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Li S, Raza MMS, Issa S. Agricultural Injury Surveillance in the United States and Canada: A Systematic Literature Review. J Agromedicine 2024; 29:122-135. [PMID: 38251421 DOI: 10.1080/1059924x.2024.2304699] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
INTRODUCTION Agricultural injuries remain a major concern in North America, with a fatal injury rate of 19.5 deaths per 100,000 workers in the United States. Numerous research efforts have sought to compile and analyze records of agricultural-related injuries and fatalities at a national level, utilizing resources, ranging from newspaper clippings and hospital records to Emergency Medical System (EMS) data, death certifications, surveys, and other multiple sources. Despite these extensive efforts, a comprehensive understanding of injury trends over extended time periods and across diverse types of data sources remains elusive, primarily due to the duration of data collection and the focus on specific subsets. METHODS This systematic review, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, consolidates and analyzes agricultural injury surveillance data from 48 eligible papers published between 1985 and 2022 to offer a holistic understanding of trends and challenges. RESULTS These papers, reporting an average of 25,000 injuries each, were analyzed by database source type, injury severity, nature of injury, body part, source of injury, event/exposure, and age. One key finding is that the top source of injury or event/exposure depends on the chosen surveillance system and injury severity, underscoring the need of diverse data sources for a nuanced understanding of agricultural injuries. CONCLUSION This study provides policymakers, researchers, and practitioners with crucial insights to bolster the development and analysis of surveillance systems in agricultural safety. The overarching aim is to address the pressing issue of agricultural injuries, contributing to a safer work environment and ultimately enhancing the overall well-being of individuals engaged in agriculture.
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Affiliation(s)
- Sihan Li
- Department of Agricultural and Biological Engineering, University of Illinois, Urbana, IL, USA
| | | | - Salah Issa
- Department of Agricultural and Biological Engineering, University of Illinois, Urbana, IL, USA
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Giordani B, Burgio A, Grippo F, Barone A, Eugeni E, Baglio G. The Use of ICD-9-CM Coding to Identify COVID-19 Diagnoses and Determine Risk Factors for 30-Day Death Rate in Hospitalized Patients in Italy: Retrospective Study. JMIR Public Health Surveill 2024; 10:e44062. [PMID: 38393763 PMCID: PMC10906716 DOI: 10.2196/44062] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 07/27/2023] [Accepted: 10/31/2023] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND In Italy, it has been difficult to accurately quantify hospital admissions of patients with a COVID-19 diagnosis using the Hospital Information System (HIS), mainly due to the heterogeneity of codes used in the hospital discharge records during different waves of the COVID-19 pandemic. OBJECTIVE The objective of this study was to define a specific combination of codes to identify the COVID-19 hospitalizations within the HIS and to investigate the risk factors associated with mortality due to COVID-19 among patients admitted to Italian hospitals in 2020. METHODS A retrospective study was conducted using the hospital discharge records, provided by more than 1300 public and private Italian hospitals. Inpatient hospitalizations were detected by implementing an algorithm based on specific International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code combinations. Hospitalizations were analyzed by different clinical presentations associated with COVID-19 diagnoses. In addition, 2 multivariable Cox regression models were performed among patients hospitalized "due to COVID-19" from January 1 to December 31, 2020, to investigate potential risk factors associated with 30-day death and the temporal changes over the course of the pandemic; in particular, the 30-day death rates during the first and the second waves were analyzed across 3 main geographical areas (North, Center, and South and Islands) and by discharge wards (ordinary and intensive care). RESULTS We identified a total of 325,810 hospitalizations with COVID-19-related diagnosis codes. Among these, 73.4% (n=239,114) were classified as "due to COVID-19," 14.5% (n=47,416) as "SARS-CoV-2 positive, but not due to COVID-19," and 12.1% (n=39,280) as "suspected COVID-19" hospitalizations. The cohort of patients hospitalized "due to COVID-19" included 205,048 patients, with a median age of 72 years and a higher prevalence of male patients (n=124,181, 60.6%). The overall 30-day death rate among hospitalized patients due to COVID-19 was 9.9 per 1000 person-days. Mortality was lower for women (hazard ratio [HR]=0.83; P<.001) and for patients coming from high migration pressure countries, especially Northern Africans (HR=0.65; P<.001) and Central and Eastern Europeans (HR=0.66; P<.001), compared to patients coming from Italy and high-income countries. In the southern regions and the Islands, mortality was higher compared to the northern regions (HR=1.17; P<.001), especially during the second wave of COVID-19 among patients with a transfer to intensive care units (HR=2.52; P<.001). CONCLUSIONS To our knowledge, the algorithm is the first attempt to define, at a national level, selection criteria for identifying COVID-19 hospitalizations within the HIS. The implemented algorithm will be used to monitor the pandemic over time, and the patients selected in 2020 will be followed up in the next years to assess the long-term effects of COVID-19.
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Affiliation(s)
- Barbara Giordani
- Research, National Outcomes Evaluation Programme (PNE) and International Relations Unit, Italian National Agency for Regional Healthcare Services, Rome, Italy
| | | | | | - Alessandra Barone
- Research, National Outcomes Evaluation Programme (PNE) and International Relations Unit, Italian National Agency for Regional Healthcare Services, Rome, Italy
| | - Erica Eugeni
- Research, National Outcomes Evaluation Programme (PNE) and International Relations Unit, Italian National Agency for Regional Healthcare Services, Rome, Italy
| | - Giovanni Baglio
- Research, National Outcomes Evaluation Programme (PNE) and International Relations Unit, Italian National Agency for Regional Healthcare Services, Rome, Italy
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Burns R, Wyke S, Boukari Y, Katikireddi SV, Zenner D, Campos-Matos I, Harron K, Aldridge RW. Linking migration and hospital data in England: linkage process and evaluation of bias. Int J Popul Data Sci 2024; 9:2181. [PMID: 38476270 PMCID: PMC10929707 DOI: 10.23889/ijpds.v9i1.2181] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024] Open
Abstract
Introduction Difficulties ascertaining migrant status in national data sources such as hospital records have limited large-scale evaluation of migrant healthcare needs in many countries, including England. Linkage of immigration data for migrants and refugees, with National Health Service (NHS) hospital care data enables research into the relationship between migration and health for a large cohort of international migrants. Objectives We aimed to describe the linkage process and compare linkage rates between migrant sub-groups to evaluate for potential bias for data on non-EU migrants and resettled refugees linked to Hospital Episode Statistics (HES) in England. Methods We used stepwise deterministic linkage to match records from migrants and refugees to a unique healthcare identifier indicating interaction with the NHS (linkage stage 1 to NHS Personal Demographic Services, PDS), and then to hospital records (linkage stage 2 to HES). We calculated linkage rates and compared linked and unlinked migrant characteristics for each linkage stage. Results Of the 1,799,307 unique migrant records, 1,134,007 (63%) linked to PDS and 451,689 (25%) linked to at least one hospital record between 01/01/2005 and 23/03/2020. Individuals on work, student, or working holiday visas were less likely to link to a hospital record than those on settlement and dependent visas and refugees. Migrants from the Middle East and North Africa and South Asia were four times more likely to link to at least one hospital record, compared to those from East Asia and the Pacific. Differences in age, sex, visa type, and region of origin between linked and unlinked samples were small to moderate. Conclusion This linked dataset represents a unique opportunity to explore healthcare use in migrants. However, lower linkage rates disproportionately affected individuals on shorter-term visas so future studies of these groups may be more biased as a result. Increasing the quality and completeness of identifiers recorded in administrative data could improve data linkage quality.
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Affiliation(s)
- Rachel Burns
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, 222 Euston Road, London NW1 2DA, United Kingdom
| | - Sacha Wyke
- UK Health Security Agency, 61 Colindale Ave, London NW9 5EQ United Kingdom
| | - Yamina Boukari
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, 222 Euston Road, London NW1 2DA, United Kingdom
| | - Sirinivasa Vittal Katikireddi
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Berkeley Square, 99 Berkeley Street, Glasgow, G3 7HR, United Kingdom
| | - Dominik Zenner
- Global Public Health Unit, Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Yvonne Carter Building, 58 Turner Street, London E1 2AB, United Kingdom
- Infection and Population Health Department, Institute of Global Health, University College London
| | - Ines Campos-Matos
- UK Health Security Agency, 61 Colindale Ave, London NW9 5EQ United Kingdom
- Office for Health Improvement and Disparities, Department of Health and Social Care, 39 Victoria Street, London SW1H 0EU, United Kingdom
| | - Katie Harron
- UCL Great Ormond Street, Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, United Kingdom
| | - Robert W. Aldridge
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, 222 Euston Road, London NW1 2DA, United Kingdom
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Moshaoa MAL, Taunyane K, Hlongwa P. Audit of dental record-keeping at a university dental hospital. Health SA 2023; 28:2442. [PMID: 38223210 PMCID: PMC10784275 DOI: 10.4102/hsag.v28i0.2442] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 09/26/2023] [Indexed: 01/16/2024] Open
Abstract
Background Good record-keeping is fundamental in clinical practice and essential for practising dental practitioners and those in training. Aim This study aimed to evaluate the level of compliance with clinical record-keeping by undergraduate dental students and staff at a university dental hospital. Setting The selected study setting was the Admissions and Emergency section at a university dental hospital. Methods A retrospective, cross-sectional review was undertaken of 257 clinical records. The CRABEL scoring system was used to evaluate 12 variables. The 12 variables included: patient name, patient hospital number, date of examination, patient main complaint, medical history, dental history, proposed treatment, proposed procedure for next visit, patient consent signature, treatment and treatment codes, student name and signature, clinical supervisor name and signature. STATA® 13 was used for descriptive analysis and all tests were conducted at 5% significance level. Results The median CRABEL score was 87 and interquartile range (IQR: 70-92). A CRABEL score of 100 was achieved by the students in the variable patient main complaint, indicating a 100% compliance with this variable. Other variables such as signature of supervisors showed poor compliance. The CRABEL scores showed no statistically significant difference (p = 0.86) between the students and clinical supervisors. Conclusion The overall audit showed that there was poor compliance with record-keeping. Contribution The study highlights the importance of good record keepings so that key information can be accessed for proper diagnosis and treatment of the patient. An electronic filing system presents an alternative manner of documenting medical records.
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Affiliation(s)
- Mpule A L Moshaoa
- Department of Orthodontics, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Keitumetse Taunyane
- Department of Orthodontics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Phumzile Hlongwa
- Department of Orthodontics, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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Storoni S, Verdonk SJE, Zhytnik L, Pals G, Treurniet S, Elting MW, Sakkers RJB, van den Aardweg JG, Eekhoff EMW, Micha D. From Genetics to Clinical Implications: A Study of 675 Dutch Osteogenesis Imperfecta Patients. Biomolecules 2023; 13. [PMID: 36830650 DOI: 10.3390/biom13020281] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/18/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
Osteogenesis imperfecta (OI) is a heritable connective tissue disorder that causes bone fragility due to pathogenic variants in genes responsible for the synthesis of type I collagen. Efforts to classify the high clinical variability in OI led to the Sillence classification. However, this classification only partially takes into account extraskeletal manifestations and the high genetic variability. Little is known about the relation between genetic variants and phenotype as of yet. The aim of the study was to create a clinically relevant genetic stratification of a cohort of 675 Dutch OI patients based on their pathogenic variant types and to provide an overview of their respective medical care demands. The clinical records of 675 OI patients were extracted from the Amsterdam UMC Genome Database and matched with the records from Statistics Netherlands (CBS). The patients were categorized based on their harbored pathogenic variant. The information on hospital admissions, outpatient clinic visits, medication, and diagnosis-treatment combinations (DTCs) was compared between the variant groups. OI patients in the Netherlands appear to have a higher number of DTCs, outpatient clinic visits, and hospital admissions when compared to the general Dutch population. Furthermore, medication usage seems higher in the OI cohort in comparison to the general population. The patients with a COL1A1 or COL1A2 dominant negative missense non-glycine substitution appear to have a lower health care need compared to the other groups, and even lower than patients with COL1A1 or COL1A2 haploinsufficiency. It would be useful to include the variant type in addition to the Sillence classification when categorizing a patient's phenotype.
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Stubbs JM, Assareh H, Achat HM, Greenaway S, Muruganantham P. Verification of administrative data to measure palliative care at terminal hospital stays. HEALTH INF MANAG J 2023; 52:28-36. [PMID: 33325250 DOI: 10.1177/1833358320968572] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 01/19/2023]
Abstract
BACKGROUND Administrative data and clinician documentation have not been directly compared for reporting palliative care, despite concerns about under-reporting. OBJECTIVE The aim of this study was to verify the use of routinely collected administrative data for reporting in-hospital palliation and to examine factors associated with coded palliative care in hospital administrative data. METHOD Hospital administrative data and inpatient palliative care activity documented in medical records were compared for patients dying in hospital between 1 July 2017 and 31 December 2017. Coding of palliative care in administrative data is based on hospital care type coded as "palliative care" and/or assignment of the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM) palliative care diagnosis code Z51.5. Medical records were searched for specified keywords, which, read in context, indicated a palliative approach to care. The list of keywords (palliative, end of life, comfort care, cease observations, crisis medications, comfort medications, syringe driver, pain or symptom management, no cardiopulmonary resuscitation, advance medical plan/resuscitation plan, deteriorating, agitation, restless and delirium) was developed in consultation with seven local clinicians specialising in palliative care or geriatric medicine. RESULTS Of the 576 patients who died in hospital, 246 were coded as having received palliative care, either solely by the ICD-10-AM diagnosis code Z51.5 (42%) or in combination with a "palliative care" care type (58%). Just over one-third of dying patients had a palliative care specialist involved in their hospital care. Involvement of a palliative care specialist and a cancer diagnosis substantially increased the odds of a Z51.5 code (odds ratio = 11 and 4, respectively). The majority of patients with a "syringe driver" or identified as being at the "end of life" were assigned a Z51.5 code (73.5% and 70.5%, respectively), compared to 53.8% and 54.7%, respectively, for "palliative" or "comfort care." For each keyword indicating a palliative approach to care, the Z51.5 code was more likely to be assigned if the patient had specialist palliative care input or if they had cancer. CONCLUSION Our results suggest administrative data under-represented in-hospital palliative care, at least partly due to medical record documentation that failed to meet ICD-10-AM coding criteria. Collaboration between clinicians and coders can enhance the quality of records and, consequently, administrative data.
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Hu YJ, Fedyukova A, Wang J, Said JM, Thomas N, Noble E, Cheong JLY, Karanatsios B, Goldfeld S, Wake M. Improving Cohort-Hospital Matching Accuracy through Standardization and Validation of Participant Identifiable Information. Children (Basel) 2022; 9. [PMID: 36553359 DOI: 10.3390/children9121916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 11/25/2022] [Accepted: 12/03/2022] [Indexed: 12/12/2022]
Abstract
Linking very large, consented birth cohorts to birthing hospitals clinical data could elucidate the lifecourse outcomes of health care and exposures during the pregnancy, birth and newborn periods. Unfortunately, cohort personally identifiable information (PII) often does not include unique identifier numbers, presenting matching challenges. To develop optimized cohort matching to birthing hospital clinical records, this pilot drew on a one-year (December 2020-December 2021) cohort for a single Australian birthing hospital participating in the whole-of-state Generation Victoria (GenV) study. For 1819 consented mother-baby pairs and 58 additional babies (whose mothers were not themselves participating), we tested the accuracy and effort of various approaches to matching. We selected demographic variables drawn from names, DOB, sex, telephone, address (and birth order for multiple births). After variable standardization and validation, accuracy rose from 10% to 99% using a deterministic-rule-based approach in 10 steps. Using cohort-specific modifications of the Australian Statistical Linkage Key (SLK-581), it took only 3 steps to reach 97% (SLK-5881) and 98% (SLK-5881.1) accuracy. We conclude that our SLK-5881 process could safely and efficiently achieve high accuracy at the population level for future birth cohort-birth hospital matching in the absence of unique identifier numbers.
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Fortuna D, Caselli L, Banchelli F, Moro ML, Costantini M. How Many Cancer Patients Need Palliative Care? A Population-Based Study. J Pain Symptom Manage 2022; 63:468-475. [PMID: 34995682 DOI: 10.1016/j.jpainsymman.2021.12.030] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/23/2021] [Accepted: 12/26/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND The number of cancer patients potentially amenable to palliative care is conventionally estimated from cancer deaths, as reported in the death certificates. However, a more representative population should also include cancer patients who die from causes other than cancer, as they may develop other life-limiting chronic conditions leading to terminal prognosis. AIM This study aimed at refining the assessment of the number of cancer patients potentially in need of palliative care, by linked hospital and death data. DESIGN Retrospective study. SETTING/PARTICIPANTS Residents in the Emilia Romagna Region in Italy, who died between 2009 and 2017. RESULTS We identified a potential palliative care population of 157,547 cancer patients. The use of different administrative data sources enhanced the sensitivity of our selection. Starting from a standard estimate of 129,212 patients based on cancer as the primary cause of death, we showed that the additional use of hospital records identified a further 11.4% of possible palliative care patients 14,687. Also considering cancer as secondary cause of death, the estimate further increased by 10.6% (13,648 new cases). Notably, the proportion of cancer patients selected by the additional data sources were characterized by more advanced age and higher prevalence of comorbidity. CONCLUSION Healthcare services addressing the issue of estimating palliative care needs of cancer patients at a population level should consider that relying on the death certificate alone may lead to underestimating these needs of about 22%.
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Affiliation(s)
- Daniela Fortuna
- Regional Agency for Health and Social Care, Bologna, Emilia Romagna, Italy
| | - Luana Caselli
- Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Emilia-Romagna, Italy
| | - Federico Banchelli
- Regional Agency for Health and Social Care, Bologna, Emilia Romagna, Italy
| | - Maria Luisa Moro
- Regional Agency for Health and Social Care, Bologna, Emilia Romagna, Italy
| | - Massimo Costantini
- Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Emilia-Romagna, Italy.
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Cervantes CE, Sperati CJ. From Dropsy to Chart Biopsy: Opportunities and Pitfalls of Electronic Health Records. Kidney360 2021; 2:1399-1401. [PMID: 35373111 PMCID: PMC8786136 DOI: 10.34067/kid.0004392021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 08/05/2021] [Indexed: 02/04/2023]
Affiliation(s)
- C. Elena Cervantes
- Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - C. John Sperati
- Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Libuy N, Harron K, Gilbert R, Caulton R, Cameron E, Blackburn R. Linking education and hospital data in England: linkage process and quality. Int J Popul Data Sci 2021; 6:1671. [PMID: 34568585 PMCID: PMC8445153 DOI: 10.23889/ijpds.v6i1.1671] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTION Linkage of administrative data for universal state education and National Health Service (NHS) hospital care would enable research into the inter-relationships between education and health for all children in England. OBJECTIVES We aim to describe the linkage process and evaluate the quality of linkage of four one-year birth cohorts within the National Pupil Database (NPD) and Hospital Episode Statistics (HES). METHODS We used multi-step deterministic linkage algorithms to link longitudinal records from state schools to the chronology of records in the NHS Personal Demographics Service (PDS; linkage stage 1), and HES (linkage stage 2). We calculated linkage rates and compared pupil characteristics in linked and unlinked samples for each stage of linkage and each cohort (1990/91, 1996/97, 1999/00, and 2004/05). RESULTS Of the 2,287,671 pupil records, 2,174,601 (95%) linked to HES. Linkage rates improved over time (92% in 1990/91 to 99% in 2004/05). Ethnic minority pupils and those living in more deprived areas were less likely to be matched to hospital records, but differences in pupil characteristics between linked and unlinked samples were moderate to small. CONCLUSION We linked nearly all pupils to at least one hospital record. The high coverage of the linkage represents a unique opportunity for wide-scale analyses across the domains of health and education. However, missed links disproportionately affected ethnic minorities or those living in the poorest neighbourhoods: selection bias could be mitigated by increasing the quality and completeness of identifiers recorded in administrative data or the application of statistical methods that account for missed links. HIGHLIGHTS Longitudinal administrative records for all children attending state school and acute hospital services in England have been used for research for more than two decades, but lack of a shared unique identifier has limited scope for linkage between these databases.We applied multi-step deterministic linkage algorithms to 4 one-year cohorts of children born 1 September-31 August in 1990/91, 1996/97, 1999/00 and 2004/05. In stage 1, full names, date of birth, and postcode histories from education data in the National Pupil Database were linked to the NHS Personal Demographic Service. In stage 2, NHS number, postcode, date of birth and sex were linked to hospital records in Hospital Episode Statistics.Between 92% and 99% of school pupils linked to at least one hospital record. Ethnic minority pupils and pupils who were living in the most deprived areas were least likely to link. Ethnic minority pupils were less likely than white children to link at the first step in both algorithms.Bias due to linkage errors could lead to an underestimate of the health needs in disadvantaged groups. Improved data quality, more sensitive linkage algorithms, and/or statistical methods that account for missed links in analyses, should be considered to reduce linkage bias.
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Affiliation(s)
- Nicolás Libuy
- Institute of Health Informatics, University College London, London, NW1 2DA, UK
| | - Katie Harron
- Institute of Health Informatics, University College London, London, NW1 2DA, UK
- UCL Great Ormond Street Institute of Child Health, University College London, London, WC1N 1EH, UK
| | - Ruth Gilbert
- Institute of Health Informatics, University College London, London, NW1 2DA, UK
- UCL Great Ormond Street Institute of Child Health, University College London, London, WC1N 1EH, UK
| | | | | | - Ruth Blackburn
- Institute of Health Informatics, University College London, London, NW1 2DA, UK
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Vestergaard SV, Birn H, Hansen AT, Nørgaard M, Nitsch D, Christiansen CF. Comparison of Patients with Hospital-Recorded Nephrotic Syndrome and Patients with Nephrotic Proteinuria and Hypoalbuminemia: A Nationwide Study in Denmark. Kidney360 2021; 2:1482-1490. [PMID: 35373110 PMCID: PMC8786138 DOI: 10.34067/kid.0000362021] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 05/28/2021] [Indexed: 02/04/2023]
Abstract
Background Registry-based studies of nephrotic syndrome (NS) may only include a subset of patients with biochemical features of NS. To address this, we compared patients with laboratory-recorded nephrotic proteinuria and hypoalbuminemia to patients with hospital-recorded NS. Methods We identified adult patients with first-time hospital-recorded NS (inpatients, outpatients, or emergency-room visitors) in the Danish National Patient Registry and compared them with adults with first-time recorded nephrotic proteinuria and hypoalbuminemia in Danish laboratory databases during 2004-2018, defining the date of admission or laboratory findings as the index date. We characterized these cohorts by demographics, comorbidity, medication use, and laboratory and histopathologic findings. Results We identified 1139 patients with hospital-recorded NS and 5268 patients with nephrotic proteinuria and hypoalbuminemia; of these, 760 patients were identified in both cohorts. Within 1 year of the first record of nephrotic proteinuria and hypoalbuminemia, 18% had recorded hospital diagnoses indicating the presence of NS, and 87% had diagnoses reflecting any kind of nephropathy. Among patients identified with nephrotic proteinuria and hypoalbuminemia, their most recent eGFR was substantially lower (median of 35 versus 61 ml/min per 1.73 m2), fewer underwent kidney biopsies around the index date (34% versus 61%), and the prevalence of thromboembolic disease (25% versus 17%) and diabetes (39% versus 18%) was higher when compared with patients with hospital-recorded NS. Conclusions Patients with nephrotic proteinuria and hypoalbuminemia are five-fold more common than patients with hospital-recorded NS, and they have a lower eGFR and more comorbidities. Selective and incomplete recording of NS may be an important issue when designing and interpreting studies of risks and prognosis of NS.
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Affiliation(s)
- Søren Viborg Vestergaard
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Birn
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark,Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Anette Tarp Hansen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark,Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
| | - Mette Nørgaard
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Dorothea Nitsch
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Vestergaard SV, Christiansen CF, Thomsen RW, Birn H, Heide-Jørgensen U. Identification of Patients with CKD in Medical Databases: A Comparison of Different Algorithms. Clin J Am Soc Nephrol 2021; 16:543-551. [PMID: 33707181 PMCID: PMC8092062 DOI: 10.2215/cjn.15691020] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 01/18/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND OBJECTIVES Despite CKD consensus definitions, epidemiologic studies use multiple different algorithms to identify CKD. We aimed to elucidate if this affects the patient characteristics and the estimated prevalence and prognosis of CKD by applying six different algorithms to identify CKD in population-based medical databases and compare the cohorts. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Patients with CKD in Northern Denmark (2009-2016) were identified using six different algorithms: five were laboratory based defined by (1) one measured outpatient eGFR <60 ml/min per 1.73 m2 (single test, n=103,435), (2) two such findings ≥90 days apart (Kidney Disease Improving Global Outcomes, n=84,688), (3) two such findings ≥90 days apart with no eGFR >60 ml/min per 1.73 m2 observed in-between (Kidney Disease Improving Global Outcomes, persistent, n=68,994), (4) two such findings ≥90 and <365 days apart (Kidney Disease Improving Global Outcomes, time limited, n=75,031), and (5) two eGFRs <60 ml/min per 1.73 m2 or two urine albumin-creatinine ratios >30 mg/g ≥90 days apart (Kidney Disease Improving Global Outcomes, eGFR/albuminuria, n=100,957). The sixth included patients identified by reported in- and outpatient hospital International Classification of Diseases diagnoses of CKD (hospital-diagnosed, n=27,947). For each cohort, we estimated baseline eGFR, CKD prevalence, and 1-year mortality using the Kaplan-Meier method. RESULTS The five different laboratory-based algorithms resulted in large differences in the estimated prevalence of CKD from 4637-8327 per 100,000 population. In contrast, 1-year mortality varied only slightly (7%-9%). Baseline eGFR levels at diagnosis were comparable (53-56 ml/min per 1.73 m2), whereas median time since first recorded eGFR <60 ml/min per 1.73 m2 varied from 0 months (single-test) to 17 months (Kidney Disease Improving Global Outcomes, persistent). The hospital-diagnosed algorithm yielded markedly lower CKD prevalence (775 per 100,000 population), a lower baseline eGFR (47 ml/min per 1.73 m2), longer time since first eGFR <60 ml/min per 1.73 m2 (median 70 months), and much higher 1-year mortality (22%). CONCLUSIONS Population prevalence of CKD identified in medical databases greatly depends on the applied algorithm to define CKD. Despite these differences, laboratory-based algorithms produce cohorts with similar prognosis. PODCAST This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2021_03_11_CJN15691020_final.mp3.
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Affiliation(s)
| | | | | | - Henrik Birn
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark,Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Uffe Heide-Jørgensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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Manuel DG, van Walraven C, Forster AJ. A commentary on the value of hospital data for covid-19 pandemic surveillance and planning. Int J Popul Data Sci 2021; 5:1393. [PMID: 34007891 PMCID: PMC8104152 DOI: 10.23889/ijpds.v5i4.1393] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Hospital data for covid-19 surveillance, planning and modelling are challenging to find worldwide in public aggregation portals. Detailed covid-19 hospital data provides insights into covid-19's health burden including identifying which sociodemographic groups are at greatest risk of covid-19 morbidity and mortality. Timely hospital data is the best source of information for actionable forecasts and projection models of hospital capacity, including critical resources such as intensive care unit beds and ventilators that take time to plan or procure. A challenge to generate timely and detailed hospital data is the reliance on separation or discharge abstracts and census counts. What are needed are well-maintained lists of patients hospitalized with covid-19. From the standpoint of public health and health services researchers and practitioners, we describe the role of hospital data for studying covid-19, why admission data are hard to find, and how improved data infrastructure can meet surveillance and planning needs in the near future. Modern hospital electronic health records can create covid-19 patient lists and these decision support tools are increasingly used for research. These tools can generate patient lists that are transmitted and combined with public health data systems.
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Affiliation(s)
- Douglas G. Manuel
- Senior Scientist, Ottawa Hospital Research Institute, Civic Campus, 1053 Carling Ave., Ottawa ON, K1Y 4E9, Canada
- Distinguished Professor of Family Medicine, School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa ON, K1G 5Z3, Canada
- Senior Core Scientist, ICES
| | - Carl van Walraven
- Senior Scientist, Ottawa Hospital Research Institute, Civic Campus, 1053 Carling Ave., Ottawa ON, K1Y 4E9, Canada
- Senior Core Scientist, ICES
- Professor of Medicine, School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa ON, K1G 5Z3, Canada
| | - Alan J. Forster
- Senior Scientist, Ottawa Hospital Research Institute, Civic Campus, 1053 Carling Ave., Ottawa ON, K1Y 4E9, Canada
- Professor of Medicine, School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa ON, K1G 5Z3, Canada
- Adjunct Scientist, ICES
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Coathup V, Macfarlane A, Quigley M. Linkage of maternity hospital episode statistics birth records to birth registration and notification records for births in England 2005-2006: quality assurance of linkage. BMJ Open 2020; 10:e037885. [PMID: 33109650 PMCID: PMC7592278 DOI: 10.1136/bmjopen-2020-037885] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES The objectives of this study were to describe the methods used to assess the quality of linkage between records of babies' birth registration and hospital birth records, and to evaluate the potential bias that may be introduced because of these methods. DESIGN/SETTING Data from the civil registration and the notification of births previously linked by the Office for National Statistics (ONS) had been further linked to birth records from the Hospital Episode Statistics (HES) for babies born in England. We developed a deterministic, six-stage algorithm to assess the quality of this linkage. PARTICIPANTS All 1 170 790 live, singleton births, occurring in National Health Service hospitals in England between 1 January 2005 and 31 December 2006. PRIMARY OUTCOME MEASURE The primary outcome was the number of successful links between ONS birth records and HES birth records. Rates of successful linkage were calculated for the cohort and the characteristics associated with unsuccessful linkage were identified. RESULTS Approximately 92% (1 074 572) of the birth registration records were successfully linked with a HES birth record. Data quality and completeness were somewhat poorer in HES birth records compared with linked birth registration and birth notification records. The quality assurance algorithms identified 1456 incorrect linkages (<1%). Compared with the linked dataset, birth records were more likely to be unlinked if babies were of white ethnic origin; born to unmarried mothers; born in East England, London, North West England or the West Midlands; or born in March. CONCLUSIONS It is possible to link administrative datasets to create large cohorts, allowing researchers to explore important questions about exposures and childhood outcomes. Missing data, coding errors and inconsistencies mean it is important that the quality of linkage is assessed prior to analysis.
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Affiliation(s)
- Victoria Coathup
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Alison Macfarlane
- Centre for Maternal and Child Health Research, School of Health Sciences, City University, London, UK
| | - Maria Quigley
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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15
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Burma AD, Mishra V, Das SK, Parivallal MB, Amudhan S, Rao GN. Monitoring and Surveillance of COVID-19 Survival and Stay Characteristics: A Need for Hospital Preparedness in India. Disaster Med Public Health Prep 2020; 14:e15-e16. [PMID: 32666914 PMCID: PMC7438623 DOI: 10.1017/dmp.2020.251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 06/25/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Ajit Deo Burma
- Department of Epidemiology, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Vinayak Mishra
- Department of Epidemiology, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Sumit Kumar Das
- Department of Biostatistics, National Institute of Mental Health And Neuro Sciences, Bangalore, India
| | - Mohana Balan Parivallal
- Department of Epidemiology, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Senthil Amudhan
- Department of Epidemiology, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Girish N. Rao
- Department of Epidemiology, National Institute of Mental Health and Neuro Sciences, Bangalore, India
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16
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Rowlands S, Tariq A, Coverdale S, Walker S, Wood M. A qualitative investigation into clinical documentation: why do clinicians document the way they do? HEALTH INF MANAG J 2020; 51:126-134. [PMID: 32643428 DOI: 10.1177/1833358320929776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/16/2022]
Abstract
BACKGROUND Clinical documentation is a fundamental component of patient care. The transition from paper based to electronic medical records/electronic health records has highlighted a number of issues associated with documentation practices including duplication. Developing new ways to document the care provided to patients and in turn, persuading clinicians to accept a change, must be supported by evidence that a change is required. In Australia, there has been a limited number of studies exploring the clinical documentation practices and beliefs of clinicians. OBJECTIVE To gain an in-depth understanding of clinician documentation practices. METHOD A qualitative design using semi-structured interviews with clinicians (allied health professionals, doctors (physicians) and nurses) working in a tertiary-level hospital in South-East Queensland, Australia. RESULTS Several themes emerged from the data: environmental factors, including departmental policy and systemic issues, and personal factors, including verification, clinical reasoning and experience influencing documentation practices. CONCLUSION Our study identified that the documentation practices of clinicians are complex, being driven by both environmental and systemic factors and personal factors. This in turn leads to duplication and some redundancy. The documentation burden of duplication could be reduced by changes in policy, supported by multidisciplinary documentation procedures and electronic systems aligned with clinician workflows, while retaining some flexible documentation practices. The documentation practices of individuals, when considered from the perspective of enhancing quality care, are considered legitimate and therefore will continue to form part of the health (medical) record regardless of the format.
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Affiliation(s)
| | - Amina Tariq
- Queensland University of Technology, Australia
| | | | - Sue Walker
- Queensland University of Technology, Australia
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17
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Brumpton BM, Fritsche LG, Zheng J, Nielsen JB, Mannila M, Surakka I, Rasheed H, Vie GÅ, Graham SE, Gabrielsen ME, Laugsand LE, Aukrust P, Vatten LJ, Damås JK, Ueland T, Janszky I, Zwart JA, Van't Hooft FM, Seidah NG, Hveem K, Willer C, Smith GD, Åsvold BO. Variation in Serum PCSK9 (Proprotein Convertase Subtilisin/Kexin Type 9), Cardiovascular Disease Risk, and an Investigation of Potential Unanticipated Effects of PCSK9 Inhibition. Circ Genom Precis Med 2020; 12:e002335. [PMID: 30645169 DOI: 10.1161/circgen.118.002335] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ben M Brumpton
- Department of Public Health and Nursing, K.G. Jebsen Center for Genetic Epidemiology (B.M.B., L.G.F., H.R., G.Å.V., M.E.G., K.H., B.O.Å.), NTNU, Norwegian University of Science and Technology, Trondheim.,MRC Integrative Epidemiology Unit, University of Bristol, United Kingdom (B.M.B., J.Z., H.R., G.D.S.).,Clinic of Thoracic and Occupational Medicine (B.M.B.), St. Olavs Hospital, Trondheim University Hospital, Norway
| | - Lars G Fritsche
- Department of Public Health and Nursing, K.G. Jebsen Center for Genetic Epidemiology (B.M.B., L.G.F., H.R., G.Å.V., M.E.G., K.H., B.O.Å.), NTNU, Norwegian University of Science and Technology, Trondheim.,Department of Biostatistics and Center for Statistical Genetics (L.G.F., C.W.), University of Michigan, Ann Arbor, MI
| | - Jie Zheng
- MRC Integrative Epidemiology Unit, University of Bristol, United Kingdom (B.M.B., J.Z., H.R., G.D.S.)
| | - Jonas Bille Nielsen
- Department of Internal Medicine (J.B.N., I.S., S.E.G., C.W.), University of Michigan, Ann Arbor, MI
| | - Maria Mannila
- Cardiology Unit (M.M.), Karolinska Institutet, Stockholm, Sweden.,Cardiovascular Medicine Unit, Department of Medicine Solna, Center for Molecular Medicine (M.M., F.M.v.H.), Karolinska Institutet, Stockholm, Sweden
| | - Ida Surakka
- Department of Internal Medicine (J.B.N., I.S., S.E.G., C.W.), University of Michigan, Ann Arbor, MI
| | - Humaira Rasheed
- Department of Public Health and Nursing, K.G. Jebsen Center for Genetic Epidemiology (B.M.B., L.G.F., H.R., G.Å.V., M.E.G., K.H., B.O.Å.), NTNU, Norwegian University of Science and Technology, Trondheim.,MRC Integrative Epidemiology Unit, University of Bristol, United Kingdom (B.M.B., J.Z., H.R., G.D.S.)
| | - Gunnhild Åberge Vie
- Department of Public Health and Nursing, K.G. Jebsen Center for Genetic Epidemiology (B.M.B., L.G.F., H.R., G.Å.V., M.E.G., K.H., B.O.Å.), NTNU, Norwegian University of Science and Technology, Trondheim.,Department of Public Health and Nursing (G.Å.V., L.E.L., L.J.V., I.J.), NTNU, Norwegian University of Science and Technology, Trondheim
| | - Sarah E Graham
- Department of Internal Medicine (J.B.N., I.S., S.E.G., C.W.), University of Michigan, Ann Arbor, MI
| | - Maiken Elvestad Gabrielsen
- Department of Public Health and Nursing, K.G. Jebsen Center for Genetic Epidemiology (B.M.B., L.G.F., H.R., G.Å.V., M.E.G., K.H., B.O.Å.), NTNU, Norwegian University of Science and Technology, Trondheim
| | - Lars Erik Laugsand
- Department of Public Health and Nursing (G.Å.V., L.E.L., L.J.V., I.J.), NTNU, Norwegian University of Science and Technology, Trondheim.,Department of Circulation and Medical Imaging (L.E.L.), NTNU, Norwegian University of Science and Technology, Trondheim.,Department of Cardiology (L.E.L.), St. Olavs Hospital, Trondheim University Hospital, Norway
| | - Pål Aukrust
- Research Institute of Internal Medicine (P.A., T.U.), Oslo University Hospital, Rikshospitalet.,Section of Clinical Immunology and Infectious Diseases (P.A.), Oslo University Hospital, Rikshospitalet.,Institute of Clinical Medicine (P.A.), University of Oslo, Norway
| | - Lars Johan Vatten
- Department of Public Health and Nursing (G.Å.V., L.E.L., L.J.V., I.J.), NTNU, Norwegian University of Science and Technology, Trondheim
| | - Jan Kristian Damås
- Department of Clinical and Molecular Medicine, Centre of Molecular Inflammation Research (J.K.D.), NTNU, Norwegian University of Science and Technology, Trondheim.,Department of Infectious Diseases (J.K.D.), St. Olavs Hospital, Trondheim University Hospital, Norway
| | - Thor Ueland
- Research Institute of Internal Medicine (P.A., T.U.), Oslo University Hospital, Rikshospitalet.,University of Oslo, Norway (T.U.).,K.G. Jebsen TREC, University of Tromsø, Norway (T.U.)
| | - Imre Janszky
- Department of Public Health and Nursing (G.Å.V., L.E.L., L.J.V., I.J.), NTNU, Norwegian University of Science and Technology, Trondheim
| | - John-Anker Zwart
- Division of Clinical Neuroscience, Oslo University Hospital (J.-A.Z.), University of Oslo, Norway
| | - Ferdinand M Van't Hooft
- Cardiovascular Medicine Unit, Department of Medicine Solna, Center for Molecular Medicine (M.M., F.M.v.H.), Karolinska Institutet, Stockholm, Sweden
| | - Nabil Georges Seidah
- Laboratory of Biochemical Neuroendocrinology, IRCM, Montreal, Quebec, Canada (N.G.S.)
| | - Kristian Hveem
- Department of Public Health and Nursing, K.G. Jebsen Center for Genetic Epidemiology (B.M.B., L.G.F., H.R., G.Å.V., M.E.G., K.H., B.O.Å.), NTNU, Norwegian University of Science and Technology, Trondheim
| | - Cristen Willer
- Department of Biostatistics and Center for Statistical Genetics (L.G.F., C.W.), University of Michigan, Ann Arbor, MI.,Department of Internal Medicine (J.B.N., I.S., S.E.G., C.W.), University of Michigan, Ann Arbor, MI.,Department of Human Genetics (C.W.), University of Michigan, Ann Arbor, MI
| | - George Davey Smith
- MRC Integrative Epidemiology Unit, University of Bristol, United Kingdom (B.M.B., J.Z., H.R., G.D.S.)
| | - Bjørn Olav Åsvold
- Department of Public Health and Nursing, K.G. Jebsen Center for Genetic Epidemiology (B.M.B., L.G.F., H.R., G.Å.V., M.E.G., K.H., B.O.Å.), NTNU, Norwegian University of Science and Technology, Trondheim.,Department of Endocrinology (B.O.Å.), St. Olavs Hospital, Trondheim University Hospital, Norway
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18
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Gupta N, Sheng Z. A population-based study of the association between food insecurity and potentially avoidable hospitalization among persons with diabetes using linked survey and administrative data. Int J Popul Data Sci 2019; 4:1102. [PMID: 32935031 PMCID: PMC7482516 DOI: 10.23889/ijpds.v4i1.1102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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] [Indexed: 12/02/2022] Open
Abstract
Background Studies have found food insecurity to be more prevalent among persons with diabetes mellitus. Other research using areal-based measures of socioeconomic status have pointed to a social gradient in diabetes hospitalizations, but without accounting for individuals’ health status. Linking person-level data from health surveys to population-based hospital records enables profiling of the role of food insecurity with hospital morbidity, focusing on the high-risk diabetic population. Objective This national study aims to assess the association between income-related household food insecurity and potentially avoidable hospital admissions among community-dwelling persons living with diagnosed diabetes. Methods We use three cycles of the Canadian Community Health Survey (2007, 2008, and 2011) linked to multiple years of hospital records from the Discharge Abstract Database (2005/06 to 2012/13), covering 12 of Canada’s 13 provinces and territories. We apply multiple logistic regression for testing the association of household food insecurity with the risk of hospitalization for diabetes and common comorbid ambulatory care sensitive conditions among persons aged 12 and over living with diabetes. Analysis Data linkage allowed us to analyze inpatient hospital records among 10,260 survey respondents with diabetes; 590 respondents had been hospitalized at least once for diabetes or a common comorbid chronic physical or mental illness. The regression results indicated that the odds of experiencing a preventable hospital admission were significantly higher among persons with diabetes who were food insecure compared to their counterparts who were food secure (OR=1.66 [95%CI=1.24-2.23]), after controlling for age, sex and other characteristics. Conclusion We found food insecurity to significantly increase the odds of hospital admission for ambulatory care sensitive conditions among Canadians living with diabetes. These results reinforce the need to consider food insecurity in public health and clinical strategies to reduce the hospital burden of diabetes and other nutrition-related chronic diseases, from primary prevention to post-discharge care.
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Affiliation(s)
- N Gupta
- Department of Sociology, University of New Brunswick, PO Box 4400, Fredericton, New Brunswick E3B 5A3, Canada
| | - Z Sheng
- Department of Sociology, University of New Brunswick, PO Box 4400, Fredericton, New Brunswick E3B 5A3, Canada
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19
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D'Aloisio F, Vittorini P, Giuliani AR, Scatigna M, Del Papa J, Muselli M, Baccari G, Fabiani L. Hospitalization Rates for Respiratory Diseases After L'Aquila Earthquake. Int J Environ Res Public Health 2019; 16:ijerph16122109. [PMID: 31207898 PMCID: PMC6616506 DOI: 10.3390/ijerph16122109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 06/09/2019] [Accepted: 06/11/2019] [Indexed: 11/20/2022]
Abstract
The study aims to investigate the impact of the earthquake on public health, in terms of hospitalizations for respiratory diseases in the Abruzzo region, focusing on the area damaged by the earthquake “Crater”. We collected data of hospitalizations of residents in Abruzzo between 2009 and 2015. Hospital Discharge Records (HDRs) with a primary diagnosis of respiratory disease were included and divided into pneumonia, Chronic Obstructive Pulmonary Disease (COPD), and respiratory insufficiency. Absolute frequencies and standardized hospitalization rates were calculated to perform both a short-term and a medium-long term analysis. A linear regression was performed using standardized hospitalization rates and the time. A total of 108.669 respiratory-related records were collected and the most frequent subgroup was respiratory insufficiency. Standardized Hospitalization Rates (SHRs) for respiratory diseases resulted higher in the non-Crater than Crater area, but the short-term analysis showed a significant increase in hospitalizations for pneumonia and respiratory insufficiency in the Crater area. The medium-long term analysis reported a significant difference on the slope decrease of hospitalizations for acute and chronic respiratory diseases in the Crater versus the non-Crater area. The earthquake may have played a triggering role in the increased detection of respiratory diseases. A temporal relationship between the quake and an increase in admissions was found although it is not yet possible to detect a direct cause-effect relationship.
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Affiliation(s)
- Francesco D'Aloisio
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Piazzale Salvatore Tommasi, 1-67100 L'Aquila (AQ), Italy.
| | - Pierpaolo Vittorini
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Piazzale Salvatore Tommasi, 1-67100 L'Aquila (AQ), Italy.
| | - Anna Rita Giuliani
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Piazzale Salvatore Tommasi, 1-67100 L'Aquila (AQ), Italy.
| | - Maria Scatigna
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Piazzale Salvatore Tommasi, 1-67100 L'Aquila (AQ), Italy.
| | - Jacopo Del Papa
- Department of Life, Health and Environmental Sciences, Graduate School of Hygiene and Preventive Medicine, University of L'Aquila, Piazzale Salvatore Tommasi, 1-67100 L'Aquila (AQ), Italy.
| | - Mario Muselli
- Department of Life, Health and Environmental Sciences, Graduate School of Hygiene and Preventive Medicine, University of L'Aquila, Piazzale Salvatore Tommasi, 1-67100 L'Aquila (AQ), Italy.
| | - Giorgio Baccari
- Department of Life, Health and Environmental Sciences, Graduate School of Hygiene and Preventive Medicine, University of L'Aquila, Piazzale Salvatore Tommasi, 1-67100 L'Aquila (AQ), Italy.
| | - Leila Fabiani
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Piazzale Salvatore Tommasi, 1-67100 L'Aquila (AQ), Italy.
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20
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Luz CF, Berends MS, Dik JWH, Lokate M, Pulcini C, Glasner C, Sinha B. Rapid Analysis of Diagnostic and Antimicrobial Patterns in R (RadaR): Interactive Open-Source Software App for Infection Management and Antimicrobial Stewardship. J Med Internet Res 2019; 21:e12843. [PMID: 31199325 PMCID: PMC6592398 DOI: 10.2196/12843] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 03/12/2019] [Accepted: 03/24/2019] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Analyzing process and outcome measures for all patients diagnosed with an infection in a hospital, including those suspected of having an infection, requires not only processing of large datasets but also accounting for numerous patient parameters and guidelines. Substantial technical expertise is required to conduct such rapid, reproducible, and adaptable analyses; however, such analyses can yield valuable insights for infection management and antimicrobial stewardship (AMS) teams. OBJECTIVE The aim of this study was to present the design, development, and testing of RadaR (Rapid analysis of diagnostic and antimicrobial patterns in R), a software app for infection management, and to ascertain whether RadaR can facilitate user-friendly, intuitive, and interactive analyses of large datasets in the absence of prior in-depth software or programming knowledge. METHODS RadaR was built in the open-source programming language R, using Shiny, an additional package to implement Web-app frameworks in R. It was developed in the context of a 1339-bed academic tertiary referral hospital to handle data of more than 180,000 admissions. RESULTS RadaR enabled visualization of analytical graphs and statistical summaries in a rapid and interactive manner. It allowed users to filter patient groups by 17 different criteria and investigate antimicrobial use, microbiological diagnostic use and results including antimicrobial resistance, and outcome in length of stay. Furthermore, with RadaR, results can be stratified and grouped to compare defined patient groups on the basis of individual patient features. CONCLUSIONS AMS teams can use RadaR to identify areas within their institutions that might benefit from increased support and targeted interventions. It can be used for the assessment of diagnostic and therapeutic procedures and for visualizing and communicating analyses. RadaR demonstrated the feasibility of developing software tools for use in infection management and for AMS teams in an open-source approach, thus making it free to use and adaptable to different settings.
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Affiliation(s)
- Christian Friedemann Luz
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Matthijs S Berends
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.,Certe Medical Diagnostics and Advice, Groningen, Netherlands
| | - Jan-Willem H Dik
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Mariëtte Lokate
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Céline Pulcini
- APEMAC, Université de Lorraine, Nancy, France.,Infectious Diseases Department, CHRU-Nancy, Université de Lorraine, Nancy, France
| | - Corinna Glasner
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Bhanu Sinha
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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Samra H, Li A, Soh B, Zain MA. Utilisation of hospital information systems for medical research in Saudi Arabia: A mixed-method exploration of the views of healthcare and IT professionals involved in hospital database management systems. Health Inf Manag 2019; 49:117-126. [PMID: 31046465 DOI: 10.1177/1833358319847120] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although in recent times the Saudi government has paid much attention to the adaptation of hospital information systems (HIS) and electronic medical records (EMR), the importance of utilising HIS to enhance medical research has been neglected. OBJECTIVE We aimed to (i) investigate the current state of medical research in Saudi Arabia, (ii) identify possible issues that hinder improvement of medical research and (iii) identify possible solutions to enhance the role of HIS in medical research in Saudi Arabia. METHOD We used a questionnaire and structured interview approach. Questionnaires were distributed to Saudi healthcare professionals. One hundred responses to our questionnaire were captured by the online Google Form designed specifically for our survey. Structured interviews with two IT professionals were conducted regarding technical aspects of their hospital data management systems. RESULTS Six themes contributing to the inefficacy of HIS in medical research in Saudi Arabia emerged from the data: incorrect datasets, difficult data collection and storage, poor data analytics, a lack of system interoperability across different HIS for universal access and negative perception of the usefulness of HIS for medical research. CONCLUSION AND IMPLICATIONS Our findings suggest (i) cloud-based HIS would support efficient, reliable and integrated data collection and storage across all hospitals in Saudi Arabia; (ii) EMR data sources should be seamlessly linked to avoid incomplete, fragmented or erroneous EMR in Saudi Arabia; and (iii) collaboration between all hospitals in Saudi Arabia to adopt a uniform standard to support interoperability and improve data exchange and integration is necessary.
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Affiliation(s)
- Halima Samra
- La Trobe University, Australia.,King Abdulaziz University, Kingdom of Saudi Arabia
| | | | - Ben Soh
- La Trobe University, Australia
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Fox M, Thomson M, Warburton J. Non-therapeutic male genital cutting and harm: Law, policy and evidence from U.K. hospitals. Bioethics 2019; 33:467-474. [PMID: 30511772 DOI: 10.1111/bioe.12542] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 07/09/2018] [Accepted: 10/04/2018] [Indexed: 06/09/2023]
Abstract
Female genital cutting (FGC) is generally understood as a gendered harm, abusive cultural practice and human rights violation. By contrast, male genital cutting (MGC) is held to be minimally invasive, an expression of religious identity and a legitimate parental choice. Yet scholars increasingly problematize this dichotomy, arguing that male and female genital cutting can occasion comparable levels of harm. In 2015 this academic critique received judicial endorsement, with Sir James Munby's acknowledgement that all genital cutting can cause 'significant harm'. This article investigates the harm occasioned by MGC. It is informed by a Freedom of Information (FoI) study which provides some empirical evidence of the nature and frequency of physical harm caused by MGC in U.K. hospitals. While acknowledging the challenges and limitations of FoI research, we outline important lessons that this preliminary study contains for medical ethics, law and policy. It provides some empirical evidence to support claims regarding the risks which accompany the procedure and the obligation of health professionals to disclose them, and reveals the paucity of measures in place to ensure that harms are recorded, disclosed and monitored.
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Affiliation(s)
- Marie Fox
- Liverpool Law School, University of Liverpool, Liverpool, Merseyside, United Kingdom of Great Britain and Northern Ireland
| | - Michael Thomson
- Law, University of Leeds, Leeds, Yorkshire, United Kingdom of Great Britain and Northern Ireland
- University of Technology Sydney, New South Wales, Australia
| | - Joshua Warburton
- Law, University of Leeds, Leeds, Yorkshire, United Kingdom of Great Britain and Northern Ireland
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Harron KL, Doidge JC, Knight HE, Gilbert RE, Goldstein H, Cromwell DA, van der Meulen JH. A guide to evaluating linkage quality for the analysis of linked data. Int J Epidemiol 2018; 46:1699-1710. [PMID: 29025131 PMCID: PMC5837697 DOI: 10.1093/ije/dyx177] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [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] [Accepted: 08/08/2017] [Indexed: 11/14/2022] Open
Abstract
Linked datasets are an important resource for epidemiological and clinical studies, but linkage error can lead to biased results. For data security reasons, linkage of personal identifiers is often performed by a third party, making it difficult for researchers to assess the quality of the linked dataset in the context of specific research questions. This is compounded by a lack of guidance on how to determine the potential impact of linkage error. We describe how linkage quality can be evaluated and provide widely applicable guidance for both data providers and researchers. Using an illustrative example of a linked dataset of maternal and baby hospital records, we demonstrate three approaches for evaluating linkage quality: applying the linkage algorithm to a subset of gold standard data to quantify linkage error; comparing characteristics of linked and unlinked data to identify potential sources of bias; and evaluating the sensitivity of results to changes in the linkage procedure. These approaches can inform our understanding of the potential impact of linkage error and provide an opportunity to select the most appropriate linkage procedure for a specific analysis. Evaluating linkage quality in this way will improve the quality and transparency of epidemiological and clinical research using linked data.
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Affiliation(s)
- Katie L Harron
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - James C Doidge
- Administrative Data Research Centre for England, UCL Great Ormond Street Institute of Child Health, UCL, London, UK.,Centre for Population Health Research, University of South Australia, Adelaide, Australia
| | - Hannah E Knight
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK.,Lindsay Stewart Centre for Audit and Clinical Informatics, Royal College of Obstetricians and Gynaecologists, London, UK
| | - Ruth E Gilbert
- Administrative Data Research Centre for England, UCL Great Ormond Street Institute of Child Health, UCL, London, UK
| | - Harvey Goldstein
- Administrative Data Research Centre for England, UCL Great Ormond Street Institute of Child Health, UCL, London, UK.,Graduate School of Education, University of Bristol, Bristol, UK
| | - David A Cromwell
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Jan H van der Meulen
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
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Carrière G, Bougie B, Kohen D. Acute care hospitalizations for mental and behavioural disorders among First Nations people. Health Rep 2018; 29:11-19. [PMID: 29924374] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND National information about acute care hospitalizations for mental/behavioural disorders among Aboriginal people in Canada is limited. DATA AND METHODS This study describes acute care hospitalizations for mental /behavioural disorders among First Nations people living on and off reserve. The 2006 Census was linked to the Discharge Abstract Database from 2006/2007 through 2008/2009 for all provinces (except Ontario and Quebec) and the three territories. Hospitalizations for seven types of disorders were identified. "Most responsible" diagnosis and secondary diagnoses were examined separately. Age-standardized hospitalization rates (ASHRs) per 100,000 population and rate ratios were calculated. RESULTS ASHRs for most responsible and secondary diagnoses of mental/behavioural disorders were significantly higher for First Nations people living on and off reserve than for non-Aboriginal people. The leading diagnoses were the same for each group, but the rank order differed. Among First Nations people, the most common diagnoses were substance-related disorders, mood disorders, and schizophrenic/psychotic disorders. Among non-Aboriginal people, mood disorders were the leading most responsible diagnosis, followed by schizophrenic/psychotic disorders and substance-related disorders. The greatest rate differences between First Nations and non-Aboriginal people for both most responsible and secondary diagnoses were for substance-related disorders. DISCUSSION The higher burden of hospitalizations due to mental/behavioural disorders among First Nations people provides benchmarks and points to the need of considering every hospital admission as an important opportunity for intervention and prevention. The Truth and Reconciliation Commission of Canada (2015) has recognized that the poorer health outcomes of Aboriginal people in Canada were rooted in the legacies of colonization. Further research is required to better understand the direct impacts on mental health.
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Affiliation(s)
- Gisèle Carrière
- Health Analysis Division, Statistics Canada, Ottawa, Ontario
| | - Bougie Bougie
- Health Analysis Division, Statistics Canada, Ottawa, Ontario
| | - Dafna Kohen
- Health Analysis Division, Statistics Canada, Ottawa, Ontario
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25
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Rotermann M. High use of acute care hospital services at age 50 or older. Health Rep 2017; 28:3-16. [PMID: 28930363] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND A small fraction of the population accounts for a disproportionate share of health care spending and resources. Linking data from health surveys with hospital and death records offers an opportunity to examine high use of acute care in more depth than is possible with administrative data alone. DATA AND METHODS Data for 62,675 respondents to three cycles of the Canadian Community Health Survey were linked to the Discharge Abstract Database and the Canadian Mortality Database. Respondents were categorized according to cumulative annual days in hospital: high users (30 days or more), non-high users (1 to 29), or not hospitalized. Cross-tabulations stratified by age (50 to 74 and 75 or older) were used to describe the socio-demographic, health, health behaviour, and hospital experience characteristics of the three groups. Multinomial logit and logistic regression were used to examine associations between these characteristics and high use or no hospitalization versus non-high use. RESULTS High users made up 0.5% of the population aged 50 to 74 and 2.6% of those aged 75 or older, but they accounted for 45.6% and 56.1%, respectively, of the days that people of these ages spent in hospital. Not having a partner, being at the end of life, having a neurological condition, as well as inactivity and comorbidity (ages 50 to 74) increased the odds of high use. Being female, not having major chronic conditions, not being at the end of life, normal/overweight, and being active were associated with no hospitalization. INTERPRETATION Linking survey, hospital, and death data improves understanding of factors associated with high hospital use.
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Thuy Trinh LT, Achat H, Loh SM, Pascoe R, Assareh H, Stubbs J, Guevarra V. Validity of routinely collected data in identifying hip fractures at a major tertiary hospital in Australia. Health Inf Manag 2017; 47:38-45. [PMID: 28745563 DOI: 10.1177/1833358317721305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 11/16/2022]
Abstract
OBJECTIVES To examine the validity of routinely collected data in identifying hip fractures (HFs) and to identify factors associated with incorrect coding. METHOD In a prospective cohort study between January 2014 and June 2016, HFs were identified using physician diagnosis and diagnostic imaging and were recorded in a Registry. Records of HFs in the health information exchange (HIE) were identified using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification/Australian Classification of Health Interventions/Australian Coding Standards codes. New HFs were estimated by episode of care, hospital admission and with an algorithm. Data from the HIE and the Registry were compared. RESULTS The number of HFs as the principal diagnosis (PD) recorded by episode (864) was higher than by admission (743), by algorithm (711) and in the Registry (638). The sensitivity was high for all methods (90-93%) but the positive predictive value was lower for episode (68%) than for admission (80%) or algorithm (81%). The number of HFs with surgery recorded in the PD by episode (639), algorithm (630) and in the Registry (623) was similar but higher than by admission (589). The episode and algorithm methods also had higher sensitivity (91-92%) than the admission method (84%) for HFs with surgery. Factors associated with coding errors included subsequent HF, long hospital stay, intracapsular fracture, younger age, male, HF without surgery and death in hospital. CONCLUSIONS When it is not practical to use the algorithm for regular monitoring of HFs, using PD by admission to estimate total HFs and PD by episode in combination with a procedure code to estimate HFs with surgery can produce robust estimations.
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Affiliation(s)
| | - Helen Achat
- Western Sydney Local Health District, Australia
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Musaazi J, Kiragga AN, Castelnuovo B, Kambugu A, Bradley J, Rehman AM. Tuberculosis treatment success among rural and urban Ugandans living with HIV: a retrospective study. Public Health Action 2017; 7:100-109. [PMID: 28695082 DOI: 10.5588/pha.16.0115] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 04/03/2017] [Indexed: 11/10/2022] Open
Abstract
Setting: Government health centres and hospitals (six urban and 20 rural) providing tuberculosis (TB) treatment for people living with the human immunodeficiency virus (PLHIV) in central and western Uganda. Objective: To identify and quantify modifiable factors that limit TB treatment success among PLHIV in rural Uganda. Design: A retrospective cross-sectional review of routine Uganda National Tuberculosis and Leprosy Programme clinic registers and patient files of HIV-positive patients who received anti-tuberculosis treatment in 2014. Results: Of 191 rural patients, 66.7% achieved treatment success compared to 81.1% of 213 urban patients. Adjusted analysis revealed higher average treatment success in urban patients than in rural patients (OR 3.95, 95%CI 2.70-5.78, P < 0.01, generalised estimating equation model). Loss to follow-up was higher and follow-up sputum smear results were less frequently recorded in TB clinic registers among rural patients. Patients receiving treatment at higher-level facilities in rural settings had greater odds of treatment success, while patients receiving treatment at facilities where drug stock-outs had occurred had lower odds of treatment success. Conclusion: Lower reported treatment success in rural settings is mainly attributed to clinic-centred factors such as treatment monitoring procedures. We recommend strengthening treatment monitoring and delivery.
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Affiliation(s)
- J Musaazi
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - A N Kiragga
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - B Castelnuovo
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - A Kambugu
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - J Bradley
- Medical Research Council Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - A M Rehman
- Medical Research Council Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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Brameld K, Spilsbury K, Rosenwax L, Murray K, Semmens J. Issues using linkage of hospital records and death certificate data to determine the size of a potential palliative care population. Palliat Med 2017; 31:537-543. [PMID: 27777376 PMCID: PMC5405828 DOI: 10.1177/0269216316673550] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Studies aiming to identify palliative care populations have used data from death certificates and in some cases hospital records. The size and characteristics of the identified populations can show considerable variation depending on the data sources used. It is important that service planners and researchers are aware of this. AIM To illustrate the differences in the size and characteristics of a potential palliative care population depending on the differential use of linked hospital records and death certificate data. DESIGN Retrospective cohort study. SETTING/PARTICIPANTS The cohort consisted of 23,852 people aged 20 years and over who died in Western Australia between 1 January 2009 and 31 December 2010 after excluding deaths related to pregnancy or trauma. Within this cohort, the number, proportion and characteristics of people who died from one or more of 10 medical conditions considered amenable to palliative care were identified using linked hospital records and death certificate data. RESULTS Depending on the information source(s) used, between 43% and 73% of the 23,852 people who died had a condition potentially amenable to palliative care identified. The median age at death and the sex distribution of the decedents by condition also varied with the information source. CONCLUSION Health service planners and researchers need to be aware of the limitations when using hospital records and death certificate data to determine a potential palliative care population. The use of Emergency Department and other administrative data sources could further exacerbate this variation.
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Affiliation(s)
- Kate Brameld
- Centre for Population Health Research, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
- Kate Brameld, Centre for Population Health Research, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, WA 6845, Australia.
| | - Katrina Spilsbury
- Centre for Population Health Research, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Lorna Rosenwax
- School of Occupational Therapy and Social Work, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Kevin Murray
- Centre for Applied Statistics, School of Mathematics and Statistics, The University of Western Australia, Perth, WA, Australia
| | - James Semmens
- Centre for Population Health Research, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
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Reyniers T, Deliens L, Pasman HRW, Vander Stichele R, Sijnave B, Houttekier D, Cohen J. Appropriateness and avoidability of terminal hospital admissions: Results of a survey among family physicians. Palliat Med 2017; 31:456-464. [PMID: 27407016 DOI: 10.1177/0269216316659211] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although the acute hospital setting is not considered to be an ideal place of death, many people are admitted to hospital at the end of life. AIM To examine what proportion of terminal hospital admissions among their patients family physicians consider to have been avoidable and/or inappropriate; which patient, family physician and admission factors are associated with the perceived inappropriateness or avoidability of terminal hospital admissions; and which interventions could have prevented them, from the perspective of family physicians. DESIGN Survey among family physicians, linked to medical record data. SETTING Patients who had died non-suddenly in the acute hospital setting of a university hospital in Belgium between January and August 2014. RESULTS We received 245 completed questionnaires (response rate 70%) and 77% of those hospital deaths ( n = 189) were considered to be non-sudden. Almost 14% of all terminal hospital admissions were considered to be potentially inappropriate, almost 14% potentially avoidable and 8% both, according to family physicians. The terminal hospital admission was more likely to be considered potentially inappropriate or potentially avoidable for patients who had died of cancer, when the patient's life expectancy at the time of admission was limited, by family physicians who had had palliative care training at basic, postgraduate or post-academic level, and when the admission was initiated by the patient, partner or other family. CONCLUSION Timely communication with the patient about their limited life expectancy and the provision of better support to family caregivers may be important strategies in reducing the number of hospital deaths.
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Affiliation(s)
- Thijs Reyniers
- 1 End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | - Luc Deliens
- 1 End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium.,2 Department of Medical Oncology, Ghent University, Ghent, Belgium
| | - H Roeline W Pasman
- 3 EMGO Institute for Health and Care Research, Expertise Center for Palliative Care, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Bart Sijnave
- 5 IT Department, Ghent University Hospital, Ghent, Belgium
| | - Dirk Houttekier
- 1 End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | - Joachim Cohen
- 1 End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
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Abstract
BACKGROUND Evidence on the association between newborn length of hospital stay (LOS) and risk of readmission is conflicting. We compared methods for modelling this relationship, by gestational age, using population-level hospital data on births in England between 2005-14. METHODS The association between LOS and unplanned readmission within 30 days of postnatal discharge was explored using four approaches: (i) modelling hospital-level LOS and readmission rates; (ii) comparing trends over time in LOS and readmission; (iii) modelling individual LOS and adjusted risk of readmission; and (iv) instrumental variable analyses (hospital-level mean LOS and number of births on the same day). RESULTS Of 4 667 827 babies, 5.2% were readmitted within 30 days. Aggregated data showed hospitals with longer mean LOS were not associated with lower readmission rates for vaginal (adjusted risk ratio (aRR) 0.87, 95% confidence interval (CI) 0.66, 1.13), or caesarean (aRR 0.89, 95% CI 0.72, 1.12) births. LOS fell by an average 2.0% per year for vaginal births and 3.4% for caesarean births, while readmission rates increased by 4.4 and 5.1% per year respectively. Approaches (iii) and (iv) indicated that longer LOS was associated with a reduced risk of readmission, but only for late preterm, vaginal births (34-36 completed weeks' gestation). CONCLUSIONS Longer newborn LOS may benefit late preterm babies, possibly due to increased medical or psychosocial support for those at greater risk of potentially preventable readmissions after birth. Research based on observational data to evaluate relationships between LOS and readmission should use methods to reduce the impact of unmeasured confounding.
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Affiliation(s)
- Katie Harron
- Department of Health Services Research and PolicyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Ruth Gilbert
- UCL Great Ormond Street Institute of Child HealthLondonUK
| | - David Cromwell
- Department of Health Services Research and PolicyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Sam Oddie
- Bradford NeonatologyBradford Royal InfirmaryBradfordUK
| | - Jan van der Meulen
- Department of Health Services Research and PolicyLondon School of Hygiene and Tropical MedicineLondonUK
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Carrière GM, Garner R, Sanmartin C. Housing conditions and respiratory hospitalizations among First Nations people in Canada. Health Rep 2017; 28:9-15. [PMID: 28422268] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Respiratory diseases are among the leading causes of acute care hospitalization for First Nations people. Poor housing conditions are associated with respiratory disorders and may be related to the likelihood of hospitalization. This analysis examines whether First Nations identity is associated with higher odds of hospitalization for respiratory conditions relative to non-Aboriginal persons, and whether such differences in hospitalization rates remain after consideration of housing conditions. DATA AND METHODS Data from the 2006 Census linked to the Discharge Abstract Database were used to analyze differences in hospitalization for respiratory tract infections and asthma between First Nations and non-Aboriginal people when housing conditions were taken into account. RESULTS Rural on-reserve First Nations people were more likely than non-Aboriginal people to be hospitalized for a respiratory tract infection (1.5% versus 0.5%) or for asthma (0.2% versus 0.1%). For respiratory tract infection hospitalizations, adjustment for housing conditions, household income and residential location reduced differences, but the odds remained nearly three times higher for on-reserve First Nations people (OR = 2.83; CI: 2.69 to 2.99) and two times higher for off-reserve First Nations people (OR = 2.03; CI: 1.87 to 2.21), compared with the non-Aboriginal cohort. For asthma hospitalizations, adjustment for household income reduced the odds more than did adjustment for housing conditions. Even with full adjustment, the odds of asthma hospitalization relative to non-Aboriginal people remained significantly higher for First Nations people. INTERPRETATION First Nations people are significantly more likely than non-Aboriginal people to be hospitalized for respiratory tract infections and asthma, even when housing conditions, household income and residential location are taken into account. While housing conditions are associated with such hospitalizations, household income may be more important.
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Affiliation(s)
| | - Rochelle Garner
- Health Analysis Division, Statistics Canada, Ottawa, Ontario
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Ng E, Sanmartin C, Manuel DG. Acute care hospitalization, by immigrant category: Linking hospital data and the Immigrant Landing File in Canada. Health Rep 2016; 27:12-18. [PMID: 27532621] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Although immigrants tend to be healthier than the Canadian-born population when they arrive, subgroups, notably different immigration categories, may differ in health and health care use. Data limitations have meant the research has seldom focused on category of immigrant-economic, family or refugee. A newly linked database has made it possible to study acute care hospitalization by immigration category and source region. DATA AND METHODS The Immigrant Landing File-Hospital Discharge Abstract Linked Database (n = 2.6 million) was used to derive sex-specific crude and age-standardized hospitalization rates (ASHRs) per 10,000 population for all-cause and leading causes of hospitalization during the 2006/2007-to-2008/2009 period. RESULTS Economic class immigrants had lower all-cause ASHRs than did their family class or refugee counterparts. Male refugees had high ASHRs overall and for circulatory diseases, digestive diseases, injury, and cancer. Female differences by immigrant class were less pronounced. All-cause ASHRs (excluding pregnancy) rose with years since arrival in Canada for male and female immigrants. Immigrants from East Asia had the lowest ASHRs; those from the United States, the highest. INTERPRETATION Although hospital use is an imperfect indicator of health status, this study supports an initial healthy immigrant effect and its subsequent decline. Marked differences emerged among immigrant subgroups with some, notably refugees and immigrants from the United States, having significantly higher hospitalization rates overall and for leading causes, compared with other groups.
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Affiliation(s)
- Edward Ng
- Health Analysis Division, Statistics Canada, Ottawa, Ontario
| | | | - Douglas G Manuel
- Health Analysis Division, Statistics Canada, the Ottawa Health Research Institute and the Institute of Clinical Evaluative Sciences
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Carrière G, Bougie E, Kohen D, Rotermann M, Sanmartin C. Acute care hospitalization by Aboriginal identity, Canada, 2006 through 2008. Health Rep 2016; 27:3-11. [PMID: 27532620] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND National data about acute care hospitalization of Aboriginal people are scarce. This study addresses that information gap by describing patterns of hospitalization by Aboriginal identity for leading diagnoses for all provinces and territories except Quebec. DATA AND METHODS The 2006 Census was linked to the 2006/2007-to-2008/2009 Discharge Abstract Database, which contains hospital records from all acute care facilities in Canada (excluding Quebec). With these linked data, hospital records could be examined by Aboriginal identity, as reported to the census. Hospitalizations were grouped by International Classification of Diseases (ICD-10) chapters based on "the most responsible diagnosis." Age-standardized hospitalization rates were calculated per 100,000 population, and rate ratios (RR) were calculated for Aboriginal groups relative to non-Aboriginal people. RESULTS Hospitalization rates were almost invariably higher for First Nations living on and off reserve, Métis, and Inuit living in Inuit Nunangat than for the non-Aboriginal population, regardless of ICD diagnostic chapter. The ranking of age-standardized hospitalization rates by frequency of diagnoses varied slightly by Aboriginal identity. RRs were highest among First Nations living on reserve, especially for endocrine, nutritional and metabolic diseases (RR = 4.9), mental and behavioural disorders (RR = 3.6), diseases of the respiratory system (RR = 3.3), and injuries (RR = 3.2). As well, the rate for endocrine, nutritional and metabolic diseases was high among First Nations living off reserve (RR = 2.7). RRs were also high among Inuit for mental and behavioural disorders (RR = 3.3) and for diseases of the respiratory system (RR = 2.7). INTERPRETATION Hospitalization rates varied by Aboriginal identity, and were consistent with recognized health disparities between Aboriginal and non-Aboriginal people. Because many factors besides health affect hospital use, further research is required to understand differences in hospital use by Aboriginal identity. These national data are relevant to health policy formulation and service delivery planning.
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Affiliation(s)
- Gisèle Carrière
- Health Analysis Division, Statistics Canada, Ottawa, Ontario
| | - Evelyne Bougie
- Health Analysis Division, Statistics Canada, Ottawa, Ontario
| | - Dafna Kohen
- Health Analysis Division, Statistics Canada, Ottawa, Ontario
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Abstract
Abstract.Background: The validity and reliability of suicide statistics have been
questioned and few nationwide studies of deliberate self-harm have been presented.
Aim: To calculate rates of deliberate self-harm in Denmark in order to
investigate trends and assess the reliability of hospital records.
Method: A register study based on all individuals recorded with an
episode of deliberate self-harm or probable deliberate self-harm in nationwide registers
during 1994–2011. Results: A substantial difference in the rates of
deliberate self-harm and probable deliberate self-harm was noted for both genders. The
average incidence rate of deliberate self-harm for women and men was 130.7 (95% CI =
129.6–131.8) per 100,000 and 86.9 (95% CI = 86.0–87.8) per 100,000, respectively. The
rates of deliberate self-harm for women increased from 137.6 (95% CI = 132.9–142.3) per
100,000 in 1994 to 152.7 (95% CI = 147.8–157.5) in 2011. For a subgroup of younger women
aged 15–24 years, an almost threefold increase was observed, IRR = 2.5 (95% CI = 2.4–2.7).
The most frequently used method was self-poisoning. Conclusion: The rates
of deliberate self-harm and probable deliberate self-harm differed significantly. An
increased incidence of deliberate self-harm among young Danish women was observed, despite
detection bias. An improved registration procedure of suicidal behavior is needed.
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Affiliation(s)
- Britt Reuter Morthorst
- 1 Research Unit, Mental Health Centre Copenhagen, Capital Region of Denmark, Denmark.,2 Faculty of Health Sciences, University of Copenhagen, Capital Region of Denmark, Denmark
| | - Bodil Soegaard
- 3 Department of Psychiatry, Region of Southern Denmark, Aabenraa, Denmark
| | - Merete Nordentoft
- 1 Research Unit, Mental Health Centre Copenhagen, Capital Region of Denmark, Denmark.,2 Faculty of Health Sciences, University of Copenhagen, Capital Region of Denmark, Denmark
| | - Annette Erlangsen
- 1 Research Unit, Mental Health Centre Copenhagen, Capital Region of Denmark, Denmark.,4 Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Nielsen TH. The Relationship Between Self-Rated Health and Hospital Records. Health Econ 2016; 25:497-512. [PMID: 25702929 DOI: 10.1002/hec.3167] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 12/05/2014] [Accepted: 01/27/2015] [Indexed: 05/03/2023]
Abstract
This paper investigates whether self-rated health (SRH) covaries with individual hospital records. By linking the Danish Longitudinal Survey on Ageing with individual hospital records covering all hospital admissions from 1995 to 2006, I show that SRH is correlated to historical, current, and future hospital records. I use both measures separately to control for health in a regression of mortality on wealth. Using only historical and current hospitalization controls for health yields the common result that SRH is a stronger predictor of mortality than objective health measures. The addition of future hospitalizations as controls shows that the estimated gradient on wealth is similar to one in which SRH is the control. The results suggest that with a sufficiently long time series of individual records, objective health measures can predict mortality to the same extent as global self-rated measures.
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Ng E, Sanmartin C, Tu JV, Manuel DG. All-cause and circulatory disease-related hospitalization, by generation status: Evidence from linked data. Health Rep 2015; 26:3-9. [PMID: 26488822] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Immigrants tend to have better health than the Canadian-born. However, the "healthy immigrant" effect diminishes over time and varies by source country. This study examines whether lower hospitalization rates persist from the first (G1) to the second generation (G2) of immigrants, compared with other Canadians (G3+). All-cause and circulatory disease-related hospitalization rates were examined by generation, with special attention to people of Chinese and South Asian descent. DATA AND METHODS Data from the 2006 Census-hospitalization linkage database (which excludes Quebec) were analysed using logistic regression. Age-standardized all-cause (excluding pregnancy) and circulatory disease-related hospitalization rates were derived for the urban population aged 30 or older for the 2006/2007 to 2008/2009 fiscal years. RESULTS Over the generations, immigrants' all-cause and circulatory disease-related hospitalization rates converged with those of the Canadian population overall. Compared with G3+, the age-adjusted odds of all-cause hospitalization among men were 0.49 (CI = 0.48-0.51) for recent G1 immigrants, 0.78 (CI = 0.77-0.79) for long-term G1 immigrants, and 0.95 (CI = 0.94-0.97) for G2. Adjustments for socioeconomic status reduced the difference, especially between G2 and G3+. For South Asians, rates converged for circulatory disease, notably among men. Hospitalization rates for people of Chinese descent rose across generations, but remained significantly below rates for G3+. INTERPRETATION The lower circulatory disease-related hospitalization risk experienced by G1 is maintained in G2 among people of Chinese descent, but not among South Asians.
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Affiliation(s)
- Edward Ng
- Health Analysis Division, Statistics Canada, Ottawa, Ontario
| | | | - Jack V Tu
- Institute for Clinical Evaluative Studies and the University of Toronto, Toronto, Ontario
| | - Douglas G Manuel
- Health Analysis Division, Statistics Canada, Ottawa Health Research Institute and the University of Ottawa, Ottawa, Ontario
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Rotermann M, Sanmartin C, Trudeau R, St-Jean H. Linking 2006 Census and hospital data in Canada. Health Rep 2015; 26:10-20. [PMID: 26488823] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Record linkage is commonly used in health research to fill data gaps. This study summarizes the linkage of the 2006 Census of Population (excluding Quebec) to hospital data from the Discharge Abstract Database (DAD). DATA AND METHODS Hierarchical deterministic exact matching was employed to link 2006 Census and DAD (2006/2007, 2007/2008 and 2008/2009) data, based on linkage keys derived from three variables common to both files-date of birth, postal code and sex. The full census file (short-form; 23.4 million) was used for record linkage; the 20% file (long-form; 4.65 million) representing the study cohort was used for validation. Linked files were compared across jurisdictions, years and other selected covariates in terms of eligibility for linkage, keys linked, and linkage and coverage rates. RESULTS Overall, 80% of linkage keys identified in the DAD were linked to the 2006 Census. The percentage of long-form census respondents linked to at least one hospital record ranged between 5% and 8% across jurisdictions; linkage rates were higher among known high users of hospital services: older age groups, lower-income individuals, and Aboriginal people. In general, the linked census file represents the majority of hospital events that occurred during the study period. Coverage rates (weighted/unweighted) varied by geography and age group, with lower weighted rates for the territories and some younger age groups. INTERPRETATION With hierarchical deterministic exact matching, census data can be linked to multiple years of DAD data. Incorporation of updated postal codes from tax files reduced linkage rate attrition over time. Lower coverage rates for the territories and younger age groups suggest that these populations may be underrepresented in the linked files.
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Affiliation(s)
| | | | - Richard Trudeau
- Special Surveys Division, Statistics Canada, Ottawa, Ontario
| | - Hélène St-Jean
- Household Survey Methods Division, Statistics Canada, Ottawa, Ontario
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Park TH, Choi JC. Validation of Stroke and Thrombolytic Therapy in Korean National Health Insurance Claim Data. J Clin Neurol 2015; 12:42-8. [PMID: 26365022 PMCID: PMC4712285 DOI: 10.3988/jcn.2016.12.1.42] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [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: 03/31/2015] [Revised: 06/08/2015] [Accepted: 06/10/2015] [Indexed: 11/17/2022] Open
Abstract
Background and Purpose The claims data of the Korean National Health Insurance (NHI) system can be useful in stroke research. The aim of this study was to validate the accuracy of hospital discharge data used for NHI claims in identifying acute stroke and use of thrombolytic therapy. Methods The hospital discharge data of 1,811 patients with stroke-related diagnosis codes were obtained from Jeju National University Hospital (JNUH) and Seoul Medical Center (SMC). Three algorithms were tested to identify discharges with acute stroke [ischemic stroke (IS), intracranial hemorrhage (ICH), or subarachnoid hemorrhage (SAH)]: 1) all diagnosis codes up to nine positions, 2) one primary diagnosis and one secondary diagnosis, and 3) only one primary diagnosis code. Reviews of medical records were considered the gold standards. Results Overall, the degree of agreement (κ) was higher for algorithms 1 and 2 than for algorithm 3, and the sensitivity and specificity of the first two algorithms for IS and SAH were both >90%, with almost perfect agreement (κ=0.83-0.84) in the JNUH data set. Regarding ICH, only algorithm 1 yielded an almost perfect agreement (κ=0.82). In the SMC data set, almost perfect agreement was found for both ICH and SAH in all three algorithms. In contrast, the three algorithms yielded a range of agreement levels, though all substantial, for IS. Almost perfect agreement was obtained for use of thrombolytic therapy in both data sets (κ=0.91-0.99). Conclusions Discharge with hemorrhagic stroke and use of thrombolytic therapy were identified with high reliability in administrative discharge data. A substantial level of agreement was also obtained for IS, despite variation between the algorithms and data sets.
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Affiliation(s)
- Tai Hwan Park
- Department of Neurology, Seoul Medical Center, Seoul, Korea
| | - Jay Chol Choi
- Department of Neurology, School of Medicine, Jeju National University, Jeju, Korea.
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39
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Rotermann M, Sanmartin C, Carrière G, Trudeau R, St-Jean H, Saïdi A, Reicker A, Ntwari A, Hortop E. Two approaches to linking census and hospital data. Health Rep 2014; 25:3-14. [PMID: 25317754] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND This study compares registry and non-registry approaches to linking 2006 Census of Population data for Manitoba and Ontario to hospital data from the Discharge Abstract Database (DAD). DATA AND METHODS Using a probabilistic linkage, the registry approach linked the census data to provincial health insurance registries, followed by a deterministic linkage to the DAD based on health insurance number (HIN). The non-registry approach used hierarchical deterministic exact matching based on three variables common to both files to link census data to the DAD. The approaches were compared in terms of linkage and coverage rates, sensitivity and specificity, and consistency of HINs on the linked records. RESULTS Results of the registry and non-registry linkage approaches were similar. In Manitoba, 7% and 6% of census long-form respondents linked to the DAD with the registry and non-registry linkage approaches, respectively; in Ontario, the linkage rate was 5% for both approaches. With the registry approach, the linked census-DAD data represented 84% (weighted) of hospital admissions in the 2006/2007 DAD in both provinces, compared with 82% in Manitoba and Ontario with the non-registry approach. INTERPRETATION In the absence of access to provincial health insurance registries with which census data can be linked, a non-registry approach can be used to create a research-quality dataset.
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Affiliation(s)
| | | | - Gisèle Carrière
- Health Analysis Division, Statistics Canada, Ottawa, Ontario K1A0T6
| | - Richard Trudeau
- Health Statistics Division, Statistics Canada, Ottawa, Ontario K1A0T6
| | - Hélène St-Jean
- Household Survey Methods Division, Statistics Canada, Ottawa, Ontario K1A0T6
| | - Abdelnasser Saïdi
- Household Survey Methods Division, Statistics Canada, Ottawa, Ontario K1A0T6
| | - Alexander Reicker
- Household Survey Methods Division, Statistics Canada, Ottawa, Ontario K1A0T6
| | - Aimé Ntwari
- Household Survey Methods Division, Statistics Canada, Ottawa, Ontario K1A0T6
| | - Eric Hortop
- Household Survey Methods Division, Statistics Canada, Ottawa, Ontario K1A0T6
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40
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Bougie E, Finès P, Oliver LN, Kohen DE. Unintentional injury hospitalizations and socio-economic status in areas with a high percentage of First Nations identity residents. Health Rep 2014; 25:3-12. [PMID: 24567245] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Few national studies of hospitalizations due to injuries among the First Nations population have been conducted. DATA AND METHODS Based on 2004/2005 to 2009/2010 data from the Discharge Abstract Database, this study examines associations between unintentional injury hospitalizations, socio-economic status and location relative to an urban core in Dissemination Areas (DAs) with a high percentage of First Nations identity residents versus a low percentage of Aboriginal identity residents. RESULTS Unintentional injury hospitalization rates were higher in the less affluent and the most remote DAs. When DAs with the same socio-economic status and location were compared, the risk of hospitalizations was greater in high-percentage First Nations identity DAs relative to low-percentage Aboriginal identity DAs. INTERPRETATION Socio-economic conditions and remote location accounted for some, but not all, of the differences in unintentional injury hospitalizations between high-percentage First Nations identity and low-percentage Aboriginal identity DAs. This suggests that characteristics not measured in this analysis--such as environmental, behavioural or other factors--play an additional role in DA-level unintentional injury hospitalization risk.
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Affiliation(s)
- Evelyne Bougie
- Health Analysis Division, Statistics Canada, Ottawa, Canada
| | - Philippe Finès
- Health Analysis Division, Statistics Canada, Ottawa, Canada
| | - Lisa N Oliver
- Health Analysis Division, Statistics Canada, Ottawa, Canada
| | - Dafna E Kohen
- Health Analysis Division, Statistics Canada, Ottawa, Canada
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Aksoy N, Arli S, Yigit O. A Retrospective Analysis of the Burn Injury Patients Records in the Emergency Department, an Epidemiologic Study. Emerg (Tehran) 2014; 2:115-20. [PMID: 26495361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Burns can be very destructive, and severely endanger the health and lives of humans. It maybe cause disability and even psychological trauma in individuals. . Such an event can also lead to economic burden on victim's families and society. The aim of our study is to evaluate epidemiology and outcome of burn patients referring to emergency department. METHODS This is a cross-sectional study was conducted by evaluation of patients' files and forensic reports of burned patients' referred to the emergency department (ED) of Akdeniz hospital, Turkey, 2008. Demographic data, the season, place, reason, anatomical sites, total body surface area, degrees, proceeding treatment, and admission time were recorded. Multinomial logistic regression was used to compare frequencies' differences among single categorized variables. Stepwise logistic regression was applied to develop a predictive model for hospitalization. P<0.05 was defined as a significant level. RESULTS Two hundred thirty patients were enrolled (53.9% female). The mean of patients' ages was 25.3 ± 22.3 years. The most prevalence of burn were in the 0-6 age group and most of which was hot liquid scalding (71.3%). The most affected parts of the body were the left and right upper extremities. With increasing the severity of triage level (OR=2.2; 95% CI: 1.02-4.66; p=0.046), intentional burn (OR=4.7; 95% CI: 1.03-21.8; p=0.047), referring from other hospitals or clinics (OR=3.4; 95% CI: 1.7-6.6; p=0.001), and percentage of burn (OR=18.1; 95% CI: 5.42-62.6; p<0.001) were independent predictive factor for hospitalization. In addition, odds of hospitalization was lower in patients older than 15 years (OR=0.7; 95% CI: 0.5-0.91; p=0.035). CONCLUSION This study revealed the most frequent burns are encountered in the age group of 0-6 years, percentage of <10%, second degree, upper extremities, indoor, and scalding from hot liquids. Increasing ESI severity, intentional burn, referring from other hospitals or clinics, and the percentage of burn were independent predictive factors for hospitalization.
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Hoover M, Rotermann M, Sanmartin C, Bernier J. Validation of an index to estimate the prevalence of frailty among community-dwelling seniors. Health Rep 2013; 24:10-17. [PMID: 24258362] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND This study validates cut-points for a frailty index (FI) to identify seniors at risk of a hospital-related event and estimates the number of frail seniors living in the community. The FI developed by Rockwood and Mitnitski defines levels of frailty based on scores of 0 to 1.0. DATA AND METHODS The cut-point validation was conducted using Stratum-Specific Likelihood Ratios applied to combined 2003 and 2005 Canadian Community Health Survey (CCHS) data, linked to hospital records from the Discharge Abstract Database (2002 to 2007). Based on the validated cut-points, frailty prevalence was estimated using 2009/2010 CCHS data. RESULTS Seniors scoring more than 0.21 on the FI were considered to be at elevated risk of hospital-related events. Four additional frailty levels were identified: non-frail (0 to ≤0.1), pre-frail (>0.1 to ≤0.21), more frail (>0.30 to ≤0.35) (women only), and most frail (frail-group subset) (0.45 or more). The number of community-dwelling seniors considered to be frail was estimated at about 1 million (24%) in 2009/2010; another 1.4 million (32%) could be considered pre-frail. Frailty prevalence rose with age; was higher among women than among men; and varied by geographic location. INTERPRETATION A cut-point of more than 0.21 can be used to identify frail seniors living in the community.
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Affiliation(s)
- Melanie Hoover
- Health Statistics Division, Statistics Canada, Ottawa, Ontario, K1A 0T6.
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Wei-Randall HK, Davidson MJ, Jin J, Mathur S, Oliver L. Acute myocardial infarction hospitalization and treatment: Areas with a high percentage of First Nations identity residents. Health Rep 2013; 24:3-10. [PMID: 24258279] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Deaths from acute myocardial infarction (AMI) are higher among First Nations people than among non-Aboriginal Canadians. Hospital interventions often involve revascularization: percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). Because patients' ethnicity is not reported consistently in hospital records, no national information is available about AMI hospitalizations or the use of such procedures among First Nations people. DATA AND METHODS This study uses an area-based approach to identify AMI hospital patients who live in Dissemination Areas with relatively high percentages of First Nations residents. Within the AMI patient cohort, procedures received during the hospital admission were identified. RESULTS The age-standardized hospitalized AMI event rates were 276.8 per 100,000 population for residents of high-percentage First Nations identity areas and 157.1 per 100,000 population for residents of low-percentage Aboriginal identity areas. AMI patients from high-percentage First Nations identity areas were less likely than patients from low-percentage Aboriginal identity areas to undergo revascularization, a difference largely driven by a lower PCI procedure rate. The lower PCI procedure rate persisted when controlling for age, sex, rural/urban residence, and the patient's condition at admission. INTERPRETATION Residents of high-percentage First Nations identity areas were more likely to be hospitalized for AMI, but were less likely to undergo revascularization.
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Amiri M, Lornejad HR, Barakati SH, Motlagh ME, Kelishadi R, Poursafa P. Mortality inequality in 1-59 months children across Iranian provinces: referring system and determinants of death based on hospital records. Int J Prev Med 2013; 4:265-70. [PMID: 23626882 PMCID: PMC3634164] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Accepted: 11/21/2012] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND To determine inequality in mortality in 1-59 months children across Iranian provinces focusing on referring system and determinants of death. METHODS After designing and examining a national questionnaire for mortality data collection of children 1-59 months, 40 medical universities have been asked to fill in the questionnaires and return to the main researcher in the health ministry in 2009. RESULTS Mortality in 1-59 months children was unequally distributed across provinces (universities). The recommended refer was 3466 but only 1620 patients were referred. The first five important determinants of death were congenital (671 children or 20.9%), accident (547 children or 17.1%), pulmonary diseases (370 children or 11.5%), cardiovascular (266 children or less than 8.3%), central nervous system (263 children or 8.2%), and infectious and parasitic diseases (245 children or 7.6%), respectively. CONCLUSIONS Our results suggest that inequality in 1-59 months mortality based on the hospital records, and specially referring system, needs more attention in Iran. In addition, it is advisable to conduct provincially representative surveys to provide recent estimates of hospital access inequalities and to allow monitoring over time.
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Affiliation(s)
- Masoud Amiri
- Social Health Determinants Research Canter and Department of Epidemiology and Biostatistics, School of Health, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Hamid Reza Lornejad
- Child Mortality Surveillance office, Ministry of Health and Medical Education, Tehran, Iran
| | | | - Mohammad Esmaeil Motlagh
- Department of Pediatrics, Jondishapour University of Medical Sciences, Ahwaz, Iran, and Community, Family and Schools Health Office, Ministry of Health and Medical Education, Tehran, Iran,Correspondence to: Prof. Mohammad Esmaeil Motlagh, Department of Pediatrics, Jondishapour University of Medical Sciences, Ahwaz, Iran, and Community, Family and Schools Health Office, Ministry of Health and Medical Education, Tehran, Iran. E-mail:
| | - Roya Kelishadi
- Child Growth and Development Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Parinaz Poursafa
- Child Growth and Development Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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