bluuebunny/crossref_metadata_2025 huggingface dataset:
A Feasibility Study for CODE-MI: High-Sensitivity Cardiac Troponin - Optimizing the Diagnosis of Acute Myocardial Infarction/Injury in Women.
Authors: Zhao Yinshan , Sivaswamy Atul , Lee May K. , Izadnegahdar Mona , Chu Anna , Ferreira-Legere Laura E. , Karin H. Humphries  , Udell Jacob A.
Published: September 2022

ObjectivesThis feasibility study was conducted to inform the design and power evaluation of CODE-MI, a pan-Canadian trial evaluating the impact of using the female-specific 99th-percentile threshold for high-sensitivity cardiac troponin (hs-cTn) on the diagnosis, treatment and outcomes of women presenting to the emergency department with symptoms suggestive for myocardial ischemia.
ApproachCODE-MI is a multi-center, stepped-wedge cluster randomized trial. The cohort and outcomes will be obtained from routinely collected administrative data. Using linked administrative data from 11 hospitals in Ontario from 2014/10 to 2017/09, this feasibility study obtained the following estimates: number of eligible patients, i.e., women presenting to the emergency department with symptoms suggestive of myocardial ischemia and a 24-hour peak hs-cTn value within the female-specific and overall thresholds (i.e. primary cohort); the rate of the 1-year composite outcome of all-cause mortality, re-admission for non-fatal myocardial infarction, incident heart failure, or emergent/urgent coronary revascularization. Study power was evaluated via simulations.
ResultsOverall, 2,073,849 emergency department visits were assessed. Among women, chest pain (with or without cardiac features) and shortness of breath were the most common complaints associated with a diagnosis of acute coronary syndrome. An estimated 7.7% of women with these complaints are eligible for inclusion in the primary cohort. The rate of the 1-year outcome in the primary cohort varied significantly across hospitals with a median rate of 12.2% (95%CI: 7.9%-17.7%). With 30 hospitals, randomized at 5-month intervals in 5 steps, approximately 19,600 women are expected to be included in CODE-MI, resulting in >82% power to detect a 20% decrease in the odds of the primary outcome at a 0.05 significance level.
ConclusionRoutinely collected administrative health data serve as a rich and essential resource for conducting pragmatic trials assessing process change, such as CODE-MI. We demonstrated the strength of using linked administrative health data to guide the design of pragmatic clinical trials and accurately evaluate the study power.
Using Health data to analyse repeat victimisation in Scotland.
Authors: Morales Ana , McVie Susan
Published: September 2022

ObjectiveThe aim of this project is to analyse temporal patterns of repeat violent victimisation (RVV) in Scotland using administrative data and explore the extent to which these patterns are associated with underlying health vulnerabilities (related to mental health and problematic alcohol and/or drug use) and vary by individual socio-demographic characteristics.
ApproachViolence in Scotland, and especially RVV, is a ‘key public health priority’. However, very little is known about the link between violence and other health vulnerabilities at an individual level, which may be useful in informing prevention approaches. This paper uses data on violence-related ambulance call-outs linked to hospital records containing information on wider health vulnerabilities. We use survival mixture models to identify and characterise population sub-groups, based on time to repeated violent episodes and explore how different health-related factors are associated with RVV and how this varies across sub-populations.
ResultsWe identify two classes of RVV with two distinct survival trajectories: a ‘low vulnerability’ class and a ‘high vulnerability’ class. People in the high vulnerability class experienced RVV more quickly and were more likely to have underlying mental health conditions and/or problematic drug or alcohol use than those in the low vulnerability class.  The association between socio-demographic characteristics and RVV differed across the two classes, with significant inequality in RVV for high-risk individuals between those in the most and the least affluent communities. The findings suggest that the first 6 months after the index event is a critical period of RVV for people in the high-risk group, but there may be different exposure mechanisms for different types of victims.
ConclusionBetter use of administrative data from health sources could help improve our understanding and identification of repeat victims of violence. The ability to identify whether victims are likely to be ‘high-risk’ or ‘low-risk’ could inform the design of focused strategic approaches and interventions aimed at reducing repeat violent victimization.
Impact of the COVID-19 pandemic on skin cancer diagnosis: A population-based study.
Authors: Nguyen Paul , Asai Yuka , Hanna Timothy
Published: September 2022

ObjectivesThe COVID-19 pandemic has been unprecedented and led to drastic reductions in nonurgent medical visits. Deferral of these visits may have critical health impact, including delayed diagnosis for melanoma and other skin cancers. We examined the influence of the pandemic on skin biopsy rates in a large population-based cohort.
ApproachUsing the universal health care claims dataset from Ontario, Canada, we examined skin biopsies from January 6, 2020 to September 27, 2020, and compared these to the same period for 2019. Those diagnosed with anogenital cancers, younger than 20 years, residing out-of-province and with lapses in coverage were excluded. The sensitivity and specificity of claims diagnoses were evaluated with a validated algorithm that identifies keratinocyte carcinoma (KC) in Ontario, and the Ontario Cancer Registry for melanoma cancer. Factors associated with biopsy during the early pandemic were investigated with modified Poisson regression.
ResultsA precipitous drop in total skin biopsies (down to 15% of expected), biopsies for KC (18%) and melanoma (27%) was seen with the onset of COVID-19 cases (p<0.01). Claims diagnoses were of high specificity for KC (99%), and for melanoma (98%), though sensitivity was less (61% and 28%, respectively). In adjusted analysis, the elderly (80+ years), females and residents of certain regions were less likely to be biopsied during the pandemic. Subsequently, there were substantial improvements in biopsy rates over 10 weeks. However, compared to 2019, a large backlog of expected cases still remained 28 weeks after lockdown (45,710 all biopsy, 9,104 KC and 595 melanoma).
ConclusionA drastic reduction in skin biopsies is noted early in the COVID-19 pandemic; this disproportionately affected the elderly, females and certain geographic regions. Though biopsies subsequently increased, a large backlog of cases remained after almost half a year. This will have implications for downstream care of skin cancer.
Using multiple routine data sources linked to a trial cohort to establish the longer-term effectiveness of specialist home visiting in England: main results of the BB:2-6 study of the Family Nurse Partnership.
Authors: Robling Michael , Cannings-John Rebecca , Lugg-Widger Fiona
Published: September 2022

ObjectivesThe Family Nurse Partnership (FNP) is a specialist home-visiting programme for first-time teenage mothers. Developed in the US, short-term outcomes (by age 2 years) were established in England in the Building Blocks trial. We used routine data (health, education, social care) linked to our trial cohort to assess longer-term impact.
ApproachMothers recruited to the trial and their first-born children were linked to health (Hospital Episode Statistics/HES: NHS Digital; Abortion statistics: Department of Health and Social Care), education/social care (National Pupil Database/NPD: Department for Education) data in England up to age 7-years. Analysis of data within in a trusted-research environment assessed programme impact upon child maltreatment, child development/educational and maternal life course outcomes when compared to usually provided health and social care support alone. Our primary outcome was child in need registration. Planned sub-group analysis included differential effects by maternal age, deprivation level, care experience and for child outcomes, sex.
ResultsMatch rates for 1547 children were 97.4% (NPD) and 98.3% (HES). We found no difference between trial arms in proportion of children assessed as in need (adjusted odds ratio (aOR) OR:0.98, 95% confidence interval (CI): 0.74 to 1.31). Aside from a longer duration in care for children in the usual care arm (two months), there were no other differences in maltreatment outcomes. Children in the FNP arm were more likely to achieve a good level of development at reception age at age 4-5 years (aOR:1.24, 95%CI: 1.01 to 1.52) and, after adjusting for month of birth, to reach the expected standard in reading at Key Stage 1 at age around 7 years (aOR:1.26, 95%CI: 1.02 to 1.57).
ConclusionsWe found programme improvements for child development/educational achievement but not for child maltreatment outcomes. Additional sub-group analysis revealed some evidence of the programme benefiting mothers with greater baseline vulnerability and boys, consistent with previous trials. The study benefits from the linkage of administrative data to a previously randomised trial cohort.
Quantifying intersecting structural racism in the youth criminal justice system: a whole-population linked administrative data study from Manitoba.
Authors: Brownell Marni , Sinclair Stephanie , Nickel Nathan , Turnbull Lorna , Linden Rick , Ricciardelli Rosemary , Au Wendy , Enns Jennifer , Chartier Mariette , Urquia Marcelo , Mahar Alyson , Wall-Wieler Elizabeth , Chateau Dan , Sanscartier Matthew , Casiano Hygiea , Quddus Farzana , Lambert Drew , Ferland Ivy
Published: September 2022

ObjectivesOver three decades ago, the Aboriginal Justice Inquiry identified structural racism in Canada’s justice system. Although rates of youth criminal charges and incarcerations have declined substantially since then, it is unclear whether First Nations youth are treated differently than non-First Nations youth for similar offences. Our study addressed this question.
ApproachThis retrospective cohort study of youth born 1991-2001 and living in Manitoba between ages 12-17 used whole-population linked administrative data to identify youth charged with a crime (N=13,543). First Nations youth (n=7,081) were compared with all other Manitoba (AOM) youth (n=6,462) on whether their criminal charge proceeded or was dropped, deferred or diverted. The study applied an intersectionality theoretical framework. Individual (age, type and severity of charge, ever in child protection care, youth and/or mother diagnosed mental disorder, maternal incarceration, number of siblings, urban/rural residence) and social strata (First Nations identity, income, sex) factors were adjusted for using multi-level models.
ResultsAfter accounting for other factors, First Nations youth had a higher risk of a charge proceeding than AOM (adjusted Relative Risk (aRR) 1.16, 95% CI 1.12-1.20). There was no difference in charges proceeding for male First Nations youth compared with male AOM, whereas among females, the risk was greater for First Nations (aRR 1.31, 95% CI 1.26-1.36). Low income and a history of being in the care of the child protection system increased the risk of charges proceeding for AOM only (aRR 1.16, 95% CI 1.13-1.18; aRR 1.13, 95% CI 1.07-1.20); for First Nations, there was no increased risk of charges proceeding associated with these intersecting factors.
ConclusionThese findings provide quantitative evidence of the intersecting structural racism in the youth criminal justice system previously identified by First Nations leaders. Future research will follow this cohort to determine whether more judicial sanctions are applied to First Nations youth throughout the justice process, including within criminal courts and corrections.
The validity of routine individuated programmatic data in HIV surveillance assessed over a 10-year period.
Authors: Jacob Nisha , Rice Brian , Boulle Andrew
Published: September 2022

ObjectivesIn the Western Cape, South Africa, public-sector individual-level routine data are consolidated from multiple non-EMR sources through the Provincial Health Data Centre (PHDC).  This enables the description of temporal changes in population-wide antenatal HIV sero-prevalence. We evaluated the validity of these data compared to aggregated program data and sentinel surveys.
ApproachWe conducted a retrospective cohort analysis of all pregnancies consolidated in the PHDC from January 2011 to December 2020. Evidence of antenatal and HIV care from electronic platforms (each with its own multi-source phenotype algorithm) were linked using a unique patient identifier. HIV prevalence estimates were triangulated with available sentinel national and provincial antenatal survey estimates as well as aggregated programmatic data from registers as recorded in the District Health Information System. Provincial, district-level and age-group HIV prevalence estimates were compared between data systems using correlation coefficients, absolute differences and trend analysis.
ResultsIn total, 982,914 pregnancies were ascertained with a median maternal age of 26.9 years. Between 2011–2013, PHDC HIV prevalence estimates were widely disparate from aggregate and survey data (due to incomplete electronic data) whereas, from 2014 onwards, estimates were more closely correlated to aggregate data estimates (r=0.83; p=0.02) with an average absolute prevalence difference of 0.97%. In keeping with survey and aggregate data trends, PHDC data show a relatively stable provincial HIV prevalence from 17.0 (95%CI 16.8%–17.2%) in 2015 to 18.9% (95%CI 18.7–19.1%) in 2020. The highest HIV prevalence was in the Cape Metro district (20.6%; 95%CI 20.4%–20.9%). Prevalence estimates by age group were comparable between sentinel surveys and PHDC from 2014 onwards with an average absolute prevalence difference of 1.6%.
ConclusionThis study is the first to compare sentinel sero-prevalence surveys with both register-based aggregate data and consolidated individuated administrative data. We show that in this setting linked individuated data may be reliably used for HIV surveillance and provide more granular estimates with greater efficiency.
A national data linkage study to determine the association of congenital anomalies with standardised education outcomes.
Authors: Rawlings Anna , Scanlon Ieuan , Glinianaia Svetlana , Rankin Judith , Loane Maria , Morris Joan , Thayer Dan , Tucker David , Jordan Sue
Published: September 2022

ObjectivesEducation outcomes predict life chances; however disabilities and concurrent learning difficulties are often barriers to school performance. Low educational achievement is also linked with socio-economic deprivation. We aimed to quantify the association of these factors with education outcomes by ages 12 and 17 for children in Wales (UK).
ApproachWe linked health, socio-economic and education data for children born after 1997 in Wales, registered with any one of 17 isolated congenital anomalies. Children were included if they had known education outcomes at ages 12 (n=9,223) and 17 (n=4524). A reference population comprised children born similarly but without anomalies, also having education records at 12 (n=261,827) and 17 (n=4,524).
Multinomial logistic regressions determined the likelihood of attainment in compulsory subjects by age 12 and of attaining five GCSE qualifications by age 17. We adjusted for socio-economic status by using free school meal eligibility (household deprivation) and area-based indices of deprivation.
ResultsWe identified 14 and 11 isolated anomalies that reduced the likelihood of achieving educational standards by ages 12 and 17 respectively. Educational achievements were lower for children with Down syndrome, Turner syndrome, hydrocephalus and limb reduction defects, particularly at age 12, indicating that children with anomalies may catch-up with their peers. While children with anomalies were less likely to achieve five GCSEs by age 17, there was no difference in the grades of those who did so. Deprivation, particularly at household level, further reduced the likelihood of education success. At age 17, household deprivation reduced 3-fold the odds of achieving any five GCSEs grades A*-C.
ConclusionsChildren with congenital anomalies from the most deprived communities and households are at particular risk of low education achievement. To realise their potential, these children should be identified from medical records at an early age and offered targeted educational support as soon as possible and at every opportunity.
The same, only different: Using physician billing data from four provincial payment systems to describe family physician practice patterns in Canada.
Authors: Lavergne Ruth , Peterson Sandra , Rudoler David , Stock David , Marshall Emily
Published: September 2022

ObjectivesIn Canada physician payment systems and associated billing data vary across provinces. We used linked billing data to develop comparable measures of family physician (FP) service volume, continuity, and comprehensiveness in each of four provinces, with the goal of describing changing patterns over time, relevant to workforce planning policy.
ApproachWe accessed linked population and physician registry data, vital statistics, physician billing data, hospital and emergency department records, and (where available) laboratory and prescription drug records in four Canadian provinces from 1996/7 to 2017/8. We tracked changes in primary care physician service volume (patient visits), continuity, and comprehensiveness over two decades, and explored the impacts of career stage and graduation cohort on patterns observed. We also quantified changes in the volume of services that required FP coordination, review, administration, and/or follow-up, reporting changes in service volume per-capita, per community-based family physician and per physician visit.
ResultsVisit volume and continuity per provider fell over time in the four provinces examined.  Visits increased with years in practice until mid-to-late-career and declined into end-of-career. We found no relationship between graduation cohort and practice volume, continuity, or comprehensiveness of care. Over this time period, the number of FPs per-capita has grown, but the number in comprehensive, community-based practice has remained constant. While primary care visits have declined, the number of prescriptions, lab tests, emergency department visits, and specialist visits per capita have all increased. When expressed per community-based FP, and particularly per community-based FP patient visit, the increases in workload range from 36.1% for lab tests to 55.0% for ED follow-up. Increases in service volume are greatest among patients ages 80 and older, a rapidly-growing population segment.
ConclusionLinked data capturing changes in practice patterns and workload suggest that even with an increasing per-capita supply of family physicians, additional resources will be needed to ensure all patients can access comprehensive primary care. Information on the various roles family physicians fill and demographic change will strengthen workforce planning.
Combining immigration records with a postpartum population-based survey to assess prevalence of perinatal psychosocial and behavioral risk factors among immigrant subgroups.
Authors: Ewesesan Roheema , Chartier Mariette , Nickel Nathan , Wall-Wieler Elizabeth , Marcelo Urquia
Published: September 2022

ObjectivesPerinatal risk factors can vary by immigration status. To advance knowledge on sociobehavioral health risks among pregnant and childbearing immigrant women, we compared perinatal health indicators between immigrant and non-immigrants, overall, and according to key immigrant characteristics (refugee status, secondary migration, birth region, and duration of residence).
ApproachWe conducted a population-based cross-sectional study of 33,754 immigrant and 172,342 non-immigrant childbearing women in Manitoba, Canada, aged 15-55 years, who had newborn screening data completed by public health nurses within two weeks postpartum from 2000 to 2017. The screening data was linked to a Canadian national immigration database. Additional databases were linked to collect demographic and perinatal clinical information. Logistic regression models were used to examine the associations between immigration characteristics and perinatal health indicators, such as social isolation, relationship distress, partner violence, depression, alcohol, smoking, substance use and late prenatal care initiation.
ResultsMore immigrant women reported being socially isolated (12.3%) than non-immigrants (3.0%) (Adjusted Odds Ratio (aOR): 6.90, 95% Confidence Interval (CI): 6.53, 7.28) but exhibited lower odds of other outcomes. In the analysis restricted to immigrants, recent immigrants (< 5 years of stay) had higher odds of being socially isolated (aOR: 9.29, 95% CI: 7.80, 11.06) and late prenatal care (aOR: 1.73, 95% CI: 1.23, 2.42) compared to long-term immigrants, but lower odds relationship distress, depression, alcohol, smoking and substance use. Refugee status was positively associated with social isolation, relationship distress, depression, and late prenatal care whereas secondary migration was protective for social isolation, relationship distress, and smoking. Relationship distress and behavioral health indicators varied by maternal birth region.
ConclusionThe novel linkage of birth screening data with the immigration data advances knowledge on immigrant perinatal health by identifying risk patterns for multiple psychosocial and behavioral health indicators, highlighting subgroups at higher and lower risk of exposures that may contribute to adverse perinatal health outcomes.
Early Childhood Exposure to Intimate Partner Violence and Developmental Vulnerability at Kindergarten: Linking Canadian Population-Level Administrative Data.
Authors: Lee Janelle Boram , Nickel Nathan , Afifi Tracie , Turnbull Lorna , Urquia Marcelo , Brownell Marni
Published: September 2022

ObjectiveThe objective was to examine the relationship between maternal intimate partner violence (IPV) victimization and children’s developmental health using linked population-wide administrative datasets. We examined developmental vulnerability (DV) at kindergarten of children exposed to maternal IPV victimization aged 0 to 5 using provincial prosecution records compared to unexposed counterparts.
ApproachThis retrospective cohort study linked administrative datasets (legal, health, education, social services) from the Population Research Data Repository at the Manitoba Centre for Health Policy. Exposed mother-child pairs with 1+ prosecution records of maternal IPV victimization during early childhood (child aged 0 to 5) between 2003-2018 in Manitoba (n = 5,728) were matched to unexposed pairs (1:3) based on sex/birthdate of child and neighbourhood income. DV at kindergarten was measured across 5 domains (physical, social, emotional, language/cognitive [LC], communication/general knowledge) using the Early Developmental Instrument (EDI). Children without eligible EDI scores were excluded. Multiple logistic regression models were conducted.
ResultsThe cohort included 5321 children (exposed n=1365, unexposed n=3956). 32.98% of the cohort was developmentally vulnerable in one or more domains (1/+) and 19.60% was developmentally vulnerable in two or more domains (2/+). Unadjusted relationships between maternal IPV victimization from age 0 to 5 and developmental vulnerability at kindergarten were statistically significant across all 5 domains (e.g., LC OR=2.76 [2.36, 3.23]) and in 1/+ (OR=2.72 [2.39, 3.09]) as well as 2/+ (OR=2.89 [2.51, 3.34]) domains. After adjusting for covariates, children who were exposed to maternal IPV victimization from ages 0 to 5 had increased odds of being developmentally vulnerable in social competence (aOR=1.33 [1.07, 1.66]) and emotional maturity (aOR=1.29 [1.03, 1.62]), also in 2/+ domains (aOR=1.42 [1.15, 1.73]) at kindergarten, compared to unexposed counterparts.
ConclusionThe study provided Canadian population-wide evidence of the association between maternal IPV victimization and early childhood development, specifically later socio-emotional vulnerability. Interventions and support systems for this population of families should be developed and implemented, with an emphasis on mitigating long-term socio-emotional developmental risks in children exposed to IPV.
The challenges of developing an application process for a new linked data resource.
Authors: McLachlan Stela , Berman Samantha , Evans Katharine , Levein Christie , Whitehorn Rebecca , Oakley Jacqueline , Campbell Kirsteen , Flaig Robin
Published: September 2022

ObjectivesDeveloping a rigorous application process for COVID-19 linked data within the UK Longitudinal Linkage Collaboration’s Trusted Research Environment (TRE) included balancing the requirements of 20+ longitudinal studies and several data providers with the need to provision data to researchers in a safe and efficient manner.
ApproachThe UK LLC is an innovative project, developing a new approach to linking >20 well-established longitudinal studies to routine health and administrative records. Setting up the process included consultation with stakeholders and other multifaceted data resources in order to implement the best practices available. We also had to acknowledge constraints imposed by a variety of data controllers and ensure meaningful public contribution. The initial process had to be flexible while we assessed the first applications, and because the TRE was regularly being updated with new data. This required an adaptive approach where the process was created, adopted, and re-evaluated in real-time.
ResultsThe UK LLC has a three-stage application and review process, starting with an enquiry through the HDRUK Innovation Gateway. Enquiries are triaged to ensure the applications meet basic requirements (UK-based, COVID-19 related, scientifically sound, and feasible) before the applicants are invited to submit a full application. The full application is then reviewed internally against the Five Safes model, in communication with applicants. Approved applications move on to the third stage which includes a review by Data Access Committees (DACs) for each study whose data is requested, and the UK LLC DAC - comprised of a public review panel advising on lay summaries and public involvement in the proposed project, and, if applicable, an additional linked data review panel on behalf of NHS Digital.
ConclusionOur process is still evolving as new datasets are added and in response to feedback. However, the team has risen to the challenge of balancing this with the needs of 20+ studies, stakeholders, applicants, and participant/public contributors, to create an agile process that can handle complex needs and requirements.
Evaluating interventions for violence prevention using linked MoJ-DfE data: a feasibility study.
Authors: Cornish Rosie , Tilling Kate , Brennan Iain
Published: September 2022

ObjectiveTo assess the feasibility of using linked education and offending data (from the National Pupil Database, Department for Education and the Police National Computer, Ministry of Justice) to identify matched control groups to evaluate violence prevention interventions.
ApproachWe simulated a plausible intervention (multi-systemic therapy aimed at high-risk young people living in high-risk areas) aimed at reducing the rate of serious violent offending between the ages of 15 and 18 years. We separately simulated an intervention in London and one outside London. We selected eligible individuals aged 14 years for inclusion in the intervention group, modelled the predictors of serious violent offending. then used two different matching algorithms – prognostic score matching and (coarsened) exact matching – to identify matched controls. We compared their effectiveness by measuring the observed rates of serious violence in the two groups.
ResultsThe dataset we used dataset included just under 1.5 million individuals born between 1st September 1995 and 31st August 1998 with complete data. Consistent with previous research, factors associated with the risk of serious violence included deprivation, geographical region, sex, ethnicity, attainment, school absence and exclusion, being in care of the local authority or classified as in need, as well as prior offending and some school-level factors. Exact matching or coarsened exact matching was more successful than prognostic score matching at selecting suitable control groups, both within and outside London. Within London, exact matching on sex, ethnicity and any offending before age 14 gave a suitable control group; outside London it was necessary to match on a few additional characteristics in order to obtain well-balanced groups.
ConclusionThe linked dataset can feasibly be used to generate suitable matched control groups to evaluate violence prevention interventions; exact matching on key characteristics is potentially the optimal solution. Its utility in practice will depend on regular data updates and having an efficient mechanism for accessing the data for such purposes.
Childhood adversity, mental health and suicide (CHASE): a longitudinal case-control linked data study of lifetime inpatient records associated with suicide.
Authors: Savinc Jan , Dougall Nadine , Maxwell Margaret , Karatzias Thanos , O'Connor Rory , Williams Brian , John Ann , Cheyne Helen , Fyvie Claire , Bisson Jonathan , Hibberd Carina , Abbott-Smith Susan , Nolan Liz
Published: September 2022

ObjectivesChildhood adversity (CA) carries an increased risk of developing later mental health (MH) problems and suicidal behaviour. This study aimed to summarise lifetime hospital attendances for CA and MH in young people who later died by suicide.
ApproachThis study is a retrospective longitudinal case control study. Lifetime Scottish inpatient acute and psychiatric records were linked to death records and summarised for individuals born since 1981 who died by suicide in the period 1991-2017 (cases), and controls (1:10) matched on sex, age, and postcode. Relevant records were coded MH (including self-harm) and/or CA. Descriptive statistics and odds ratios (OR) were computed.
ResultsData for 2,477 and 24,777 ‘cases’ and ‘controls’ were extracted, of whom 2,106 cases (85%) and 13,589 controls (55%) had lifespan hospital records. Mean age at death for cases was 23.7 (SD=4.9) and 75.9% were male. Psychiatric records represented 11.6% and 1.4% of records for cases and controls, respectively.
For the age range 10-18, Maltreatment & violence-related codes were recorded for 160 (7.6%) cases and 371 (2.7%) controls, corresponding to OR=2.9 (95%CI: 2.4-3.6). This was compared with MH at 458 (21.7%) cases and 560 (4.1%) controls and OR=6.5 (95%CI: 5.7-7.4). The highest adjusted ORs were for self-harm episodes recorded in general hospital with aORmale=6.56 (95%CI: 4.96-8.68) and aORfemale=6.87 (95%CI: 4.99-9.48).
ConclusionAll CA and MH presentations in inpatient hospital records were associated with greater risk of subsequent suicide, with the strongest association for self-harm.
AD|ARC (Administrative Data Agri-Research Collection): Linking Individual, Household and Farm Business Data for Agricultural Research.
Authors: Caskie Paul , Morrison-Rees Sian
Published: September 2022

ObjectivesTo create an anonymised data resource of farm households in the UK to generate evidence to support policy development, implementation and evaluation; improve understanding of farm family socio-economic characteristics; and assist all stakeholders interested in understanding about the health and well-being, resilience and prosperity and spatial properties of farming communities.
ApproachThe AD|ARC resource is being created in each UK country.  The core dataset comprises of linking together existing agricultural datasets (farm business activity data, Rural Payments data) the Inter Departmental Business Register and the Population Census. This hub dataset is linked to the health and education data available in each country. The research is being conducted in a separate but coordinated way across the UK, harmonising the data to allow aggregation to a UK level where possible.
Our research objectives are in four broad categories of Socio-Demographics, Health and Well-being, Prosperity and Resilience and Environment and Place.
ResultsThe presentation will report on initial findings from the socio-demographic research theme where researchers have investigated the composition and characteristics of farming households both in terms of the farm business (e.g. farm type, turnover, active farm diversification) and individual characteristics (e.g. age, educational attainment, off-farm income streams). From this analysis it will be possible to determine the degree of homogeneity that exists within the farming population for key indicators, the degree of homogeneity that exists amongst the broader group of farm households members for key indicators, and the extent to which farmers and farm household members conform to the socio-economic characteristics of the non-farming rural population. Results will be assessed for policy relevance and areas of ongoing investigation will be highlighted.
ConclusionAgriculture is currently facing a range of challenges with little known about the impact on farmers and farming households. AD|ARC introduces a new, powerful and versatile resource that will inform debate and policy decision-makers, potentially leading to better outcomes on a range of issues relevant to farmers and farming communities.
Integrating administrative and clinical datasets to improve patient outcomes.
Authors: Reid Jennifer , Welk Blayne , Garg Amit , Fitzgerald Theresa , Kearns Glen , Shariff Salimah
Published: September 2022

Integrating electronic health records (EHR) with health administrative data offer opportunities for enhanced decision support, health systems evaluations and research for improved patient care. We describe the process of integrating EHR data from 12 hospitals in Southwestern Ontario, Canada and present a health systems evaluation enabled by this linkage.
With support and buy-in from the hospital Chief Executive Officers, a data sharing agreement (DSA) with ICES was executed, outlining the process to approve data transfer requests. Due to the complexity and volume of the EHR, complete data were not immediately transferred to ICES; instead, a project subcommittee comprising of physician leadership, local and regional privacy and risk officers, and ICES staff was assembled to review and approve project-specific data integration requests. An evaluation of the adoption of an electronic medication reconciliation system within the EHR on potentially inappropriate prescribing after hospital discharge was conducted using interrupted time-series analyses.
The data integration request process begins with confirmation of data availability and accuracy within the EHR, enabled by a dedicated health information analyst and institutional decision support teams. Once data feasibility is confirmed, project rationale is submitted to the project subcommittee approval. Following approval, the request undergoes privacy and legal assessment as per the DSA and a project-ready dataset is submitted for linkage.
An evaluation of the adoption of an electronic medication reconciliation system demonstrated an immediate and dramatic reduction in inappropriate medication prescribing and associated adverse events such as a fall or fracture among elderly patients discharged following acute inpatient stays.
Administrative data are valuable at assessing population-based health, but often lack key clinical information present in EHRs. Integrating both data sources offers a more comprehensive picture of patient care and allows for robust analyses. Rigorous investigations generate trusted evidence for decision makers to inform policy and quality improvements within the healthcare system.
Probabilistic linkage of multiple data sources for estimating prevalence of problem drug users in England in 2018/19.
Authors: Djennad Abdelmajid , Jahr Stefan , Harris Ross , Charlett Andre
Published: September 2022

ObjectivesProblem drug use (PDU) prevalence is an essential part of evidence base to formulate policy, inform service provision, and assess interventions. Opiate and crack use, particularly injecting, is associated with infectious diseases. Multiple data sources, where PDU are observed, are linked to estimate the hidden population of PDU using capture-recapture.
ApproachDatasets consisted of (1) community treatment, (2) prison treatment, (3) probation (Ministry of Justice), and (4) drug-related deaths, for financial year 2018/19. The following offenders’ attributes and geography are used: first and second initials, date of birth, gender, multiple areas of residence and area of prison release. Geography information consists of local authority code and region name. Probabilistic linkage approach of Fellegi–Sunter is applied through FastLink package in R, where pairs of records are classified as match, possible match, or non-match at 85% threshold. Estimates of error rates, sensitivity and specificity are used to test the results.
ResultsThere were 138,341 records in community treatment, 41,700 records in prison, 18,849 in probation and 2,368 deaths from opiate or cocaine. The total number of individuals observed in at least one linked dataset is estimated at 170,307 records at 85% threshold. The number of exact and possible matches overlapping between community treatment and prison is estimated at 17,544 records, from which 13,731 (78.3%) are exact matches, and 3,813 (21.7%) are possible matches at 85% threshold. The number of exact and possible matches overlapping between linked community treatment/prison and probation is estimated at 12,586 records, from which 9,872 (78.4%) are exact and 2,714 (21.6%) are possible matches at 85% threshold. False discovery rate was estimated at 0.3%, sensitivity and specificity were 99.8%.
ConclusionsInformation on PDUs attending community treatment is poor and relying on exact matches underestimate the overlap between data sources. This tend to bias hidden population estimates derived from capture-recapture. Probabilistic approaches, and use of multiple candidate geographic areas for matching, maximise linkages between individuals and thus likely to improve estimates.
Evaluation of low acuity patients discharged from a virtual emergency department at a major urban academic health sciences centre in Toronto, Canada.
Authors: Borgundvaag Emily , Plumptre Lesley , Paterson Michael , An Diana , McLeod Shelley , Tarride Jean-Eric , Atzema Clare , Schull Michael , Verma Aikta , Hall Justin
Published: September 2022

ObjectiveIn response to the COVID-19 pandemic, Sunnybrook Health Sciences Centre launched the first virtual emergency department (VED) in Toronto, Ontario. The objective of this pilot project was to leverage linked administrative data to describe the healthcare utilization of VED patients compared to matched patients who attended an ED in person.
ApproachEvaluation of the VED program was supported by the ICES Applied Health Research Question Program, which is funded by the Ontario Ministry of Health to answer questions directly related to Ontario healthcare policy, planning, or practice. VED visit records from December 2020 to May 2021 were linked with Ontario administrative data. VED patients with low acuity complaints were matched 1:1 with in-person ED comparators according to visit date, presenting complaint, and a propensity score that incorporated age, sex, comorbidities, and other important potential confounders. The primary outcomes were healthcare utilization within 7 days and all-cause mortality within 30 days.
ResultsOf the 609 eligible patients discharged from the VED, 600 (98.5%) were successfully matched to a comparator. Mean (SD) age was 43.0 (21.1) and 64.1% were female. In-person ED revisits and hospitalizations were similar for VED and comparator patients at 72 hours (ED: 12.1% vs. 11.3%; Δ 0.8%, 95%: -2.8, 4.5%; hospitalization:  1.2% vs. 1.5%; Δ 0.3%, 95%: -0.7, 1.4%,) and 7 days (ED: 16.1% vs. 14.4%; Δ 1.7, 95%: -2.4, 5.7%; hospitalization: 1.7% vs. 1.8%; Δ 0.2%, 95%: -0.1, 1.4%) following the index visit. The number of patients visiting a primary care provider within 7 days was also similar between groups (36.7% vs. 32.4%; Δ 4.3, 95%: -1.1, 9.8%). No patients died within 30 days.
Conclusion/ImplicationsVED patients and their matched comparators had similar healthcare utilization in the 7 days following their index ED visit. Methodology from this study will inform a province-wide evaluation of VED programs across Ontario.
Inclusion, Diversity, Equity, and Accessibility (IDEA) in multi-regional data research: An approach to facilitating change in a distributed research environment.
Authors: Freier Amy , Katz Alan
Published: September 2022

ObjectiveA recently established data research network identified the need to address Inclusion, Diversity, Equity, and Accessibility and established a team committed to IDEA informed change. The Team identifies, develops, and implements IDEA strategies in distributed research network. We will share the process of establishing this Team and outline identified coordinated opportunities moving forward.
ApproachAdministrative data and analyses are not neutral. Colonialism, racism, gender discrimination, ableism, and other forms of oppression have shaped the data that are available and the research processes that are used to analyze and evaluate data. It is imperative that health data research adopts and develops methods that embed IDEA. An informal survey of a health data research network identified four areas for action including capacity building, culture shifts, information sharing, and coordinated development of policies, practices, and tools. A multi-regional team was established to move forward with this work with an emphasis on operations and research practices.
ResultsIn the fall of 2021 IDEA Team members were recruited from data centres across the network, including IDEA professionals, researchers, data collection and curation specialists, human resource professionals, and public/patient engagement specialists. The first IDEA Team meetings focused on team buildings and building shared purpose by shaping the Terms of Reference and creating principles for working together. Next steps will include an environmental audit to assess network capacity and a consensus oriented decision-making process to identify priorities. The Team includes over 20 members with a broad range of knowledge and expertise, making facilitation a key operational component. Establishing a baseline of knowledge and defining priorities will encompass the first year of the Teams work, navigating the distinct needs of a distributed network, the diverse needs of data centres, and the breadth of data that flows through the network.
ConclusionThis multi-regional inter-disciplinary team is crucial to adopting, developing and embedding IDEA in a distributed data network and could serve as a model for other data research organizations. The Team will work towards capacity building, creating an internal culture shift and coordinating the development of new tools and resources.
Exploring a novel linked dataset and building linked data analytics skills in Public Health Intelligence teams in Sussex.
Authors: Johnston Natalie , Ford Elizabeth , Tyler Richard , Spencer-Hughes Vicki , Madzvamuse Anotida , Evans Graham , Gilchrist Kate
Published: September 2022

ObjectivesPublic health intelligence teams in Sussex wanted to use newly linked health and social care data, to gain insights into local patterns of multi-morbidity, service use, service provision and socio-demographic data. In this study we report initial exploration of this new linked dataset, in a partnership between university and local authority analysts.
ApproachThe Sussex Integrated Dataset (SID) comprises person-level health and social care data on residents and services users across Sussex. During a 6-month secondment, two analysts evaluated the number of data sources available for each individual, evaluated data quality for identifying long-term conditions, developed presentation methods to compare SID outputs on demographics and condition prevalence with open source or expected distributions, and identified the skills-mix and infrastructure required in local authorities for future work. They worked alongside the SID data processing team to inform and improve data quality; and with university data-scientists to learn prediction modelling.
ResultsAnalysts established an efficient querying system to investigate the breadth of data available, more thoroughly focusing on encounters and demographic data in all sources. Long-term conditions were identified through code lists in a range of NHS data sources, to enable consideration of multi-morbidity by demographic. A range of quality issues were identified, such as non-current patients being uploaded into the SID, distorting prevalence estimates, and GP practice populations that did not match expected figures published by NHS digital. Results were represented in multi-morbidity plots, maps, and theographs. Through this data exploration, we have been able to identify the skills-mix needed for local Public Health Intelligence teams to maximise the use of linked data to achieve Public Health objectives.
ConclusionWe have made many conceptual breakthroughs, particularly in understanding data quality, however still need a more complete understanding of quality issues in SID for public health outputs to have meaningful use. Further investigation into the patterns of service use, as well as modelling of multi-morbidity to make predictions and target interventions, will be key next steps.
Risk of children being taken into care amongst Metis parents experiencing incarceration: A linked administrative data study.
Authors: Brownell Emily , Sanguins Julianne , Enns Jennifer , Brownell Marni , Walld Randy , Quddus Farzana , Allard-Chartrand Shannon , Durksen Anita , Lee Janelle Boram , Turnbull Lorna , Urquia Marcelo , Mahar Alyson , Wall-Wieler Elizabeth , Casiano Hygiea , Nickel Nathan
Published: September 2022

ObjectivesIndigenous children in Canada, including Metis children, are taken into care by the child welfare system at a disproportionately high rate. The objective of this study was to explore factors related to having a child taken into care from Metis families in Manitoba, and specifically from Metis mothers experiencing incarceration.
ApproachThe cohort comprised all mother-child dyads in Manitoba, Canada with live births between Jan 1, 2004-Dec 31, 2014. The factors we examined included the mother experiencing incarceration after the birth of a child, having prior interaction with the legal system, socioeconomic status, maternal age, and mother’s mental health disorder diagnoses. Using the Cox proportional hazards model, unadjusted and adjusted hazard ratios describing the risk of a child being taken into care by five years of age were generated for three exposure groups: no incarceration, prenatal incarceration, and postnatal incarceration.
ResultsBefore adjustment, mothers experiencing incarceration after the birth of a child had greater risk of having a child taken into care (HR 9.3; 95% CI 7.7-11.3) compared with women who did not experience incarceration; after adjusting for measured confounders, their elevated risk dropped to aHR 6.1 (5.0-7.4). After further adjustment for prior custody in the prenatal period, mothers experiencing incarceration had 3.8 times the risk (3.0-5.0), and after adjusting for maternal mental health disorders, this dropped to 2.6 times the risk (2.0-3.4). In fully adjusted models, other factors associated with having a child taken into care included receiving diagnoses for a substance use disorder (aHR 2.6; 2.1-3.2) and for psychosis (aHR 2.4; 1.4-4.1) during the five years prior to the child’s birth.
ConclusionDue to colonialism, Metis women experience high levels of social and mental health complexity, placing their children at increased risk of being taken into care. Responding to the Truth and Reconciliation Commission’s Calls to Action to redress the harms of colonialism is necessary to support Metis children’s health and well-being.