | | | | | | | | | - Simu K Thomas
- Novartis Pharmaceuticals Corporation, East Hanover, NJ 07936, USA
| | - Jie Zhang
- Novartis Pharmaceuticals Corporation, East Hanover, NJ 07936, USA
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Heinzel S, Berg D, Binder S, Ebersbach G, Hickstein L, Herbst H, Lorrain M, Wellach I, Maetzler W, Petersen G, Schmedt N, Volkmann J, Woitalla D, Amelung V. Do We Need to Rethink the Epidemiology and Healthcare Utilization of Parkinson's Disease in Germany? Front Neurol 2018; 9:500. [PMID: 30008693 PMCID: PMC6033992 DOI: 10.3389/fneur.2018.00500] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 06/07/2018] [Indexed: 12/22/2022] Open
Abstract
Epidemiological aspects of Parkinson's disease (PD), co-occurring diseases and medical healthcare utilization of PD patients are still largely elusive. Based on claims data of 3.7 million statutory insurance members in Germany in 2015 the prevalence and incidence of PD was determined. PD cases had at least one main hospital discharge diagnosis of PD, or one physician diagnosis confirmed by a subsequent or independent diagnosis or by PD medication in 2015. Prevalence of (co-)occurring diseases, mortality, and healthcare measures in PD cases and matched controls were compared. In 2015, 21,714 prevalent PD cases (standardized prevalence: 511.4/100,000 persons) and 3,541 incident PD cases (standardized incidence: 84.1/100,000 persons) were identified. Prevalence of several (co-)occurring diseases/complications, e.g., dementia (PD/controls: 39/13%), depression (45/22%), bladder dysfunction (46/22%), and diabetes (35/31%), as well as mortality (10.7/5.8%) differed between PD cases and controls. The annual healthcare utilization was increased in PD cases compared to controls, e.g., regarding mean ± SD physician contacts (15.2 ± 7.6/12.2 ± 7.3), hospitalizations (1.3 ± 1.8/0.7 ± 1.4), drug prescriptions (overall: 37.7 ± 24.2/21.7 ± 19.6; anti-PD medication: 7.4 ± 7.4/0.1 ± 0.7), assistive/therapeutic devices (47/30%), and therapeutic remedies (57/16%). The standardized prevalence and incidence of PD in Germany as well as mortality in PD may be substantially higher than reported previously. While frequently diagnosed with co-occurring diseases/complications, such as dementia, depression, bladder dysfunction and diabetes, the degree of healthcare utilization shows large variability between PD patients. These findings encourage a rethinking of the epidemiology and healthcare utilization in PD, at least in Germany. Longitudinal studies of insurance claims data should further investigate the individual and epidemiological progression and healthcare demands in PD.
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Affiliation(s)
- Sebastian Heinzel
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany
| | - Daniela Berg
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany.,Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
| | - Sebastian Binder
- inav - Institute for Applied Health Services Research GmbH, Berlin, Germany
| | | | - Lennart Hickstein
- InGef - Institute for Applied Health Research Berlin GmbH, Berlin, Germany.,Department of General Practice, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | | | | | - Ingmar Wellach
- Office for Neurology/Ev. Amalie Sieveking Hospital, Hamburg, Germany
| | - Walter Maetzler
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany.,Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
| | | | - Niklas Schmedt
- InGef - Institute for Applied Health Research Berlin GmbH, Berlin, Germany
| | - Jens Volkmann
- Department of Neurology, University Hospital of Würzburg, University of Würzburg, Würzburg, Germany
| | - Dirk Woitalla
- Department of Neurology, Sankt Josef Hospital, Bochum, Germany
| | - Volker Amelung
- inav - Institute for Applied Health Services Research GmbH, Berlin, Germany
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Ringshausen FC, Wagner D, de Roux A, Diel R, Hohmann D, Hickstein L, Welte T, Rademacher J. Prevalence of Nontuberculous Mycobacterial Pulmonary Disease, Germany, 2009-2014. Emerg Infect Dis 2018; 22:1102-5. [PMID: 27191473 PMCID: PMC4880102 DOI: 10.3201/eid2206.151642] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
We analyzed routine statutory health insurance claim data to determine prevalence of nontuberculous mycobacterial pulmonary disease in Germany. Documented prevalence rates of this nonnotifiable disease increased from 2.3 to 3.3 cases/100,000 population from 2009 to 2014. Prevalence showed a strong association with advanced age and chronic obstructive pulmonary disease.
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Hickstein L, Kiel S, Raus C, Heß S, Walker J, Chenot JF. [Acupuncture covered by statutory health insurance in Germany : An observational study based on claims data]. Schmerz 2017; 32:30-38. [PMID: 29230550 DOI: 10.1007/s00482-017-0258-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The coverage for acupuncture for chronic lower back or knee pain by the statutory health insurance was introduced in 2007. The aim of this study was to investigate characteristics of patients and providers of acupuncture and temporal and regional trends in the utilization of acupuncture. METHODS This retrospective observational study used anonymized statutory health insurance claims data from a sample of roughly four million subjects. The sample is representative of the German population regarding age and gender in 2013. RESULTS Lower back pain was the most common coded indication (86%) for billing acupuncture. Women were more often treated with acupuncture than men; the mean age was 61.1 years. For 63% acupuncture was billed in 2014 for the first time, 37% already had an acupuncture treatment in 2012 or 2013. Premature termination (<6 sessions) was observed in 14% of all insurants receiving acupuncture for the first time in 2014 for knee pain and in 21% of those with back pain. Overall there was a statistically significant decrease in the utilization of acupuncture from 2008 to 2015. Regional differences between East and West Germany and city states were observed. Half of all acupuncture treatments in 2014 were provided by 11% of all physicians who billed acupuncture at least once. DISCUSSION Higher utilization of acupuncture by women reflects the epidemiology of back and knee pain and their preference for alternative complementary medicine. On the one hand, the large proportion of patients treated repeatedly with acupuncture suggests perceived benefits. On the other hand, provision of acupuncture services is decreasing continuously and a relevant proportion of subjects are terminating treatment prematurely.
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Affiliation(s)
- L Hickstein
- InGef - Institut für angewandte Gesundheitsforschung Berlin GmbH, Spittelmarkt 12, 10117, Berlin, Deutschland.
- Abteilung Allgemeinmedizin, Institut für Community Medicine, Universitätsmedizin Greifswald, Greifswald, Deutschland.
| | - S Kiel
- Abteilung Allgemeinmedizin, Institut für Community Medicine, Universitätsmedizin Greifswald, Greifswald, Deutschland
| | - C Raus
- Abteilung Allgemeinmedizin, Institut für Community Medicine, Universitätsmedizin Greifswald, Greifswald, Deutschland
| | - S Heß
- InGef - Institut für angewandte Gesundheitsforschung Berlin GmbH, Spittelmarkt 12, 10117, Berlin, Deutschland
| | - J Walker
- InGef - Institut für angewandte Gesundheitsforschung Berlin GmbH, Spittelmarkt 12, 10117, Berlin, Deutschland
| | - J-F Chenot
- Abteilung Allgemeinmedizin, Institut für Community Medicine, Universitätsmedizin Greifswald, Greifswald, Deutschland
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Kossack N, Schindler C, Weinhold I, Hickstein L, Lehne M, Walker J, Neubauer AS, Häckl D. German claims data analysis to assess impact of different intraocular lenses on posterior capsule opacification and related healthcare costs. Z Gesundh Wiss 2017; 26:81-90. [PMID: 29416961 PMCID: PMC5794811 DOI: 10.1007/s10389-017-0851-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 09/26/2017] [Indexed: 12/31/2022]
Abstract
Aim Cataract extraction is one of the most frequent surgeries in Germany. In most cases, the clouded natural lens is replaced by a hydrophobic or hydrophilic acrylic intraocular lens (IOL) implant. The most common long-term complication after cataract surgery is the development of a posterior capsule opacification (PCO). Although no precise real world data are available, published evidence suggests a lower risk for PCO development for hydrophobic acrylic IOLs compared to hydrophilic acrylic IOLs. Therefore, in the present study we assessed real world data on the impact of different IOL material types on the incidence of post-operative PCO treatment. Subject and methods In this retrospective study, we included 3,025 patients who underwent cataract extraction and implantation of either an acrylic hydrophobic or hydrophilic IOL in 2010. We assessed clinical outcomes and direct costs in a 4-year follow-up period after cataract surgery from a statutory health insurance (SHI) perspective in Germany. Results PCO that required capsulotomies occurred significantly (p < 0.0001) less frequent in patients who had received a hydrophobic IOL (31.57% of 2,078 patients) compared to the group with hydrophilic IOL implants (56.6% of 947 patients) and costs per patient for postoperative treatment in a 4-year follow-up were 50.03 € vs. 87.81 € (i.e. 75% higher in the latter group, p < 0.0001). Conclusion Considering the high prevalence of cataract, the economic burden associated with adverse effects of cataract extraction is of great relevance for the German SHI. Hydrophobic lenses seem to be superior regarding both medical and economic results.
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Affiliation(s)
- Nils Kossack
- WIG2 Institute for Health Economics and Health System Research, Leipzig, Germany
| | - Christian Schindler
- WIG2 Institute for Health Economics and Health System Research, Leipzig, Germany
| | - Ines Weinhold
- WIG2 Institute for Health Economics and Health System Research, Leipzig, Germany
| | | | | | - Jochen Walker
- InGef Institut für angewandte Gesundheitsforschung, Berlin, Germany
| | | | - Dennis Häckl
- WIG2 Institute for Health Economics and Health System Research, Leipzig, Germany
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Lonnemann G, Duttlinger J, Hohmann D, Hickstein L, Reichel H. Timely Referral to Outpatient Nephrology Care Slows Progression and Reduces Treatment Costs of Chronic Kidney Diseases. Kidney Int Rep 2016; 2:142-151. [PMID: 29318212 PMCID: PMC5720523 DOI: 10.1016/j.ekir.2016.09.062] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 08/26/2016] [Accepted: 09/27/2016] [Indexed: 11/15/2022] Open
Abstract
Introduction We present a new approach to evaluate the importance of ambulatory nephrology care in patients with chronic kidney disease (CKD). Methods An anonymized health claims database of German insurance companies was searched in a retrospective analysis for patients with CKD using the codes of the International Classification of Diseases, 10th German modification. A total of 105,219 patients with CKD were identified. Patients were assigned to the group "timely referral," when nephrology care was present in the starting year 2009, or initiated during the following 3 years in CKD1-4. Using frequency matching for age and gender, 21,024 of the late referral group were matched with the equal number of patients in the timely referral group. Hospital admission rates, total treatment costs, and kidney function (change in CKD stages, start of dialysis, mortality) were documented each year during the 4-year follow-up. Results Hospital admission rates (110%-186%) and total treatment costs (119%-160%) were significantly higher (P < 0.03) in late referral compared with timely referral. In the timely referral group, significantly more patients did not change their CKD stage (65%-72.9% vs. 52%-64.6%, P < 0.05) compared with late referral. Starting in CKD3 more patients tended to start dialysis in 1 year in timely referral (1.9 ± 0.6 vs. 1.0 ± 0.4, P = 0.1). In contrast, death rates were significantly higher in the late referral group (18.8 ± 1.8% vs. 6.7 ± 0.4%, P = 0.0001). Discussion Timely referral to outpatient nephrology care is associated with slowed disease progression, less hospital admissions, reduced total treatment costs, and improved survival in patients with CKD.
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Ringshausen FC, Wagner D, de Roux A, Diel R, Hohmann D, Hickstein L, Welte T, Rademacher J. Prevalence of Nontuberculous Mycobacterial Pulmonary Disease, Germany, 2009 – 2014. Pneumologie 2016. [DOI: 10.1055/s-0036-1592245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Viniol A, Hickstein L, Walker J, Donner-Banzhoff N, Baum E, Becker A. Influence of thyroid hormone therapy on the fracture rate - A claims data cohort study. Bone 2016; 86:86-90. [PMID: 26946131 DOI: 10.1016/j.bone.2016.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 02/19/2016] [Accepted: 03/01/2016] [Indexed: 01/18/2023]
Abstract
INTRODUCTION It has been debated for years whether long-term thyroid hormone intake causes fractures. Not only have previous studies suffered from design limitations, they also reached contradictory conclusions. We investigated thyroid hormones (thyroxine) as a possible risk factor for fractures in a cohort of 6.7 million persons based on administrative data. METHODS The database consists of anonymized settlement data of approximately 70 German statutory health insurances covering a time period of six years. All subjects aged 60 and above were included in the study; subjects with repeated thyroxine prescriptions were assigned to the exposure group; members without thyroxine prescriptions to the control group. Outcome was any incident fracture during a declared time period. In order to calculate fracture risk, we performed multivariate cox regression analyses to adjust for confounders. RESULTS Of 798 770 subjects fulfilling the inclusion criteria, 11.7% took thyroxine regularly and belong to the exposure group. The final cox regression showed that subjects taking thyroxine have a 6.3% higher risk (HR 1.063; CI 1.046-1.080, p=<.0001) than members of the control group. DISCUSSION The study supports the assumption that long term thyroxine intake leads to an increase in fracture risk among patients older than 60years. The findings have implications for long term thyroxine treatment.
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Affiliation(s)
- Annika Viniol
- Department of General Practice/Family Medicine, University of Marburg, Karl-von-Frisch-Str. 4, 35043 Marburg, Germany.
| | - Lennart Hickstein
- Health Risk Institute, Spittelmarkt 12, 10117 Berlin, Germany; Health Analytics Germany, Elsevier, Jägerstraße 41, 10117 Berlin, Germany
| | - Jochen Walker
- Health Risk Institute, Spittelmarkt 12, 10117 Berlin, Germany; Health Analytics Germany, Elsevier, Jägerstraße 41, 10117 Berlin, Germany
| | - Norbert Donner-Banzhoff
- Department of General Practice/Family Medicine, University of Marburg, Karl-von-Frisch-Str. 4, 35043 Marburg, Germany
| | - Erika Baum
- Department of General Practice/Family Medicine, University of Marburg, Karl-von-Frisch-Str. 4, 35043 Marburg, Germany
| | - Annette Becker
- Department of General Practice/Family Medicine, University of Marburg, Karl-von-Frisch-Str. 4, 35043 Marburg, Germany
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Muraro A, Werfel T, Hoffmann-Sommergruber K, Roberts G, Beyer K, Bindslev-Jensen C, Cardona V, Dubois A, duToit G, Eigenmann P, Fernandez Rivas M, Halken S, Hickstein L, Høst A, Knol E, Lack G, Marchisotto MJ, Niggemann B, Nwaru BI, Papadopoulos NG, Poulsen LK, Santos AF, Skypala I, Schoepfer A, Van Ree R, Venter C, Worm M, Vlieg-Boerstra B, Panesar S, de Silva D, Soares-Weiser K, Sheikh A, Ballmer-Weber BK, Nilsson C, de Jong NW, Akdis CA. EAACI food allergy and anaphylaxis guidelines: diagnosis and management of food allergy. Allergy 2014; 69:1008-25. [PMID: 24909706 DOI: 10.1111/all.12429] [Citation(s) in RCA: 767] [Impact Index Per Article: 76.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2014] [Indexed: 12/11/2022]
Abstract
Food allergy can result in considerable morbidity, impact negatively on quality of life, and prove costly in terms of medical care. These guidelines have been prepared by the European Academy of Allergy and Clinical Immunology's (EAACI) Guidelines for Food Allergy and Anaphylaxis Group, building on previous EAACI position papers on adverse reaction to foods and three recent systematic reviews on the epidemiology, diagnosis, and management of food allergy, and provide evidence-based recommendations for the diagnosis and management of food allergy. While the primary audience is allergists, this document is relevant for all other healthcare professionals, including primary care physicians, and pediatric and adult specialists, dieticians, pharmacists and paramedics. Our current understanding of the manifestations of food allergy, the role of diagnostic tests, and the effective management of patients of all ages with food allergy is presented. The acute management of non-life-threatening reactions is covered in these guidelines, but for guidance on the emergency management of anaphylaxis, readers are referred to the related EAACI Anaphylaxis Guidelines.
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Nwaru BI, Hickstein L, Panesar SS, Roberts G, Muraro A, Sheikh A. Prevalence of common food allergies in Europe: a systematic review and meta-analysis. Allergy 2014; 69:992-1007. [PMID: 24816523 DOI: 10.1111/all.12423] [Citation(s) in RCA: 571] [Impact Index Per Article: 57.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2014] [Indexed: 02/03/2023]
Abstract
Allergy to cow's milk, egg, wheat, soy, peanut, tree nuts, fish, and shellfish constitutes the majority of food allergy reactions, but reliable estimates of their prevalence are lacking. This systematic review aimed to provide up-to-date estimates of their prevalence in Europe.Studies published in Europe from January 1, 2000, to September 30, 2012, were identified from searches of four electronic databases. Two independent reviewers appraised the studies and extracted the estimates of interest. Data were pooled using random-effects meta-analyses. Fifty studies were included in a narrative synthesis and 42 studies in the meta-analyses. Although there were significant heterogeneity between the studies, the overall pooled estimates for all age groups of self-reported lifetime prevalence of allergy to cow's milk, egg, wheat, soy, peanut, tree nuts, fish, and shellfish were 6.0% (95% confidence interval: 5.7-6.4), 2.5% (2.3-2.7), 3.6% (3.0-4.2), 0.4% (0.3-0.6), 1.3% (1.2-1.5), 2.2% (1.8-2.5), and 1.3% (0.9-1.7), respectively. The prevalence of food-challenge-defined allergy to cow's milk, egg, wheat, soy, peanut, tree nuts, fish, and shellfish was 0.6% (0.5-0.8), 0.2% (0.2-0.3), 0.1% (0.01-0.2), 0.3% (0.1-0.4), 0.2% (0.2-0.3), 0.5% (0.08-0.8), 0.1% (0.02-0.2), and 0.1% (0.06-0.3), respectively. Allergy to cow's milk and egg was more common among younger children, while allergy to peanut, tree nuts, fish, and shellfish was more common among the older ones. There were insufficient data to compare the estimates of soy and wheat allergy between the age groups. Allergy to most foods, except soy and peanut, appeared to be more common in Northern Europe. In summary, the lifetime self-reported prevalence of allergy to common foods in Europe ranged from 0.1 to 6.0%. The heterogeneity between studies was high, and participation rates varied across studies reaching as low as <20% in some studies. Standardizing the methods of assessment of food allergies and initiating strategies to increase participation will advance this evidence base.
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Affiliation(s)
- B. I. Nwaru
- School of Health Sciences; University of Tampere; Tampere Finland
- Allergy & Respiratory Research Group; Center for Population Health Sciences; The University of Edinburgh; Edinburgh UK
| | - L. Hickstein
- Institute for Medical Informatics, Biometry and Epidemiology; University of Munich; Munich Germany
| | - S. S. Panesar
- Allergy & Respiratory Research Group; Center for Population Health Sciences; The University of Edinburgh; Edinburgh UK
| | - G. Roberts
- David Hide Asthma and Allergy Research Centre; St Mary's Hospital; Newport Isle of Wight UK
- NIHR Southampton Respiratory Biomedical Research Unit; University of Southampton and University Hospital Southampton NHS Foundation Trust; Southampton UK
- Human Development and Health and Clinical Experimental Sciences Academic Unit; Faculty of Medicine; University of Southampton; Southampton UK
| | - A. Muraro
- Department of Pediatrics; Center for Food Allergy Diagnosis and Treatment; University of Padua; Veneto Region Italy
| | - A. Sheikh
- Allergy & Respiratory Research Group; Center for Population Health Sciences; The University of Edinburgh; Edinburgh UK
- Division of General Internal Medicine and Primary Care; Brigham and Women's Hospital; Boston MA USA
- Department of Medicine; Harvard Medical School; Boston MA USA
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Nwaru BI, Hickstein L, Panesar SS, Muraro A, Werfel T, Cardona V, Dubois AEJ, Halken S, Hoffmann-Sommergruber K, Poulsen LK, Roberts G, Van Ree R, Vlieg-Boerstra BJ, Sheikh A. The epidemiology of food allergy in Europe: a systematic review and meta-analysis. Allergy 2014; 69:62-75. [PMID: 24205824 DOI: 10.1111/all.12305] [Citation(s) in RCA: 322] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2013] [Indexed: 11/29/2022]
Abstract
Food allergy (FA) is an important atopic disease although its precise burden is unclear. This systematic review aimed to provide recent, up-to-date data on the incidence, prevalence, time trends, and risk and prognostic factors for FA in Europe. We searched four electronic databases, covering studies published from 1 January 2000 to 30 September 2012. Two independent reviewers appraised the studies and qualified the risk of bias using the Critical Appraisal Skills Programme tool. Seventy-five eligible articles (comprising 56 primary studies) were included in a narrative synthesis, and 30 studies in a random-effects meta-analysis. Most of the studies were graded as at moderate risk of bias. The pooled lifetime and point prevalence of self-reported FA were 17.3% (95% CI: 17.0-17.6) and 5.9% (95% CI: 5.7-6.1), respectively. The point prevalence of sensitization to ≥1 food as assessed by specific IgE was 10.1% (95% CI: 9.4-10.8) and skin prick test 2.7% (95% CI: 2.4-3.0), food challenge positivity 0.9% (95% CI: 0.8-1.1). While the incidence of FA appeared stable over time, there was some evidence that the prevalence may be increasing. There were no consistent risk or prognostic factors for the development or resolution of FA identified, but sex, age, country of residence, familial atopic history, and the presence of other allergic diseases seem to be important. Food allergy is a significant clinical problem in Europe. The evidence base in this area would benefit from additional studies using standardized, rigorous methodology; data are particularly required from Eastern and Southern Europe.
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Affiliation(s)
- B. I. Nwaru
- School of Health Sciences; University of Tampere; Tampere Finland
| | - L. Hickstein
- Institute for Medical Informatics, Biometry and Epidemiology; University of Munich; Munich Germany
| | - S. S. Panesar
- Allergy & Respiratory Research Group; Center for Population Health Sciences; The University of Edinburgh; Edinburgh UK
| | - A. Muraro
- Department of Pediatrics; Center for Food Allergy Diagnosis and Treatment; Veneto Region; University of Padua; Padua Italy
| | - T. Werfel
- Hannover Medical School; Hanover Germany
| | | | - A. E. J. Dubois
- Department of Paediatrics; Division of Paediatric Pulmonology and Paediatric Allergy; University Medical Centre Groningen; University of Groningen; RB Groningen the Netherlands
| | - S. Halken
- Odense University Hospital; Odense C Denmark
| | - K. Hoffmann-Sommergruber
- Department of Pathophysiology and Allergy Research; Medical University of Vienna; Vienna Austria
| | - L. K. Poulsen
- Laboratory of Medical Allergology; Allergy Clinic; Copenhagen University Hospital; Hellerup Denmark
| | - G. Roberts
- David Hide Asthma and Allergy Research Centre; St Mary's Hospital; Newport
- NIHR Southampton Respiratory Biomedical Research Unit; University of Southampton and University Hospital Southampton NHS Foundation Trust; Southampton UK
- Human Development and Health Academic Unit; Faculty of Medicine; University of Southampton; Southampton UK
| | - R. Van Ree
- Departments of Experimental Immunology and of Otorhinolaryngology; Academic Medical Center; University of Amsterdam; Amsterdam The Netherlands
| | - B. J. Vlieg-Boerstra
- Department of Pediatric Respiratory Medicine and Allergy; Emma Children's Hospital; Academic Medical Center; University of Amsterdam; Amsterdam the Netherlands
| | - A. Sheikh
- Allergy & Respiratory Research Group; Center for Population Health Sciences; The University of Edinburgh; Edinburgh UK
- Division of General Internal Medicine and Primary Care Brigham and Women's Hospital/Harvard Medical School; Boston, MA USA
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Panesar SS, Javad S, de Silva D, Nwaru BI, Hickstein L, Muraro A, Roberts G, Worm M, Bilò MB, Cardona V, Dubois AEJ, Dunn Galvin A, Eigenmann P, Fernandez-Rivas M, Halken S, Lack G, Niggemann B, Santos AF, Vlieg-Boerstra BJ, Zolkipli ZQ, Sheikh A. The epidemiology of anaphylaxis in Europe: a systematic review. Allergy 2013; 68:1353-61. [PMID: 24117770 DOI: 10.1111/all.12272] [Citation(s) in RCA: 225] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND Anaphylaxis is an acute, potentially fatal, multi-organ system, allergic reaction caused by the release of chemical mediators from mast cells and basophils. Uncertainty exists around epidemiological measures of incidence and prevalence, risk factors, risk of recurrence, and death due to anaphylaxis. This systematic review aimed to (1) understand and describe the epidemiology of anaphylaxis and (2) describe how these characteristics vary by person, place, and time. METHODS Using a highly sensitive search strategy, we identified systematic reviews of epidemiological studies, descriptive and analytical epidemiological investigations, and studies involving analysis of routine data. RESULTS Our searches identified a total of 5,843 potentially eligible studies, of which 49 satisfied our inclusion criteria. Of these, three were suitable for pooled estimates of prevalence. The incidence rates for all-cause anaphylaxis ranged from 1.5 to 7.9 per 100,000 person-years. These data indicated that an estimated 0.3% (95% CI 0.1-0.5) of the population experience anaphylaxis at some point in their lives. Food, drugs, stinging insects, and latex were the most commonly identified triggers. CONCLUSIONS Anaphylaxis is a common problem, affecting an estimated 1 in 300 of the European population at some time in their lives. Future research needs to focus on better understanding of the trends across Europe and identifying those most likely to experience fatal reactions.
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Affiliation(s)
- S. S. Panesar
- Allergy & Respiratory Research Group; Center for Population Health Sciences; The University of Edinburgh; Edinburgh UK
| | - S. Javad
- School of Public Health; Imperial College; London UK
| | | | - B. I. Nwaru
- School of Health Sciences; University of Tampere; Tampere Finland
| | - L. Hickstein
- Biometry and Epidemiology; Institute for Medical Informatics; University of Munich; Munich Germany
| | - A. Muraro
- Department of Pediatrics; Center for Food Allergy Diagnosis and Treatment; Veneto Region; University of Padua; Padua Italy
| | - G. Roberts
- David Hide Asthma and Allergy Research Centre; St Mary's Hospital; Newport; Isle of Wight UK
- NIHR Southampton Respiratory Biomedical Research Unit; University Hospital Southampton NHS Foundation Trust; Southampton UK
- Faculty of Medicine; Human Development and Health and Clinical Experimental Sciences Academic Units; University of Southampton; Southampton UK
| | - M. Worm
- Allergy-Center-Charité; Department of Dermatology and Allergy; Charité Universitätsmedizin Berlin; Berlin Germany
| | - M. B. Bilò
- Allergy Unit; Department Internal Medicine; University Hospital; Ospedali Riuniti; Ancona Italy
| | - V. Cardona
- Allergy Section; Department of Internal Medicine; Hospital Universitari Vall d'Hebron; Barcelona Spain
| | - A. E. J. Dubois
- Department of Pediatric Pulmonology and Pediatric Allergy; University of Groningen; University Medical Center Groningen; GRIAC Research Institute; Groningen the Netherlands
| | - A. Dunn Galvin
- Department of Paediatrics and Child Health; University College; Cork Ireland
| | - P. Eigenmann
- University Hospitals of Geneva; Geneva Switzerland
| | - M. Fernandez-Rivas
- Department of Allergy; Hospital Clinico San Carlos; IdISSC; Madrid Spain
| | - S. Halken
- Hans Christian Andersen Children's Hospital; Odense University Hospital; Odense Denmark
| | - G. Lack
- MRC & Asthma UK Centre in Allergic Mechanisms of Asthma; London UK
| | - B. Niggemann
- Allergy Center Charité; University Hospital Charité; Berlin Germany
| | - A. F. Santos
- Department of Pediatric Allergy; Division of Asthma; Allergy & Lung Biology; King's College; London UK
- MRC & Asthma UK Centre in Allergic Mechanisms of Asthma; London UK
- Department of Immunoallergology; Coimbra University Hospital; Coimbra Portugal
| | - B. J. Vlieg-Boerstra
- Department of Pediatric Respiratory Medicine and Allergy; Emma Children's Hospital; Academic Medical Center; University of Amsterdam; Amsterdam the Netherlands
| | - Z. Q. Zolkipli
- NIHR Southampton Respiratory Biomedical Research Unit; University Hospital Southampton NHS Foundation Trust; Southampton UK
- Faculty of Medicine; Human Development and Health and Clinical Experimental Sciences Academic Units; University of Southampton; Southampton UK
| | - A. Sheikh
- Allergy & Respiratory Research Group; Center for Population Health Sciences; The University of Edinburgh; Edinburgh UK
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital/Harvard Medical School; Boston MA USA
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Nwaru BI, Panesar SS, Hickstein L, Rader T, Werfel T, Muraro A, Hoffmann-Sommergruber K, Roberts G, Sheikh A. The epidemiology of food allergy in Europe: protocol for a systematic review. Clin Transl Allergy 2013; 3:13. [PMID: 23547766 PMCID: PMC3762068 DOI: 10.1186/2045-7022-3-13] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Accepted: 03/23/2013] [Indexed: 11/18/2022] Open
Abstract
Background The European Academy of Allergy and Clinical Immunology is in the process of
developing its Guideline for Food Allergy and Anaphylaxis, and this protocol
of a systematic review is one of seven inter-linked evidence syntheses that
are being undertaken in order to provide a state-of-the-art synopsis of the
current evidence base in relation to epidemiology, prevention, diagnosis and
clinical management and impact on quality of life, which will be used to
inform the formulation of clinical recommendations. The aims of the systematic review will be to understand and describe the
epidemiology of food allergy, i.e. frequency, risk factors and outcomes of
patients suffering from food allergy, and to describe how these
characteristics vary by person, place and time. Methods A highly sensitive search strategy has been developed to retrieve articles
that have investigated the various aspects of the epidemiology of food
allergy. The search will be implemented by combining the concepts of food
allergy and its epidemiology from electronic bibliographic databases. Discussion This systematic review will provide the most up to date estimates of the
frequency of food allergy in Europe. We will attempt to break these down by
age and geographical region in Europe. Our analysis will take into account
the suitability of the study design and the respective study biases that
could affect exposure and outcome. We will examine the different methods to
diagnose food allergy and the associated measures of occurrence.
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Affiliation(s)
- Bright I Nwaru
- University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK.
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Panesar SS, Nwaru BI, Hickstein L, Rader T, Hamadah H, Ali DFI, Patel B, Muraro A, Roberts G, Worm M, Sheikh A. The epidemiology of anaphylaxis in Europe: protocol for a systematic review. Clin Transl Allergy 2013; 3:9. [PMID: 23537345 PMCID: PMC3685580 DOI: 10.1186/2045-7022-3-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Accepted: 03/23/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The European Academy of Allergy and Clinical Immunology is in the process of developing its Guideline for Food Allergy and Anaphylaxis, and this systematic review is one of seven inter-linked evidence syntheses that are being undertaken in order to provide a state-of-the-art synopsis of the current evidence base in relation to epidemiology, prevention, diagnosis and clinical management and impact on quality of life, which will be used to inform clinical recommendations.The aims of this systematic review will be to understand and describe the epidemiology of anaphylaxis, i.e. frequency, risk factors and outcomes of anaphylaxis, and describe how these characteristics vary by person, place and time. METHODS A highly sensitive search strategy has been designed to retrieve all articles combining the concepts of anaphylaxis and epidemiology from electronic bibliographic databases. DISCUSSION This review will aim to provide some estimates of the incidence and prevalence of anaphylaxis in Europe. The occurrence of anaphylaxis can have a profound effect on the quality of life of the sufferer and their family. Estimates of disease frequency will help us to ascertain the burden of anaphylaxis and provide useful comparators for management strategies.
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Affiliation(s)
| | - Bright I Nwaru
- University of Tampere, Kalevantie 4, Tampere, FI-33014, Finland
| | - Lennart Hickstein
- Ludwig-Maximilian-University, Leopoldstr. 3 /018a 80802, Munich, Germany
| | - Tamara Rader
- University of Ottawa, 75 Laurier Avenue East, Ottawa, ON, K1N 6N5, Canada
| | - Hala Hamadah
- St. George’s University, Cranmer Terrace, London, SW17 0RE, UK
| | | | - Bhavesh Patel
- Open University, Walton Hall, Milton Keynes, Buckingahmshire, MK7 6AA, UK
| | - Antonella Muraro
- Padua General University Hospital, Via Giustiniani 3, Padua, 35128, Italy
| | - Graham Roberts
- Faculty of Medicine, University of Southampton, Southampton, SO171BJ, UK
| | - Margitta Worm
- Charité University Charitestraße 1, Berlin, 10117, Germany
| | - Aziz Sheikh
- Centre for Population Health Sciences, The University of Edinburgh Medical School, Doorway 3, Teviot Place, Edinburgh, EH8 9AG, UK
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