An integrated framework for the geographic surveillance of chronic disease

<p>Abstract</p> <p>Background</p> <p>Geographic public health surveillance is concerned with describing and disseminating geographic information about disease and other measures of health to policy makers and the public. While methodological developments in the geographical analysis of disease are numerous, few have been integrated into a framework that also considers the effects of case ascertainment bias on the effectiveness of chronic disease surveillance.</p> <p>Results</p> <p>We present a framework for the geographic surveillance of chronic disease that integrates methodological developments in the spatial statistical analysis and case ascertainment. The framework uses an hierarchical approach to organize and model health information derived from an administrative health data system, and importantly, supports the detection and analysis of case ascertainment bias in geographic data. We test the framework on asthmatic data from Alberta, Canada. We observe high prevalence in south-western Alberta, particularly among Aboriginal females. We also observe that persons likely mistaken for asthmatics tend to be distributed in a pattern similar to asthmatics, suggesting that there may be an underlying social vulnerability to a variety of respiratory illnesses, or the presence of a diagnostic practice style effect. Finally, we note that clustering of asthmatics tends to occur at small geographic scales, while clustering of persons mistaken for asthmatics tends to occur at larger geographic scales.</p> <p>Conclusion</p> <p>Routine and ongoing geographic surveillance of chronic diseases is critical to developing an understanding of underlying epidemiology, and is critical to informing policy makers and the public about the health of the population.</p

Direct health system costs for systemic lupus erythematosus patients in Alberta, Canada

Systemic lupus Erythematosus (SLE) is a chronic multi-system autoimmune disease that can affect a person’s physical, mental, and social life. It imposes a substantial economic burden up on patients, carers, healthcare systems, and wider society. This is the first study to examine the direct health care costs of SLE in Alberta using real-world data. Alberta maintains a publicly funded, universally available health care system. Health service use and direct healthcare costs of SLE and non-SLE cases were determined from inpatient hospital services, fee-for-physician services, emergency services, and ambulatory care services. All costs were estimated for calendar year 2016. Data were analysed using central measures specifically the mean to determine the annual costs of SLE and non-SLE. A total number of 10,932 (Male = 2,546; Female = 8,386), and 41,851,36 (Male = 21,157,76; Female = 20,693,60) of SLE and non-SLE cases, respectively were included in this study. The mean annual costs of SLE, and non-SLE per case were $7,740.19 (Male =$7,986.59; Female = $7,665.38), and$2,479.53 (Male = $2,265.57; Female =$2,698.30), (p &lt; 0.001) respectively. The mean annual costs of fee-for-physician services (SLE = $2,160.03; non-SLE =$840.00) (p &lt; 0.001), inpatient hospital services (SLE = $3,462.86; non-SLE =$1,007.29), (p &lt; 0.001) emergency services (SLE = $440.28; non-SLE =$176.65), (p &lt; 0.001) and ambulatory care services (SLE = $1,677.03; non-SLE =$455.05) (p &lt; 0.001) per case were estimated. The findings showed that the costs of SLE were considerably high for patients and healthcare system. This highlights the importance of appropriate treatment and management of SLE. Further studies are required to fully investigate both the direct and indirect economic burden of SLE including out-of-pocket expenses, costs to patients and caregivers and productivity loss

Clinical and medication profiles stratified by household income in patients referred for diabetes care

BACKGROUND: Low income individuals with diabetes are at particularly high risk for poor health outcomes. While specialized diabetes care may help reduce this risk, it is not currently known whether there are significant clinical differences across income groups at the time of referral. The objective of this study is to determine if the clinical profiles and medication use of patients referred for diabetes care differ across income quintiles. METHODS: This cross-sectional study was conducted using a Canadian, urban, Diabetes Education Centre (DEC) database. Clinical information on the 4687 patients referred to the DEC from May 2000 – January 2002 was examined. These data were merged with 2001 Canadian census data on income. Potential differences in continuous clinical parameters across income quintiles were examined using regression models. Differences in medication use were examined using Chi square analyses. RESULTS: Multivariate regression analysis indicated that income was negatively associated with BMI (p < 0.0005) and age (p = 0.023) at time of referral. The highest income quintiles were found to have lower serum triglycerides (p = 0.011) and higher HDL-c (p = 0.008) at time of referral. No significant differences were found in HBA1C, LDL-c or duration of diabetes. The Chi square analysis of medication use revealed that despite no significant differences in HBA1C, the lowest income quintiles used more metformin (p = 0.001) and sulfonylureas (p < 0.0005) than the wealthy. Use of other therapies were similar across income groups, including lipid lowering medications. High income patients were more likely to be treated with diet alone (p < 0.0005). CONCLUSION: Our findings demonstrate that low income patients present to diabetes clinic older, heavier and with a more atherogenic lipid profile than do high income patients. Overall medication use was higher among the lower income group suggesting that differences in clinical profiles are not the result of under-treatment, thus invoking lifestyle factors as potential contributors to these findings

The prevalence of systemic autoimmune rheumatic diseases in Canadian pediatric populations: administrative database estimates

CI 17.9, 29.2). SARDs were more common in females than in males across all provinces. There was a slightly higher prevalence among those living in urban compared to rural areas of Alberta (rate difference 14.4, 95 % CI 8.6, 20.1) and Saskatchewan (rate difference 13.8, 95 % CI 1.0, 26.6). Our results provide population-based prevalence estimates of pediatric SARDs in four Canadian provinces. Keywords Pediatric rheumatic diseases · Systemic autoimmune rheumatic diseases · Epidemiology · Disease prevalence Abstract To estimate systemic autoimmune rheumatic disease (SARD) prevalence using administrative data for pediatric populations in four Canadian provinces. Physician billing claims and inpatient hospitalizations from Alberta, Manitoba, Quebec, and Saskatchewan were used to define cases aged ≤18 years with a SARD diagnosis code in: one or more hospitalization, two or more physician visits within 2 years and at least 2 months apart, or one or more physician visit to a rheumatologist. Estimates ranged from 15.9/100,000 in Quebec [95 % confidence interval (95 % CI) 14.1, 18.0] to 23.0/100,000 in Manitoba (95 % Rheumatology INTERNATIONA

Prognosis for long-term survival and renal recovery in critically ill patients with severe acute renal failure: a population-based study

INTRODUCTION: Severe acute renal failure (sARF) is associated with considerable morbidity, mortality and use of healthcare resources; however, its precise epidemiology and long-term outcomes have not been well described in a non-specified population. METHODS: Population-based surveillance was conducted among all adult residents of the Calgary Health Region (population 1 million) admitted to multidisciplinary and cardiovascular surgical intensive care units between May 1 1999 and April 30 2002. Clinical records were reviewed and outcome at 1 year was assessed. RESULTS: sARF occurred in 240 patients (11.0 per 100,000 population/year). Rates were highest in males and older patients (≥65 years of age). Risk factors for development of sARF included previous heart disease, stroke, pulmonary disease, diabetes mellitus, cancer, connective tissue disease, chronic renal dysfunction, and alcoholism. The annual mortality rate was 7.3 per 100,000 population with rates highest in males and those ≥65 years. The 28-day, 90-day, and 1-year case-fatality rates were 51%, 60%, and 64%, respectively. Increased Charlson co-morbidity index, presence of liver disease, higher APACHE II score, septic shock, and need for continuous renal replacement therapy were independently associated with death at 1 year. Renal recovery occurred in 78% (68/87) of survivors at 1 year. CONCLUSION: sARF is common and males, older patients, and those with underlying medical conditions are at greatest risk. Although the majority of patients with sARF will die, most survivors will become independent from renal replacement therapy within a year

Disease-modifying drugs for multiple sclerosis and subsequent health service use

OBJECTIVE: We assessed the relationship between the multiple sclerosis (MS) disease-modifying drugs (DMDs) and healthcare use. METHODS: Persons with MS (aged ⩾18 years) were identified using linked population-based health administrative data in four Canadian provinces and were followed from the most recent of their first MS/demyelinating event or 1 January 1996 until the earliest of death, emigration, or study end (31 December 2017 or 31 March 2018). Prescription records captured DMD exposure, examined as any DMD, then by generation (first-generation (the injectables) or second-generation (orals/infusions)) and individual DMD. The associations with subsequent all-cause hospitalizations and physician visits were examined using proportional means model and negative binomial regression. RESULTS: Of 35,894 MS cases (72% female), mean follow-up was 12.0 years, with person-years of DMD exposure for any, or any first- or second-generation DMD being 63,290, 54,605 and 8685, respectively. Any DMD or any first-generation DMD exposure (versus non-exposure) was associated with a 24% lower hazard of hospitalization (adjusted hazard ratio, aHR: 0.76; 95% confidence intervals (CIs): 0.71–0.82), rising to 29% for the second-generation DMDs (aHR: 0.71; 95% CI: 0.58–0.88). This ranged from 18% for teriflunomide (aHR: 0.82; 95% CI: 0.67–1.00) to 44% for fingolimod (aHR: 0.56; 95% CI: 0.36–0.87). In contrast, DMD exposure was generally not associated with substantial differences in physician visits. CONCLUSION: Findings provide real-world evidence of a beneficial relationship between DMD exposure and hospitalizations

Socio-economic status and types of childhood injury in Alberta: a population based study

BACKGROUND: Childhood injury is the leading cause of mortality, morbidity and permanent disability in children in the developed world. This research examines relationships between socio-economic status (SES), demographics, and types of childhood injury in the province of Alberta, Canada. METHODS: Secondary analysis was performed using administrative health care data provided by Alberta Health and Wellness on all children, aged 0 to 17 years, who had injuries treated by a physician, either in a physician's office, outpatient department, emergency room and/or as a hospital inpatient, between April 1(st). 1995 to March 31(st). 1996. Thirteen types of childhood injury were assessed with respect to age, gender and urban/rural location using ICD9 codes, and were related to SES as determined by an individual level SES indicator, the payment status of the Alberta provincial health insurance plan. The relationships between gender, SES, rural/urban status and injury type were determined using logistic regression. RESULTS: Twenty-four percent of Alberta children had an injury treated by physician during the one year period. Peak injury rates occurred about ages 2 and 13–17 years. All injury types except poisoning were more common in males. Injuries were more frequent in urban Alberta and in urban children with lower SES (receiving health care premium assistance). Among the four most common types of injury (78.6% of the total), superficial wounds and open wounds were more common among children with lower SES, while fractures and dislocations/sprains/strains were more common among children receiving no premium assistance. CONCLUSION: These results show that childhood injury in Alberta is a major health concern especially among males, children living in urban centres, and those living on welfare or have Treaty status. Most types of injury were more frequent in children of lower SES. Analysis of the three types of the healthcare premium subsidy allowed a more comprehensive picture of childhood injury with children whose families are on welfare and those of Treaty status presenting more frequently for an injury-related physician's consultation than other children. This report also demonstrates that administrative health care data can be usefully employed to describe injury patterns in children

The Effect of Universal Influenza Immunization on Mortality and Health Care Use

Comparing influenza-related mortality and health care use between Ontario and other Canadian provinces, Jeffrey Kwong and colleagues find evidence that Ontario's universal vaccination program has reduced the burden of influenza

Real-world incidence and prevalence of systemic lupus erythematosus in Alberta, Canada

Systemic lupus erythematosus (SLE) is rather uncommon than rare. The purpose of this study was to estimate the incidence and prevalence of SLE in the population of Alberta, Canada, using administrative health data. Multiple population-based data sources, including the Alberta Health Care Insurance Plan Central Stakeholder Registry (AHCIP CSR), Fee-For-Service, and Hospital Discharge Abstract Database were used. Age- and sex-specific incidence and prevalence rates, and 95% confidence intervals (CI), were computed using the AHCIP CSR mid-year population estimates as the denominator, for the period of 2000–2015. The overall incidence of SLE for all age groups was 4.43 (95% CI 3.65, 5.04) per 100,000 population. The overall incidence in male and female of all age groups was 1.26 (95% CI 0.72, 1.76) and 7.69 (95% CI 6.22, 8.81) per 100,000 population, respectively. A prevalence of 47.99 per 100,000 (male = 13.5, female = 83.2) of SLE was observed for the year 2000 and has increased to 90 (male = 25.5, female = 156.7) per 100,000 population in 2015. Over the 16-year period, the incidence of SLE in women was approximately six times higher than in men (odds ratio = 6.16). The highest and lowest incidence was recorded in 2001 and 2015, respectively. Despite the stable incidence of SLE, the findings of the study confirms that the prevalence of SLE has increased over the 16-year period. The increase in prevalence of SLE in Alberta will have an impact on health service utilizations. This finding can be used for planning and evaluating health services for this group of patients. Further studies are required to determine the economic burden of the condition