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Koltai M, Moyes J, Nyawanda B, Nyiro J, Munywoki PK, Tempia S, Li X, Antillon M, Bilcke J, Flasche S, Beutels P, Nokes DJ, Cohen C, Jit M. Estimating the cost-effectiveness of maternal vaccination and monoclonal antibodies for respiratory syncytial virus in Kenya and South Africa. BMC Med 2023; 21:120. [PMID: 37004062 PMCID: PMC10064962 DOI: 10.1186/s12916-023-02806-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 02/22/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) causes a substantial burden of acute lower respiratory infection in children under 5 years, particularly in low- and middle-income countries (LMICs). Maternal vaccine (MV) and next-generation monoclonal antibody (mAb) candidates have been shown to reduce RSV disease in infants in phase 3 clinical trials. The cost-effectiveness of these biologics has been estimated using disease burden data from global meta-analyses, but these are sensitive to the detailed age breakdown of paediatric RSV disease, for which there have previously been limited data. METHODS We use original hospital-based incidence data from South Africa (ZAF) and Kenya (KEN) collected between 2010 and 2018 of RSV-associated acute respiratory infection (ARI), influenza-like illness (ILI), and severe acute respiratory infection (SARI) as well as deaths with monthly age-stratification, supplemented with data on healthcare-seeking behaviour and costs to the healthcare system and households. We estimated the incremental cost per DALY averted (incremental cost-effectiveness ratio or ICER) of public health interventions by MV or mAb for a plausible range of prices (5-50 USD for MV, 10-125 USD for mAb), using an adjusted version of a previously published health economic model of RSV immunisation. RESULTS Our data show higher disease incidence for infants younger than 6 months of age in the case of Kenya and South Africa than suggested by earlier projections from community incidence-based meta-analyses of LMIC data. Since MV and mAb provide protection for these youngest age groups, this leads to a substantially larger reduction of disease burden and, therefore, more favourable cost-effectiveness of both interventions in both countries. Using the latest efficacy data and inferred coverage levels based on antenatal care (ANC-3) coverage (KEN: 61.7%, ZAF: 75.2%), our median estimate of the reduction in RSV-associated deaths in children under 5 years in Kenya is 10.5% (95% CI: 7.9, 13.3) for MV and 13.5% (10.7, 16.4) for mAb, while in South Africa, it is 27.4% (21.6, 32.3) and 37.9% (32.3, 43.0), respectively. Starting from a dose price of 5 USD, in Kenya, net cost (for the healthcare system) per (undiscounted) DALY averted for MV is 179 (126, 267) USD, rising to 1512 (1166, 2070) USD at 30 USD per dose; for mAb, it is 684 (543, 895) USD at 20 USD per dose and 1496 (1203, 1934) USD at 40 USD per dose. In South Africa, a MV at 5 USD per dose would be net cost-saving for the healthcare system and net cost per DALY averted is still below the ZAF's GDP per capita at 40 USD dose price (median: 2350, 95% CI: 1720, 3346). For mAb in ZAF, net cost per DALY averted is 247 (46, 510) USD at 20 USD per dose, rising to 2028 (1565, 2638) USD at 50 USD per dose and to 6481 (5364, 7959) USD at 125 USD per dose. CONCLUSIONS Incorporation of new data indicating the disease burden is highly concentrated in the first 6 months of life in two African settings suggests that interventions against RSV disease may be more cost-effective than previously estimated.
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Affiliation(s)
- Mihaly Koltai
- Department for Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK.
| | - Jocelyn Moyes
- Centre for Respiratory Disease and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Bryan Nyawanda
- Kenya Medical Research Institute (KEMRI) - Center for Global Health Research, Kisumu, Kenya
| | - Joyce Nyiro
- KEMRI-Wellcome Trust Research Programme, KEMRI Centre for Geographical Medicine Research-Coast, Kilifi, Kenya
| | - Patrick K Munywoki
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Stefano Tempia
- Centre for Respiratory Disease and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Xiao Li
- Centre for Health Economic Research and Modelling Infectious Diseases (CHERMID), Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Marina Antillon
- Centre for Health Economic Research and Modelling Infectious Diseases (CHERMID), Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Joke Bilcke
- Centre for Health Economic Research and Modelling Infectious Diseases (CHERMID), Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Stefan Flasche
- Department for Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Philippe Beutels
- Centre for Health Economic Research and Modelling Infectious Diseases (CHERMID), Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - D James Nokes
- KEMRI-Wellcome Trust Research Programme, KEMRI Centre for Geographical Medicine Research-Coast, Kilifi, Kenya
- School of Life Sciences, University of Warwick, Coventry, UK
| | - Cheryl Cohen
- Centre for Respiratory Disease and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mark Jit
- Department for Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK
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Haussleiter IS, Lehmann I, Ueberberg B, Heinz J, Zielasek J, Gouzoulis-Mayfrank E, Juckel G. Homelessness among psychiatric inpatients in North Rhine-Westphalia: a retrospective routine data analysis. BMC Psychiatry 2022; 22:132. [PMID: 35183140 PMCID: PMC8857834 DOI: 10.1186/s12888-022-03786-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 02/08/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Within the last five years the number of homeless persons in Germany has more than doubled, with many suffering from mental illnesses that require treatment. Whether the mental illness itself led to losing shelter or whether the state of being homeless increased the likelihood of developing symptoms of a mental disorder remains unclear. The current study assessed the interaction of homelessness and mental illness from a care provider perspective. METHODS We conducted a retrospective analysis of inpatient routine data from 20 psychiatric hospitals in North Rhine-Westphalia (NRW), Germany, over a period of four years (N = 366,767 inpatient treatment cases). Patients were considered "homeless" if they had no fixed unique address. RESULTS About 2.4% of the analyzed cohort was classified as homeless, with increasing tendency over the study period (+14% from 2016 to 2019). The percentage of homeless patients varied broadly between the hospitals (0.2-6.3%). Homeless patients were more often male and on average eight years younger than patients with a fixed address. Homeless patients experienced more involuntary measures (admission and restraint), had a shorter course of treatment and were more often discharged within one day. Every second homeless case was diagnosed with a substance use disorder and every third homeless case with a psychotic disorder, whereas affective disorders were diagnosed less frequently in this group. Psychiatric comorbidity occurred more often in homeless patients whereas somatic diseases did not. CONCLUSIONS Multiple patient-related sociodemographic and local factors are associated with homelessness of psychiatric inpatients. In addition, clinical factors differ between homeless and non-homeless patients, pointing to more severe mental illness and treatment complications (e.g., coercive measures) in homeless persons. Thus, homelessness of psychiatric inpatients can imply special challenges that need to be considered by healthcare providers and politicians, with the goal of optimizing mental and social care and the mental health outcomes of homeless persons.
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Affiliation(s)
- Ida Sibylle Haussleiter
- LWL Research Institute for Mental Health, Ruhr University Bochum, LWL University Hospital, Bochum, Germany. .,Department of Psychiatry, Ruhr University Bochum, LWL University Hospital, Alexandrinenstrasse 1, 44791, Bochum, Germany.
| | - Isabell Lehmann
- LVR Institute for Healthcare Research, LVR Institute for Research and Education, Wilhelm-Griesinger-Strasse 23, 51109 Cologne (Köln), Germany
| | - Bianca Ueberberg
- grid.5570.70000 0004 0490 981XLWL Research Institute for Mental Health, Ruhr University Bochum, LWL University Hospital, Bochum, Germany
| | - Josephine Heinz
- LVR Institute for Healthcare Research, LVR Institute for Research and Education, Wilhelm-Griesinger-Strasse 23, 51109 Cologne (Köln), Germany
| | - Jürgen Zielasek
- LVR Institute for Healthcare Research, LVR Institute for Research and Education, Wilhelm-Griesinger-Strasse 23, 51109 Cologne (Köln), Germany ,grid.411327.20000 0001 2176 9917Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Euphrosyne Gouzoulis-Mayfrank
- LVR Institute for Healthcare Research, LVR Institute for Research and Education, Wilhelm-Griesinger-Strasse 23, 51109 Cologne (Köln), Germany ,LVR Clinics Cologne, Cologne, Germany
| | - Georg Juckel
- grid.5570.70000 0004 0490 981XLWL Research Institute for Mental Health, Ruhr University Bochum, LWL University Hospital, Bochum, Germany ,grid.5570.70000 0004 0490 981XDepartment of Psychiatry, Ruhr University Bochum, LWL University Hospital, Alexandrinenstrasse 1, 44791 Bochum, Germany
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Santaularia NJ, Ramirez MR, Osypuk TL, Mason SM. Measuring the hidden burden of violence: use of explicit and proxy codes in Minnesota injury hospitalizations, 2004-2014. Inj Epidemiol 2021; 8:63. [PMID: 34724989 PMCID: PMC8559360 DOI: 10.1186/s40621-021-00354-6] [Citation(s) in RCA: 2] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 09/30/2021] [Indexed: 01/07/2023] Open
Abstract
PURPOSE Commonly-used violence surveillance systems are biased towards certain populations due to overreporting or over-scrutinized. Hospital discharge data may offer a more representative view of violence, through use of proxy codes, i.e. diagnosis of injuries correlated with violence. The goals of this paper are to compare the trends in violence in Minnesota, and associations of county-level demographic characteristics with violence rates, measured through explicitly diagnosed violence and proxy codes. It is an exploration of how certain sub-populations are overrepresented in traditional surveillance systems. METHODS Using Minnesota hospital discharge data linked with census data from 2004 to 2014, this study examined the distribution and time trends of explicit, proxy, and combined (proxy and explicit) codes for child abuse, intimate partner violence (IPV), and elder abuse. The associations between county-level risk factors (e.g., poverty) and county violence rates were estimated using negative binomial regression models with generalized estimation equations to account for clustering over time. RESULTS The main finding was that the patterns of county-level violence differed depending on whether one used explicit or proxy codes. In particular, explicit codes suggested that child abuse and IPV trends were flat or decreased slightly from 2004 to 2014, while proxy codes suggested the opposite. Elder abuse increased during this timeframe for both explicit and proxy codes, but more dramatically when using proxy codes. In regard to the associations between county level characteristics and each violence subtype, previously identified county-level risk factors were more strongly related to explicitly-identified violence than to proxy-identified violence. Given the larger number of proxy-identified cases as compared with explicit-identified violence cases, the trends and associations of combined codes align more closely with proxy codes, especially for elder abuse and IPV. CONCLUSIONS Violence surveillance utilizing hospital discharge data, and particularly proxy codes, may add important information that traditional surveillance misses. Most importantly, explicit and proxy codes indicate different associations with county sociodemographic characteristics. Future research should examine hospital discharge data for violence identification to validate proxy codes that can be utilized to help to identify the hidden burden of violence.
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Affiliation(s)
- N. Jeanie Santaularia
- grid.17635.360000000419368657Division of Epidemiology and Community Health, University of Minnesota School of Public Health, 300 West Bank Office Building, 1300 S. 2nd St., Minneapolis, MN 55454 USA ,grid.17635.360000000419368657Minnesota Population Center, University of Minnesota, 225 19th Ave S #50th, Minneapolis, MN 55455 USA
| | - Marizen R. Ramirez
- grid.17635.360000000419368657Division of Environmental Health Sciences, University of Minnesota School of Public Health, 1260 Mayo Building, MMC 807, 420 Delaware St. SE, Minneapolis, MN 55455 USA
| | - Theresa L. Osypuk
- grid.17635.360000000419368657Division of Epidemiology and Community Health, University of Minnesota School of Public Health, 300 West Bank Office Building, 1300 S. 2nd St., Minneapolis, MN 55454 USA ,grid.17635.360000000419368657Minnesota Population Center, University of Minnesota, 225 19th Ave S #50th, Minneapolis, MN 55455 USA
| | - Susan M. Mason
- grid.17635.360000000419368657Division of Epidemiology and Community Health, University of Minnesota School of Public Health, 300 West Bank Office Building, 1300 S. 2nd St., Minneapolis, MN 55454 USA
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Rens E, Michielsen J, Dom G, Remmen R, Van den Broeck K. iPSYcare: the development of a linked electronic medical records database to study and optimize psychiatric care in Antwerp. BMC Res Notes 2021; 14:377. [PMID: 34565465 PMCID: PMC8474849 DOI: 10.1186/s13104-021-05791-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/15/2021] [Indexed: 11/29/2022] Open
Abstract
Objective The study of care trajectories of psychiatric patients across hospitals was previously not possible in Belgium as each hospital stores its data autonomously, and government-related registrations do not contain a unique identifier or are incomplete. A new longitudinal database called iPSYcare (Improved Psychiatric Care and Research) was therefore constructed in 2021, and links the electronic medical records of patients in psychiatric units of eight hospitals in the Antwerp Province, Belgium. The database provides a wide range of information on patients, care trajectories and delivered care in the region. In a first phase, the database will only contain information about adult patients who were admitted to a hospital or treated by an outreach team and who gave explicit consent. In the future, the database may be expanded to other regions and additional data on outpatient care may be added. Results IPSYcare is a close collaboration between the University of Antwerp and hospitals in the province of Antwerp. This paper describes the development of the database, how privacy and ethical issues will be handled, and how the governance of the database will be organized.
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Affiliation(s)
- Eva Rens
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium. .,Family Medicine and Population Health (FAMPOP), University of Antwerp, Antwerp, Belgium.
| | | | - Geert Dom
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium
| | - Roy Remmen
- Family Medicine and Population Health (FAMPOP), University of Antwerp, Antwerp, Belgium
| | - Kris Van den Broeck
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium.,Family Medicine and Population Health (FAMPOP), University of Antwerp, Antwerp, Belgium
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Deschepper M, Eeckloo K, Malfait S, Benoit D, Callens S, Vansteelandt S. Prediction of hospital bed capacity during the COVID- 19 pandemic. BMC Health Serv Res 2021; 21:468. [PMID: 34006279 PMCID: PMC8128685 DOI: 10.1186/s12913-021-06492-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 05/06/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Prediction of the necessary capacity of beds by ward type (e.g. ICU) is essential for planning purposes during epidemics, such as the COVID- 19 pandemic. The COVID- 19 taskforce within the Ghent University hospital made use of ten-day forecasts on the required number of beds for COVID- 19 patients across different wards. METHODS The planning tool combined a Poisson model for the number of newly admitted patients on each day with a multistate model for the transitions of admitted patients to the different wards, discharge or death. These models were used to simulate the required capacity of beds by ward type over the next 10 days, along with worst-case and best-case bounds. RESULTS Overall, the models resulted in good predictions of the required number of beds across different hospital wards. Short-term predictions were especially accurate as these are less sensitive to sudden changes in number of beds on a given ward (e.g. due to referrals). Code snippets and details on the set-up are provided to guide the reader to apply the planning tool on one's own hospital data. CONCLUSIONS We were able to achieve a fast setup of a planning tool useful within the COVID- 19 pandemic, with a fair prediction on the needed capacity by ward type. This methodology can also be applied for other epidemics.
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Affiliation(s)
- Mieke Deschepper
- Strategic Policy Cell at Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium.
| | - Kristof Eeckloo
- Strategic Policy Cell at Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
- Department of Public Health and Primary Care, Ghent University, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Simon Malfait
- Strategic Policy Cell at Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Dominique Benoit
- Department of Intensive Care Medicine, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Steven Callens
- Department of General Internal Medicine, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Stijn Vansteelandt
- Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Krijgslaan 281 S9, 9000, Ghent, Belgium
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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Petit JM, Goueslard K, Chauvet-Gelinier JC, Bouillet B, Vergès B, Jollant F, Quantin C. Association between hospital admission for ketoacidosis and subsequent suicide attempt in young adults with type 1 diabetes. Diabetologia 2020; 63:1745-1752. [PMID: 32642808 DOI: 10.1007/s00125-020-05206-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 02/20/2020] [Accepted: 05/14/2020] [Indexed: 01/22/2023]
Abstract
AIMS/HYPOTHESIS The aim of this study was to examine the associations between hospitalisation for diabetic ketoacidosis and subsequent hospitalisation for suicide attempt in young adults with type 1 diabetes. METHODS This nationwide historical cohort study included hospital data on all young people hospitalised in France for type 1 diabetes in 2008. Epidemiological follow-up focused on hospitalisations (medical and psychiatric hospital data) from the index hospitalisation to 2017. Survival analyses were done using a Cox proportional hazards regression model to explore the association between hospitalisation for ketoacidosis and subsequent hospitalisation for a suicide attempt. RESULTS In 2008, 16,431 people aged 18-35 years had a hospitalisation mentioning type 1 diabetes. Among them, 1539 (9.4%) had at least one hospitalisation for ketoacidosis between 2008 and 2010. At 9 years, 7.2% of the group hospitalised for ketoacidosis had been hospitalised for a suicide attempt vs only 2.5% in the group not hospitalised for ketoacidosis. The association between hospitalisation for ketoacidosis and suicide attempt decreased over time and was no longer significant after 5 years. CONCLUSIONS/INTERPRETATION We found that young adults admitted to hospital for diabetic ketoacidosis have an increased risk of being admitted to hospital for a subsequent suicide attempt. The risk of a suicide attempt was the highest in the 12 months following the ketoacidosis episode. Our findings support the recommendation that screening for depression and suicide risk should be part of the routine clinical assessment of individuals with type 1 diabetes and ketoacidosis.
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Affiliation(s)
- Jean-Michel Petit
- Inserm Unit, LNC-UMR 1231, University of Burgundy, Dijon, France.
- Department of Endocrinology, Diabetes and Metabolic Disorders, Dijon University Hospital, 14 rue Gaffarel, BP 77908, 21079, Dijon Cedex, France.
| | - Karine Goueslard
- Biostatistics and Bioinformatics (DIM), Dijon University Hospital, Dijon, France
- University of Burgundy and Franche-Comte, Dijon, France, Inserm, CIC 1432, Dijon, France
- Dijon University Hospital, Clinical Investigation Center, Clinical Epidemiology/Clinical Trials Unit, Dijon, France
| | | | - Benjamin Bouillet
- Inserm Unit, LNC-UMR 1231, University of Burgundy, Dijon, France
- Department of Endocrinology, Diabetes and Metabolic Disorders, Dijon University Hospital, 14 rue Gaffarel, BP 77908, 21079, Dijon Cedex, France
| | - Bruno Vergès
- Inserm Unit, LNC-UMR 1231, University of Burgundy, Dijon, France
- Department of Endocrinology, Diabetes and Metabolic Disorders, Dijon University Hospital, 14 rue Gaffarel, BP 77908, 21079, Dijon Cedex, France
| | - Fabrice Jollant
- Paris-Descartes University and Sainte-Anne Hospital, Paris, France
| | - Catherine Quantin
- Biostatistics and Bioinformatics (DIM), Dijon University Hospital, Dijon, France
- University of Burgundy and Franche-Comte, Dijon, France, Inserm, CIC 1432, Dijon, France
- Dijon University Hospital, Clinical Investigation Center, Clinical Epidemiology/Clinical Trials Unit, Dijon, France
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Hobbs JL, Whelan M, Winter AL, Murti M, Hohenadel K. Getting a grippe on severity: a retrospective comparison of influenza-related hospitalizations and deaths captured in reportable disease and administrative data sources in Ontario, Canada. BMC Public Health 2019; 19:567. [PMID: 31088426 PMCID: PMC6518682 DOI: 10.1186/s12889-019-6924-9] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 04/30/2019] [Indexed: 11/30/2022] Open
Abstract
Background Since 2009, in Ontario, reportable disease surveillance data has been used for timely in-season estimates of influenza severity (i.e., hospitalizations and deaths). Due to changes in reporting requirements influenza reporting no longer captures these indicators of severity, necessitating exploration of other potential sources of data. The purpose of this study was to complete a retrospective analysis to assess the comparability of influenza-related hospitalizations and deaths captured in the Ontario reportable disease information system to those captured in Ontario’s hospital-based discharge database. Methods Hospitalizations and deaths of laboratory-confirmed influenza cases reported during the 2010–11 to 2013–14 influenza seasons were analyzed. Information on hospitalizations and deaths for laboratory-confirmed influenza cases were obtained from two databases; the integrated Public Health Information System, which is the provincial reportable disease database, and the Discharge Abstract Database, which contains information on all in-patient hospital visits using the International Classification of Diseases, 10th Revision, Canada (ICD-10-CA) coding standards. Analyses were completed using the ICD-10 J09 and J10 diagnosis codes as an indicator for laboratory-confirmed influenza, and a secondary analysis included the physician-diagnosed influenza J11 diagnosis code. Results For each season, reported hospitalizations for laboratory-confirmed influenza cases in the reportable disease data were higher compared to hospitalizations with J09 and J10 diagnoses codes, but lower when J11 codes were included. The number of deaths was higher in the reportable disease data, whether or not J11 codes were included. For all four seasons, the weekly trends in the number of hospitalizations and deaths were similar for the reportable disease and hospital data (with and without J11), with seasonal peaks occurring during the same week or within 1 week of each other. Conclusion In our retrospective analyses we found that hospital data provided a reliable estimate of the trends of influenza-related hospitalizations and deaths compared to the reportable disease data for the 2010–11 to 2013–14 influenza seasons in Ontario, but may under-estimate the total seasonal number of deaths. Hospital data could be used for retrospective end-of-season assessments of severity, but due to delays in data availability are unlikely to be timely estimates of severity during in-season surveillance.
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Affiliation(s)
- J Leigh Hobbs
- Public Health Ontario, 480 University Avenue, Suite 300, Toronto, Ontario, M5G 1V2, Canada.
| | - Michael Whelan
- Public Health Ontario, 480 University Avenue, Suite 300, Toronto, Ontario, M5G 1V2, Canada
| | - Anne-Luise Winter
- Public Health Ontario, 480 University Avenue, Suite 300, Toronto, Ontario, M5G 1V2, Canada
| | - Michelle Murti
- Public Health Ontario, 480 University Avenue, Suite 300, Toronto, Ontario, M5G 1V2, Canada.,Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, M5T 3M7, Canada
| | - Karin Hohenadel
- Public Health Ontario, 480 University Avenue, Suite 300, Toronto, Ontario, M5G 1V2, Canada
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Abstract
The predictive value of factor V Leiden and the G20210A prothrombin mutation regarding recurrent venous thromboembolism (VTE) is limited and does not influence subsequent patient management. Systematic testing for such genetic thrombophilia should be avoided, but to which extent such testing is practiced in a Swiss Hospital is unknown. To examine the current practice of factor V Leiden and/or G20210A prothrombin mutation testing in a University Hospital, and to assess the clinical consequences of testing on patients. 1388 adult patients (48.7% women) with a main diagnosis of VTE hospitalized at the Lausanne university hospital between January 2013 and December 2015. FV Leiden and/or prothrombin G20210A mutation testing was performed in 61 (4.4%) patients with VTE, an average of 20 patients/year. On multivariable analysis, age < 65 years [odds ratio and (95% confidence interval) 5.91 (3.12-11.19)], being admitted in a medical ward [5.71 (2.02-16.16)] and staying in the intensive care unit [0.34 (0.12-0.97)] were associated with thrombophilia testing. No differences were found between patients with and without testing regarding in-hospital mortality [OR and 95% CI for tested vs. non-tested: 0.23 (0.03-1.73), p = 0.153] and length of stay (multivariable adjusted average ± standard error: 16.9 ± 3.3 vs. 20.0 ± 0.7 days for tested and non-tested patients, respectively, p = 0.875). Thrombophilia testing in hospitalized patients with a main diagnosis of VTE is seldom performed. FV Leiden and/or prothrombin G20210A mutation should not be routinely assessed in patients with acute VTE.
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Affiliation(s)
- Daryoush Samim
- Department of Medicine, Service of Internal Medicine, Lausanne University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
| | - Pedro Marques-Vidal
- Department of Medicine, Service of Internal Medicine, Lausanne University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Lorenzo Alberio
- Department of Oncology, Haematology, Lausanne University Hospital, Lausanne, Switzerland
| | - Gérard Waeber
- Department of Medicine, Service of Internal Medicine, Lausanne University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Marie Méan
- Department of Medicine, Service of Internal Medicine, Lausanne University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland
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Tran HT, Nguyen HP, Walker SM, Hill PS, Rao C. Validation of verbal autopsy methods using hospital medical records: a case study in Vietnam. BMC Med Res Methodol 2018; 18:43. [PMID: 29776431 PMCID: PMC5960129 DOI: 10.1186/s12874-018-0497-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 07/26/2017] [Accepted: 04/30/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Information on causes of death (COD) is crucial for measuring the health outcomes of populations and progress towards the Sustainable Development Goals. In many countries such as Vietnam where the civil registration and vital statistics (CRVS) system is dysfunctional, information on vital events will continue to rely on verbal autopsy (VA) methods. This study assesses the validity of VA methods used in Vietnam, and provides recommendations on methods for implementing VA validation studies in Vietnam. METHODS This validation study was conducted on a sample of 670 deaths from a recent VA study in Quang Ninh province. The study covered 116 cases from this sample, which met three inclusion criteria: a) the death occurred within 30 days of discharge after last hospitalisation, and b) medical records (MRs) for the deceased were available from respective hospitals, and c) the medical record mentioned that the patient was terminally ill at discharge. For each death, the underlying cause of death (UCOD) identified from MRs was compared to the UCOD from VA. The validity of VA diagnoses for major causes of death was measured using sensitivity, specificity and positive predictive value (PPV). RESULTS The sensitivity of VA was at least 75% in identifying some leading CODs such as stroke, road traffic accidents and several site-specific cancers. However, sensitivity was less than 50% for other important causes including ischemic heart disease, chronic obstructive pulmonary diseases, and diabetes. Overall, there was 57% agreement between UCOD from VA and MR, which increased to 76% when multiple causes from VA were compared to UCOD from MR. CONCLUSIONS Our findings suggest that VA is a valid method to ascertain UCOD in contexts such as Vietnam. Furthermore, within cultural contexts in which patients prefer to die at home instead of a healthcare facility, using the available MRs as the gold standard may be meaningful to the extent that recall bias from the interval between last hospital discharge and death can be minimized. Therefore, future studies should evaluate validity of MRs as a gold standard for VA studies in contexts similar to the Vietnamese context.
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Affiliation(s)
- Hong Thi Tran
- Faculty of Fundamental Sciences, Hanoi University of Public Health, Hanoi, Vietnam. .,School of Public Health, University of Queensland, Brisbane, Australia.
| | - Hoa Phuong Nguyen
- Family Medicine Department, Hanoi Medical University, Hanoi, Vietnam
| | - Sue M Walker
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia.,National Centre for Health Information Research and Training, Queensland University of Technology, Brisbane, Australia
| | - Peter S Hill
- School of Public Health, University of Queensland, Brisbane, Australia
| | - Chalapati Rao
- Department of Global Health, Research School of Population Health, ANU College of Health and Medicine, Australian National University, Canberra, Australia
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Abstract
BACKGROUND The objective of the study is to analyze procedural and safety outcomes associated with bariatric surgery and describe the characteristics of patients undertaking bariatric procedures in England between April 2006 and March 2012. METHODS This is a retrospective cohort study of all adult patients in England diagnosed with obesity and undergoing bariatric surgery as a primary procedure in NHS-funded sites between April 2006 and March 2012 using data sourced from the Hospital Episode Statistics dataset. Length of stay (LOS), 30-day readmission, and post-surgery complication were analyzed as primary outcomes. Socio-demographic background, provider type, procedure volume, and comorbidities were all analyzed as potential explanatory variables. RESULTS Gastric bypass (GBP, 12,628) was the most utilized procedure, followed by gastric banding (GB, 6872) and sleeve gastrectomy (SG, 3251). The most prevalent comorbidity was type 2 diabetes (23%). Inpatient mortality was low (≤ 0.15%) for all procedure types. LOS and the risks of both post-operative complication and 30-day readmission were significantly lower for GB, relative to those for GBP and SG. Ethnicity, geographical area, surgery type, and volume were all associated with LOS, risk of readmission, and complication. Provider type and deprivation were further associated with LOS while age correlated with readmission only. An increasing comorbidity burden was associated with an increased risk of both readmission and complication. CONCLUSIONS Gastric bypass was the most frequently reported procedure in England across the observation period. While utilization across all procedure types increased between 2007 and 2010, overall uptake of bariatric surgery in England represents only a small proportion of the eligible population. Readmission and complication rates were lower for gastric banding relative to those for either gastric bypass or sleeve gastrectomy. The observed inpatient mortality rate was low across all procedure types.
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Affiliation(s)
- Sun Sun
- Synergus AB, Kevinge Strand 20, 182 57, Stockholm, Sweden.
- Health Outcomes and Economic Evaluation Research Group, Center for Healthcare Ethics, Department of Learning, Information, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
- Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
| | - Oleg Borisenko
- Synergus AB, Kevinge Strand 20, 182 57, Stockholm, Sweden
| | - Tim Spelman
- Synergus AB, Kevinge Strand 20, 182 57, Stockholm, Sweden
- Centre for Population Health, Burnet Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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