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In the context of an emerging new additional learning needs (ALN) system in Wales, this research explores who was likely to be identified with special educational needs (SEN) under the previous system. Our study reveals analysis of linked Welsh education and health data on SEN identification in learners in mainstream education settings born between 2002/3 and 2008/9. Using longitudinal multilevel modelling, we explore (i) who is likely identified with SEN and (ii) whether there is evidence of social patterning in SEN identification. We find that 48% of those born in the year 2002/3 were identified with SEN at some point during their schooling years. Furthermore, when controlling for health‐related variables, those who are identified with SEN in Wales were more likely to be male, White, from a deprived background, with lower school attendance, had not experienced breastfeeding and were born later in the academic year. Taken together, the research findings suggest that SEN identification was influenced by a child's context. The study thus underscores the critical importance of examining the relationship between socioeconomic, environmental and biological factors in SEN identification, urging for a comprehensive and cross‐organisation approach to enhance outcomes for learners with diverse needs. It also highlights the need for follow‐up research to explore unfolding trends as the new ALN system in Wales becomes fully implemented and integrated over the coming years. [ABSTRACT FROM AUTHOR]

Purpose: Few studies have reported the agreement between medication information derived from ambulatory EHR data compared to administrative claims for high‐cost specialty drugs. We used data from a national EHR‐enabled registry, the Rheumatology Informatics System for Effectiveness (RISE), with linked Medicare claims in a population of patients with rheumatoid arthritis (RA) to investigate variations in agreement for different biologic disease‐modifying agents (bDMARDs) between two data sources (RISE EHR data vs. Medicare claims), categorized by drug, route of administration, and patient insurance factors (dual eligibility). Methods: Patients ≥ 65 years old, with ≥ 2 visits in RISE with RA ICD codes ≥ 30 days apart, and continuous enrollment in Medicare Parts B and D in 2017–2018 were included. We classified patients as bDMARD users or nonusers in Medicare claims or EHR data in 2018, and we calculated sensitivity, specificity, positive predicted value (PPV), and negative predicted value (NPV) of EHR data for identifying bDMARD users, using Medicare as the reference standard. We also calculated these metrics after stratifying by clinic‐administered (Part B) versus. pharmacy‐dispensed (Part D) bDMARDs and by patient dual‐eligibility. Results: A total of 26 097 patients were included in the study. Using Medicare claims as the reference standard, EHR data had a sensitivity of 75.0%–90.8% for identifying patients with the same medication and route. PPV for Part B bDMARDs was higher compared with Part D bDMARDs (range 94.3%–97.3% vs. 51.0%–69.6%). We observed higher PPVs for Part D bDMARDs among patients who were dual‐eligible (range 82.4%–95.1%). Conclusion: The risk of misclassification of drug exposure based on EHR data sources alone is small for Medicare Part B bDMARDs but could be as high as 50% for Part D bDMARDs, in particular for patients who are not dually eligible for Medicare and Medicaid. [ABSTRACT FROM AUTHOR]

Aims: Heart failure (HF) and chronic kidney disease (CKD) place significant challenges on the healthcare system, and their co‐existence is associated with shared adverse outcomes. The multinational CaReMe project was initiated to provide contemporary, real‐world epidemiological data on cardiovascular and reno‐metabolic diseases. Utilizing data from the German CaReMe cohort, we characterize a multicentric HF population and describe in‐hospital outcomes stratified for co‐morbid CKD. Methods and results: This retrospective, observational study analysed administrative data from inpatient cases hospitalized in 87 German Helios hospitals between 1 January 2016 and 31 August 2022. The first hospitalization of patients aged ≥18 years with a primary discharge diagnosis of HF, based on ICD‐10 codes, were considered the index cases, and subsequent hospitalizations were considered as readmissions. Baseline characteristics and outcomes were stratified for co‐morbid CKD using ICD‐10‐encoding from the index cases. Cox regression was utilized for readmission endpoints and in‐hospital mortality. In total, 174 829 index cases (mean age 79 ± 15 years, 49.9% female) were included; of these, 55.0% had coexisting CKD. Patients with CKD were older, suffered from worse HF‐related symptoms, had a higher co‐morbidity burden, and in‐hospital mortality was increased at index and during follow‐up. Prevalent CKD was associated with higher rehospitalization rates and was an independent predictor for in‐hospital death. Conclusions: Within this HF inpatient cohort from a multicentric German database, CKD was diagnosed in more than half of the patients and was associated with increased in‐hospital mortality at baseline and during follow‐up. Rehospitalizations were observed earlier and more frequently in patients with HF and co‐morbid CKD. [ABSTRACT FROM AUTHOR]

This paper presents stylised facts on the labour supply and income inequality of individuals aged 25–55, drawn from the 1989–2020 Bank of Italy Survey of Household Income and Wealth. Over the sample period, earnings inequality has increased considerably although the gap is smaller when considered in terms of household disposable income. We investigate the possible drivers of this increase using administrative data on employees. The evidence suggests that labour market reforms implemented since the start of the 1990s are the most plausible explanation for this growth in earnings inequality. Comparison between earnings and disposable income suggests that both government and households are important for reducing inequalities. [ABSTRACT FROM AUTHOR]

Purpose: The magnitude of repeat exposures to culprit medications after hospital discharge is not well studied. We combined prospective cohort data with administrative health data to understand the frequency of repeat exposures to culprit medications after discharge and the risk factors for their occurrence. Methods: This was a retrospective analysis of three prospective cohorts of patients who presented to the hospital with an adverse drug event in British Columbia, from 2008 to 2015 (n = 849). We linked prospectively identified adverse drug events to administrative data to examine patterns of redispensing of culprit medications. We used Cox regression to assess risk factors for re‐exposure, and conducted subgroup analyses for essential vs. nonessential medications. Results: Among 849 diagnosed adverse drug events, 45.2% had subsequent culprit medication redispensing within a year of hospital discharge. The factors associated with re‐exposures included atrial fibrillation, adverse drug event type (e.g. adverse reaction), culprit medication type, and longer historical duration of medication use. Conclusions: Re‐exposures to culprit medications occurred in almost half of the adverse drug events diagnosed in emergency departments. Many of these were appropriate re‐exposures to essential medications for indications in which the risk of uncontrolled disease likely outweighed the risk of a repeat adverse event. More research is needed to understand re‐exposures to nonessential medications or medications with safer alternatives. [ABSTRACT FROM AUTHOR]

This study explores the relationship between four sociodemographic factors (socioeconomic status, household composition, immigrant background, and gender) and referral patterns to the Norwegian child welfare system (CWS). Using panel administrative data, the article first examines the impact of these factors on risk for referral to the CWS in the entire 2005 birth cohort over a 5‐year observation period, from when the cohort was 8 to 12 years old (2013–2017). Next, using a dataset consisting of all CWS referrals regarding children in the birth cohort during this observation period, we explore associations between these sociodemographic factors and registered reasons for referral to the CWS. Our analyses indicate that both risk for referral and registered reasons for referral vary according to sociodemographic factors. [ABSTRACT FROM AUTHOR]

Objectives: Community based dementia prevalence studies are expensive and resource intensive. Aotearoa New Zealand (NZ) has never had a community based dementia prevalence study representing all major ethnic groups. In recent years, dementia prevalence estimates have been derived from routinely collected health data but issues of underdiagnosis and undercoding limit their utility. Capture‐recapture techniques can estimate the number of dementia cases missing from health datasets by modelling the ascertained overlaps between linked data sources. Methods: Three routinely collected national health data sets—interRAI, Public hospital discharges, and Pharmaceuticals—were linked and all prevalent cases of dementia in NZ for the year 1 January 2021–31 December 2021 were identified. Capture‐recapture analysis fitted eight loglinear models to the data, with the best fitting model used to estimate the number of prevalent cases missing from all three datasets. Results: We estimated that almost half (47.8%) of dementia cases are not present in any of the three datasets. Dementia prevalence increased from 3.7% to 7.1% (95% CI 6.9%–7.4%) in the NZ 60+ population and from 4.9% to 9.2% (95% CI 8.9%–9.6%) in the NZ 65+ population when missing cases were included. Estimates of missing cases were significantly higher (p < 0.001) in Māori (49.2%), Pacific peoples (50.6%) and Asian (59.6%) compared to Europeans (46.4%). Conclusions: This study provides updated estimates of dementia prevalence in NZ and the proportion of undiagnosed dementia in NZ, highlighting the need for better access to dementia assessment and diagnosis. [ABSTRACT FROM AUTHOR]

Aims: While diagnostic codes from administrative health data might be a valuable source to identify adverse drug events (ADEs), their ability to identify unintended harms remains unclear. We validated claims‐based diagnosis codes for ADEs based on events identified in a prospective cohort study and assessed whether key attributes predicted their documentation in administrative data. Methods: This was a retrospective analysis of 3 prospective cohorts in British Columbia, from 2008 to 2015 (n = 13 969). We linked prospectively identified ADEs to administrative insurance data to examine the sensitivity and specificity of different diagnostic code schemes. We used logistic regression to assess which key attributes (e.g., type of event, symptoms and culprit medications) were associated with better documentation of ADEs in administrative data. Results: Among 1178 diagnosed events, the sensitivity of the diagnostic codes in administrative data ranged from 3.4 to 52.6%, depending on the database and codes used. We found that documentation was worse for certain types of ADEs (dose‐related: odds ratio [OR]: 0.32, 95% confidence interval [CI]: 0.15, 0.69; nonadherence events (OR: 0.35, 95% CI: 0.20, 0.62), and better for those experiencing arrhythmias (OR: 4.19, 95% CI: 0.96, 18.28). Conclusion: ADEs were not well documented in administrative data. Alternative methods should be explored to capture ADEs for health research. [ABSTRACT FROM AUTHOR]

The Sample of Integrated Welfare Benefit Biographies (SIG) provides comprehensive administrative data on the labour market participation, household composition and financial situation of welfare benefit recipients and their household members in Germany between 2007 and 2020. The SIG data enables research on the dynamics of welfare receipt and labour market participation of welfare recipients. The aim of the article is to introduce the SIG and to showcase its analytical potential by empirically examining benefit loans that can be granted by welfare agencies when unexpected expenses cannot be covered by welfare recipients themselves. Loans and detailed further financial information available can be used to assess the severity of financial restrictions during welfare receipt. We found that 2% of welfare recipients received loans at least once during their benefit episode and that loans were most likely to be granted right at the beginning of a benefit episode. Moreover, the likelihood of loans increased with higher benefit needs and when a parallel employment episode started. [ABSTRACT FROM AUTHOR]

Objectives: To provide insight into the health and social care costs during the disease trajectory in persons with dementia and the impact of institutionalization and death on healthcare costs compared with matched persons without dementia. Methods: Electronic health record data from family physicians were linked with national administrative databases to estimate costs of primary care, medication, secondary care, mental care, home care and institutional care for people with dementia and matched persons from the year before the recorded dementia diagnosis until death or a maximum of 4 years after the diagnosis. Results: Total mean health and social care costs among persons with dementia increased substantially during the disease trajectory, mainly due to institutional care costs. For people who remained living in the community, mean health and social care costs are higher for people with dementia than for those without dementia, while for those who are admitted to a long‐term care facility, mean health and social care costs are higher for people without dementia than for those with dementia. Conclusions: The steep rise in health and social care costs across the dementia care trajectory is mainly due to increasing costs for institutional care. For those remaining in the community, home care costs and hospital care costs were the main cost drivers. Future research should adopt a societal perspective to investigate the influence of including social costs. Key points: Health and social care costs among persons with dementia increase substantially during the disease trajectory.This steep rise in costs during the disease trajectory is mainly due to institutional care costs.For people who remained living in the community, mean health and social care costs are higher for people with dementia than for those without dementia.For people who are admitted to a long‐term care facility, mean health and social care costs are higher for people without dementia than for those with dementia. [ABSTRACT FROM AUTHOR]

Aims: Medication non‐adherence is a type of adverse drug event that can lead to untreated and exacerbated chronic illness, and that drives healthcare utilization. Research using medication claims data has attempted to identify instances of medication non‐adherence using the proportion of days covered or by examining gaps between medication refills. We sought to validate these measures compared to a gold standard diagnosis of non‐adherence made in hospital. Methods: This was a retrospective analysis of adverse drug events diagnosed during three prospective cohorts in British Columbia between 2008 and 2015 (n = 976). We linked prospectively identified adverse drug events to medication claims data to examine the sensitivity and specificity of typical non‐adherence measures. Results: The sensitivity of the non‐adherence measures ranged from 22.4% to 37.5%, with a proportion of days covered threshold of 95% performing the best; the non‐persistence measures had sensitivities ranging from 10.4% to 58.3%. While a 7‐day gap was most sensitive, it classified 61.2% of the sample as non‐adherent, whereas only 19.6% were diagnosed as such in hospital. Conclusions: The methods used to identify non‐adherence in administrative databases are not accurate when compared to a gold standard diagnosis by healthcare providers. Research that has relied on administrative data to identify non‐adherent patients both underestimates the magnitude of the problem and may label patients as non‐adherent who were in fact adherent. [ABSTRACT FROM AUTHOR]

Background and aims: Longitudinal studies have revealed that substance use treatment use is often recurrent among patients; the longitudinal patterns and characteristics of those treatment trajectories have received less attention, particularly in the global south. This study aimed to disentangle heterogeneity in treatment use among adult patients in Chile by identifying distinct treatment trajectory groups and factors associated with them. Design: National‐level registry‐based retrospective cohort. Setting and participants: Adults admitted to publicly funded substance use disorder treatment programs in Chile from November 2009 to November 2010 and followed for 9 years (n = 6266). Measurements Monthly treatment use; type of treatment; ownership of the treatment center; discharge status; primary substance used; sociodemographic. Findings A seven‐class treatment trajectory solution was chosen using latent class growth analysis. We identified three trajectory groups that did not recur and had different treatment lengths: Early discontinuation (32%), Less than a year in treatment (19.7%) and Year‐long episode, without recurrence (12.3%). We also identified a mixed trajectory group that had a long first treatment or two treatment episodes with a brief time between treatments: Long first treatment, or immediate recurrence (6.3%), and three recurrent treatment trajectory groups: Recurrent and decreasing (14.2%), Early discontinuation with recurrence (9.9%) and Recurrent after long between treatments period (5.7%). Inpatient or outpatient high intensity (vs. outpatient low intensity) at first entry increased the odds of being in the longer one‐episode groups compared with the Early discontinuation group. Women had increased odds of belonging to all the recurrent groups. Using cocaine paste (vs. alcohol) as a primary substance decreased the odds of belonging to long one‐episode groups. Conclusions: In Chile, people in publicly funded treatment for substance use disorder show seven distinct care trajectories: three groups with different treatment lengths and no recurring episodes, a mixed group with a long first treatment or two treatment episodes with a short between‐treatment‐episodes period and three recurrent treatment groups. [ABSTRACT FROM AUTHOR]

Purpose: To characterize antibiotic utilization for outpatient community‐acquired pneumonia (CAP) in the United States. Methods: We conducted a cohort study among adults 18–64 years diagnosed with outpatient CAP and a same‐day guideline‐recommended oral antibiotic fill in the MarketScan® Commercial Database (2008–2019). We excluded patients coded for chronic lung disease or immunosuppressive disease; recent hospitalization or frequent healthcare exposure (e.g., home wound care, patients with cancer); recent antibiotics; or recent infection. We characterized utilization of broad‐spectrum antibiotics (respiratory fluoroquinolone, β‐lactam + macrolide, β‐lactam + doxycycline) versus narrow‐spectrum antibiotics (macrolide, doxycycline) overall and by patient‐ and provider‐level characteristics. Per 2007 IDSA/ATS guidelines, we stratified analyses by otherwise healthy patients and patients with comorbidities (coded for diabetes; chronic heart, liver, or renal disease; etc.). Results: Among 263 914 otherwise healthy CAP patients, 35% received broad‐spectrum antibiotics (not recommended); among 37 161 CAP patients with comorbidities, 44% received broad‐spectrum antibiotics (recommended). Ten‐day antibiotic treatment durations were the most common for all antibiotic classes except macrolides. From 2008 to 2019, broad‐spectrum antibiotic use substantially decreased from 45% to 19% in otherwise healthy patients (average annual percentage change [AAPC], −7.5% [95% CI −9.2%, −5.9%]), and from 55% to 29% in patients with comorbidities (AAPC, −5.8% [95% CI −8.8%, −2.6%]). In subgroup analyses, broad‐spectrum antibiotic use varied by age, geographic region, provider specialty, and provider location. Conclusions: Real‐world use of broad‐spectrum antibiotics for outpatient CAP declined over time but remained common, irrespective of comorbidity status. Prolonged duration of therapy was common. Antimicrobial stewardship is needed to aid selection according to comorbidity status and to promote shorter courses. [ABSTRACT FROM AUTHOR]

As long as welfare arrangements have been in existence, there has been a strong belief that high‐benefit generosity leads to welfare reliance. In this study, we investigate whether an increase in welfare generosity in Norway resulted in higher social assistance (SA) uptake and decreased engagement in paid work. By utilizing high‐quality administrative data and employing a difference‐in‐difference design, we find no overall effects on SA or work activity. However, we do observe a significant reduction in work activity and an increase in SA for specific predefined high‐risk groups, which are believed to be particularly responsive to financial incentives. Thus, we discover evidence of unfavorable effects for child families, non‐Western immigrants, and the combined group of non‐Western immigrant child families. These latter findings are interpreted in light of the particular socioeconomic circumstances of these groups. [ABSTRACT FROM AUTHOR]

Background: Chronic health conditions impact worker outcomes but are challenging to measure using administrative workers' compensation (WC) data. The Functional Comorbidity Index (FCI) was developed to predict functional outcomes in community‐based adult populations, but has not been validated for WC settings. We assessed a WC‐based FCI (additive index of 18 conditions) for identifying chronic conditions and predicting work outcomes. Methods: WC data were linked to a prospective survey in Ohio (N = 512) and Washington (N = 2,839). Workers were interviewed 6 weeks and 6 months after work‐related injury. Observed prevalence and concordance were calculated; survey data provided the reference standard for WC data. Predictive validity and utility for control of confounding were assessed using 6‐month work‐related outcomes. Results: The WC‐based FCI had high specificity but low sensitivity and was weakly associated with work‐related outcomes. The survey‐based FCI suggested more comorbidity in the Ohio sample (Ohio mean = 1.38; Washington mean = 1.14), whereas the WC‐based FCI suggested more comorbidity in the Washington sample (Ohio mean = 0.10; Washington mean = 0.33). In the confounding assessment, adding the survey‐based FCI to the base model moved the state effect estimates slightly toward null (<1% change). However, substituting the WC‐based FCI moved the estimate away from null (8.95% change). Conclusions: The WC‐based FCI may be useful for identifying specific subsets of workers with chronic conditions, but less useful for chronic condition prevalence. Using the WC‐based FCI cross‐state appeared to introduce substantial confounding. We strongly advise caution—including state‐specific analyses with a reliable reference standard—before using a WC‐based FCI in studies involving multiple states. [ABSTRACT FROM AUTHOR]

Studies on health insurance coverage often rely on measures self‐reported by respondents, but the accuracy of such measures has not been thoroughly validated. This paper is the first to use linked Australian National Health Survey and administrative population tax data to explore the accuracy of self‐reported private health insurance (PHI) coverage in survey data. We find that 11.86% of individuals misreport their PHI coverage status, with 11.57% of true PHI holders reporting that they are uninsured and 12.37% of true non‐insured persons self‐identifying as insured. Our results show reporting errors are systematically correlated with individual and household characteristics. Our evidence on the determinants of errors is supportive of common reasons for misreporting. We directly investigate biases in the determinants of PHI enrollment using survey data. We find that, as compared to administrative data, survey data depict a quantitatively different picture of PHI enrollment determinants, especially those capturing age, gender, language proficiency, labor force status, disability status, number of children in the household, or household income. We also show that PHI coverage misreporting is subsequently associated with misreporting of reasons for purchasing PHI, type of cover and length of cover. [ABSTRACT FROM AUTHOR]

The article discusses the labor market trajectories of Australian university graduates from various disadvantaged social backgrounds over a ten-year period using population-wide linked administrative data. It addresses gaps in existing research by providing a comprehensive and methodologically robust analysis of post-graduation outcomes, including income, employment, and unemployment benefit receipt, while emphasizing the implications for labor market policies aimed at improving social equity.

Purpose: To examine prescriptions of valproate and oral antiepileptic drugs (OAED) in Germany irrespective of the indication in women in general and particularly in women of childbearing age (13–49 years) and during pregnancy between 2010 and 2020, that is, before, during and after the implementation of the EU risk minimization measures (RMMs). Methods: Analysis of claims data. Study population: all women continuously insured with the AOK health insurance fund in the respective observation year (2010–2020) and the previous year. OAED were identified by ATC code N03. Period of pregnancy was calculated based on birth information in claims data. Main outcomes measures: (i) prevalent use of valproate/OAED: number of women with at least one prescription of valproate/OAED per year divided by all women of the study population (rate per 1000 women); (ii) percentage of OAED recipients with at least one valproate prescription during pregnancy (13–49 years) in the respective observation year. Results: Prevalence rate/1000 women for valproate use decreased by −31.33% across all age groups (2010–2014: −7.48%; 2014–2018: −16.47%; 2018–2020: −11,17%) with a strong reduction in women 13–49 years between 2014 and 2018 (−28.74%). The rate for OAED across all age groups rose from 33.43/1000 women in 2010 to 41.03/1000 (+22,73%). Valproate use during pregnancy of women with OAED declined from 1.29% in 2010 to 0.59% in 2020 (−54,26%) (2010–2014: −5.14%; 2014–2018: −42.31%; 2018–2020: −16.69%). Conclusion: Even if, due to the descriptive nature of the study, no causal relationship can be postulated between the RMMs and the strong decrease in valproate prescriptions, our results are compatible with the hypothesis that the measures have improved drug therapy safety. [ABSTRACT FROM AUTHOR]

Objective: Understand health resource, medication use, and cost of adults with chronic migraine who received guideline‐recommended onabotulinumtoxinA (botulinum toxin) treatment frequency and then continued or reduced/stopped. Background: Botulinum toxin may be a beneficial treatment for chronic migraine; the trajectory of health resources utilization among those with continued or reduced/stopped use is unclear. Methods: A retrospective population‐based cohort study utilizing administrative data from Alberta, Canada (2012–2020), was performed. A cohort of adults who received ≥5 botulinum toxin treatment cycles for chronic migraine over 18 months (6‐month run‐in; 1‐year pre‐index period) were grouped into those who (1) continued use (≥3 treatments/year), or (2) stopped or reduced use (stopped for 6 months then received 0 or 1–2 treatments/year, respectively) over a 1‐year post‐index period. Health resources and medication use were described, and pre–post costs were assessed. A second cohort that received ≥3 treatments/year immediately followed by 1 year of stopped or reduced use was considered in sensitivity analysis. Results: Pre–post health resource, medication use, and costs were similar among those with continued use (n = 3336). Among those who stopped or reduced use (n = 1099; 756 stopped, 343 reduced), health resource, medication use, and costs were lower in the post‐ (total median per‐person cost [IQR]: all‐cause $4851 [$8090]; migraine‐related $835 [$1915]) versus pre‐ (all‐cause $6096 [$7207]; migraine‐related $2995 [$1950]) index period (estimated cost ratios [95% CI]: total all‐cause 0.86 [0.79, 0.95]; total migraine‐related 0.44 [0.40, 0.48]). In the second cohort (n = 3763), return to continued use (≥3 treatments/year) occurred in up to 70.4% in those with reduced use. Conclusions: Of adults treated with botulinum toxin for chronic migraine, 75.2% had continued use, stable health resource and medication use, and costs over a 2 year period. In those that stopped/reduced use, the observed lower health resource and migraine medication use may indicate improved symptom control, but the resumption of guideline‐recommended treatment intervals after reduced use was common. [ABSTRACT FROM AUTHOR]

Study Objective: The objective of this work is to describe the risk of fracture in adults aged 17 to 64 years across categories of daily opioid dose. Design: A retrospective analysis of insurance claims data. Data source: Information from a private health insurance provider for the years 2003–2014 for enrolled individuals living in Iowa. Patients: Patients who were aged 17 to 64 years and prescribed an opioid were followed for the length of opioid treatment plus 30 days to determine whether a fracture occurred. Measurements: Average daily morphine milligram equivalent (MME) was determined for patients who received a prescription for opioids. The outcome of interest was incident fracture following opioid treatment initiation. Cox proportional hazard models were used to compare the risk of fracture across categorical groups of average daily MME. Inverse probability weighting was used to control for patient‐level variables. Main Results: In total, 316,024 individual patients were identified in the administrative claims data as having an opioid prescription from 2003 to 2014, and 3038 fractures occurred during follow‐up (9.6 fractures per 1000 opioid‐prescribed patients). Relative to the lowest quartile of prescribed opioid (⟨22 MME), patients in each higher prescribed level were more likely to experience a fracture (22–36 MME Hazard Ratio (HR) = 1.35, 95% Confidence Interval (CI): 1.21–1.51; 37–50 MME HR = 1.38, 95% CI: 1.24–1.54; ⟩50 MME HR = 1.35, 95% CI: 1.20–1.52). Conclusions: We observed an increased fracture risk in all three higher categories of opioid exposure relative to the lowest category (⟨22 MME). The risk of a fracture should be considered in opioid treatment decisions. [ABSTRACT FROM AUTHOR]

Objective: To develop easy to use and validated predictive models to identify beneficiaries experiencing homelessness from administrative data. Data Sources: We pooled enrollment and claims data from enrollees of the California Whole Person Care (WPC) Medicaid demonstration program that coordinated the care of a subset of Medicaid beneficiaries identified as high utilizers in 26 California counties (25 WPC Pilots). We also used public directories of social service and health care facilities. Study Design: Using WPC Pilot‐reported homelessness status, we trained seven supervised learning algorithms with different specifications to identify beneficiaries experiencing homelessness. The list of predictors included address‐ and claims‐based indicators, demographics, health status, health care utilization, and county‐level homelessness rate. We then assessed model performance using measures of balanced accuracy (BA), sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve (area under the curve [AUC]). Data Collection/Extraction Methods: We included 93,656 WPC enrollees from 2017 to 2018, 37,441 of whom had a WPC Pilot‐reported homelessness indicator. Principal Findings: The random forest algorithm with all available indicators had the best performance (87% BA and 0.95 AUC), but a simpler Generalized Linear Model (GLM) also performed well (74% BA and 0.83 AUC). Reducing predictors to the top 20 and top five most important indicators in a GLM model yields only slightly lower performance (86% BA and 0.94 AUC for the top 20 and 86% BA and 0.91 AUC for the top five). Conclusions: Large samples can be used to accurately predict homelessness in Medicaid administrative data if a validated homelessness indicator for a small subset can be obtained. In the absence of a validated indicator, the likelihood of homelessness can be calculated using county rate of homelessness, address‐ and claim‐based indicators, and beneficiary age using a prediction model presented here. These approaches are needed given the rising prevalence of homelessness and the focus of Medicaid and other payers on addressing homelessness and its outcomes. [ABSTRACT FROM AUTHOR]

Whether genetic testing in autism can help understand longitudinal health outcomes and health service needs is unclear. The objective of this study was to determine whether carrying an autism‐associated rare genetic variant is associated with differences in health system utilization by autistic children and youth. This retrospective cohort study examined 415 autistic children/youth who underwent genome sequencing and data collection through a translational neuroscience program (Province of Ontario Neurodevelopmental Disorders Network). Participant data were linked to provincial health administrative databases to identify historical health service utilization, health care costs, and complex chronic medical conditions during a 3‐year period. Health administrative data were compared between participants with and without a rare genetic variant in at least 1 of 74 genes associated with autism. Participants with a rare variant impacting an autism‐associated gene (n = 83, 20%) were less likely to have received psychiatric care (at least one psychiatrist visit: 19.3% vs. 34.3%, p = 0.01; outpatient mental health visit: 66% vs. 77%, p = 0.04). Health care costs were similar between groups (median: $5589 vs. $4938, p = 0.4) and genetic status was not associated with odds of being a high‐cost participant (top 20%) in this cohort. There were no differences in the proportion with complex chronic medical conditions between those with and without an autism‐associated genetic variant. Our study highlights the feasibility and potential value of genomic and health system data linkage to understand health service needs, disparities, and health trajectories in individuals with neurodevelopmental conditions. Lay Summary: In this study, we linked genome‐sequencing data from 415 autistic children and youth to their real‐world health data. We examined their types of medical visits, health care costs, and number of complex medical problems. We found that autistic children with an underlying genetic diagnosis explaining their autism were less likely to have received mental health care than children without a genetic diagnosis. [ABSTRACT FROM AUTHOR]

Background: Children with congenital heart defects (CHD) are twice as likely as their peers to be born preterm (<37 weeks' gestation), yet descriptions of recent trends in long‐term survival by gestational age at birth (GA) are lacking. Objectives: To quantify changes in survival to age 5 years of children in England with severe CHD by GA. Methods: We estimated changes in survival to age five of children with severe CHD and all other children born in England between April 2004 and March 2016, overall and by GA‐group using linked hospital and mortality records. Results: Of 5,953,598 livebirths, 5.7% (339,080 of 5,953,598) were born preterm, 0.35% (20,648 of 5,953,598) died before age five and 3.6 per 1000 (21,291 of 5,953,598) had severe CHD. Adjusting for GA, under‐five mortality rates fell at a similar rate between 2004–2008 and 2012–2016 for children with severe CHD (adjusted hazard ratio [HR] 0.79, 95% CI 0.71, 0.88) and all other children (HR 0.78, 95% CI 0.76, 0.81). For children with severe CHD, overall survival to age five increased from 87.5% (95% CI 86.6, 88.4) in 2004–2008 to 89.6% (95% CI 88.9, 90.3) in 2012–2016. There was strong evidence for better survival in the ≥39‐week group (90.2%, 95% CI 89.1, 91.2 to 93%, 95% CI 92.4, 93.9), weaker evidence at 24–31 and 37–38 weeks and no evidence at 32–36 weeks. We estimate that 51 deaths (95% CI 24, 77) per year in children with severe CHD were averted in 2012–2016 compared to what would have been the case had 2004–2008 mortality rates persisted. Conclusions: Nine out of 10 children with severe CHD in 2012–2016 survived to age five. The small improvement in survival over the study period was driven by increased survival in term children. Most children with severe CHD are reaching school age and may require additional support by schools and healthcare services. [ABSTRACT FROM AUTHOR]

Background: Lung cancer is the primary cause of cancer mortality and non‐small cell lung cancer (NSCLC) accounts for the majority of lung cancer cases. New drug treatments have been developed since 2010 but there are concerns about the increase in medical costs. This study aimed to compare survival and medical costs among patients with NSCLC according to their initial treatment to estimate the impact of early NSCLC detection. Methods: Patients with primary NSCLC who filed insurance claims between April 2013 and March 2019 were identified using the Kyoto City Integrated Database. Patients were divided into two groups depending on their initial treatment: the resection group and drug or radiation group. The survival and medical costs were calculated. Results: A total of 2609 patients with primary NSCLC were identified. Among them, 1035 patients underwent resection. The 5‐year survival was 75% for the resection group while below 25% for the drug or radiation group. At 6 months of survival, the median cumulative total cost was 2409 thousand yen (interquartile range [IQR] 1947–4012 thousand yen) in the resection group and 2951 thousand yen (IQR 1600–4706 thousand yen) in the drug or radiation group. At 4 years of survival, the cumulative median total cost was 5257 thousand yen (IQR 3808–8243 thousand yen) in the resection group and 10 202 thousand yen (IQR 4845–20 450 thousand yen) in the drug or radiation group. Conclusions: As a first‐line therapy in newly diagnosed patients with NSCLC, surgical resection is associated with longer survival and lower medical costs than pharmacotherapy or radiotherapy. [ABSTRACT FROM AUTHOR]

Purpose: The current study aimed to identify differences in Veterans Affairs (VA) chronic pain care for Black, Asian, and Hispanic Americans, compared to non‐Hispanic White Americans, and examine the intersection of race and rurality. Methods: Using national administrative data, all veterans who presented to the VA for chronic pain in 2018 were included. Demographic and comorbidity variables were built from 2018 data and health care utilization variables from 2019 data. Multivariate log‐binomial regression models examined differences between racialized groups, and interactions with rural/urban residence, for each health care utilization variable. Findings: The full cohort included 2,135,216 veterans with chronic pain. There were no differences between racialized groups in pain‐related primary care visits. Black Americans were less likely to receive pain clinic visits (aRR = 0.87, CI: 0.86‐0.88). Rurality further decreased the likelihood of Black Americans visiting a pain clinic. Black, Hispanic, and Asian Americans were more likely to receive pain‐related physical therapy visits relative to White Americans. Black and Hispanic Americans were more likely to present to emergency/urgent care for chronic pain. While there were no differences in pain‐related primary care visits, the decreased likelihood of pain clinic visits and increased use of emergency department/urgent care among Black Americans could indicate inadequate management of chronic pain. Conclusions: Tailored strategies are needed to provide equitable care that meets the needs of patients from racialized groups while accounting for systemic and cultural factors. [ABSTRACT FROM AUTHOR]

Aim: Little is known about the attitudes of Australian patients with a history of breast cancer toward the reuse of administrative health data and clinical trial data. Issues of consent, privacy, and information security are key to the discussion. Cancer care and research provides an opportune setting to develop an understanding of attitudes toward data sharing and reuse in individuals with a history of breast cancer. Methods: An anonymous, online questionnaire for individuals with a history or diagnosis of breast cancer was distributed by two peak bodies (Breast Cancer Trials [BCT] and Breast Cancer Network of Australia [BCNA]) to their memberships between July 14, 2020 and October 17, 2020. Results were captured in RedCap; data analysis was undertaken using Stata, and a thematic analysis of free text responses was undertaken using NVivo. Results: One hundred and thirty‐two complete responses were received. Twenty‐three percent of respondents had participated in a clinical trial, and 12% were currently receiving treatment (chemotherapy, radiotherapy, surgery, or endocrine). Respondents were supportive of the secondary use of de‐identified administrative health data and clinical trial data, but showed concern about data security and privacy. Respondents emphasized that the reuse of data should be for improved societal health outcomes, not profit. Many assumed secondary analysis was already undertaken on de‐identified administrative health data and clinical trial data. Conclusions: Respondents were supportive of the secondary use of de‐identified administrative health and clinal trial data within the established bounds of good clinical practice and ethical oversight. [ABSTRACT FROM AUTHOR]

Western North America experienced an unprecedented extreme heat event (EHE) in 2021, characterized by high temperatures and reduced air quality. There were approximately 740 excess deaths during the EHE in the province of British Columbia, making it one of the deadliest weather events in Canadian history. It is important to understand who is at risk of death during EHEs so that appropriate public health interventions can be developed. This study compares 1,614 deaths from 25 June to 02 July 2021 with 6,524 deaths on the same dates from 2012 to 2020 to examine differences in the prevalence of 26 chronic diseases between the two groups. Conditional logistic regression was used to estimate the odds ratio (OR) for each chronic disease, adjusted for age, sex, and all other diseases, and conditioned on geographic area. The OR [95% confidence interval] for schizophrenia among all EHE deaths was 3.07 [2.39, 3.94], and was larger than the ORs for other conditions. Chronic kidney disease and ischemic heart disease were also significantly increased among all EHE deaths, with ORs of 1.36 [1.18, 1.56] and 1.18 [1.00, 1.38], respectively. Chronic diseases associated with EHE mortality were somewhat different for deaths attributed to extreme heat, deaths with an unknown/pending cause, and non‐heat‐related deaths. Schizophrenia was the only condition associated with significantly increased odds of EHE mortality in all three subgroups. These results confirm the role of mental illness in EHE risk and provide further impetus for interventions that target specific groups of high‐risk individuals based on underlying chronic conditions. Plain Language Summary: Western North America experienced the most severe extreme heat event (EHE) ever recorded in the region during the summer of 2021. There were approximately 740 more deaths than usual in British Columbia, Canada during the EHE, which made it one of the deadliest weather events in Canadian history. This study compares people who died during the EHE with people who died at the same time of year in other years to identify differences between the two groups with respect to 26 chronic diseases. We found that people with schizophrenia were at much higher risk than others during the EHE. People with chronic kidney disease and ischemic heart disease were also at increased risk. This information will be used to help develop programs that support people at higher risk during future EHEs. Key Points: British Columbia experienced an unprecedented extreme heat event (EHE) in summer 2021 associated with a 95% increase in population mortalityDeaths during the EHE and previous years were compared with respect to chronic diseases present at time of deathSchizophrenia was most strongly associated with higher risk of death during the EHE [ABSTRACT FROM AUTHOR]

Aim: To estimate the relative risk of sudden unexpected death in infancy (SUDI) by district health board (DHB) in New Zealand after adjustment for socio‐economic deprivation, ethnicity and other demographic factors. Methods: We conducted a population‐based cohort study using data from the Integrated Data Infrastructure, a large research database containing linked data from a range of government agencies. The study population was all live births and their mothers in New Zealand from 2012 to 2018. The exposure of interest was DHB. The outcome was SUDI. Results: There were 418 068 live births in New Zealand from 2012 to 2018, and of these 415 401 (99.4%) had valid DHB data. There was considerable variation in the proportion of infants in each DHB living in the most deprived decile varying from 4.5% in Nelson, West Coast and Canterbury to 29.7% in Counties Manukau. There were 267 SUDI cases, giving an overall rate of 0.64/1000 live births during the study period (2012–2018). The SUDI rate varied from 1.11/1000 in Northland to 0.30/1000 in Waitemata and Auckland. Counties Manukau had the largest number of deaths (n = 54; rate = 1.08/1000). Five DHB regions had increased risk of SUDI compared to the reference group but, after adjustment, no DHB was significantly increased. Conclusions: This study found that there is marked variation in SUDI risk by DHB, but this is explained by socio‐economic and demographic variation within DHBs. This study emphasises the importance of the contribution of social determinants of health to SUDI. [ABSTRACT FROM AUTHOR]

Purpose: Acute otitis media (AOM) is a common indication for antibiotics in children. We sought to characterize the frequency of nonguideline concordant antibiotic therapy for AOM in the United States, by agent and duration. Methods: Using national administrative claims data (2016–2019), we identified children aged 6 months to 17 years with an oral antibiotic dispensed within 3 days of a new diagnosis of suppurative AOM. Use of nonguideline concordant agents and durations, defined based on national treatment guidelines, were summarized by age, race, rurality, region, and insurance type. Subsequent oral antibiotic dispensing within the year after AOM diagnosis was also evaluated. We created sunburst diagrams to visualize longitudinal patterns of within‐person antibiotic utilization for AOM, by agent and duration. Results: We identified 789 424 eligible commercially‐insured and 502 239 medicaid‐insured children. Among commercially insured children, 35% received nonguideline concordant agents for AOM, including cefdinir (16%), amoxicillin‐clavulanate (12%), and azithromycin (7%). Fewer children age <2 years received a nonguideline concordant initial agent (27%) compared to age ≥6 years (41%). More children age <2 years received three or more antibiotics over the following year (34% vs. 3% for children age ≥6 years). The most common treatment duration was 10 days for all ages; treatment duration for the initial antibiotic was nonguideline concordant for 95% and 89% of children age 2–5 years and ≥6 years, respectively. Patterns were similar for medicaid‐insured children. Conclusions: Nonguideline concordant antibiotic use is common when treating AOM in children, including use of broad‐spectrum agents and longer‐than‐recommended antibiotic durations. [ABSTRACT FROM AUTHOR]

Background: Rates of death and avoidable deaths are reportedly higher among people with intellectual and developmental disabilities. This study contributes to our understanding of how mortality and intellectual and development disabilities are associated. Method: General population and intellectual and developmental disabilities adult cohorts were defined using linked administrative data. All‐cause and amenable deaths between 2010 and 2015 were reported for these cohorts and subcohorts with and without Down syndrome. Cox proportional hazards models evaluated the impact of potential contributors to amenable deaths. Results: Adults with intellectual and developmental disabilities had higher all‐cause (6.1 vs. 1.6%) and amenable death percentages (21.4 vs. 14.1%) than general population comparators. Within intellectual and developmental disabilities, those with Down syndrome had higher all‐cause (12.0 vs. 6.0%) but lower amenable death percentages (19.2 vs. 21.8%) than those without. Conclusions: Results suggest that interventions to reduce amenable deaths target provider‐care‐recipient interactions and coordination across care and support sectors. [ABSTRACT FROM AUTHOR]

Background: Respiratory syncytial virus (RSV) is a leading cause of acute lower respiratory infection (ALRI) in young children and is of considerable burden on healthcare systems. Our study aimed to evaluate ALRI hospitalizations related to RSV in children in Portugal. Methods: We reviewed hospitalizations potentially related to RSV in children aged <5 years from 2015 to 2018, using anonymized administrative data covering all public hospital discharges in mainland Portugal. Three case definitions were considered: (a) RSV‐specific, (b) (a) plus unspecified acute bronchiolitis (RSV‐specific & Bronchiolitis), and (c) (b) plus unspecified ALRI (RSV‐specific & ALRI). Results: A total of 9697 RSV‐specific hospitalizations were identified from 2015 to 2018—increasing to 26 062 for RSV‐specific & ALRI hospitalizations—of which 74.7% were during seasons 2015/2016–2017/2018 (November–March). Mean hospitalization rates per season were, for RSV‐specific, RSV‐specific & Bronchiolitis, and RSV‐specific & ALRI, respectively, 5.6, 9.4, and 11.8 per 1000 children aged <5 years and 13.4, 22.5, and 25.9 in children aged <2 years. Most RSV‐specific hospitalizations occurred in healthy children (94.9%) and in children aged <2 years (96.3%). Annual direct costs of €2.4 million were estimated for RSV‐specific hospitalizations—rising to €5.1 million for RSV‐specific & ALRI—mostly driven by healthy children (87.6%). Conclusion: RSV is accountable for a substantial number of hospitalizations in children, especially during their first year of life. Hospitalizations are mainly driven by healthy children. The variability of the potential RSV burden across case definitions highlights the need for a universal RSV surveillance system to guide prevention strategies. [ABSTRACT FROM AUTHOR]

Summary: This paper proposes an instrumental variable regression estimator of population totals using a sample, a set of links between the sample units and records on an administrative file, and a set of calibration totals calculated from the administrative file. This paper proposes a survey‐weighted estimator of a population total that is valid when the survey non‐response mechanism is non‐ignorable and false negatives occur in the administrative‐survey linkage. False negatives lead to measurement error in the administrative variables that are available on the survey and will lead to biased estimates if not taken into account. We show the benefit of the proposed approach in a simulation and in a case study. [ABSTRACT FROM AUTHOR]

Health administrative data are oftentimes of limited use in epidemiological study on drug safety in pregnancy, due to lacking information on gestational age at birth (GAB). Although several studies have proposed algorithms to estimate GAB using claims database, failing to incorporate the unique distributional shape of GAB, can introduce bias in estimates and subsequent modeling. Hence, we develop a Bayesian latent class model to predict GAB. The model employs a mixture of Gaussian distributions with linear covariates within each class. This approach allows modeling heterogeneity in the population by identifying latent subgroups and estimating class‐specific regression coefficients. We fit this model in a Bayesian framework conducting posterior computation with Markov Chain Monte Carlo methods. The method is illustrated with a dataset of 10,043 Rhode Island Medicaid mother–child pairs. We found that the three‐class and six‐class mixture specifications maximized prediction accuracy. Based on our results, Medicaid women were partitioned into three classes, featured by extreme preterm or preterm birth, preterm or" early" term birth, and" late" term birth. Obstetrical complications appeared to pose a significant influence on class‐membership. Altogether, compared to traditional linear models our approach shows an advantage in predictive accuracy, because of superior flexibility in modeling a skewed response and population heterogeneity. [ABSTRACT FROM AUTHOR]

Using rich administrative and household survey data spanning 34 years from 1985 to 2018, we document a series of new facts on earnings inequality and dynamics in a developing country with a large informal sector: Brazil. Since the mid-1990s, both inequality and volatility of earnings have declined significantly in Brazil's formal sector. Higher-order moments of the distribution of earnings changes show cyclical movements in Brazil that are similar to those in developed countries like theUS. Relative to the formal sector, the informal sector is associated with a significant earnings penalty and higher earnings volatility for identical workers. Earnings changes of workers who switch from formal to informal (from informal to formal) employment are relatively negative (positive) and large in magnitude, dispersed, negatively (positively) skewed, and less leptokurtic. Our results suggest that informal employment is an imperfect insurance mechanism. [ABSTRACT FROM AUTHOR]

This paper studies earnings inequality and dynamics in Argentina between 1996 and 2015. Following the 2001-2002 crisis, the Argentine economy transitioned from a low- to a high-inflation regime, while collective bargaining and the minimum wage gained influence. This transition was associated with a persistent decrease in earnings dispersion and cyclical movements in higher-order moments of the distribution of earnings changes. To shed light on the changing nature of wage rigidity during this period, we develop a new method to estimate regularwage processes. As the Argentine economy transitioned from low to high inflation, the monthly frequency of regular-wage changes almost doubled, while the distribution of regular-wage changes morphed from having a mode around zero and positive skewness to having a positive mode and more symmetric tails. [ABSTRACT FROM AUTHOR]

The Global Repository of Income Dynamics (GRID) is a new open-access, crosscountry database that contains a wide range of micro statistics on income inequality, dynamics, and mobility. It has four key characteristics: it is built on micro panel data drawn from administrative records; it fully exploits the longitudinal dimension of the underlying data sets; it offers granular descriptions of income inequality and income dynamics for finely defined subpopulations; and it is designed from the ground up with the goals of harmonization and cross-country comparability. This paper introduces the database and presents a set of global trends in income inequality and income dynamics across the 13 countries that are currently in GRID. Our results are based on the statistics created for GRID by the 13 country teams who also contributed to this special issue with individual articles. [ABSTRACT FROM AUTHOR]

Real‐world data are considered a potentially valuable source of evidence for assessing medical technologies in clinical practice, but their widespread use is hampered by numerous challenges. Using the case of coronary stents in Italy, we investigate the potential of administrative databases for estimating costs and health outcomes associated with the use of medical devices in real world conditions. An administrative dataset was created ad hoc by merging hospital records from patients admitted between 2013 and 2019 for stent implantations with ambulatory records, pharmaceutical use data and vital statistics. Health outcomes were multifold: all‐cause and cardiac mortality and myocardial infarction, within 30 days, 1, 2, 5 years. Costs were estimated from the National Health System perspective. We used multivariable Cox models and propensity score (PS) methods (PS matching; stratification on PS; inverse probability of treatment weighting using PS; PS adjustment). 257,907 coronary stents were implanted in 113,912 patients. For all health outcomes and follow‐up times, and across all methods, patients receiving drug‐eluting stents (DES) presented lower risk. For all‐cause mortality, the DES patient advantage over bare‐metal stent (BMS) patients declined over time but remained significant even at 5 years. For myocardial infarction, results remained quite stable. The DES group presented lower cumulative total costs (ranging from 3264 to 2363 Euros less depending on methods). Our results confirm the consolidated evidence of the benefits of DES compared to BMS. The consistency of results across methods suggests internal validity of the study, while highlighting strengths and limitations of each depending on research context. Administrative data yield great potential to perform comparative effectiveness and cost‐effectiveness analysis of medical devices provided certain conditions are met. [ABSTRACT FROM AUTHOR]

Purpose: Health care insurance claims databases are becoming a more common data source for studies of medication safety during pregnancy. While pregnancies have historically been identified in such databases by pregnancy outcomes, International Classification of Diseases, 10th revision Clinical Modification (ICD‐10‐CM) Z3A codes denoting weeks of gestation provide more granular information on pregnancies and pregnancy periods (i.e., start and end dates). The purpose of this study was to develop a process that uses Z3A codes to identify pregnancies, pregnancy periods, and links infants within a commercial health insurance claims database. Methods: We identified pregnancies, gestation periods, pregnancy outcomes, and linked infants within the US‐based Optum Research Database between 2015 and 2020 via a series of algorithms utilizing diagnosis and procedure codes on claims. The diagnosis and procedure codes included ICD‐10‐CM codes, Current Procedural Terminology (CPT) codes, and Healthcare Common Procedure Coding System (HCPCS) codes. Results: We identified 1 030 874 pregnancies among 841 196 women of reproductive age. Of pregnancies with livebirth outcomes, 84% were successfully linked to infants. The prevalence of pregnancy outcomes (livebirth, stillbirth, ectopic, molar, and abortion) was similar to national estimates. Conclusions: This process provides an opportunity to study drug safety and care patterns during pregnancy and may be replicated in other claims databases containing ICD‐10‐CM, CPT, and HCPCS codes. Work is underway to validate and refine the various algorithms. [ABSTRACT FROM AUTHOR]

A rapidly growing literature examines the impacts of COVID‐19 on consumer spending and business operations. However, little is yet known about its effects on the food industry. We contribute to this topic by quantifying the effects of COVID‐19 on the Taiwanese food industry, including food manufacturing, wholesale, retail and service sectors. Using administrative data on the business transactions of food industry firms in Taiwan with a difference‐in‐differences model, we find that COVID‐19 reduced the total sales value of the food industry by 24%. However, the negative effects are unequally distributed among different sectors of the food industry. The negative effect is more pronounced in the food manufacturing sector. We also find a substantial impact in urban areas, high‐income areas and areas with a larger proportion of elderly population. Compared to most of the countries that implemented mandatory lockdowns to cope with COVID‐19, Taiwan maintained good control over the pandemic in 2020. The mobility of Taiwanese residents is much higher than those of other countries with severe infection rates. However, we show that there are still significant economic impacts on the food industry in Taiwan. [ABSTRACT FROM AUTHOR]

Purpose Validating outcome measures is a prerequisite for using administrative databases for comparative effectiveness research. Although the Japanese Diagnosis Procedure Combination database is widely used in surgical studies, the outcome measure for postsurgical infection has not been validated. We developed a model to identify postsurgical infections using the routinely collected Diagnosis Procedure Combination data. Methods: We retrospectively identified inpatients who underwent surgery for gastric, colon, or liver cancer between April 2016 and March 2018 at four hospitals. Chart reviews were conducted to identify postsurgical infections. We used bootstrap analysis with backwards variable elimination to select independent variables from routinely collected diagnosis and procedure data. Selected variables were used to create a score predicting the chart review‐identified infections, and the performance of the score was tested. Results: Among the 746 eligible patients, 96 patients (13%) had postoperative infections. Three variables were identified as predictors: diagnosis of infectious disease recorded as a complication arising after admission, addition of an intravenous antibiotic, and bacterial microscopy or culture. The prediction model had a C‐statistic of 0.885 and pseudo‐R2 of 0.358. A cut‐off of one point of the score showed a sensitivity of 92% and specificity of 72%, and a cut‐off of two points showed a sensitivity of 75% and specificity of 91%. Conclusions: Our model using routinely collected administrative data accurately identified postoperative infections. Further external validation would lead to the application of the model for research using administrative databases. [ABSTRACT FROM AUTHOR]

Gender data are essential for assessing gender‐equitable outcomes for children. However, significant data gaps continue to compromise country ability to implement gender‐responsive policies and monitor gender equality. This study explores the potential role of administrative systems in filling critical gender data gaps. It notes the substantial challenges to sourcing gender data from administrative systems—challenges related to limitations of administrative data itself, and challenges specific to the production and use of gender statistics. Overall, while data from administrative systems alone cannot address all gender data gaps, they are critical to a holistic approach to addressing national gender data needs. [ABSTRACT FROM AUTHOR]

Aims: To estimate the treated prevalence of mental illness, substance use disorder (SUD) and dual diagnosis and the association between dual diagnosis and fatal and non‐fatal overdose among residents of British Columbia (BC), Canada. Design A retrospective cohort study using linked health, income assistance, corrections and death records. Setting: British Columbia (BC), Canada. Participants: A total of 921 346 BC residents (455 549 males and 465 797 females) aged 10 years and older. Measurements Hospital and primary‐care administrative data were used to identify a history of mental illness only, SUD only, dual diagnosis or no history of SUD or mental illness (2010–14) and overdoses resulting in medical care (2015–17). We calculated crude incidence rates of non‐fatal and fatal overdose by dual diagnosis history. Andersen–Gill and competing risks regression were used to examine the association between dual diagnosis and non‐fatal and fatal overdose, respectively, adjusting for age, sex, comorbidities, incarceration history, social assistance, history of prescription opioid and benzodiazepine dispensing and region of residence. Findings Of the 921 346 people in the cohort, 176 780 (19.2%), 6147 (0.7%) and 15 269 (1.7%) had a history of mental illness only, SUD only and dual diagnosis, respectively; 4696 (0.5%) people experienced 688 fatal and 6938 non‐fatal overdoses. In multivariable analyses, mental illness only, SUD only and dual diagnosis were associated with increased rate of non‐fatal [hazard ratio (HR) = 1.8, 95% confidence interval (CI) = 1.6–2.1; HR = 9.0, 95% CI = 7.0–11.5, HR = 8.7, 95% CI = 6.9–10.9, respectively] and fatal overdose (HR = 1.6, 95% CI = 1.3–2.0, HR = 4.3, 95% CI = 2.8–6.5, HR = 4.1, 95% CI = 2.8–6.0, respectively) compared with no history. Conclusions: In a large sample of residents of British Columbia (Canada), approximately one in five people had sought care for a substance use disorder or mental illness in the past 5 years. The rate of overdose was elevated in people with a mental illness alone, higher again in people with a substance use disorder alone and highest in people with a dual diagnosis. The adjusted hazard rates were similar for people with substance use disorder only and people with a dual diagnosis. [ABSTRACT FROM AUTHOR]

Background: We aimed to identify and characterize adult population‐based multimorbidity measures using health administrative data and the International Classification of Diseases (ICD) codes for disease identification. Methods: We performed a narrative systematic review of studies using or describing development or validation of multimorbidity measures. We compared the number of diseases included in the measures, the process of data extraction (case definition) and the validation process. We assessed the methodological robustness using eight criteria, five based on general criteria for indicators (AIRE instrument) and three multimorbidity‐specific criteria. Results: Twenty‐two multimorbidity measures were identified. The number of diseases they included ranged from 5 to 84 (median = 20), with 19 measures including both physical and mental conditions. Diseases were identified using ICD codes extracted from inpatient and outpatient data (18/22) and sometimes including drug claims (10/22). The validation process relied mainly on the capacity of the measures to predict health outcome (5/22), or on the validation of each individual disease against a gold standard (8/22). Six multimorbidity measures met at least six of the eight robustness criteria assessed. Conclusion: There is significant heterogeneity among the measures used to assess multimorbidity in administrative databases, and about a third are of low to moderate quality. A more consensual approach to the number of diseases or groups of diseases included in multimorbidity measures may improve comparison between regions, and potentially provide better control for multimorbidity‐related confounding in studies. [ABSTRACT FROM AUTHOR]

Purpose: In clinical practice, warfarin therapy requires frequent dose adjustments. In pharmacy claims, the days supplied value may not reflect the true duration of warfarin dispensation. This may affect the measures of association comparing the safety of direct oral anticoagulants (DOACs) versus warfarin. Methods: Using Quebec healthcare administrative databases, we formed a cohort of 55 230 patients newly treated with oral anticoagulants between 2010 and 2016. The duration of dispensations was defined using two approaches: the recorded days supplied value, and the longitudinal coverage approximation (data‐driven) that may account for individual variation in drug usage patterns. Propensity scores adjusted Cox proportional hazards regression models were used to estimate the hazard ratio (HR) of major bleeding with dabigatran or rivaroxaban versus warfarin. Results: Using the days supplied, the mean (and standard deviation) dispensation durations for dabigatran, rivaroxaban, and warfarin were 19 (15), 19 (14), and 13 (12) days, respectively. Using the data‐driven approach, the durations were 20 (16), 19 (15), and 15 (16) days, respectively. The choice of the approach had no impact on the HR estimates. Conclusions: In our settings, the data‐driven approach closely approximated the recorded days supplied value for the standard dose therapies such as dabigatran and rivaroxaban. For warfarin, the data‐driven approach captured more variability in the duration of dispensations compared to the days supplied value, which may better reflect the true drug‐taking behavior of warfarin. Both approaches may provide valid estimates when comparing the safety of DOACs versus warfarin. [ABSTRACT FROM AUTHOR]

Background: Reduced hospital admission rates for heart failure (HF) and evidence of increased in‐hospital mortality were reported during the COVID‐19 pandemic. The aim of this study was to apply a machine learning (ML)‐based mortality prediction model to examine whether the latter is attributable to differing case mixes and exceeds expected mortality rates. Methods and Results: Inpatient cases with a primary discharge diagnosis of HF non‐electively admitted to 86 German Helios hospitals between 01/01/2016 and 08/31/2020 were identified. Patients with proven or suspected SARS‐CoV‐2 infection were excluded. ML‐based models were developed, tuned, and tested using cases of 2016–2018 (n = 64,440; randomly split 75%/25%). Extreme gradient boosting showed the best model performance indicated by a receiver operating characteristic area under the curve of 0.882 (95% confidence interval [CI]: 0.872–0.893). The model was applied on data sets of 2019 and 2020 (n = 28,556 cases) and the hospital standardized mortality ratio (HSMR) was computed as the observed to expected death ratio. Observed mortality rates were 5.84% (2019) and 6.21% (2020), HSMRs based on an individual case‐based mortality probability were 100.0 (95% CI: 93.3–107.2; p = 1.000) for 2019 and 99.3 (95% CI: 92.5–106.4; p =.850) for 2020. Within subgroups of age or hospital volume, there were no significant differences between observed and expected deaths. When stratified for pandemic phases, no excess death during the COVID‐19 pandemic was observed. Conclusion: Applying an ML algorithm to calculate expected inpatient mortality based on administrative data, there was no excess death above expected event rates in HF patients during the COVID‐19 pandemic. [ABSTRACT FROM AUTHOR]

Objective: To identify and explore differences in spending and utilization of key health services at the end of life among hip fracture patients across seven developed countries. Data Sources: Individual‐level claims data from the inpatient and outpatient health care sectors compiled by the International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC). Study Design: We retrospectively analyzed utilization and spending from acute hospital care, emergency department, outpatient primary care and specialty physician visits, and outpatient drugs. Patterns of spending and utilization were compared in the last 30, 90, and 180 days across Australia, Canada, England, Germany, New Zealand, Spain, and the United States. We employed linear regression models to measure age‐ and sex‐specific effects within and across countries. In addition, we analyzed hospital‐centricity, that is, the days spent in hospital and site of death. Data Collection/Extraction Methods: We identified patients who sustained a hip fracture in 2016 and died within 12 months from date of admission. Principal Findings: Resource use, costs, and the proportion of deaths in hospital showed large variability being high in England and Spain, while low in New Zealand. Days in hospital significantly decreased with increasing age in Canada, Germany, Spain, and the United States. Hospital spending near date of death was significantly lower for women in Canada, Germany, and the United States. The age gradient and the sex effect were less pronounced in utilization and spending of emergency care, outpatient care, and drugs. Conclusions: Across seven countries, we find important variations in end‐of‐life care for patients who sustained a hip fracture, with some differences explained by sex and age. Our work sheds important insights that may help ongoing health policy discussions on equity, efficiency, and reimbursement in health care systems. [ABSTRACT FROM AUTHOR]

Introduction/Aims: Amyotrophic lateral sclerosis (ALS) symptoms mimic those of other conditions and often require multiple physician and healthcare contacts for investigation and accurate diagnosis. We examined the type and frequency of healthcare service utilization prior to ALS diagnosis and tracheostomy‐free survival by sex and rurality among individuals treated with riluzole in Ontario, Canada. Methods: This population‐based cohort study used administrative databases to identify patients aged 18+ y diagnosed with ALS and started on riluzole between April 2002–March 2018. Using Poisson regression, rate ratios of healthcare utilization and atypical diagnostic tests and unnecessary therapeutic interventions 5 y prior to ALS diagnosis were compared by sex and rurality. Tracheostomy‐free survival after diagnosis was compared between groups using Kaplan–Meier estimators and proportional hazards models. Results: A total of 1071 patients with ALS were identified with a mean age of 70 y; 563 (52.6%) were men and 134 (12.5%) were rural residents. The number of physician visits increased in the 18 mo prior to ALS diagnosis. We observed modest sex differences in healthcare utilization. Rural patients had lower neurologist visit rates (rate ratio [RR], 0.78; 95% confidence interval [CI], 0.70–0.87) and were significantly more likely to receive an atypical diagnostic test or unnecessary therapeutic intervention (RR, 1.80; 95% CI, 1.04–3.10). Tracheostomy‐free survival did not differ by sex (log‐rank P‐value =.78) or rurality (log‐rank P‐value =.84). Discussion Given disparities observed in healthcare of rural ALS patients, policy strategies are needed to ensure all patients have timely access to care along the pathway from symptom onset to ALS diagnosis, to enable access to new therapeutics and clinical trials. [ABSTRACT FROM AUTHOR]

Background: Complete physical examinations (CPE) can identify health disparities in persons with intellectual or developmental disabilities. The objective of this study was to determine and compare rates of CPE among Manitoba adults with and without intellectual or developmental disabilities over time and to identify factors that were associated with receiving a CPE. Method: A retrospective cohort study using linked administrative health and non‐health data from 1995 to 2015 was conducted. Poisson and logistic regression were used to calculate CPE rates and examine factors associated with CPE. Results: The rates of CPE are decreasing over time and are higher among Manitobans with an intellectual or developmental disability. Characteristics such as being male, living rurally, low socioeconomic status, and high continuity of care led to lower odds of receiving a CPE. Conclusions: The current state of CPE provision to adults with intellectual or developmental disabilities in Manitoba is encouraging but needs improvement. [ABSTRACT FROM AUTHOR]

Previous studies, mostly analyzing data from high‐income economies, present mixed evidence on the relationship between retirement and healthcare utilization. This study leverages administrative data for over 80,000 urban Chinese workers to explore the effect of retirement on outpatient and inpatient care utilization using a fuzzy regression discontinuity design. The analyses of medical claims from a large city in China complement and extend the current literature by providing evidence of potential mechanisms underlying increased short‐run utilization. In this relatively well‐insured population, annual total healthcare expenditures significantly increase primarily because of more intensive use of outpatient care at retirement, especially at the right tail of the distribution of outpatient visits. This increase in outpatient care appears to stem from a decline in the patient cost‐sharing rate and the reduced opportunity cost of time upon retirement, interacting with supplier‐induced demand, not from any sudden impact on health. We do not find evidence of change in inpatient care at retirement. The results hold for both females and males, and are robust to a number of sensitivity analyses. [ABSTRACT FROM AUTHOR]

Background: Preclinical and epidemiological data suggest that phosphoglycerate kinase 1 activators could have neuroprotective properties and prevent PD.Objectives: The objective of this study was to compare the association between increased use of phosphoglycerate kinase 1 activators and increased use of tamsulosin with PD incidence.Methods: Our retrospective cohort study included men older than age 66 years newly exposed to phosphoglycerate kinase 1 activators or tamsulosin and compared their PD incidence, using health care administrative data of Ontario, Canada.Results: Among 265,745 men, each additional year of cumulative use of phosphoglycerate kinase 1 activators or tamsulosin was associated with 6% and 8% reduction, respectively, in the hazard of PD incidence. These hazards were not significantly different (P = 0.2094). A secondary analysis with the observation window starting after 6 months and 1 and 2 years showed similar results.Conclusions: Increasing exposure to phosphoglycerate kinase 1 activators and tamsulosin were both associated with small reductions in PD incidence. These results support further investigation of phosphoglycerate kinase 1 activators and tamsulosin for possible PD disease-modifying properties. © 2021 International Parkinson and Movement Disorder Society. [ABSTRACT FROM AUTHOR]