Defining a low-risk birth cohort: a cohort study comparing two perinatal data sets in Ontario, Canada

Introduction

There are two main data sources for perinatal data in Ontario, Canada: the BORN BIS and CIHI-DAD. Such databases are used for perinatal health surveillance and research, and to guide health care related decisions.

Objectives

Our primary objective was to examine the level of agreement between the BIS and CIHI-DAD. Our secondary objectives were to identify the differences between the data sources when identifying a low-risk birth (LRB) cohort and to understand their implications.

Methods

We conducted a population-based cohort study comparing characteristics and clinical outcomes of all linkable births in BIS and CIHI-DAD between 1st April 2012 and 31st March 2018. We excluded out-of-hospital births, those with invalid healthcare numbers, non-Ontario residents and gestational age <20 weeks. We compared the portion of the cohort that met the criteria of a provincial definition of LRB based on each data source and compared clinical outcomes between the groups.

Results

During the study period, 779,979 eligible births were linkable between the two data sources. After applying the LRB exclusions, there were 129,908 cases in the BIS and 136,184 cases in CIHI-DAD. Most exclusion criteria had almost perfect, substantial or moderate agreement. The agreement for non-cephalic presentation and BMI ≥ 40 kg/m2 (kappa coefficients 0.409 and 0.256, respectively) was fair. Comparison between the two LRB cohorts identified differences in the prevalence of cesarean (14.3% BIS versus 12.0% CIHI-DAD) and NICU admission (8.7% BIS versus 7.5% CIHI-DAD) and only 0.01% difference in the prevalence of ICU admission.

Conclusions

Overall, we found high levels of agreement between the BIS and CIHI-DAD. Identifying a LRB cohort in either database may be appropriate, with the caveat of appropriate understanding of the collection, coding and definition of certain outcomes. The decision for selecting a database may depend on which variables are most important in a particular analysis.

Delivered relative dose intensity in adolescent and young adult germ cell tumours in England: Assessment of data quality and consistency from clinical trials compared to national cancer registration data

Adolescent and young adults (AYA) with germ cell tumours (GCT) have poorer survival rates than children and many older adults with the same cancers. There are several likely contributing factors to this, including the treatment received. The prognostic benefit of intended dose intensity is well documented in GCT from trials comparing regimens. However, evidence specific to AYA is limited by poor recruitment of AYA to trials and dose delivery outside trials not being well examined. We examined the utility of cancer registration data and a clinical trials dataset to investigate the delivery of relative dose intensity (RDI) in routine National Health Service practice in England, compared to within international clinical trials. Linked data from the Cancer Outcomes and Services Dataset (COSD) and the Systemic Anti-Cancer Therapy (SACT) dataset, and data from four international clinical trials were analysed. Survival over time was described using Kaplan-Meier estimation; overall, by age category, International Germ-Cell Cancer Collaborative Group (IGCCCG) classification, stage, tumour subtype, primary site, ethnicity and deprivation. Cox regression models were used to determine the fully adjusted effect of RDI on mortality risk. The quality of both datasets was critically evaluated and clinically enhanced. RDI was found to be well maintained in all datasets with higher RDIs associated with improved survival outcomes. Real-world data demonstrated several strengths, including population coverage and inclusion of sociodemographic variables and comorbidity. It is limited in GCT however, by the poor completion of data items enabling risk classification of patients and a higher proportion of missing data.

Is parent education a factor in identifying autism/takiwātanga in an ethnic cohort of Pacific children in Aotearoa, New Zealand? A national cross-sectional study using linked administrative data

LAY ABSTRACT

Previous studies of autism in Aotearoa, New Zealand, suggest that fewer Pacific children receive an autism diagnosis compared to European children. This study aimed to explore if formal education qualification of parents is related to receiving an autism diagnosis for their Pacific child. Our findings show that autism was identified in 1.1% of Pacific children compared with 1.6% among non-Māori, non-Pacific children. Parents with higher levels of education were more likely to receive an autism diagnosis for their Pacific child. While the study findings indicate education plays a positive role in receiving a diagnosis for autistic children, they suggest a systemic failure of supporting Pacific parents and communities to navigate the health and education systems that exist in Aotearoa, New Zealand.

Complete Mitochondrial DNA Genome Variation in the Swedish Population

The development of complete mitochondrial genome (mitogenome) reference data for inclusion in publicly available population databases is currently underway, and the generation of more high-quality mitogenomes will only enhance the statistical power of this forensically useful locus. To characterize mitogenome variation in Sweden, the mitochondrial DNA (mtDNA) reads from the SweGen whole genome sequencing (WGS) dataset were analyzed. To overcome the interference from low-frequency nuclear mtDNA segments (NUMTs), a 10% variant frequency threshold was applied for the analysis. In total, 934 forensic-quality mitogenome haplotypes were characterized. Almost 45% of the SweGen haplotypes belonged to haplogroup H. Nearly all mitogenome haplotypes (99.1%) were assigned to European haplogroups, which was expected based on previous mtDNA studies of the Swedish population. There were signature northern Swedish and Finnish haplogroups observed in the dataset (e.g., U5b1, W1a), consistent with the nuclear DNA analyses of the SweGen data. The complete mitogenome analysis resulted in high haplotype diversity (0.9996) with a random match probability of 0.15%. Overall, the SweGen mitogenomes provide a large mtDNA reference dataset for the Swedish population and also contribute to the effort to estimate global mitogenome haplotype frequencies.

Advanced variant classification framework reduces the false positive rate of predicted loss-of-function variants in population sequencing data

Predicted loss of function (pLoF) variants are often highly deleterious and play an important role in disease biology, but many pLoF variants may not result in loss of function (LoF). Here we present a framework that advances interpretation of pLoF variants in research and clinical settings by considering three categories of LoF evasion: (1) predicted rescue by secondary sequence properties, (2) uncertain biological relevance, and (3) potential technical artifacts. We also provide recommendations on adjustments to ACMG/AMP guidelines' PVS1 criterion. Applying this framework to all high-confidence pLoF variants in 22 genes associated with autosomal-recessive disease from the Genome Aggregation Database (gnomAD v.2.1.1) revealed predicted LoF evasion or potential artifacts in 27.3% (304/1,113) of variants. The major reasons were location in the last exon, in a homopolymer repeat, in a low proportion expressed across transcripts (pext) scored region, or the presence of cryptic in-frame splice rescues. Variants predicted to evade LoF or to be potential artifacts were enriched for ClinVar benign variants. PVS1 was downgraded in 99.4% (162/163) of pLoF variants predicted as likely not LoF/not LoF, with 17.2% (28/163) downgraded as a result of our framework, adding to previous guidelines. Variant pathogenicity was affected (mostly from likely pathogenic to VUS) in 20 (71.4%) of these 28 variants. This framework guides assessment of pLoF variants beyond standard annotation pipelines and substantially reduces false positive rates, which is key to ensure accurate LoF variant prediction in both a research and clinical setting.

Genetic Polymorphism and Population Genetic Structure Analysis of 21 Autosomal STR Loci for a Han-Chinese Population from Luzhou of Southwest China

The Han nationality is an ancient and populous people, and different places in China may have their distinct group relationships. Luzhou area, as a crossroads of several provinces in Southwest China, lacks autosomal short tandem repeat (STR) research and population genetics research. In this study, 21 autosomal STR loci were evaluated in 1959 Han-Chinese individuals from Luzhou area. There was no substantial linkage disequilibrium (LD) among the 21 autosomal STR markers, and all markers were in Hardy-Weinberg equilibrium (HWE). The total discrimination power (TDP) and cumulative probability of exclusion (CPE) of the 21 autosomal STR loci were calculated to be 1-9.8505 × 10^-16 and 1-1.9406 × 10^-9, respectively. There were 333 alleles for 21 STRs with allelic frequencies ranging from 0.00026 to 0.51302, and the number of alleles ranged from 7 in locus TPOX to 29 in locus Penta E. According to the results of population comparison and population differentiation, historical influences, geographical distribution, cultural integration, and economic development may have an impact on the Luzhou Han population and other Chinese populations. These 21 STR loci were found to enrich autosomal STR information in forensic databases and provide highly informative polymorphisms for our forensic practice in China, including personal identification and parentage testing.

Consultation Rate and Mode by Deprivation in English General Practice From 2018 to 2022: Population-Based Study

BACKGROUND

The COVID-19 pandemic has had a significant impact on primary care service delivery with an increased use of remote consultations. With general practice delivering record numbers of appointments and rising concerns around access, funding, and staffing in the UK National Health Service, we assessed contemporary trends in consultation rate and modes (ie, face-to-face versus remote).

OBJECTIVE

This paper describes trends in consultation rates in general practice in England for key demographics before and during the COVID-19 pandemic. We explore the use of remote and face-to-face consultations with regard to socioeconomic deprivation to understand the possible effect of changes in consultation modes on health inequalities.

METHODS

We did a retrospective analysis of 9,429,919 consultations by general practitioners, nurses, or other health care professionals between March 2018 and February 2022 for patients registered at 397 general practices in England. We used routine electronic health records from Clinical Practice Research Datalink Aurum with linkage to national data sets. Negative binomial models were used to predict consultation rates and modes (ie, remote versus face-to-face) by age, sex, and socioeconomic deprivation over time.

RESULTS

Overall consultation rates increased by 15% from 4.92 in 2018-2019 to 5.66 in 2021-2022 with some fluctuation during the start of the COVID-19 pandemic. The breakdown into face-to-face and remote consultations shows that the pandemic precipitated a rapid increase in remote consultations across all groups, but the extent varies by age. Consultation rates increased with increasing levels of deprivation. Socioeconomic differences in consultation rates, adjusted for sex and age, halved during the pandemic (from 0.36 to 0.18, indicating more consultations in the most deprived), effectively narrowing relative differences between deprivation quintiles. This trend remains when stratified by sex, but the difference across deprivation quintiles is smaller for men. The most deprived saw a relatively larger increase in remote and decrease in face-to-face consultation rates compared to the least deprived.

CONCLUSIONS

The substantial increases in consultation rates observed in this study imply an increased pressure on general practice. The narrowing of consultation rates between deprivation quintiles is cause for concern, given ample evidence that health needs are greater in more deprived areas.

Breast Cancer: Impact of New Treatments?

BACKGROUND

Breast cancer treatment has seen tremendous progress since the early 1980s, with the first findings of new chemotherapy and hormone therapies. Screening started in the same period.

METHODS

A review of population data (SEER and the literature) shows an increase in recurrence-free survival until 2000 and it stagnates afterwards.

RESULTS

Over the period 1980-2000, the 15% survival gain was presented by pharma as a contribution of new molecules. The contribution of screening during that same period was not implemented by them, although screening has been accepted as a routine procedure in the States since the 1980s and everywhere else since 2000.

CONCLUSIONS

Interpretation of breast cancer outcome has largely focused on drugs, whereas other factors, such as screening, prevention, biologics, and genetics, were largely neglected. More attention should now be paid to examining the strategy based on realistic global data.

A profile of the Grampian Data Safe Haven, a regional Scottish safe haven for health and population data research

There has been a recent emphasis to establish and codify large-scale or national Trusted Research Environments (TREs) in the United Kingdom, with a view to limit smaller, local TREs. The basis for this argument is that it avoids duplication of infrastructure, information governance, privacy risks, monopolies and will promote innovation, particularly with commercial partners. However, the work around establishing TREs in the UK largely ignores the long-established local TRE landscape in Scotland, and the way in which local TREs can actually improve data quality, solve technical architecture challenges, promote information governance and risk minimisation, and encourage innovation and collaboration (both academic and commercial). This data centre profile focuses on the Grampian Data Safe Haven (DaSH), a secure, virtual healthcare data analysis and storage centre located in Aberdeen, Scotland. DaSH was co-established by the NHS Grampian Health Board and University of Aberdeen to allow for the secure processing and linking of health data for the Grampian and Scottish population when it is not practicable to obtain consent from individual patients. As an established trusted research environment now in its 10th operating year, DaSH technology ensures healthcare, social care data and other types of sensitive data, routinely collected and used without individual patient consent, are made accessible for both academic research and clinical service evaluation and improvements whilst protecting individuals' privacy at the local, national and international levels. DaSH has registered almost 600 projects and facilitated over 200 distinct research projects with data hosting, extraction, and novel linkages to completion. Ongoing innovation and collaboration between DaSH and the NHS Grampian Health Board continues to expand researcher access to new types of data and data linkages, introduce new technologies for advanced statistical research methods, and supports interdisciplinary research using population health and social care data for research, clinical and commercial advancements, and real-world practitioner applications. The purpose of this paper is to present DaSH's data population, operating model, architecture and information technology, governance, legislation and management, privacy-by-design principles and data access, data linkage methods, data sources, noteworthy research outputs, and further developments in order to demonstrate the value of local TREs within the data management and access debate.

Advanced variant classification framework reduces the false positive rate of predicted loss of function (pLoF) variants in population sequencing data

Predicted loss of function (pLoF) variants are highly deleterious and play an important role in disease biology, but many of these variants may not actually result in loss-of-function. Here we present a framework that advances interpretation of pLoF variants in research and clinical settings by considering three categories of LoF evasion: (1) predicted rescue by secondary sequence properties, (2) uncertain biological relevance, and (3) potential technical artifacts. We also provide recommendations on adjustments to ACMG/AMP guidelines's PVS1 criterion. Applying this framework to all high-confidence pLoF variants in 22 autosomal recessive disease-genes from the Genome Aggregation Database (gnomAD, v2.1.1) revealed predicted LoF evasion or potential artifacts in 27.3% (304/1,113) of variants. The major reasons were location in the last exon, in a homopolymer repeat, in low per-base expression (pext) score regions, or the presence of cryptic splice rescues. Variants predicted to be potential artifacts or to evade LoF were enriched for ClinVar benign variants. PVS1 was downgraded in 99.4% (162/163) of LoF evading variants assessed, with 17.2% (28/163) downgraded as a result of our framework, adding to previous guidelines. Variant pathogenicity was affected (mostly from likely pathogenic to VUS) in 20 (71.4%) of these 28 variants. This framework guides assessment of pLoF variants beyond standard annotation pipelines, and substantially reduces false positive rates, which is key to ensure accurate LoF variant prediction in both a research and clinical setting.

Associations of Preterm Birth with Dental and Gastrointestinal Diseases: Machine Learning Analysis Using National Health Insurance Data

BACKGROUND

This study uses machine learning with large-scale population data to assess the associations of preterm birth (PTB) with dental and gastrointestinal diseases.

METHODS

Population-based retrospective cohort data came from Korea National Health Insurance claims for 124,606 primiparous women aged 25-40 and delivered in 2017. The 186 independent variables included demographic/socioeconomic determinants, disease information, and medication history. Machine learning analysis was used to establish the prediction model of PTB. Random forest variable importance was used for identifying major determinants of PTB and testing its associations with dental and gastrointestinal diseases, medication history, and socioeconomic status.

RESULTS

The random forest with oversampling data registered an accuracy of 84.03, and the areas under the receiver-operating-characteristic curves with the range of 84.03-84.04. Based on random forest variable importance with oversampling data, PTB has strong associations with socioeconomic status (0.284), age (0.214), year 2014 gastroesophageal reflux disease (GERD) (0.026), year 2015 GERD (0.026), year 2013 GERD (0.024), progesterone (0.024), year 2012 GERD (0.023), year 2011 GERD (0.021), tricyclic antidepressant (0.020) and year 2016 infertility (0.019). For example, the accuracy of the model will decrease by 28.4%, 2.6%, or 1.9% if the values of socioeconomic status, year 2014 GERD, or year 2016 infertility are randomly permutated (or shuffled).

CONCLUSION

By using machine learning, we established a valid prediction model for PTB. PTB has strong associations with GERD and infertility. Pregnant women need close surveillance for gastrointestinal and obstetric risks at the same time.

British Gynaecological Cancer Society Recommendations for Evidence Based, Population Data Derived Quality Performance Indicators for Ovarian Cancer

Ovarian cancer survival in the UK lags behind comparable countries. Results from the ongoing National Ovarian Cancer Audit feasibility pilot (OCAFP) show that approximately 1 in 4 women with advanced ovarian cancer (Stage 2, 3, 4 and unstaged cancer) do not receive any anticancer treatment and only 51% in England receive international standard of care treatment, i.e., the combination of surgery and chemotherapy. The audit has also demonstrated wide variation in the percentage of women receiving anticancer treatment for advanced ovarian cancer, be it surgery or chemotherapy across the 19 geographical regions for organisation of cancer delivery (Cancer Alliances). Receipt of treatment also correlates with survival: 5 year Cancer survival varies from 28.6% to 49.6% across England. Here, we take a systems wide approach encompassing both diagnostic pathways and cancer treatment, derived from the whole cohort of women with ovarian cancer to set out recommendations and quality performance indicators (QPI). A multidisciplinary panel established by the British Gynaecological Cancer Society carefully identified QPI against criteria: metrics selected were those easily evaluable nationally using routinely available data and where there was a clear evidence base to support interventions. These QPI will be valuable to other taxpayer funded systems with national data collection mechanisms and are to our knowledge the only population level data derived standards in ovarian cancer. We also identify interventions for Best practice and Research recommendations.

Genetic diversity of 15 STR loci in Yunnan Va ethnic minority and the phylogenetic relationships with 26 other populations

BACKGROUND

The Va (also called "Wa") people are an ethnic minority living mainly in the southwest of Yunnan Province.

AIM

This study was conducted to obtain the genetic information and forensic statistical parameters of 15 autosomal short tandem repeat (STR) loci included in the AmpFlSTR^®Identifiler™ kit (Applied Biosystems, Foster City, CA) in the Yunnan Va population, with a view to enriching the genetic databases of the Chinese Va population.

SUBJECTS AND METHODS

A total of 508 unrelated Chinese Va individuals were genotyped with this 15 STR kit, the genetic polymorphisms and associated forensic parameters were calculated. The genetic relationships between Chinese Va and 26 other Chinese populations were also evaluated.

RESULTS

All of the STR loci reached the Hardy-Weinberg equilibrium after Bonferroni correction. A total of 159 alleles were observed with allele frequencies ranging from 0.000984 to 0.606299. The combined discrimination power (CDP) and the cumulative probability of excluding (CPE) of the 15 STR loci were 0.999 999 999 999 999 988 126 and 0.999 995 734, respectively. Our results indicated that the geographically adjacent or ethnically close populations showed a higher genetic affinity.

CONCLUSIONS

The results of this study will enrich the forensic databases of the Chinese Va population and could be applied in forensic analysis.

[Spatialization and Spatio-temporal Dynamics of Energy Consumption Carbon Emissions in China]

The adverse effects of global climate change on human production and life are becoming increasingly prominent. Responding to climate change has become a severe challenge faced by human society, and the reduction in greenhouse gas emissions has gradually become a common action by all countries. Therefore, analyzing carbon emissions through scientific methods has become an important foundation for responding to the national "dual carbon" strategy. This study used provincial-level carbon emission statistics, combined with nighttime light data and population data, and assigned carbon emissions to the grid scale. It also analyzed the temporal and spatial characteristics and evolution characteristics of carbon emissions in China in 2000, 2005, 2010, 2015, and 2018, as well as the correlation between carbon emissions and the economy. The results showed that:① from 2000 to 2018, the total CO₂ emissions in China continued to grow, but the growth rate slowed over time. The average annual growth rate of carbon emissions dropped from 9.9% in 2000-2010 to 7.4% in 2010-2018. From the perspective of spatial distribution, carbon-free areas were mainly distributed in the northwest uninhabited area and northeast forest and mountainous areas, low-carbon emissions were mainly distributed in the vast small and medium-sized cities and towns, and high-carbon emissions were concentrated in northern, central, eastern coastal, and western provincial capitals and urban agglomerations. ② Carbon emissions had high-value or low-value agglomerations at prefecture-level cities; this agglomeration tended to stabilize as a whole and had strengthened after 2005. Low-low agglomeration areas were mainly distributed in the western contiguous areas and Hainan Island. With economic and social development, low-low agglomeration areas began to fragment and reduce in size; high-high agglomeration areas were mainly distributed in the Beijing-Tianjin-Hebei urban agglomeration, Taiyuan urban agglomeration, Yangtze River Delta urban agglomerations, and Pearl River Delta urban agglomerations, and the scale was gradually strengthened and consolidated; high-low and low-high agglomeration areas mainly appeared in neighboring cities with large differences in economic development levels. ③ Carbon emissions in most parts of China were relatively stable. The areas where carbon emissions had changed were mainly distributed in the peripheral areas of provincial capitals and key cities, and there was a circle structure with no changes in the central urban area and changes in carbon emissions in the peripheral areas. ④ The overall process of urban development in China from 2000 to 2018 followed a shift from "low emission-low income" to "high emission-low income" to "high emission-high income" and finally to "low emission-high income." The growth rate of carbon emissions in China is slowing down. Under the background of the "dual carbon" strategy, different regions face different carbon emission reduction tasks and pressures due to different carbon emission situations. Therefore, the differentiated carbon emissions policy should be implemented by regions and industries.

The Need for a Data Ecosystem for Youth Mental Health in The Netherlands

The Netherlands is missing nationally representative data on child and adolescent mental health, e.g., on prevalence, course, and consequences of psychological disorders and mental health care utilization. Researchers and policy makers also lack a basic data infrastructure that is necessary to provide timely and reliable data crucial for benchmarking and informed decision making. In this article, we describe the necessity for a clear and well-organized overview of data on youth mental health and mental health care. We look back on three key moments in time to illustrate the breadth of the desire for data. Barriers in collecting structured, national data on a frequent basis are discussed, and several recommendations are provided of what is needed to move towards a data ecosystem that can help us to track the development and mental well-being of all children and youth and the impact of the care they receive.

Medication Burden among Pediatric Cancer Survivors: Analysis of a Population-Wide Electronic Database in Hong Kong

BACKGROUND

Few studies have evaluated the medication burden borne by survivors of pediatric cancer. This study aimed to describe the drug utilization pattern of chronic medications in a cohort of young pediatric cancer survivors.

METHODS

This was a population-based study of patients diagnosed with cancer at aged ≤18 years between 2000 and 2013 in Hong Kong, and had survived ≥5 years post-diagnosis. The primary outcome is the use of any chronic medication (medications that were prescribed for ≥30 consecutive days within a 6-month period). Multivariable log-binomial models were used to identify factors associated with chronic medication use. Kaplan-Meier analysis was used to present the cumulative proportion of survivors initiated on a chronic medication across time from cancer diagnosis.

RESULTS

Of the 2,444 survivors (median age = 22 years, IQR = 16-27 years), 669 (27.4%) required ≥1 chronic medication at ≥ 5 years post-diagnosis. Survivors who developed a chronic health condition (CHC) had a 5.48 (95% CI 4.49-6.71) times higher risk of taking a chronic medication than those without CHC. At 10 years post-diagnosis, the cumulative proportion of survivors being initiated a chronic medication was 33.4% (95% CI 31.1-35.6%) for the overall cohort. Higher cumulative proportions were observed in survivors with endocrine (74.6%, 95% CI 68.4-79.6%), renal (68.8%, 95% CI 54.2-78.7%), neurological (58.6%, 95% CI 46.1-68.1%) and cardiovascular (54.7%, 95% CI 44.0-63.4%) disorders.

CONCLUSION

Survivors with certain CHCs had a higher risk of starting a prescription medication early phase of survivorship. Future studies include examining the impact of medication burden on survivors' functional status.

A systematic review of the biological, social, and environmental determinants of intellectual disability in children and adolescents

AIM

This systematic review aimed to identify the most important social, environmental, biological, and/or genetic risk factors for intellectual disability (ID).

METHODS

Eligible were published prospective or retrospective comparative studies investigating risk factors for ID in children 4-18 years. Exclusions were single group studies with no comparator without ID and a sample size <100. Electronic databases (Medline, Cochrane Library, EMBASE, PsycInfo, Campbell Collaboration, and CINAHL) were searched for eligible publications from 1980 to 2020. Joanna Briggs Institute critical appraisal instruments, appropriate for study type, were used to assess study quality and risk of bias. Descriptive characteristics and individual study results were presented followed by the synthesis for individual risk factors, also assessed using GRADE.

RESULTS

Fifty-eight individual eligible studies were grouped into six exposure topics: sociodemographic; antenatal and perinatal; maternal physical health; maternal mental health; environmental; genetic or biological studies. There were few eligible genetic studies. For half the topics, the certainty of evidence (GRADE) was moderate or high.

CONCLUSION

Multiple studies have examined individual potential determinants of ID, but few have investigated holistically to identify those populations most at risk. Our review would indicate that there are vulnerable groups where risk factors we identified, such as low socioeconomic status, minority ethnicity, teenage motherhood, maternal mental illness, and alcohol abuse, may cluster, highlighting a target for preventive strategies. At-risk populations need to be identified and monitored so that interventions can be implemented when appropriate, at preconception, during pregnancy, or after birth. This could reduce the likelihood of ID and provide optimal opportunities for vulnerable infants.

SYSTEMATIC REVIEW REGISTRATION

[https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=120032], identifier [CRD42019120032].

Has demography witnessed a data revolution? Promises and pitfalls of a changing data ecosystem

Over the past 25 years, technological improvements that have made the collection, transmission, storage, and analysis of data significantly easier and more cost efficient have ushered in what has been described as the 'big data' era or the 'data revolution'. In the social sciences context, the data revolution has often been characterized in terms of increased volume and variety of data, and much excitement has focused on the growing opportunity to repurpose data that are the by-products of the digitalization of social life for research. However, many features of the data revolution are not new for demographers, who have long used large-scale population data and been accustomed to repurposing imperfect data not originally collected for research. Nevertheless, I argue that demography, too, has been affected by the data revolution, and the data ecosystem for demographic research has been significantly enriched. These developments have occurred across two dimensions. The first involves the augmented granularity, variety, and opportunities for linkage that have bolstered the capabilities of 'old' big population data sources, such as censuses, administrative data, and surveys. The second involves the growing interest in and use of 'new' big data sources, such as 'digital traces' generated through internet and mobile phone use, and related to this, the emergence of 'digital demography'. These developments have enabled new opportunities and offer much promise moving forward, but they also raise important ethical, technical, and conceptual challenges for the field.

Developing the Total Health Profile, a Generalizable Unified Set of Multimorbidity Risk Scores Derived From Machine Learning for Broad Patient Populations: Retrospective Cohort Study

BACKGROUND

Multimorbidity clinical risk scores allow clinicians to quickly assess their patients' health for decision making, often for recommendation to care management programs. However, these scores are limited by several issues: existing multimorbidity scores (1) are generally limited to one data group (eg, diagnoses, labs) and may be missing vital information, (2) are usually limited to specific demographic groups (eg, age), and (3) do not formally provide any granularity in the form of more nuanced multimorbidity risk scores to direct clinician attention.

OBJECTIVE

Using diagnosis, lab, prescription, procedure, and demographic data from electronic health records (EHRs), we developed a physiologically diverse and generalizable set of multimorbidity risk scores.

METHODS

Using EHR data from a nationwide cohort of patients, we developed the total health profile, a set of six integrated risk scores reflecting five distinct organ systems and overall health. We selected the occurrence of an inpatient hospital visitation over a 2-year follow-up window, attributable to specific organ systems, as our risk endpoint. Using a physician-curated set of features, we trained six machine learning models on 794,294 patients to predict the calibrated probability of the aforementioned endpoint, producing risk scores for heart, lung, neuro, kidney, and digestive functions and a sixth score for combined risk. We evaluated the scores using a held-out test cohort of 198,574 patients.

RESULTS

Study patients closely matched national census averages, with a median age of 41 years, a median income of $66,829, and racial averages by zip code of 73.8% White, 5.9% Asian, and 11.9% African American. All models were well calibrated and demonstrated strong performance with areas under the receiver operating curve (AUROCs) of 0.83 for the total health score (THS), 0.89 for heart, 0.86 for lung, 0.84 for neuro, 0.90 for kidney, and 0.83 for digestive functions. There was consistent performance of this scoring system across sexes, diverse patient ages, and zip code income levels. Each model learned to generate predictions by focusing on appropriate clinically relevant patient features, such as heart-related hospitalizations and chronic hypertension diagnosis for the heart model. The THS outperformed the other commonly used multimorbidity scoring systems, specifically the Charlson Comorbidity Index (CCI) and the Elixhauser Comorbidity Index (ECI) overall (AUROCs: THS=0.823, CCI=0.735, ECI=0.649) as well as for every age, sex, and income bracket. Performance improvements were most pronounced for middle-aged and lower-income subgroups. Ablation tests using only diagnosis, prescription, social determinants of health, and lab feature groups, while retaining procedure-related features, showed that the combination of feature groups has the best predictive performance, though only marginally better than the diagnosis-only model on at-risk groups.

CONCLUSIONS

Massive retrospective EHR data sets have made it possible to use machine learning to build practical multimorbidity risk scores that are highly predictive, personalizable, intuitive to explain, and generalizable across diverse patient populations.

Data Sources That Enumerate People Experiencing Homelessness in the United States: Opportunities and Challenges for Epidemiologic Research

Homelessness is associated with a multitude of poor health outcomes. However, the full extent of the risks associated with homelessness is not possible to quantify without reliable population data. Here, we outline 3 federal, publicly available data sources for estimating the number of people experiencing homelessness in the United States. We describe the appropriate uses and limitations of each data source in the context of infectious disease epidemiology. These data sources provide an opportunity to expand current research and develop actionable analyses.

Pregnancy outcomes for women with a history of stroke: A population-based record linkage study

BACKGROUND

Little is known about the pregnancy outcomes of women who have had a stroke prior to a first pregnancy.

AIM

To identify a cohort of primiparous women giving birth to a single baby and compare the pregnancy outcomes of those with a pre-pregnancy stroke hospitalisation record to those without a stroke hospitalisation record.

MATERIALS AND METHODS

Record linkage study of all primiparous women aged 15-44 years with singleton pregnancies birthing in New South Wales, Australia from 2003 to 2015. Stroke was identified from 2001 to 2015 hospital data using International Classification of Diseases tenth Edition - Australian Modification codes I60-64. Women whose first hospital record of stroke was during pregnancy or <42 days after birth were excluded. Outcomes included diabetes or hypertension during pregnancy, mode of delivery, haemorrhage, severe maternal morbidity (validated composite outcome indicator), gestational age at birth, Apgar score (1 min < 7), and small-for-gestational age.

RESULTS

Of 487 767 women with a first pregnancy, 124 (2.5/10 000) had a hospital record which included a pre-pregnancy stroke diagnosis. Women with a stroke history were more likely to have an early-term delivery (37-38 weeks; relative risk (RR) 1.49, 95% CI 1.17-1.90) and a pre-labour caesarean (RR 2.83, 95% CI 2.20-3.63). There were no significant differences in other maternal or neonatal outcomes.

CONCLUSION

This is the largest reported study of pregnancy and birth outcomes for women with a history of stroke. With the exception of pre-labour caesarean, there were no differences in pregnancy outcomes for women with a history of stroke compared with women with no history of stroke.

The STRidER Report on Two Years of Quality Control of Autosomal STR Population Datasets

STRidER, the STRs for Identity ENFSI Reference Database, is a curated, freely publicly available online allele frequency database, quality control (QC) and software platform for autosomal Short Tandem Repeats (STRs) developed under the endorsement of the International Society for Forensic Genetics. Continuous updates comprise additional STR loci and populations in the frequency database and many further STR-related aspects. One significant innovation is the autosomal STR data QC provided prior to publication of datasets. Such scrutiny was lacking previously, leaving QC to authors, reviewers and editors, which led to an unacceptably high error rate in scientific papers. The results from scrutinizing 184 STR datasets containing >177,000 individual genotypes submitted in the first two years of STRidER QC since 2017 revealed that about two-thirds of the STR datasets were either being withdrawn by the authors after initial feedback or rejected based on a conservative error rate. Almost no error-free submissions were received, which clearly shows that centralized QC and data curation are essential to maintain the high-quality standard required in forensic genetics. While many errors had minor impact on the resulting allele frequencies, multiple error categories were commonly found within single datasets. Several datasets contained serious flaws. We discuss the factors that caused the errors to draw the attention to redundant pitfalls and thus contribute to better quality of autosomal STR datasets and allele frequency reports.

Mortality of people with intellectual disabilities during the 2017/2018 influenza epidemic in the Netherlands: potential implications for the COVID-19 pandemic

BACKGROUND

Data on the development of Covid-19 among people with intellectual disabilities (IDs) are scarce and it is uncertain to what extent general population data applies to people with ID. To give an indication of possible implications, this study investigated excess mortality patterns during a previous influenza epidemic.

METHODS

Using Dutch population and mortality registers, a historical cohort study was designed to compare mortality during the 2017-2018 influenza epidemic with mortality in the same period in the three previous years. People with ID were identified by entitlements to residential ID-care services as retrieved from a national database.

RESULTS

Data covered the entire adult Dutch population (12.6 million; GenPop), of which 91 064 individuals were identified with an ID. During the influenza epidemic, mortality among people with ID increased almost three times as much than in the GenPop (15.2% vs. 5.4%), and more among male individuals with ID (+19.5%) than among female individuals with ID (+10.6%), as compared with baseline. In both cohorts, comparable increases in mortality within older age groups and due to respiratory causes were seen. Particularly in the ID-cohort, excess deaths also occurred in younger age groups, due to endocrine diseases and ID-specific causes.

CONCLUSIONS

During the 2017-2018 influenza epidemic, excess mortality among people with ID was three times higher than in the general Dutch population, appeared more often at young age and with a broader range of underlying causes. These findings suggest that a pandemic may disproportionally affect people with ID while population data may not immediately raise warnings. Early detection of diverging patterns and faster implementation of tailored strategies therefore require collection of good quality data.

Mutation analysis of 21 autosomal short tandem repeats in Han population from Hunan, China

Background: Short tandem repeats (STRs) are powerful genetic markers widely used in human genetics. Population data and locus-specific mutation rates of STRs are crucial for the evaluation and interpretation of genetic evidence in forensic and population genetics.Aim: To investigate the mutation rates of 21 autosomal STRs in a population from central south China.Subjects and methods: This study analysed 3420 paternity cases with a Combined Paternity Index >10,000 from Han population in Hunan. A total of 68,743 meiotic transfers were analysed and 62 mutations were identified.Results: The overall mutation rate of STR loci was 0.9 × 10^-3 (95% CI, 0.0007-0.0011) and the locus-specific mutation rates were estimated ranging from 0.0000-0.0023. Locus D1S1656 exhibited the highest mutation rate of 2.3 × 10^-3 (95% CI, 0.0005-0.0006), followed by D12S391 with a mutation rate of 2.0 × 10^-3 (95% CI, 0.0007-0.0044). No mutation was observed at TPOX, D2S1338 or Penta D. One-step mutation cases accounted for 96.77% of total mutations and the ratio of paternal vs maternal mutations was ∼4.85:1. Inter-population comparisons of locus-specific mutation rates of several STRs revealed significant differences between Han in Hunan and Han in other regions of China. Conclusion: The data justified the use of geographical data in further genetic applications.

Paternalism and certitude

When paternalism is deemed morally justified, weak paternalism-which restricts itself to assisting the target of paternalism realize his own preferences-is the preferred (less problematic) alternative. In determining the appropriateness of weak paternalism, the level of certitude of the paternalist regarding the correctness of her assessment of the true preferences of the one-paternalized is obviously a crucial factor. Yet in the ethics of paternalism this parameter has escaped systematic treatment. This paper aims to initiate discussion on this indispensable consideration for weak paternalism. Analysing a real-life dilemma of paternalism in healthcare, the paper focuses on the theoretical question of how the paternalist can optimize her certitude by combining personal knowledge of the individual patient with population data on treatment refusal/consent of patients facing similar decisions. The paper presents an outline of a decision-making scheme that can be valuable in medical ethics and beyond.

Population-Based Brain Tumor Survival Analysis via Spatial- and Temporal-Smoothing

In cancer research, population-based survival analysis has played an important role. In this article, we conduct survival analysis on patients with brain tumors using the SEER (Surveillance, Epidemiology, and End Results) database from the NCI (National Cancer Institute). It has been recognized that cancer survival models have spatial and temporal variations which are caused by multiple factors, but such variations are usually not “abrupt” (that is, they should be smooth). As such, spatially and temporally pooling all data and analyzing each spatial/temporal point separately are either inappropriate or ineffective. In this article, we develop and implement a spatial- and temporal-smoothing technique, which can effectively accommodate spatial/temporal variations and realize information borrowing across spatial/temporal points. Simulation demonstrates effectiveness of the proposed approach in improving estimation. Data on a total of 123,571 patients with brain tumors diagnosed between 1911 and 2010 from 16 SEER sites is analyzed. Findings different from separate estimation and simple pooling are made. Overall, this study may provide a practically useful way for modeling the survival of brain tumor (and other cancers) using population data.

Disparities in Thyroid Screening and Medication Use in Quebec, Canada

Background: No studies have examined the frequency of thyroid screening in the Canadian population, and whether thyroid screening and medication use vary by sex, race, income, and preexisting health conditions.

Methods: Using data from the 2011, 2012 cycles of the Canadian Community Health Survey, we report rates of thyroid screening among Quebec residents ≥35 (n=7024) and rates of thyroid medication use among Quebec residents ≥35 (n=16,081). We examine variations in medication use and screening by sex, age, race, immigration status, access to a regular doctor, and health conditions that have been linked to thyroid disease.

Results: Of the Quebec residents ≥35, 10.3% reported taking thyroid medication and 0.4% reported that the last blood test a physician ordered was to check for a new thyroid condition. Canadian-born residents and those who identified as White reported higher medication use and screening rates, compared to immigrants and those who identified as visible minorities. Racial disparities were especially pronounced, with White Quebec residents reporting three times greater odds of thyroid screening than visible minorities. The strongest predictors of both thyroid medication use and screening were access to a regular doctor. Despite women being eight times more likely to suffer from thyroid disease, women were not significantly more likely to be screened, compared to men (odds ratio=1.38, 95% confidence interval: 0.74–2.60).

Discussion: Strategies are needed to decrease disparities in thyroid screening and medication use. Interventions that target health systems (e.g., increasing physician supply), providers (continuing professional education modules about thyroid disease for family physicians), and recipients of care (multilanguage public awareness campaigns and posters at walk-in clinics that describe common symptoms of different thyroid disorders) should be implemented and tested.

Determinants of Macular Layers and Optic Disc Characteristics on SD-OCT: The Rhineland Study

Purpose

To investigate variation and determinants of macular layers, peripapillary retinal nerve fiber layer (pRNFL) and Bruch's membrane opening-minimum rim width (BMO-MRW) in the general population.

Methods

In 1306 participants, we performed spectral domain optical coherence tomography (SD-OCT) scans of the macula, pRNFL, and BMO-MRW, and assessed their determinants using multivariable regression. Intraindividual interocular differences were analyzed using Spearman's rank correlation analysis.

Results

Participant age ranged from 30 to 95 years (mean ± standard deviation, 56.1 ± 13.9) and 56% were women. Interocular correlation ranged from 0.63 to 0.93. Differences increased with age and were larger in persons with glaucoma or prior stroke. pRNFL and BMO-MRW decreased with increasing age. Except for RNFL, volumes of various inner macular layers and the outer nuclear layer (ONL) decreased with increasing age, more negative spherical equivalent (SE), and were lower in women compared to men. For some layers, age effects amplified over the life course. History of stroke was associated with smaller volumes of various layers, without reaching statistical significance. We found no association of further systemic parameters with any SD-OCT parameter.

Conclusions

We provide large-scale normative data from a Caucasian general population for various SD-OCT measures. Interocular variability increased with age and specific pathology. Factors, such as age, sex, refraction, and a history of stroke, were associated with various retinal assessments.

Translational Relevance

In clinical routine, our findings should be considered on a per eye basis when interpreting SD-OCT volumes, pRNFL, or BMO-MRW to avoid confounded results.

Socioeconomic inequalities in health and the use of healthcare services in Catalonia: analysis of the individual data of 7.5 million residents

Background

The aim of this study is to analyse the health status, the use of public healthcare services and the consumption of prescription drugs in the population of Catalonia, taking into consideration the socioeconomic level of individuals and paying special attention to vulnerable groups.

Methods

Cross-sectional study of the entire population resident in Catalonia in 2015 (7.5 million people) using administrative records. Twenty indicators are analysed related to health, the use of healthcare services and consumption of prescription drugs. Rates, frequencies and averages are obtained for the different variables stratified by age groups (under 15 years, 15–64 years and 65 years or older), gender and socioeconomic status (calculated on the basis of pharmacy copayment levels and Social Security benefits received).

Results

A socioeconomic gradient was observed in all the indicators analysed, in both sexes and in all age groups. Morbidity, use of mental healthcare centres, hospitalisation rates and probability of drug consumption among children is 3–7 times higher for those with low socioeconomic level respect to those with a higher one. In children and adults, the steepest gradient was found in the use of mental health services. Moreover, there are gender inequalities.

Conclusion

There are significant socioeconomic inequalities in health status and in the use of healthcare services in the population of Catalonia. To respond to this situation, new policies on health and other areas, such as education and employment, are required, especially those that have an impact on early years.

Chinese Xibe population genetic composition according to linkage groups of X-chromosomal STRs: population genetic variability and interpopulation comparisons

BACKGROUND

The Xibe population is one of China's officially recognised populations and is now distributed separately from west to east in the northern part of China. X-chromosomal short tandem repeats have a special inheritance pattern, and could be used as complements in forensic application, especially for complex or deficiency cases.

SUBJECTS AND METHODS

This study obtained the allelic and haplotypic frequencies of 19 X-STR loci in the Xibe population from Xinjiang Uygur Autonomous Region, China, and studied the genetic differentiations between the Xibe and other populations.

RESULTS

The combined power of discrimination in females and males and mean exclusion chances in deficiency cases, normal trios and duo cases was at least 0.999 999 994. In the haplotypic study, the Xibe population showed a more similar pattern of haplotype distribution with Asian populations than populations from other continents, while allelic study also indicated a closer relationship between the Xibe and Asian populations.

CONCLUSIONS

The 19 X-STR loci would be useful in forensic application in the studied population. The Xibe population showed a closer genetic relationship with Asian populations in the study, and more population data would be necessary for more detailed genetic relationship studies.

Y STR haplotype diversity in central Indian population

AIMS

Seventeen Y-STR loci (DYS19, DYS389I, DYS389II, DYS390, DYS391, DYS392, DYS393, DYS385a/b, DYS437, DYS438, DYS439, DYS448, DYS456, DYS458, DYS635 and Y-GATA-H4) were analysed in 173 males belonging to the central Indian population with the aim of studying genetic diversity and adding to the population database.

METHODS

Multiplexed PCR amplifications of the 17 Y STR loci were performed using AmpFlSTR® Yfiler® Kit. Amplified products were genotyped using a multi capillary electrophoresis with POP-4 polymer in ABI Prism 3100 Genetic Analyzer. Population genetic diversity and allele frequencies were calculated. The haplotype data obtained in the study was compared with the Y-STR haplotypes reference database (YHRD, http://www.yhrd.org ) and with previously published population data using the AMOVA tool and visualised in two-dimensional multidimensional scaling (MDS) plots.

RESULTS

A total of 147 haplotypes were observed, out of which 125 were unique. Haplotype diversity and discriminating capacity were found to be 0.9979 and 0.8497, respectively. The gene diversity at the loci ranged from 0.398-0.785. Genotype diversity at the locus DYS385a/b was found to be 0.869.

CONCLUSIONS

The population of central India was found to be significantly different (p < 0.05) when compared with populations from other parts of the Indian sub-continent and the population data of other countries. The population data generated in this study are useful for forensic, anthropological and demographic studies.

Internal migration and mortality: the case of Finland

In light of possibilities and limitations of data from the Finnish population register, and the general demographic development of Finland, this paper illuminates the complex interrelation between internal migration and mortality. We explore the roles played by health selection, birth region, and migration as a potentially harmful event. A five per cent random sample from a longitudinal data file that contains deaths for a period of 24 years is used. The focus is on people aged 40-59 years living in Southern Finland, who are defined by birth region and time since immigration. We find some indications of a healthy-migrant effect, but also that migrants may have integration difficulties or that they are negatively selected with regard to health behaviours and lifestyles. In line with previous studies on Finland, birth region is found to be a very decisive mortality determinant.

The possibilities and the realities of home care

BACKGROUND

An analysis of a provincial home care dataset, comparing home care client, service, and providers in 1991/92 through 2000/01, was undertaken to describe changes over the decade, and permit a more informed discussion of home care in relation to Canadian health policy developments and health system reforms.

METHODS

After data were obtained upon request from Alberta's Ministry of Health and Wellness, descriptive and comparative statistical analyses were undertaken using the SPSS computer program. Logistic regression was used to compare multiple client characteristics in the first and last years.

RESULTS

Home care clients doubled and the mean hours of care per client increased substantially, although the duration of care provision declined. The mean age of clients also declined. Home care continued to be primarily provided by Home Support Aides, with self-managed care increasing dramatically. Sustained geographical differences in home care were noted.

CONCLUSION

Although home care has much potential for enabling early discharge from hospital, and for maintaining or improving health, few population-level studies of home care trends exist. In Alberta, although formal home care hours increased, home care expansion was not uniform across the province. Home Support Aides continued to be the primary care provider. In the face of substantial hospital downsizing, these observations could imply that the provision of home care has been off loaded to families. Moreover, home care increases do not appear to be related to an aging population.

An analysis of first-time enquirers to the CancerBACUP information service: variations with cancer site, demographic status and geographical location

A retrospective comparison of cancer incidence data and, where relevant, population data with 16,955 first-time users (patients, relatives and friends) of a national cancer information service (CancerBACUP) during the period April 1995 to March 1996 is presented. The number of events observed was compared with the number of events expected, were the national rates of cancer incidence and population demographics apply. Standardized incidence ratios (SIRs) (observed - expected ratios) were used to indicate any differences. Statistically significant differences (P < 0.001) in the observed and expected sex, age and primary site distribution of patients enquired about were found. Statistically significant differences (P < 0.001) were also identified for the age, employment status, socioeconomic class and geographical location of first-time enquirers (patients, relatives and friends). Enquiries about brain, testis and breast cancers and non-Hodgkin's lymphoma (NHL) were substantially higher than expected; enquiries about bladder, lung, stomach and colorectal cancers were much lower than expected. As the service is provided via a freephone number, it is available to all, and users might be expected to be randomly distributed across the variables listed. The underlying reasons for the differences identified need to be investigated, and the role of information in the care of cancer patients should be formally evaluated.