scholarly journals Polypharmacy and Pharmacological Treatment of Diabetes in Older Individuals: A Population-Based Study in Quebec, Canada

Pharmacy ◽  
2019 ◽  
Vol 7 (4) ◽  
pp. 161
Author(s):  
Marie-Eve Gagnon ◽  
Caroline Sirois ◽  
Marc Simard ◽  
Céline Plante
Keyword(s):  
Disease Surveillance ◽  
Population Level ◽  
Population Based ◽  
Lipid Lowering ◽  
Hypoglycemic Agents ◽  
Older Individuals ◽  
Factors Associated ◽  
Cardiovascular Comorbidities ◽  
Disease Surveillance System ◽  
Lipid Lowering Agents

Our objectives were to describe the use of pharmacological treatments in older adults with diabetes and to identify the factors associated with the use of a combination of hypoglycemic, antihypertensive and lipid-lowering agents. Using the Quebec Integrated Chronic Disease Surveillance System, we conducted a population-based cohort study among individuals aged 66–75 years with diabetes in 2014–2015. We described the number of medications and the classes of medications used and calculated the proportion of individuals using at least one medication from each of these classes: hypoglycemics, antihypertensives and lipid-lowering agents. We identified the factors associated with the use of this combination of treatments by performing robust Poisson regressions. The 146,710 individuals used an average of 12 (SD 7) different medications, mostly cardiovascular (91.3% of users), hormones, including hypoglycemic agents (84.5%), and central nervous system medications (79.8%). The majority of individuals (59%) were exposed to the combination of treatments and the factor most strongly associated was the presence of cardiovascular comorbidities (RR: 1.29; 99% CI: 1.28–1.31). Older individuals with diabetes are exposed to a large number of medications. While the use of the combination of treatments is significant and could translate into cardiovascular benefits at the population level, the potential risk associated with polypharmacy needs to be documented.

scholarly journals Trends of polypharmacy among older adults with schizophrenia in Quebec, Canada between 2000 and 2017

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
C Lunghi ◽  
L Rochette ◽  
A Ouali ◽  
C Sirois
Keyword(s):  
Older Adults ◽  
Disease Surveillance ◽  
Variance Estimation ◽  
Age Groups ◽  
Population Based ◽  
Older Individuals ◽  
Noticeable Increase ◽  
Disease Surveillance System ◽  
Increased Risk ◽  
Age And Sex

Abstract Background Schizophrenia is a severe psychiatric disorder associated with an increased risk of type 2 diabetes, dyslipidemia and obesity. As adults with schizophrenia age, they become at high risk for multimorbidity and polypharmacy. However, little is known about the trends in total medications use within this population. The objective of this study was to draw a portrait of polypharmacy among Quebec older adults with schizophrenia from 2000 to 2017. Methods This population-based cohort study used the data of the Quebec Integrated Chronic Disease Surveillance System of the National Institute of Public Health of Quebec to characterize recent trends and patterns of medications use, according to age and sex. We identified all Quebec residents over 65 years with an ICD-9 or ICD-10 diagnosis of schizophrenia. We calculated the total number of medications used by every individual in each year under study, and the age- and sex-standardized proportion of individuals with polypharmacy (10+ medications, 15+, and 20+). We further identified the clinical and socio-demographic factors associated with polypharmacy using Poisson regression models with robust variance estimation. Results From 2000 to 2017, the prevalence of total medications used increased across all age groups, with a median of 8 medications consumed in 2000-2001, which rose to 11 in 2016-2017. The age-standardized proportion of people exposed to different degrees of polypharmacy also increased over time: 5+: 76.6% to 89.3%; 10+ drugs: 36.9% to 62.2%; 15+: 13.3% to 34.4%; 20+: 3.9% to 14.4%. In the multivariate regression, the only clinically significant factor associated with polypharmacy was the high number of diseases (e.g., 5+: RR = 1.29; 95% IC:1.44-1.53). Conclusions This study shows a noticeable increase in polypharmacy exposure of older adults with schizophrenia, raising concerns about the growing risks for adverse effects and drug interactions with antipsychotic treatments. Key messages Polypharmacy has constantly grown in the last two decades. Further research is needed to better understand outcomes of polypharmacy among older individuals with schizophrenia.

scholarly journals Analysis of in-hospital mortality among people with and without Diabetes in Australian Public Hospitals (2014-2017)

2021 ◽  
Author(s):  
Tina Gao ◽  
Kingsley E Agho ◽  
Milan K Piya ◽  
David Simmons ◽  
Uchechukwu L Osuagwu
Keyword(s):  
Mortality Rate ◽  
Hospital Mortality ◽  
Age Groups ◽  
Public Health Problem ◽  
Binary Logistic Regression ◽  
Population Based ◽  
Public Hospitals ◽  
Major Public Health Problem ◽  
Factors Associated ◽  
Cardiovascular Comorbidities

Abstract Background Diabetes is a major public health problem affecting about 1.4 million Australians, especially in South Western Sydney, a hotspot of diabetes with higher than average rates for hospitalisations. The current understanding of the international burden of diabetes and related complications is poor and there is paucity of data on hospital outcomes and/or what common factors influence mortality rate in people with diabetes in Australia. This study determined in-hospital mortality rate and the factors associated among people with and without diabetes. Methods Retrospective data for 554,421 adult inpatients was extracted from the population-based New South Wales (NSW) Admitted Patient Data over 3 financial years (from 2014-15 to 2016-17). The in-hospital mortality per 1000 admitted persons, standardised mortality ratios (SMR) were calculated. Binary logistic regression was performed, adjusting for potential covariates and co-morbidities for people with and without diabetes over three years. Results Over three years 8.7% (48,038 people) of admissions involved those with diabetes. This increased from 8.4% in 2014-15 to 8.9% in 2016-17 (p = 0.007). Across all age groups, in-hospital mortality rate was significantly greater in people with diabetes (20.6, 95% Confidence intervals CI 19.3–21.9 per 1000 persons) than those without diabetes (11.8, 95%CI 11.5–12.1) and more in men than women (23.1, 95%CI 21.2–25.0 vs 17.9, 95%CI 16.2–19.8) with diabetes. The SMR for those with and without diabetes were 3.13 (95%CI 1.78–4.48) and 1.79 (95%CI 0.77–2.82), respectively. There were similarities in the factors associated with in hospital mortality in both groups including: aged > 54years, men, the widowed, those who stayed longer than 4 days or received intensive care in admission and had respiratory and cardiovascular comorbidities. Conclusions The study found that in-patients with diabetes continue to have higher mortality rates than those without diabetes and the Australian population. Overall, similar factors influenced mortality rate in people with and without diabetes in this region indicating that continued improved management of all inpatients is needed in order to minimise the persistent poor outcomes.

scholarly journals Antibiotic use for typhoid in India: Estimation from private sector prescription data during 2013-15

2021 ◽  
Author(s):  
Shaffi Fazaludeen Koya ◽  
Habib Hasan Farooqui ◽  
Aashna Mehta ◽  
Sakthivel Selvaraj ◽  
Sandro Galea
Keyword(s):  
Private Sector ◽  
Disease Surveillance ◽  
Primary Care Physicians ◽  
Antibiotic Prescription ◽  
Antibiotic Use ◽  
Population Based ◽  
Prescription Data ◽  
Adult Age ◽  
Disease Surveillance System ◽  
Prescription Rates

Background India's typhoid burden estimates are based on a limited number of population-based studies and data from a grossly incomplete disease surveillance system. In this study, we estimated the total and sex-and age-specific antibiotic prescription rates for typhoid. Methods We used systematic antibiotic prescription by private sector primary care physicians in India. We categorized antibiotics using the WHO classification system and calculated the prescription for various classes of antibiotics. Results We analyzed 671 million prescriptions for the three-year period (2013-2015), of which an average of 8.98 million antibiotic prescriptions per year was for typhoid, accounting for 714 prescriptions per 100,000 population. Combination antibiotics are the preferred choice of prescribers in the adult age group, while cephalosporins are the preferred choice in children and young age. The prescription rate decreased from 792/100,000 in 2013 to 635 in 2015. Conclusion We report a higher rate of antibiotic prescription for typhoid using prescription data, indicating a higher disease burden than previously estimated. Quinolones are still widely used in monotherapy, and children less than 10 years account for more than a million cases annually, which calls for a routine vaccination program.

scholarly journals The Canadian Chronic Disease Surveillance System: A model for collaborative surveillance

2018 ◽  
Vol 3 (3) ◽  
Author(s):  
Lisa Lix ◽  
James Ayles ◽  
Sharon Bartholomew ◽  
Charmaine Cooke ◽  
Joellyn Ellison ◽  
...  
Keyword(s):  
Chronic Disease ◽  
Surveillance System ◽  
Disease Surveillance ◽  
Health Agency ◽  
Population Based ◽  
Population Characteristics ◽  
Administrative Databases ◽  
Distributed Model ◽  
Case Definitions ◽  
Disease Surveillance System

Chronic diseases have a major impact on populations and healthcare systems worldwide. Administrative health data are an ideal resource for chronic disease surveillance because they are population-based and routinely collected. For multi-jurisdictional surveillance, a distributed model is advantageous because it does not require individual-level data to be shared across jurisdictional boundaries. Our objective is to describe the process, structure, benefits, and challenges of a distributed model for chronic disease surveillance across all Canadian provinces and territories (P/Ts) using linked administrative data. The Public Health Agency of Canada (PHAC) established the Canadian Chronic Disease Surveillance System (CCDSS) in 2009 to facilitate standardized, national estimates of chronic disease prevalence, incidence, and outcomes. The CCDSS primarily relies on linked health insurance registration files, physician billing claims, and hospital discharge abstracts. Standardized case definitions and common analytic protocols are applied to the data for each P/T; aggregate data are shared with PHAC and summarized for reports and open access data initiatives. Advantages of this distributed model include: it uses the rich data resources available in all P/Ts; it supports chronic disease surveillance capacity building in all P/Ts; and changes in surveillance methodology can be easily developed by PHAC and implemented by the P/Ts. However, there are challenges: heterogeneity in administrative databases across jurisdictions and changes in data quality over time threaten the production of standardized disease estimates; a limited set of databases are common to all P/Ts, which hinders potential CCDSS expansion; and there is a need to balance comprehensive reporting with P/T disclosure requirements to protect privacy. The CCDSS distributed model for chronic disease surveillance has been successfully implemented and sustained by PHAC and its P/T partners. Many lessons have been learned about national surveillance involving jurisdictions that are heterogeneous with respect to healthcare databases, expertise and analytical capacity, population characteristics, and priorities.

scholarly journals Use of Lipid-lowering Agents in Rheumatoid Arthritis: A Population-based Cohort Study

2013 ◽  
Vol 40 (7) ◽  
pp. 1082-1088 ◽  
Author(s):  
Bharath Manu Akkara Veetil ◽  
Elena Myasoedova ◽  
Eric L. Matteson ◽  
Sherine E. Gabriel ◽  
Cynthia S. Crowson
Keyword(s):  
Rheumatoid Arthritis ◽  
General Population ◽  
Population Based ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Lowering Therapy ◽  
Kaplan Meier ◽  
Increased Risk ◽  
Lipid Testing ◽  
Lipid Lowering Agents

Objective.Rheumatoid arthritis (RA) is associated with an increased risk of cardiovascular disease and mortality. Lipid-lowering therapy is reportedly underused in patients with RA. Longitudinal cohort studies comparing use of lipid-lowering medications in patients with RA versus the general population are lacking.Methods.Cardiovascular risk factors, lipid measures, and use of lipid-lowering agents were assessed in a population-based inception cohort of patients with RA and a cohort of non-RA subjects followed from January 1, 1988, to December 31, 2008. The National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATPIII) guidelines were assessed at the time of each lipid measure throughout followup. Time from meeting guidelines to initiation of lipid-lowering agents was assessed using Kaplan-Meier methods.Results.The study population included 412 RA and 438 non-RA patients with ≥ 1 lipid measure during followup and no prior use of lipid-lowering agents. Rates of lipid testing were lower among patients with RA compared to non-RA subjects. Among patients who met NCEP ATPIII criteria for lipid-lowering therapy (n = 106 RA; n = 120 non-RA), only 27% of RA and 26% of non-RA subjects initiated lipid-lowering agents within 2 years of meeting the guidelines for initiation.Conclusion.There was substantial undertreatment in both the RA and the non-RA cohorts who met NCEP ATPIII criteria for initiation of lipid-lowering agents. Patients with RA did not have as frequent lipid testing as individuals in the general population.

scholarly journals Factors associated with increasing campylobacteriosis incidence in Michigan, 2004–2013

2016 ◽  
Vol 144 (15) ◽  
pp. 3316-3325 ◽  
Author(s):  
W. CHA ◽  
T. HENDERSON ◽  
J. COLLINS ◽  
S. D. MANNING
Keyword(s):  
Risk Factors ◽  
Disease Surveillance ◽  
Age Groups ◽  
Spatial Analyses ◽  
Factors Associated ◽  
Disease Surveillance System ◽  
Animal Density ◽  
Increased Risk ◽  
Increasing Trend ◽  
Case Data

SUMMARYThis study was conducted to examine the incidence trend of campylobacteriosis in Michigan over a 10-year period and to investigate risk factors and clinical outcomes associated with infection. Campylobacter case data from 2004 to 2013 was obtained from the Michigan Disease Surveillance System. We conducted statistical and spatial analyses to examine trends and identify factors linked to campylobacteriosis as well as ecological associations using animal density data from the National Agricultural Statistics Service. An increasing trend of Campylobacter incidence and hospitalization was observed, which was linked to specific age groups and rural residence. Cases reporting ruminant contact and well water as the primary drinking source had a higher risk of campylobacteriosis, while higher cattle density was associated with an increased risk at the county level. Additional studies are needed to identify age-specific risk factors and examine prevalence and transmission dynamics in ruminants and the environment to aid in the development of more effective preventive strategies.

SporadicSalmonella entericaserotype Javiana infections in Georgia and Tennessee: a hypothesis-generating study

2009 ◽  
Vol 138 (3) ◽  
pp. 340-346 ◽  
Author(s):  
L. S. CLARKSON ◽  
M. TOBIN-D'ANGELO ◽  
C. SHULER ◽  
S. HANNA ◽  
J. BENSON ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Disease Surveillance ◽  
Population Based ◽  
Well Water ◽  
Surveillance Programme ◽  
Factors Associated ◽  
Exposure Data ◽  
Animal Contact ◽  
The U.S ◽  
Population Based Survey

SUMMARYFrom 1996 to 2004, the incidence ofSalmonellaJaviana infections increased in FoodNet, the U.S. national active foodborne disease surveillance programme. Contact with amphibians and consumption of tomatoes have been associated with outbreaks ofS. Javiana infection. To generate and test hypotheses about risk factors associated with sporadicS. Javiana infections, we interviewed patients with laboratory-confirmedS. Javiana infection identified in Georgia and Tennessee during August–October 2004. We collected data on food and water consumption, animal contact, and environmental exposure from cases. Responses were compared with population-based survey exposure data. Seventy-two of 117 identifiedS. Javiana case-patients were interviewed. Consumption of well water [adjusted odds ratio (aOR) 4·3, 95% confidence interval (CI) 1·6–11·2] and reptile or amphibian contact (aOR 2·6, 95% CI 0·9–7·1) were associated with infection. Consumption of tomatoes (aOR 0·5, 95% CI 0·3–0·9) and poultry (aOR 0·5, 95% CI 0·2–1·0) were protective. Our study suggests that environmental factors are associated withS. Javiana infections in Georgia and Tennessee.

scholarly journals Trends in prevalence, incidence and mortality of diagnosed and silent coronary heart disease in Quebec

2015 ◽  
Vol 35 (10) ◽  
pp. 184-193 ◽  
Author(s):  
C. Blais ◽  
L. Rochette
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Disease Surveillance ◽  
Population Based ◽  
Administrative Databases ◽  
Case Definitions ◽  
Disease Surveillance System ◽  
Incidence And Mortality ◽  
Causes Of Mortality ◽  
Incident Cases

Introduction Of all cardiovascular causes of mortality, coronary heart disease (CHD) remains the leading cause of death. Our objectives were to establish trends in the prevalence and incidence of CHD in the province of Quebec, and to determine the proportion of CHD mortality that had no previous CHD diagnosis. Methods Trends in prevalence, incidence and mortality were examined with a population-based study using the Quebec Integrated Chronic Disease Surveillance System, which links several health administrative databases. Data are presented using two case definitions for Quebecers aged 20 years and over: 1) a validated definition, and 2) CHD causes of death codes added to estimate the proportion of deaths that occurred without any previous CHD diagnosis as a proxy for sudden cardiac death (SCD). Results In 2012/2013, the crude prevalence of CHD was 9.4% with the first definition (593 000 people). Between 2000/2001 and 2012/2013, the age-standardized prevalence increased by 14%, although it has been decreasing slightly since 2009/2010. Agestandardized incidence and mortality rates decreased by 46% and 26% respectively, and represented a crude rate of 6.9 per 1000 and 5.2% in 2012/2013. The proportion identified only by CHD mortality, our SCD proxy, was only significant for the incident cases (0.38 per 1000 in 2009/2010) and declined over the study period. Conclusion The prevalence of CHD has tended to decrease in recent years, and incidence and mortality have been declining in Quebec. Most CHD mortality occurs in previously diagnosed patients and only a small proportion of incident cases were not previously identified.

scholarly journals Establishing the Occupational Disease Surveillance System (ODSS) for Ontario: a linkage of administrative data

2018 ◽  
Vol 3 (4) ◽  
Author(s):  
Jill MacLeod ◽  
Chloe Logar-Henderson ◽  
Chris McLeod ◽  
Alice Peter ◽  
Paul A Demers
Keyword(s):  
Risk Factors ◽  
Occupational Disease ◽  
Surveillance System ◽  
Disease Surveillance ◽  
Population Level ◽  
Work Related ◽  
Related Disease ◽  
Disease Surveillance System ◽  
Related Risk ◽  
Administrative Health Databases

IntroductionWorkplace conditions and exposures are important determinants of health. However, identifying and monitoring population-level trends in work-related disease is challenged by existing data limitations. Administrative health databases capture timely and accurate information about disease diagnoses among the Ontario population, but these data do not include work history. Objectives and ApproachThe Occupational Disease Surveillance System (ODSS), launched in 2017, captures and reports trends in work-related disease in Ontario. A cohort of 2+ million workers was identified from compensation claims (1983-2014). Records were linked through probabilistic and deterministic methods to the Registered Persons Database (1990-2015), and administrative health databases including the Ontario Cancer Registry (1964-2016), hospitalization (2006-2016), ambulatory care (2006-2016) and provincial health insurance plan billing data (1999-2016). Preliminary applications of ODSS have examined risks of 28 cancer sites and 11 non-cancer health conditions. Risks are estimated with Cox proportional hazards models for thousands of industry and occupation groups. ResultsLinkage of existing administrative databases is an efficient approach for examining risk factors for work-related disease at the population level. ODSS can identify groups of workers by industry or occupation that are at increased risk of disease due to known or suspected workplace conditions and risk factors. For example, ODSS detected elevated risk of lung cancer among known at-risk workers employed in mining and quarrying (HR 1.47, 95% CI 1.33-1.61), transport equipment operating (HR 1.39, 95% CI 1.34-1.44), and construction (HR 1.09, 95% CI 1.06-1.13). Exploratory analyses can also detect previously unknown associations between work-related risk factors and disease. For example, although dermatitis and asthma are common occupational diseases, many causative exposures remain unclear. ODSS is currently being used to further explore potential risk factors. Conclusion/ImplicationsTimely information about work-related disease is crucial to support prevention initiatives to protect workers. This novel linkage identifies existing and emerging trends in occupational disease in Ontario. By capturing work-related risk factors, ODSS serves as a model for other provinces to overcome existing gaps in disease surveillance.

scholarly journals Establishing the Incidence and Prevalence of Multiple Sclerosis in Saskatchewan

2018 ◽  
Vol 45 (3) ◽  
pp. 295-303 ◽  
Author(s):  
Lina H. Al-Sakran ◽  
Ruth Ann Marrie ◽  
David F. Blackburn ◽  
Katherine B. Knox ◽  
Charity D. Evans
Keyword(s):  
Multiple Sclerosis ◽  
Administrative Data ◽  
Predictive Value ◽  
Disease Surveillance ◽  
Population Based ◽  
Case Definition ◽  
Case Definitions ◽  
Health Administrative Data ◽  
Disease Surveillance System ◽  
Definition Of

AbstractObjective: To validate a case definition of multiple sclerosis (MS) using health administrative data and to provide the first province-wide estimates of MS incidence and prevalence for Saskatchewan, Canada. Methods: We used population-based health administrative data between January 1, 1996 and December 31, 2015 to identify individuals with MS using two potential case definitions: (1) ≥3 hospital, physician, or prescription claims (Marrie definition); (2) ≥1 hospitalization or ≥5 physician claims within 2 years (Canadian Chronic Disease Surveillance System [CCDSS] definition). We validated the case definitions using diagnoses from medical records (n=400) as the gold standard. Results: The Marrie definition had a sensitivity of 99.5% (95% confidence interval [CI] 92.3-99.2), specificity of 98.5% (95% CI 97.3-100.0), positive predictive value (PPV) of 99.5% (95% CI 97.2-100.0), and negative predictive value (NPV) of 97.5% (95% CI 94.4-99.2). The CCDSS definition had a sensitivity of 91.0% (95% CI 81.2-94.6), specificity of 99.0% (95% CI 96.4-99.9), PPV of 98.9% (95% CI 96.1-99.9), and NPV of 91.7% (95% CI 87.2-95.0). Using the more sensitive Marrie definition, the average annual adjusted incidence per 100,000 between 2001 and 2013 was 16.5 (95% CI 15.8-17.2), and the age- and sex-standardized prevalence of MS in Saskatchewan in 2013 was 313.6 per 100,000 (95% CI 303.0-324.3). Over the study period, incidence remained stable while prevalence increased slightly. Conclusion: We confirm Saskatchewan has one of the highest rates of MS in the world. Similar to other regions in Canada, incidence has remained stable while prevalence has gradually increased.

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