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Kuenzig ME, Bitton A, Carroll MW, Otley AR, Singh H, Kaplan GG, Stukel TA, Mack DR, Jacobson K, Griffiths AM, El-Matary W, Targownik LE, Nguyen GC, Jones JL, Murthy SK, Bernstein CN, Lix LM, Peña-Sánchez JN, Dummer TJB, Spruin S, Fung SG, Nugent Z, Coward S, Cui Y, Coulombe J, Filliter C, Benchimol EI. Health Services Utilization and Specialist Care in Pediatric Inflammatory Bowel Disease: A Multiprovince Population-Based Cohort Study. Inflamm Bowel Dis 2024:izae010. [PMID: 38366807 DOI: 10.1093/ibd/izae010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Indexed: 02/18/2024]
Abstract
BACKGROUND Patterns of health services utilization among children with inflammatory bowel disease (IBD) are important to understand as the number of children with IBD continues to increase. We compared health services utilization and surgery among children diagnosed <10 years of age (Paris classification: A1a) and between 10 and <16 years of age (A1b). METHODS Incident cases of IBD diagnosed <16 years of age were identified using validated algorithms from deterministically linked health administrative data in 5 Canadian provinces (Alberta, Manitoba, Nova Scotia, Ontario, Quebec) to conduct a retrospective cohort study. We compared the frequency of IBD-specific outpatient visits, emergency department visits, and hospitalizations across age groups (A1a vs A1b [reference]) using negative binomial regression. The risk of surgery was compared across age groups using Cox proportional hazards models. Models were adjusted for sex, rural/urban residence location, and mean neighborhood income quintile. Province-specific estimates were pooled using random-effects meta-analysis. RESULTS Among the 1165 (65.7% Crohn's) children with IBD included in our study, there were no age differences in the frequency of hospitalizations (rate ratio [RR], 0.88; 95% confidence interval [CI], 0.74-1.06) or outpatient visits (RR, 0.95; 95% CI, 0.78-1.16). A1a children had fewer emergency department visits (RR, 0.70; 95% CI, 0.50-0.97) and were less likely to require a Crohn's-related surgery (hazard ratio, 0.49; 95% CI, 0.26-0.92). The risk of colectomy was similar among children with ulcerative colitis in both age groups (hazard ratio, 0.71; 95% CI, 0.49-1.01). CONCLUSIONS Patterns of health services utilization are generally similar when comparing children diagnosed across age groups.
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Affiliation(s)
- M Ellen Kuenzig
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, ON, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Alain Bitton
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, QC, Canada
| | - Matthew W Carroll
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Anthony R Otley
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Harminder Singh
- University of Manitoba IBD Clinical and Research Centre, University of Manitoba, Winnipeg, MB, Canada
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
- Research Institute at CancerCare Manitoba, Winnipeg, MB, Canada
| | - Gilaad G Kaplan
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Therese A Stukel
- ICES, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - David R Mack
- CHEO Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, CHEO, Ottawa, ON, Canada
- CHEO Research Institute, Ottawa, ON, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
| | - Kevan Jacobson
- Department of Pediatrics, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Anne M Griffiths
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, ON, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Wael El-Matary
- Department of Pediatrics, University of Manitoba, Winnipeg, MB, Canada
| | - Laura E Targownik
- Mount Sinai Hospital Centre for Inflammatory Bowel Disease, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Geoffrey C Nguyen
- ICES, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Mount Sinai Hospital Centre for Inflammatory Bowel Disease, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jennifer L Jones
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Sanjay K Murthy
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Division of Gastroenterology, Ottawa Hospital IBD Centre, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Charles N Bernstein
- University of Manitoba IBD Clinical and Research Centre, University of Manitoba, Winnipeg, MB, Canada
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Lisa M Lix
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Juan Nicolás Peña-Sánchez
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Trevor J B Dummer
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Sarah Spruin
- ICES, Toronto, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Stephen G Fung
- CHEO Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, CHEO, Ottawa, ON, Canada
- CHEO Research Institute, Ottawa, ON, Canada
| | - Zoann Nugent
- University of Manitoba IBD Clinical and Research Centre, University of Manitoba, Winnipeg, MB, Canada
| | - Stephanie Coward
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Yunsong Cui
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Janie Coulombe
- Department of Mathematics and Statistics, Université de Montréal, Montréal, QC, Canada
| | - Christopher Filliter
- Lady Davis Institute of Medical Research, Jewish General Hospital, Montreal, QC, Canada
| | - Eric I Benchimol
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, ON, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
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Kuenzig ME, Stukel TA, Carroll MW, Kaplan GG, Otley AR, Singh H, Bitton A, Fung SG, Spruin S, Coward S, Cui Y, Nugent Z, Griffiths AM, Mack DR, Jacobson K, Nguyen GC, Targownik LE, El-Matary W, Bernstein CN, Dummer TJB, Jones JL, Lix LM, Murthy SK, Peña-Sánchez JN, Nasiri S, Benchimol EI. Variation in the Care of Children with Inflammatory Bowel Disease Within and Across Canadian Provinces: A Multi-Province Population-Based Cohort Study. Clin Epidemiol 2024; 16:91-108. [PMID: 38374886 PMCID: PMC10875172 DOI: 10.2147/clep.s449183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 01/25/2024] [Indexed: 02/21/2024] Open
Abstract
Purpose The incidence of childhood-onset inflammatory bowel disease (IBD) is rising. We described variation in health services utilization and need for surgery among children with IBD between six and 60 months following IBD diagnosis across Canadian pediatric centers and evaluated the associations between care provided at diagnosis at each center and the variation in these outcomes. Patients and Methods Using population-based deterministically-linked health administrative data from four Canadian provinces (Alberta, Manitoba, Nova Scotia, Ontario) we identified children diagnosed with IBD <16 years of age using validated algorithms. Children were assigned to a pediatric center of care using a hierarchical approach based on where they received their initial care. Outcomes included IBD-related hospitalizations, emergency department (ED) visits, and IBD-related abdominal surgery occurring between 6 and sixty months after diagnosis. Mixed-effects meta-analysis was used to pool results and examine the association between center-level care provision and outcomes. Results We identified 3784 incident cases of pediatric IBD, of whom 2937 (77.6%) were treated at pediatric centers. Almost a third (31.4%) of children had ≥1 IBD-related hospitalization and there were 0.66 hospitalizations per person during follow-up. More than half (55.8%) of children had ≥1 ED visit and there were 1.64 ED visits per person. Between-center heterogeneity was high for both outcomes; centers where more children visited the ED at diagnosis had more IBD-related hospitalizations and more ED visits during follow-up. Between-center heterogeneity was high for intestinal resection in Crohn's disease but not colectomy in ulcerative colitis. Conclusion There is variation in health services utilization among children with IBD and risk of undergoing intestinal resection in those with Crohn's disease, but not colectomy among children with ulcerative colitis, across Canadian pediatric tertiary-care centers. Improvements in clinical care pathways are needed to ensure all children have equitable and timely access to high quality care.
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Affiliation(s)
- M Ellen Kuenzig
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children (Sickkids), Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Therese A Stukel
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Matthew W Carroll
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Gilaad G Kaplan
- Departments of Medicine & Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Anthony R Otley
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Harminder Singh
- Univeristy of Manitoba IBD Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Research Institute at CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Alain Bitton
- McGill University Health Centre, Division of Gastroenterology and Hepatology, Montreal, Québec, Canada
| | - Stephen G Fung
- CHEO Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, CHEO, Ottawa, Ontario, Canada
- CHEO Research Institute, Ottawa, Ontario, Canada
| | - Sarah Spruin
- ICES, Toronto, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Stephanie Coward
- Departments of Medicine & Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Yunsong Cui
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Zoann Nugent
- Univeristy of Manitoba IBD Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Anne M Griffiths
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children (Sickkids), Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - David R Mack
- CHEO Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, CHEO, Ottawa, Ontario, Canada
- CHEO Research Institute, Ottawa, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Kevan Jacobson
- Department of Pediatrics, BC Children’s Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Geoffrey C Nguyen
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Mount Sinai Hospital Centre for Inflammatory Bowel Disease, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Laura E Targownik
- Mount Sinai Hospital Centre for Inflammatory Bowel Disease, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Wael El-Matary
- Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Charles N Bernstein
- Univeristy of Manitoba IBD Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Trevor J B Dummer
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Jennifer L Jones
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Lisa M Lix
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sanjay K Murthy
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Division of Gastroenterology, The Ottawa Hospital IBD Centre, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Juan Nicolás Peña-Sánchez
- Department of Community Health & Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Soheila Nasiri
- CHEO Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, CHEO, Ottawa, Ontario, Canada
- CHEO Research Institute, Ottawa, Ontario, Canada
| | - Eric I Benchimol
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children (Sickkids), Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - On behalf of the Canadian Gastro-Intestinal Epidemiology Consortium
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children (Sickkids), Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
- Departments of Medicine & Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
- Univeristy of Manitoba IBD Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Research Institute at CancerCare Manitoba, Winnipeg, Manitoba, Canada
- McGill University Health Centre, Division of Gastroenterology and Hepatology, Montreal, Québec, Canada
- CHEO Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, CHEO, Ottawa, Ontario, Canada
- CHEO Research Institute, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
- Department of Pediatrics, BC Children’s Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
- Mount Sinai Hospital Centre for Inflammatory Bowel Disease, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Division of Gastroenterology, The Ottawa Hospital IBD Centre, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Department of Community Health & Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Procter TD, Ogasawara H, Spruin S, Wijayasri S, Abraham N, Blaser C, Hutchings K, Shaw A, Ogunnaike-Cooke S. Thrombosis with thrombocytopenia syndrome (TTS) following adenovirus vector COVID-19 vaccination in Canada. Vaccine 2023:S0264-410X(23)01159-3. [PMID: 37806804 DOI: 10.1016/j.vaccine.2023.09.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 09/01/2023] [Accepted: 09/29/2023] [Indexed: 10/10/2023]
Abstract
INTRODUCTION Identifying and monitoring adverse events following vaccination contributed to the safety and effectiveness of COVID-19 mass vaccination campaigns. In March 2021, international reports emerged of an adverse event following vaccination with adenovirus vector COVID-19 vaccines (ChAdOx1-S [recombinant] and Ad26.COV2.S) of thrombosis with low platelet counts, referred to as thrombosis with thrombocytopenia syndrome (TTS). We described TTS reports in Canada following adenovirus vector COVID-19 vaccines and investigated whether the observed number of events were higher than expected. METHODS Reports of TTS following receipt of ChAdOx1-S [recombinant] or Ad26.COV2.S meeting the Canadian case definition for TTS and diagnostic certainty levels 1-3 of the Brighton Collaboration case definition, submitted to the Canadian Adverse Events Following Immunization Surveillance System and Canada Vigilance Database between February 26, 2021 and October 31, 2022 were included. Demographics and characteristics of the TTS reports are described along with an analysis comparing the observed number of reports to the expected number. RESULTS As of October 31, 2022, 56 reports of TTS following administration of ChAdOx1-S [recombinant] and no reports following Ad26.COV2.S vaccines were reported in Canada, of which 37 had functionally positive anti-PF4 antibodies. The median age was 56 years; males accounted for 54 % of reports. Five deaths were reported. The observed number of reports exceeded the expected for all ages and sexes combined, as well as for males aged 30-49 and 60-69 years, and females aged 40-59 years. CONCLUSION Based on international surveillance data, Canada evaluated a statistical signal of TTS following adenovirus vector vaccines. The investigation of this signal demonstrated how post-market vaccine safety surveillance systems were successful in investigating rare adverse events during the rollout of COVID-19 vaccines in Canada. As adenovirus vector vaccines continue to be administered, characterization of the association between the vaccine and TTS informs immunization programs and policies.
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Affiliation(s)
- T D Procter
- Centre for Immunization Surveillance, Public Health Agency of Canada, Ottawa, ON, Canada.
| | - H Ogasawara
- Centre for Immunization Surveillance, Public Health Agency of Canada, Ottawa, ON, Canada
| | - S Spruin
- Centre for Immunization Surveillance, Public Health Agency of Canada, Ottawa, ON, Canada
| | - S Wijayasri
- Centre for Immunization Surveillance, Public Health Agency of Canada, Ottawa, ON, Canada
| | - N Abraham
- Centre for Immunization Surveillance, Public Health Agency of Canada, Ottawa, ON, Canada
| | - C Blaser
- Centre for Immunization Surveillance, Public Health Agency of Canada, Ottawa, ON, Canada
| | - K Hutchings
- Centre for Immunization Surveillance, Public Health Agency of Canada, Ottawa, ON, Canada
| | - A Shaw
- Centre for Immunization Surveillance, Public Health Agency of Canada, Ottawa, ON, Canada
| | - S Ogunnaike-Cooke
- Centre for Immunization Surveillance, Public Health Agency of Canada, Ottawa, ON, Canada
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Kuenzig E, Singh H, Bitton A, Kaplan GG, Carroll MW, Otley AR, Stukel TA, Spruin S, Griffiths AM, Mack DR, Jacobson K, Nguyen GC, Targownik LE, El-Matary W, Nasiri S, Benchimol EI. A183 VARIATION IN HEALTH SERVICES UTILIZATION AND RISK OF SURGERY ACROSS CHILDREN WITH INFLAMMATORY BOWEL DISEASE: A MULTIPROVINCE COHORT STUDY. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991127 DOI: 10.1093/jcag/gwac036.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background Marked variation in access to care and health services utilization is a marker of variation in quality of care. With the rising incidence of pediatric inflammatory bowel disease (IBD), we must understand variation in access to and outcomes of care to improve quality. Purpose Describe variation in care for pediatric IBD treated in 4 Canadian provinces. Method Incident cases of IBD diagnosed in children <16y were identified from health administrative data in Alberta (AB), Manitoba, Nova Scotia, and Ontario (ON) using validated algorithms. Children were assigned to one of 8 centres of care using a hierarchical assessment of health services use within 6 months of diagnosis. Children treated by adult gastroenterologists or community-based pediatric gastroenterologists were excluded due to small sample size. Outcomes included IBD-related hospitalizations, emergency department (ED) visits (AB/ON only), and IBD-related abdominal surgery. Hospitalizations and ED visits were counted cumulatively from 6-60 months after diagnosis. The risk of first surgery was defined during the same 6-60 month period. Mixed-effects meta-analysis was used to pool results across centres. Heterogeneity among centres was quantified using I2 (variation in pooled event rates between centres) and τ (standard deviation of the true event rates). R2 quantified the residual heterogeneity in outcomes not attributable to among-province variation. Result(s) We identified 3777 incident cases of pediatric IBD, 2936 (78%) of which were treated at 8 pediatric centres. The number of hospitalizations was 0.67 (95% CI 0.56-0.79) per person with high between-centre heterogeneity (I2 84%, τ 0.1556). Provincial differences accounted for 93% of heterogeneity across centres (residual heterogeneity: I2 29%, τ 0.0412). Hospitalizations were less frequent in AB than other provinces (0.43 vs. 0.72-0.78). Children averaged 1.94 IBD-related ED visits, with significant heterogeneity (I2 99%, τ 1.33) with 99.7% of heterogeneity attributable to among-province differences (residual heterogeneity: I2 32%; τ 0.074). Mean ED visits were 1.1 visits in ON (I2 39%) and 3.7 in AB (I2 0%). Intestinal resection was required by 12% (95% CI 0.08-0.15) of Crohn’s patients with high among-centre heterogeneity (I2 81%, τ 0.042), and low (19%) heterogeneity due to provincial differences (residual heterogeneity: I2 76%; τ 0.039). Colectomy was required by 12% (95% CI 10-14) of children with ulcerative colitis (UC) with no between-centre heterogeneity (I2 0%, τ 0). Conclusion(s) There is a high degree of between-province (but not between-centre, within province) variability in health services utilization among children with IBD. There was significant between-centre variability in surgery rates for Crohn’s, but not colectomy for UC. Differences in patient characteristics or provincial health systems may be more important predictors of variation in care. Surgery for Crohn’s disease may be a target for inter-centre quality improvement efforts. Please acknowledge all funding agencies by checking the applicable boxes below CCC Disclosure of Interest None Declared
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Affiliation(s)
- E Kuenzig
- Child Health Evaluative Sciences, SickKids Research Institute,SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto
| | - H Singh
- University of Manitoba IBD Clinical and Research Centre,Department of Internal Medicine, Max Rady College of Medicine, , University of Manitoba,Research Institute at CancerCare Manitoba, Winnipeg
| | - A Bitton
- Gastroenterology and Hepatology, McGill University Health Centre, Montreal
| | - G G Kaplan
- Medicine & Community Health Sciences, University of Calgary, Calgary
| | | | - A R Otley
- Pediatrics, Dalhousie University, Halifax
| | - T A Stukel
- ICES,Institute of Health Policy, Management and Evaluation
| | | | - A M Griffiths
- Child Health Evaluative Sciences, SickKids Research Institute,SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto,Paediatrics, University of Toronto, Toronto
| | - D R Mack
- Pediatrics, University of Ottawa,CHEO Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, CHEO,CHEO Research Institute, Ottawa
| | - K Jacobson
- Department of Pediatrics, BC Children's Hospital Research Institute, University of British Columbia, Vancouver
| | - G C Nguyen
- ICES,Institute of Health Policy, Management and Evaluation,Mount Sinai Hospital Centre for Inflammatory Bowel Disease, Department of Medicine, University of Toronto, Toronto
| | - L E Targownik
- Mount Sinai Hospital Centre for Inflammatory Bowel Disease, Department of Medicine, University of Toronto, Toronto
| | - W El-Matary
- Pediatrics, University of Manitoba, Winnipeg, Canada
| | | | - E I Benchimol
- Child Health Evaluative Sciences, SickKids Research Institute,SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto,ICES,Institute of Health Policy, Management and Evaluation,Paediatrics, University of Toronto, Toronto
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Kuenzig E, Singh H, Bitton A, Kaplan GG, Carroll MW, Otley AR, Stukel TA, Spruin S, Griffiths AM, Mack DR, Jacobson K, Nguyen GC, Targownik LE, El-Matary W, Benchimol EI. A189 EMERGENCY DEPARTMENT UTILIZATION AND RISK OF INTESTINAL RESECTION IS LOWER AMONG CHILDREN DIAGNOSED WITH INFLAMMATORY BOWEL DISEASE BEFORE 10 YEARS OF AGE: A MULTIPROVINCE POPULATION-BASED COHORT STUDY. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991184 DOI: 10.1093/jcag/gwac036.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background In Canada, the incidence of inflammatory bowel disease (IBD) is increasing faster among those <10 years (y) of age than in any other age group. Understanding the health services burden of IBD in this population is important for health system planning. Purpose To compare healthcare utilization and risk of surgery among children diagnosed with IBD across age groups defined by the Paris Classification (A1a: <10y; A1b: 10 to <16y) across 5 Canadian provinces. Method Children diagnosed with IBD <16 years of age were identified from health administrative data using validated algorithms in Alberta, Manitoba, Nova Scotia, Ontario, and Québec. Negative binomial regression models were used to compare (1) the pre-diagnosis frequency of health services utilization (outpatient, emergency department (ED), and hospitalization) using diagnostic codes suggestive of future IBD and (2) the annual post-diagnosis frequency of IBD-specific and IBD-related (signs, symptoms, and extra-intestinal manifestations of IBD) visits among children diagnosed <10y (A1a) and 10 to <16y (A1b). Cox proportional hazard models compared the risk of surgery (identified with validated procedure codes) across age groups. All regression models were adjusted for sex, rural/urban residence, and mean neighbourhood income quintile. Province-specific event counts (all ages combined) and models (comparing age groups; reference: A1b [10 to <16y]) were pooled using random-effects meta-analysis. Result(s) Among 5124 children with IBD (1165 [23%] were <10y at diagnosis), the mean number of pre-diagnosis healthcare encounters was 1.0 (95% CI 0.38 to 1.68, I2=99.6%). The mean annual post-diagnosis number of IBD-specific outpatient visits was 3.2 (95% CI 1.9-4.4, I2=99.6%); hospitalizations, 0.19 (95% CI 0.17-0.21, I2=74%); ED visits, 0.17 (95% CI 0.19-0.39, I2=99%). The mean annual post-diagnosis number of IBD-related outpatient visits was 3.9 (95% CI 2.3-5.5, I2=99.7%); hospitalizations, 0.21 (95% CI 0.19-0.23, I2=79%); ED visits, 0.29 (95% CI 0.19-0.39, I2=97%). Intestinal resection or colectomy within 5y of diagnosis occurred in 13% (95%CI 8-22, I2=93%) with Crohn’s disease (CD) and 16% (95% CI 14-18, I2=40%) with ulcerative colitis. IBD-specific ED visits (RR 0.70, 95% CI 0.50-0.97, I2=80) and the risk of intestinal resection in CD (HR 0.49, 95% CI 0.26-0.92, I2=40%) were significantly lower among children diagnosed <10y. There were no age-related differences in pre-diagnosis health services utilization or other post-diagnosis outcomes, including frequency of outpatient visits to a gastroenterologist. Conclusion(s) Health services utilization was generally similar for children diagnosed with IBD at <10y and between 10 and <16y, except for lower rates of IBD-specific ED visits and intestinal resection in children with CD. Further exploration of between-province differences, represented by the high statistical heterogeneity (I2) in the meta-analyses, is needed to understand sources of variation in care. Please acknowledge all funding agencies by checking the applicable boxes below CCC Disclosure of Interest E. Kuenzig: None Declared, H. Singh Consultant of: Amgen Canada, Bristol-Myers Squibb Canada, Sandoz Canada, Roche Canada, Takeda Canada and Guardant Health, A. Bitton: None Declared, G. Kaplan Grant / Research support from: Ferring, Consultant of: AbbVie, Janssen, Pfizer, Amgen, Sandoz, Pendophram, and Takeda, Speakers bureau of: AbbVie, Janssen, Pfizer, Amgen, Sandoz, Pendophram, and Takeda, M. Carroll: None Declared, A. Otley Grant / Research support from: Research support: AbbVie Global. Research site: AbbVie, Pfizer, Eli-Lily, Janssen, Consultant of: AbbVie Canada, T. Stukel: None Declared, S. Spruin: None Declared, A. Griffiths Grant / Research support from: Abbvie, Consultant of: Abbvie, Amgen, BristolMyersSquibb, Janssen, Lilly, Takeda, Speakers bureau of: Abbvie, Janssen, Takeda, D. Mack: None Declared, K. Jacobson Grant / Research support from: Abbvie Canada and Janssen Canada, Consultant of: Abbvie Canada, Janssen Canada, Merck Canada and Mylan Pharmaceuticals, Speakers bureau of: Abbvie Canada and Janssen Canada, G. Nguyen: None Declared, L. Targownik Grant / Research support from: Janssen Canada, Consultant of: AbbVie Canada, Sandoz Canada, Takeda Canada, Merck Canada, Pfizer Canada, Janssen Canada, and Roche Canada, W. El-Matary Consultant of: Abbvie and MERCK, Speakers bureau of: Abbvie and MERCK, E. Benchimol Consultant of: McKesson Canada, Dairy Farmers of Ontario (unrelated to medications used to treat inflammatory bowel disease)
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Affiliation(s)
- E Kuenzig
- Child Health Evaluative Sciences, SickKids Research Institute,SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto
| | - H Singh
- University of Manitoba IBD Clinical and Research Centre,Department of Internal Medicine, Max Rady College of Medicine, , University of Manitoba,Research Institute at CancerCare Manitoba, Winnipeg
| | - A Bitton
- Gastroenterology and Hepatology, McGill University Health Centre, Montreal
| | - G G Kaplan
- Medicine & Community Health Sciences, University of Calgary, Calgary
| | | | - A R Otley
- Pediatrics, Dalhousie University, Halifax
| | - T A Stukel
- ICES,Institute of Health Policy, Management and Evaluation
| | | | - A M Griffiths
- Child Health Evaluative Sciences, SickKids Research Institute,SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto,Paediatrics, University of Toronto, Toronto
| | - D R Mack
- Pediatrics, University of Ottawa,CHEO Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, CHEO,CHEO Research Institute, Ottawa
| | - K Jacobson
- Department of Pediatrics, BC Children's Hospital Research Institute, University of British Columbia, Vancouver
| | - G C Nguyen
- ICES,Institute of Health Policy, Management and Evaluation,Mount Sinai Hospital Centre for Inflammatory Bowel Disease, Department of Medicine, University of Toronto, Toronto
| | - L E Targownik
- Mount Sinai Hospital Centre for Inflammatory Bowel Disease, Department of Medicine, University of Toronto, Toronto
| | - W El-Matary
- Pediatrics, University of Manitoba, Winnipeg, Canada
| | - E I Benchimol
- Child Health Evaluative Sciences, SickKids Research Institute,SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto,ICES,Institute of Health Policy, Management and Evaluation,Paediatrics, University of Toronto, Toronto
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6
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Kuenzig ME, Benchimol EI, Bernstein CN, Bitton A, Carroll MW, Griffiths AM, Kaplan GG, Nguyen GC, Otley AR, Stukel TA, Dummer TJ, El-Matary W, Jacobson K, Jones JL, Lix LM, Mack DR, Murthy SK, Peña-Sánchez JN, Targownik LE, Fung SG, Spruin S, Coward S, Cui Y, Filliter C, Nugent Z, Siddiq S, Singh H. Hospitalization With Clostridioides difficile in Pediatric Inflammatory Bowel Disease: a Population-Based Study. J Pediatr Gastroenterol Nutr 2022; 75:173-180. [PMID: 35675701 PMCID: PMC9278713 DOI: 10.1097/mpg.0000000000003489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 02/25/2022] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Several studies have demonstrated higher rates of Clostridioides difficile infection (CDI) in adults with inflammatory bowel disease (IBD). We conducted a population-based study comparing the risk of hospitalization with CDI in children with and without IBD. METHODS Using health administrative data and validated algorithms, we identified all children (<16 years) diagnosed with IBD in 5 Canadian provinces, then age and sex matched to 5 children without IBD. Province-specific 5-year incidence rates of hospitalization with CDI were pooled and generalized linear mixed-effects models were used to estimate the crude incidence rate ratio (IRR) comparing (1) children with and without IBD and (2) children with Crohn disease and ulcerative colitis. Hazard ratios (HR) from Cox proportional hazards models adjusting for age, sex, rural/urban household, and income were pooled using fixed-effects models. RESULTS The incidence rate of CDI identified during hospitalization was 49.06 [95% confidence interval (CI), 39.40-61.08] per 10,000 person-years (PY) in 3593 children with IBD compared to 0.39 (95% CI, 0.13-1.21) per 10,000 PY in 16,284 children without IBD (crude IRR, 133.4, 95% CI, 42.1-422.7; adjusted HR, 68.2, 95% CI, 24.4-190.4). CDI was identified less often in children with Crohn disease than ulcerative colitis (crude IRR, 0.51, 95% CI, 0.32-0.82; adjusted HR, 0.69, 95% CI, 0.46-1.05). CONCLUSIONS Children with IBD have a markedly higher incidence of CDI identified during a hospitalization relative to children without IBD. Consequently, symptomatic children with IBD who are hospitalized should be screened for CDI.
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Affiliation(s)
- M. Ellen Kuenzig
- From the SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- the Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | - Eric I. Benchimol
- From the SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- the Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- the ICES, Toronto, Ontario, Canada
- the Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- the Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
- the CHEO Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, CHEO, Ottawa, Ontario, Canada
- the CHEO Research Institute, Ottawa, Ontario, Canada
| | - Charles N. Bernstein
- the Univeristy of Manitoba IBD Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada
- the Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Alain Bitton
- the McGill University Health Centre, Division of Gastroenterology and Hepatology, Montreal, Québec, Canada
| | - Matthew W. Carroll
- the Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Anne M. Griffiths
- From the SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- the Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- the Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Gilaad G. Kaplan
- the Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Geoffrey C. Nguyen
- the ICES, Toronto, Ontario, Canada
- the Mount Sinai Hospital Centre for Inflammatory Bowel Disease, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- the Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Anthony R. Otley
- the Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Therese A. Stukel
- the ICES, Toronto, Ontario, Canada
- the Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Trevor J.B. Dummer
- the School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Wael El-Matary
- the Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kevan Jacobson
- the Department of Pediatrics, BC Children’s Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jennifer L. Jones
- the Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Lisa M. Lix
- the Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- the George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, Manitoba, Winnipeg, Manitoba, Canada
| | - David R. Mack
- the Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
- the CHEO Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, CHEO, Ottawa, Ontario, Canada
- the CHEO Research Institute, Ottawa, Ontario, Canada
| | - Sanjay K. Murthy
- the Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- the Division of Gastroenterology, The Ottawa Hospital IBD Centre, Ottawa, Ontario, Canada
- the School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Laura E. Targownik
- the Mount Sinai Hospital Centre for Inflammatory Bowel Disease, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Stephen G. Fung
- the ICES, Toronto, Ontario, Canada
- the CHEO Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, CHEO, Ottawa, Ontario, Canada
- the CHEO Research Institute, Ottawa, Ontario, Canada
| | - Sarah Spruin
- the ICES, Toronto, Ontario, Canada
- the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Stephanie Coward
- the Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Yunsong Cui
- the Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Christopher Filliter
- the Lady Davis Institute of Medical Research, Jewish General Hospital, Montreal, Québec, Canada
| | - Zoann Nugent
- the Univeristy of Manitoba IBD Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Shabnaz Siddiq
- the ICES, Toronto, Ontario, Canada
- the CHEO Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, CHEO, Ottawa, Ontario, Canada
- the CHEO Research Institute, Ottawa, Ontario, Canada
| | - Harminder Singh
- the Univeristy of Manitoba IBD Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada
- the Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- the Research Institute at CancerCare Manitoba, Winnipeg, Manitoba, Canada
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McCurdy JD, Ellen Kuenzig M, Spruin S, Fung OW, Mallik R, Williams L, Murthy SK, Carrier M, Nguyen G, Benchimol EI. Surgery and the Subtype of Inflammatory Bowel Disease Impact the Risk of Venous Thromboembolism After Hospital Discharge. Dig Dis Sci 2022; 67:2471-2479. [PMID: 34114153 DOI: 10.1007/s10620-021-07064-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/15/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Surgery for inflammatory bowel disease (IBD) is associated with an increased risk of venous thromboembolism (VTE) during hospitalization. It is unclear whether this association persists after hospital discharge. AIMS We assessed the association between surgery and VTE following hospital discharge in IBD. METHODS We conducted a population-based cohort study between 2002 and 2016 in Ontario, Canada. Adults with IBD hospitalized for ≥ 72 h who underwent an intra-abdominal surgery were compared to hospitalized, nonsurgical IBD patients. Multivariable Cox proportional hazard models were used to compare VTE risk within 12 months of discharge. RESULTS A total of 80,445 hospital discharges were analyzed: 60% Crohn's disease (CD) and 40% ulcerative colitis (UC). The median time to VTE was three times longer for nonsurgical patients with CD and 1.6 times longer for nonsurgical patients with UC. Compared with nonsurgical patients, surgery for CD was associated with a lower cumulative risk of VTE in the 2 weeks after discharge and persisted through to 12 months after discharge (adjusted HR 0.24; 95% CI 0.15-0.40). In contrast, urgent surgery for UC was associated with an increased risk of VTE. The increased risk was greatest at 2 weeks after discharge (aHR, 1.80; 95% CI 1.26-2.57) and declined progressively over the course of 12 months. CONCLUSIONS Surgery was associated with a greater risk of VTE after hospital discharge in UC but not CD. In patients with UC who have undergone urgent surgery, healthcare providers should consider an extended period of prophylaxis after hospital discharge.
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Affiliation(s)
- Jeffrey D McCurdy
- Department of Medicine, University of Ottawa, Ottawa, Canada.
- The Ottawa Hospital Research Institute, Ottawa, Canada.
| | - M Ellen Kuenzig
- CHEO Inflammatory Bowel Disease Centre, Division of Gastroenterology Hepatology and Nutrition, Children's Hospital of Eastern Ontario, Ottawa, Canada
- ICES uOttawa, Ottawa, Canada
| | | | - Oliver W Fung
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | | | - Lara Williams
- The Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Surgery, University of Ottawa, Ottawa, Canada
| | - Sanjay K Murthy
- Department of Medicine, University of Ottawa, Ottawa, Canada
- The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Marc Carrier
- Department of Medicine, University of Ottawa, Ottawa, Canada
- The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Geoff Nguyen
- Department of Medicine, University of Toronto, Toronto, Canada
- Division of Gastroenterology, Mount Sinai Hospital Centre for Inflammatory Bowel Disease, Toronto, Canada
| | - Eric I Benchimol
- CHEO Inflammatory Bowel Disease Centre, Division of Gastroenterology Hepatology and Nutrition, Children's Hospital of Eastern Ontario, Ottawa, Canada
- ICES uOttawa, Ottawa, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
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Abraham N, Spruin S, Rossi T, Fireman B, Zafack J, Blaser C, Shaw A, Hutchings K, Ogunnaike-Cooke S. Myocarditis and/or pericarditis risk after mRNA COVID-19 vaccination: A Canadian head to head comparison of BNT162b2 and mRNA-1273 vaccines. Vaccine 2022; 40:4663-4671. [PMID: 35750537 PMCID: PMC9130641 DOI: 10.1016/j.vaccine.2022.05.048] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 04/17/2022] [Accepted: 05/19/2022] [Indexed: 12/15/2022]
Abstract
Background Canadian and international data suggest the risk of myocarditis and/or pericarditis is elevated during the week after mRNA COVID-19 vaccination, particularly in younger age groups, in males, and after second doses. Objectives This article examines whether there is a product-specific difference in the risk for myocarditis and/or pericarditis between the two mRNA vaccines administered in Canada: BNT162b2 (Pfizer-BioNTech Comirnaty) and mRNA-1273 (Moderna Spikevax). Materials and methods Reporting rates of myocarditis and/or pericarditis were calculated from reports received by the Canadian Adverse Events Following Immunization Surveillance System from December 2020-March 2022. Excess cases and attributable incidence among individuals aged 18–39 were estimated for each vaccine in comparison with background rates from 2015 to 2019. Head-to-head comparisons used Poisson regression, conditioned on week of vaccine administration, to estimate rate ratios for the week after mRNA-1273 vaccination versus the week after BNT162b2, by age and sex as well as overall. Analyses were restricted to May 30–March 13, 2021, when heightened media awareness was unlikely to have affected reporting rates for the two products differentially. Results In 18–29 year-old males who received a second dose of mRNA COVID-19 vaccine, attributable risk of myocarditis and/or pericarditis was found to be 5.69 (95% CI: 4.07 – 7.95; p < 0.001) times higher among mRNA-1273 recipients (n = 106) as compared to BNT162b2 recipients (n = 33). In the same group, Poisson regression modelling estimated that the risk of myocarditis and/or pericarditis was 4.72 (p-value = <0.001) times higher after mRNA-1723 compared to BNT162b2 vaccination. Conclusions The risk of myocarditis and/or pericarditis is higher after mRNA-1723 vaccination than BNT162b2 vaccination in those aged 18–39 years, especially in males aged 18–29 years, where the risk is several times higher.
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Affiliation(s)
| | - Sarah Spruin
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Tanya Rossi
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Bruce Fireman
- Kaiser Permanente Northern California, Oakland, CA, USA
| | | | | | - Amanda Shaw
- Public Health Agency of Canada, Ottawa, Ontario, Canada
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Oakley LL, Regan AK, Fell DB, Spruin S, Bakken IJ, Kwong JC, Pereira G, Nassar N, Aaberg KM, Wilcox AJ, Håberg SE. Childhood seizures after prenatal exposure to maternal influenza infection: a population-based cohort study from Norway, Australia and Canada. Arch Dis Child 2022; 107:153-159. [PMID: 34187781 PMCID: PMC8908878 DOI: 10.1136/archdischild-2021-322210] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/10/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess whether clinical and/or laboratory-confirmed diagnosis of maternal influenza during pregnancy increases the risk of seizures in early childhood. DESIGN Analysis of prospectively collected registry data for children born between 2009 and 2013 in three high-income countries. We used Cox regression to estimate country-level adjusted HRs (aHRs); fixed-effects meta-analyses were used to pool adjusted estimates. SETTING Population-based. PARTICIPANTS 1 360 629 children born between 1 January 2009 and 31 December 2013 in Norway, Australia (New South Wales) and Canada (Ontario). EXPOSURE Clinical and/or laboratory-confirmed diagnosis of maternal influenza infection during pregnancy. MAIN OUTCOME MEASURES We extracted data on recorded seizure diagnosis in secondary/specialist healthcare between birth and up to 7 years of age; additional analyses were performed for the specific seizure outcomes 'epilepsy' and 'febrile seizures'. RESULTS Among 1 360 629 children in the study population, 14 280 (1.0%) were exposed to maternal influenza in utero. Exposed children were at increased risk of seizures (aHR 1.17, 95% CI 1.07 to 1.28), and also febrile seizures (aHR 1.20, 95% CI 1.07 to 1.34). There was no strong evidence of an increased risk of epilepsy (aHR 1.07, 95% CI 0.81 to 1.41). Risk estimates for seizures were higher after influenza infection during the second and third trimester than for first trimester. CONCLUSIONS In this large international study, prenatal exposure to influenza infection was associated with increased risk of childhood seizures.
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Affiliation(s)
- Laura L. Oakley
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK,Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Annette K. Regan
- School of Nursing and Health Professions, University of San Francisco, San Francisco CA, US,School of Public Health, Curtin University, Perth, Australia,Fielding School of Public Health, University of California Los Angeles, Los Angeles CA, US
| | - Deshayne B. Fell
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada,ICES, Toronto, Ontario, Canada,Children’s Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, Canada
| | - Sarah Spruin
- ICES, Toronto, Ontario, Canada,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Inger Johanne Bakken
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Jeffrey C. Kwong
- ICES, Toronto, Ontario, Canada,Public Health Ontario, Toronto, Canada,Department of Family and Community Medicine, University of Toronto, Toronto, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada,University Health Network, Toronto, Canada
| | - Gavin Pereira
- School of Public Health, Curtin University, Perth, Australia
| | - Natasha Nassar
- Children’s Hospital at Westmead Clinical School, University of Sydney, NSW, Australia
| | - Kari M. Aaberg
- The National Center for Epilepsy, Oslo University Hospital, Oslo, Norway
| | - Allen J. Wilcox
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway,The National Institute of Environmental Health Sciences, Durham NC, US
| | - Siri E. Håberg
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
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Lysecki DL, Gupta S, Rapoport A, Rhodes E, Spruin S, Vadeboncoeur C, Widger K, Tanuseputro P. Children's Health Care Utilization and Cost in the Last Year of Life: A Cohort Comparison with and without Regional Specialist Pediatric Palliative Care. J Palliat Med 2022; 25:1031-1040. [PMID: 34981956 DOI: 10.1089/jpm.2021.0175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Research remains inconclusive regarding the impact of specialist pediatric palliative care (SPPC) on health care utilization and cost. Objective: To better understand and quantify the impact of regional SPPC services on children's health care utilization and cost near end of life. Design: A retrospective cohort study used administrative databases to compare outcomes for child decedents (age 31 days to 19 years) from two similar regions in Ontario, Canada between 2010 and 2014, wherein one region had SPPC services (SPPC+) and the other did not (SPPC-). Measurements: Administrative databases provided demographics, health care utilization (days), and costs Canadian dollars) across settings in the last year of life, and location of death. Multivariable analyses produced relative rates (RRs) of health care days (acute and home care), intensive care unit (ICU) days, and health care costs (inpatient, outpatient, home, and physician) as well as the odds ratio (OR) of in-hospital death. Counterfactual analysis quantified the differences in utilization and costs. Results: A total of 807 children were included. On multivariable analysis, residence in the SPPC+ region (n = 363) was associated with fewer mean health care days (RR = 0.73; 95% confidence interval [CI]: 0.59-0.90); fewer mean ICU days (RR = 0.64; 95% CI: 0.44-0.94); lower mean health care costs (RR = 0.71; 95% CI: 0.56-0.91); and lower likelihood of in-hospital death (OR = 0.67; 95% CI: 0.49-0.92). The counterfactual analysis estimated mean reductions of 16.2 days (95% CI: 14.4-18.0) and $24,940 (95% CI: $21,703-$28,177) per child in the SPPC+ region. Conclusions: Although not a causal study, these results support an association between regional SPPC services and decreased health care utilization, intensity, and cost for children near end of life.
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Affiliation(s)
- David L Lysecki
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,Quality of Life and Advanced Care, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Sumit Gupta
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada.,Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada
| | - Adam Rapoport
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.,Paediatric Advanced Care Team, Hospital for Sick Children, Toronto, Ontario, Canada.,Emily's House, Toronto, Ontario, Canada
| | - Emily Rhodes
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Sarah Spruin
- Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Christina Vadeboncoeur
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada.,Department of Pediatrics, CHEO, Ottawa, Ontario, Canada.,Roger Neilson House, Ottawa, Ontario, Canada
| | - Kimberley Widger
- Paediatric Advanced Care Team, Hospital for Sick Children, Toronto, Ontario, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontatio, Canada
| | - Peter Tanuseputro
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Bruyère Research Institute, University of Ottawa, Ottawa, Ontario, Canada
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Gardiner H, Robitaille C, Spruin S. Validation of Short-Term Projection of Diabetes Prevalence Using the Canadian Chronic Disease Surveillance System. Can J Diabetes 2021. [DOI: 10.1016/j.jcjd.2021.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Hsu AT, Manuel DG, Spruin S, Bennett C, Taljaard M, Beach S, Sequeira Y, Talarico R, Chalifoux M, Kobewka D, Costa AP, Bronskill SE, Tanuseputro P. Predicting death in home care users: derivation and validation of the Risk Evaluation for Support: Predictions for Elder-Life in the Community Tool (RESPECT). CMAJ 2021; 193:E997-E1005. [PMID: 34226263 PMCID: PMC8248571 DOI: 10.1503/cmaj.200022] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND: Prognostication tools that report personalized mortality risk and survival could improve discussions about end-of-life and advance care planning. We sought to develop and validate a mortality risk model for older adults with diverse care needs in home care using self-reportable information — the Risk Evaluation for Support: Predictions for Elder-Life in the Community Tool (RESPECT). METHODS: Using a derivation cohort that comprised adults living in Ontario, Canada, aged 50 years and older with at least 1 Resident Assessment Instrument for Home Care (RAI-HC) record between Jan. 1, 2007, and Dec. 31, 2012, we developed a mortality risk model. The primary outcome was mortality 6 months after a RAI-HC assessment. We used proportional hazards regression with robust standard errors to account for clustering by the individual. We validated this algorithm for a second cohort of users of home care who were assessed between Jan. 1 and Dec. 31, 2013. We used Kaplan–Meier survival curves to estimate the observed risk of death at 6 months for assessment of calibration and median survival. We constructed 61 risk groups based on incremental increases in the estimated median survival of about 3 weeks among adults at high risk and 3 months among adults at lower risk. RESULTS: The derivation and validation cohorts included 435 009 and 139 388 adults, respectively. We identified a total of 122 823 deaths within 6 months of a RAI-HC assessment in the derivation cohort. The mean predicted 6-month mortality risk was 10.8% (95% confidence interval [CI] 10.7%–10.8%) and ranged from 1.54% (95% CI 1.53%–1.54%) in the lowest to 98.1% (95% CI 98.1%–98.2%) in the highest risk group. Estimated median survival spanned from 28 days (11 to 84 d at the 25th and 75th percentiles) in the highest risk group to over 8 years (1925 to 3420 d) in the lowest risk group. The algorithm had a c-statistic of 0.753 (95% CI 0.750–0.756) in our validation cohort. INTERPRETATION: The RESPECT mortality risk prediction tool that makes use of readily available information can improve the identification of palliative and end-of-life care needs in a diverse older adult population receiving home care.
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Affiliation(s)
- Amy T Hsu
- Bruyère Research Institute (Hsu, Manuel, Tanuseputro); Clinical Epidemiology Program (Hsu, Manuel, Bennett, Taljaard, Beach, Sequeira, Kobewka, Tanuseputro), Ottawa Hospital Research Institute; ICES uOttawa (Chalifoux, Manuel, Spruin, Talarico, Tanuseputro); School of Epidemiology and Public Health (Taljaard, Manuel), Division of Palliative Care (Tanuseputro) and Department of Medicine (Kobewka), University of Ottawa, Ottawa, Ont.; Department of Clinical Epidemiology and Biostatistics (Costa), McMaster University, Hamilton, Ont.; ICES Central (Bronskill); Women's College Research Institute (Bronskill), Women's College Hospital, Toronto, Ont.
| | - Douglas G Manuel
- Bruyère Research Institute (Hsu, Manuel, Tanuseputro); Clinical Epidemiology Program (Hsu, Manuel, Bennett, Taljaard, Beach, Sequeira, Kobewka, Tanuseputro), Ottawa Hospital Research Institute; ICES uOttawa (Chalifoux, Manuel, Spruin, Talarico, Tanuseputro); School of Epidemiology and Public Health (Taljaard, Manuel), Division of Palliative Care (Tanuseputro) and Department of Medicine (Kobewka), University of Ottawa, Ottawa, Ont.; Department of Clinical Epidemiology and Biostatistics (Costa), McMaster University, Hamilton, Ont.; ICES Central (Bronskill); Women's College Research Institute (Bronskill), Women's College Hospital, Toronto, Ont
| | - Sarah Spruin
- Bruyère Research Institute (Hsu, Manuel, Tanuseputro); Clinical Epidemiology Program (Hsu, Manuel, Bennett, Taljaard, Beach, Sequeira, Kobewka, Tanuseputro), Ottawa Hospital Research Institute; ICES uOttawa (Chalifoux, Manuel, Spruin, Talarico, Tanuseputro); School of Epidemiology and Public Health (Taljaard, Manuel), Division of Palliative Care (Tanuseputro) and Department of Medicine (Kobewka), University of Ottawa, Ottawa, Ont.; Department of Clinical Epidemiology and Biostatistics (Costa), McMaster University, Hamilton, Ont.; ICES Central (Bronskill); Women's College Research Institute (Bronskill), Women's College Hospital, Toronto, Ont
| | - Carol Bennett
- Bruyère Research Institute (Hsu, Manuel, Tanuseputro); Clinical Epidemiology Program (Hsu, Manuel, Bennett, Taljaard, Beach, Sequeira, Kobewka, Tanuseputro), Ottawa Hospital Research Institute; ICES uOttawa (Chalifoux, Manuel, Spruin, Talarico, Tanuseputro); School of Epidemiology and Public Health (Taljaard, Manuel), Division of Palliative Care (Tanuseputro) and Department of Medicine (Kobewka), University of Ottawa, Ottawa, Ont.; Department of Clinical Epidemiology and Biostatistics (Costa), McMaster University, Hamilton, Ont.; ICES Central (Bronskill); Women's College Research Institute (Bronskill), Women's College Hospital, Toronto, Ont
| | - Monica Taljaard
- Bruyère Research Institute (Hsu, Manuel, Tanuseputro); Clinical Epidemiology Program (Hsu, Manuel, Bennett, Taljaard, Beach, Sequeira, Kobewka, Tanuseputro), Ottawa Hospital Research Institute; ICES uOttawa (Chalifoux, Manuel, Spruin, Talarico, Tanuseputro); School of Epidemiology and Public Health (Taljaard, Manuel), Division of Palliative Care (Tanuseputro) and Department of Medicine (Kobewka), University of Ottawa, Ottawa, Ont.; Department of Clinical Epidemiology and Biostatistics (Costa), McMaster University, Hamilton, Ont.; ICES Central (Bronskill); Women's College Research Institute (Bronskill), Women's College Hospital, Toronto, Ont
| | - Sarah Beach
- Bruyère Research Institute (Hsu, Manuel, Tanuseputro); Clinical Epidemiology Program (Hsu, Manuel, Bennett, Taljaard, Beach, Sequeira, Kobewka, Tanuseputro), Ottawa Hospital Research Institute; ICES uOttawa (Chalifoux, Manuel, Spruin, Talarico, Tanuseputro); School of Epidemiology and Public Health (Taljaard, Manuel), Division of Palliative Care (Tanuseputro) and Department of Medicine (Kobewka), University of Ottawa, Ottawa, Ont.; Department of Clinical Epidemiology and Biostatistics (Costa), McMaster University, Hamilton, Ont.; ICES Central (Bronskill); Women's College Research Institute (Bronskill), Women's College Hospital, Toronto, Ont
| | - Yulric Sequeira
- Bruyère Research Institute (Hsu, Manuel, Tanuseputro); Clinical Epidemiology Program (Hsu, Manuel, Bennett, Taljaard, Beach, Sequeira, Kobewka, Tanuseputro), Ottawa Hospital Research Institute; ICES uOttawa (Chalifoux, Manuel, Spruin, Talarico, Tanuseputro); School of Epidemiology and Public Health (Taljaard, Manuel), Division of Palliative Care (Tanuseputro) and Department of Medicine (Kobewka), University of Ottawa, Ottawa, Ont.; Department of Clinical Epidemiology and Biostatistics (Costa), McMaster University, Hamilton, Ont.; ICES Central (Bronskill); Women's College Research Institute (Bronskill), Women's College Hospital, Toronto, Ont
| | - Robert Talarico
- Bruyère Research Institute (Hsu, Manuel, Tanuseputro); Clinical Epidemiology Program (Hsu, Manuel, Bennett, Taljaard, Beach, Sequeira, Kobewka, Tanuseputro), Ottawa Hospital Research Institute; ICES uOttawa (Chalifoux, Manuel, Spruin, Talarico, Tanuseputro); School of Epidemiology and Public Health (Taljaard, Manuel), Division of Palliative Care (Tanuseputro) and Department of Medicine (Kobewka), University of Ottawa, Ottawa, Ont.; Department of Clinical Epidemiology and Biostatistics (Costa), McMaster University, Hamilton, Ont.; ICES Central (Bronskill); Women's College Research Institute (Bronskill), Women's College Hospital, Toronto, Ont
| | - Mathieu Chalifoux
- Bruyère Research Institute (Hsu, Manuel, Tanuseputro); Clinical Epidemiology Program (Hsu, Manuel, Bennett, Taljaard, Beach, Sequeira, Kobewka, Tanuseputro), Ottawa Hospital Research Institute; ICES uOttawa (Chalifoux, Manuel, Spruin, Talarico, Tanuseputro); School of Epidemiology and Public Health (Taljaard, Manuel), Division of Palliative Care (Tanuseputro) and Department of Medicine (Kobewka), University of Ottawa, Ottawa, Ont.; Department of Clinical Epidemiology and Biostatistics (Costa), McMaster University, Hamilton, Ont.; ICES Central (Bronskill); Women's College Research Institute (Bronskill), Women's College Hospital, Toronto, Ont
| | - Daniel Kobewka
- Bruyère Research Institute (Hsu, Manuel, Tanuseputro); Clinical Epidemiology Program (Hsu, Manuel, Bennett, Taljaard, Beach, Sequeira, Kobewka, Tanuseputro), Ottawa Hospital Research Institute; ICES uOttawa (Chalifoux, Manuel, Spruin, Talarico, Tanuseputro); School of Epidemiology and Public Health (Taljaard, Manuel), Division of Palliative Care (Tanuseputro) and Department of Medicine (Kobewka), University of Ottawa, Ottawa, Ont.; Department of Clinical Epidemiology and Biostatistics (Costa), McMaster University, Hamilton, Ont.; ICES Central (Bronskill); Women's College Research Institute (Bronskill), Women's College Hospital, Toronto, Ont
| | - Andrew P Costa
- Bruyère Research Institute (Hsu, Manuel, Tanuseputro); Clinical Epidemiology Program (Hsu, Manuel, Bennett, Taljaard, Beach, Sequeira, Kobewka, Tanuseputro), Ottawa Hospital Research Institute; ICES uOttawa (Chalifoux, Manuel, Spruin, Talarico, Tanuseputro); School of Epidemiology and Public Health (Taljaard, Manuel), Division of Palliative Care (Tanuseputro) and Department of Medicine (Kobewka), University of Ottawa, Ottawa, Ont.; Department of Clinical Epidemiology and Biostatistics (Costa), McMaster University, Hamilton, Ont.; ICES Central (Bronskill); Women's College Research Institute (Bronskill), Women's College Hospital, Toronto, Ont
| | - Susan E Bronskill
- Bruyère Research Institute (Hsu, Manuel, Tanuseputro); Clinical Epidemiology Program (Hsu, Manuel, Bennett, Taljaard, Beach, Sequeira, Kobewka, Tanuseputro), Ottawa Hospital Research Institute; ICES uOttawa (Chalifoux, Manuel, Spruin, Talarico, Tanuseputro); School of Epidemiology and Public Health (Taljaard, Manuel), Division of Palliative Care (Tanuseputro) and Department of Medicine (Kobewka), University of Ottawa, Ottawa, Ont.; Department of Clinical Epidemiology and Biostatistics (Costa), McMaster University, Hamilton, Ont.; ICES Central (Bronskill); Women's College Research Institute (Bronskill), Women's College Hospital, Toronto, Ont
| | - Peter Tanuseputro
- Bruyère Research Institute (Hsu, Manuel, Tanuseputro); Clinical Epidemiology Program (Hsu, Manuel, Bennett, Taljaard, Beach, Sequeira, Kobewka, Tanuseputro), Ottawa Hospital Research Institute; ICES uOttawa (Chalifoux, Manuel, Spruin, Talarico, Tanuseputro); School of Epidemiology and Public Health (Taljaard, Manuel), Division of Palliative Care (Tanuseputro) and Department of Medicine (Kobewka), University of Ottawa, Ottawa, Ont.; Department of Clinical Epidemiology and Biostatistics (Costa), McMaster University, Hamilton, Ont.; ICES Central (Bronskill); Women's College Research Institute (Bronskill), Women's College Hospital, Toronto, Ont
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Kuenzig ME, Bitton A, Carroll MW, Kaplan GG, Otley AR, Singh H, Nguyen GC, Griffiths AM, Stukel TA, Targownik LE, Jones JL, Murthy SK, McCurdy JD, Bernstein CN, Lix LM, Peña-Sánchez JN, Mack DR, Jacobson K, El-Matary W, Dummer TJB, Fung SG, Spruin S, Nugent Z, Tanyingoh D, Cui Y, Filliter C, Coward S, Siddiq S, Benchimol EI. Inflammatory Bowel Disease Increases the Risk of Venous Thromboembolism in Children: A Population-Based Matched Cohort Study. J Crohns Colitis 2021; 15:2031-2040. [PMID: 34175936 PMCID: PMC8684458 DOI: 10.1093/ecco-jcc/jjab113] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Although venous thromboembolism [VTE] is a well-known complication of inflammatory bowel disease [IBD] in adults, limited data exist on the risk in children. We report the incidence of VTE among children with and without IBD. METHODS We conducted a matched cohort study within a distributed network of population-based Canadian provincial health administrative databases. Children <16 years diagnosed with IBD were identified using validated algorithms from administrative data in Alberta, Manitoba, Nova Scotia, Ontario and Québec and compared to age- and sex-matched children without IBD. Hospitalizations for VTE within 5 years of IBD diagnosis were identified. Generalized linear mixed-effects models were used to pool province-specific incidence rates and incidence rate ratios [IRR] with 95% confidence intervals [CI]. Hazard ratios [HR] from Cox proportional hazards models were pooled with fixed-effects meta-analysis. RESULTS The 5-year incidence of VTE among 3593 children with IBD was 31.2 [95% CI 23.7-41.0] per 10 000 person-years [PY] compared to 0.8 [95% CI 0.4-1.7] per 10 000 PY among 16 289 children without IBD [unadjusted IRR 38.84, 95% CI 16.59-90.83; adjusted HR 22.91, 95% CI 11.50-45.63]. VTE was less common in Crohn's disease than ulcerative colitis [unadjusted IRR 0.47, 95% CI 0.27-0.83; adjusted HR 0.52, 95% CI 0.29-0.94]. The findings were similar for deep vein thrombosis and pulmonary embolism when comparing children with and without IBD. CONCLUSIONS The risk of VTE is much higher in children with IBD than controls without IBD. While the absolute risk is low, we found a higher incidence rate than previously described in the pediatric literature.Conference Presentation: An abstract based on the data included in this paper was presented at Canadian Digestive Diseases Week [Montréal, Canada] in March 2020.
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Affiliation(s)
- M Ellen Kuenzig
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada,Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | - Alain Bitton
- McGill University Health Centre, Division of Gastroenterology and Hepatology, Montreal, Québec, Canada
| | - Matthew W Carroll
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Gilaad G Kaplan
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Anthony R Otley
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Harminder Singh
- Univeristy of Manitoba IBD Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada,Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada,Research Institute at CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Geoffrey C Nguyen
- ICES, Toronto, Ontario, Canada,Mount Sinai Hospital Centre for Inflammatory Bowel Disease, Department of Medicine, University of Toronto, Toronto, Ontario, Canada,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Anne M Griffiths
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada,Department of Paediatrics, and Institute of Health Policy, Management and Evaluation University of Toronto, Toronto, Ontario, Canada
| | - Therese A Stukel
- ICES, Toronto, Ontario, Canada,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Laura E Targownik
- Mount Sinai Hospital Centre for Inflammatory Bowel Disease, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer L Jones
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sanjay K Murthy
- ICES, Toronto, Ontario, Canada,Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada,Division of Gastroenterology, The Ottawa Hospital IBD Centre, Ottawa, Ontario, Canada,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Jeffrey D McCurdy
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada,Division of Gastroenterology, The Ottawa Hospital IBD Centre, Ottawa, Ontario, Canada
| | - Charles N Bernstein
- Univeristy of Manitoba IBD Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada,Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lisa M Lix
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada,George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Juan Nicolás Peña-Sánchez
- Department of Community Health & Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - David R Mack
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada,CHEO Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, CHEO, Ottawa, Ontario, Canada,CHEO Research Institute, Ottawa, Ontario, Canada
| | - Kevan Jacobson
- Department of Pediatrics, BC Children’s Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Wael El-Matary
- Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Trevor J B Dummer
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephen G Fung
- ICES, Toronto, Ontario, Canada,CHEO Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, CHEO, Ottawa, Ontario, Canada,CHEO Research Institute, Ottawa, Ontario, Canada
| | | | - Zoann Nugent
- Univeristy of Manitoba IBD Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Divine Tanyingoh
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Yunsong Cui
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Christopher Filliter
- Lady Davis Institute of Medical Research, Jewish General Hospital, Montreal, Québec, Canada
| | - Stephanie Coward
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Shabnaz Siddiq
- ICES, Toronto, Ontario, Canada,CHEO Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, CHEO, Ottawa, Ontario, Canada,CHEO Research Institute, Ottawa, Ontario, Canada
| | - Eric I Benchimol
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada,Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada,ICES, Toronto, Ontario, Canada,Department of Paediatrics, and Institute of Health Policy, Management and Evaluation University of Toronto, Toronto, Ontario, Canada,Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada,CHEO Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, CHEO, Ottawa, Ontario, Canada,CHEO Research Institute, Ottawa, Ontario, Canada,Corresponding author: Eric Benchimol, MD, PhD, FRCPC, The Hospital for Sick Children, Division of Gastroenterology, Hepatology and Nutrition, 555 University Avenue, Toronto, ON, M5G 1X8, Canada. Tel: (416]813-1500 ext. 308179; Fax: (416]813-4972;
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Brown CRL, Webber C, Seow HY, Howard M, Hsu AT, Isenberg SR, Jiang M, Smith GA, Spruin S, Tanuseputro P. Impact of physician-based palliative care delivery models on health care utilization outcomes: A population-based retrospective cohort study. Palliat Med 2021; 35:1170-1180. [PMID: 33884934 DOI: 10.1177/02692163211009440] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Increasing involvement of palliative care generalists may improve access to palliative care. It is unknown, however, if their involvement with and without palliative care specialists are associated with different outcomes. AIM To describe physician-based models of palliative care and their association with healthcare utilization outcomes including: emergency department visits, acute hospitalizations and intensive care unit (ICU) admissions in last 30 days of life; and, place of death. DESIGN Population-based retrospective cohort study using linked health administrative data. We used descriptive statistics to compare outcomes across three models (generalist-only palliative care; consultation palliative care, comprising of both generalist and specialist care; and specialist-only palliative care) and conducted a logistic regression for community death. SETTING/PARTICIPANTS All adults aged 18-105 who died in Ontario, Canada between April 1, 2012 and March 31, 2017. RESULTS Of the 231,047 decedents who received palliative services, 40.3% received generalist, 32.3% consultation and 27.4% specialist palliative care. Across models, we noted minimal to modest variation for decedents with at least one emergency department visit (50%-59%), acute hospitalization (64%-69%) or ICU admission (7%-17%), as well as community death (36%-40%). In our adjusted analysis, receipt of a physician home visit was a stronger predictor for increased likelihood of community death (odds ratio 9.6, 95% confidence interval 9.4-9.8) than palliative care model (generalist vs consultation palliative care 2.0, 1.9-2.0). CONCLUSION The generalist palliative care model achieved similar healthcare utilization outcomes as consultation and specialist models. Including a physician home visit component in each model may promote community death.
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Affiliation(s)
- Catherine R L Brown
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Colleen Webber
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, ON, Canada.,ICES, Ottawa, ON, Canada
| | - Hsien-Yeang Seow
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Michelle Howard
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Amy T Hsu
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, ON, Canada.,ICES, Ottawa, ON, Canada.,Bruyère Research Institute, Ottawa, ON, Canada.,Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Sarina R Isenberg
- Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Mengzhu Jiang
- Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Glenys A Smith
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, ON, Canada.,ICES, Ottawa, ON, Canada
| | - Sarah Spruin
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, ON, Canada.,ICES, Ottawa, ON, Canada
| | - Peter Tanuseputro
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, ON, Canada.,ICES, Ottawa, ON, Canada.,Bruyère Research Institute, Ottawa, ON, Canada.,Department of Medicine, University of Ottawa, Ottawa, ON, Canada
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Funnell S, Walker J, Letendre A, Bearskin RLB, Manuel D, Scott M, Spruin S, Tanuseputro P. Places of death and places of care for Indigenous Peoples in Ontario: a retrospective cohort study. Can J Public Health 2021; 112:685-696. [PMID: 34008135 DOI: 10.17269/s41997-021-00482-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 01/25/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Most people, including Indigenous people in Ontario, wish to die in their communities. How often Indigenous people in Ontario die in their preferred settings is unknown. This study aims to describe the places of care and death for Indigenous people in Ontario who received provincially funded home care services. METHODS We conducted a retrospective cohort study using linked health administrative databases housed at ICES. We used a population-based cohort of Indigenous and non-Indigenous people in Ontario who died between April 1, 2010 and March 31, 2015 to describe characteristics of people, places of death, and places of care. RESULTS Indigenous decedents were on average 8.8 years younger, had more chronic diseases, and lived in lower income neighbourhoods compared with their non-Indigenous counterparts. Indigenous decedents spent nearly 8 more days in acute care in the last year of life and more died in acute care (56.1% versus 46.1%). When controlling for covariates, Indigenous decedents received 1.9 fewer home care nursing hours and 5 fewer personal support worker hours and showed decreased odds (OR 0.72) of receiving a palliative physician visit in the last 90 days of life. Among Indigenous decedents, a palliative physician visit lowered odds of dying in acute care by 50% and total days in acute care by 18%. CONCLUSION Our study identified a gap in end-of-life care for Indigenous Peoples in Ontario receiving provincially funded home care. Without continued efforts to address challenges that perpetuate health inequalities, we expect many Indigenous people will continue to die in acute care away from their people, families, and culturally relevant supports.
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Affiliation(s)
- Sarah Funnell
- Department of Family Medicine, Queen's University, 220 Bagot Street, Kingston, ON, K7L 3G2, Canada.
| | | | - Angeline Letendre
- Canadian Indigenous Nurses Association (CINA), Ottawa, Ontario, Canada
| | | | - Douglas Manuel
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,The Ottawa Hospital, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Bruyère Research Institute, Ottawa, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Statistics Canada, Ottawa, Ontario, Canada.,C.T. Lamont Primary Health Care Research Centre, Ottawa, Ontario, Canada
| | | | | | - Peter Tanuseputro
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,The Ottawa Hospital, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Bruyère Research Institute, Ottawa, Ontario, Canada.,ICES, Toronto, Ontario, Canada
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Huyer G, Brown CRL, Spruin S, Hsu AT, Fisher S, Manuel DG, Bronskill SE, Qureshi D, Tanuseputro P. Five-year risk of admission to long-term care home and death for older adults given a new diagnosis of dementia: a population-based retrospective cohort study. CMAJ 2021; 192:E422-E430. [PMID: 32312824 DOI: 10.1503/cmaj.190999] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2020] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND After diagnosis of a health condition, information about survival and potential transition from community into institutional care can be helpful for patients and care providers. We sought to describe the association between a new diagnosis of dementia and risk of admission to a long-term care home and death at 5 years. METHODS We conducted a population-based retrospective cohort study using linked health administrative databases. We identified individuals aged 65 years or older, living in the community, with a first documented diagnosis of dementia between Jan. 1, 2010, and Dec. 31, 2012, in Ontario, Canada. Dementia diagnosis was captured using diagnostic codes from hospital discharges, physician billings, assessments conducted for home care and long-term care, and dispensed prescriptions for cholinesterase inhibitors. Our primary outcome measures were 5-year risk of death and placement in a long-term care home, adjusted for sociodemographic and clinical factors. RESULTS We identified 108 757 individuals in our study cohort. By the end of 5 years, 24.4% remained alive in the community and 20.5% were living in a long-term care home. Of the 55.1% who died, about half (27.9%) were admitted to a long-term care home before death. Three risk factors were associated with increased odds of death: older age (age ≥ 90 yr; odds ratio [OR] 9.5, 95% confidence interval [CI] 8.8-10.2 [reference: age 65-69 yr]), male sex (OR 1.7, 95% CI 1.6-1.7), and the presence of organ failure, including chronic obstructive pulmonary disease (OR 1.7, 95% CI 1.7-1.8), congestive heart failure (OR 2.0, 95% CI 1.9-2.0) and renal failure (OR 1.7, 95% CI 1.6-1.8). Groups formed by combinations of these 3 factors had an observed 5-year risk of death varying between 22% and 91%. INTERPRETATION Among community-dwelling older adults with newly identified dementia in Ontario, the majority died or were admitted to a long-term care home within 5 years. This information may be helpful for discussions on prognosis and need for admission to long-term care.
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Affiliation(s)
- Gregory Huyer
- Clinical Epidemiology Program (Huyer, Brown, Hsu, Fisher, Manuel, Qureshi, Tanuseputro), Ottawa Hospital Research Institute; Telfer School of Management (Huyer) and School of Epidemiology and Public Health (Brown, Fisher, Tanuseputro), University of Ottawa; Bruyere Research Institute (Hsu, Qureshi, Tanuseputro); ICES uOttawa (Spruin, Hsu, Manuel, Tanuseputro), Ottawa, Ont.; ICES Central (Bronskill); Institute of Health Policy, Management and Evaluation (Bronskill), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont
| | - Catherine R L Brown
- Clinical Epidemiology Program (Huyer, Brown, Hsu, Fisher, Manuel, Qureshi, Tanuseputro), Ottawa Hospital Research Institute; Telfer School of Management (Huyer) and School of Epidemiology and Public Health (Brown, Fisher, Tanuseputro), University of Ottawa; Bruyere Research Institute (Hsu, Qureshi, Tanuseputro); ICES uOttawa (Spruin, Hsu, Manuel, Tanuseputro), Ottawa, Ont.; ICES Central (Bronskill); Institute of Health Policy, Management and Evaluation (Bronskill), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont
| | - Sarah Spruin
- Clinical Epidemiology Program (Huyer, Brown, Hsu, Fisher, Manuel, Qureshi, Tanuseputro), Ottawa Hospital Research Institute; Telfer School of Management (Huyer) and School of Epidemiology and Public Health (Brown, Fisher, Tanuseputro), University of Ottawa; Bruyere Research Institute (Hsu, Qureshi, Tanuseputro); ICES uOttawa (Spruin, Hsu, Manuel, Tanuseputro), Ottawa, Ont.; ICES Central (Bronskill); Institute of Health Policy, Management and Evaluation (Bronskill), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont
| | - Amy T Hsu
- Clinical Epidemiology Program (Huyer, Brown, Hsu, Fisher, Manuel, Qureshi, Tanuseputro), Ottawa Hospital Research Institute; Telfer School of Management (Huyer) and School of Epidemiology and Public Health (Brown, Fisher, Tanuseputro), University of Ottawa; Bruyere Research Institute (Hsu, Qureshi, Tanuseputro); ICES uOttawa (Spruin, Hsu, Manuel, Tanuseputro), Ottawa, Ont.; ICES Central (Bronskill); Institute of Health Policy, Management and Evaluation (Bronskill), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont
| | - Stacey Fisher
- Clinical Epidemiology Program (Huyer, Brown, Hsu, Fisher, Manuel, Qureshi, Tanuseputro), Ottawa Hospital Research Institute; Telfer School of Management (Huyer) and School of Epidemiology and Public Health (Brown, Fisher, Tanuseputro), University of Ottawa; Bruyere Research Institute (Hsu, Qureshi, Tanuseputro); ICES uOttawa (Spruin, Hsu, Manuel, Tanuseputro), Ottawa, Ont.; ICES Central (Bronskill); Institute of Health Policy, Management and Evaluation (Bronskill), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont
| | - Douglas G Manuel
- Clinical Epidemiology Program (Huyer, Brown, Hsu, Fisher, Manuel, Qureshi, Tanuseputro), Ottawa Hospital Research Institute; Telfer School of Management (Huyer) and School of Epidemiology and Public Health (Brown, Fisher, Tanuseputro), University of Ottawa; Bruyere Research Institute (Hsu, Qureshi, Tanuseputro); ICES uOttawa (Spruin, Hsu, Manuel, Tanuseputro), Ottawa, Ont.; ICES Central (Bronskill); Institute of Health Policy, Management and Evaluation (Bronskill), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont
| | - Susan E Bronskill
- Clinical Epidemiology Program (Huyer, Brown, Hsu, Fisher, Manuel, Qureshi, Tanuseputro), Ottawa Hospital Research Institute; Telfer School of Management (Huyer) and School of Epidemiology and Public Health (Brown, Fisher, Tanuseputro), University of Ottawa; Bruyere Research Institute (Hsu, Qureshi, Tanuseputro); ICES uOttawa (Spruin, Hsu, Manuel, Tanuseputro), Ottawa, Ont.; ICES Central (Bronskill); Institute of Health Policy, Management and Evaluation (Bronskill), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont
| | - Danial Qureshi
- Clinical Epidemiology Program (Huyer, Brown, Hsu, Fisher, Manuel, Qureshi, Tanuseputro), Ottawa Hospital Research Institute; Telfer School of Management (Huyer) and School of Epidemiology and Public Health (Brown, Fisher, Tanuseputro), University of Ottawa; Bruyere Research Institute (Hsu, Qureshi, Tanuseputro); ICES uOttawa (Spruin, Hsu, Manuel, Tanuseputro), Ottawa, Ont.; ICES Central (Bronskill); Institute of Health Policy, Management and Evaluation (Bronskill), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont
| | - Peter Tanuseputro
- Clinical Epidemiology Program (Huyer, Brown, Hsu, Fisher, Manuel, Qureshi, Tanuseputro), Ottawa Hospital Research Institute; Telfer School of Management (Huyer) and School of Epidemiology and Public Health (Brown, Fisher, Tanuseputro), University of Ottawa; Bruyere Research Institute (Hsu, Qureshi, Tanuseputro); ICES uOttawa (Spruin, Hsu, Manuel, Tanuseputro), Ottawa, Ont.; ICES Central (Bronskill); Institute of Health Policy, Management and Evaluation (Bronskill), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.
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Webber C, Chan R, Scott M, Brown C, Spruin S, Hsu AT, Bush SH, Isenberg SR, Quinn K, Scott J, Tanuseputro P. Delivery of Palliative Care in Acute Care Hospitals: A Population-Based Retrospective Cohort Study Describing the Level of Involvement and Timing of Inpatient Palliative Care in the Last Year of Life. J Palliat Med 2020; 24:1000-1010. [PMID: 33337265 DOI: 10.1089/jpm.2020.0056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Background: Much end-of-life care is provided in hospital, yet little is known about the delivery of palliative care during end-of-life hospitalizations. Objectives: To characterize the level of palliative care involvement across hospitalizations in the last year of life. Methods: A population-based retrospective cohort study of adults in Ontario, Canada, who died between April 1, 2012, and March 31, 2017, and had at least one acute care hospitalization in their last year of life. Using linked administrative health data, we developed a hierarchy of inpatient palliative care involvement reflecting the degree to which care was delivered with palliative intent. This hierarchy was based on palliative care diagnosis and service provider codes on hospitalization records and physician claims. We examined variations in the level of palliative care involvement across key patient characteristics. Results: In the last year of life, 65.1% of hospitalizations had no indication of palliative care involvement, 16.7% had a low level of involvement, 13.5% had a medium level of involvement, and 4.7% had a high level of involvement. Most hospitalizations with palliative care involvement (85.6%) occurred in the two months before death. Compared to patients who received no inpatient palliative care, patients who received a high level of palliative care involvement tended to be younger, died of cancer, resided in urban or lower income neighborhoods, and had fewer chronic conditions. Discussion: While many hospitalizations occurred in the last year of life, the majority did not involve palliative care, and very few had a high level of palliative care involvement.
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Affiliation(s)
- Colleen Webber
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Raphael Chan
- Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada
| | - Mary Scott
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Catherine Brown
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Sarah Spruin
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,ICES, Ottawa, Ontario, Canada
| | - Amy T Hsu
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Shirley H Bush
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Bruyère Research Institute, Ottawa, Ontario, Canada.,Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada
| | - Sarina R Isenberg
- Temmy Latner Centre for Palliative Care and Lunenfeld Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada.,Department of Family and Community Medicine and University of Toronto, Toronto, Ontario, Canada
| | - Kieran Quinn
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - John Scott
- Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada
| | - Peter Tanuseputro
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Bruyère Research Institute, Ottawa, Ontario, Canada.,Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada
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18
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Fisher S, Manuel DG, Spruin S, Anderson G, Taljaard M, Tanuseputro P. Life expectancy and health care utilization of individuals with dementia in Ontario, Canada: A population-level study. Int J Popul Data Sci 2020. [DOI: 10.23889/ijpds.v5i5.1428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
IntroductionIt is important for dementia patients, their families and caregivers, and health planners to have an understanding of life expectancy and the likely care experience of patients from dementia diagnosis to end-of-life.
Objectives and ApproachUsing administrative health data of all dementia patients in Ontario, Canada (2014 to 2017) and period life table methodology, life expectancy and average health care use and cost for individuals from dementia diagnosis to death was examined. Dementia was ascertained by a validated case ascertainment definition and information from long-term care, home care and complex continuing care assessments. Formal care was categorized as inpatient, outpatient, home care or long-term care.
ResultsLife expectancy at dementia diagnosis was 8.7 years and 9.8 years for men and women diagnosed prior to age 75, of which 3.7 years (42%) and 4.7 years (49%) was spent receiving formal care, respectively. Life expectancy was 4.4 and 5.2 years for men and women diagnosed after age 75, of which 2.2 years (50%) and 3.1 years (60%) was spent receiving care, respectively. Women received proportionally more long-term and home care compared to men, while men received more inpatient and outpatient care. In the year prior to dementia diagnosis, individuals received formal care for 20 days per 100 person-days. Those at the end-of-life received care for 79 days per 100 person-days, including 55 long-term care days and 7.8 inpatient care days. Average direct health care costs from diagnosis to end-of-life was $230,000 and was higer for women and those diagnosed before age 75.
ConclusionThe burden of formal care for those with dementia is substantial. The results of this study will be used by physicians to inform conversations with patients, their families and caregivers around what to expect after a dementia diagnosis, and by health care planners for population health planning.
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McCurdy JD, Kuenzig ME, Smith G, Spruin S, Murthy SK, Carrier M, Nguyen GC, Benchimol EI. Risk of Venous Thromboembolism After Hospital Discharge in Patients With Inflammatory Bowel Disease: A Population-based Study. Inflamm Bowel Dis 2020; 26:1761-1768. [PMID: 31995204 DOI: 10.1093/ibd/izaa002] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) is associated with a high risk of venous thromboembolism (VTE) during hospitalization. It is unclear if this association persists after discharge. We aimed to assess the incidence of postdischarge VTE in IBD patients and to determine if IBD is associated with increased VTE risk. METHODS We performed a population-based cohort study between 2002 and 2016 using Ontario health administrative data sets. Hospitalized (≥72 hours) adults with IBD were stratified into nonsurgical and surgical cohorts and matched on propensity score to non-IBD controls. Time to postdischarge VTE was assessed by Kaplan-Meier methods, and VTE risk was assessed by Cox proportional hazard models. RESULTS A total of 81,900 IBD discharges (62,848 nonsurgical and 19,052 surgical) were matched to non-IBD controls. The cumulative incidence of VTE at 12 months after discharge was 2.3% for nonsurgical IBD patients and 1.6% for surgical IBD patients. The incidence increased in the nonsurgical IBD cohort by 4% per year (incidence rate ratio, 1.04; 95% CI, 1.02-1.05). In our propensity score-matched analysis, the risk of VTE at 1-month postdischarge was greater in nonsurgical IBD patients (hazard ratio [HR], 1.72; 95% CI, 1.51-1.96) and surgical patients with ulcerative colitis (HR, 1.68; 95% CI, 1.16-2.45) but not surgical patients with Crohn's disease. These trends persisted through 12 months. CONCLUSIONS Nonsurgical IBD patients and surgical patients with ulcerative colitis are 1.7-fold more likely to develop postdischarge VTE than non-IBD patients. These findings support the need for increased vigilance and consideration of thromboprophylaxis in this population.
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Affiliation(s)
- Jeffrey D McCurdy
- Department of Medicine, University of Ottawa, Ottawa, Canada.,Division of Gastroenterology, The Ottawa Hospital IBD Center, Ottawa, Canada.,The Ottawa Hospital Research Institute, Ottawa, Canada
| | - M Ellen Kuenzig
- CHEO Inflammatory Bowel Disease Centre, Division of Gastroenterology Hepatology & Nutrition, Children's Hospital of Eastern Ontario, Ottawa, Canada; ¶ICES uOttawa, Ottawa, Canada
| | - Glenys Smith
- Division of Hematology, The Ottawa Hospital, Ottawa, Canada
| | - Sarah Spruin
- Division of Hematology, The Ottawa Hospital, Ottawa, Canada
| | - Sanjay K Murthy
- Department of Medicine, University of Ottawa, Ottawa, Canada.,Division of Gastroenterology, The Ottawa Hospital IBD Center, Ottawa, Canada.,The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Marc Carrier
- Department of Medicine, University of Ottawa, Ottawa, Canada.,The Ottawa Hospital Research Institute, Ottawa, Canada.,Division of Hematology, The Ottawa Hospital, Ottawa, Canada
| | - Geoffrey C Nguyen
- Department of Medicine, University of Toronto, Toronto, Canada.,Mount Sinai Hospital Centre for Inflammatory Bowel Disease, Division of Gastroenterology, Toronto, Canada
| | - Eric I Benchimol
- CHEO Inflammatory Bowel Disease Centre, Division of Gastroenterology Hepatology & Nutrition, Children's Hospital of Eastern Ontario, Ottawa, Canada; ¶ICES uOttawa, Ottawa, Canada.,Department of Pediatrics and School of Epidemiology and Public Health, University of Ottawa, Canada
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20
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Kuenzig E, Singh H, Bitton A, Kaplan GG, Carroll MW, Otley A, Stukel TA, Spruin S, Nugent Z, Tanyingoh D, Cui Y, Filliter C, Coward S, Griffiths A, Mack D, Jacobson K, Nguyen GC, Targownik L, El-Matary W, Benchimol EI. A26 PEDIATRIC-ONSET INFLAMMATORY BOWEL DISEASE INCREASES THE RISK OF VENOUS THROMBOEMBOLISM: A CANGIEC POPULATION-BASED STUDY. J Can Assoc Gastroenterol 2020. [DOI: 10.1093/jcag/gwz047.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Inflammatory bowel disease (IBD) increases the risk of venous thromboembolism (VTE) in patients of all ages but the risk of VTE among Canadian children with IBD has not previously been investigated.
Aims
Report the incidence of VTE and subtypes pulmonary embolism (PE) and deep vein thrombosis (DVT) in children with and without IBD.
Methods
Children diagnosed with IBD <16y were identified from health administrative data in Ontario (2002–2014), Alberta (2007–2015), and Nova Scotia (2002–2012) using validated algorithms and matched by age and sex to children without IBD (1:5 ratio). Validated ICD-10 codes identified hospitalizations for incident VTE (DVT, PE, and sinovenous thrombosis). Province-specific 5-year cumulative incidence per 1000 person-years (PY) of VTEs were pooled using fixed-effects generalized linear mixed models with a Freeman-Tukey double arcsine transformation. Incidence rate ratios (IRR) within 5 years of diagnosis were pooled using fixed-effects generalized linear mixed models to compare children with and without IBD, and children with Crohn’s disease (CD) and ulcerative colitis (UC).
Results
3127 children with IBD (1826 CD; 1045 UC) were matched to 15,635 children without IBD. The cumulative incidence of VTE within 5 years of IBD diagnosis was 2.8 (95% CI 2.1–3.8) per 1000 PYs compared to 0.13 (95% CI 0.07–0.24) per 1000 PYs in children without IBD (Table). The 5-year cumulative incidences of VTE, DVT, and PE were significantly higher in children with IBD than in children without IBD (VTE: IRR 21.44, 95% CI 10.73–42.82; DVT: IRR 25.15, 95% CI 11.12–56.89; PE: IRR 4.01, 95% CI 1.22–13.18). Compared to UC patients, children with CD were at lower risk of VTE (IRR 0.53, 95% CI 0.29–0.96) and numerically, but not statistically, lower risk of DVT (IRR 0.59, 95% CI 0.30–1.14).
Conclusions
Although VTEs are relatively rare among children with IBD, these children are at much greater risk than children without IBD. Gastroenterologists caring for these patients should be cognizant of VTE risk and provide appropriate prophylaxis to those at high risk of VTE.
Funding Agencies
CCC
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Affiliation(s)
- E Kuenzig
- Gastroenterology, Hepatology and Nutrition, Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - H Singh
- University of Manitoba, Winnipeg, MB, Canada
| | - A Bitton
- Royal Victoria Hospital, McGill University, Montreal, QC, Canada
| | - G G Kaplan
- Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - M W Carroll
- Pediatric Gastroenterology, Univeristy of Alberta, Edmonton, AB, Canada
| | - A Otley
- Pediatrics, Dalhousie University, Halifax, NS, Canada
| | | | | | - Z Nugent
- University of Manitoba, Winnipeg, MB, Canada
| | - D Tanyingoh
- Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Y Cui
- Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - C Filliter
- Royal Victoria Hospital, McGill University, Montreal, QC, Canada
| | - S Coward
- University of Calgary, Calgary, AB, Canada
| | - A Griffiths
- Hospital for Sick Children, Toronto, ON, Canada
| | - D Mack
- Gastroenterology, Hepatology and Nutrition, Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - K Jacobson
- BC Children’s Hospital, Vancouver, BC, Canada
| | - G C Nguyen
- Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - L Targownik
- Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - W El-Matary
- Pediatric Gastroenterology, University of Manitoba, Winnipeg, MB, Canada
| | - E I Benchimol
- Gastroenterology, Hepatology and Nutrition, Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada
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Fell DB, Wilson LA, Hawken S, Spruin S, Murphy M, Potter BK, Little J, Chakraborty P, Lacaze-Masmonteil T, Wilson K. Association between newborn screening analyte profiles and infant mortality. J Matern Fetal Neonatal Med 2019; 34:835-838. [PMID: 31046492 PMCID: PMC7722351 DOI: 10.1080/14767058.2019.1615048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objective To assess whether newborn screening analytes could be utilized beyond their traditional application to identify infants at high risk of mortality within the first 6 months of life. Methods We linked a province-wide newborn screening registry with health administrative databases to identify infant deaths within 6 months in a source population of live-born infants between 2010 and 2014. We used a nested case-control study design, in which all infant deaths between 7 days and 6 months of age were included as cases, and a random sample of infants from the source population were selected as controls and were matched to cases at a ratio of 10:1. We examined the association between mortality and screening analytes (acylcarnitines, amino acids, fetal-to-adult hemoglobin ratio, endocrine markers, and enzymes) using lasso regression to fit multivariable models. Results Among 350 infant deaths between 7 days and 6 months of age, and 3498 matched controls with complete data, our multivariable model demonstrated only modest ability to identify infant deaths (optimism-corrected c-statistic: 0.61, 95% confidence interval: 0.50–0.71). Conclusions We did not find newborn screening analytes to be strongly predictive of infant mortality between 7 days and 6 months of age in the general population of newborns. Future studies should investigate whether predictive modeling within more homogeneous cause-of-death categories could lead to improved predictive ability for infant mortality.
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Affiliation(s)
- Deshayne B Fell
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Lindsay A Wilson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Steven Hawken
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Sarah Spruin
- Institute for Clinical Evaluative Sciences, Ottawa, Canada
| | - Malia Murphy
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Beth K Potter
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Julian Little
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | | | | | - Kumanan Wilson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
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Fisher S, Talarico R, Sequeira Y, Bennett C, Spruin S, Hsu A, Tanuseputro P, Manuel D. A Data Science Approach to Predictive Analytic Research and Knowledge Translation. Int J Popul Data Sci 2018. [DOI: 10.23889/ijpds.v3i4.797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
IntroductionCurrent approaches to the development and application of predictive studies is inefficient and difficult to reproduce. Thousands of predictive health algorithms have been developed; however, less than 2\% have been assessed outside their original setting and even fewer have been applied and evaluated in practice.
Objectives and ApproachObjective: To develop a standardized workflow for algorithm development, dissemination and implementation.
Existing predictive analytics workflow and open standards were adapted and expanded for health research and health care settings. The approach was designed to work within multidisciplinary teams and to improve research transparency, reproducibility, quality, efficiency and application. Key components include standardized algorithm description files, documentation and code libraries. All libraries and programming packages, which were created for/with open-source software, can be used for a wide range of statistical and machine learning models. Publicly-available repositories contain the algorithms, validation data, R code and other supporting infrastructure.
ResultsAlgorithm development involves variable pre-specification and documentation of model variables, followed by creation of data preprocessing code to generate model variables from the study dataset. Preprocessing uses algorithm specification documentation and a function library, building upon and integrating with existing algorithms when possible to preventing code duplication. Models are output as a Predictive Modelling Markup Language (PMML) file, a portable industry standard for describing and scoring predictive models. A separate scoring "engine" is used to implement PMML-described algorithms in a range of settings, including algorithm validation at other research institutions. Algorithm applications currently include the Project Big Life (www.projectbiglife.ca) online calculators, population, health services and public health planning uses and an algorithm visualization tool. An API permits use of the calculator engine by other organizations.
Conclusion/ImplicationsBarriers to the implementation of predictive analytics in real-world settings—such as within electronic medical records or decision aid applications—can be mitigated with well described algorithms that are easy to replicate and implement, especially as access to big health data increases and algorithms become increasingly complex.
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Spruin S, Olds J, Fitzpatrick E, Rosella L, Nicholls S, Pigeon M, Whittingham J, MacDougall J, Schramm D, Benchimol E. Use of Large Data Sets in Evaluating Program Outcome in Pediatric Hearing Loss. Int J Popul Data Sci 2018. [DOI: 10.23889/ijpds.v3i4.634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
IntroductionPermanent hearing loss (PHL) in childhood can profoundly impact development, with high economic costs to children and society. Hearing technology and service delivery advances, including universal newborn hearing screening implemented in Ontario in 2002 as part of the Infant Hearing Program (IHP), aim to improve outcomes of children with PHL.
Objectives and ApproachWe examined the impact of IHP screening on age of identification of PHL, and compared healthcare utilization in children with and without PHL, in the Census Metropolitan Area of Ottawa. Children with PHL, identified from a database at the Children’s Hospital of Eastern Ontario, were linked to health administrative data housed at the Institute for Clinical Evaluative Sciences. Five residents of Ottawa acted as non-PHL controls for each PHL case. A regression discontinuity design (RDD) was used to investigate differences in age of identification pre- and post-IHP implementation. Poisson regression will compare healthcare utilization among children with and without PHL.
ResultsReceipt of the HBPB was associated with reductions in low birth weight births (adjusted Relative Risk (aRR): 0.77; 95% CI: 0.63, 0.93) and preterm births (aRR: 0.78 (0.68, 0.90)), and increases in breastfeeding initiation (aRR: 1.05 (1.00, 1.09)) and large-for-gestational age births (aRR: 1.11 (1.01, 1.23)). HBPB receipt during pregnancy was also associated with increases in 1- and 2-year immunizations for FN children (aRR: 1.14 (1.09, 1.19), and aRR: 1.28 (1.19, 1.36), respectively). Reductions in the risk of being developmentally vulnerable in the language and cognitive domain of the EDI were also found for FN children whose mothers had received the HBPB during pregnancy (aRR: 0.85 (0.74, 0.97).
Conclusion/ImplicationsIHP implementation resulted in earlier identificationof PHL in children, allowing earlier access to audiologic and habilitative services. However, children with PHL used the health system more often and in different ways from those without PHL. These results can support improvements in service delivery for children with PHL.
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Spruin S, Hsu A, Talarico R, Sequeira Y, Taljaard M, Bennett C, Tanuseputro P, Manuel D. Using Large Data to Present Uncertainty for Risk Prediction in the Era of Precision Medicine: The RESPECT Algorithm for Predicted Death at End-of-Life. Int J Popul Data Sci 2018. [DOI: 10.23889/ijpds.v3i4.642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
IntroductionIn Ontario, only 52% of people received palliative care in their last year of life, with only 20\% of those receiving it at home, which can improve the dying experience. Existing algorithms identifying people at end-of-life can potentially improve access to palliative care but are difficult for patients to understand.
Objectives and ApproachTo predict and communicate risk of death for community dwelling older adults using a pre-specified and published approach (Trial registration NCT02779309). All assessments from community-dwelling Ontarians (N = 488,636) who received at least one home care assessment from the residential assessment instrument – home care (RAI HC) from 2007 to 2013 (N=1,331,273) were included. The algorithm used a two-step approach by rank ordering participants into 61 groups based on six-month probability of death (from Cox-proportional hazard models) and generated Kaplan-Meier five-year survival curves for each group. Median Survival time is reported with uncertainties expressed with 25th to 75th percentiles.
ResultsThe median predicted probability of death within six-months was 0.1095 (0.1093-0.1097, 95% CI). Risk varied among the 61 groups from 0.0158 (0.0158-0.0159) to 0.9820 (0.9810-0.9830). Median observed survival time varied from 27 days (10 to 81 days, 25th and 75th percentile) in the highest risk group to 10 years (3655 days (2111 to >3655 days)) in the lowest risk group. Discrimination and calibration were satisfactory between the derivation (2007-2012 assessments) and validation (2013 assessments) cohorts, with a C statistics of 0.77 and discrimination plot intercept 0.094, slope 0.914. The Kaplan-Meier five-year survival curves for each of the 61 groups will be visually represented in six different ways displaying the risk and uncertainty, and can be altered to yield information of interest specific to each patient/caregiver.
Conclusion/ImplicationsRESPECT is adaptive and personalized, with instantaneous feedback as the user provides a response to each question. We will present RESPECT’s development and implementation processes and set up an interactive presentation of the calculator, demonstrating RESPECT’s ability to deliver patient-comprehensible end-of-life prognoses with uncertainty to patients and their caregivers.
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