Administrative Datasets Research Articles

Estimating the rates of dementia using administrative data linked to cohort studies.

Current estimates of dementia and Alzheimer's disease incidence and prevalence are required to understand the health needs of the elderly. We used two Australia cohort studies, administrative datasets, and data linkage techniques to estimate dementia rates in Australia. The study used Australian Longitudinal Study on Women's Health and the Health in Men Cohort Study. Records of dementia were obtained from linked sources and incidence and prevalence estimates were produced. Capture-recapture methods were used to estimate numbers of dementia cases not identified through data linkage. There were 3399 (28.5%) men with dementia identified from any source and 3767 (34.8%) women. Rates of dementia incidence and prevalence were similar between sexes but were raised in men once estimates of unidentified cases were included. Cohort studies and linked administrative data can be used together to produce current estimates of dementia prevalence and incidence comparable to other population estimates.

Abstract 4144585: Association of renal function with mortality and heart failure hospitalization rates after Transcatheter Mitral Valve Edge to Edge Repair

Background: Transcatheter edge to edge repair (TEER) is an established treatment for patients with symptomatic severe functional MR on optimal medical therapy or severe symptomatic primary MR and high surgical risk. Renal dysfunction is associated with adverse outcomes but the threshold at which risks rise are uncertain. Aim To determine the association of estimated glomerular filtration rate (eGFR) with adverse outcomes in patients undergoing TEER for severe symptomatic mitral regurgitation (MR) in Ontario, Canada. Methods: This was a population-based retrospective cohort study using linked administrative datasets of patients who underwent TEER in Ontario, Canada, between 2011 and 2023. The key exposure was eGFR, which was modeled using restricted cubic splines. Outcomes were 1-year mortality, cardiovascular mortality (CV) and heart failure hospitalization (HF). Cause-specific hazards regression was used to model the association between eGFR and outcomes, utilizing eGFR 30ml/min/1.73m2 as the reference value. Results: We studied 2076 patients, of whom 294 (14.2%) had eGFR <30ml/min/1.73m2 and 841 (40.5%) had eGFR 30-60ml/min/1.73m2. The incidence at one year was 16.8% for all-cause mortality, 11% for CV mortality and 14.2% for HF hospitalizations. The Figure illustrates that the predicted incidence of adverse outcomes increases with lower eGFR, with subtle differences in patterns of change in risk at lower eGFR levels such that all-cause mortality and CV mortality begin to rise rapidly at eGFR values ≤30ml/min/1.73m2, while HF hospitalization increases linearly at eGFR ≤50ml/min/1.73m2. Conclusions: There was a progressive increase in all-cause, CV mortality and HF hospitalization after TEER for patients with lower eGFR, particularly those with values <30 ml/min/1.73m2. This data can inform patient discussions and guide post-procedural follow-up.

Equity of access to pathological diagnosis and bronchoscopy for lung cancer in Aotearoa New Zealand.

Māori are less likely to survive their lung cancer once diagnosed, but it remains unclear whether this is partially driven by poorer access to best-practice diagnostic services. We examined all lung cancer registrations in Aotearoa New Zealand between 2007-2019 (n=27,869) linked to national administrative health datasets and further stratified by ethnicity, tumour type and stage of disease. Using descriptive and regression analyses, we compared ethnic groups in terms of the basis of diagnosis (e.g., histology, cytology), receipt of bronchoscopy and travel distance and time to access bronchoscopy. We found no differences in access to a pathological diagnosis between ethnic groups regardless of cancer type or stage. We found that Māori within the cohort were marginally more likely to access bronchoscopy than the majority European group; however, we also found that Māori had lower odds of living close to the location of their bronchoscopy, and correspondingly higher odds of living 100-200km (adjusted odds ratio [adj. OR] 1.46, 95% confidence interval [CI] 1.26-1.69) or more than 200km away (1.36, 95% CI 1.15-1.61) than Europeans. Interventions that aim to further support Māori to overcome the systematic and cumulative disadvantages in access to cancer care should be broadly supported and resourced.

Comparing five-year and ten-year predicted cardiovascular disease risk in Aotearoa New Zealand: national data linkage study of 1.7 million adults.

There is no consensus on the optimal time horizon for predicting cardiovascular disease (CVD) risk to inform treatment decisions. New Zealand and Australia recommend 5 years, whereas most countries recommend 10 years. We compared predicted risk and treatment-eligible groups using 5-year and 10-year equations. Individual-level linked administrative datasets identified 1,746,665 New Zealanders without CVD, aged 30-74 years in 2006, with follow-up to 2018. Participants were randomly allocated to derivation and validation cohorts. Sex-specific 5-year and 10-year risk prediction models were developed in the derivation cohort and applied in the validation cohort. 28,116 (3.2%) and 62,027 (7.1%) first CVD events occurred during 5-years and 10-years follow-up respectively (cumulative risk, derivation cohort). Median predicted 10-year CVD risk (3.8%) was approximately 2.5 times 5-year risk (1.6%) and 95% of individuals in the top quintile of 5-year risk were also in the top quintile of 10-year risk, across age/gender groups (validation cohort). Using common guideline-recommended treatment thresholds (5% 5-year, 10% 10-year risk), approximately 14% and 28% of women and men respectively were identified as treatment-eligible applying 5-year equations compared to 17% and 32% of women and men applying 10-year equations. Older age was the major contributor to treatment eligibility in both sexes. Predicted 10-year CVD risk was approximately 2.5 times 5-year risk. Both equations identified mostly the same individuals in the highest risk quintile. Conversely, commonly used treatment thresholds identified more treatment-eligible individuals using 10-year equations and both equations identified approximately twice as many treatment-eligible men as women. The treatment threshold, rather than the risk horizon, is the main determinant of treatment eligibility.

Long-term clinical outcomes and healthcare resource utilization in male and female patients following hospitalization for heart failure.

Heart failure (HF) is a leading cause of hospitalization, and sex differences in care have been described. We assessed sex-specific clinical outcomes and healthcare resource utilization following hospitalization for HF. This was an exploratory analysis of patients hospitalized for HF across 10 Canadian hospitals in the Patient-Centered Care Transitions in HF (PACT-HF) cluster-randomized trial. The primary outcome was all-cause mortality. Secondary outcomes included all-cause readmissions, HF readmissions, emergency department (ED) visits, and healthcare resource utilization. Outcomes were obtained via linkages with administrative datasets. Among 4441 patients discharged alive, 50.7% were female. By 5 years, 63.6% and 65.5% of male and female patients, respectively, had died (p = 0.19); 85.4% and 84.4%, respectively, were readmitted (p = 0.35); and 72.2% and 70.9%, respectively, received ED care without hospitalization (p = 0.34). There were no sex differences in mean [SD] number of all-cause readmissions (males, 2.8 [7.8] and females, 3.0 [8.4], p = 0.54), HF readmissions (males, 0.9 [3.6] and females, 0.9 [4.5], p = 0.80), or ED visits (males, 1.8 [11.3] and females, 1.5 [6.0], p = 0.24) per person. There were no sex differences in mean [SD] annual direct healthcare cost per patient (males, $80 334 [116 762] versus females, $81 010 [112 625], p = 0.90), but males received more specialist, multidisciplinary HF clinic, haemodialysis, and day surgical care, and females received more home visits, continuing/convalescent care, and long-term care. Annualized clinical events were highest in first year following index discharge in both males and females. Among people discharged alive after hospitalization for HF, there were no sex differences in total and annual deaths, readmissions, and ED visits, or in total direct healthcare costs. Despite similar risk profiles, males received relatively more specialist care and day surgical procedures, and females received more supportive care. ClinicalTrials.gov NCT02112227.

Postsecondary pathways and graduate earnings: does transfer make cents?

ABSTRACT Post-secondary education (PSE) experienced explosive growth and diversification over the past century, affording students a range of increasingly complex pathways that they can travel to acquire a credential. In various jurisdictions, governments have made significant investments to facilitate student uptake of unconventional transfer pathways that involve stops at multiple institutions. But, there has been limited effort to understand the impact of travelling these unconventional pathways on graduate labour market outcomes. Moreover, existing studies across many jurisdictions typically lack access to detailed measures of academic performance, demographics, and other pertinent controls that could explain the relationship between PSE pathway uptake and labour market outcomes. Through this study we model this relationship by drawing on a large custom linkage between student records from the Toronto District School Board (TDSB) and three large administrative datasets housed in Statistics Canada’s Education and Labour Market Longitudinal Linkage Platform (ELMLP). This linkage offers census-level coverage of the population of interest and allows us to longitudinally track students from their Grade 9 year at the Toronto District School Board (TDSB), into and through Ontario PSE, and then as they enter the labour market. Our analyses unearth a series of pathway-based earnings disparities that prove robust to available controls. We elaborate on the implications of these findings for policymakers and draw attention to their relevance for scholars interested in school-to-work transitions in Canada and abroad.

Trends in the incidence of young-adult-onset diabetes by diabetes type: a multi-national population-based study from an international diabetes consortium

Population-based incidence data on young-adult-onset type 1 diabetes and type 2 diabetes are limited. We aimed to examine secular trends in the incidence of diagnosed type 1 diabetes and type 2 diabetes with an age of onset between 15 and 39 years. In this multicountry aggregate data analysis, we assembled eight administrative datasets from high-income jurisdictions and countries (Australia, Denmark, Finland, Hungary, Japan, Scotland, South Korea, and Spain [Catalonia]) that had appropriate data available from an international diabetes consortium (GLOBODIAB) describing incidence by diabetes type among people aged 15-39 years from 2000 to 2020. We modelled type 1 diabetes and type 2 diabetes incidence rates using Poisson regression including age and calendar time by sex. During the years 2000-20, there were 349 591 incident diabetes (both types) cases from 346 million person-years of follow-up among people aged 15-39 years. Over time, there was no statistically significant change in the incidence of type 1 diabetes in Hungary and Japan. The incidence of type 1 diabetes significantly increased in Australia, Denmark, Finland, Scotland, South Korea, and Spain, with annual changes ranging from 0·5% to 6·0%. The incidence of type 2 diabetes significantly increased in four of eight jurisdictions (Denmark, Finland, Japan, and South Korea), with annual increases from 2·0% to 8·5%. The magnitude of increase in incidence of type 2 diabetes was greater in Asian than non-Asian jurisdictions. There was no statistically significant change in type 2 diabetes incidence in Australia and Hungary. The incidence of type 2 diabetes significantly decreased in Scotland and Spain, with annual changes of -0·7% and -1·5%, respectively. There is variability in the trajectory of the incidence of young-adult-onset type 2 diabetes among high-income countries or jurisdictions, with a greater evidence of increase in Asian than non-Asian countries. Evolving trends in the incidence of type 1 and type 2 diabetes in young adults call for the ongoing surveillance of diabetes incidence and a greater research focus on this population. US Centers for Disease Control and Prevention, Diabetes Australia Research Programme, and Victoria State Government Operational Infrastructure Support Programme.

Utilization and cost of non-insulin glucose-lowering drugs in Australia from 2013 to 2023.

To investigate the utilization and costs of non-insulin glucose-lowering drugs (GLDs) in Australia from 2013 to 2023. We conducted a retrospective analysis of the Australian Pharmaceutical Benefits Scheme (PBS) administrative dataset of 118 727 494 GLD prescriptions. The main outcome measures were the annual number of GLD prescriptions dispensed, accounting for type 2 diabetes mellitus (T2DM) prevalence and healthcare system costs, adjusted for inflation. Utilization of GLDs doubled from 6.4 million prescriptions in 2013 to 15.6 million in 2023. The average annual percent increase in utilization was 8.1%, compared to the average annual increase in prevalence of T2DM of 1.8%. The biggest change was in sodium-glucose cotransporter-2 (SGLT2) inhibitors, for which there was an average annual increase in utilization of 59.4% (95% confidence interval [CI] 51.7%, 68.2%; p < 0.05) from 2014 (first full year of PBS listing), followed by glucagon-like peptide-1 receptor agonists (GLP-1RAs), which showed an increase of 31.4% (95% CI 28.5%, 33.8%; p < 0.05) annually (2013 to 2023). Dipeptidyl peptidase-4 inhibitor utilization tripled, with an average annual increase of 10.9% (95% CI 8.1%, 13.8%; p < 0.05), but this plateaued from 2020. Metformin utilization increased by 4.7% (95% CI 2.0%, 6.9%; p < 0.05) annually. In contrast, sulphonylurea, glitazone and acarbose utilization declined. Total GLD costs increased threefold over the same period. Despite only accounting for 11.7% of utilization, GLP-1RAs contributed to 35% of the costs. Utilization of GLDs doubled, and associated costs tripled over the past 11 years, with no sign of either utilization or costs plateauing, predominantly due to increased GLP-1RA and SGLT2 inhibitor prescribing.

Ulcerative Colitis Patients are at Increased Risk for Adverse Events Following Total Hip Arthroplasty

BackgroundPatients who have the autoinflammatory bowel disease ulcerative colitis (UC) may become candidates for total hip arthroplasty (THA). Having UC may predispose patients to postoperative adverse events, but it remains unclear if these events are related more to the disease process itself or perhaps related to the medications used to treat the condition. MethodsPatients undergoing THA were identified from a large administrative dataset. Those who did not have and those who had UC were matched 4:1 based on patient age, sex, and the Elixhauser Comorbidity Index (ECI). Matched THA patients who did not have UC (n = 19,482) and those who had UC (n = 4,874) were identified. The matched groups were compared regarding 90-day adverse and five-year survival. Further analyses were performed based on classes of medications. ResultsControlling for patient age, sex, and ECI, UC patients were at significantly higher odds of 90-day adverse events: any (odds ratio [OR] 1.59), severe (OR 1.72), and minor (OR 1.63) (all P < 0.001). Despite this, no differences in 5-year survival were identified. Relative to those who did not have UC, there were increasing odds of any adverse event based on the potency of related medications: no corticosteroids /immunomodulators/5-aminosalicylic acid (5-ASA) (OR 1.42), corticosteroids only (OR 1.58), 5-ASA ± corticosteroids OR (1.72), and immunomodulators ± corticosteroids (OR 1.74, all P < 0.001). ConclusionsTotal hip arthroplasty patients who have UC were at higher odds for 90-day postoperative adverse events relative to those who did not have UC, and this risk was even greater for those on defined classes of medications. Total hip arthroplasty patients who have UC bear specific considerations, and surgeons must carefully consider and manage the patient’s medication regimen in the perioperative period of the THA.

Sex-specific clinical outcomes and healthcare resource utilization in the 5 years following hospitalization for heart failure

Abstract Background Heart failure (HF) a leading cause of hospitalization, and sex differences in care have been described. Purpose We assessed sex-specific clinical outcomes and healthcare resource utilization following hospitalization for HF. Methods This was an exploratory analysis of patients hospitalized for HF across 10 Canadian hospitals enrolled in the Patient-Centred Care Transitions in HF pragmatic cluster-randomized trial. Primary outcome was all-cause mortality. Secondary outcomes included all-cause readmissions, HF readmissions, emergency department (ED) visits, and healthcare resource utilization. Outcomes were obtained via linkages with administrative datasets. Results The 4441 patients (50.7% female) had high event rates. At 5 years of follow-up, 63.6% male and 65.5% of male and female patients, respectively, had died (p=0.19); 85.4% and 84.4% of male and female patients, respectively, were readmitted with no sex differences in mean [SD] all-cause readmissions (males, 2.8 [7.8] and females, 3.0 [8.4], p=0.54) or HF readmissions (males, 0.9 [3.6] and females, 0.9 [4.5], p=0.80) per person. The mean (SD) annual total healthcare costs per patient was $80334 (116762) for males and $81010 (112625) for females, with no sex difference (p=0.90); however, there were sex differences in cost breakdown: males incurred greater costs from specialist, hemodialysis, and day surgical care, and females incurred greater costs from home visits and long-term care. Conclusions Males and females were at similarly high risk of mortality and readmissions, and had similar total healthcare costs following hospitalized for HF. Notwithstanding similar risks, males received relatively more specialist and invasive care, and females received relatively more supportive care.

Assessing the alignment of obstructive hypertrophic cardiomyopathy pharmacological treatments with ESC guidelines in Germany

Abstract Introduction The European Society of Cardiology (ESC) recently updated treatment guidelines for hypertrophic cardiomyopathy (HCM). Purpose The aim of this study was to describe the treatment of obstructive HCM in Germany and assess alignment with the 2014 and 2023 ESC guidelines. Methods Adults with HCM were identified using a nationally representative administrative claims dataset (WIG2 Benchmark database) from several German Statutory Health Insurances between 2012 and 2018. Obstructive HCM was identified as any obstructive HCM diagnosis (ICD-10: I42.1) or any HCM diagnosis (I42.2, I42.9) with septal reduction therapy. The index date was defined as the date where the patient met all eligibility criteria for HCM. Minimum follow-up time was set to one year. Patients had at least 1 year of baseline data prior to the index HCM diagnosis and were followed up for at least 1 year after the diagnosis (or until death within 1 year). Patients with phenocopies were excluded. ESC guideline-directed pharmacological treatments for HCM included beta-blockers (BB), calcium channel blockers (CCB), disopyramide, and/or mavacamten (approved by EMA June 2023). While the 2014 ESC Guidelines on Diagnosis and Management of HCM were applicable during the study, recommendations pertaining to the use of non-vasodilating BBs and non-dihydropyridine (DHP) CCBs did not change in the 2023 ESC Guidelines for the Management of Cardiomyopathies; thus, this study applies to both. Results Out of 6793 patients with HCM analysed in the period 2012-2018, 1,141 had obstructive HCM. The average follow-up was 5 years. Patients were mostly male (62%) with a mean age of 60 years. Hypertension, hyperlipidaemia, coronary artery disease, heart failure, and atrial fibrillation were among the most common comorbidities; the mean Charlson Comorbidity Index score was 2.3. At index, 46% of patients were on BB monotherapy, 23% were on CCB monotherapy, &amp;lt;1% were on a combination of BBs or a combination of CCBs, 9% were on a combination of BBs and CCBs, and as many as 22% received no HCM treatment. Patients experienced 1615 unique treatment combinations throughout the study across all lines of therapy (Table 1). The most common treatments were bisoprolol (24%), metoprolol (19%), amlodipine (12%), and verapamil (12%). The use of propranolol was negligible (1%). 43% of pharmacological treatments were not in line with ESC guidelines. The most common reason for not aligning was using DHP-CCBs or vasodilating BBs. Conclusion This study shows that 57% of obstructive HCM treatments received by patients during the study were aligned with recommendations from the 2023 ESC guidelines on cardiomyopathies. Research is needed to investigate barriers and enablers to implementing the guideline including awareness of recommended treatments, as well as the management of comorbidities.

Cardiovascular disease risk in people with diabetes in the era of universal diabetes screening

Abstract Background/Introduction Traditionally, most people with diabetes have been considered at high cardiovascular disease (CVD) risk and CVD preventive treatment has been recommended for almost all patients after diagnosis. However, guidelines are increasingly recommending a more stratified approach to preventive treatment informed by predicted CVD risk. In the early 2000’s, New Zealand initiated the world-first national diabetes screening programme, as a component of a national CVD risk assessment programme, and by 2016, approximately 90% of eligible New Zealand adults had been screened. We hypothesised that in the era of universal diabetes screening, many recently diagnosed patients will be at low CVD risk and that contemporary CVD risk prediction equations would be required to accurately assess their risk. Purpose We aimed to develop sex-specific 5-year CVD risk prediction models in people with diabetes in New Zealand using a contemporary natural-population based cohort, and to characterise the distribution of CVD risk. Methods De-identified individual-level linkage of multiple health administrative datasets was undertaken to establish a cohort of almost all adults with diabetes in the northern region of New Zealand (one-third of the national population), without CVD or heart failure, and aged 30–74 years on January 1, 2014, with follow-up linkage to hospitalisations and mortality until December 31, 2018. Sex-specific models were developed to estimate the 5-year risk of CVD hospitalisation or death, with 15 pre-defined predictors, including sociodemographic variables, diabetes-related and renal function measures. Results 64,645 participants (median age: 57 years [IQR: 49–65]) were included in the final cohort, of whom 4,992 had first CVD events during 301,272 person-years follow-up. Models calibrated well in both women and men (Figure 1). Overall, increasing age; high deprivation level; smoking-related hospitalisations or use of smoking cessation medications; history of atrial fibrillation; high levels of haemoglobin A1c, total cholesterol to HDL cholesterol ratio, and albumin-to-creatinine ratio; use of blood pressure-lowering medications and insulin were associated with elevated CVD risk. Median 5-year CVD risks were 4.9% (IQR: 2.9%–8.1%) in women and 7.7% (4.8%–12.0%) in men. There was a wide range of predicted 5-year CVD risk, with 51% of women and 27% of men having a predicted risk below 5%, and 6% of women and 16% of men having a risk of 15% or above (Figure 2). Conclusions This study demonstrated marked heterogeneity in predicted CVD risk in people with diabetes in an era of universal diabetes screening. As diabetes screening is increasingly undertaken as part of a routine CVD risk assessment, these findings will have important clinical implications for accurately targeting new but expensive CVD preventive medications to the highest risk patients.

Real-world analysis exploring the association between anti-hypertensive therapy with perindopril-based single-pill combinations (SPC) and cardiovascular outcomes and all-cause mortality in Italy

Abstract Background/Introduction A combination of blood pressure (BP)-lowering medications is recommended by guidelines as an effective strategy to obtain rapid and optimal BP control in hypertensive patients. However, the prescription of multiple BP-lowering medications increases the pill burden, potentially reducing medication adherence. Guidelines also recommend using single pill combinations(SPCs) containing ≥2 anti-hypertensive medications as a practical approach to simplify treatment schedules and possibly improve adherence. Yet, real-world evidence on the association between SPC or free combination of BP-lowering medications and hyperthensive patient outcome remains limited. Purpose We compared the association of SPC versus free-pill combination(free) on cardiovascular outcomes and all-cause mortality in hypertensive patients treated with perindopril(PER)-based therapies in real clinical practice in Italy. Methods A retrospective analysis was conducted using administrative databases covering 6.7 million health-assisted Italian residents. Among adults with hospitalization discharge diagnosis or exemption code for hypertension between 2010 and 2021, the study included patients prescribed with a combination of PER with amlodipine(AML) and/or indapamide(IND), either as SPC or free or mixed (SPC plus separate pill) combinations. Results The analysis included 24,476 hypertensive subjects receiving a PER-based therapy, 22,663 (93%) of them using SPC, 1458 (6%) free and 355 (1.4%) mixed. The last cohort was not included in the analysis due to the small sample size (N=355). The patients in the free cohort were significantly older than those in the SPC cohort (69.5±12.3 vs. 64.3±12.2 years, p&amp;lt;0.001), showed a higher number of pre-existing comorbidities (0.5±0.8 vs. 0.4±0.7, p&amp;lt;0.001), and received a larger number of different medications (pill burden: 1.2±1.7 vs. 0.7±1.3, p&amp;lt;0.001). To minimize selection bias, the groups were balanced with propensity score and inverse probability weighting (IPW), adjusting for baseline covariates, including comorbidity profile and pill burden. The IPW-adjusted Kaplan-Meier plots and Cox’s proportional hazard model (Table 1) revealed that, compared with SPC users, patients on free regimens had a significantly increased risk of all-cause mortality (36%, p&amp;lt;0.001), all cardiovascular events (45%, p&amp;lt;0.001), ischemic heart disease (29%, p&amp;lt;0.05), cerebrovascular events (84%, p&amp;lt;0.001), and occurrence of the composite outcome cardiovascular events/all-cause mortality (40%, p&amp;lt;0.001). Conclusions This real-world data from a large Italian administrative dataset suggested that PER-based anti-hypertensive therapy with SPC results in significant clinical benefits in terms of lowered risk of cardiovascular/cerebrovascular events and all-cause mortality. Reducing pill burden and simplifying therapeutic schedules is of crucial importance to maximize the potential benefits derived from the prescription of anti-hypertensive treatment.

Pathways to Eviction

Abstract Over the past several years, socio-legal researchers have focused attention on the phenomenon of eviction, particularly in low-income communities and communities of color. One major aspect of the eviction phenomenon has been largely overlooked: how and why certain eviction filings result in forced, legally compelled tenant moves and others do not. Through coding of the legal documents associated with eviction filings and multi-level regression analysis, this article advances the analysis of evictions in two crucial ways. First, it identifies and describes the frequency of the distinct legal procedural pathways that result in forced tenant moves once an eviction case has been filed. Second, it identifies the case, tenancy, neighborhood, and property correlates of forced tenant moves and of distinct procedural pathways to forced tenant moves. The article demonstrates that move-out agreements are the primary procedural pathway by which tenants are forcibly moved, yet they have been largely overlooked in previous eviction research because they are not easily analyzable in administrative datasets. The regression analyses advance the growing work examining the role of landlord characteristics in shaping tenants’ housing stability and break new ground in identifying the characteristics of the different pathways through which tenants are forced out of their homes following eviction filing.

Application of Duty of Candour legislation in post-colonoscopy colorectal cancer: a prospective cohort study.

Background & Study Aims The study investigates the application of Duty of Candour (DoC) legislation in the context of post-colonoscopy colorectal cancers (PCCRCs). DoC mandates transparent disclosure of notifiable safety incidents to patients in the English National Health Service, including those leading to severe or moderate harm. This study aims to analyse the application of DoC in PCCRCs, improve understanding of the legislation and identify challenges in its implementation. Patients & Methods A national audit of PCCRCs was conducted between September 2021 to May 2022. PCCRCs were identified using linked administrative datasets and root-cause analyses were performed using a structured template. 1,724 PCCRCs were included. 'Avoidability' and harm categorised into specific levels, with guidance provided to improve consistency in judgments. Results 16% of PCCRCs resulted in major harm or death, of which 27%(75) were at least probably avoidable. Hospitals deemed DoC discharge necessary in only 53% of these cases. When including moderate harm, 11% of all PCCRCs would trigger DoC discharge, yet this was deemed necessary in only 41% of these cases. Conclusions There is inconsistent application of DoC in PCCRC cases. Challenges include determining 'avoidability' and harm, particularly when there is a delay in diagnosis. Clearer guidance and definitions of harm are needed to improve adherence to regulations.

Help-Seeking Behaviors of Young People with Problematic Sexualized Behaviors

ABSTRACT A substantial proportion of all reported child sexual abuse is perpetrated by other young people, though it is challenging to accurately depict its prevalence. Even less is known about the help-seeking behaviors of young people. Understanding how they seek help for their own problematic sexualized behavior is crucial to better inform therapeutic interventions and early intervention opportunities. This study used an administrative dataset of contacts (N = 901) received by Kids Helpline over nine years. Given the paucity of research on this topic, our approach to draw upon the contacts made to Kids Helpline by young people concerned about their own sexualized interests or behaviors is innovative and exploratory. Descriptive analyses were conducted to examine the characteristics of each contact as well as the demographics of the young people making contact. The present study examined the characteristics of 695 males and 206 females (aged 10 to 25) seeking help for their own problematic sexualized behaviors. Young people who contacted Kids Helpline for problematic sexualized behavior reported the following specific concerns: sexual behaviors (40.50%) and pornography use (38.20%). A quarter of contacts (25.86%) raised multiple concerns. Results suggest that intervention should be provided early and in an age-graded way. Several implications for theory and practice are discussed.

Patterns of Migration Following Dementia Diagnosis

Diseases have historically prompted individual relocations to mitigate the risk of disease acquisition or improve access to care. As dementia prevalence increases, comprehending the migration patterns of affected individuals is vital for public policy. To quantify the association of dementia diagnosis with migration patterns by examining the proportion of individuals with dementia who relocate, the timing of their moves relative to diagnosis, and the nature of their new living arrangements, whether in institutional settings or different households. This cohort study leveraged a comprehensive dataset of national Medicare claims and assessments spanning from 2012 to 2020, including Medicare Beneficiary Summary File and nursing home administrative datasets. The study focused on beneficiaries who received diagnoses in 2016 of dementia, myocardial infarction, chronic obstructive pulmonary disease, or colon cancer. Analyses were performed from March 2023 to August 2024. The primary outcome was migration, defined as change in county or state. The analysis distinguished between migrations with and without a nursing home stay. By tracking patients' residential county for 4 years before and after diagnosis, a difference-in-differences approach was used to contrast migration tendencies associated with dementia against the other 3 conditions. The sample included 1 626 127 Medicare beneficiaries (mean [SD] age, 80.1 [8.0] years; 922 194 women [56.7%]) who received diagnoses of the 4 conditions in 2016. In total, 818 862 had a new dementia diagnosis (age, 82.0 [7.8] years; 492 146 women [60.1%]). Comparing between the prediagnosis and postdiagnosis months, the proportion migrating to a different county increased by 8.5 percentage points (95% CI, 7.6-9.4 percentage points) for individuals with dementia and between 4.2 to 5.8 percentage points among those with myocardial infarction, chronic obstructive pulmonary disease, or colon cancer. The difference-in-difference estimates indicated a 3.9 percentage point (95% CI, 3.7-4.0 percentage points) increase in intercounty migration and a 1.9 percentage point (95% CI, 1.8-2.0 percentage points) increase in interstate migration for patients with dementia, effectively doubling the likelihood of migration compared with the other conditions. Of the excess migrations resulting from dementia diagnosis, 55% occurred in community settings, and 45% occurred in institutional settings. In this retrospective cohort study of Medicare fee-for-service beneficiaries, dementia was associated with a marked increase in migration rates over other major illnesses. This finding underscores the need to understand the factors associated with these distinct migration behaviors.

Design of a Location-Based Case-Control Study of Built Environment Risk Factors for Pedestrian Fatalities in the U.S.

The location-based case-control design is a useful approach for studies where the exposures of interest are aspects of the environment around the location of a health event such as a pedestrian fatality. In this design locations are the unit of analysis and an enumerated cohort of locations are followed through time for the health events of interest and a case-control study of locations is nested within the cohort. Locations where events occurred (case-locations) are compared to matched locations where these events did not occur (control-locations). We describe the application of this design to the issue of pedestrian fatalities using a cohort of 9,612,698 intersections, 17,737,728 road segments, and 222,318 entrance/exit ramp segments that existed in 2017 across all 384 U.S. Metropolitan Statistical Areas. This cohort of locations was followed up from Jan 1, 2017 to Dec 31, 2018 for pedestrian fatalities using the National Highway Traffic Safety Administration Fatality Analysis Reporting System. In total, 10,587 fatalities were identified as having occurred on cohort locations and 21,174 matched control locations were selected using incidence density sampling. Geographic information systems, spatially linked administrative data sets and virtual neighborhood audits via Google Street View are underway to characterize study locations.

Prediction of the Remaining Useful Life of Lithium-Ion Battery Using Multilayer Perceptron

Cogitating the reliability of the supply and ensuring continuous delivery of power to the loads, especially in the growing demand for Lithium-Ion batteries in electric vehicle applications, prediction of the remaining useful life of Lithium-Ion batteries is crucial for the timely replacement. For prediction of non-linear and chaotic relationship, experience-based approach, physics-based approach and data driven approach are used among which data driven approach is a model free, accurate and reliable approach. Therefore, a driven approach in predicting remaining useful life can be implemented in the battery management system. This research uses a multilayer perceptron to predict the remaining useful life of the battery. The NASA Ames Prognostics Center of Excellence (PCoE) battery dataset is used to test the proposed methodology. The use of multilayer perceptron for remaining life prediction seems promising despite the significant number of jump points, gaps in data and a small quantity of experimental data in the National Aeronautics and Space Administration (NASA) dataset. The predicted result was obtained with 8.52 % mean absolute error and 9.59 % root mean square error. When compared with the predicted results of different literatures, proposed multilayer perceptron with sliding window approach outperforms most of the existing approach. Incorporation of optimization techniques and hybrid algorithm in proposed approach can further enhance the accuracy of the model.

Exploring the potential cost-effectiveness of a new computerised decision support tool for identifying fetal compromise during monitored term labours: an early health economic model

BackgroundAround 60% of term labours in the UK are continuously monitored using cardiotocography (CTG) to guide clinical labour management. Interpreting the CTG trace is challenging, leading to some babies suffering adverse outcomes and others unnecessary expedited deliveries. A new data driven computerised tool combining multiple clinical risk factors with CTG data (attentive CTG) was developed to help identify term babies at risk of severe compromise during labour. This paper presents an early health economic model exploring its potential cost-effectiveness.MethodsThe model compared attentive CTG and usual care with usual care alone and simulated clinical events, healthcare costs, and infant quality-adjusted life years over 18 years. It was populated using data from a cohort of term pregnancies, the literature, and administrative datasets. Attentive CTG effectiveness was projected through improved monitoring sensitivity/specificity and potential reductions in numbers of severely compromised infants. Scenario analyses explored the impact of including litigation costs.ResultsNationally, attentive CTG could potentially avoid 10,000 unnecessary alerts in labour and 2400 emergency C-section deliveries through improved specificity. A reduction of 21 intrapartum stillbirths amongst severely compromised infants was also predicted with improved sensitivity. Attentive CTG could potentially lead to cost savings and health gains with a probability of being cost-effective at £25,000 per QALY ranging from 70 to 95%. Potential exists for further cost savings if litigation costs are included.ConclusionsAttentive CTG could offer a cost-effective use of healthcare resources. Prospective patient-level studies are needed to formally evaluate its effectiveness and economic impact in routine clinical practice.