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Cirera L, Bañón RM, Maeso S, Molina P, Ballesta M, Chirlaque MD, Salmerón D. Territorial gaps on quality of causes of death statistics over the last forty years in Spain. BMC Public Health 2024; 24:361. [PMID: 38310211 PMCID: PMC10837971 DOI: 10.1186/s12889-023-17616-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 12/29/2023] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND The quality of the statistics on causes of death (CoD) does not present consolidated indicators in literature further than the coding group of ill-defined conditions of the International Classification of Diseases. Our objective was to assess the territorial quality of CoD by reliability of the official mortality statistics in Spain over the years 1980-2019. METHODS A descriptive epidemiological design of four decades (1980-, 1990-, 2000-, and 2010-2019) by region (18) and sex was implemented. The CoD cases, age-adjusted rates and ratios (to all-cause) were assigned by reliability to unspecific and ill-defined quality categories. The regional mortality rates were contrasted to the Spanish median by decade and sex by the Comparative Mortality Ratio (CMR) in a Bayesian perspective. Statistical significance was considered when the CMR did not contain the value 1 in the 95% credible intervals. RESULTS Unspecific, ill-defined, and all-cause rates by region and sex decreased over 1980-2019, although they scored higher in men than in women. The ratio of ill-defined CoD decreased in both sexes over these decades, but was still prominent in 4 regions. CMR of ill-defined CoD in both sexes exceeded the Spanish median in 3 regions in all decades. In the last decade, women's CMR significantly exceeded in 5 regions for ill-defined and in 6 regions for unspecific CoD, while men's CMR exceeded in 4 and 2 of the 18 regions, respectively on quality categories. CONCLUSIONS The quality of mortality statistics of causes of death has increased over the 40 years in Spain in both sexes. Quality gaps still remain mostly in Southern regions. Authorities involved might consider to take action and upgrading regional and national death statistics, and developing a systematic medical post-grade training on death certification.
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Affiliation(s)
- Lluís Cirera
- Department of Epidemiology, Regional Health Council, IMIB-Arrixaca. Ronda de Levante 11, 30008, Murcia, Spain
- Spanish Consortium for Research On Epidemiology and Public Health (CIBERESP), Calle de Melchor Fernández Almagro, 3, 28029, Madrid, Spain
- Department of Health and Social Sciences, University of Murcia, IMIB-Arrixaca, 32. 30120, Buenavista, Spain
| | - Rafael-María Bañón
- Medico-Legal Advisor. Ministry of Justice. Calle San Bernardo, 21. 28071, Madrid, Spain
| | - Sergio Maeso
- National Centre for Epidemiology, Carlos III Institute of Health (ISCIII), Avenida Monforte de Lemos 5, 28029, Madrid, Spain
| | - Puri Molina
- SGAIPE. Departament de Salut, Generalitat de Catalunya. Travessera de Les Corts, 131. 08028, Barcelona, Spain
| | - Mónica Ballesta
- Department of Epidemiology, Regional Health Council, IMIB-Arrixaca. Ronda de Levante 11, 30008, Murcia, Spain
- Department of Health and Social Sciences, University of Murcia, IMIB-Arrixaca, 32. 30120, Buenavista, Spain
| | - María-Dolores Chirlaque
- Department of Epidemiology, Regional Health Council, IMIB-Arrixaca. Ronda de Levante 11, 30008, Murcia, Spain
- Spanish Consortium for Research On Epidemiology and Public Health (CIBERESP), Calle de Melchor Fernández Almagro, 3, 28029, Madrid, Spain
- Department of Health and Social Sciences, University of Murcia, IMIB-Arrixaca, 32. 30120, Buenavista, Spain
| | - Diego Salmerón
- Spanish Consortium for Research On Epidemiology and Public Health (CIBERESP), Calle de Melchor Fernández Almagro, 3, 28029, Madrid, Spain.
- Department of Health and Social Sciences, University of Murcia, IMIB-Arrixaca, 32. 30120, Buenavista, Spain.
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Devleesschauwer B, Scohy A, De Pauw R, Gorasso V, Kongs A, Neirynck E, Verduyckt P, Wyper GMA, Van den Borre L. Investigating years of life lost in Belgium, 2004-2019: A comprehensive analysis using a probabilistic redistribution approach. Arch Public Health 2023; 81:160. [PMID: 37626403 PMCID: PMC10464430 DOI: 10.1186/s13690-023-01163-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/27/2023] [Indexed: 08/27/2023] Open
Abstract
INTRODUCTION Information on years of life lost (YLL) due to premature mortality is instrumental to assess the fatal impact of disease and necessary for the calculation of Belgian disability-adjusted life years (DALYs). This study presents a novel method to reallocate causes of death data. MATERIALS AND METHODS Causes of death data are provided by Statistics Belgium (Statbel). First, the specific ICD-10 codes that define the underlying cause of death are mapped to the GBD cause list. Second, ill-defined deaths (IDDs) are redistributed to specific ICD-10 codes. A four-step probabilistic redistribution was developed to fit the Belgian context: redistribution using predefined ICD codes, redistribution using multiple causes of death data, internal redistribution, and redistribution to all causes. Finally, we used the GBD 2019 reference life table to calculate Standard Expected Years of Life Lost (SEYLL). RESULTS In Belgium, between 2004 and 2019, IDDs increased from 31 to 34% of all deaths. The majority was redistributed using predefined ICD codes (14-15%), followed by the redistribution using multiple causes of death data (10-12%). The total number of SEYLL decreased from 1.83 to 1.73 million per year. In 2019, the top cause of SEYLL was lung cancer with a share of 8.5%, followed by ischemic heart disease (8.1%) and Alzheimer's disease and other dementias (5.7%). All results are available in an online tool https://burden.sciensano.be/shiny/mortality2019/ . CONCLUSION The redistribution process assigned a specific cause of death to all deaths in Belgium, making it possible to investigate the full mortality burden for the first time. A large number of estimates were produced to estimate SEYLL by age, sex, and region for a large number of causes of death and every year between 2004 and 2019. These estimates are important stepping stones for future investigations on Disability-Adjusted Life Years (DALYs) in Belgium.
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Affiliation(s)
- Brecht Devleesschauwer
- Service Health Information, Department of Epidemiology and Public Health, Sciensano, Rue Juliette Wytsman 14, Brussels, 1050, Belgium.
- Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium.
| | - Aline Scohy
- Service Health Information, Department of Epidemiology and Public Health, Sciensano, Rue Juliette Wytsman 14, Brussels, 1050, Belgium
| | - Robby De Pauw
- Service Health Information, Department of Epidemiology and Public Health, Sciensano, Rue Juliette Wytsman 14, Brussels, 1050, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Vanessa Gorasso
- Service Health Information, Department of Epidemiology and Public Health, Sciensano, Rue Juliette Wytsman 14, Brussels, 1050, Belgium
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Anne Kongs
- Department of Care, Flemish Public Administration, Brussels, Belgium
| | | | - Peter Verduyckt
- Brussels-Capital Health and Social Observatory, Brussels, Belgium
| | - Grant M A Wyper
- Place and Wellbeing Directorate, Public Health Scotland, Glasgow, UK
- School of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Laura Van den Borre
- Service Health Information, Department of Epidemiology and Public Health, Sciensano, Rue Juliette Wytsman 14, Brussels, 1050, Belgium
- Interface Demography, Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium
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Calais-Ferreira L, Young JT, Francis K, Willoughby M, Pearce L, Clough A, Spittal MJ, Brown A, Borschmann R, Sawyer SM, Patton GC, Kinner SA. Non-communicable disease mortality in young people with a history of contact with the youth justice system in Queensland, Australia: a retrospective, population-based cohort study. Lancet Public Health 2023; 8:e600-e609. [PMID: 37516476 DOI: 10.1016/s2468-2667(23)00144-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 05/15/2023] [Accepted: 07/04/2023] [Indexed: 07/31/2023]
Abstract
BACKGROUND Young people who have had contact with the criminal justice system are at increased risk of early death, especially from injuries. However, deaths due to non-communicable diseases (NCDs) in this population remain poorly described. We aimed to estimate mortality due to NCDs in people with a history of involvement with the youth justice system, compare NCD mortality rates in this population with those in the general population, and characterise demographic and justice-related factors associated with deaths caused by NCDs in people with a history of contact with the youth justice system. METHODS In this retrospective, population-based cohort study (the Youth Justice Mortality [YJ-Mort] study), we included all people aged 10-18 years (at baseline) charged with a criminal offence in Queensland, Australia, between June 30, 1993, and July 1, 2014. We probabilistically linked youth justice records with adult correctional records and national death records up to Jan 31, 2017. Indigenous status was ascertained from youth justice and adult correctional records, with individuals identified as Indigenous in either source classified as Indigenous in the final dataset. We estimated crude mortality rates and standardised mortality ratios (SMRs) for comparisons with data from the Australian general population. We identified risk factors for NCD deaths using competing-risks regression. FINDINGS Of 48 670 individuals aged 10-18 years (at baseline) charged with a criminal offence in Queensland, Australia, between June 30, 1993, and July 1, 2014, 11 897 (24·4%) individuals were female, 36 773 (75·6%) were male, and 13 250 (27·2%) were identified as identified as Indigenous. The median age at first contact with the youth justice system was 15 years (IQR 14-16), the median follow-up time was 13·4 years (8·4-18·4), and the median age at the end of the study was 28·6 years (23·6-33·6). Of 1431 deaths, 932 (65·1%) had a known and attributed cause, and 121 (13·0%) of these were caused by an NCD. The crude mortality rate from NCDs was 18·5 (95% CI 15·5-22·1) per 100 000 person-years among individuals with a history of involvement with the youth justice system, which was higher than among the age-matched and sex-matched Australian general population (SMR 1·67 [1·39-1·99]). Two or more admissions to adult custody (compared with none; adjusted sub-distribution hazard ratio 2·09 [1·36-3·22]), and up to 52 weeks in adult custody (compared with none; 1·98 [1·18-3·32]) was associated with NCD death. INTERPRETATION Young people with a history of contact with the justice system are at increased risk of death from NCDs compared with age-matched and sex-matched peers in the general Australian population. Reducing youth incarceration and providing young people's rights to access clinical, preventive, and restorative services should be a priority. FUNDING National Health and Medical Research Council.
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Affiliation(s)
- Lucas Calais-Ferreira
- Centre for Adolescent Health, Murdoch Children's Research Institute and Royal Children's Hospital, Melbourne, VIC, Australia; Centre for Mental Health, The University of Melbourne, Melbourne, VIC, Australia; Justice Health Unit, The University of Melbourne, Melbourne, VIC, Australia.
| | - Jesse T Young
- Centre for Adolescent Health, Murdoch Children's Research Institute and Royal Children's Hospital, Melbourne, VIC, Australia; Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne, VIC, Australia; School of Population and Global Health, The University of Western Australia, Perth, WA, Australia; National Drug Research Institute, Curtin University, Perth, WA, Australia; Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Kate Francis
- Centre for Adolescent Health, Murdoch Children's Research Institute and Royal Children's Hospital, Melbourne, VIC, Australia; Melbourne School of Population and Global Health, and Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Melissa Willoughby
- Centre for Adolescent Health, Murdoch Children's Research Institute and Royal Children's Hospital, Melbourne, VIC, Australia; Justice Health Unit, The University of Melbourne, Melbourne, VIC, Australia
| | - Lindsay Pearce
- Centre for Adolescent Health, Murdoch Children's Research Institute and Royal Children's Hospital, Melbourne, VIC, Australia; School of Population Health, Curtin University, Perth, WA, Australia
| | - Alan Clough
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, QLD, Australia
| | - Matthew J Spittal
- Centre for Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Alex Brown
- National Centre for Indigenous Genomics, Australian National University, Canberra, ACT, Australia; Telethon Kids Institute, Adelaide, SA, Australia
| | - Rohan Borschmann
- Centre for Adolescent Health, Murdoch Children's Research Institute and Royal Children's Hospital, Melbourne, VIC, Australia; Centre for Mental Health, The University of Melbourne, Melbourne, VIC, Australia; Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia; School of Population Health, Curtin University, Perth, WA, Australia; Department of Psychiatry, University of Oxford, Oxford, UK
| | - Susan M Sawyer
- Centre for Adolescent Health, Murdoch Children's Research Institute and Royal Children's Hospital, Melbourne, VIC, Australia; Melbourne School of Population and Global Health, and Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - George C Patton
- Centre for Adolescent Health, Murdoch Children's Research Institute and Royal Children's Hospital, Melbourne, VIC, Australia; Melbourne School of Population and Global Health, and Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Stuart A Kinner
- Centre for Adolescent Health, Murdoch Children's Research Institute and Royal Children's Hospital, Melbourne, VIC, Australia; Justice Health Unit, The University of Melbourne, Melbourne, VIC, Australia; School of Population Health, Curtin University, Perth, WA, Australia; Griffith Criminology Institute, Griffith University, Brisbane, QLD, Australia
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Chi YC, Chu WM, Chang HY, Lu TH. International Variations in Dementia and Alzheimer Disease Diagnosis and Certification Habits and Their Associations With Dementia and Alzheimer Disease Mortality: A Cross-Sectional Study of 38 Countries. Alzheimer Dis Assoc Disord 2023; 37:215-221. [PMID: 37615486 DOI: 10.1097/wad.0000000000000573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 07/03/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVE To examine international variations in national diagnosis and certification habits prefer recording dementia (D) versus Alzhiemer disease (AD) as the underlying cause of death (UCOD) and their associations with mortality rates of dementia and AD. METHODS We calculated proportions of D/D+AD and AD/D+AD deaths as proxies of national diagnosis and certification habits. Pearson correlation coefficients (r) were estimated to assess the associations of proportions with the mortality rates of dementia or AD among adults aged 75 to 84 years across 38 countries. RESULTS The countries with a high preference for recording dementia as the UCOD were Taiwan and Latvia with proportion of D/D+AD deaths of 92% and 88%, respectively, and those with a high preference for recording AD as the UCOD were Slovenia, Turkey, and Poland with proportion of AD/D+AD deaths of 100%, 99%, and 89%, respectively. The r values for the proportions and mortality rate for dementia and AD were 0.67 (95% CI: 0.44-0.81) and 0.46 (95% CI: 0.16-0.68), respectively. CONCLUSION We identified a small number of countries with obvious natonal diagnosis and certification habits preferring dementia or AD and had moderate effects on international variations in the mortality rates of dementia and AD.
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Affiliation(s)
- Ying-Chen Chi
- Department of Healthcare Information & Management, School of Health Technology, Ming Chuan University, Taoyuan
| | - Wei-Min Chu
- Department of Family Medicine, Taichung Veterans General Hospital
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung
- School of Medicine, National Yang Ming Chiao Tung University, Taipei
| | - Hsin-Yun Chang
- Department of Family Medicine, Tainan Hospital, Ministry of Health and Welfare
- Institute of Allied Health Sciences
- Department of Family Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
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Tak YW, Han JH, Park YJ, Kim DH, Oh JS, Lee Y. Examining Final-Administered Medication as a Measure of Data Quality: A Comparative Analysis of Death Data with the Central Cancer Registry in Republic of Korea. Cancers (Basel) 2023; 15:3371. [PMID: 37444480 DOI: 10.3390/cancers15133371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/21/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
Death is a crucial outcome in retrospective cohort studies, serving as a criterion for analyzing mortality in a database. This study aimed to assess the quality of extracted death data and investigate the potential of the final-administered medication as a variable to quantify accuracy for the validation dataset. Electronic health records from both an in-hospital and the Korean Central Cancer Registry were used for this study. The gold standard was established by examining the differences between the dates of in-hospital deaths and cancer-registered deaths. Cosine similarity was employed to quantify the final-administered medication similarities between the gold standard and other cohorts. The gold standard was determined as patients who died in the hospital after 2006 and whose final hospital visit/discharge date and death date differed by 0 or 1 day. For all three criteria-(a) cancer stage, (b) cancer type, and (c) type of final visit-there was a positive correlation between mortality rates and the similarities of the final-administered medication. This study introduces a measure that can provide additional accurate information regarding death and differentiates the reliability of the dataset.
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Affiliation(s)
- Yae Won Tak
- Department of Information Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Jeong Hyun Han
- Department of Information Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Yu Jin Park
- Medical Information-Management Team, Asan Medical Center, Seoul 05505, Republic of Korea
| | - Do-Hoon Kim
- Medical Big Data Research Center, Kyungpook National University Hospital, Daegu 41944, Republic of Korea
| | - Ji Seon Oh
- Department of Information Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Yura Lee
- Department of Information Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
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Shah SHBU, Alavi M, Hajarizadeh B, Matthews G, Valerio H, Dore GJ. Liver-related mortality among people with hepatitis B and C: Evaluation of definitions based on linked healthcare administrative datasets. J Viral Hepat 2023; 30:520-529. [PMID: 36843500 PMCID: PMC10946991 DOI: 10.1111/jvh.13824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 02/28/2023]
Abstract
Routinely collected and linked healthcare administrative datasets could be used to monitor mortality among people with hepatitis B (HBV) and C (HCV). This study aimed to evaluate the concordance in records of liver-related mortality among people with an HBV or HCV notification, between data on hospitalization for end-stage liver disease (ESLD) and death certificates. In New South Wales, Australia, HBV and HCV notifications (1993-2017) were linked to hospital admissions (2001-2018), all-cause mortality (1993-2018) and cause-specific mortality (1993-2016) datasets. Hospitalization for ESLD was defined as a first-time hospital admission due to decompensated cirrhosis (DC) or hepatocellular carcinoma (HCC). Consistency of liver death definition of mortality following hospitalization for ESLD was compared with two death certificate-based definitions of liver deaths coded among primary and secondary cause-specific mortality data, including ESLD-related (deaths due to DC and HCC) and all-liver deaths (ESLD-related and other liver-related causes). Of 63,292 and 107,430 individuals with an HBV and HCV notification, there were 4478 (2.6%) post-ESLD hospitalization deaths, 5572 (3.3%) death certificate liver disease deaths and 2910 (1.7%) death certificate ESLD deaths. Between 2001 and 2016, among HBV post-ESLD hospitalization deaths (n = 891), 63% (562) had death certificate ESLD recorded, and 83% (741) had death certificate liver disease recorded. Between 2001 and 2016, among HCV post-ESLD hospitalization deaths (n = 3587), 58% (2082) had death certificate ESLD recorded, and 87% (3135) had death certificate liver disease recorded. At least one-third of death certificates with DC and HCC as cause of death had no mention of HBV, HCV or viral hepatitis. Our study identified limitations in estimating and tracking HBV and HCV liver disease mortality using death certificate-based data only. The optimum data for this purpose is either ESLD hospitalisations with vital status information or a combination of these with cause-specific death certificate data.
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Affiliation(s)
| | - Maryam Alavi
- The Kirby InstituteUNSW SydneySydneyNew South WalesAustralia
| | | | - Gail Matthews
- The Kirby InstituteUNSW SydneySydneyNew South WalesAustralia
| | - Heather Valerio
- The Kirby InstituteUNSW SydneySydneyNew South WalesAustralia
| | - Gregory J. Dore
- The Kirby InstituteUNSW SydneySydneyNew South WalesAustralia
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Al Busaidi S, Al Alawi AM, Al Masruri R, Al Balushi S, Al-Badi A. Quality of death certification based on the documented underlying cause of death: A retrospective study. J Forensic Leg Med 2023; 97:102547. [PMID: 37307775 DOI: 10.1016/j.jflm.2023.102547] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 05/09/2023] [Accepted: 05/29/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND The underlying cause of death (UCOD) documented in the death certificate is a cornerstone in the mortality data that has significant impact on national policies, health system, and socioeconomics. However, a wide range of inaccuracies have been reported worldwide and were linked to multiple factors, including sociodemographic development and lack of physician training. Hence, this study aimed to assess the quality of death certification by reviewing the reported UCOD in the death certificate and study the potential factors that might be associated with inaccuracies. METHODS All in-patient deaths that occurred in the Sultan Qaboos University Hospital from January 2020 to 31 December 2020 were included in this retrospective study. The study investigators reviewed all death certifications that were recorded during the study period for the accuracy of the documented UCOD using a systemic framework recommended by the World Health Organization. RESULTS The study included 384 mortality cases. The mean age at the time of death was 55.7 ± 27.1 years, and 209 (54.3%) cases were men. Approximately 80% (95% confidence interval: 84-76%) of the deceased patients had inaccurate data on the UCOD. Old age (58.1 ± 25.8 vs 46.5 ± 30.1, p < 0.001), death certification by doctor in training (70.8% vs 51.9%, p = 0.001), and admission under the Department of Medicine (68.5% vs 54.4%, p = 0.019) were more common in mortality cases with inaccurate data on the UCOD. Regression analysis confirmed that old age, male sex, and certification by doctor in training were independent predictors of inaccurate data on the UCOD. CONCLUSION Inaccurate data on the UCOD is a prevalent issue in many healthcare settings, especially in the developing countries. Introduction of death certification training in the medical curriculum for medical doctors, implementation of periodic auditing, and provision of feedback are among the evidence-based approaches that are likely to improve the overall accuracy of mortality data.
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Affiliation(s)
- Salim Al Busaidi
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman; Internal Medicine Training Program, Oman Medical Specialty Board, Muscat, Oman.
| | - Abdullah M Al Alawi
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman; Internal Medicine Training Program, Oman Medical Specialty Board, Muscat, Oman.
| | - Reema Al Masruri
- College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman.
| | - Shahad Al Balushi
- College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman.
| | - Amira Al-Badi
- Internal Medicine Training Program, Oman Medical Specialty Board, Muscat, Oman.
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8
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Jamiołkowski J, Genowska A, Pająk A. Is area-level socioeconomic deprivation associated with mortality due to circulatory system diseases in Poland? BMC Public Health 2023; 23:7. [PMID: 36597073 PMCID: PMC9809142 DOI: 10.1186/s12889-022-14914-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 12/20/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Socioeconomic deprivation (SED) is known to influence cardiovascular health. However, studies analyzing the relationship between deprivation and circulatory system diseases (CSD) in Central and Eastern Europe are limited. This study aimed to assess the relationship between SED and mortality due to CSD at a population level in 66 sub-regions of Poland. METHODS The 2010-2014 data regarding mortality and SED components were obtained from the Central Statistical Office. An area-based SED index was calculated based on the higher education rates, employment structure, wages, unemployment, and poverty. The dynamics of changes in mortality due to CSD was expressed by the number of deaths prevented or postponed (DPP) in terciles of the SED index. The associations between the mortality from CSD and SED index were analyzed using multivariate Poisson regression models and generalized estimating equations. RESULTS Among men, the percentage of DPP in 2014 was 13.1% for CSD, 23.4% for ischemic heart disease (IHD), and 21.4% for cerebrovascular diseases (CeVD). In the case of women, the proportion of DPP was 12.8, 25.6, and 21.6%, respectively. More deprived sub-regions experienced a greater decrease in CSD-related mortality than less deprived sub-regions. The disparity in mortality reduction between more deprived and less deprived sub-regions was even more pronounced for women. After adjusting for smoking prevalence, average BMI, population density, and changes in mortality over time, it was found that the SED index over the 2010-2014 time period was significantly associated with CSD- and IHD-related mortality for men (respectively 5.3 and 19.5% expected mortality increase per 1-unit increase of SED index), and with IHD- and CeVD-related mortality for women (respectively 30.3 and 23.0% expected mortality increase per 1-unit increase of SED index). CONCLUSIONS Significant differences in mortality changes due to CSD in Poland could be observed in relation to socioeconomic deprivation, resulting in reduced health inequalities. To reduce CSD mortality, more comprehensive preventive measures, including approaches addressing the socioeconomic factors, mainly poverty, education and employment, are needed, particularly in less urbanized areas.
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Affiliation(s)
- Jacek Jamiołkowski
- grid.48324.390000000122482838Department of Population Medicine and Lifestyle Diseases Prevention, Medical University of Bialystok, Białystok, Poland
| | - Agnieszka Genowska
- grid.48324.390000000122482838Department of Public Health, Medical University of Bialystok, Białystok, Poland
| | - Andrzej Pająk
- grid.5522.00000 0001 2162 9631Department of Epidemiology and Population Studies, Jagiellonian University Medical College, Kraków, Poland
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Ohta R, Weiss E, Mekky M, Sano C. Relationship between Dysphagia and Home Discharge among Older Patients Receiving Hospital Rehabilitation in Rural Japan: A Retrospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10125. [PMID: 36011757 PMCID: PMC9408141 DOI: 10.3390/ijerph191610125] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/13/2022] [Accepted: 08/14/2022] [Indexed: 06/15/2023]
Abstract
Dysphagia refers to swallowing difficulty, which impacts patients' quality of life. Dysphagia influences clinical outcomes, including mortality rates and length of hospital stay of older hospitalized patients. Dysphagia may affect the current and future quality of life of these patients. However, its exact impact remains unclear. We aimed to clarify the impact of dysphagia on discharge to home in older patients in a rural rehabilitation unit. We conducted a secondary analysis using data from a retrospective cohort study including patients aged over 65 years who had been discharged from a community hospital rehabilitation unit in rural Japan. Data from the participants had been previously collected from April 2016 to March 2020. The primary outcome was home discharge. The average participant age was 82.1 (standard deviation, 10.8) years; 34.5% were men. Among medical conditions, brain stroke (44.3%) was the most frequent reason for admission; the most frequent orthopedic condition was femoral fracture (42.9%). The presence of dysphagia (odds ratio [OR] = 0.38, 95% confidence interval [CI]: 0.20-0.73), polypharmacy (OR = 0.5, 95% CI: 0.32-0.90), and admission for internal medicine diseases (OR = 0.44, 95% CI: 0.26-0.77) were negatively associated with home discharge. High motor domain scores of the Functional Independence Measure were positively associated with home discharge (OR = 1.07, 95% CI: 1.05-1.08). Dysphagia was negatively associated with home discharge as were polypharmacy and admission for internal medicine diseases and conditions. By clarifying effective interventions through interventional studies, including approaches to managing multimorbidity and polypharmacy through interprofessional collaboration, the health conditions of older patients in rural areas may be improved.
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Affiliation(s)
- Ryuichi Ohta
- Community Care, Unnan City Hospital, 96-1 Iida, Daito-cho, Unnan 699-1221, Japan
| | - Emily Weiss
- Department of Public Health, Old College, University of Edinburgh, South Bridge, Edinburgh EH8 9YL, UK
| | - Magda Mekky
- Department of Public Health, Old College, University of Edinburgh, South Bridge, Edinburgh EH8 9YL, UK
| | - Chiaki Sano
- Department of Community Medicine Management, Faculty of Medicine, Shimane University, 89-1 Enya-cho, Izumo 693-8501, Japan
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Piccoli L, Wanner P. The political determinants of the health of undocumented immigrants: a comparative analysis of mortality patterns in Switzerland. BMC Public Health 2022; 22:804. [PMID: 35459130 PMCID: PMC9024067 DOI: 10.1186/s12889-022-13188-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 04/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The health of undocumented immigrants is an important concern in most societies. However, there is no conclusive evidence that inclusive health care policies lead to better outcomes for this group of the population. The aim of this study is to analyse whether there is an association between inclusive health care policies and the mortality patterns of undocumented immigrants, or the distribution of different causes of death among those who have died. METHODS We analyse individual data concerning the deceased in Switzerland between 2011 and 2017. We proceed in two steps. First, we estimate and compare the patterns of mortality of Swiss citizens, documented immigrants, and undocumented immigrants. Second, we test whether there is an association between cantonal authorities' policies and differing mortality patterns. We use logistic regressions and multinomial regressions to estimate the relationship between legal status and mortality patterns both in Switzerland and across different cantons. RESULTS We find a difference in the patterns of mortality between undocumented immigrants and the other groups of the population. Specifically, death from circulatory system diseases is twice as frequent among undocumented immigrants compared to documented immigrants and Swiss citizens. However, this difference is smaller in the Swiss cantons that have more inclusive health care policies towards undocumented immigrants. CONCLUSIONS We interpret these results as an indication that policies that expand access to health services lead to better outcomes for undocumented immigrants. This finding has implications for research on civic stratification and public health. Further analysis is needed to evaluate the effects of extending public health care for undocumented immigrants in different contexts.
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Affiliation(s)
- Lorenzo Piccoli
- European University Institute, Robert Schuman Centre for Advanced Studies, Via Giovanni Boccaccio 121, 50133, Florence, Italy.
| | - Philippe Wanner
- University of Geneva, Institute of Demography and Socioeconomics, 24 rue du Général-Dufour, 1211, Geneva, Switzerland
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Danilova I, Rau R, Barbieri M, Grigoriev P, Jdanov DA, Meslé F, Vallin J, Shkolnikov VM, Guerrouche K. Cohérence des données sur les causes de décès à l’échelle infranationale : les exemples de la Russie, de l’Allemagne, des États-Unis et de la France. POPULATION 2022. [DOI: 10.3917/popu.2104.0693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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12
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Eynstone-Hinkins J, Moran L. Enhancing Australian Mortality Data to Meet Future Health Information Demands. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19010603. [PMID: 35010855 PMCID: PMC8744765 DOI: 10.3390/ijerph19010603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/22/2021] [Accepted: 12/31/2021] [Indexed: 11/16/2022]
Abstract
The Australian mortality data are a foundational health dataset which supports research, policy and planning. The COVID-19 pandemic necessitated the need for more timely mortality data that could assist in monitoring direct mortality from the virus as well as indirect mortality due to social and economic societal change. This paper discusses the evolution of mortality data in Australia during the pandemic and looks at emerging opportunities associated with electronic infrastructure such as electronic Medical Certificates of Cause of Death (eMCCDs), ICD-11 and automated coding tools that will form the foundations of a more responsive and comprehensive future mortality dataset.
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Costa ACDO, Ferreira BH, Souza MDR, Costa Filho AM, Souza AAD. Análise da qualidade da informação sobre óbitos por neoplasias no Brasil, entre 2009 e 2019. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2022; 25:e220022. [DOI: 10.1590/1980-549720220022.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 06/08/2022] [Indexed: 12/23/2022] Open
Abstract
RESUMO Objetivo: Avaliar a qualidade das informações sobre mortalidade por neoplasias no âmbito do Sistema de Informação sobre Mortalidade. Métodos: Estudo descritivo observacional com avaliação da qualidade do Sistema de Informação sobre Mortalidade, com desfecho referente aos dados de óbitos por neoplasias ocorridos entre os anos de 2009 e 2019 na população brasileira (≥15 anos). A qualidade da informação (QI) foi mensurada para o Brasil e para as Unidades Federativas por meio das dimensões: cobertura, especificidade e completude dos dados. Resultados: A qualidade da dimensão cobertura variou entre “boa” e “excelente” nas abrangências nacional e estadual. A dimensão especificidade foi classificada como inadequada predominantemente nos Estados das Regiões Norte e Nordeste. A proporção de causas mal definidas foi classificada como de “baixa” qualidade na maioria das unidades de análise ao longo da série. A completude dos dados variou de acordo com o indicador utilizado, os indicadores sexo e idade mostraram-se “excelentes” para todo o período e unidades de análise, a escolaridade apresentou variação de qualidade tanto nas unidades como nos períodos e o estado civil apresentou melhoria da qualidade de seu registro ao longo do período, assim como o indicador raça/cor. Conclusões: A qualidade dos dados de mortalidade por neoplasias na população brasileira (≥15 anos) é, em sua maioria, adequada, mas há lacunas importantes que merecem ser preenchidas, pois a ampliação da QI busca dar visibilidade à condição de saúde da população brasileira, bem como propor ações públicas para sua melhoria.
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Costa ACDO, Ferreira BH, Souza MDR, Costa Filho AM, Souza AAD. Analysis of quality of information about deaths from neoplasms in Brazil between 2009 and 2019. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2022. [DOI: 10.1590/1980-549720220022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
ABSTRACT Objective To assess the quality of information about mortality from neoplasm within the Mortality Information System. Methods: Descriptive observational study evaluating the quality of the Mortality Information System, with an outcome referring to data on deaths from neoplasm between 2009 and 2019 in the Brazilian population (≥15 years). Information Quality (IQ) was measured through coverage, specificity and completeness of data, at national and state level. Results: The quality of the coverage dimension ranged from “good” to “excellent” in the national and state coverages. Specificity was classified as inadequate mainly in the states of the North and Northeast regions. The proportion of ill-defined causes was classified as “poor” quality in most units of analysis throughout the series. Data completeness varied according to indicator. Gender and age indicators were proven “excellent” for the entire period and units of analysis, while educational level varied in quality across units and periods, marital status had its quality improved over the period, as well as ethnicity/skin color. Conclusions: The quality of data on mortality from neoplasm in the Brazilian population (≥15 years) is mostly adequate, but there are important gaps to be filled, as the expansion of IQ seeks to give visibility to the health condition of the Brazilian population and to propose public actions for its improvement.
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Nyondo T, Msigwa G, Cobos D, Kabadi G, Macha T, Karugendo E, Mugasa J, Semu G, Levira F, Fruchtman CS, Mwanza J, Lyatuu I, Bratschi M, Kumalija CJ, Setel P, de Savigny D. Improving quality of medical certification of causes of death in health facilities in Tanzania 2014-2019. BMC Health Serv Res 2021; 21:214. [PMID: 34511104 PMCID: PMC8436444 DOI: 10.1186/s12913-021-06189-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 02/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Monitoring medically certified causes of death is essential to shape national health policies, track progress to Sustainable Development Goals, and gauge responses to epidemic and pandemic disease. The combination of electronic health information systems with new methods for data quality monitoring can facilitate quality assessments and help target quality improvement. Since 2015, Tanzania has been upgrading its Civil Registration and Vital Statistics system including efforts to improve the availability and quality of mortality data. METHODS We used a computer application (ANACONDA v4.01) to assess the quality of medical certification of cause of death (MCCD) and ICD-10 coding for the underlying cause of death for 155,461 deaths from health facilities from 2014 to 2018. From 2018 to 2019, we continued quality analysis for 2690 deaths in one large administrative region 9 months before, and 9 months following MCCD quality improvement interventions. Interventions addressed governance, training, process, and practice. We assessed changes in the levels, distributions, and nature of unusable and insufficiently specified codes, and how these influenced estimates of the leading causes of death. RESULTS 9.7% of expected annual deaths in Tanzania obtained a medically certified cause of death. Of these, 52% of MCCD ICD-10 codes were usable for health policy and planning, with no significant improvement over 5 years. Of certified deaths, 25% had unusable codes, 17% had insufficiently specified codes, and 6% were undetermined causes. Comparing the before and after intervention periods in one Region, codes usable for public health policy purposes improved from 48 to 65% within 1 year and the resulting distortions in the top twenty cause-specific mortality fractions due to unusable causes reduced from 27.4 to 13.5%. CONCLUSION Data from less than 5% of annual deaths in Tanzania are usable for informing policy. For deaths with medical certification, errors were prevalent in almost half. This constrains capacity to monitor the 15 SDG indicators that require cause-specific mortality. Sustainable quality assurance mechanisms and interventions can result in rapid improvements in the quality of medically certified causes of death. ANACONDA provides an effective means for evaluation of such changes and helps target interventions to remaining weaknesses.
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Affiliation(s)
- Trust Nyondo
- Ministry of Health, Community Development, Gender, Elderly, and Children, Dodoma, Tanzania
| | - Gisbert Msigwa
- Ministry of Health, Community Development, Gender, Elderly, and Children, Dodoma, Tanzania
- Bloomberg Philanthropies Data for Health Initiative, Vital Strategies, New York, NY, USA
| | - Daniel Cobos
- Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
| | - Gregory Kabadi
- Ministry of Health, Community Development, Gender, Elderly, and Children, Dodoma, Tanzania
- Bloomberg Philanthropies Data for Health Initiative, Vital Strategies, New York, NY, USA
| | - Tumaniel Macha
- Ministry of Health, Community Development, Gender, Elderly, and Children, Dodoma, Tanzania
| | | | - Joyce Mugasa
- Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Geofrey Semu
- Muhimbili National Hospital, Dar es Salaam, Tanzania
| | | | | | - James Mwanza
- Bloomberg Philanthropies Data for Health Initiative, Vital Strategies, New York, NY, USA
| | - Isaac Lyatuu
- Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
- Ifakara Health Institute, Dar es Salaam, Tanzania
- Africa Academy for Public Health, Dar es Salaam, Tanzania
| | - Martin Bratschi
- Bloomberg Philanthropies Data for Health Initiative, Vital Strategies, New York, NY, USA
| | - Claud J Kumalija
- Ministry of Health, Community Development, Gender, Elderly, and Children, Dodoma, Tanzania
| | - Philip Setel
- Bloomberg Philanthropies Data for Health Initiative, Vital Strategies, New York, NY, USA
| | - Don de Savigny
- Bloomberg Philanthropies Data for Health Initiative, Vital Strategies, New York, NY, USA.
- Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland.
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The Contribution of Temporal Flat Lateral Position on the Mortality and Discharge Rates of Older Patients with Severe Dysphagia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168443. [PMID: 34444198 PMCID: PMC8394130 DOI: 10.3390/ijerph18168443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/07/2021] [Accepted: 08/09/2021] [Indexed: 01/31/2023]
Abstract
Severe dysphagia leads to mortality in older patients and hinders their discharge from hospitals. The temporal flat lateral position (TFLP) enables them to continuously eat, thus resolving the aforementioned issues. We aimed to explore the effect of TFLP on the mortality and discharge rates of older patients with severe dysphagia. This interventional study comprised a historical control of patients admitted to a rural community hospital from January 2019 to December 2020 and diagnosed with severe dysphagia. The primary outcomes included the mortality and the rate of discharge from the hospital. While the intervention group was treated with TFLP, the control group underwent no treatment. We selected 79 participants (intervention group = 26, control group = 53), with an average age of 87.9 years. The discharge rate was significantly higher in the intervention group than in the control group (57.7% vs. 26.4%, p = 0.012). The mortality rate was also significantly lower in the intervention group compared to the control group (34.6% vs. 71.7%, p = 0.003). TFLP can improve the discharge and mortality rates in community hospitals, thereby improving patient outcomes. Clinicians should focus on practical education and the implementation of TFLP in communities in order to promote it.
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Verma AA, Hora T, Jung HY, Fralick M, Malecki SL, Lapointe-Shaw L, Weinerman A, Tang T, Kwan JL, Liu JJ, Rawal S, Chan TCY, Cheung AM, Rosella LC, Ghassemi M, Herridge M, Mamdani M, Razak F. Caractéristiques et issues des hospitalisations pour les cas de COVID-19 et d’influenza dans la région de Toronto. CMAJ 2021; 193:E859-E869. [PMID: 34099474 PMCID: PMC8203257 DOI: 10.1503/cmaj.202795-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2021] [Indexed: 12/15/2022] Open
Abstract
CONTEXTE: Les caractéristiques des patients, les soins cliniques, l’utilisation des ressources et les issues cliniques des personnes atteintes de la maladie à coronavirus 2019 (COVID-19) hospitalisées au Canada ne sont pas bien connus. MÉTHODES: Nous avons recueilli des données sur tous les adultes hospitalisés atteints de la COVID-19 ou de l’influenza ayant obtenu leur congé d’unités médicales ou d’unités de soins intensifs médicaux et chirurgicaux entre le 1er novembre 2019 et le 30 juin 2020 dans 7 centres hospitaliers de Toronto et de Mississauga (Ontario). Nous avons comparé les issues cliniques des patients à l’aide de modèles de régression multivariée, en tenant compte des facteurs sociodémographiques et de l’intensité des comorbidités. Nous avons validé le degré d’exactitude de 7 scores de risque mis au point à l’externe pour déterminer leur capacité à prédire le risque de décès chez les patients atteints de la COVID-19. RÉSULTATS: Parmi les hospitalisations retenues, 1027 patients étaient atteints de la COVID-19 (âge médian de 65 ans, 59,1 % d’hommes) et 783 étaient atteints de l’influenza (âge médian de 68 ans, 50,8 % d’hommes). Les patients âgés de moins de 50 ans comptaient pour 21,2 % de toutes les hospitalisations dues à la COVID-19 et 24,0 % des séjours aux soins intensifs. Comparativement aux patients atteints de l’influenza, les patients atteints de la COVID-19 présentaient un taux de mortalité perhospitalière (mortalité non ajustée 19,9 % c. 6,1 %; risque relatif [RR] ajusté 3,46 %, intervalle de confiance [IC] à 95 % 2,56–4,68) et un taux d’utilisation des ressources des unités de soins intensifs (taux non ajusté 26,4 % c. 18,0 %; RR ajusté 1,50, IC à 95 % 1,25–1,80) significativement plus élevés, ainsi qu’une durée d’hospitalisation (durée médiane non ajustée 8,7 jours c. 4,8 jours; rapport des taux d’incidence ajusté 1,45; IC à 95 % 1,25–1,69) significativement plus longue. Le taux de réhospitalisation dans les 30 jours n’était pas significativement différent (taux non ajusté 9,3 % c. 9,6 %; RR ajusté 0,98 %, IC à 95 % 0,70–1,39). Trois scores de risque utilisant un pointage pour prédire la mortalité perhospitalière ont montré une bonne discrimination (aire sous la courbe [ASC] de la fonction d’efficacité du récepteur [ROC] 0,72–0,81) et une bonne calibration. INTERPRÉTATION: Durant la première vague de la pandémie, l’hospitalisation des patients atteints de la COVID-19 était associée à des taux de mortalité et d’utilisation des ressources des unités de soins intensifs et à une durée d’hospitalisation significativement plus importants que les hospitalisations des patients atteints de l’influenza. De simples scores de risque peuvent prédire avec une bonne exactitude le risque de mortalité perhospitalière des patients atteints de la COVID-19.
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Affiliation(s)
- Amol A Verma
- Institut du savoir Li Ka Shing (Verma, Hora, Jung, Chan, Mamdani, Razak), Hôpital St. Michael, Unity Health Toronto; Département de médecine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak) et Institut des politiques, de la gestion et de l'évaluation de la santé (Verma, Cheung, Mamdani, Razak), Université de Toronto, Toronto, Ont.; Département de géographie et de gestion environnementale (Hora), Université de Waterloo, Waterloo, Ont.; Département de médecine (Fralick, Kwan), Système de santé Sinai; Département de médecine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) et Institut de recherche de l'Hôpital général de Toronto (Lapointe-Shaw), Réseau universitaire de santé; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Hôpital Women's College; ICES Central (Lapointe-Shaw, Rosella); Département de médecine (Weinerman), Centre des sciences de la santé Sunnybrook; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Département de génie mécanique et industriel (Chan), Université de Toronto; Département conjoint d'imagerie médicale (Cheung), Réseau universitaire de santé; Division d'épidémiologie (Cheung, Rosella), École de santé publique Dalla Lana; Institut Vecteur (Rosella, Ghassemi); Département d'informatique (Ghassemi) et Faculté de pharmacie Leslie Dan (Mamdani), Université de Toronto, Ont.
| | - Tejasvi Hora
- Institut du savoir Li Ka Shing (Verma, Hora, Jung, Chan, Mamdani, Razak), Hôpital St. Michael, Unity Health Toronto; Département de médecine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak) et Institut des politiques, de la gestion et de l'évaluation de la santé (Verma, Cheung, Mamdani, Razak), Université de Toronto, Toronto, Ont.; Département de géographie et de gestion environnementale (Hora), Université de Waterloo, Waterloo, Ont.; Département de médecine (Fralick, Kwan), Système de santé Sinai; Département de médecine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) et Institut de recherche de l'Hôpital général de Toronto (Lapointe-Shaw), Réseau universitaire de santé; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Hôpital Women's College; ICES Central (Lapointe-Shaw, Rosella); Département de médecine (Weinerman), Centre des sciences de la santé Sunnybrook; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Département de génie mécanique et industriel (Chan), Université de Toronto; Département conjoint d'imagerie médicale (Cheung), Réseau universitaire de santé; Division d'épidémiologie (Cheung, Rosella), École de santé publique Dalla Lana; Institut Vecteur (Rosella, Ghassemi); Département d'informatique (Ghassemi) et Faculté de pharmacie Leslie Dan (Mamdani), Université de Toronto, Ont
| | - Hae Young Jung
- Institut du savoir Li Ka Shing (Verma, Hora, Jung, Chan, Mamdani, Razak), Hôpital St. Michael, Unity Health Toronto; Département de médecine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak) et Institut des politiques, de la gestion et de l'évaluation de la santé (Verma, Cheung, Mamdani, Razak), Université de Toronto, Toronto, Ont.; Département de géographie et de gestion environnementale (Hora), Université de Waterloo, Waterloo, Ont.; Département de médecine (Fralick, Kwan), Système de santé Sinai; Département de médecine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) et Institut de recherche de l'Hôpital général de Toronto (Lapointe-Shaw), Réseau universitaire de santé; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Hôpital Women's College; ICES Central (Lapointe-Shaw, Rosella); Département de médecine (Weinerman), Centre des sciences de la santé Sunnybrook; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Département de génie mécanique et industriel (Chan), Université de Toronto; Département conjoint d'imagerie médicale (Cheung), Réseau universitaire de santé; Division d'épidémiologie (Cheung, Rosella), École de santé publique Dalla Lana; Institut Vecteur (Rosella, Ghassemi); Département d'informatique (Ghassemi) et Faculté de pharmacie Leslie Dan (Mamdani), Université de Toronto, Ont
| | - Michael Fralick
- Institut du savoir Li Ka Shing (Verma, Hora, Jung, Chan, Mamdani, Razak), Hôpital St. Michael, Unity Health Toronto; Département de médecine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak) et Institut des politiques, de la gestion et de l'évaluation de la santé (Verma, Cheung, Mamdani, Razak), Université de Toronto, Toronto, Ont.; Département de géographie et de gestion environnementale (Hora), Université de Waterloo, Waterloo, Ont.; Département de médecine (Fralick, Kwan), Système de santé Sinai; Département de médecine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) et Institut de recherche de l'Hôpital général de Toronto (Lapointe-Shaw), Réseau universitaire de santé; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Hôpital Women's College; ICES Central (Lapointe-Shaw, Rosella); Département de médecine (Weinerman), Centre des sciences de la santé Sunnybrook; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Département de génie mécanique et industriel (Chan), Université de Toronto; Département conjoint d'imagerie médicale (Cheung), Réseau universitaire de santé; Division d'épidémiologie (Cheung, Rosella), École de santé publique Dalla Lana; Institut Vecteur (Rosella, Ghassemi); Département d'informatique (Ghassemi) et Faculté de pharmacie Leslie Dan (Mamdani), Université de Toronto, Ont
| | - Sarah L Malecki
- Institut du savoir Li Ka Shing (Verma, Hora, Jung, Chan, Mamdani, Razak), Hôpital St. Michael, Unity Health Toronto; Département de médecine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak) et Institut des politiques, de la gestion et de l'évaluation de la santé (Verma, Cheung, Mamdani, Razak), Université de Toronto, Toronto, Ont.; Département de géographie et de gestion environnementale (Hora), Université de Waterloo, Waterloo, Ont.; Département de médecine (Fralick, Kwan), Système de santé Sinai; Département de médecine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) et Institut de recherche de l'Hôpital général de Toronto (Lapointe-Shaw), Réseau universitaire de santé; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Hôpital Women's College; ICES Central (Lapointe-Shaw, Rosella); Département de médecine (Weinerman), Centre des sciences de la santé Sunnybrook; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Département de génie mécanique et industriel (Chan), Université de Toronto; Département conjoint d'imagerie médicale (Cheung), Réseau universitaire de santé; Division d'épidémiologie (Cheung, Rosella), École de santé publique Dalla Lana; Institut Vecteur (Rosella, Ghassemi); Département d'informatique (Ghassemi) et Faculté de pharmacie Leslie Dan (Mamdani), Université de Toronto, Ont
| | - Lauren Lapointe-Shaw
- Institut du savoir Li Ka Shing (Verma, Hora, Jung, Chan, Mamdani, Razak), Hôpital St. Michael, Unity Health Toronto; Département de médecine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak) et Institut des politiques, de la gestion et de l'évaluation de la santé (Verma, Cheung, Mamdani, Razak), Université de Toronto, Toronto, Ont.; Département de géographie et de gestion environnementale (Hora), Université de Waterloo, Waterloo, Ont.; Département de médecine (Fralick, Kwan), Système de santé Sinai; Département de médecine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) et Institut de recherche de l'Hôpital général de Toronto (Lapointe-Shaw), Réseau universitaire de santé; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Hôpital Women's College; ICES Central (Lapointe-Shaw, Rosella); Département de médecine (Weinerman), Centre des sciences de la santé Sunnybrook; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Département de génie mécanique et industriel (Chan), Université de Toronto; Département conjoint d'imagerie médicale (Cheung), Réseau universitaire de santé; Division d'épidémiologie (Cheung, Rosella), École de santé publique Dalla Lana; Institut Vecteur (Rosella, Ghassemi); Département d'informatique (Ghassemi) et Faculté de pharmacie Leslie Dan (Mamdani), Université de Toronto, Ont
| | - Adina Weinerman
- Institut du savoir Li Ka Shing (Verma, Hora, Jung, Chan, Mamdani, Razak), Hôpital St. Michael, Unity Health Toronto; Département de médecine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak) et Institut des politiques, de la gestion et de l'évaluation de la santé (Verma, Cheung, Mamdani, Razak), Université de Toronto, Toronto, Ont.; Département de géographie et de gestion environnementale (Hora), Université de Waterloo, Waterloo, Ont.; Département de médecine (Fralick, Kwan), Système de santé Sinai; Département de médecine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) et Institut de recherche de l'Hôpital général de Toronto (Lapointe-Shaw), Réseau universitaire de santé; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Hôpital Women's College; ICES Central (Lapointe-Shaw, Rosella); Département de médecine (Weinerman), Centre des sciences de la santé Sunnybrook; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Département de génie mécanique et industriel (Chan), Université de Toronto; Département conjoint d'imagerie médicale (Cheung), Réseau universitaire de santé; Division d'épidémiologie (Cheung, Rosella), École de santé publique Dalla Lana; Institut Vecteur (Rosella, Ghassemi); Département d'informatique (Ghassemi) et Faculté de pharmacie Leslie Dan (Mamdani), Université de Toronto, Ont
| | - Terence Tang
- Institut du savoir Li Ka Shing (Verma, Hora, Jung, Chan, Mamdani, Razak), Hôpital St. Michael, Unity Health Toronto; Département de médecine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak) et Institut des politiques, de la gestion et de l'évaluation de la santé (Verma, Cheung, Mamdani, Razak), Université de Toronto, Toronto, Ont.; Département de géographie et de gestion environnementale (Hora), Université de Waterloo, Waterloo, Ont.; Département de médecine (Fralick, Kwan), Système de santé Sinai; Département de médecine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) et Institut de recherche de l'Hôpital général de Toronto (Lapointe-Shaw), Réseau universitaire de santé; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Hôpital Women's College; ICES Central (Lapointe-Shaw, Rosella); Département de médecine (Weinerman), Centre des sciences de la santé Sunnybrook; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Département de génie mécanique et industriel (Chan), Université de Toronto; Département conjoint d'imagerie médicale (Cheung), Réseau universitaire de santé; Division d'épidémiologie (Cheung, Rosella), École de santé publique Dalla Lana; Institut Vecteur (Rosella, Ghassemi); Département d'informatique (Ghassemi) et Faculté de pharmacie Leslie Dan (Mamdani), Université de Toronto, Ont
| | - Janice L Kwan
- Institut du savoir Li Ka Shing (Verma, Hora, Jung, Chan, Mamdani, Razak), Hôpital St. Michael, Unity Health Toronto; Département de médecine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak) et Institut des politiques, de la gestion et de l'évaluation de la santé (Verma, Cheung, Mamdani, Razak), Université de Toronto, Toronto, Ont.; Département de géographie et de gestion environnementale (Hora), Université de Waterloo, Waterloo, Ont.; Département de médecine (Fralick, Kwan), Système de santé Sinai; Département de médecine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) et Institut de recherche de l'Hôpital général de Toronto (Lapointe-Shaw), Réseau universitaire de santé; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Hôpital Women's College; ICES Central (Lapointe-Shaw, Rosella); Département de médecine (Weinerman), Centre des sciences de la santé Sunnybrook; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Département de génie mécanique et industriel (Chan), Université de Toronto; Département conjoint d'imagerie médicale (Cheung), Réseau universitaire de santé; Division d'épidémiologie (Cheung, Rosella), École de santé publique Dalla Lana; Institut Vecteur (Rosella, Ghassemi); Département d'informatique (Ghassemi) et Faculté de pharmacie Leslie Dan (Mamdani), Université de Toronto, Ont
| | - Jessica J Liu
- Institut du savoir Li Ka Shing (Verma, Hora, Jung, Chan, Mamdani, Razak), Hôpital St. Michael, Unity Health Toronto; Département de médecine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak) et Institut des politiques, de la gestion et de l'évaluation de la santé (Verma, Cheung, Mamdani, Razak), Université de Toronto, Toronto, Ont.; Département de géographie et de gestion environnementale (Hora), Université de Waterloo, Waterloo, Ont.; Département de médecine (Fralick, Kwan), Système de santé Sinai; Département de médecine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) et Institut de recherche de l'Hôpital général de Toronto (Lapointe-Shaw), Réseau universitaire de santé; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Hôpital Women's College; ICES Central (Lapointe-Shaw, Rosella); Département de médecine (Weinerman), Centre des sciences de la santé Sunnybrook; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Département de génie mécanique et industriel (Chan), Université de Toronto; Département conjoint d'imagerie médicale (Cheung), Réseau universitaire de santé; Division d'épidémiologie (Cheung, Rosella), École de santé publique Dalla Lana; Institut Vecteur (Rosella, Ghassemi); Département d'informatique (Ghassemi) et Faculté de pharmacie Leslie Dan (Mamdani), Université de Toronto, Ont
| | - Shail Rawal
- Institut du savoir Li Ka Shing (Verma, Hora, Jung, Chan, Mamdani, Razak), Hôpital St. Michael, Unity Health Toronto; Département de médecine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak) et Institut des politiques, de la gestion et de l'évaluation de la santé (Verma, Cheung, Mamdani, Razak), Université de Toronto, Toronto, Ont.; Département de géographie et de gestion environnementale (Hora), Université de Waterloo, Waterloo, Ont.; Département de médecine (Fralick, Kwan), Système de santé Sinai; Département de médecine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) et Institut de recherche de l'Hôpital général de Toronto (Lapointe-Shaw), Réseau universitaire de santé; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Hôpital Women's College; ICES Central (Lapointe-Shaw, Rosella); Département de médecine (Weinerman), Centre des sciences de la santé Sunnybrook; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Département de génie mécanique et industriel (Chan), Université de Toronto; Département conjoint d'imagerie médicale (Cheung), Réseau universitaire de santé; Division d'épidémiologie (Cheung, Rosella), École de santé publique Dalla Lana; Institut Vecteur (Rosella, Ghassemi); Département d'informatique (Ghassemi) et Faculté de pharmacie Leslie Dan (Mamdani), Université de Toronto, Ont
| | - Timothy C Y Chan
- Institut du savoir Li Ka Shing (Verma, Hora, Jung, Chan, Mamdani, Razak), Hôpital St. Michael, Unity Health Toronto; Département de médecine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak) et Institut des politiques, de la gestion et de l'évaluation de la santé (Verma, Cheung, Mamdani, Razak), Université de Toronto, Toronto, Ont.; Département de géographie et de gestion environnementale (Hora), Université de Waterloo, Waterloo, Ont.; Département de médecine (Fralick, Kwan), Système de santé Sinai; Département de médecine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) et Institut de recherche de l'Hôpital général de Toronto (Lapointe-Shaw), Réseau universitaire de santé; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Hôpital Women's College; ICES Central (Lapointe-Shaw, Rosella); Département de médecine (Weinerman), Centre des sciences de la santé Sunnybrook; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Département de génie mécanique et industriel (Chan), Université de Toronto; Département conjoint d'imagerie médicale (Cheung), Réseau universitaire de santé; Division d'épidémiologie (Cheung, Rosella), École de santé publique Dalla Lana; Institut Vecteur (Rosella, Ghassemi); Département d'informatique (Ghassemi) et Faculté de pharmacie Leslie Dan (Mamdani), Université de Toronto, Ont
| | - Angela M Cheung
- Institut du savoir Li Ka Shing (Verma, Hora, Jung, Chan, Mamdani, Razak), Hôpital St. Michael, Unity Health Toronto; Département de médecine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak) et Institut des politiques, de la gestion et de l'évaluation de la santé (Verma, Cheung, Mamdani, Razak), Université de Toronto, Toronto, Ont.; Département de géographie et de gestion environnementale (Hora), Université de Waterloo, Waterloo, Ont.; Département de médecine (Fralick, Kwan), Système de santé Sinai; Département de médecine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) et Institut de recherche de l'Hôpital général de Toronto (Lapointe-Shaw), Réseau universitaire de santé; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Hôpital Women's College; ICES Central (Lapointe-Shaw, Rosella); Département de médecine (Weinerman), Centre des sciences de la santé Sunnybrook; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Département de génie mécanique et industriel (Chan), Université de Toronto; Département conjoint d'imagerie médicale (Cheung), Réseau universitaire de santé; Division d'épidémiologie (Cheung, Rosella), École de santé publique Dalla Lana; Institut Vecteur (Rosella, Ghassemi); Département d'informatique (Ghassemi) et Faculté de pharmacie Leslie Dan (Mamdani), Université de Toronto, Ont
| | - Laura C Rosella
- Institut du savoir Li Ka Shing (Verma, Hora, Jung, Chan, Mamdani, Razak), Hôpital St. Michael, Unity Health Toronto; Département de médecine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak) et Institut des politiques, de la gestion et de l'évaluation de la santé (Verma, Cheung, Mamdani, Razak), Université de Toronto, Toronto, Ont.; Département de géographie et de gestion environnementale (Hora), Université de Waterloo, Waterloo, Ont.; Département de médecine (Fralick, Kwan), Système de santé Sinai; Département de médecine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) et Institut de recherche de l'Hôpital général de Toronto (Lapointe-Shaw), Réseau universitaire de santé; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Hôpital Women's College; ICES Central (Lapointe-Shaw, Rosella); Département de médecine (Weinerman), Centre des sciences de la santé Sunnybrook; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Département de génie mécanique et industriel (Chan), Université de Toronto; Département conjoint d'imagerie médicale (Cheung), Réseau universitaire de santé; Division d'épidémiologie (Cheung, Rosella), École de santé publique Dalla Lana; Institut Vecteur (Rosella, Ghassemi); Département d'informatique (Ghassemi) et Faculté de pharmacie Leslie Dan (Mamdani), Université de Toronto, Ont
| | - Marzyeh Ghassemi
- Institut du savoir Li Ka Shing (Verma, Hora, Jung, Chan, Mamdani, Razak), Hôpital St. Michael, Unity Health Toronto; Département de médecine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak) et Institut des politiques, de la gestion et de l'évaluation de la santé (Verma, Cheung, Mamdani, Razak), Université de Toronto, Toronto, Ont.; Département de géographie et de gestion environnementale (Hora), Université de Waterloo, Waterloo, Ont.; Département de médecine (Fralick, Kwan), Système de santé Sinai; Département de médecine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) et Institut de recherche de l'Hôpital général de Toronto (Lapointe-Shaw), Réseau universitaire de santé; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Hôpital Women's College; ICES Central (Lapointe-Shaw, Rosella); Département de médecine (Weinerman), Centre des sciences de la santé Sunnybrook; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Département de génie mécanique et industriel (Chan), Université de Toronto; Département conjoint d'imagerie médicale (Cheung), Réseau universitaire de santé; Division d'épidémiologie (Cheung, Rosella), École de santé publique Dalla Lana; Institut Vecteur (Rosella, Ghassemi); Département d'informatique (Ghassemi) et Faculté de pharmacie Leslie Dan (Mamdani), Université de Toronto, Ont
| | - Margaret Herridge
- Institut du savoir Li Ka Shing (Verma, Hora, Jung, Chan, Mamdani, Razak), Hôpital St. Michael, Unity Health Toronto; Département de médecine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak) et Institut des politiques, de la gestion et de l'évaluation de la santé (Verma, Cheung, Mamdani, Razak), Université de Toronto, Toronto, Ont.; Département de géographie et de gestion environnementale (Hora), Université de Waterloo, Waterloo, Ont.; Département de médecine (Fralick, Kwan), Système de santé Sinai; Département de médecine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) et Institut de recherche de l'Hôpital général de Toronto (Lapointe-Shaw), Réseau universitaire de santé; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Hôpital Women's College; ICES Central (Lapointe-Shaw, Rosella); Département de médecine (Weinerman), Centre des sciences de la santé Sunnybrook; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Département de génie mécanique et industriel (Chan), Université de Toronto; Département conjoint d'imagerie médicale (Cheung), Réseau universitaire de santé; Division d'épidémiologie (Cheung, Rosella), École de santé publique Dalla Lana; Institut Vecteur (Rosella, Ghassemi); Département d'informatique (Ghassemi) et Faculté de pharmacie Leslie Dan (Mamdani), Université de Toronto, Ont
| | - Muhammad Mamdani
- Institut du savoir Li Ka Shing (Verma, Hora, Jung, Chan, Mamdani, Razak), Hôpital St. Michael, Unity Health Toronto; Département de médecine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak) et Institut des politiques, de la gestion et de l'évaluation de la santé (Verma, Cheung, Mamdani, Razak), Université de Toronto, Toronto, Ont.; Département de géographie et de gestion environnementale (Hora), Université de Waterloo, Waterloo, Ont.; Département de médecine (Fralick, Kwan), Système de santé Sinai; Département de médecine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) et Institut de recherche de l'Hôpital général de Toronto (Lapointe-Shaw), Réseau universitaire de santé; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Hôpital Women's College; ICES Central (Lapointe-Shaw, Rosella); Département de médecine (Weinerman), Centre des sciences de la santé Sunnybrook; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Département de génie mécanique et industriel (Chan), Université de Toronto; Département conjoint d'imagerie médicale (Cheung), Réseau universitaire de santé; Division d'épidémiologie (Cheung, Rosella), École de santé publique Dalla Lana; Institut Vecteur (Rosella, Ghassemi); Département d'informatique (Ghassemi) et Faculté de pharmacie Leslie Dan (Mamdani), Université de Toronto, Ont
| | - Fahad Razak
- Institut du savoir Li Ka Shing (Verma, Hora, Jung, Chan, Mamdani, Razak), Hôpital St. Michael, Unity Health Toronto; Département de médecine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak) et Institut des politiques, de la gestion et de l'évaluation de la santé (Verma, Cheung, Mamdani, Razak), Université de Toronto, Toronto, Ont.; Département de géographie et de gestion environnementale (Hora), Université de Waterloo, Waterloo, Ont.; Département de médecine (Fralick, Kwan), Système de santé Sinai; Département de médecine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) et Institut de recherche de l'Hôpital général de Toronto (Lapointe-Shaw), Réseau universitaire de santé; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Hôpital Women's College; ICES Central (Lapointe-Shaw, Rosella); Département de médecine (Weinerman), Centre des sciences de la santé Sunnybrook; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Département de génie mécanique et industriel (Chan), Université de Toronto; Département conjoint d'imagerie médicale (Cheung), Réseau universitaire de santé; Division d'épidémiologie (Cheung, Rosella), École de santé publique Dalla Lana; Institut Vecteur (Rosella, Ghassemi); Département d'informatique (Ghassemi) et Faculté de pharmacie Leslie Dan (Mamdani), Université de Toronto, Ont
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Wengler A, Gruhl H, Plaß D, Leddin J, Rommel A, von der Lippe E. Redistributing ill-defined causes of death - a case study from the BURDEN 2020-project in Germany. Arch Public Health 2021; 79:33. [PMID: 33722272 PMCID: PMC7958488 DOI: 10.1186/s13690-021-00535-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/24/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The cause of death statistics in Germany include a relatively high share (26% in 2017) of ill-defined deaths (IDD). To make use of the cause of death statistics for Burden of Disease calculations we redistribute those IDD to valid causes of death. METHODS The process of proportional redistribution is described in detail. It makes use of the distribution of the valid ICD-codes in the cause of death data. We use examples of stroke, diabetes, and heart failure to illustrate how IDD are reallocated. RESULTS The largest increases in the number of deaths for both women and men were found for lower respiratory infections, diabetes mellitus, and stroke. The numbers of deaths for these causes more than doubled after redistribution. CONCLUSION This is the first comprehensive redistribution of IDD using the German cause of death statistics. Performing a redistribution is necessary for burden of disease analyses, otherwise there would be an underreporting of certain causes of death or large numbers of deaths coded to residual or unspecific codes.
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Affiliation(s)
- Annelene Wengler
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany.
| | - Heike Gruhl
- Department of Environmental Hygiene, German Environment Agency, Berlin, Germany
| | - Dietrich Plaß
- Department of Environmental Hygiene, German Environment Agency, Berlin, Germany
| | - Janko Leddin
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Alexander Rommel
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Elena von der Lippe
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
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Verma AA, Hora T, Jung HY, Fralick M, Malecki SL, Lapointe-Shaw L, Weinerman A, Tang T, Kwan JL, Liu JJ, Rawal S, Chan TCY, Cheung AM, Rosella LC, Ghassemi M, Herridge M, Mamdani M, Razak F. Characteristics and outcomes of hospital admissions for COVID-19 and influenza in the Toronto area. CMAJ 2021; 193:E410-E418. [PMID: 33568436 PMCID: PMC8096386 DOI: 10.1503/cmaj.202795] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND: Patient characteristics, clinical care, resource use and outcomes associated with admission to hospital for coronavirus disease 2019 (COVID-19) in Canada are not well described. METHODS: We described all adults with COVID-19 or influenza discharged from inpatient medical services and medical–surgical intensive care units (ICUs) between Nov. 1, 2019, and June 30, 2020, at 7 hospitals in Toronto and Mississauga, Ontario. We compared patient outcomes using multivariable regression models, controlling for patient sociodemographic factors and comorbidity level. We validated the accuracy of 7 externally developed risk scores to predict mortality among patients with COVID-19. RESULTS: There were 1027 hospital admissions with COVID-19 (median age 65 yr, 59.1% male) and 783 with influenza (median age 68 yr, 50.8% male). Patients younger than 50 years accounted for 21.2% of all admissions for COVID-19 and 24.0% of ICU admissions. Compared with influenza, patients with COVID-19 had significantly greater in-hospital mortality (unadjusted 19.9% v. 6.1%, adjusted relative risk [RR] 3.46, 95% confidence interval [CI] 2.56–4.68), ICU use (unadjusted 26.4% v. 18.0%, adjusted RR 1.50, 95% CI 1.25–1.80) and hospital length of stay (unadjusted median 8.7 d v. 4.8 d, adjusted rate ratio 1.45, 95% CI 1.25–1.69). Thirty-day readmission was not significantly different (unadjusted 9.3% v. 9.6%, adjusted RR 0.98, 95% CI 0.70–1.39). Three points-based risk scores for predicting in-hospital mortality showed good discrimination (area under the receiver operating characteristic curve [AUC] ranging from 0.72 to 0.81) and calibration. INTERPRETATION: During the first wave of the pandemic, admission to hospital for COVID-19 was associated with significantly greater mortality, ICU use and hospital length of stay than influenza. Simple risk scores can predict in-hospital mortality in patients with COVID-19 with good accuracy.
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Affiliation(s)
- Amol A Verma
- Li Ka Shing Knowledge Institute (Verma, Hora, Jung, Chan, Mamdani, Razak), St. Michael's Hospital, Unity Health Toronto; Department of Medicine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak), and Institute of Health Policy, Management and Evaluation (Verma, Cheung, Mamdani, Razak), University of Toronto, Toronto, Ont.; Department of Geography and Environmental Management (Hora), University of Waterloo, Waterloo, Ont.; Department of Medicine (Fralick, Kwan), Sinai Health System; Department of Medicine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) and Toronto General Hospital Research Institute (Lapointe-Shaw), University Health Network; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Women's College Hospital; ICES Central (Lapointe-Shaw, Rosella); Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Department of Mechanical and Industrial Engineering (Chan), University of Toronto; Joint Department of Medical Imaging (Cheung), University Health Network; Division of Epidemiology (Cheung, Rosella), Dalla Lana School of Public Health; Vector Institute (Rosella, Ghassemi); Department of Computer Science (Ghassemi) and Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto, Ont.
| | - Tejasvi Hora
- Li Ka Shing Knowledge Institute (Verma, Hora, Jung, Chan, Mamdani, Razak), St. Michael's Hospital, Unity Health Toronto; Department of Medicine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak), and Institute of Health Policy, Management and Evaluation (Verma, Cheung, Mamdani, Razak), University of Toronto, Toronto, Ont.; Department of Geography and Environmental Management (Hora), University of Waterloo, Waterloo, Ont.; Department of Medicine (Fralick, Kwan), Sinai Health System; Department of Medicine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) and Toronto General Hospital Research Institute (Lapointe-Shaw), University Health Network; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Women's College Hospital; ICES Central (Lapointe-Shaw, Rosella); Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Department of Mechanical and Industrial Engineering (Chan), University of Toronto; Joint Department of Medical Imaging (Cheung), University Health Network; Division of Epidemiology (Cheung, Rosella), Dalla Lana School of Public Health; Vector Institute (Rosella, Ghassemi); Department of Computer Science (Ghassemi) and Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto, Ont
| | - Hae Young Jung
- Li Ka Shing Knowledge Institute (Verma, Hora, Jung, Chan, Mamdani, Razak), St. Michael's Hospital, Unity Health Toronto; Department of Medicine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak), and Institute of Health Policy, Management and Evaluation (Verma, Cheung, Mamdani, Razak), University of Toronto, Toronto, Ont.; Department of Geography and Environmental Management (Hora), University of Waterloo, Waterloo, Ont.; Department of Medicine (Fralick, Kwan), Sinai Health System; Department of Medicine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) and Toronto General Hospital Research Institute (Lapointe-Shaw), University Health Network; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Women's College Hospital; ICES Central (Lapointe-Shaw, Rosella); Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Department of Mechanical and Industrial Engineering (Chan), University of Toronto; Joint Department of Medical Imaging (Cheung), University Health Network; Division of Epidemiology (Cheung, Rosella), Dalla Lana School of Public Health; Vector Institute (Rosella, Ghassemi); Department of Computer Science (Ghassemi) and Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto, Ont
| | - Michael Fralick
- Li Ka Shing Knowledge Institute (Verma, Hora, Jung, Chan, Mamdani, Razak), St. Michael's Hospital, Unity Health Toronto; Department of Medicine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak), and Institute of Health Policy, Management and Evaluation (Verma, Cheung, Mamdani, Razak), University of Toronto, Toronto, Ont.; Department of Geography and Environmental Management (Hora), University of Waterloo, Waterloo, Ont.; Department of Medicine (Fralick, Kwan), Sinai Health System; Department of Medicine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) and Toronto General Hospital Research Institute (Lapointe-Shaw), University Health Network; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Women's College Hospital; ICES Central (Lapointe-Shaw, Rosella); Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Department of Mechanical and Industrial Engineering (Chan), University of Toronto; Joint Department of Medical Imaging (Cheung), University Health Network; Division of Epidemiology (Cheung, Rosella), Dalla Lana School of Public Health; Vector Institute (Rosella, Ghassemi); Department of Computer Science (Ghassemi) and Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto, Ont
| | - Sarah L Malecki
- Li Ka Shing Knowledge Institute (Verma, Hora, Jung, Chan, Mamdani, Razak), St. Michael's Hospital, Unity Health Toronto; Department of Medicine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak), and Institute of Health Policy, Management and Evaluation (Verma, Cheung, Mamdani, Razak), University of Toronto, Toronto, Ont.; Department of Geography and Environmental Management (Hora), University of Waterloo, Waterloo, Ont.; Department of Medicine (Fralick, Kwan), Sinai Health System; Department of Medicine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) and Toronto General Hospital Research Institute (Lapointe-Shaw), University Health Network; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Women's College Hospital; ICES Central (Lapointe-Shaw, Rosella); Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Department of Mechanical and Industrial Engineering (Chan), University of Toronto; Joint Department of Medical Imaging (Cheung), University Health Network; Division of Epidemiology (Cheung, Rosella), Dalla Lana School of Public Health; Vector Institute (Rosella, Ghassemi); Department of Computer Science (Ghassemi) and Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto, Ont
| | - Lauren Lapointe-Shaw
- Li Ka Shing Knowledge Institute (Verma, Hora, Jung, Chan, Mamdani, Razak), St. Michael's Hospital, Unity Health Toronto; Department of Medicine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak), and Institute of Health Policy, Management and Evaluation (Verma, Cheung, Mamdani, Razak), University of Toronto, Toronto, Ont.; Department of Geography and Environmental Management (Hora), University of Waterloo, Waterloo, Ont.; Department of Medicine (Fralick, Kwan), Sinai Health System; Department of Medicine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) and Toronto General Hospital Research Institute (Lapointe-Shaw), University Health Network; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Women's College Hospital; ICES Central (Lapointe-Shaw, Rosella); Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Department of Mechanical and Industrial Engineering (Chan), University of Toronto; Joint Department of Medical Imaging (Cheung), University Health Network; Division of Epidemiology (Cheung, Rosella), Dalla Lana School of Public Health; Vector Institute (Rosella, Ghassemi); Department of Computer Science (Ghassemi) and Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto, Ont
| | - Adina Weinerman
- Li Ka Shing Knowledge Institute (Verma, Hora, Jung, Chan, Mamdani, Razak), St. Michael's Hospital, Unity Health Toronto; Department of Medicine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak), and Institute of Health Policy, Management and Evaluation (Verma, Cheung, Mamdani, Razak), University of Toronto, Toronto, Ont.; Department of Geography and Environmental Management (Hora), University of Waterloo, Waterloo, Ont.; Department of Medicine (Fralick, Kwan), Sinai Health System; Department of Medicine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) and Toronto General Hospital Research Institute (Lapointe-Shaw), University Health Network; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Women's College Hospital; ICES Central (Lapointe-Shaw, Rosella); Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Department of Mechanical and Industrial Engineering (Chan), University of Toronto; Joint Department of Medical Imaging (Cheung), University Health Network; Division of Epidemiology (Cheung, Rosella), Dalla Lana School of Public Health; Vector Institute (Rosella, Ghassemi); Department of Computer Science (Ghassemi) and Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto, Ont
| | - Terence Tang
- Li Ka Shing Knowledge Institute (Verma, Hora, Jung, Chan, Mamdani, Razak), St. Michael's Hospital, Unity Health Toronto; Department of Medicine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak), and Institute of Health Policy, Management and Evaluation (Verma, Cheung, Mamdani, Razak), University of Toronto, Toronto, Ont.; Department of Geography and Environmental Management (Hora), University of Waterloo, Waterloo, Ont.; Department of Medicine (Fralick, Kwan), Sinai Health System; Department of Medicine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) and Toronto General Hospital Research Institute (Lapointe-Shaw), University Health Network; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Women's College Hospital; ICES Central (Lapointe-Shaw, Rosella); Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Department of Mechanical and Industrial Engineering (Chan), University of Toronto; Joint Department of Medical Imaging (Cheung), University Health Network; Division of Epidemiology (Cheung, Rosella), Dalla Lana School of Public Health; Vector Institute (Rosella, Ghassemi); Department of Computer Science (Ghassemi) and Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto, Ont
| | - Janice L Kwan
- Li Ka Shing Knowledge Institute (Verma, Hora, Jung, Chan, Mamdani, Razak), St. Michael's Hospital, Unity Health Toronto; Department of Medicine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak), and Institute of Health Policy, Management and Evaluation (Verma, Cheung, Mamdani, Razak), University of Toronto, Toronto, Ont.; Department of Geography and Environmental Management (Hora), University of Waterloo, Waterloo, Ont.; Department of Medicine (Fralick, Kwan), Sinai Health System; Department of Medicine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) and Toronto General Hospital Research Institute (Lapointe-Shaw), University Health Network; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Women's College Hospital; ICES Central (Lapointe-Shaw, Rosella); Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Department of Mechanical and Industrial Engineering (Chan), University of Toronto; Joint Department of Medical Imaging (Cheung), University Health Network; Division of Epidemiology (Cheung, Rosella), Dalla Lana School of Public Health; Vector Institute (Rosella, Ghassemi); Department of Computer Science (Ghassemi) and Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto, Ont
| | - Jessica J Liu
- Li Ka Shing Knowledge Institute (Verma, Hora, Jung, Chan, Mamdani, Razak), St. Michael's Hospital, Unity Health Toronto; Department of Medicine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak), and Institute of Health Policy, Management and Evaluation (Verma, Cheung, Mamdani, Razak), University of Toronto, Toronto, Ont.; Department of Geography and Environmental Management (Hora), University of Waterloo, Waterloo, Ont.; Department of Medicine (Fralick, Kwan), Sinai Health System; Department of Medicine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) and Toronto General Hospital Research Institute (Lapointe-Shaw), University Health Network; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Women's College Hospital; ICES Central (Lapointe-Shaw, Rosella); Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Department of Mechanical and Industrial Engineering (Chan), University of Toronto; Joint Department of Medical Imaging (Cheung), University Health Network; Division of Epidemiology (Cheung, Rosella), Dalla Lana School of Public Health; Vector Institute (Rosella, Ghassemi); Department of Computer Science (Ghassemi) and Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto, Ont
| | - Shail Rawal
- Li Ka Shing Knowledge Institute (Verma, Hora, Jung, Chan, Mamdani, Razak), St. Michael's Hospital, Unity Health Toronto; Department of Medicine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak), and Institute of Health Policy, Management and Evaluation (Verma, Cheung, Mamdani, Razak), University of Toronto, Toronto, Ont.; Department of Geography and Environmental Management (Hora), University of Waterloo, Waterloo, Ont.; Department of Medicine (Fralick, Kwan), Sinai Health System; Department of Medicine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) and Toronto General Hospital Research Institute (Lapointe-Shaw), University Health Network; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Women's College Hospital; ICES Central (Lapointe-Shaw, Rosella); Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Department of Mechanical and Industrial Engineering (Chan), University of Toronto; Joint Department of Medical Imaging (Cheung), University Health Network; Division of Epidemiology (Cheung, Rosella), Dalla Lana School of Public Health; Vector Institute (Rosella, Ghassemi); Department of Computer Science (Ghassemi) and Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto, Ont
| | - Timothy C Y Chan
- Li Ka Shing Knowledge Institute (Verma, Hora, Jung, Chan, Mamdani, Razak), St. Michael's Hospital, Unity Health Toronto; Department of Medicine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak), and Institute of Health Policy, Management and Evaluation (Verma, Cheung, Mamdani, Razak), University of Toronto, Toronto, Ont.; Department of Geography and Environmental Management (Hora), University of Waterloo, Waterloo, Ont.; Department of Medicine (Fralick, Kwan), Sinai Health System; Department of Medicine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) and Toronto General Hospital Research Institute (Lapointe-Shaw), University Health Network; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Women's College Hospital; ICES Central (Lapointe-Shaw, Rosella); Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Department of Mechanical and Industrial Engineering (Chan), University of Toronto; Joint Department of Medical Imaging (Cheung), University Health Network; Division of Epidemiology (Cheung, Rosella), Dalla Lana School of Public Health; Vector Institute (Rosella, Ghassemi); Department of Computer Science (Ghassemi) and Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto, Ont
| | - Angela M Cheung
- Li Ka Shing Knowledge Institute (Verma, Hora, Jung, Chan, Mamdani, Razak), St. Michael's Hospital, Unity Health Toronto; Department of Medicine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak), and Institute of Health Policy, Management and Evaluation (Verma, Cheung, Mamdani, Razak), University of Toronto, Toronto, Ont.; Department of Geography and Environmental Management (Hora), University of Waterloo, Waterloo, Ont.; Department of Medicine (Fralick, Kwan), Sinai Health System; Department of Medicine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) and Toronto General Hospital Research Institute (Lapointe-Shaw), University Health Network; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Women's College Hospital; ICES Central (Lapointe-Shaw, Rosella); Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Department of Mechanical and Industrial Engineering (Chan), University of Toronto; Joint Department of Medical Imaging (Cheung), University Health Network; Division of Epidemiology (Cheung, Rosella), Dalla Lana School of Public Health; Vector Institute (Rosella, Ghassemi); Department of Computer Science (Ghassemi) and Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto, Ont
| | - Laura C Rosella
- Li Ka Shing Knowledge Institute (Verma, Hora, Jung, Chan, Mamdani, Razak), St. Michael's Hospital, Unity Health Toronto; Department of Medicine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak), and Institute of Health Policy, Management and Evaluation (Verma, Cheung, Mamdani, Razak), University of Toronto, Toronto, Ont.; Department of Geography and Environmental Management (Hora), University of Waterloo, Waterloo, Ont.; Department of Medicine (Fralick, Kwan), Sinai Health System; Department of Medicine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) and Toronto General Hospital Research Institute (Lapointe-Shaw), University Health Network; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Women's College Hospital; ICES Central (Lapointe-Shaw, Rosella); Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Department of Mechanical and Industrial Engineering (Chan), University of Toronto; Joint Department of Medical Imaging (Cheung), University Health Network; Division of Epidemiology (Cheung, Rosella), Dalla Lana School of Public Health; Vector Institute (Rosella, Ghassemi); Department of Computer Science (Ghassemi) and Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto, Ont
| | - Marzyeh Ghassemi
- Li Ka Shing Knowledge Institute (Verma, Hora, Jung, Chan, Mamdani, Razak), St. Michael's Hospital, Unity Health Toronto; Department of Medicine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak), and Institute of Health Policy, Management and Evaluation (Verma, Cheung, Mamdani, Razak), University of Toronto, Toronto, Ont.; Department of Geography and Environmental Management (Hora), University of Waterloo, Waterloo, Ont.; Department of Medicine (Fralick, Kwan), Sinai Health System; Department of Medicine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) and Toronto General Hospital Research Institute (Lapointe-Shaw), University Health Network; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Women's College Hospital; ICES Central (Lapointe-Shaw, Rosella); Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Department of Mechanical and Industrial Engineering (Chan), University of Toronto; Joint Department of Medical Imaging (Cheung), University Health Network; Division of Epidemiology (Cheung, Rosella), Dalla Lana School of Public Health; Vector Institute (Rosella, Ghassemi); Department of Computer Science (Ghassemi) and Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto, Ont
| | - Margaret Herridge
- Li Ka Shing Knowledge Institute (Verma, Hora, Jung, Chan, Mamdani, Razak), St. Michael's Hospital, Unity Health Toronto; Department of Medicine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak), and Institute of Health Policy, Management and Evaluation (Verma, Cheung, Mamdani, Razak), University of Toronto, Toronto, Ont.; Department of Geography and Environmental Management (Hora), University of Waterloo, Waterloo, Ont.; Department of Medicine (Fralick, Kwan), Sinai Health System; Department of Medicine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) and Toronto General Hospital Research Institute (Lapointe-Shaw), University Health Network; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Women's College Hospital; ICES Central (Lapointe-Shaw, Rosella); Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Department of Mechanical and Industrial Engineering (Chan), University of Toronto; Joint Department of Medical Imaging (Cheung), University Health Network; Division of Epidemiology (Cheung, Rosella), Dalla Lana School of Public Health; Vector Institute (Rosella, Ghassemi); Department of Computer Science (Ghassemi) and Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto, Ont
| | - Muhammad Mamdani
- Li Ka Shing Knowledge Institute (Verma, Hora, Jung, Chan, Mamdani, Razak), St. Michael's Hospital, Unity Health Toronto; Department of Medicine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak), and Institute of Health Policy, Management and Evaluation (Verma, Cheung, Mamdani, Razak), University of Toronto, Toronto, Ont.; Department of Geography and Environmental Management (Hora), University of Waterloo, Waterloo, Ont.; Department of Medicine (Fralick, Kwan), Sinai Health System; Department of Medicine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) and Toronto General Hospital Research Institute (Lapointe-Shaw), University Health Network; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Women's College Hospital; ICES Central (Lapointe-Shaw, Rosella); Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Department of Mechanical and Industrial Engineering (Chan), University of Toronto; Joint Department of Medical Imaging (Cheung), University Health Network; Division of Epidemiology (Cheung, Rosella), Dalla Lana School of Public Health; Vector Institute (Rosella, Ghassemi); Department of Computer Science (Ghassemi) and Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto, Ont
| | - Fahad Razak
- Li Ka Shing Knowledge Institute (Verma, Hora, Jung, Chan, Mamdani, Razak), St. Michael's Hospital, Unity Health Toronto; Department of Medicine (Verma, Fralick, Malecki, Lapointe-Shaw, Weinerman, Tang, Kwan, Liu, Rawal, Cheung, Herridge, Mamdani, Razak), and Institute of Health Policy, Management and Evaluation (Verma, Cheung, Mamdani, Razak), University of Toronto, Toronto, Ont.; Department of Geography and Environmental Management (Hora), University of Waterloo, Waterloo, Ont.; Department of Medicine (Fralick, Kwan), Sinai Health System; Department of Medicine (Lapointe-Shaw, Liu, Rawal, Cheung, Herridge) and Toronto General Hospital Research Institute (Lapointe-Shaw), University Health Network; Women's Institute for Health System Solutions and Virtual Care (Lapointe-Shaw), Women's College Hospital; ICES Central (Lapointe-Shaw, Rosella); Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Institute for Better Health (Tang, Rosella), Trillium Health Partners, Mississauga, Ont.; Department of Mechanical and Industrial Engineering (Chan), University of Toronto; Joint Department of Medical Imaging (Cheung), University Health Network; Division of Epidemiology (Cheung, Rosella), Dalla Lana School of Public Health; Vector Institute (Rosella, Ghassemi); Department of Computer Science (Ghassemi) and Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto, Ont
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von der Lippe E, Devleesschauwer B, Gourley M, Haagsma J, Hilderink H, Porst M, Wengler A, Wyper G, Grant I. Reflections on key methodological decisions in national burden of disease assessments. Arch Public Health 2020; 78:137. [PMID: 33384020 PMCID: PMC7774238 DOI: 10.1186/s13690-020-00519-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 12/08/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Summary measures of population health are increasingly used in different public health reporting systems for setting priorities for health care and social service delivery and planning. Disability-adjusted life years (DALYs) are one of the most commonly used health gap summary measures in the field of public health and have become the key metric for quantifying burden of disease (BoD). BoD methodology is, however, complex and highly data demanding, requiring a substantial capacity to apply, which has led to major disparities across researchers and nations in their resources to perform themselves BoD studies and interpret the soundness of available estimates produced by the Global Burden of Disease Study. METHODS BoD researchers from the COST Action European Burden of Disease network reflect on the most important methodological choices to be made when estimating DALYs. The paper provides an overview of eleven methodological decisions and challenges drawing on the experiences of countries working with BoD methodology in their own national studies. Each of these steps are briefly described and, where appropriate, some examples are provided from different BoD studies across the world. RESULTS In this review article we have identified some of the key methodological choices and challenges that are important to understand when calculating BoD metrics. We have provided examples from different BoD studies that have developed their own strategies in data usage and implementation of statistical methods in the production of BoD estimates. CONCLUSIONS With the increase in national BoD studies developing their own strategies in data usage and implementation of statistical methods in the production of BoD estimates, there is a pressing need for equitable capacity building on the one hand, and harmonization of methods on the other hand. In response to these issues, several BoD networks have emerged in the European region that bring together expertise across different domains and professional backgrounds. An intensive exchange in the experience of the researchers in the different countries will enable the understanding of the methods and the interpretation of the results from the local authorities who can effectively integrate the BoD estimates in public health policies, intervention and prevention programs.
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Affiliation(s)
- Elena von der Lippe
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany.
| | | | - Michelle Gourley
- Indigenous Data Analysis and Reporting Unit, Australian Institute of Health and Welfare, Canberra, Australia
| | - Juanita Haagsma
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Henk Hilderink
- Centre for Public Health Forecasting, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Michael Porst
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Annelene Wengler
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Grant Wyper
- Public Health Scotland, Edinburgh, Scotland, UK
| | - Ian Grant
- Public Health Scotland, Edinburgh, Scotland, UK
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Rubio JA, Jiménez S, Lázaro-Martínez JL. Mortality in Patients with Diabetic Foot Ulcers: Causes, Risk Factors, and Their Association with Evolution and Severity of Ulcer. J Clin Med 2020; 9:jcm9093009. [PMID: 32961974 PMCID: PMC7565534 DOI: 10.3390/jcm9093009] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/08/2020] [Accepted: 09/14/2020] [Indexed: 12/17/2022] Open
Abstract
Background: This study reviews the mortality of patients with diabetic foot ulcers (DFU) from the first consultation with a Multidisciplinary Diabetic Foot Team (MDFT) and analyzes the main cause of death, as well as the relevant clinical factors associated with survival. Methods: Data of 338 consecutive patients referred to the MDFT center for a new DFU during the 2008–2014 period were analyzed. Follow-up: until death or until 30 April 2020, for up to 12.2 years. Results: Clinical characteristics: median age was 71 years, 92.9% had type 2 diabetes, and about 50% had micro-macrovascular complications. Ulcer characteristics: Wagner grade 1–2 (82.3%), ischemic (49.2%), and infected ulcers (56.2%). During follow-up, 201 patients died (59.5%), 110 (54.7%) due to cardiovascular disease. Kaplan—Meier curves estimated a reduction in survival of 60% with a 95% confidence interval (95% CI), (54.7–65.3) at 5 years. Cox regression analysis adjusted to a multivariate model showed the following associations with mortality, with hazard ratios (HRs) (95% CI): age, 1.07 (1.05–1.08); HbA1c value < 7% (53 mmol/mol), 1.43 (1.02–2.0); active smoking, 1.59 (1.02–2.47); ischemic heart or cerebrovascular disease, 1.55 (1.15–2.11); chronic kidney disease, 1.86 (1.37–2.53); and ulcer severity (SINBAD system) 1.12 (1.02–1.26). Conclusion: Patients with a history of DFU have high mortality. Two less known predictors of mortality were identified: HbA1c value < 7% (53 mmol/mol) and ulcer severity.
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Affiliation(s)
- José Antonio Rubio
- Diabetic Foot Unit, Department of Endocrinology, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, 28805 Madrid, Spain;
- Department of Biomedical Sciences, Universidad de Alcalá, Alcalá de Henares, 28805 Madrid, Spain
- Correspondence: ; Tel.: +34-918-878-100
| | - Sara Jiménez
- Diabetic Foot Unit, Department of Endocrinology, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, 28805 Madrid, Spain;
| | - José Luis Lázaro-Martínez
- Diabetic Foot Unit, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain;
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22
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Iburg KM, Mikkelsen L, Adair T, Lopez AD. Are cause of death data fit for purpose? evidence from 20 countries at different levels of socio-economic development. PLoS One 2020; 15:e0237539. [PMID: 32834006 PMCID: PMC7446871 DOI: 10.1371/journal.pone.0237539] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 07/28/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Many countries have used the new ANACONDA (Analysis of Causes of National Death for Action) tool to assess the quality of their cause of death data (COD), but no cross-country analysis has been done to verify how different or similar patterns of diagnostic errors and data quality are in countries or how they are related to the local cultural or epidemiological environment or to levels of development. Our objective is to measure whether the usability of COD data and the patterns of unusable codes are related to a country's level of socio-economic development. METHODS We have assessed the quality of 20 national COD datasets from the WHO Mortality Database by assessing their completeness of COD reporting and the extent, pattern and severity of garbage codes, i.e. codes that provide little or no information about the true underlying COD. Garbage codes were classified into four groups based on the severity of the error in the code. The Vital Statistics Performance Index for Quality (VSPI(Q)) was used to measure the overall quality of each country's mortality surveillance system. FINDINGS The proportion of 'garbage codes' varied from 7 to 66% across the 20 countries. Countries with a high SDI generally had a lower proportion of high impact (i.e. more severe) garbage codes than countries with low SDI. While the magnitude and pattern of garbage codes differed among countries, the specific codes commonly used did not. CONCLUSIONS There is an inverse relationship between a country's socio-demographic development and the overall quality of its cause of death data, but with important exceptions. In particular, some low SDI countries have vital statistics systems that are as reliable as more developed countries. However, in low-income countries, where most people die at home, the proportion of unusable codes often exceeds 50%, implying that half of all cause-specific mortality data collected is of little or no use in guiding public policy. Moreover, the cause of death pattern identified from the data is likely to seriously under-represent the true extent of the leading causes of death in the population, with very significant consequences for health priority setting. Garbage codes are prevalent at all ages, contrary to expectations. Further research into effective strategies deployed in these countries to improve data quality can inform efforts elsewhere to improve COD reporting systems.
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Affiliation(s)
| | - Lene Mikkelsen
- Global Burden of Disease Group, University of Melbourne, Melbourne, Australia
| | - Tim Adair
- Global Burden of Disease Group, University of Melbourne, Melbourne, Australia
| | - Alan D. Lopez
- Global Burden of Disease Group, University of Melbourne, Melbourne, Australia
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23
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Swain MG, Ramji A, Patel K, Sebastiani G, Shaheen AA, Tam E, Marotta P, Elkhashab M, Bajaj HS, Estes C, Razavi H. Burden of nonalcoholic fatty liver disease in Canada, 2019-2030: a modelling study. CMAJ Open 2020; 8:E429-E436. [PMID: 32518095 PMCID: PMC7286622 DOI: 10.9778/cmajo.20190212] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) account for a growing proportion of liver disease cases, and there is a need to better understand future disease burden. We used a modelling framework to forecast the burden of disease of NAFLD and NASH for Canada. METHODS We used a Markov model to forecast fibrosis progression from stage F0 (no fibrosis) to stage F4 (compensated cirrhosis) and subsequent progression to decompensated cirrhosis, hepatocellular carcinoma, liver transplantation and liver-related death among Canadians with NAFLD from 2019 to 2030. We used historical trends for obesity prevalence among adults to estimate longitudinal changes in the number of incident NAFLD cases. RESULTS The model projected that the number of NAFLD cases would increase by 20% between 2019 and 2030, from an estimated 7 757 000 cases to 9 305 000 cases. Increases in advanced fibrosis cases were relatively greater, as the number of model-estimated prevalent stage F3 cases would increase by 65%, to 357 000, and that of prevalent stage F4 cases would increase by 95%, to 195 000. Estimated incident cases of hepatocellular carcinoma and decompensated cirrhosis would increase by up to 95%, and the number of annual NAFLD-related deaths would double, to 5600. INTERPRETATION Increasing rates of obesity translate into increasing NAFLD-related cases of cirrhosis and hepatocellular carcinoma and related mortality. Prevention efforts should be aimed at reducing the incidence of NAFLD and slowing fibrosis progression among those already affected.
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Affiliation(s)
- Mark G Swain
- Division of Gastroenterology and Hepatology (Swain, Shaheen), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ramji), University of British Columbia, Vancouver, BC; Toronto Centre for Liver Disease (Patel), University Hospital Network, Toronto, Ont.; Division of Gastroenterology and Hepatology (Sebastiani), McGill University Health Centre, Montréal, Que.; LAIR Centre (Tam), Vancouver, BC; Division of Gastroenterology (Marotta), Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ont.; Toronto Liver Centre (Elkhashab), Toronto, Ont.; LMC Diabetes and Endocrinology Brampton (Bajaj), Brampton, Ont.; Leadership Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital, Toronto, Ont.; Center for Disease Analysis Foundation (Estes, Razavi), Lafayette, Colo
| | - Alnoor Ramji
- Division of Gastroenterology and Hepatology (Swain, Shaheen), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ramji), University of British Columbia, Vancouver, BC; Toronto Centre for Liver Disease (Patel), University Hospital Network, Toronto, Ont.; Division of Gastroenterology and Hepatology (Sebastiani), McGill University Health Centre, Montréal, Que.; LAIR Centre (Tam), Vancouver, BC; Division of Gastroenterology (Marotta), Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ont.; Toronto Liver Centre (Elkhashab), Toronto, Ont.; LMC Diabetes and Endocrinology Brampton (Bajaj), Brampton, Ont.; Leadership Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital, Toronto, Ont.; Center for Disease Analysis Foundation (Estes, Razavi), Lafayette, Colo
| | - Keyur Patel
- Division of Gastroenterology and Hepatology (Swain, Shaheen), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ramji), University of British Columbia, Vancouver, BC; Toronto Centre for Liver Disease (Patel), University Hospital Network, Toronto, Ont.; Division of Gastroenterology and Hepatology (Sebastiani), McGill University Health Centre, Montréal, Que.; LAIR Centre (Tam), Vancouver, BC; Division of Gastroenterology (Marotta), Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ont.; Toronto Liver Centre (Elkhashab), Toronto, Ont.; LMC Diabetes and Endocrinology Brampton (Bajaj), Brampton, Ont.; Leadership Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital, Toronto, Ont.; Center for Disease Analysis Foundation (Estes, Razavi), Lafayette, Colo
| | - Giada Sebastiani
- Division of Gastroenterology and Hepatology (Swain, Shaheen), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ramji), University of British Columbia, Vancouver, BC; Toronto Centre for Liver Disease (Patel), University Hospital Network, Toronto, Ont.; Division of Gastroenterology and Hepatology (Sebastiani), McGill University Health Centre, Montréal, Que.; LAIR Centre (Tam), Vancouver, BC; Division of Gastroenterology (Marotta), Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ont.; Toronto Liver Centre (Elkhashab), Toronto, Ont.; LMC Diabetes and Endocrinology Brampton (Bajaj), Brampton, Ont.; Leadership Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital, Toronto, Ont.; Center for Disease Analysis Foundation (Estes, Razavi), Lafayette, Colo
| | - Abdel Aziz Shaheen
- Division of Gastroenterology and Hepatology (Swain, Shaheen), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ramji), University of British Columbia, Vancouver, BC; Toronto Centre for Liver Disease (Patel), University Hospital Network, Toronto, Ont.; Division of Gastroenterology and Hepatology (Sebastiani), McGill University Health Centre, Montréal, Que.; LAIR Centre (Tam), Vancouver, BC; Division of Gastroenterology (Marotta), Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ont.; Toronto Liver Centre (Elkhashab), Toronto, Ont.; LMC Diabetes and Endocrinology Brampton (Bajaj), Brampton, Ont.; Leadership Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital, Toronto, Ont.; Center for Disease Analysis Foundation (Estes, Razavi), Lafayette, Colo
| | - Edward Tam
- Division of Gastroenterology and Hepatology (Swain, Shaheen), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ramji), University of British Columbia, Vancouver, BC; Toronto Centre for Liver Disease (Patel), University Hospital Network, Toronto, Ont.; Division of Gastroenterology and Hepatology (Sebastiani), McGill University Health Centre, Montréal, Que.; LAIR Centre (Tam), Vancouver, BC; Division of Gastroenterology (Marotta), Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ont.; Toronto Liver Centre (Elkhashab), Toronto, Ont.; LMC Diabetes and Endocrinology Brampton (Bajaj), Brampton, Ont.; Leadership Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital, Toronto, Ont.; Center for Disease Analysis Foundation (Estes, Razavi), Lafayette, Colo
| | - Paul Marotta
- Division of Gastroenterology and Hepatology (Swain, Shaheen), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ramji), University of British Columbia, Vancouver, BC; Toronto Centre for Liver Disease (Patel), University Hospital Network, Toronto, Ont.; Division of Gastroenterology and Hepatology (Sebastiani), McGill University Health Centre, Montréal, Que.; LAIR Centre (Tam), Vancouver, BC; Division of Gastroenterology (Marotta), Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ont.; Toronto Liver Centre (Elkhashab), Toronto, Ont.; LMC Diabetes and Endocrinology Brampton (Bajaj), Brampton, Ont.; Leadership Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital, Toronto, Ont.; Center for Disease Analysis Foundation (Estes, Razavi), Lafayette, Colo
| | - Magdy Elkhashab
- Division of Gastroenterology and Hepatology (Swain, Shaheen), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ramji), University of British Columbia, Vancouver, BC; Toronto Centre for Liver Disease (Patel), University Hospital Network, Toronto, Ont.; Division of Gastroenterology and Hepatology (Sebastiani), McGill University Health Centre, Montréal, Que.; LAIR Centre (Tam), Vancouver, BC; Division of Gastroenterology (Marotta), Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ont.; Toronto Liver Centre (Elkhashab), Toronto, Ont.; LMC Diabetes and Endocrinology Brampton (Bajaj), Brampton, Ont.; Leadership Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital, Toronto, Ont.; Center for Disease Analysis Foundation (Estes, Razavi), Lafayette, Colo
| | - Harpreet S Bajaj
- Division of Gastroenterology and Hepatology (Swain, Shaheen), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ramji), University of British Columbia, Vancouver, BC; Toronto Centre for Liver Disease (Patel), University Hospital Network, Toronto, Ont.; Division of Gastroenterology and Hepatology (Sebastiani), McGill University Health Centre, Montréal, Que.; LAIR Centre (Tam), Vancouver, BC; Division of Gastroenterology (Marotta), Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ont.; Toronto Liver Centre (Elkhashab), Toronto, Ont.; LMC Diabetes and Endocrinology Brampton (Bajaj), Brampton, Ont.; Leadership Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital, Toronto, Ont.; Center for Disease Analysis Foundation (Estes, Razavi), Lafayette, Colo
| | - Chris Estes
- Division of Gastroenterology and Hepatology (Swain, Shaheen), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ramji), University of British Columbia, Vancouver, BC; Toronto Centre for Liver Disease (Patel), University Hospital Network, Toronto, Ont.; Division of Gastroenterology and Hepatology (Sebastiani), McGill University Health Centre, Montréal, Que.; LAIR Centre (Tam), Vancouver, BC; Division of Gastroenterology (Marotta), Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ont.; Toronto Liver Centre (Elkhashab), Toronto, Ont.; LMC Diabetes and Endocrinology Brampton (Bajaj), Brampton, Ont.; Leadership Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital, Toronto, Ont.; Center for Disease Analysis Foundation (Estes, Razavi), Lafayette, Colo.
| | - Homie Razavi
- Division of Gastroenterology and Hepatology (Swain, Shaheen), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ramji), University of British Columbia, Vancouver, BC; Toronto Centre for Liver Disease (Patel), University Hospital Network, Toronto, Ont.; Division of Gastroenterology and Hepatology (Sebastiani), McGill University Health Centre, Montréal, Que.; LAIR Centre (Tam), Vancouver, BC; Division of Gastroenterology (Marotta), Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ont.; Toronto Liver Centre (Elkhashab), Toronto, Ont.; LMC Diabetes and Endocrinology Brampton (Bajaj), Brampton, Ont.; Leadership Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital, Toronto, Ont.; Center for Disease Analysis Foundation (Estes, Razavi), Lafayette, Colo
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Badgery-Parker T, Pearson SA, Elshaug AG. Estimating misclassification error in a binary performance indicator: case study of low value care in Australian hospitals. BMJ Qual Saf 2020; 29:992-999. [PMID: 32165412 DOI: 10.1136/bmjqs-2019-010564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 02/17/2020] [Accepted: 02/23/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Indicators based on hospital administrative data have potential for misclassification error, especially if they rely on clinical detail that may not be well recorded in the data. We applied an approach using modified logistic regression models to assess the misclassification (false-positive and false-negative) rates of low-value care indicators. DESIGN AND SETTING We applied indicators involving 19 procedures to an extract from the New South Wales Admitted Patient Data Collection (1 January 2012 to 30 June 2015) to label episodes as low value. We fit four models (no misclassification, false-positive only, false-negative only, both false-positive and false-negative) for each indicator to estimate misclassification rates and used the posterior probabilities of the models to assess which model fit best. RESULTS False-positive rates were low for most indicators-if the indicator labels care as low value, the care is most likely truly low value according to the relevant recommendation. False-negative rates were much higher but were poorly estimated (wide credible intervals). For most indicators, the models allowing no misclassification or allowing false-negatives but no false-positives had the highest posterior probability. The overall low-value care rate from the indicators was 12%. After adjusting for the estimated misclassification rates from the highest probability models, this increased to 35%. CONCLUSION Binary performance indicators have a potential for misclassification error, especially if they depend on clinical information extracted from administrative data. Indicators should be validated by chart review, but this is resource-intensive and costly. The modelling approach presented here can be used as an initial validation step to identify and revise indicators that may have issues before continuing to a full chart review validation.
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Affiliation(s)
- Tim Badgery-Parker
- Faculty of Medicine and Health, School of Public Health, Menzies Centre for Health Policy, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Sallie-Anne Pearson
- Faculty of Medicine and Health, School of Public Health, Menzies Centre for Health Policy, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia.,Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Adam G Elshaug
- Faculty of Medicine and Health, School of Public Health, Menzies Centre for Health Policy, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia.,The Brookings Institution, Washington, DC, USA
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