bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of Health Behaviour Mortality Hazards in Canada and the United States
Authors: Fisher Stacey , Bennett Carol , Hennessy Deirdre , Fines Philippe , Jessri Mahsa , Eddeen Anan Bader , Sanmartin Claudia , Manuel Doug 
Published: September 2018

IntroductionNational health surveys, available in over 100 countries, are the most common data used for health behaviour surveillance and are increasingly being linked to individual-level health outcomes. We propose that improved health behaviour hazard estimates can be obtained from pooled international population health surveys linked to outcome data.
Objectives and ApproachThe objective of this study was to compare smoking, alcohol, diet and physical activity all-cause mortality hazards in Canada and the United States using individual-level, linked population health survey data and common model specifications. The Canadian Community Health Survey (CCHS) (2003-2007) and the United States National Health Interview Survey (NHIS) (2000, 2005) linked to individual-level mortality outcomes with follow up to December 31, 2011 were used. Variable definitions consistent across the CCHS and NHIS were developed and used to estimate country-specific mortality hazards with sex-specific Cox proportional hazard models, including health behaviours, sociodemographic indicators and proximal factors including disease history.
ResultsA total of 296,407 respondents and 1,813,884 million person-years of follow-up from the CCHS and 62,226 respondents and 497,909 person-years from the NHIS were included. Hazards of smoking, alcohol consumption, diet and physical activity in Canada and the United States are of similar magnitude and direction, with similar dose response relationships. The largest health behaviour mortality hazards were associated with female heavy smokers in both Canada (HR: 3.36, 95% CI: 2.86, 3.95) and the United States (Female HR: 2.63, 95% CI: 2.11, 3.27), compared to non-smokers.
Conclusion/ImplicationsHealth behaviour mortality hazards are comparable in Canada and the United States, supporting the use of hazards obtained from pooled analyses for population heath. These hazards can replace those obtained from independent epidemiology studies that are often incompletely adjusted, rarely population-based and often not generalizable to the population of interest.
Development of a frailty score based on hospital discharge data linked to cohort data
Authors: Le Pogam Marie Annick , Trächsel Bastien , Seematter Laurence , Rousson Valentin , Burnand Bernard , Santos-Eggimann Brigitte 
Published: September 2018

IntroductionFrailty is strongly associated with adverse health outcomes and health care costs in elders. However, we have almost no idea of the prevalence of frail older inpatients in Swiss hospitals. Hospital discharge data could contribute to predicting frailty in these patients, and eventually improving SwissDRGs system or casemix-adjustment.
Objectives and ApproachThe HFrailty project aimed to develop a predictive model of Fried’s Frailty Phenotype (FFP) based on hospital discharge data. We linked Lausanne University Hospital (CHUV) discharge data to clinical data from the Lausanne cohort study (Lc65+) over the period 2004-2015. The Lc65+ is a longitudinal population-based cohort comprising three random samples of approximately 1500 Lausanne residents aged 65 to 70, born respectively before, during and after World War II. With stepwise and lasso penalized logistic regression, random forest and neural networks, we identified the best-performing model for predicting FFP using CHUV’s data recorded within 12 months prior to frailty assessments.
ResultsAmong Lc65+ participants, 1649 were assessed for frailty and hospitalized at least once during the follow-up period, resulting in 3499 FFP assessments of which 544 were preceded by at least one hospitalization within 12 months. In total, 45.7% of the participants were men and 9.4% were frail (FFP score ≥ 3). As expected, prevalence of frailty increased with age from 4.1% in the 66-70 age group, to 5.3% and 10.5% in the 71-75 and 76-80 groups, respectively. Logistic regression with lasso penalty was finally the best model regarding both performance and complexity. It had an area under receiver operating curve of 0.67 to predict FFP based on detailed diagnosis and procedure codes.
Conclusion/ImplicationsHospital discharge data may be used to identify frail and non-frail individuals and estimate their prevalence in the Swiss non-institutionalized population. Our predictive model showed limited performance and could be improved. We are currently testing groups of diagnosis and procedure codes, as predictors, instead of detailed ones.
Secondary care provision for children and young people with Cerebral palsy: A data-linkage study
Authors: Carter Bethan , Jones Hywel , Bethell Jackie , Kemp Alison , Wang Ting , Perra Oliver 
Published: September 2018

IntroductionData on children with cerebral palsies are often held in registries, but these contain limited information with varying levels of follow-up. Here we show how record-linkage with healthcare datasets has enabled longitudinal follow-up if these children to understand how they use secondary care health services.
Objectives and ApproachOur primary aim was to explore healthcare utilisation for children and young people (CYP) with CP aged 0-25 years between 2004 and 2014 by severity, measured by recorded Gross Motor Function Classification System (GMFCS) level. This was achieved by linking Northern Ireland Cerebral Palsy Register (NICPR) data to routinely collected secondary care data. Comparison was made to the population of CYP who were not on the NICPR i.e. non CP cases.
ResultsThere were 1,693 cases in the NICPR cohort born 1981-2011. Of those, 286 (16.9%) were GMFCS 1, 662 (39.1%) GMFCS 2, 277 (16.4%) GMFCS 3, 105 (6.2%) GMFCS 4 and 342 (20.2%) were GMFCS 5 (21 (1.2%) missing).
NICPR cases had 11,844 hospital admissions and 19,750 outpatient appointments during the study period accounting for 1.7% of both inpatient and outpatient attendances. Those with severe CP were more likely to have an inpatient admission and had longer stays in hospital than those with less severe CP and those without CP. 592/948 (62.4%) patients with GMFCS 1&2 had an admission compared to 345/447 (77.2%) of GMFCS 4&5 cases. The proportion of elective to emergency admissions was 72.4% versus 53.7% for non CP.
Conclusion/ImplicationsThis study adds to understanding of service utilisation for those with CP in the UK, and provides comparable figures with a recent study in Australia. Thus, further demonstrating that linkage between CP registers and routinely collected healthcare may be useful for health services research and informing healthcare delivery.
Using Administrative Health Data to Define a Cohort of Youth Affected by Chronic Health Conditions: Preparing for Cross-Sectoral Data Linkage
Authors: Schraeder Kyleigh , Barrett Olesya , Nettel-Aguirre Alberto , Dimitropoulos Gina , Mackie Andrew , Samuel Susan 
Published: September 2018

IntroductionIn Alberta, 2,400 youth with chronic needs transition to adulthood every year, and many are not prepared for this change. Transferring youth from pediatric to adult-oriented care is poorly managed. To improve this process, we need to know how youth patients use health services during this period.
Objectives and ApproachWe used the Alberta Health Services Corporate Data Repository (CDR-9), which collects records of ambulatory visits, to define a cohort of patients with chronic disease using pediatric tertiary care; data is available from 2008 to 2016. Personal health numbers allowed for deterministic data linkage to CDR-9, registry data (e.g., death dates, moves out of province), and area deprivation indices. Eligible patients were: (a) between ages 12-15 years in 2008 (for ≥2 years observation in adulthood, after age 18), (b) involved with a Chronic Care Clinic (CCC) at Alberta Children’s Hospital, and (c) had repeated CCC visits with ≥3 months between visits.
ResultsWe identified 26 Chronic Care Clinics (CCC) at Alberta Children’s Hospital (Calgary, Alberta), with stakeholder input. Using CDR-9, a total of 10,111 patients at the hospital were identified who were 12 to 15 years old at the start of the study window (in 2008), and who visited a CCC before age 18. Less than 1% (n=418) were excluded due to moving out of province or having an invalid personal heath number. Final sample sizes were captured across 3 algorithms (A1, A2, A3), based on frequency of CCC visits within a 2-year period: (i) A1: ≥2 CCC visits (N=4123); (ii) A2: ≥3 CCC visits (N=2242); (iii) A3: ≥4 CCC visits (N=1344).
Conclusion/ImplicationsOur identified cohort of youth affected by chronic conditions is the first of its kind in Alberta, and can answer important questions about patterns of service utilization in other sectors of care. Our next step is to link the cohort to population-level datasets (e.g., physician claims, NACRS, CIHI-DAD).
NHS Scotland Public Benefit and Privacy Panel (PBPP) – Much Ado about Governance 3 years on
Authors: Morris Carole , Gray Ashley , Scott Jennifer 
Published: September 2018

IntroductionSince its’ inception in May 2015, the Public Benefit and Privacy Panel has provided a centralised, simplified and truly national Information Governance scrutiny process. It has successfully harnessed expertise across NHS Scotland health boards implementing a collaborative approach which contributes to consistency and continued capacity development across the sector.
Objectives and ApproachOver the last 3 years PBPP developed several procedures within its’ operations to become more efficient and achieve consistent decision making to ensure there is adequate information sharing amongst both Tier 1 and Tier 2 PBPP members. These components include:

Integrated working with eDRIS team to support applicants pre submission
Established an operational group with action plan
Monthly reporting to NHS Boards Information Governance colleagues
Annual learning and sharing workshop
Annual audit of Tier 1 Proportionate Governance approved applications
Documented Case Law
Information Sheets on categories of applications to aid consistent decision making

ResultsTier 1 panel members have noted that the quality of applications is noticeably improved when assistance is provided pre-submission aiding the speed of their proportionate review and that reference documents provide valuable information on the foundations of previous decisions. As a result of this and other improvements 90% of all applications are approved by Tier 1. Only those deemed highly complex or novel proposals are usually referred to Tier 2 at which 8% are reviewed and approved out of committee via email and the remaining 2% are heard at a Full Committee meeting. Whilst the average “clocked” days for an application is approximately 31 days.
Conclusion/ImplicationsPBPP needs to continue to evolve in order to continue providing efficient and pragmatic IG assessments for new technologies, more complex, voluminous data linkages and innovation. This is no mean feat in a fast paced environment and we have to ensure those involved are given sufficient time to do so.
Validating coding for a chronic condition (Cerebral Palsy) in routinely collected hospital admissions data
Authors: Carter Bethan , Jones Hywel , Bethell Jackie , Kemp Alison , Wang Ting 
Published: September 2018

IntroductionData-linkage provides an opportunity to evaluate healthcare utilisation of patients with chronic health conditions. However the consistency and accuracy of recording chronic conditions in routinely collected healthcare data is unclear and we aim to explore this in children and young people (CYP) with a cerebral palsy (CP).
Objectives and ApproachThe study aims to validate CP case identification in routinely collected data by data-linking cases from The Northern Ireland Cerebral Palsy Register (NICPR) born 1981-2011 with routinely collected hospital admission data and cross-referencing cases between the two datasets. CP cases were identified in the administrative data using ICD-10 codes G80 (cerebral palsy), G81 (hemiplegia), G82 (paraplegia and tetraplegia) and G83.0-83.3 (diplegia and monoplegias).
ResultsThere were 1,693 cases in the NICPR cohort and 1,733 cases of CP identified in the hospital admissions data, 915 of which were on the NICPR giving a positive predictive value for identifying a CP case within routinely collected data of 52.8%. Specificity was high (99.8%) however sensitivity was low (54.1%).
1,157 (68.3%) patients on the NICPR had at least one hospital admission. 914 (79.0 %) cases were coded at some time point with G80-83.3 (829 (71.7%) G80, 328 (28.3%) G81-83.3). NICPR cases had a total 11,844 hospital admissions and a CP code was recorded during 6,397 (54.0%).
The type of CP was recorded in NICPR for 1,673 (98.8%) cases whereas in the hospital admissions, data the majority (70.6%) were coded as other/unspecified CP (G80.8-9).
Conclusion/ImplicationsThis study adds to understanding of CP coding practices within routinely collected hospital data, further supporting claims that coding of CP within such datasets is poor. Coding must be accurate and consistent if data are to be meaningful, comparable and useful to inform health outcome reviews and patient care.
The association between maternal and offspring preterm birth. Results from a sibling design
Authors: Urquia Marcelo 
Published: September 2018

IntroductionPrevious studies have reported an intergenerational association between maternal and offspring preterm birth (PTB) but the nature of the association remains unclear.
Objectives and ApproachThe objective was to revisit the association between maternal and offspring preterm birth using a quasi-experimental sibling design and distinguishing between preterm birth types. We conducted a retrospective intergenerational cohort study of 39,573 women born singleton in Manitoba, Canada (1980-2002) who gave birth to 79,198 singleton infants (1995-2016). To account for familial confounding we defined a matched subcohort of 1033 sister mothers with discordant PTB status and compared offspring PTB rates between 2,499 differentially exposed cousins using log-binomial fixed-effects generalized estimating equation models. PTB was defined as a delivery < 37 gestation weeks, divided into spontaneous and provider-initiated.
ResultsIn the population, mothers born preterm were more likely to give birth preterm [Adjusted Relative Risk (ARR): 1.39; 95\% Confidence Interval (CI): 1.25, 1.54]. The intergenerational association was not apparent among births to sisters with discordant PTB status [ARR: 1.02; 95\% CI: 0.77, 1.34]. However, the lack of association in the sibling analyses is explained by the fact that infants whose maternal aunts, but not their mothers, were born preterm had similarly elevated risk of PTB (10\%) than infants whose mothers were born preterm. Intergenerational patterns were observed for spontaneous PTB but not for provider-initiated PTB.
Conclusion/ImplicationsThese findings suggest that it is not the fact of having been born preterm that puts women at higher risk of delivering preterm, but the fact of having been born to a mother who ever delivered a preterm baby. Consideration of family history of PTB may better identify women-at-risk.
Concordance of EDI-based prevalence rates of health disorders with administrative data in two Canadian provinces
Authors: Reid-Westoby Caroline , Horner Matt , Janus Magdalena 
Published: September 2018

IntroductionPopulation level data provide unprecedented opportunities to explore low-frequency health disorders, yet few suitable sources exist for young children. Early Development Instrument (EDI) data on child development in kindergarten in publically-funded schools in Canada include information on children’s health disorders that may be used as a source for prevalence estimates.
Objectives and ApproachWe aimed to examine the concordance of EDI-based prevalence rates of health disorders with administrative data in two Canadian provinces by linking data at various levels. In Manitoba, individual EDI data were linked with health and educational data containing information on diagnosis prior to kindergarten for six health disorders: Autism Spectrum Disorder (ASD), Fetal Alcohol Spectrum Disorder (FASD), Attention Deficit and Hyperactivity Disorder (ADHD), Cerebral Palsy (CP), Anxiety, and Asthma. In Ontario, the prevalence rate of ASD based on the EDI was compared to the prevalence rate obtained from regional ASD service providers, matched on area geocodes.
ResultsIn Manitoba, the total number of children with one of the six diagnoses in the linked database was 10,181. EDI data from 2011 and 2013 demonstrated concordance rates ranging from 0% (Anxiety) to 37% (ASD) between EDI and pre-kindergarten individual administrative data for the prevalence of the health disorders. In Ontario, interrater reliability was established with 2010-2012 EDI data in 12 regions (total number of children with ASD based on the EDI =1,329) to examine consistency among the two data sources. Results showed a “fair” concordance rate for the two sources of ASD prevalence information (Kappa = 0.329; p < 0.001), with rates varying from 0.85% to 1.05%. Linkages with subsequent cohorts of children are ongoing and will be examined for consistency with current results.
Conclusion/ImplicationsWhile the results are somewhat lower than expected, they established feasibility of linkages in 2 provinces and will be repeated in others, potentially with a broader time-frame (up to 1-2 years post-kindergarten). This will further inform successful utilization of existing data sources to monitor the prevalence of children’s health disorders.
Spatial epidemiology of premature mortality in Ontario, Canada
Authors: Buajitti Emmalin , Watson Tristan , Norwood Todd , Rosella Laura 
Published: September 2018

IntroductionGeographic disparities in health indicators, such as premature mortality, may reveal area-level weaknesses in health system performance. Monitoring geographic trends can therefore have powerful implications for system evaluation and planning. However, attempts to understand patterns of population health can be complicated by underlying regional differences in demographics and behaviours.
Objectives and ApproachThis study aimed to identify regional disparities in premature mortality (defined as death before age 75), and to investigate how fully these disparities can be explained by population-level characteristics. Ontario’s 76 administrative Local Health Integration Network (LHIN) sub-regions, which vary in geographic and population size, were analyzed using linked population-level data from the Institute for Clinical Evaluative Sciences and Cancer Care Ontario.
Spatially structured, sex-stratified Bayesian hierarchical models were used to estimate standardized mortality ratios (SMRs) for each LHIN sub-region in the 2011-2015 period. Models were adjusted for key population-level demographic and behavioural risk factors.
ResultsLarge disparities in premature mortality presented at the sub-region level in males and females. Low premature mortality clustered around large, urban population centers in Ottawa and Toronto. Premature mortality was comparatively higher throughout the rest of the province, particularly in northern and southeast Ontario.
Higher prevalence of material deprivation, overweight and obesity, sedentary behaviour, and smoking were all significantly (α=0.05) associated with elevated premature mortality risk, while increased alcohol consumption and immigrant population were associated with decreased risk.
Adjusting for model covariates reduced variance of sub-region SMR estimates by 87% in males and 89% in females. Population-level characteristics thus explain a large proportion of geographic inequality in premature mortality. However, residual spatial variation suggests that systematic regional differences in premature mortality extend beyond population-level traits.
Conclusion/Implications
This study represents a novel application of small-area analytic techniques to Ontario mortality data, made possible by comprehensive linkage of vital statistics. The findings highlight the importance of population composition to geographic disparities in health. Future work should investigate the influence of system-level factors in areas with elevated premature mortality.
Connecting the dots: a qualitative study of dog-bite data in Calgary (AB, Canada)
Authors: Mouton Morgan , Rault Dawn , Rock Melanie 
Published: September 2018

IntroductionWorldwide, dog-bites remain a leading cause of pediatric injuries. Local governments are key because they can enact and enforce policies on dogs. The City of Calgary has earned an international reputation for its approach to regulating dogs and dog-owners, which has resulted in marked reductions in per capita dog-aggression complaints.
Objectives and ApproachThis presentation reflects on how data on dogs are collected, sorted and used by local governments. Our approach has been qualitative in nature: we observed bylaw officers during ride-alongs, and we conducted in-depth interviews with officials who conceived and/or use the databases involving dogs in Calgary. We took a particular interest in the migration of the City of Calgary’s ‘canine data’ (e.g., dog licensing, reports by enforcement officers) to a more comprehensive database listing all of the incidents recorded by municipal services (including ‘911’ and ‘311’ calls, etc.).
ResultsPreliminary results point to difficulties in linking data stemming from several sources. Within the municipality itself, the transition comes with important challenges. Moreover, to improve public health surveillance for dog-bites, and ultimately to improve preventive strategies, other sources of data should be linked, including emergency services, animal welfare charities, and and veterinary clinics. This fragmentation of available data would be difficult to overcome. Local governments and animal welfare charities may cooperate during investigations but do not share their administrative data. The issue of privacy is a strong barrier for municipal services to obtain healthcare data, while veterinary clinics are private entities that have few incentives to align with administrative data held by local governments or healthcare services.
Conclusion/ImplicationsIn a city whose model is built upon the close monitoring of pets and their people, the issue of data linkages is critical. New partnerships and new solutions, respectful of citizen privacy and organizations’ respective scope of practice, should be developed.