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2. Value of a national administrative database to guide public decisions: From the système national d’information interrégimes de l’Assurance Maladie (SNIIRAM) to the système national des données de santé (SNDS) in France

Author

Tuppin, P., primary, Rudant, J., additional, Constantinou, P., additional, Gastaldi-Ménager, C., additional, Rachas, A., additional, de Roquefeuil, L., additional, Maura, G., additional, Caillol, H., additional, Tajahmady, A., additional, Coste, J., additional, Gissot, C., additional, Weill, A., additional, and Fagot-Campagna, A., additional

Published
2017
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4. Value of a national administrative database to guide public decisions: From the système national d’information interrégimes de l’Assurance Maladie(SNIIRAM) to the système national des données de santé(SNDS) in France

Author

Tuppin, P., Rudant, J., Constantinou, P., Gastaldi-Ménager, C., Rachas, A., de Roquefeuil, L., Maura, G., Caillol, H., Tajahmady, A., Coste, J., Gissot, C., Weill, A., and Fagot-Campagna, A.

Abstract

In 1999, French legislators asked health insurance funds to develop a système national d’information interrégimes de l’Assurance Maladie(SNIIRAM) [national health insurance information system] in order to more precisely determine and evaluate health care utilization and health care expenditure of beneficiaries. These data, based on almost 66 million inhabitants in 2015, have already been the subject of numerous international publications on various topics: prevalence and incidence of diseases, patient care pathways, health status and health care utilization of specific populations, real-life use of drugs, assessment of adverse effects of drugs or other health care procedures, monitoring of national health insurance expenditure, etc. SNIIRAM comprises individual information on the sociodemographic and medical characteristics of beneficiaries and all hospital care and office medicine reimbursements, coded according to various systems. Access to data is controlled by permissions dependent on the type of data requested or used, their temporality and the researcher's status. In general, data can be analyzed by accredited agencies over a period covering the last three years plus the current year, and specific requests can be submitted to extract data over longer periods. A 1/97th random sample of SNIIRAM, the échantillon généraliste des bénéficiaires(EGB), representative of the national population of health insurance beneficiaries, was composed in 2005 to allow 20-year follow-up with facilitated access for medical research. The EGB is an open cohort, which includes new beneficiaries and newborn infants. SNIIRAM has continued to grow and extend to become, in 2016, the cornerstone of the future système national des données de santé(SNDS) [national health data system], which will gradually integrate new information (causes of death, social and medical data and complementary health insurance). In parallel, the modalities of data access and protection systems have also evolved. This article describes the SNIIRAM data warehouse and its transformation into SNDS, the data collected, the tools developed in order to facilitate data analysis, the limitations encountered, and changing access permissions.

Published
2017
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6. Risk of death related to psychotropic drug use in older people during the European 2003 heatwave: a population-based case-control study.

Author

Nordon C, Martin-Latry K, de Roquefeuil L, Latry P, Bégaud B, Falissard B, Rouillon F, and Verdoux H

Subjects
Aged, Aged, 80 and over, Antidepressive Agents adverse effects, Antipsychotic Agents adverse effects, Case-Control Studies, Dose-Response Relationship, Drug, Europe epidemiology, Female, France epidemiology, Geriatric Assessment methods, Geriatric Assessment statistics & numerical data, Humans, Male, Odds Ratio, Retrospective Studies, Risk Factors, Heat Stress Disorders chemically induced, Heat Stress Disorders mortality, Hot Temperature adverse effects, Psychotropic Drugs adverse effects
Abstract

Objective: The authors investigated the association between death of older people and use of psychotropic drugs before and during the Western European August 2003 heatwave., Method: A retrospective population-based case-control study was conducted using the French social security insurance national database. Exposure to psychotropic drugs in cases aged 70-100 years who died before (N = 2,093) and during (N = 9,531) the August 2003 heatwave was compared with those of survivors matched for age, gender, and presence of chronic illness, by using conditional logistic regressions., Results: The association between death and psychotropic drug use was modified by level of external temperature (Wald chi(2) = 13.1, degree of freedom = 1, p <0.001). Use of any psychotropic drug was associated with a 30% increased risk of death during the heatwave, with a significant dose-response relationship between the number of psychotropic drugs and the risk of death (adjusted odds ratio [aOR] for linear trend 1.25, 95% confidence interval [95% CI]: 1.21-1.29). During the heatwave, therapeutic classes independently associated with an increased risk of death were antidepressants (aOR 1.71, 95% CI: 1.57-1.86) and antipsychotics (aOR 2.09, 95% CI: 1.89-2.35), whereas exposure to anxiolytics/hypnotics use (aOR 0.85, 0.79-0.91) was associated with a decreased risk. Findings remained unchanged after adjustment on cardiotropic, antidementia, or anti-parkinsonian drug use., Conclusion: Our findings suggest that a causal relationship may exist between psychotropic drug use during a heatwave and increased risk of death in older people. The risk/benefit ratio of antidepressant and antipsychotic drugs should be carefully assessed in older people during a heatwave.

Published
2009
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