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Pergeline J, Rey S, Fresson J, Debeugny G, Rachas A, Tuppin P. Factors associated with hospital admission and 30-day readmission for children less than 18 years of age in 2018 in France: a one-year nationwide observational study. BMC Health Serv Res 2023; 23:901. [PMID: 37612699 PMCID: PMC10464416 DOI: 10.1186/s12913-023-09861-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 07/28/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Nationwide data for children for short-stay hospitalisation (SSH) and associated factors are scarce. This retrospective study of children in France < 18 years of age followed after their birth or birthday in 2018 focused on at least one annual SSH, stay < 1 night or ≥ 1 night, or 30-day readmission ≥ 1 night. METHODS Children were selected from the national health data system (SNDS), which includes data on long-term chronic disease (LTD) status with full reimbursement and complementary universal coverage based on low household income (CMUC). Uni and multivariate quasi-Poisson regression were applied for each outcome. RESULTS Among 13.211 million children (94.4% population, 51.2% boys), CMUC was identified for 17.5% and at least one LTD for 4% (0-<1 year: 1.5%; 14-<18 year: 5.2%). The most frequent LTDs were pervasive developmental diseases (0.53%), asthma (0.24%), epilepsy (0.17%), and type 1 diabetes (0.15%). At least one SSH was found for 8.8%: SSH < 1 night (4.9%), SSH ≥ 1 night (4.5%), readmission (0.4%). Children with at least one SSH were younger (median 6 vs. 9 years) and more often had CMUC (21%), a LTD (12%), an emergency department (ED) visit (56%), or various primary healthcare visits than all children. Those with a SSH ≥1 night vs. < 1 night were older (median: 9 vs. 4 years). They had the same frequency of LTD (13.4%) but more often an ED visit (78% vs. 42%). Children with readmissions were younger (median 3 years). They had the highest levels of CMUC (29.3%), LTD (34%), EDs in their municipality (35% vs. 29% for the whole population) and ED visits (87%). In adjusted analysis, each outcome was significantly less frequent among girls than boys and more frequent for children with CMUC. LTDs with the largest association with SSH < 1 night were cystic fibrosis, sickle cell diseases (SCD), diabetes type 1, those with SSH ≥1 night type 1 diabetes epilepsy and SCD, and those for readmissions lymphoid leukaemia, malignant neoplasm of the brain, and SCD. Among all SSH admissions of children < 10 years, 25.8% were potentially preventable. CONCLUSION Higher SSH and readmission rates were found for children with certain LTD living in low-income households, suggesting the need or increase of specific policy actions and research.
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Affiliation(s)
- Jeanne Pergeline
- Caisse Nationale de l'Assurance Maladie, Direction de la Stratégie des Etudes et des Statistiques, F-75986, Paris Cedex 20, France
| | - Sylvie Rey
- Direction de la Recherche, des Etudes, de l'Evaluation et des Statistiques (Drees), 75015, Paris, France
| | - Jeanne Fresson
- Direction de la Recherche, des Etudes, de l'Evaluation et des Statistiques (Drees), 75015, Paris, France
| | - Gonzague Debeugny
- Caisse Nationale de l'Assurance Maladie, Direction de la Stratégie des Etudes et des Statistiques, F-75986, Paris Cedex 20, France
| | - Antoine Rachas
- Caisse Nationale de l'Assurance Maladie, Direction de la Stratégie des Etudes et des Statistiques, F-75986, Paris Cedex 20, France
| | - Philippe Tuppin
- Caisse Nationale de l'Assurance Maladie, Direction de la Stratégie des Etudes et des Statistiques, F-75986, Paris Cedex 20, France.
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Pergeline J, Rivière S, Rey S, Fresson J, Rachas A, Tuppin P. Social deprivation and the use of healthcare services over one year by children less than 18 years of age in 2018: A French nationwide observational study. PLoS One 2023; 18:e0285467. [PMID: 37224152 DOI: 10.1371/journal.pone.0285467] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 03/07/2023] [Indexed: 05/26/2023] Open
Abstract
This study aimed to describe the health status of children and how social deprivation affects their use of healthcare services and mortality. Children living in mainland France were selected from the national health data system (SNDS) on their date of birth or birthday in 2018 (< 18 years) and followed for one year. Information included data on healthcare reimbursements, long-term chronic diseases (LTDs) eligible for 100% reimbursement, geographic deprivation index (FDep) by quintile (Q5 most disadvantaged), and individual complementary universal insurance (CMUc) status, granted to households with an annual income below the French poverty level. The number of children who had at least one annual visit or hospital admission was compared using the ratio of geographic deprivation (rQ5/Q1) and CMUc (rCMUc/Not) after gender and age-standardization. Over 13 million children were included; 17.5% had CMUc, with an increase across quintiles (rQ5/Q1 = 3.5) and 4.0% a LTD (rQ5/Q1 = 1.44). The 10 most frequent LTDs (6 psychiatric) were more common as the deprivation increased. Visits to general practitioners (GPs) were similar (≈84%) for each FDep quintile and the density of GPs similar. The density decreased with increasing deprivation for specialists and visits: paediatricians (rQ5/Q1 = 0.46) and psychiatrists (rQ5/Q1 = 0.26). Dentist visits also decreased (rQ5/Q1 = 0.86) and deprived children were more often hospitalised for dental caries (rQ5/Q1 = 2.17, 2.1% vs 0.7%). Emergency department (ED) visits increased with deprivation (rCMUc/Not = 1.35, 30% vs 22%) but 50% of CMUc children lived in a municipality with an ED vs. 25% without. Approximately 9% of children were admitted for a short stay and 4.5% for a stay > 1 night (rQ5/Q1 = 1.44). Psychiatric hospitalization was more frequent for children with CMUc (rCMUc/Not = 3.5, 0.7% vs 0.2%). Higher mortality was observed for deprived children < 18 years (rQ5/Q1 = 1.59). Our results show a lower use of pediatricians, other specialists, and dentists among deprived children that may be due, in part, to an insufficient supply of care in their area of residence. These results have been used to recommend optimization and specifically adapted individual or area-wide policies on the use of healthcare services, their density, and activities.
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Affiliation(s)
- Jeanne Pergeline
- Caisse Nationale de l'assurance Maladie (Cnam), Direction de la Stratégie des études et des Statistiques, Paris, France
| | - Sébastien Rivière
- Caisse Nationale de l'assurance Maladie (Cnam), Direction de la Stratégie des études et des Statistiques, Paris, France
| | - Sylvie Rey
- Direction de la Recherche, des études, de l'évaluation et des Statistiques (Drees), Paris, France
| | - Jeanne Fresson
- Direction de la Recherche, des études, de l'évaluation et des Statistiques (Drees), Paris, France
| | - Antoine Rachas
- Caisse Nationale de l'assurance Maladie (Cnam), Direction de la Stratégie des études et des Statistiques, Paris, France
| | - Philippe Tuppin
- Caisse Nationale de l'assurance Maladie (Cnam), Direction de la Stratégie des études et des Statistiques, Paris, France
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Osuagwu UL, Xu M, Piya MK, Agho KE, Simmons D. Factors associated with long intensive care unit (ICU) admission among inpatients with and without diabetes in South Western Sydney public hospitals using the New South Wales admission patient data collection (2014-2017). BMC Endocr Disord 2022; 22:27. [PMID: 35057791 PMCID: PMC8781508 DOI: 10.1186/s12902-022-00933-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 01/04/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Long stay in intensive care unit (ICU) is associated with poor outcomes, particularly in people with diabetes. It increases the financial burden of care and this is a challenge to the South Western Sydney region, which is already a hotspot for diabetes in Australia. This study compared ICU admission characteristics of people with and without diabetes and the factors associated with long ICU stay among patients admitted to public hospitals in this metropolitan health district from 2014 to 2017. METHODS Cross-sectional datasets on 187,660, including all ICU admissions in the New South Wales Admitted Patient Data Collection (APDC) from June 2014 - July 2017 in public hospital were extracted. Data on demographic and health insurance status, primary admission diagnosis using ICD-10, comorbidities including death among hospital inpatients aged ≥18 years residing in SWS were analysed. The ICU length of stay was the outcome variable and were classified into short stay (≤48 h) and long stay (> 48 h), and were examined against potential confounding factors using bivariate and multiple logistic regression analyses. RESULTS Our results showed higher ICU admissions in patients with diabetes than in those without diabetes (5% vs. 3.3%, P < 0.001) over three years. The median and interquartile range (IQR) of length of the ICU stay were similar in both groups [diabetes: 40 h, IQR = 16-88 h vs. non-diabetes: 43 h, IQR = 19-79 h]. The prevalence of long ICU stays among people with and without diabetes were 44.9% [95% CI 42.1, 47.7%] and 43.6% [95% CI 42.2, 44.9%], respectively. For both groups, increased odds of long ICU stay were associated with death and circulatory system disease admissions, while musculoskeletal disease admissions were associated with lower risk of long ICU stay. In the non-diabetes group, male sex, nervous system disease admissions and living in peri-urban areas were associated with higher odds of long ICU stay. CONCLUSIONS The rate of ICU admissions among inpatients remain higher in people with diabetes. One in every two admissions to ICU had a long stay. Additional care for those admitted with circulatory system diseases are needed to reduce long ICU stay related deaths in SWS.
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Affiliation(s)
- Uchechukwu L Osuagwu
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia.
- African Vision Research Institute (AVRI), University of KwaZulu-Natal, Durban, 4041, South Africa.
- Diabetes, Obesity and Metabolism Translational Research Unit (DOMTRU), School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia.
| | - Matthew Xu
- Diabetes, Obesity and Metabolism Translational Research Unit (DOMTRU), School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia
| | - Milan K Piya
- Diabetes, Obesity and Metabolism Translational Research Unit (DOMTRU), School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia
- Macarthur Diabetes Service, Camden and Campbelltown Hospital, Campbelltown, NSW, 2560, Australia
| | - Kingsley E Agho
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia
- African Vision Research Institute (AVRI), University of KwaZulu-Natal, Durban, 4041, South Africa
- School of Health Sciences, Western Sydney University, Campbelltown, NSW, 2560, Australia
| | - David Simmons
- Diabetes, Obesity and Metabolism Translational Research Unit (DOMTRU), School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia
- Macarthur Diabetes Service, Camden and Campbelltown Hospital, Campbelltown, NSW, 2560, Australia
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Quantin C, Yamdjieu Ngadeu C, Cottenet J, Escolano S, Bechraoui‐Quantin S, Rozenberg P, Tubert‐Bitter P, Gouyon J. Early exposure of pregnant women to non-steroidal anti-inflammatory drugs delivered outside hospitals and preterm birth risk: nationwide cohort study. BJOG 2021; 128:1575-1584. [PMID: 33590634 PMCID: PMC8451913 DOI: 10.1111/1471-0528.16670] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To assess the risk of preterm birth associated with nonsteroidal anti-inflammatory drugs (NSAIDs), focusing on early exposure in the period from conception to 22 weeks of gestation (WG). DESIGN National population-based retrospective cohort study. SETTING The French National Health Insurance Database that includes hospital discharge data and health claims data. POPULATION Singleton pregnancies (2012-2014) with a live birth occurring after 22WG from women between 15 and 45 years old and insured the year before the first day of gestation and during pregnancy were included. We excluded pregnancies for which anti-inflammatory medications were dispensed after 22WG. METHODS The association between exposure and risk of preterm birth was evaluated with GEE models, adjusting on a large number of covariables, socio-demographic variables, maternal comorbidities, prescription drugs and pregnancy complications. MAIN OUTCOME MEASURES Prematurity, defined as a birth that occurred before 37WG. RESULTS Among our 1 598 330 singleton pregnancies, early exposure to non-selective NSAIDs was associated with a significantly increased risk of preterm birth, regardless of the severity of prematurity: adjusted odds ratio (aOR) = 1.76 (95% CI 1.54-2.00) for extreme prematurity (95% CI 22-27WG), 1.28 (95% CI 1.17-1.40) for moderate prematurity (28-31WG) and 1.08 (95% CI 1.05-1.11) for late prematurity (32-36WG), with non-overlapping confidence intervals. We identified five NSAIDs for which the risk of premature birth was significantly increased: ketoprofen, flurbiprofen, nabumetone, etodolac and indomethacin: for the latter, aOR = 1.92 (95% CI 1.37-2.70) with aOR = 9.33 (95% CI 3.75-23.22) for extreme prematurity. CONCLUSION Overall, non-selective NSAID use (delivered outside hospitals) during the first 22WG was found to be associated with an increased risk of prematurity. However, the association differs among NSAIDs. TWEETABLE ABSTRACT French study for which early exposure to non-selective NSAIDs was associated with increased risk of prematurity.
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Affiliation(s)
- C Quantin
- High‐Dimensional Biostatistics for Drug Safety and GenomicsUniversité Paris‐SaclayUVSQUniv. Paris‐SudInsermCESPVillejuifFrance
- Biostatistics and Bioinformatics (DIM)University HospitalDijonFrance
- Bourgogne Franche‐Comté UniversityDijonFrance
- InsermCIC 1432DijonFrance
- Clinical Investigation CentreClinical Epidemiology/Clinical Trials UnitDijon University HospitalDijonFrance
| | - C Yamdjieu Ngadeu
- Biostatistics and Bioinformatics (DIM)University HospitalDijonFrance
- Bourgogne Franche‐Comté UniversityDijonFrance
| | - J Cottenet
- Biostatistics and Bioinformatics (DIM)University HospitalDijonFrance
- Bourgogne Franche‐Comté UniversityDijonFrance
| | - S Escolano
- High‐Dimensional Biostatistics for Drug Safety and GenomicsUniversité Paris‐SaclayUVSQUniv. Paris‐SudInsermCESPVillejuifFrance
| | - S Bechraoui‐Quantin
- Biostatistics and Bioinformatics (DIM)University HospitalDijonFrance
- Bourgogne Franche‐Comté UniversityDijonFrance
| | - P Rozenberg
- Department of Obstetrics and GynaecologyPoissy‐Saint Germain HospitalPoissyFrance
- Paris Saclay University, UVSQ, Inserm, Team U1018, Clinical Epidemiology, CESPMontigny‐le‐BretonneuxFrance
| | - P Tubert‐Bitter
- High‐Dimensional Biostatistics for Drug Safety and GenomicsUniversité Paris‐SaclayUVSQUniv. Paris‐SudInsermCESPVillejuifFrance
| | - J‐B Gouyon
- Centre d’Etudes Périnatales Océan Indien (EA 7388)Centre Hospitalier Universitaire Sud RéunionLa RéunionSaint PierreFrance
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Penso L, Dray-Spira R, Weill A, Zureik M, Sbidian E. Psoriasis-related treatment exposure and hospitalization or in-hospital mortality due to COVID-19 during the first and second wave of the pandemic: cohort study of 1 326 312 patients in France. Br J Dermatol 2021; 186:59-68. [PMID: 34310699 PMCID: PMC8444811 DOI: 10.1111/bjd.20659] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2021] [Indexed: 12/15/2022]
Abstract
Background Data on treatment exposures for psoriasis and poor COVID‐19 outcomes are limited. Objectives To assess the risk of hospitalization or in‐hospital mortality due to COVID‐19 by treatment exposure in patients with psoriasis. Methods All adults with psoriasis registered in the French national health‐insurance (Système National des Données de Santé, SNDS) database between 2008 and 2019 were eligible. Two study periods were considered: 15 February to 30 June 2020 and 1 October 2020 to 31 January 2021, the first and second waves of the COVID‐19 pandemic in France, respectively. Patients were classified according to their baseline treatment: biologics, nonbiologics, topicals or no treatment. The primary endpoint was hospitalization for COVID‐19 using Cox models with inverse probability of treatment weighting. The secondary endpoint was in‐hospital mortality due to COVID‐19. Results We identified 1 326 312 patients with psoriasis (mean age 59 years; males, 48%). During the first study period, 3871 patients were hospitalized for COVID‐19 and 759 (20%) died; during the second period 3603 were hospitalized for COVID‐19 and 686 (19%) died. In the propensity score‐weighted Cox models, risk of hospitalization for COVID‐19 was associated with exposure to topicals or nonbiologics [hazard ratio (95% confidence interval): 1·11 (1·04–1·20) and 1·27 (1·09–1·48), respectively] during the first period, and with all exposure types, during the second period. None of the exposure types was associated with in‐hospital mortality due to COVID‐19. Conclusions Systemic treatments for psoriasis (including biologics) were not associated with increased risk of in‐hospital mortality due to COVID‐19. These results support maintaining systemic treatment for psoriasis during the pandemic. Whatis already known about this topic? Almost all chronic diseases have emerged as risk factors for hospitalization for COVID‐19 and poor COVID‐19 outcomes. Multimorbidity is frequent in psoriasis. In France, psoriasis was found to be associated with increased risk of hospitalization for COVID‐19 but not in‐hospital mortality due to COVID‐19. Biologics are associated with an increased risk of infection. Few data have been published on the course of COVID‐19 in patients with psoriasis receiving biologics.
Whatdoes this study add? Systemic treatments for psoriasis (including nonbiologics and biologics) were not associated with an increased risk of in‐hospital mortality due to COVID‐19. Our results did not support a prophylactic effect of long‐term use of biologics on risk of hospitalization for COVID‐19 or in‐hospital mortality. These results provide evidence supporting the continuity of care for psoriasis and maintaining systemic treatment for psoriasis during the pandemic.
Linked Comment: S. Cazzaniga and L. Naldi. Br J Dermatol 2022; 186:7–8. Plain language summary available online
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Affiliation(s)
- L Penso
- GIS-EPIPHARE, Groupement d'intérêt scientifique Epidémiologie des produits de santé ANSM-CNAM, Paris, F-75020, France.,Univ Paris-Est Creteil, EpiDermE, Créteil, F-94010, France
| | - R Dray-Spira
- GIS-EPIPHARE, Groupement d'intérêt scientifique Epidémiologie des produits de santé ANSM-CNAM, Paris, F-75020, France
| | - A Weill
- GIS-EPIPHARE, Groupement d'intérêt scientifique Epidémiologie des produits de santé ANSM-CNAM, Paris, F-75020, France.,Caisse Nationale d'assurance Maladie des Travailleurs Salariés (CNAM), Paris, F-75020, France
| | - M Zureik
- GIS-EPIPHARE, Groupement d'intérêt scientifique Epidémiologie des produits de santé ANSM-CNAM, Paris, F-75020, France.,INSERM, Echappement aux anti-infectieux et Pharmacoépidémiologie, CESP, UVSQ, Montigny le Bretonneux, F-78180, France
| | - E Sbidian
- GIS-EPIPHARE, Groupement d'intérêt scientifique Epidémiologie des produits de santé ANSM-CNAM, Paris, F-75020, France.,Univ Paris-Est Creteil, EpiDermE, Créteil, F-94010, France.,AP-HP, Hôpitaux universitaires Henri Mondor, Département de Dermatologie, UPEC, Créteil, F-94010, France.,INSERM, Centre d'Investigation Clinique 1430, Créteil, F-94010, France
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Penso L, Dray-Spira R, Weill A, Pina Vegas L, Zureik M, Sbidian E. Association Between Biologics Use and Risk of Serious Infection in Patients With Psoriasis. JAMA Dermatol 2021; 157:1056-1065. [PMID: 34287624 DOI: 10.1001/jamadermatol.2021.2599] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Importance Biologics and targeted therapies, such as apremilast, are efficient treatments to manage moderate to severe psoriasis. More information about the risk of serious infection is needed for the newest treatment options in a real-world setting. Objective To assess the risk of serious infection among biologics and apremilast used to treat psoriasis, with etanercept as the comparator. Design, Setting, and Participants This nationwide cohort study from France involved data from the National Health Data System covering approximately 99% of the French population. All adults with psoriasis, defined as receiving at least 2 prescriptions of a topical vitamin D derivative within a 2-year period, registered in the database between January 1, 2008, and May 31, 2019, were eligible. The study population included those who were new users of biologic agents or apremilast (ie, without any prescriptions of a biologic or apremilast during the previous year). Patients with HIV infection or a history of cancer, transplant, or serious infection were excluded. End of follow-up was January 31, 2020. Main Outcome Measures The primary end point was a serious infection in a time-to-event analysis using propensity score-weighted Cox proportional hazards regression models, estimating weighted hazard ratios (wHRs) and 95% CIs. Results A total of 44 239 new users of biologic treatment were identified (mean [SD] age, 48.4 [13.8] years; 22 866 [51.7%] men; median follow-up, 12 months [interquartile range, 7-24 months]). A total of 29 618 (66.9%) were prescribed a tumor necrosis factor inhibitor first, 6658 (15.0%) an interleukin (IL) 12/23 inhibitor, 4093 (9.3%) an IL-17 inhibitor, 526 (1.2%) an IL-23 inhibitor, and 3344 (7.6%) apremilast. The total number of serious infections was 1656, and the overall crude incidence rate was 25.0 (95% CI, 23.8-26.2) per 1000 person-years. The most frequent serious infections were gastrointestinal infections (645 patients [38.9%]). After adjusting for time-dependent covariables, risk of serious infections was higher for new users of adalimumab (wHR, 1.22; 95% CI, 1.07-1.38) or infliximab (wHR, 1.79; 95% CI 1.49-2.16) vs etanercept, whereas ustekinumab was associated with a lower risk of having a serious infection (wHR, 0.79; 95% CI, 0.67-0.94). Risk of serious infections was not increased for new users of IL-17 and the IL-23 inhibitor guselkumab or apremilast vs etanercept. Risk of serious infections was increased with concomitant nonsteroidal anti-inflammatory drugs or systemic corticosteroids. Conclusions and Relevance In this cohort study of individuals with moderate to severe psoriasis, risk of serious infections was increased in new users of infliximab and adalimumab vs etanercept, whereas ustekinumab users had lower risk of having a serious infection but not new users of IL-17 and IL-23 inhibitors or apremilast. Other observational studies are needed to confirm results for the most recent drugs.
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Affiliation(s)
- Laetitia Penso
- Groupement d'intérêt scientifique Epidémiologie des produits de santé, L'Agence Nationale de Sécurité du Médicament et des Produits de Santé -Caisse Nationale de l'Assurance Maladie, Paris, France.,Epidémiologie en Dermatologie et Evaluation des Thérapeutiques, Université Paris-Est Creteil, Créteil, France
| | - Rosemary Dray-Spira
- Groupement d'intérêt scientifique Epidémiologie des produits de santé, L'Agence Nationale de Sécurité du Médicament et des Produits de Santé -Caisse Nationale de l'Assurance Maladie, Paris, France
| | - Alain Weill
- Groupement d'intérêt scientifique Epidémiologie des produits de santé, L'Agence Nationale de Sécurité du Médicament et des Produits de Santé -Caisse Nationale de l'Assurance Maladie, Paris, France.,Caisse Nationale d'Assurance Maladie des Travailleurs Salariés, Paris, France
| | - Laura Pina Vegas
- Epidémiologie en Dermatologie et Evaluation des Thérapeutiques, Université Paris-Est Creteil, Créteil, France.,Département de Rhumatologie, Assistance Publique-Hôpitaux de Paris, Hôpitaux universitaires Henri Mondor, Créteil, France
| | - Mahmoud Zureik
- Groupement d'intérêt scientifique Epidémiologie des produits de santé, L'Agence Nationale de Sécurité du Médicament et des Produits de Santé -Caisse Nationale de l'Assurance Maladie, Paris, France.,INSERM, Echappement aux anti-infectieux et Pharmacoépidémiologie, Centre de recherche en épidémiologie et santé des populations, Université de Versailles Saint-Quentin-en-Yvelines, Montigny le Bretonneux, France
| | - Emilie Sbidian
- Groupement d'intérêt scientifique Epidémiologie des produits de santé, L'Agence Nationale de Sécurité du Médicament et des Produits de Santé -Caisse Nationale de l'Assurance Maladie, Paris, France.,Epidémiologie en Dermatologie et Evaluation des Thérapeutiques, Université Paris-Est Creteil, Créteil, France.,Département de Dermatologie, Assistance Publique-Hôpitaux de Paris, Hôpitaux universitaires Henri Mondor, Université Paris-Est Creteil, Créteil, France.,INSERM, Centre d'Investigation Clinique 1430, Créteil, France
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7
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Pina Vegas L, Sbidian E, Penso L, Claudepierre P. Epidemiologic study of patients with psoriatic arthritis in a real-world analysis: a cohort study of the French health insurance database. Rheumatology (Oxford) 2021; 60:1243-1251. [PMID: 32911531 DOI: 10.1093/rheumatology/keaa448] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/30/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE PsA is a chronic inflammatory arthritis with heterogeneous disease manifestations. Data on the prevalence of PsA in adults differ widely depending on the study and the country. This study aimed to estimate the prevalence and incidence of PsA in France, characterize comorbidities associated to PsA and identify prescribed treatments. METHODS This nationwide cohort study involved the administrative healthcare database (Système National des Données de Santé) of the French health insurance scheme linked to the national hospital discharge database. All adults with PsA registered in the database and identified with a specific International Classification of Diseases, 10th revision code (M07) were included between 1 January 2015 and 31 December 2018. RESULTS A total of 63 598 patients were identified as having PsA [55.9 years (s.d. 14.4), 45.6% males]. The prevalence of PsA was estimated at 0.1% and the incidence at 8.4 per 100 000 person-years in the general population. The most common comorbidities were hypertension, diabetes, chronic obstructive pulmonary disease and dyslipidaemia. The prevalence of treatment with conventional synthetic DMARDs (csDMARDs), biological or biosimilar DMARDs (b/bsDMARDs) and apremilast for PsA was 25.9% (16 453), 30.4% (19 325) and 3.5% (2231), respectively. Overall, 8966 (14.1%) patients were new users of csDMARDs, 8311 (13.1%) were new users of b/bsDMARDs and 1529 (7.4%) were new users of apremilast. The most common first-line csDMARD was methotrexate (70.9%) and the most frequent first-line b/bsDMARD was adalimumab (30.8%). CONCLUSION Our results lead to a better understanding of PsA. Results were similar to those from other published studies using other data sources, which highlights the reliability of insurance databases for studies.
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Affiliation(s)
- Laura Pina Vegas
- Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE), EA7379, Paris-Est University, UPEC, Créteil, France.,Department of Rheumatology, Mondor Hospital (AP-HP), Paris Est Créteil University, Créteil, France
| | - Emilie Sbidian
- Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE), EA7379, Paris-Est University, UPEC, Créteil, France.,Department of Dermatology, Mondor Hospital (AP-HP), Paris Est Créteil University, Créteil, France.,Clinical Investigation Center 1430, INSERM, Créteil, France
| | - Laetitia Penso
- Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE), EA7379, Paris-Est University, UPEC, Créteil, France
| | - Pascal Claudepierre
- Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE), EA7379, Paris-Est University, UPEC, Créteil, France.,Department of Rheumatology, Mondor Hospital (AP-HP), Paris Est Créteil University, Créteil, France
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Sbidian E, Penso L, Herlemont P, Botton J, Baricault B, Semenzato L, Drouin J, Weill A, Dray-Spira R, Zureik M. Comment on 'Baseline use of hydroxychloroquine in systemic lupus erythematosus does not preclude SARS-CoV-2 infection and severe COVID-19' by Konig et al. Long-term exposure to hydroxychloroquine or chloroquine and the risk of hospitalisation with COVID-19: a nationwide, observational cohort study in 54 873 exposed individuals and 155 689 matched unexposed individuals in France. Ann Rheum Dis 2020; 82:e117. [PMID: 32859610 DOI: 10.1136/annrheumdis-2020-218647] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 07/22/2020] [Accepted: 07/25/2020] [Indexed: 01/28/2023]
Affiliation(s)
- Emilie Sbidian
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products from the French National Agency for the Safety of Medicines and Health Products and the French National Health Insurance, F-93285, Saint Denis, France .,University Paris-Est Créteil, Research Unit Epidemiology in Dermatology and evaluation of therapeutics, F-94000, Créteil, France
| | - Laetitia Penso
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products from the French National Agency for the Safety of Medicines and Health Products and the French National Health Insurance, F-93285, Saint Denis, France.,University Paris-Est Créteil, Research Unit Epidemiology in Dermatology and evaluation of therapeutics, F-94000, Créteil, France
| | - Philippe Herlemont
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products from the French National Agency for the Safety of Medicines and Health Products and the French National Health Insurance, F-93285, Saint Denis, France
| | - Jérémie Botton
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products from the French National Agency for the Safety of Medicines and Health Products and the French National Health Insurance, F-93285, Saint Denis, France
| | - Bérangère Baricault
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products from the French National Agency for the Safety of Medicines and Health Products and the French National Health Insurance, F-93285, Saint Denis, France
| | - Laura Semenzato
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products from the French National Agency for the Safety of Medicines and Health Products and the French National Health Insurance, F-93285, Saint Denis, France
| | - Jérome Drouin
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products from the French National Agency for the Safety of Medicines and Health Products and the French National Health Insurance, F-93285, Saint Denis, France
| | - Alain Weill
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products from the French National Agency for the Safety of Medicines and Health Products and the French National Health Insurance, F-93285, Saint Denis, France
| | - Rosemay Dray-Spira
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products from the French National Agency for the Safety of Medicines and Health Products and the French National Health Insurance, F-93285, Saint Denis, France
| | - Mahmoud Zureik
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products from the French National Agency for the Safety of Medicines and Health Products and the French National Health Insurance, F-93285, Saint Denis, France.,University Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Anti-infective evasion and pharmacoepidemiology, CESP, F-78180, Montigny le Bretonneux, France
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Grodner C, Sbidian E, Weill A, Mezzarobba M. Epidemiologic study in a real‐world analysis of patients with treatment for psoriasis in the French national health insurance database. J Eur Acad Dermatol Venereol 2020; 35:411-416. [DOI: 10.1111/jdv.16566] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 04/03/2020] [Indexed: 12/22/2022]
Affiliation(s)
- C. Grodner
- Département de Dermatologie AP‐HP Hôpitaux Universitaires Henri Mondor UPEC Créteil France
| | - E. Sbidian
- GIS‐EPIPHARE, Groupement d’intérêt scientifique Epidémiologie des produits de santé ANSM‐CNAM Paris France
- Centre d’Investigation Clinique 1430 INSERM Créteil France
- EA 7379 EpidermE Université Paris‐Est Créteil UPEC Créteil France
| | - A. Weill
- GIS‐EPIPHARE, Groupement d’intérêt scientifique Epidémiologie des produits de santé ANSM‐CNAM Paris France
- Caisse Nationale d’Assurance Maladie des Travailleurs Salariés (CNAM) Paris France
| | - M. Mezzarobba
- Caisse Nationale d’Assurance Maladie des Travailleurs Salariés (CNAM) Paris France
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Sbidian E, Billionnet C, Weill A, Maura G, Mezzarobba M. Persistence of apremilast in moderate-to-severe psoriasis: a real-world analysis of 14 147 apremilast- and methotrexate-naive patients in the French National Health Insurance database. Br J Dermatol 2019; 182:690-697. [PMID: 31021438 DOI: 10.1111/bjd.18047] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Real-world data on the persistence of apremilast vs. methotrexate are inconclusive. OBJECTIVES To assess and compare the long-term persistence of apremilast and methotrexate in a large cohort of patients with psoriasis. METHODS All adult patients with psoriasis registered in the French national health insurance database ('Système National des Données de Santé') between 2009 and 2017 were eligible for inclusion. The study population comprised apremilast- and methotrexate-naive patients, defined as those with a first prescription of apremilast or methotrexate. Levels of persistence were compared using a Cox model with propensity-score matching that included potential confounders (notably age, sex, psoriatic arthritis, comorbidities and previous exposure to topical and systemic treatments). RESULTS In this nationwide population-based cohort, 14 147 adult patients with psoriasis (mean age 52·3 years, 55·2% male) were found to be naive to both apremilast and methotrexate. After propensity-score matching, two subgroups of 4805 patients with similar baseline characteristics were included, of whom 3207 apremilast-treated patients and 2736 methotrexate-treated patients discontinued their treatment. Kaplan-Meier survival propensity-score analyses revealed a discontinuation rate of 69% for apremilast and 59% for methotrexate in the first year of treatment. Apremilast-treated patients had a higher risk of discontinuation than methotrexate-treated patients when considering the study population as a whole (hazard ratio 1·28, 95% confidence interval 1·23-1·34) or in a propensity-score-matched analysis (hazard ratio 1·34, 95% confidence interval 1·27-1·41; P < 0·001). CONCLUSIONS Our real-world data suggest that in the first year of treatment, the discontinuation rate was significantly higher for apremilast-treated patients than for methotrexate-treated patients, regardless of the previous therapeutic lines received. What's already known about this topic? Psoriasis is a common chronic, relapse-remitting, inflammatory skin disease associated with severe psychosocial impact. Apremilast, a phosphodiesterase 4 inhibitor, is one of the most recently commercialized psoriasis drugs. Little is known about the long-term clinical effectiveness of apremilast. What does this study add? The discontinuation rate at 1 year for apremilast was 69%, compared with 58% for methotrexate, in a nationwide population-based cohort including 14 147 nonselected adult patients with psoriasis. Patients in the apremilast cohort had a higher risk of discontinuation than patients in the methotrexate cohort using propensity-score matching, including potentially relevant individual risk factors such as age, sex, comorbidities and psoriatic arthritis, and regardless of the previous therapeutic lines received. In daily practice, physicians should take these results into account when choosing between methotrexate and apremilast as a first-line systemic therapy.
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Affiliation(s)
- E Sbidian
- Département d'Etudes en Santé Publique, Direction de la Stratégie, des Etudes et des Statistiques, Caisse Nationale d'Assurance Maladie des Travailleurs Salariés (CNAM), Paris, F-75020, France.,AP-HP, Hôpitaux Universitaires Henri Mondor, Département de Dermatologie, Université Paris-Est Créteil, Créteil, F-94010, France.,INSERM, Centre d'Investigation Clinique 1430, Créteil, F-94010, France.,EA 7379 EpidermE, Université Paris-Est Créteil, Créteil, F-94010, France
| | - C Billionnet
- Département d'Etudes en Santé Publique, Direction de la Stratégie, des Etudes et des Statistiques, Caisse Nationale d'Assurance Maladie des Travailleurs Salariés (CNAM), Paris, F-75020, France
| | - A Weill
- Département d'Etudes en Santé Publique, Direction de la Stratégie, des Etudes et des Statistiques, Caisse Nationale d'Assurance Maladie des Travailleurs Salariés (CNAM), Paris, F-75020, France
| | - G Maura
- Département d'Etudes en Santé Publique, Direction de la Stratégie, des Etudes et des Statistiques, Caisse Nationale d'Assurance Maladie des Travailleurs Salariés (CNAM), Paris, F-75020, France
| | - M Mezzarobba
- Département d'Etudes en Santé Publique, Direction de la Stratégie, des Etudes et des Statistiques, Caisse Nationale d'Assurance Maladie des Travailleurs Salariés (CNAM), Paris, F-75020, France
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11
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Miao Y, Yuan X, Gu J, Zhang L, He R, Sandeep S, Wu J. Constructing a value-based healthcare system for hypertensive patients through changing payment mode: evidence from a comparative study in rural China. J Med Econ 2019; 22:245-251. [PMID: 30547700 DOI: 10.1080/13696998.2018.1558864] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To construct a value-based healthcare system for rural Chinese hypertensive patients through an increasing outpatient care reimbursement ratio. METHODS This comparative study sampled two similar counties, Dangyang County and Zhijiang County, in Hubei Province of China, as the intervention group and the control group, respectively. The Social Health Insurance Fund of the intervention group budgeted 600 yuan per capita per year to insured patients with third stage hypertension to cover their outpatient expenditures, while the outpatient expenditures of the control group were not covered by its Social Health Insurance Fund. The inpatient expenditure reimbursement policies in both groups were not adjusted during the study. Value improvement in this study was defined as reduction in medical costs and improvement in health outcomes within the pilot healthcare system. A propensity score matching model combined with a difference-in-differences model was used to estimate the changes in medical costs and health outcomes. RESULTS In total, 1,673 pairs of patients were enrolled into statistical analysis after the propensity score matching. The intervention increased per capita annual outpatient expenditure by 81.2 (+31.8%) yuan (p > .05), but decreased the per capita annual inpatient expenditure and total medical expenditure by 475.4 (-40.7%) yuan and 394.2 (-27.7%) yuan, respectively (p < .05). Accordingly, the per capita annual total medical expenditure reimbursement decreased by 192.3 (-28.5%) yuan (p < .05), and the per capita annual total out-of-pocket expenditure by 201.9 (-29.9%) yuan (p < .05). The diastolic blood pressure of the intervention group decreased significantly by 2.9 mmHg (p < .05), but no significant change was found in systolic blood pressure and prevalence of hypertension complications (p > .05). CONCLUSION Increasing the outpatient expenditures, the reimbursement ratio was beneficial to the value of the healthcare system for hypertensive patients. Outpatient care for patients with chronic diseases should be prioritized for rural China and healthcare settings with inadequate health insurance funds.
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Affiliation(s)
- Yudong Miao
- a Department of General Medicine of Henan Provincial People's Hospital , Zhengzhou , China
- b School of Health Policy and Management , Nanjing Medical University , Nanjing , China
| | - Xiangdong Yuan
- c Guangdong General Hospital , Guangdong Academy of Medical Sciences , Guangzhou , China
| | - Jianqin Gu
- a Department of General Medicine of Henan Provincial People's Hospital , Zhengzhou , China
| | - Liang Zhang
- d School of Medicine and Health Management , Tongji Medical College, Huazhong University of Science & Technology , Wuhan , China
| | - Ruibo He
- d School of Medicine and Health Management , Tongji Medical College, Huazhong University of Science & Technology , Wuhan , China
| | - Sandeep Sandeep
- d School of Medicine and Health Management , Tongji Medical College, Huazhong University of Science & Technology , Wuhan , China
| | - Jian Wu
- e College of Public Health , Zhengzhou University , Zhengzhou , China
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12
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Sbidian E, Mezzarobba M, Weill A, Coste J, Rudant J. Persistence of treatment with biologics for patients with psoriasis: a real‐world analysis of 16 545 biologic‐naïve patients from the French National Health Insurance database (SNIIRAM). Br J Dermatol 2018; 180:86-93. [DOI: 10.1111/bjd.16809] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2018] [Indexed: 01/04/2023]
Affiliation(s)
- E. Sbidian
- Département d’études en santé publique Direction de la stratégie, des études et des statistiques Caisse Nationale d'Assurance Maladie des Travailleurs Salariés (CNAM) Paris F‐75020 France
- AP‐HP Hôpitaux universitaires Henri Mondor Département de Dermatologie UPEC 51, av du Maréchal de Lattre de Tassigny Créteil F‐94010 France
- INSERM Centre d'Investigation Clinique 1430 Créteil F‐94010 France
- EA 7379 EpidermE Université Paris‐Est Créteil UPEC Créteil F‐94010 France
| | - M. Mezzarobba
- Département d’études en santé publique Direction de la stratégie, des études et des statistiques Caisse Nationale d'Assurance Maladie des Travailleurs Salariés (CNAM) Paris F‐75020 France
| | - A. Weill
- Département d’études en santé publique Direction de la stratégie, des études et des statistiques Caisse Nationale d'Assurance Maladie des Travailleurs Salariés (CNAM) Paris F‐75020 France
| | - J. Coste
- Département d’études en santé publique Direction de la stratégie, des études et des statistiques Caisse Nationale d'Assurance Maladie des Travailleurs Salariés (CNAM) Paris F‐75020 France
| | - J. Rudant
- Département d’études en santé publique Direction de la stratégie, des études et des statistiques Caisse Nationale d'Assurance Maladie des Travailleurs Salariés (CNAM) Paris F‐75020 France
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Garland A, Olafson K, Ramsey CD, Yogendranc M, Fransoo R. Reassessing access to intensive care using an estimate of the population incidence of critical illness. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2018; 22:208. [PMID: 30122152 PMCID: PMC6100704 DOI: 10.1186/s13054-018-2132-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 07/20/2018] [Indexed: 11/14/2022]
Abstract
Background The consistently observed male predominance of patients in intensive care units (ICUs) has raised concerns about gender-based disparities in ICU access. Comparing rates of ICU admission requires choosing a normalizing factor (denominator), and the denominator usually used to compare such rates between subpopulations is the size of those subpopulations. However, the appropriate denominator is the number of people whose medical condition warranted ICU care. We devised an estimate of the number of critically ill people in the general population, and used it to compare rates of ICU admission by gender and income. Methods This population-based, retrospective analysis included all adults in the Canadian province of Manitoba, 2004–2015. We created an estimate for the number of critically ill people who warrant ICU care, and used it as the denominator to generate critical illness-normalized rates of ICU admission. These were compared to the usual population-normalized rates of ICU care. Results Men outnumbered women in ICUs for all age groups; population-normalized male:female rate ratios significantly exceed 0 for every age group, ranging from 1.15 to 2.10. Using critical-illness normalized rates, this male predominance largely disappeared; critically ill men and women aged 45–74 years were admitted in equivalent proportions (critical-illness normalized rate ratios 0.96–1.01). While population-normalized rates of ICU care were higher in lower income strata (p < 0.001), the gradient for critical illness-based rates was reversed (p < 0.001). Conclusions Across a 30-year adult age span, the male predominance of ICU patients was accounted for by higher estimated rates of critical illness among men. People in lower income strata had lower critical-illness normalized rates of ICU admission. Our methods highlight that correct inferences about access to healthcare require calculating rates using denominators appropriate for this purpose. Electronic supplementary material The online version of this article (10.1186/s13054-018-2132-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Allan Garland
- Department of Internal Medicine, University of Manitoba, 820 Sherbrook Street, Winnipeg, MB, R3A1R9, Canada. .,Department of Community Health Sciences, University of Manitoba, Room S113, 750 Bannatyne Avenue, Winnipeg, MB, R3E0W3, Canada. .,Manitoba Centre for Health Policy, University of Manitoba, Room 408, 727 McDermot Avenue, Winnipeg, MB, R3E3P5, Canada.
| | - Kendiss Olafson
- Department of Internal Medicine, University of Manitoba, 820 Sherbrook Street, Winnipeg, MB, R3A1R9, Canada
| | - Clare D Ramsey
- Department of Internal Medicine, University of Manitoba, 820 Sherbrook Street, Winnipeg, MB, R3A1R9, Canada.,Department of Community Health Sciences, University of Manitoba, Room S113, 750 Bannatyne Avenue, Winnipeg, MB, R3E0W3, Canada
| | - Marina Yogendranc
- Manitoba Centre for Health Policy, University of Manitoba, Room 408, 727 McDermot Avenue, Winnipeg, MB, R3E3P5, Canada
| | - Randall Fransoo
- Manitoba Centre for Health Policy, University of Manitoba, Room 408, 727 McDermot Avenue, Winnipeg, MB, R3E3P5, Canada
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Moulis G, Ibañez B, Palmaro A, Aizpuru F, Millan E, Lapeyre-Mestre M, Sailler L, Cambra K. Cross-national health care database utilization between Spain and France: results from the EPICHRONIC study assessing the prevalence of type 2 diabetes mellitus. Clin Epidemiol 2018; 10:863-874. [PMID: 30100760 PMCID: PMC6067780 DOI: 10.2147/clep.s151890] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
AIM The EPICHRONIC (EPIdemiology of CHRONIC diseases) project investigated the possibility of developing common procedures for French and Spanish electronic health care databases to enable large-scale pharmacoepidemiological studies on chronic diseases. A feasibility study assessed the prevalence of type 2 diabetes mellitus (T2DM) in Navarre and the Basque Country (Spain) and the Midi-Pyrénées region (France). PATIENTS AND METHODS We described and compared database structures and the availability of hospital, outpatient, and drug-dispensing data from 5.9 million inhabitants. Due to differences in database structures and recorded data, we could not develop a common procedure to estimate T2DM prevalence, but identified an algorithm specific to each database. Patients were identified using primary care diagnosis codes previously validated in Spanish databases and a combination of primary care diagnosis codes, hospital diagnosis codes, and data on exposure to oral antidiabetic drugs from the French database. RESULTS Spanish and French databases (the latter termed Système National d'Information Inter-Régimes de l'Assurance Maladie [SNIIRAM]) included demographic, primary care diagnoses, hospital diagnoses, and outpatient drug-dispensing data. Diagnoses were encoded using the International Classification of Primary Care (version 2) and the International Classification of Diseases, version 9 and version 10 (ICD-9 and ICD-10) in the Spanish databases, whereas the SNIIRAM contained ICD-10 codes. All data were anonymized before transferring to researchers. T2DM prevalence in the population over 20 years was estimated to be 6.6-7.0% in the Spanish regions and 6.3% in the Midi-Pyrénées region with ~2% higher estimates for males in the three regions. CONCLUSION Tailored procedures can be designed to estimate the prevalence of T2DM in population-based studies from Spanish and French electronic health care records.
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Affiliation(s)
- Guillaume Moulis
- Department of Internal Medicine, Toulouse University Hospital, Toulouse, France,
- UMR1027 INSERM, University of Toulouse, Toulouse, France,
- Clinical Investigation Center 1436, Toulouse University Hospital, Toulouse, France,
| | - Berta Ibañez
- Navarrabiomed, Health Department, Public University of Navarra, Pamplona, Spain
- IdiSNA, Pamplona, Spain
- Health Service Research on Chronic Patients Network (REDISSEC), Pamplona, Spain
| | - Aurore Palmaro
- UMR1027 INSERM, University of Toulouse, Toulouse, France,
- Clinical Investigation Center 1436, Toulouse University Hospital, Toulouse, France,
| | - Felipe Aizpuru
- Health Service Research on Chronic Patients Network (REDISSEC), Pamplona, Spain
- Research Unit Araba (BioAraba), Osakidetza-Basque Health Department, Vitoria-Gasteiz, Spain
- Healthcare Services Sub-directorate, Osakidetza-Basque Health Service, Araba, Spain
| | - Eduardo Millan
- Health Service Research on Chronic Patients Network (REDISSEC), Pamplona, Spain
- Healthcare Services Sub-directorate, Osakidetza-Basque Health Service, Araba, Spain
| | - Maryse Lapeyre-Mestre
- UMR1027 INSERM, University of Toulouse, Toulouse, France,
- Clinical Investigation Center 1436, Toulouse University Hospital, Toulouse, France,
- Department of Medical and Clinical Pharmacology, Toulouse University Hospital, Toulouse, France
| | - Laurent Sailler
- Department of Internal Medicine, Toulouse University Hospital, Toulouse, France,
- UMR1027 INSERM, University of Toulouse, Toulouse, France,
- Clinical Investigation Center 1436, Toulouse University Hospital, Toulouse, France,
| | - Koldo Cambra
- IdiSNA, Pamplona, Spain
- Health Service Research on Chronic Patients Network (REDISSEC), Pamplona, Spain
- Institute of Public Health and Labour Health of Navarra, Pamplona, Spain
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Zhu D, Guo N, Wang J, Nicholas S, Chen L. Socioeconomic inequalities of outpatient and inpatient service utilization in China: personal and regional perspectives. Int J Equity Health 2017; 16:210. [PMID: 29202843 PMCID: PMC5715559 DOI: 10.1186/s12939-017-0706-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Accepted: 11/23/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND China's health system has shown remarkable progress in health provision and health outcomes in recent decades, however inequality in health care utilization persists and poses a serious social problem. While government pro-poor health policies addressed affordability as the major obstacle to equality in health care access, this policy direction deserves further examination. Our study examines the issue of health care inequalities in China, analyzing both regional and individual socioeconomic factors associated with the inequality, and provides evidence to improve governmental health policies. METHODS The China Health and Nutrition Survey (CHNS) 1991-2011 data were used to analyze the inequality of health care utilization. The random effects logistic regression technique was used to model health care utilization as the dependent variable, and income and regional location as the independent variables, controlling for individuals' age, gender, marital status, education, health insurance, body mass index (BMI), and period variations. The dynamic trend of 1991-2011 regional disparities was estimated using an interaction term between the regional group dummy and the wave dummy. RESULTS The probability of using outpatient service and inpatient services during the previous 4 weeks was 8.6 and 1.1% respectively. Compared to urban residents, suburban (OR: 0.802, 95% CI: 0.720-0.893), town (OR: 0.722, 95% CI: 0.648-0.804), rich (OR: 0.728, 95% CI: 0.656-0.807) and poor village (OR: 0.778, 95% CI: 0.698-0.868) residents were less likely to use outpatient service; and rich (OR: 0.609, 95% CI: 0.472-0.785) and poor village (OR: 0.752, 95% CI: 0. 576-0.983) residents were less likely to use inpatient health care. But the differences between income groups were not significant, except the differences between top and bottom income group in outpatient service use. CONCLUSION Regional location was a more important factor than individual characteristics in determining access to health care. Besides demand-side subsidies, Chinese policy makers should pay enhanced attention to health care resource allocation to address inequity in health care access.
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Affiliation(s)
- Dawei Zhu
- Center for Health Policy and Management, Institute of Medical Information & Library, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100020 China
| | - Na Guo
- China Population and Development Research Center, Beijing, 100081 China
| | - Jian Wang
- School of Public Health, Shandong University, Jinan, 265400 China
| | - Stephen Nicholas
- School of Management and School of Economics, Tianjin Normal University, Tianjin, 300074 China
- Guangdong Research Institute of International Strategies, Guangdong University of Foreign Studies, Guangzhou, 510420 China
- Beijing Foreign Studies University, Beijing, 100089 China
- Newcastle Business School, University of Newcastle, Newcastle, 2308 NSW Australia
| | - Li Chen
- Center for Health Policy and Management, Institute of Medical Information & Library, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100020 China
- Georgia Prevention Institute, Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, 30912 GA USA
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Garland A, Olafson K, Ramsey CD, Yogendran M, Fransoo R. Epidemiology of critically ill patients in intensive care units: a population-based observational study. Crit Care 2013; 17:R212. [PMID: 24079640 PMCID: PMC4056438 DOI: 10.1186/cc13026] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 07/25/2013] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Epidemiologic assessment of critically ill people in Intensive Care Units (ICUs) is needed to ensure the health care system can meet current and future needs. However, few such studies have been published. METHODS Population-based analysis of all adult ICU care in the Canadian province of Manitoba, 1999 to 2007, using administrative data. We calculated age-adjusted rates and trends of ICU care, overall and subdivided by age, sex and income. RESULTS In 2007, Manitoba had a population of 1.2 million, 118 ICU beds in 21 ICUs, for 9.8 beds per 100,000 population. Approximately 0.72% of men and 0.47% of women were admitted to ICUs yearly. The age-adjusted, male:female rate ratio was 1.75 (95% CI 1.64 to 1.88). Mean age was 64.5 ± 16.4 years. Rates rose rapidly after age 40, peaked at age 75 to 80, and declined for the oldest age groups. Rates were higher among residents of lower income areas, for example declining from 7.9 to 4.4 per 100,000 population from the poorest to the wealthiest income quintiles (p <0.0001). Rates of ICU admission slowly declined over time, while cumulative yearly ICU bed-days slowly rose; changes were age-dependent, with faster declines in admission rates with older age. There was a high rate of recidivism; 16% of ICU patients had received ICU care previously. CONCLUSIONS These temporal trends in ICU admission rates and cumulative bed-days used have significant implications for health system planning. The differences by age, sex and socioeconomic status, and the high rate of recidivism require further research to clarify their causes, and to devise strategies for reducing critical illness in high-risk groups.
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Tuppin P, Ricci-Renaud P, de Peretti C, Fagot-Campagna A, Gastaldi-Menager C, Danchin N, Alla F, Allemand H. Antihypertensive, antidiabetic and lipid-lowering treatment frequencies in France in 2010. Arch Cardiovasc Dis 2013; 106:274-86. [PMID: 23769402 DOI: 10.1016/j.acvd.2013.02.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 02/28/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND The frequencies of treatment for cardiovascular risk factors are poorly documented in large populations, particularly according to the presence or absence of cardiovascular disease (CVD). AIMS To assess frequencies of reimbursements for antihypertensive, lipid-lowering and antidiabetic medications in France among national health insurance beneficiaries in 2010 and their associations according to age, sex, French regions, level deprivation and the presence of certain CVD. METHODS Treatment frequencies were calculated among the beneficiaries (58 million people) on the basis of reimbursements for three specific categories of medicinal products in 2010. The presence of CVD was defined by a diagnosis associated with chronic disease status and hospital stays in 2010. RESULTS Among people aged greater or equal to 20years, treatment frequencies were 22% (men 20% vs. women 23%) for antihypertensives, 15% (14% vs. 16%) for lipid-lowering agents and 6% (6% vs. 5%) for antidiabetic medications. These frequencies were, respectively, 33%, 23% and 8% in patients aged greater or equal to 40years and 55%, 38% and 14% in patients aged greater or equal to 60 years. The frequency of at least one treatment for at least one of the three risk factors was 41% in patients aged greater or equal to 40 years and 66% in patients aged greater or equal to 60 years. Among patients aged greater or equal to 20 years, 22% were treated for at least one risk factor in the absence of CVD and 3% were treated for at least one risk factor in the presence of CVD. Regional differences were observed, with higher frequencies of antihypertensive and antidiabetic use in the North, North-East and Overseas regions. Treatment frequencies increased with level of deprivation, especially for antidiabetics. CONCLUSION This national study more clearly defines treatment frequencies and the populations and regions with the highest treatment frequencies.
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Affiliation(s)
- Philippe Tuppin
- Caisse nationale d'assurance maladie des travailleurs salariés (CNAMTS), direction de la stratégie des études et des statistiques, 26-50, avenue du Professeur-André-Lemierre, 75986 Paris cedex 20, France.
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Plug I, Hoffmann R, Artnik B, Bopp M, Borrell C, Costa G, Deboosere P, Esnaola S, Kalediene R, Leinsalu M, Lundberg O, Martikainen P, Regidor E, Rychtarikova J, Strand BH, Wojtyniak B, Mackenbach JP. Socioeconomic inequalities in mortality from conditions amenable to medical interventions: do they reflect inequalities in access or quality of health care? BMC Public Health 2012; 12:346. [PMID: 22578154 PMCID: PMC3413570 DOI: 10.1186/1471-2458-12-346] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Accepted: 05/11/2012] [Indexed: 11/27/2022] Open
Abstract
Background Previous studies have reported large socioeconomic inequalities in mortality from conditions amenable to medical intervention, but it is unclear whether these can be attributed to inequalities in access or quality of health care, or to confounding influences such as inequalities in background risk of diseases. We therefore studied whether inequalities in mortality from conditions amenable to medical intervention vary between countries in patterns which differ from those observed for other (non-amenable) causes of death. More specifically, we hypothesized that, as compared to non-amenable causes, inequalities in mortality from amenable causes are more strongly associated with inequalities in health care use and less strongly with inequalities in common risk factors for disease such as smoking. Methods Cause-specific mortality data for people aged 30–74 years were obtained for 14 countries, and were analysed by calculating age-standardized mortality rates and relative risks comparing a lower with a higher educational group. Survey data on health care use and behavioural risk factors for people aged 30–74 years were obtained for 12 countries, and were analysed by calculating age-and sex-adjusted odds ratios comparing a low with a higher educational group. Patterns of association were explored by calculating correlation coefficients. Results In most countries and for most amenable causes of death substantial inequalities in mortality were observed, but inequalities in mortality from amenable causes did not vary between countries in patterns that are different from those seen for inequalities in non-amenable mortality. As compared to non-amenable causes, inequalities in mortality from amenable causes are not more strongly associated with inequalities in health care use. Inequalities in mortality from amenable causes are also not less strongly associated with common risk factors such as smoking. Conclusions We did not find evidence that inequalities in mortality from amenable conditions are related to inequalities in access or quality of health care. Further research is needed to find the causes of socio-economic inequalities in mortality from amenable conditions, and caution should be exercised in interpreting these inequalities as indicating health care deficiencies.
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Affiliation(s)
- Iris Plug
- Department of Public Health, Erasmus MC, Rotterdam, Netherlands
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