bluuebunny/crossref_metadata_2025 huggingface dataset:
Self-harm hospitalised morbidity and mortality risk in Australia using a matched population-based cohort
Authors: Mitchell Rebecca , Cameron Cate
Published: September 2018

IntroductionPrior and repeated self-harm hospitalisations are common risk factors for suicide. However, few studies have accounted for pre-existing comorbidities and prior hospital use when quantifying the burden of self-harm.

Objectives and ApproachTo quantify hospitalisation in the 12 months preceding and re-hospitalisation and mortality risk in the 12 months post a self-harm hospitalisation. A population-based matched cohort study of individuals ≥18 years using linked hospitalisation and mortality records from four Australian states. Self-harm was identified using a principal diagnosis of injury (S00-T75 or T79) and an external cause of self-harm (X60-X84). The index self-harm hospitalisation was identified and 12-month pre- and post-index injury health service use was examined. The non-injured comparison cohort was randomly selected from the electoral roll and was matched 1:1 on age, gender, and postcode of residence. Comorbidities were identified using diagnosis classifications with a 1-year lookback. Negative binomial regression was used to quantify associations between self-harm and counts of hospital admissions 12-months post the index hospitalisation using rate ratios and 95%CIs.

ResultsThere were 11,597 individuals with a self-harm hospitalisation in New South Wales, South Australia, Queensland or Tasmania with a matched comparison. Mean age was 38.6 years (SD=14.9) and 57.6% were female. The self-harm cohort had a higher proportion of Charlson comorbidities, mental health diagnoses, alcohol misuse and drug-related dependence than their matched counterparts. The self-harm cohort experienced a higher proportion of health service use in the 12-months preceding (20.5% vs 10.1%) and post (21.2% vs 10.6%) the index admission and a higher mortality rate (2.9% vs 0.3%) than their matched counterparts. The adjusted rate ratios (ARR) for hospital readmission were highest for females (ARR: 2.86; 95% CI: 2.33-3.52) and individuals aged 55-64 years (ARR: 3.96; 95%CI: 2.79-5.64).

Conclusion/ImplicationsImproved hospitalisation burden quantification for self-harm can inform resource allocation for intervention and after care services for individuals at-risk of repeated self-harm. Better assessment of at-risk self-harm behaviour, appropriate referrals and improved post-discharge care, focusing on care continuity is needed.
Linking cohort data with administrative health data to develop a new hypertension prediction model to aid precision health approach
Authors: Chowdhury Mohammad , Turin Tanvir , Leung Alex , O’Beirne Maeve , Sikdar Khokan , Quan Hude
Published: September 2018

IntroductionHypertension is a common medical condition, affecting 1 in 5 Canadians, and is a major risk factor for heart attack, stroke, and kidney disease. Predicting the risk of developing incident hypertension may help to inform targeted preventive strategies.

Objectives and ApproachIdentification of major risk factors and incorporation into a multivariable model for risk stratification may help to identify individuals who are at highest risk for developing incident hypertension and would potentially benefit most from intervention. The goal of the proposed research is to develop a robust hypertension prediction model for the general population using the Alberta Tomorrow Project (ATP) cohort data linked with Alberta’s administrative health data. ATP is Alberta's largest population health cohort, contains baseline data on socio-demographic characteristic, personal and family history of disease, medication use, lifestyle and health behavior, environmental exposures, physical measures and bio samples.

ResultsAlberta’s administrative health data additionally provides information on health care utilization, enrollment, drugs, physician services, and hospital services. A prediction model for hypertension will be developed using logistic regression where information on candidate variables for the model will be gathered from ATP data and outcome (incident hypertension) will be ascertained from administrative health data (physicians/practitioner claim data and hospital discharge abstract data). Lacking follow-up information in current ATP data has laid the foundation of linking the two data sources through an anonymous unique person identifier (e.g. PHN) that will eventually provide follow-up information on ATP participants who are free of hypertension at baseline developed the disease as well as information on other potential variables.

Conclusion/ImplicationsThe proposed prediction model will help to identify individuals at highest risk for developing hypertension and those who may benefit most from targeted healthy behavioral interventions and/or treatment. Such identification of high risk people may help prevent hypertension as well as the continuing costly cycle of managing hypertension and its complications.
Qualifying information on the deaths and serious injuries caused by road traffic in five Brazilian capitals using record linkage
Authors: Mandacaru Polyana , Neto Otaliba Libânio Morais , Andradde Ana Lucia , Souza Marli , Aguiar Fernanda
Published: September 2018

IntroductionRoad traffic crashes (RTCs) represent an public health problem, accounting for 1.2 million deaths per year. However, these figures may be even greater if health databases are linked to police records.

Objectives and ApproachMeasure the numbers of deaths and seriously injured victims and to estimate the percentage of corrections of the underlying cause of death, cause of hospitalization, and injury severity of the victims in five representative state capitals of the five macro-regions of Brazil. This was cross-sectional, study using the Hospital Information System, Mortality Information System and Police Road Traffic database. The RecLink III was used for the record linkage by identifying true pairs to calculate the correction percentage of the underlying cause of death, cause of hospitalization, and injury severity of the victims in the traffic records.

ResultsChange in the diagnosis of hospitalization in the Hospital Information System with percentage of correction of the cause at 24.4% for Belo Horizonte, 96.9% for Campo Grande, 100.0% for Palmas, and 33.2% for Teresina. The correction of the underlying cause of death in the Mortality Information System were 29.9%, 11.9%, 4.2%, and 33.5% for Belo Horizonte, Campo Grande, Curitiba, and Teresina, respectively. Change in the classification of injury severity was observed with an overall percentage of 100.0% for Belo Horizonte and Teresina, 48.0% for Campo Grande, and 51.4% for Palmas.

Conclusion/ImplicationsThe results showed the importance of the record linkage between health and police databases for the qualification of the RTCs and the victims in the five capital cities studied. This implies that deaths and serious injuries caused by RTCs are underestimated in the absence of integration of databases that record
Impact of linkage quality on inferences drawn from analyses using imperfectly matched data with high rates of linkage errors
Authors: Rentsch Christopher , Reniers Georges , Harron Katie , Machemba Richard , Mtenga Baltazar , Michael Denna , Kabudula Chodziwadziwa , Natalis Redempta , Urassa Mark , Todd Jim , Zaba Basia
Published: September 2018

IntroductionStudies based on high-quality linked data in developed countries show that residual linkage errors impact the bias and precision of subsequent analyses. Since 2015, we conducted point-of-contact interactive record linkage (PIRL) between serological survey data and manually digitised medical records with low data quality from three clinics in rural Tanzania.

Objectives and ApproachWe sought to determine the impact of the substantial linkage errors made by automated probabilistic linkage (a commonly used, less accurate, but much cheaper alternative to PIRL) on the bias and precision of inferences drawn from Cox regression analyses, comparing time from a positive HIV diagnostic test to registration at a local HIV care and treatment clinic (CTC) by testing modality (sero-survey vs. clinic). Using PIRL links as the gold standard, we quantified false/missed matches, compared characteristics between linked and unlinked data, and evaluated regression estimates at low, medium, and high (25th, 50th, and 75th percentile) match score thresholds.

ResultsBetween 2015-2017, 297 and 147 individuals with gold standard links received HIV+ test results in sero-surveys and clinics, respectively. Automated probabilistic linkage correctly identified 276 individuals (positive predictive value [PPV]=62%) at the low threshold and 43 individuals (PPV=96%) at the high threshold. At the lowest threshold, false matches were more likely to be clinic testers and less likely to register at CTC. These differences attenuated with increased threshold. Testing modality was significantly associated with time to CTC registration in the gold standard data (adjusted hazard ratio [HR] 6.42, 95%CI 4.45-9.28). Increasing false matches progressively weakened the association (low threshold: HR 4.99, 95%CI 3.45-7.21). Increases in missed matches were strongly correlated with a reduction in the precision of coefficient estimates (R-squared=0.94; p=0.0001).

Conclusion/ImplicationsWhile the significance of inferences did not change, a clear direction of bias was identified. High rates of false matches in this setting reduced the magnitude of the association; missed matches reduced precision. Adjusting for these biases could provide more robust results using data with considerable linkage errors.
Avoidable mortality among parents whose children were placed in care in Sweden: A retrospective matched cohort study
Authors: Wall-Wieler Elizabeth , Vinnerljung Bo , Liu Can , Roos Leslie , Hjern Anders
Published: September 2018

IntroductionSeparation from one’s child can have significant consequences for parental health and well-being.

Objectives and ApproachWe aimed to investigate whether parents whose children were placed in care had higher rates of avoidable (amenable and preventable) mortality. Data were obtained from the Swedish national registers. Mortality rates among parents whose children were placed in care between 1990 and 2012 (17 505 mothers, 18 286 fathers) were compared with a 5:1 matched cohort of parents whose children were not placed. We computed rate differences and hazard ratios of all-cause and avoidable mortality.

ResultsWhen compared with parents who did not have a child placed in care, there were an additional 21 avoidable deaths per 10 000-person years among mothers and an additional 27 avoidable deaths per 10 000-person years among fathers whose children were placed in care. Among mothers, death due to preventable causes were 3·83 times greater (95% CI 2·82-5·21) and deaths due to amenable causes were 3·12 times greater (95% CI 2·07-4·69) for those whose children were placed in care. Among fathers, death due to preventable causes was 1·75 times greater (95% CI 1·41-2·16) and deaths due to amenable causes were 1·52 times greater (95% CI 1·08- 2·13) for those whose children were placed in care. Avoidable mortality rates were higher among mothers whose children were young when placed in care and parents whose children were all placed in care.

Conclusion/ImplicationsMothers who had a young child placed and parents whose children were all placed in care are at much higher risk of avoidable mortality than parents whose children were not placed in care. Targeted public health interventions and more attentive health care could reduce risk of avoidable mortality in this group of parents.
Towards an ethically-founded framework for the use of mobile phone CDRs in health research
Authors: Jones Kerina , Daniels Helen , Heys Sharon , Ford David
Published: September 2018

IntroductionCall Detail Records (CDRs) are collected by mobile network operators in the course of service provision, and they are increasingly being used in health research. It has been identified that further work is needed to show that CDRs can be used within an ethically-founded framework that meets with social acceptability.

Objectives and ApproachThe published research literature was reviewed to identify data governance arrangements, challenges and potential opportunities for the greater use of the location element of CDRs in health research. A series of 3 workshops with members of the public (N=61) were conducted to gain views on the use of CDRs for health research. Data use scenarios of CDRs for health research were constructed to consider risk and mitigating controls. The findings were drawn together against a backdrop of legislative and regulatory requirements.

ResultsThe majority of published studies focused on low and middle income countries, often modelling the transmission of infectious diseases, and population movement following natural disasters. CDRs were used in anonymised or aggregated form, and gaining regulatory approvals varied with data provider and by jurisdiction. Only 2 people knew CDR data was being used for health research, but ultimately, most (N=49) were happy for their anonymised CDRs to be used, provided that safeguards were in place. Recommendations towards an ethically-founded framework for using CDR locations in health research are proposed, including the need for greater transparency, accountability, and the incorporation of public views for social acceptability.

Conclusion/ImplicationsDespite limitations inherent in the data, mobile phone CDRs have been used successfully in health research. People are generally amenable to the use of anonymised CDR data, but they want to be properly informed. The proposed recommendations should be taken into consideration to contribute towards a consistent, socially-acceptable, ethically founded framework.
Estimating the effect of referral for nephrology care on the survival of adults with advanced chronic kidney disease in a real-world clinical setting
Authors: Liu Ping , Karim Mohammad Ehsanul , Ronksley Paul E , Hemmelgarn Brenda R , Quan Hude , Quinn Robert R , Ravani Pietro
Published: September 2018

IntroductionLongitudinal studies ascertain exposure, covariates, and outcomes over time. For estimating treatment effect on mortality, ignoring the time-varying nature of an exposure may lead to immortal time bias. Time-dependent confounding that affects future treatment may bias the estimated effects. Differences in baseline prognosis between treatment groups further complicate this issue.

Objectives and ApproachWe applied sequential Cox modeling to estimate the causal effect of referral for nephrology care on the survival of adults with advanced chronic kidney disease, linking laboratory and administrative data from Alberta, Canada. We created pseudo-data by mimicking successive randomized controlled trials. To address immortal time bias, each “mini-trial” consisted of individuals starting treatment, and those not yet treated, in each 3-month time interval. We incorporated inverse-probability-of-treatment-weights (IPTW) to minimize treatment selection bias for each “mini-trial. ” We fit a “mini-trial”-stratified, weighted Cox model to estimate the overall hazard ratio for death by averaging the effect estimates across “mini-trials.”

ResultsWe included 9,675 patients who entered the cohort between 2002 and 2013. The mean age was 82 years; 35% were male; and 33% were ultimately referred to a nephrologist after a median wait-period of 6 months. Compared to non-referred patients, those referred were younger and had fewer comorbidities at baseline. Referral was associated with a significant 45% lower hazard for death in an adjusted Cox model. The effect was attenuated in a multivariate Cox model with a time-varying exposure and in a sequential Cox model further controlling for potential time-dependent confounding by measures reflecting kidney-, cardiovascular-, and cerebrovascular-health. After incorporating IPTW for addressing treatment selection bias in the same sequential Cox model, the effect estimate was toward the null and no longer significant.

Conclusion/ImplicationsWe found that applying analytical strategies that addressed immortal time bias, time-dependent confounding, and treatment selection bias, the survival benefit associated with nephrology referral was attenuated. Inverse-probability-of treatment weighted sequential Cox approach may be used to address these important biases and confounding that are common in real-world clinical settings.
Effectiveness of rotavirus vaccine against rotavirus-coded hospitalisations among Australian Aboriginal and non-Aboriginal children
Authors: Fathima Parveen , Snelling Tom
Published: September 2018

IntroductionRotavirus vaccine, RV1 (Rotarix), was included in the immunisation programs in Western Australia (WA) and New South Wales from mid-2007. In WA, RV1 was replaced with RV5 (RotaTeq) in mid-2009. Marked declines in rotavirus-related hospitalisations in both Aboriginal and non-Aboriginal children have been demonstrated following the implementation of the program.

Objectives and ApproachWe aimed to assess RV1 vaccine effectiveness (VE) against rotavirus-coded hospitalisations among Aboriginal and non-Aboriginal children aged (1-hazard ratio*100) were obtained from Cox proportional hazards models (adjusted for infant, maternal and demographic factors and stratified by state of birth) for Aboriginal and non-Aboriginal children.

ResultsThere were a total of 623 rotavirus-coded hospitalisations among the cohort children aged <2 years. Rotavirus hospitalisation rates were 143.0/100,000 child-years (95% confidence interval [CI]: 113.3-180.4) among Aboriginal children and 49.0/100,000 child-years (95% CI: 44.8-53.5) among non-Aboriginal children.

Compared to unvaccinated children, 1-dose VE among Aboriginal children against rotavirus-coded hospitalisations was 52.1% (95% CI: -0.02-77.1%) and 2-dose VE was 62.4% (95% CI: 26.9-80.7%) adjusting for birthweight, region of residence, socio-economic status, and year of birth. Among non-Aboriginal children, 1-dose VE was 39.0% (95% CI: 13.1-57.2%) and 2-dose VE was 53.4% (95% CI: 38.1-65.1%) adjusting for birth weight, mode of delivery and maternal age at birth and year of birth.

Conclusion/ImplicationsBurden of rotavirus gastroenteritis remains significant in Aboriginal children. Given the previously demonstrated declines in rotavirus-related hospitalisations in this population following vaccine introduction, our lower-than-expected VE estimates might represent bias introduced by differences in health-seeking behaviour between the vaccinated and unvaccinated, herd immunity and/or possible non-differential misclassification of the outcome.
Health Inequalities in British Nurses using Census derived databases linked to an adjusted UK Index of Multiple Deprivation
Authors: Ball Will , Kyle Richard , Atherton Iain , Dougall Nadine
Published: September 2018

IntroductionScottish health outcomes are worse than in England and Wales. This variation remains after controlling for deprivation, which explains less excess mortality now than previously. Alternative cross-national deprivation measures have limitations which may explain some of this trend. Recent policy interventions to reduce inequalities have not been effective.

Objectives and ApproachThis study aims to test a recently developed measure of area deprivation, the UK adjusted Index of Multiple Deprivation which has been linked to National Census derived Longitudinal Studies in England, Wales and Scotland. This adjusted measure is consistent across UK countries and addresses some limitations of previously utilised area measures of deprivation.

This study also aims to test whether characteristics of Nurses are protective against inequalities in health. This study will test whether Nurses are more socio-economically homogenous and whether higher health literacy is protective against the social gradient in health outcomes.

Results(1) Comparing Nurses to Non-Nurses in Scotland we found that they have systematically different demographic characteristics. Nurses are; older on average, more likely to be female, more likely to own their home, more likely to live in less deprived areas and they report better self-rated health. (1a) Correlation tests will examine the strength of relationship between health and Deprivation quintile for these groups.

(2) Comparing Self-Rated Health of Scottish Nurses with English and Welsh Nurses will determine whether any ‘excess’ in worse health outcomes exists and (2a) if an excess does exist, whether the UK consistent deprivation measure can account for this.

Analysis is currently ongoing and will be completed, with full results cleared for dissemination through disclosure control, prior to conference.

Conclusion/ImplicationsThis study implements methods which provide a basis for cross-national comparison of inequalities using individual-level data and a consistent measure of area deprivation.

Results from this study may also permit recommendations to improve the effectiveness of policy aimed at improving population health and reducing socio-economic inequalities in health.
Longitudinal trajectories of asthma exacerbations from infancy to school age.
Authors: Deliu Matea
Published: September 2018

IntroductionPrevious studies which used data-driven methodologies have reported the existence of an exacerbation-prone asthma subtype, which is independent of asthma severity. However, longitudinal patterns of asthma exacerbations during childhood have not been studied.

Objectives and ApproachWe sought to investigate whether there are distinct longitudinal trajectories of asthma exacerbations from infancy to school-age that could facilitate better understanding of the heterogeneity of asthma syndrome.

We used longitudinal k-means modelling (an unsupervised data-driven method), to analyse linked primary care data from 916 participants in a population-based birth cohort study (Manchester Asthma and Allergy Study), to ascertain clusters of children with similar trajectories of asthma exacerbations during childhood (n=160). We tested the validity of these clusters in relation to lung function, airway hyperreactivity and inflammation, allergic sensitisation, and the use of asthma medication.

ResultsA two-cluster model provided the optimal solution for our data set. Based on the pattern of exacerbations from infancy to age 8 years, we assigned the clusters as: “Early-onset frequent exacerbations (FE)” (n=10) and “Infrequent exacerbations (IE)” (n=150). Shorter duration of breastfeeding was the strongest risk factor for FE (median weeks 0 (IQR: 0-1.75) vs IE, median weeks 6 (IQR: 0-20), p<0.001). Children in the FE cluster were more likely to exhibit persistent wheeze (90% vs 47%, p=0.03) and have poorer lung function, more airway hyperreactivity, and more airway inflammation throughout childhood (Table 1). In a post-hoc analysis, when we compared children in the exacerbation clusters with those who have wheezed only (n=389), and those that wheezed but had no exacerbations (n=338), other early life risk factors such as atopic sensitisation (IE - RR: 3.2 (95%CI: 2.1-5.1), p<0.001) (FE - RR: 10.9 (95%CI: 2.1-57.7), p=0.004), exposure to tobacco smoke at birth (FE - RR: 2.8 (95%CI: 1.3-6.3) ,p=0.02), position in sibship (IE - RR: 1.5 (95%CI: 1.0-2.3), p=0.03), and day care attendance (IE - RR:0.6 (95%CI: 0.4-0.9), p=0.01) were significantly associated with exacerbations.

Conclusion/ImplicationsWe have identified two distinct patterns of asthma exacerbations during childhood with different outcomes, early-life risk factors, and lung function when compared to children who wheeze, but have no exacerbations. These results indicate that exacerbations represent an independent susceptibility phenotype.
Statistical Population Register: using administrative in the Canadian Census
Authors: Cloutier Sylvain
Published: September 2018

IntroductionFor a number of years, Statistics Canada has been evaluating the potential of increasing its use of administrative data into its Census Program. The research conducted so far has revealed that it could be possible to produce the census population counts by using existing administrative data.

Objectives and ApproachThe building of the Statistical Population Register (SPR) is one step towards achieving the use of administrative data into the Canadian Census Program. In addition, the SPR, in combination with the Business Register and the Statistical Building Register, would support a more efficient production of statistics via a multi-register-based system in the future. The SPR is created by linking numerous administrative data sources (federal, provincial, municipal and private). The in-scope Canadian population is then identified and extracted from the SPR.

ResultsThe presentation will focus on the reasons as well as the goals that had to be met in the initial research project in order to demonstrate the potential of using administrative data within the Census Program. The current state of the project will be highlighted by presenting high-level results at the Canadian, provincial and territorial levels. This is accomplished by comparing the Statistical Population Register’s in-scope population to its reference, Statistics Canada’s official population counts.

Conclusion/ImplicationsDespite promising results, areas of improvements have already been identified and work is under way in order to improve the quality of the upcoming Statistical Population Register. The final section of the presentation will be devoted to the future research agenda of the Census Program.
Using administrative health data to inform health service planning for specialist cancer care in Nova Scotia, Canada
Authors: Urquhart Robin , Lethbridge Lynn
Published: September 2018

IntroductionResearch has demonstrated that primary care providers can safely and effectively provide follow-up care after a person has received treatment for cancer. Yet, discharge to primary care after cancer treatment is variable, despite the fact that cancer systems are challenged to provide follow-up care given constrained cancer specialist resources.

Objectives and ApproachTo inform cancer system planning, we examined (1) cancer centre routine follow-up (CC-FUP) care for prevalent cancer types and (2) changes in CC-FUP over time. From the Nova Scotia Cancer Registry, we identified all persons diagnosed in Nova Scotia, Canada, with an invasive breast, colorectal, gynecological, or prostate cancer between 01/01/2006 and 31/12/2013. We linked this dataset to cancer centre/clinic data and identified a non-metastatic cancer survivor cohort (n=12,267). Descriptive statistics were computed to describe patterns of care. Negative binomial regression was used to examine changes over time for both CC-FUP and all cancer centre visits, adjusting for other covariates.

ResultsNearly half of survivors (48.4\%) had at least one CC-FUP visit, which varied by disease site (range: 30.2-62.4\%). Variation existed across providers, with six oncologists providing 34.7\% of the CC-FUP visits to the study population. Year of diagnosis was associated with receipt of CC-FUP care, with each successive calendar year associated with an 8\% increase in CC-FUP visits (IRR=1.08, 95\%CI=1.07-1.10). Similarly, each successive calendar year was associated with a 14\% increase in all cancer centre visits (IRR=1.14, 95\%CI=1.13-1.15). Results were shared with cancer system decision-makers at regular intervals to inform ongoing analyses.

Conclusion/ImplicationsBoth the number of CC-FUP visits and all visits increased over time, with the latter at a greater rate. The increases were much higher than assumed by cancer system decision makers (2\% increase per year) for resource planning, demonstrating the value of population-based administrative data to informing health service planning.
Evaluating area-based socioeconomic status predictors of pediatric health outcomes in Manitoba
Authors: Kroeker Kristine , Sharma Atul , Chateau Dan , Brownell Marni , Rodd Celia
Published: September 2018

IntroductionSocioeconomic gradients in health exist in Canada. Although multiple Canadian area-based socioeconomic measures (ABSM) have been developed, none have been specifically validated against relevant pediatric outcomes. Our objective was to use key pediatric health outcomes and compare the strength of association with a number of ABSM, including income quintile.

Objectives and ApproachThis is a retrospective cross-sectional assessment of the association between socioeconomic status (SES) measured by ABSM and key pediatric health outcomes at the population level. Data from the Manitoba Population Research Data Repository was used for residents aged 0-19y. The timeframe was 2010-2015. Outcomes included preterm births, birth weight, mortality, vaccination rates and teen pregnancy. Regressions used each outcome against various ABSM (e.g. CAN-Marg, SEFI2, INSPQ) or income quintile. Best model for each outcome was assessed by goodness of fit measure (AIC). Measures of inequality included SII (Slope Index of Inequality) and RII (Relative Index of Inequality, both RIImean and RIIratio).

ResultsIn our regression models, the 4 Can-Marg subcomponents consistently had about 15% lower AICs (best fit) across all 16 key pediatric outcomes compared to INSPQ (Raymond-Pampalon), income quintile or SEFI2 (Socioeconomic Factor Index - Version 2). Sex differences were small and inconsequential. Whether ABSMs were treated as continuous or categorical predictors was of little statistical consequence. Of note, 15 of the 16 outcomes had socioeconomic gradients identified by SII or RII on at least one of the ABSMs. Income quintile detected 12 of 15, CAN-Marg material deprivation detected 9; the combination of CAN-Marg material deprivation and ethnicity detected 13 of 15. SEFI2 detected only 3 and the National INSPQ detected 6.

Conclusion/ImplicationsThere are significant health inequalities in pediatric outcomes in Manitoba (15 of 16 studied). Combining CAN-Marg measures of poverty (material deprivation) and ethnic concentration identified 13/15 cases of documented inequality and was the best ABSM for capturing pediatric health gradients; it was similar to income quintile alone.
Patient Experiences with Cardiac Surgery in Alberta, Canada: Results from a Validated Survey
Authors: Kemp Kyle , Santana Maria , Knudtson Merril , Paolucci Elizabeth Oddone , Quan Hude
Published: September 2018

IntroductionResearch shows that a better patient experience may be associated with better outcomes. Most investigations, however, have only examined patients’ overall rating of care, which does not identify individual aspects of care which may be improved. Additionally, little is known about the experience of specific clinical groups in acute care.

Objectives and ApproachThe study objective was to examine the experience of patients undergoing cardiac surgery across Alberta. Surveys were completed within 6 weeks of hospital discharge, and linked with inpatient administrative records. Study eligibility was determined using Canadian Classification of Intervention (CCI) procedure codes, to include patients who underwent coronary artery bypass graft (CABG), valve replacement, and/or percutaneous coronary intervention (angioplasty). The survey contained 56 questions and assessed multiple aspects of care. Results for each question were classified as percentage in “top box”, where “top box” represented the best possible result (e.g. nurses “always” explaining things in a way patients could understand).

ResultsFrom April 2014 to March 2017, 1,921 patients completed a survey following cardiac surgery. This included 1,117 angioplasty only (58.2%), 409 CABG only (21.3%), 308 valve replacements (16.0%) and 87 (4.5%) who underwent multiple procedures. Patients were predominantly male (74.2%), over 50 years of age (88.6%) and admitted to hospital urgently (72.7%). The top three performing questions were nurses treating patients with courtesy and respect (91.4% reporting “always”), receiving written information about symptoms to watch out for after leaving hospital (90.9% “yes”), and discussion with hospital staff about help needed once leaving hospital (90.2% “yes”). The three poorest performing questions were hospital room quietness at night (48.6% “always”), staff describing possible side effects of new medications (51.4% “always”), and hospital room/bathroom cleanliness (64.9% “always”).

Conclusion/ImplicationsOur results provide patient-reported feedback about the perceived strengths and areas for improvement associated with cardiac surgery in Alberta. By linking completed surveys with administrative data, we are able to examine the experience of specific clinical groups, while eliminating additional survey burden for patients.
No Strings Attached: The Impact of an Unconditional Prenatal Income Supplement on First Nations Birth and Early Childhood Outcomes
Authors: Brownell Marni , Chartier Mariette , Nickel Nathan , Campbell Rhonda , Enns Jennifer , Phillips-Beck Wanda , Chateau Dan , Burland Elaine , Sarkar Joykrishna , Lee Janelle Boram
Published: September 2018

IntroductionIn Manitoba, low-income pregnant women are eligible for the Healthy Baby Prenatal Benefit (HBPB), an unconditional income supplement provided during the second and third trimester of pregnancy. HBPB is associated with improved birth outcomes for Manitoba women; its association with birth outcomes for First Nations (Indigenous) women is unknown.

Objectives and ApproachTo determine the association between HBPB and First Nations’ (FN) newborn and early childhood outcomes, we linked whole-population data from health, public health, family services and education. We included only FN women receiving income assistance during pregnancy (n=7074) to develop comparable treatment (received HBPB; n=5283) and comparison (no HBPB; n=1791) groups. Propensity score weighting adjusted for differences in maternal characteristics between groups. Multi-variable regressions compared groups on breastfeeding initiation, low birth weight, preterm birth, small- and large-for-gestational age, Apgar scores, complete immunizations at 1 and 2 years, and developmental vulnerability in kindergarten measured with the Early Development Instrument (EDI).

ResultsReceipt of the HBPB was associated with reductions in low birth weight births (adjusted Relative Risk (aRR): 0.77; 95% CI: 0.63, 0.93) and preterm births (aRR: 0.78 (0.68, 0.90)), and increases in breastfeeding initiation (aRR: 1.05 (1.00, 1.09)) and large-for-gestational age births (aRR: 1.11 (1.01, 1.23)). HBPB receipt during pregnancy was also associated with increases in 1- and 2-year immunizations for FN children (aRR: 1.14 (1.09, 1.19), and aRR: 1.28 (1.19, 1.36), respectively). Reductions in the risk of being developmentally vulnerable in the language and cognitive domain of the EDI were also found for FN children whose mothers had received the HBPB during pregnancy (aRR: 0.85 (0.74, 0.97).

Conclusion/ImplicationsA modest unconditional income supplement during pregnancy was associated with improved birth outcomes, increased immunization rates, and improved language and cognitive development at kindergarten for children born to low-income First Nations women. Long-term strategies to address structural inequities and the ongoing effects of colonization are also needed.
The Mysterious Case of the Delayed Twin: using research data to resolve linkage questions.
Authors: Avery Daniel
Published: September 2018

IntroductionIn a large biobank of over half a million people, we have several pairs of participants who appear to share their genome. As more individuals are sequenced, more pairs are likely to be found. If these are twins then this is great news, but it isn’t quite that simple.

Objectives and ApproachWhere 2 people share a genome we need to be able to confirm that these pairs are twins. However, there are a number of issues which could cause 2 people to appear to share a genome; for example being recruited twice, donating blood on another’s behalf, etc. We already identify and exclude participant data based on these conditions. We developed our methodology by looking at the first identified pair in great detail, looking for evidence which specifically ruled out possible alternate explanations, and then applying and refining the method on later pairs.

ResultsWe were able to demonstrate the pair were almost certainly twins using their biochemistry and family questionnaire data as principal sources. We also identified a number of variables which were useful in indicating the likelihood of a twin, and now form part of a methodology which we are still developing. Even more usefully, we identified a number of variables that seemed like useful measures but proved extremely misleading. To date we have 26 pairs of possible twins, with 9 confirmed as twins and the remainder looking likely to be twins but falling short of a threshold for confidence. We also have 75 pairs which confirm duplicate participants we have already excluded.

Conclusion/ImplicationsWe formed two lessons: even very simply linkages come with pitfalls, and you should gather more administrative data than you think. We’re proposing the collection of additional familial relationship data in our third resurvey. We are also looking into machine learning and statistical techniques to better identify twins and duplicates.
To Err is Human, all hail your Robot Overseer: automated testing as part of a robust data delivery platform.
Authors: Avery Daniel
Published: September 2018

IntroductionWe have a large cohort study of half a million people, which continually incorporates new data through health insurance, centre for disease control records, death certificates, resurveys, and ongoing quality assurance and participant information updates. To support our researchers we need data which is correct, up-to-date, and unchanging.

Objectives and ApproachWe must provide the new data, fixes and corrections to researchers, without missing anything or introducing issues. We make sequential iterations of our data available to researchers on a biannual basis; allowing a static version that can be referenced with regards to earlier work and providing the newest version of the data for new work. Due to the very large size of the data/code base and the small size of the team managing it, delivering this without error is a struggle. To mitigate this we developed testing scripts which catch issues and flag for resolution prior to release to researchers.

ResultsWe currently have 32 tests which catch all known issues which occur during a rebuild. On any occasion where a new type of issue is encountered, tests which would catch that issue and related issues are developed. As a result our last few releases have gone far more smoothly, with few if any issues reported after a release and certainly no previously encountered issues! Examples of current tests include: detection of a failed health insurance import; that we have the same number of participants; failure to increment version number between releases; checking that disease numbers have not changed dramatically over the shared timeframe.

Conclusion/ImplicationsProducing multiple static releases is a good way to balance the needs of a researcher for both static and current data, but it does introduce opportunities for both human and computer errors. Mitigating this risk with automated testing is convenient and effective.
Power of Linked Administrative Data
Authors: Izakian Hesam , Bhatt Hitesh , Jagodzinski Robert , Twilley Leslie , Cui Xinjie
Published: September 2018

IntroductionLinking administrative data provides valuable information about individuals using government services and can be very useful for policy-makers in improving and developing services and policies. The Child and Youth Data Laboratory (CYDL) links and analyses administrative data from Alberta Government ministries to provide evidence for policy and program development.

Objectives and ApproachData from 20 programs of six Government of Alberta ministries (Advanced Education, Education, Health, Children’s Services, Community and Social Services, and Justice and Solicitor General) were linked anonymously. The data spans six years from 2005/06 to 2010/11 and consists of almost 50 million records corresponding to over 2 million unique Albertans aged 0 to 25 years. A data visualization tool called the Program Overlap Matrix summarises the overlap rates among the programs. It is comprised of a matrix of squares, where each cell represents the overlap between two programs.

ResultsThe Program Overlap Matrix is publically available at https://visualization.policywise.com/P2matrix/. It consists of overlap rates between programs in any study year (2005/06 to 2010/11), individual years, the first year vs. future years, and the last year vs. previous years which can be used to answer many policy-related questions such as: other service use (e.g., what other services do ESL students use?), over-represented programs (e.g., in what programs are Child Care Subsidy clients over-represented?), resilience (e.g., what is the proportion of Child Intervention clients in post-secondary institutions?), transitions (e.g., what types of services do students with special needs receive as they transition to adulthood?), and time trend (e.g., what types of services did Income Support clients receive in the past?)

Conclusion/ImplicationsThe program overlap matrix is a powerful tool to discover relationships between programs. It is a useful instrument to inform public and policy-makers about the overlap rates between government programs. It can be used to answer a variety of policy-related questions.
Identifying vulnerable population groups: On-time infant vaccination coverage in Australia
Authors: Moore Hannah , Fathima Parveen , Gidding Heather , De Klerk Nicholas , Liu Bette , Sheppeard Vicky
Published: September 2018

IntroductionImmunisation coverage is a good measure of immunisation program effectiveness. Coverage of the 3-dose infant schedule in Australia assessed at age 12 months is >90%. Timeliness is an important goal for population immunity, but on-time coverage of the 2-4-6 month schedule and coverage in specific populations is rarely reported.

Objectives and ApproachWe conducted a retrospective population-based cohort study of 1.9 million Australian births, 1996-2012 (approximately 42% of Australia’s population). Individual data from state-held birth and perinatal records were combined with Commonwealth-held immunisation and death records, through probabilistic linkage. We assessed on-time coverage across 13 demographic and perinatal characteristics of diphtheria-tetanus-pertussis vaccines (DTP) defined as vaccination 14 days prior to the scheduled due date, to 30 days afterwards.

ResultsOn-time DTP vaccination coverage in non-Aboriginal infants was 88.1% for the 2-month dose, 82.0% for 4-month dose, and 76.7% for 6-month dose; 3-dose coverage was 91.3% when assessed at 12 months. On-time DTP coverage for Aboriginal infants was 77.0%, 66.5%, and 61.0%; 3-dose coverage at 12 months was 79.3%. Appreciable differences in on-time coverage were observed across population subgroups. On-time coverage in non-Aboriginal infants born to mothers with ≥3 previous pregnancies was 62.5% for the 6-month dose (47.9% for Aboriginal infants); up to 23.5% lower than for first-borns. Infants born to mothers who smoked during pregnancy had coverage 8.7-10.3% lower than infants born to non-smoking mothers for the 4- and 6-month dose. A linear relationship was apparent with increasing socio-economic disadvantage and decreasing on-time coverage.

Conclusion/ImplicationsOn-time vaccination coverage of the 2-4-6 month schedule is only 50-60% across specific population subgroups representing a significant avoidable public health risk. Australian Aboriginal infants, multiparous mothers, and those who are socio-economically disadvantaged are key groups most likely to benefit from targeted programs addressing vaccine timeliness.
Screening Women in Glasgow: Comparing uptake across cancer screening programmes at an individual patient level
Authors: Papworth Richard , McCowan Colin , McSkimming Paula , Kotzur Marie , McConnachie Alex , MacDonald Sara , Wyke Sally , Crighton Emilia , Weller David , Campbell Christine , Steele Robert JC , Robb Katie
Published: September 2018

IntroductionPopulation-based screening has been shown to reduce cancer specific mortality. Within Scotland, three national screening programmes exist: breast, cervical and bowel. Despite being a common and preventable form of cancer, the uptake for bowel cancer screening among women lags behind that for breast and cervical cancer.

Objectives and ApproachSince the benefits of screening accrue with participation, it is important to understand why differences in screening uptake exist. In this study, data on women aged 24-74 in the Greater Glasgow and Clyde Health Board, invited to take part in one or more screening programme during the period 2009-2013, were linked to demographic and medical data. Uptake was determined based on the presence of a screening attendance or result; the impact of age, deprivation and co-morbidity on uptake was determined using logistic regression for each individual programme, and for the cohort of women invited to participate in all three programmes.

ResultsOverall, 430,591 women were invited to take part in one or more screening programme during the study period. The uptake for bowel screening was, at 61.7%, lower than that seen in either the breast (72.6%) or cervical (80.7%) programme. Despite these differences, the same demographic factors were associated with uptake of each individual screening programme: older women and those living in affluent areas were most likely to attend. Medical factors did differentially influence uptake, those with multi-morbid illness being less likely to participate in breast and bowel, but not the cervical programme. For the 68,324 women invited to participate in all programmes, 52.1% took part in all three while 7.2% participated in none.

Conclusion/ImplicationsUptake of bowel screening was confirmed as lower than uptake of other programmes, although all were similarly impacted by demographic, clinical and socioeconomic factors. Individuals were more likely to complete bowel screening if they participate in another programme, suggesting these may serve as a vehicle for improving bowel screening uptake.