bluuebunny/crossref_metadata_2025_split huggingface dataset:
98Framework for the Treatment And Reporting of Missing data in Observational Studies: The TARMOS framework
Authors: Cornish Rosie , Tilling Kate , Cornish Rosie , Carpenter James 
Published: September 2021

Abstract

Focus of presentation
Missing data are ubiquitous in medical research. Although there is increasing guidance on how to handle missing data, practice is changing slowly and misapprehensions abound, particularly in observational research. We present a practical framework for handling and reporting the analysis of incomplete data in observational studies, which we illustrate using a case study from the Avon Longitudinal Study of Parents and Children.

Findings
The framework consists of three steps: 1) Develop an analysis plan specifying the analysis model and how missing data are going to be addressed. Important considerations are whether a complete records analysis is likely to be valid, whether multiple imputation or an alternative approach is likely to offer benefits, and whether a sensitivity analysis regarding the missingness mechanism is required. 2) Explore the data, checking the methods outlined in the analysis plan are appropriate, and conduct the pre-planned analysis. 3) Report the results, including a description of the missing data, details on how missing data were addressed, and the results from all analyses, interpreted in light of the missing data and clinical relevance.

Conclusions/Implications
This framework encourages researchers to think carefully about their missing data and be transparent about the potential effect on the study results. This will increase confidence in the reliability and reproducibility of results from published papers.

Key messages
Researchers need to develop a plan for missing data prior to conducting their analysis, and be transparent about how they handled the missing data and its potential effect when reporting their results.
743Determinants of childhood mortality sex ratios in low- and middle-income countries
Authors: Costa Janaina Calu , Victora Cesar 
Published: September 2021

Abstract

Background
Child mortality sex ratios may reflect community preferences and gender discrimination in health care. We assessed differences between observed and expected sex ratios of under-five mortality and their association with contextual factors.

Methods
Full birth histories from Demographic and Health Surveys and Multiple Indicator Cluster Surveys (2010–2018) in 77 countries were used to estimate under-five mortality sex ratios (male-to-female). Expected sex ratios and their residuals (difference of observed from expected) were derived from a fractional polynomial model, adjusted for overall mortality. Higher male-to-female residuals indicate lower likelihood of discrimination against girls. The same approach was used for 720 subnational regions from 75 countries. Associations between residuals and national gender and development indices, and with survey-derived child health care indicators were tested using Spearman’s correlation.

Results
Greater positive residuals were found in countries with higher Gross National Product per capita (rho=0.26), women older age at first marriage (rho=0.36), Human Development Index (rho = 0.23), and the Women, Peace and Security Index (rho=0.25). The Gender Inequality Index, which indicates less discrimination among women, was inversely correlated with the residuals (rho=-0.30). None of the survey-based indicators of gender bias in health care were significantly associated with the residuals, either at national or subnational levels.

Conclusion
Contextual variables measured at country level are associated with the sex ratio of under-five mortality.

Key messages
In more developed societies there is less evidence of gender bias in child deaths.
467Hypertension, Dyslipidaemia and Pregnancy Complications in Filipino Women
Authors: Durante Cherry Ann 
Published: September 2021

Abstract

Background
There is an increasing trend of pregnancy complications in the Philippines. However, these are not well documented due to the lack of a national database. This study describes the prevalence of hypertension and lipid abnormalities among Filipino pregnant women, which result to complications during pregnancy.

Methods
Multi-stage stratified random sampling was employed in the National Nutrition Survey and 6,166 pregnant women were included in the study. Demographic data was gathered through an interview questionnaire. Blood samples were drawn to determine fasting blood sugar (FBS), cholesterol, HDL and LDL, and triglycerides levels.

Results
One in ten pregnant women (n = 661) showed signs of pregnancy complications. High risk pregnancies were identified, ranging from heart disease (2.9%), gestational diabetes (3.2%), asthma (3.51%) and goiter (4.12%). Prevalence of pregnancy-induced hypertension is 18.26%. Dyslipidemia is high among sample population with a prevalence of 39.54% (n = 376). Results showed that patients with hypertension are twice more likely to have pregnancy complications than those with normal BP (OR:1.95, CI 0.47, 6.08).

Conclusions
Based on the data, there is a high prevalence of pregnancy complications in the Philippines which is associated with having hypertension and lipid abnormalities.

Key messages
Health policies should be made to cater to the early detection of disease in pregnant women and widespread campaign for affordable prenatal check-ups.
576Is the method of longitudinal data analysis equally relevant for common versus uncommon endpoints?
Authors: Dzikiti Moleen , Laughton Barbara , Innes Steve , Cotton Mark 
Published: September 2021

Abstract

Background
We explored the effects of predominant breastfeeding on infection-related hospitalization (uncommon outcome), over the first year of life, using the Mother Infant Health cohort study (MIHS), and the effect of early antiretroviral treatment (ART) on viral suppression (&lt; 400 copies/mL) (common outcome), in children aged 7 to 12 weeks, using a subset of the Children with HIV Early AntiRetroviral Treatment (CHER) clinical trial data. We assessed the sensitivity of findings to different models to account for dependency of uncommon and common binary outcome.

Methods
We fitted generalized linear mixed model with (1) random intercept and (2) random slope, generalized estimating equations (GEE) with 3) an exchangeable correlation structure; 4) autoregressive correlation structure of order 1 (AR1) and 5) unstructured correlation structure and 6) logistic regression model.

Results
Eighty four and 119 children from MIHS were non-predominantly and predominantly breastfed, respectively. There were 34 infection-related hospitalizations overall. Most infants were hospitalized once, except for four with two hospitalizations. We analysed 88 HIV-infected children from the CHER trial. On average, a child achieved viral suppression twice, range of one to four. The effect of predominant breastfeeding on infection-related hospitalization was similar across all models, except for the GEE with AR1 that had a high estimate (wider confidence intervals). The effect of early ART exposure on viral suppression varied across models.

Conclusions
The sensitivity of estimates to the method of analysis was driven by frequency of the outcome.
1216Combining propensity score-weighting and multiple imputation is not a trivial task
Authors: Eiset Andreas Halgreen , Frydenberg Morten 
Published: September 2021

Abstract

Background
Propensity score (PS)-weighting and multiple imputation are two widely used statistical methods. Combining the two is not trivial and has received little attention in theory and practice. We present our considerations for their combination with application to a study of long-distance migration and post-traumatic stress disorder. We elaborate on the assumptions underlying the methods and discuss the methodological and practical implications of our choices and alternatives.

Methods
We made a number of choices a priori: to use logistic regression-based PS to produce “standardised mortality ratio”-weights and SMC-FCS to multiply impute missing data. We present a methodology to combine the methods by choosing the PS model based on covariate balance, using this model as the substantive model in the multiple imputation, producing and averaging the point estimates from each multiply imputed data set to give the estimate of association and computing the percentile confidence interval by bootstrapping.

Results
In our application, a simple PS model was chosen as the substantive model for imputing 10 data sets with 40 iterations and repeating the entirety 999 times to obtain a bootstrap confidence interval. Computing time was approximately 36 hours.

Conclusions
Our structured approach is demanding in both work-load and computational time. We do not consider the prior a draw-back: it makes some of the underlying assumptions explicit and the latter may be a nuisance that diminishes with time.

Key messages
Combining propensity score-weighting and multiple imputation is not a trivial task.
1437Rates of low value care in NSW public hospitals: variation between public and private inpatients
Authors: Costa Juliana de Oliveira , Pearson Sallie-Anne , Elshaug Adam , Gool Kees van , Jorm Louisa , Falster Michael 
Published: September 2021

Abstract

Background
Low value care (LVC) services have limited or no benefit to patients, and curtailing LVC can curb unnecessary spending and improve the quality of care. Some public hospitals in Australia have financial incentives to perform procedures for patients with private health insurance, yet little is known if there are differences in LVC between public and private patients.

Methods
We performed a retrospective analysis of New South Wales public hospital data from January 2013 to June 2018. We measured hospital-specific rates of five LVC services and compared rates within each public hospital by patient funding status (private or public), descriptively and using random-slope multilevel models.

Results
Overall rates of LVC varied between services, ranging from 0.3 to 30.8 procedures per 1,000 eligible patients for hyperbaric oxygen therapy and vertebroplasty, respectively. There was large variation in rates of the LVC services between hospitals, and a few hospitals had higher rates of LVC among private than public patients. However, we found no consistent association between patient funding status and LVC services: private patients had lower rates of knee arthroscopic debridement than public patients (aOR:0.56) and higher rates of low value vertebroplasty for osteoporotic spinal fractures (aOR:1.08), hyperbaric oxygen therapy (aOR:1.53) and oophorectomy (aOR:1.77); all statistically non-significant.

Conclusions
Private patient funding may contribute to LVC in some public hospitals, but it was not consistently associated with higher rates of the five LVC services measured.

Key messages
Reducing LVC services requires investigating the role of health-system factors at both the global- and local-level.
1394Better Cardiac Care Data Linkage Project: utilising cross-jurisdictional data to improve patient-flow capture
Authors: Farber Rachel , Igic Branislav , Alfaro-Ramirez Maria , Nelson Michael , Khanlari Sarah , Francis Catherine , Taylor Lee 
Published: September 2021

Abstract

Background
For patients experiencing acute myocardial infarction (AMI), particularly ST-elevation myocardial infarction (STEMI), timely revascularisation is important to optimise prognosis. The AMI patient journey often involves presentation to the closest appropriate facility and transfers between hospitals, including across jurisdictions. The Better Cardiac Care (BCC) dataset consists of cross-jurisdictional linked ambulance, emergency, hospital, outpatient, deaths, Medicare and Pharmaceutical Benefits Scheme records for residents of New South Wales (NSW), Australia. This dataset will be updated annually.

Methods
The BCC dataset comprises 332 million records, from 18 datasets, across 6 jurisdictions. For NSW residents hospitalised for STEMI between 2013 to 2018, we compared the number of STEMI hospitalisations, the proportion of patients receiving revascularisation procedures, and the time to procedures using only NSW records versus records from all jurisdictions and Medicare Benefits Scheme.

Results
Compared with NSW hospital data, including data from other jurisdictions increased the ascertainment of STEMI hospitalisations by 8.0% and procedures by 11.2% for NSW residents. This increase was greatest for residents living near state borders, increasing the number of STEMI hospitalisations by up to 210% and the percentage receiving procedures by up to 70%.

Conclusions
Cross-jurisdictional data is essential to understand patient journeys of residents who live in border areas and to evaluate patient care for STEMI and AMI more broadly.

Key messages
The BCC dataset is a vital asset that enables a more comprehensive view of care for AMI than has been possible to date.
263Disability and inequality on the social determinants of health: data, data gaps, and policy implications
Authors: Fortune Nicola , Badland Hannah , Clifton Shane , Emerson Emeritus Eric , Stancliffe Emeritus Roger , Llewellyn Gwynnyth 
Published: September 2021

Abstract

Focus of Presentation
People with disability experience inequality in relation to social determinants of health such as employment, education and housing. Under the UN Convention on the Rights of Persons with Disabilities, Australia must collect data to assess fulfilment of its Convention obligations and to identify and address barriers faced by people with disability in exercising their rights. The objective of our research was to determine the extent to which such data are currently available.

Findings
With input from people with disability, we developed a monitoring framework and indicators to measure inequalities between Australians with and without disability in relation to social determinants of health. National data sources that included a disability identifier were available to report on 73% of the 128 indicators. For example, in the domain ‘Employment’, national data were available for indicators of labour force status, long-term unemployment, leave entitlements, and employment in high-skill jobs. Data were not available for the following indicators: under-employment, access to job design modifications, and disability-related discrimination in the workplace.

Conclusions/Implications
It is currently not possible to quantify inequalities between Australians with and without disability, track change over time, or identify factors that can inform effective policy responses for indicators where we lack national data that include a disability identifier.

Key messages
Addressing data gaps, including by facilitating disability identification in existing data collections, is essential for tackling disability-related inequalities on social determinants of health and meeting our obligations under the UN Convention on the Rights of Persons with Disabilities.
918Building the evidence base for australia’s veteran population
Authors: Gates Louise , Petricevic Mark , Gorman Patrick 
Published: September 2021

Abstract

Background
There is a wealth of existing research on Australia’s veteran population. However, much of the existing research seeks to answer questions on specific issues, veterans of specific conflicts, or of veterans who use the Department of Veterans’ Affairs services, with little to no information beyond these specific populations.

Methods
Several large administrative datasets including the Pharmaceutical Benefits Schedule (PBS), Causes of Death and Specialist Homelessness Services were linked with Defence information to enable analysis of veterans’ information against a range of topics, such as cause of death, health service and homelessness service use. Comparisons were made between the Australian Population as a whole and the veteran population.

Results
Results show some similarities and some differences between the veteran population and the whole Australian population. Results are disaggregated between those who are currently serving, in the reserves and ex-serving as well as by service type and other variables.

Conclusions
These results have helped to improve what is known about the broader veteran community. They provide important context for policy makers to understand how best to service the veteran community that was previously unknown, and help identify areas for more detailed research and exploration.

Key messages
Data linkage provides an important opportunity to understand the specific health and welfare needs of veterans who are otherwise difficult to identify in large administrative datasets. Comparison of veterans’ health and welfare service use with the broader Australian population provides important information for policy makers.
32Do the risks of Lynch syndrome-related cancers depend on the parent-of-origin of the mutation?
Authors: Gemechu Shimelis , van Vliet Christine M. , Win Aung Ko , Figueiredo Jane C. , Marchand Loic Le , Gallinger Steven , Newcomb Polly A. , Hopper John L. , Lindor Noralane M. , Jenkins Mark A. , Dowty James G. 
Published: September 2021

Abstract

Background
Individuals who carry pathogenic mutations in DNA mismatch repair (MMR) genes have high risks of cancer, and small studies have suggested that these risks depend on the sex of the parent from whom the mutation was inherited. We have conducted the first large study of such a parent-of-origin effect (POE).

Methods
Our study was based on all MMR gene mutation carriers and their relatives in the Colon Cancer Family Registry, comprising 18,226 people. The POE was estimated as a hazard ratio (HR) using a segregation analysis approach that adjusted for ascertainment. HR = 1 corresponds to no POE and HR &gt; 1 corresponds to higher risks for maternal mutations.

Results
For all MMR genes combined, the estimated POE HRs were 1.02 (95% confidence interval (CI) 0.75-1.39, p = 0.9) for male colorectal cancer, 1.12 (95% CI 0.81-1.54, p = 0.5) for female colorectal cancer and 0.84 (95% CI 0.52-1.36, p = 0.5) for endometrial cancer. Separate results for each MMR gene were similar.

Conclusions
Despite being well-powered, our study did not find any evidence that cancer risks for MMR gene mutation carriers depend on the parent-of-origin of the mutation. Based on current evidence, we don’t recommend that POEs be incorporated into the clinical guidelines or advice for such carriers.

Key messages
MMR gene mutations inherited from the maternal and paternal side confer similar risks of developing colorectal and endometrial cancer.
971Ethnicity and Cardiovascular Disease in the Australian Population
Authors: Georgousopoulou Ekavi , Lord Sally 
Published: September 2021

Abstract

Focus of Presentation
Cardiovascular disease (CVD) risk prediction is recommended for Australians over 45 and Indigenous Australians over 35 years of age. UK evidence for the QRISK tool suggests that including ethnic background as a moderator, improves risk prediction. Australian risk-charts do not account for ethnicity, despite the diversity of the population. Our aim was to compare CVD prevalence among Australian ethnic groups, defined by country of birth and summarized in the following regions: 1.Oceania and Antarctica, 2.North-West-, 3.Southern and Eastern Europe, 4.North Africa and Middle East, 5.South-East-, 6.North-East-, 7.Southern and Central Asia, 8.America and 9.Sub-Saharan Africa.

Findings
Aggregated data from the Australian Health Survey Core Content–Risk Factors and Health Conditions 2011-12 TableBuilder of Australian Bureau of Statistics were representative of approximately 21.5M Australians according to weights’ analysis; however, age standardisation was impossible. Ischemic CVD prevalence for Australians born in Oceania and Antarctica was approximately 2.6%, North-West Europe 5.1%, Southern and Eastern Europe 6.7%, North Africa and Middle East 4.3%, South-East Asia 1.3%, north-East Asia 0.3%, South and Central Asia 1.2%, America 2.3% and Sub-Saharan Africa 1.2%. In all ethnic sub-groups, males represented 51-83% of individuals with CVD.

Conclusions/Implications
Country of birth may be used as a proxy of ethnic background for investigating potential socio-cultural CVD risk factors and if accounted for, might increase risk-charts’ performance.

Key messages
Australians’ ethnic background is associated with CVD prevalence. Including ethnicity in risk-tools might increase accuracy in CVD risk prediction.
1456Changes in dietary patterns from preconception to during pregnancy and its association with socio-demographic factors
Authors: Gete Dereje , Waller Michael , Mishra Gita 
Published: September 2021

Abstract

Background
Little is known about the changes in dietary patterns from preconception to during pregnancy, nor of their association with socio-demographic and lifestyle factors. This study, therefore, examined dietary patterns changes from preconception to during pregnancy and their associations with socio-demographic and lifestyle factors.

Methods
This study used data from the Australian Longitudinal Study on Women’s Health (ALSWH), a population-based prospective cohort study. Women’s dietary patterns were assessed using Healthy Eating Index-2015 (HEI-2015) score and the four patterns obtained from the factor analysis (meats, high-fats, and sugar; vegetable and grains; traditional vegetable; and fruit patterns). Multivariable linear regression and repeated measures mixed-effect models were used.

Results
Women’s scores increased on the ‘HEI-2015’, ‘traditional vegetable’, and ‘fruit’ patterns while the ‘vegetable and grains’ decreased from preconception to during pregnancy. Women with higher education were more likely to increase their HEI-2015 score and fruit consumption from preconception to during pregnancy respectively (β = 2.31, 95%CI: 0.02, 4.60) and (β = 23.78, 95%CI: 4.58, 42.97), than those with lower educational status. Single women were more likely to increase the consumption of vegetables and grains compared to married women (β = 76.08, 95% CI: 20.83, 131.32). Women with higher income had a greater increase in the HEI-2015 score than those with lower income (β = 3.02, 95% CI: 0.21, 5.83).

Conclusion
The findings indicate that there have been marked dietary changes from preconception to during pregnancy. Changes in healthy dietary patterns were influenced by education, marital status, and income.

Key messages
Early shaping of adequate dietary behaviours before pregnancy is very important for the mothers and their children's health since pre-conception diets have a critical role in placental and foetal tissue developments.