Population-based Ecological Study Research Articles

Burden of schistosomiasis‐related mortality in Brazil: epidemiological patterns and spatial–temporal distribution, 2003–2018

To characterise the epidemiological patterns and the spatial-temporal distribution of schistosomiasis-related mortality in Brazil from 2003 to 2018. A national population-based ecological study that used official data from the Mortality Information System. The data included all deaths recorded in Brazil from 2003 to 2018 in which schistosomiasis was mentioned in the death certificate as an underlying or associated cause of death (multiple causes). The municipalities of residence were used as units of geographic analysis, and standardised and smoothed mortality rates (per 100000 inhabitants) were calculated using the local empirical Bayes method. Spatial autocorrelation was evaluated using global and local Moran indexes. To analyse the spatial dependence, the Getis-Ord G and Gi* statistics were used. During the study period, 18421113 deaths were recorded in Brazil. Schistosomiasis was mentioned in 11487 deaths (proportional mortality: 0.06%); for 8141 deaths (70.87%), it was listed as the underlying cause, and for 3346 deaths (29.13%), it was listed as an associated cause. The mean mortality rate was 0.38 deaths/100000 inhabitants. Individuals≥70years of age (RR: 115.34, 95% CI: 68.56-194.03) and residents in the Northeast region (RR: 10.81, 95% CI: 5.95-19.66) presented higher risks related to schistosomiasis. Municipalities with high mortality rates were identified in all regions, and high-risk clusters were found in municipalities located in the Northeast and Southeast regions of the country. Schistosomiasis remains an important cause of death in persistently endemic areas in Brazil, particularly in those with a high prevalence of the disease and a marked parasite load.

Public awareness, emotional reactions and human mobility in response to the COVID-19 outbreak in China - a population-based ecological study.

The outbreak of COVID-19 generated severe emotional reactions, and restricted mobility was a crucial measure to reduce the spread of the virus. This study describes the changes in public emotional reactions and mobility patterns in the Chinese population during the COVID-19 outbreak. We collected data on public emotional reactions in response to the outbreak through Weibo, the Chinese Twitter, between 1st January and 31st March 2020. Using anonymized location-tracking information, we analyzed the daily mobility patterns of approximately 90% of Sichuan residents. There were three distinct phases of the emotional and behavioral reactions to the COVID-19 outbreak. The alarm phase (19th-26th January) was a restriction-free period, characterized by few new daily cases, but a large amount public negative emotions [the number of negative comments per Weibo post increased by 246.9 per day, 95% confidence interval (CI) 122.5-371.3], and a substantial increase in self-limiting mobility (from 45.6% to 54.5%, changing by 1.5% per day, 95% CI 0.7%-2.3%). The epidemic phase (27th January-15th February) exhibited rapidly increasing numbers of new daily cases, decreasing expression of negative emotions (a decrease of 27.3 negative comments per post per day, 95% CI -40.4 to -14.2), and a stabilized level of self-limiting mobility. The relief phase (16th February-31st March) had a steady decline in new daily cases and decreasing levels of negative emotion and self-limiting mobility. During the COVID-19 outbreak in China, the public's emotional reaction was strongest before the actual peak of the outbreak and declined thereafter. The change in human mobility patterns occurred before the implementation of restriction orders, suggesting a possible link between emotion and behavior.

State Medical Cannabis Laws Associated With Reduction in Opioid Prescriptions by Orthopaedic Surgeons in Medicare Part D Cohort.

Opioid prescriptions and abuse remain a significant national concern. Cannabinoids offer a potentially attractive nonopioid analgesic option for orthopaedic patients, and 32 US states have passed medical cannabis laws (MCLs), legalizing patient access to cannabinoids. We examine the association between implementation of state cannabis laws and prescribing patterns for opioids by orthopaedic surgeons in Medicare Part D patients between 2013 and 2017. Using the Medicare Part D Prescription Drug Event database, we measured annual aggregate daily doses of all opioid medications (excluding buprenorphine) prescribed by orthopaedic surgeons in each US state (and DC), in addition to total daily doses of opioid medications by generic name (hydrocodone, oxycodone, fentanyl, morphine, methadone, and "other opioids"). We used adjusted linear regression models to examine associations between state-specific cannabis regulations (state MCL, MCL type-dispensary or home cultivation, and recreational cannabis legalization) and annual total daily doses of opioid medications (all opioids and opioid types, separately). State MCLs were associated with a statistically significant reduction in aggregate opioid prescribing of 144,000 daily doses (19.7% reduction) annually (95% confidence interval [CI], -0.535 to -0.024 million; P < 0.01). States with MCLs allowing access to in-state dispensaries had a statistically significant reduction in total opioid prescriptions of 96,000 daily doses (13.1%) annually (95% CI, -0.165 to -0.026 million; P < 0.01). Specifically, MCLs were associated with a statistically significant reduction of 72,000 daily doses of hydrocodone annually (95% CI, -0.164 to -0.019 million; P < 0.01). No significant association between recreational marijuana legalization and opioid prescribing was found. Orthopaedic surgeons are among the highest prescribers of opioids, highlighting the importance of providing nonopioid analgesic alternatives in efforts to reduce opioid use in the patient cohort. This study is the first to examine the association between implementation of state cannabis laws and prescribing patterns for opioids by orthopaedic surgeons in Medicare Part D patients. Population-based ecological study.

10-Year Trends in Dietary Intakes in the High- and Low-Risk Areas for Esophageal Cancer: A Population-Based Ecological Study in Northern Iran.

BACKGROUND We assessed dietary intakes in the high- and low-risk areas for esophageal cancer (EC) in Golestan province, Northern Iran. METHODS Considering the EC rates, Golestan province was divided into high- and low-risk regions. Data on households’ food consumption were obtained from the Statistical Center of Iran. We used multivariable logistic regression to assess the relationships between consumption of main food and EC risk. Adjusted odds ratios (aOR) were calculated. Joint point program was used for time trend analysis and average annual percent changes (AAPC) were reported. RESULTS Overall, 11910 households were recruited during 2006-2015. 4710 (39.5%) households were enrolled from the high-risk region. There were significant positive relationships between high consumption of sweets (aOR = 1.62; 95% CI: 1.24-2.10), oil/fat (aOR = 1.36; 95% CI: 1.04-1.79), and red meat (aOR = 1.33; 95% CI: 1.07-1.65) with EC risk. We found significant negative relationships between high consumption of dairy products (aOR = 0.62; 95% CI: 0.46-0.82), vegetables (aOR = 0.66; 95% CI: 0.50-0.87) and fruit (aOR = 0.72; 95% CI: 0.55-0.95) with the risk of EC. Time trend analysis showed a significant increasing trend in the proportions of households with low consumption of vegetables (AAPC = 4.71, p = 0.01) and dairy products (AAPC = 5.26, p = 0.02) in the low-risk region for EC. CONCLUSION Dietary intakes may be important etiological factors for EC in Northern Iran. Further studies are warranted to assess the role of dietary factors in this high-risk population.

Low performance of operational indicators for leprosy control in the state of Bahia: spatiotemporal patterns, 2001-2014.

To characterize spatiotemporal patterns of operational indicators for leprosy control in the state of Bahia from 2001 to 2014. This is a population-based ecological study, with spatial distribution and autocorrelation of operational indicators for leprosy control. From 2001 to 2007, 42.7% (n=178) of the municipalities presented a cure rate lower than 75%, increasing to 61.4% (n =291) from 2009 to 2014. Between 2001 and 2007, 32.5% (n=54) of the municipalities reported more than 10% of the total number of relapses in the state, increasing to 36.9% (n=75) between 2008 and 2014. From 2001 to 2014, 38% (n=159) of the municipalities presented an assessment index of disability grading at the time of diagnosis within the regular performance parameter. Between 2009 and 2014, the number of municipalities with a high incidence of grade 2 disability (G2D) at the time of diagnosis increased, reaching 55.3% (n=230) of the municipalities. Most municipalities in the state of Bahia showed poor performance in the implementation of planned actions for leprosy control, with little change or relative worsening in the patterns of operational indicators throughout the historical series. The operational context in Bahia indicates significant institutional vulnerability, leading to the need for expansion and qualification of the surveillance and health care network in the different regions and conditions analyzed in the public health system (Sistema Único de Saúde - SUS).

Leprosy in the North and Northeast regions of Brazil: an integrated spatiotemporal approach.

To analyse the spatiotemporal patterns of leprosy occurrence in the North and Northeast regions of Brazil from 2001 to 2017. Mixed population-based ecological study with spatial and temporal trend analysis of epidemiological indicators based on new cases reported to the Information System for Notifiable Diseases of the Ministry of Health occurring in individuals residing in North and Northeast states of Brazil. A total of 396987 new cases were analysed; 9.2% of these involved children <15years of age, and 5.4% involved individuals with grade 2 disability (G2D). The Northeast region recorded 66.4% of the new cases. Most cases involved males between 15 and 59years of age and of brown race/colour. The temporal trend showed a reduction in most of the indicators and study variables. The G2D rate did not have trends over time in the Northeast Region, in individuals 0-14years of age, or in municipalities with 'very high' social vulnerability indexes. The spatial and spatiotemporal analysis showed the presence of hyperendemic foci with high detection risk involving municipalities in the states of Tocantins, Pará and Maranhão. Leprosy in the North and Northeast regions of Brazil persists as a critical public health problem. Temporal and spatiotemporal patterns identified in this study confirm that leprosy remains epidemiologically relevant in vulnerable areas. Surveillance and control interventions are needed in municipalities with low detection in the general population, in children and in individuals with G2D, to reduce late diagnosis.

Assessing the impacts of various street-level characteristics on the burden of urban burglary in Kaduna, Nigeria

Evidence suggests that crimes committed in urban environments are geographically concentrated across a range of scales, and that the variation in rates of crime within an urban space is significantly dependent on the physical environment as well as the situation in which the crime takes place. However, these assertions are typically drawn from environmental criminological studies that have focussed on Euro-American cities and western intellectual perspectives. We seek to move beyond these by focussing on a second-tier city in sub-Saharan Africa (Kaduna, Nigeria), a context for which very little literature exists. This paper therefore examines the association between a range of street characteristics and the risk of residential burglary in Kaduna for the first time. It describes a methodology for conducting a household crime victimisation survey in Nigeria, and then aggregating the information to a street-level to perform a population-based ecological study. It integrates street network analysis and statistical modelling techniques in order to provide novel estimates for factors that may increase the risk of burglary such as street accessibility metrics (e.g. connectivity, betweenness and closeness centrality), segment length, socioeconomic status and business activities. Finally, the article provides a discussion on the plausibility and implication of findings within the sub-Saharan African context.

Childhood leukemia in Ukraine after the Chornobyl accident

This population-based ecological study analyzes the prevalence of childhood leukemia in Ukraine before and after the Chornobyl nuclear power plant accident, based on the contamination status of the territory, time period, gender, and age. Three regions-Zhytomyr, Kyiv (except Kyiv city), and Chernihiv were included as areas contaminated by radioactive 137Cs from 1 to 15Ci/km2 with annual effective doses exceeding 1.0mSv, and Sumy region as the control (non-contaminated) area with 137Cs contamination less than 1Ci/km2 and effective doses less than 0.5mSv per year. The integrated database of the National Research Centre for Radiation Medicine used in the present study included 1085 childhood leukemia cases. Two aggregated periods were used for analysis: 1980-1986 (pre-accident) and 1987-2000 (post-accident). ICD-9 codes for leukemia (204-208.9) were used to perform analyses according to the extent of leukemic cells maturity (acute, chronic, and maturity unspecified leukemia), leukemic cell lineage (lymphoid, myeloid and lineage unspecified leukemia) and all leukemia cases in different age subgroups (1-4, 5-9, 10-14, and 15-19years). Standard methods of descriptive epidemiology were used to calculate the prevalence of disease and frequency ratio in regression models. A statistically significant increase in frequency ratio for acute leukemia (1.44; 95% confidence interval (CI), 1.22-1.71), myeloid leukemia (2.93; 95% CI, 1.71-5.40), cell lineage unspecified leukemia (II) (1.48; 95% CI, 1.18-1.87) and all forms of leukemia (1.59; 95% CI, 1.36-1.86) was found for the post-accident period in highly contaminated areas. The results indicate that the frequency of childhood leukemia (and of some of its types) increased in contaminated areas during the post-accident period, suggesting that radiation exposure after the Chornobyl accident might be the cause of the increase. However, further analytical studies, with individual or at least group dose estimates, are needed to confirm a link between childhood leukemia and the Chornobyl accident.

Testicular Cancer mortality in Brazil: trends and predictions until 2030

BackgroundDespite the fact that testicular cancer presents good prognosis, wide variations in mortality rates have been reported internationally. In Brazil, mortality trends and estimates have not been fully assessed. The objective of the study presented herein is to analyze the mortality trends for testicular cancer in Brazil in the period 2001–2015 and calculate mortality predictions for the period 2016–2030.MethodsThis is a population-based ecological study that utilized information of the Mortality Information System, on testicular cancer-related deaths in Brazil. Mortality trends were analyzed by Joinpoint regression, and Nordpred was utilized for the calculation of predictions.ResultsThe mortality rate for men, standardized to the world population, varied between 0.36/100,000 for the year 2001, to 0.41/100,000 for the year 2015. There was an increasing trend for Brazil (APC = 1.3% CI95% 0.6; 2.0) and the Southeast region (APC = 1.5% CI95%0.2; 2.7). When analyzing Brazilian data for the period 2016–2030, predictions indicate 2888 deaths due to testicular cancer, which corresponds to a 26.6% change when compared to the 2011–2015 period. This change is mostly explained by an increase in the risk of death (14.2%) when compared with modifications in the demographic structure (12.4%).ConclusionsTesticular cancer mortality in Brazil presents increasing trends, and until 2030 these rates continue to increase.

Does sleep predict next-day napping or does napping influence same-day nocturnal sleep? Results of a population-based ecological momentary assessment study

Study objectivesThe temporal relationship between nocturnal sleep and daytime napping has only been assessed in small non-representative samples, and suggests that nocturnal sleep and napping are interdependent, although mixed results exist. In this study, we investigated the temporal relationship between nocturnal sleep and napping (and vice versa). MethodsA population-based sample of middle-aged adults (N = 683, mean age 60.7 [SD 9.5]) completed seven days of ecological momentary assessment reporting sleep and nap characteristics. Multilevel random-effects models were used to assess the temporal relationship between sleep duration and quality, and nap occurrence and duration (and vice versa). ResultsIn sum, 64% of the study population took at least one nap over the course of seven days. Poor subjective sleep quality and shorter sleep duration increased the likelihood and duration of next-day napping. No effect of nap occurrence or duration was found on same-day nocturnal sleep duration and quality. However, when considering the timing of nap, afternoon naps, but not morning or evening naps, decreased same-day nocturnal sleep duration. ConclusionNaps seem to compensate for poor subjective sleep quality, and to some extent for short sleep duration. As only afternoon naps reduced same-day nocturnal sleep duration, timing of the daytime nap seems to matter with respect to same-day nocturnal sleep duration.

Emergency Department Visits and Disease Burden Attributable to Ambulatory Care Sensitive Conditions in Elderly Adults

Many countries worldwide are aging rapidly, and the complex care needs of older adults generate an unprecedented demand for health services. Common reasons for elderly emergency department (ED) visits frequently involve conditions triggered by preventable infections also known as ambulatory care sensitive conditions (ACSCs). This study aims to describe the trend and the associated disease burden attributable to ACSC-related ED visits made by elderly patients and to characterize their ED use by nursing home residence. We designed a population-based ecological study using administrative data on Taiwan EDs between 2002 and 2013. A total of 563,647 ED visits from individuals aged 65 or over were examined. All elderly ED visits due to ACSCs (tuberculosis, upper respiratory infection, pneumonia, sepsis, cellulitis and urinary tract infection (UTI)) were further identified. Subsequent hospital admissions, related deaths after discharge, total health care costs and disability-adjusted life years (DALYs) were compared among different ACSCs. Prevalence of ACSCs was then assessed between nursing home (NH) residents and non-NH residents. Within the 12-year observation period, we find that there was a steady increase in both the rate of ACSC ED visits and the proportion of elderly with a visit. Overall, pneumonia is the most prevalent among six ACSCs for elderly ED visits (2.10%; 2.06 to 2.14), subsequent hospital admissions (5.77%; 5.59 to 5.94) and associated mortality following admission (17.37%; 16.74 to 18.01). UTI is the second prevalent ACSC consistently across ED visits (2.02%; 1.98 to 2.05), subsequent hospital admissions (2.36%, 2.25 to 2.48) and mortality following admission (10.80%; 10.28 to 11.32). Sepsis ranks third highest in the proportion of hospitalization following ED visit (2.29%; 2.18 to 2.41) and related deaths after hospital discharge (7.39%; 6.95 to 7.83), but it accounts for the highest average total health care expenditure (NT$94,595 ± 120,239; ≈US$3185.02) per case. When examining the likelihood of ACSC-attributable ED use, significantly higher odds were observed in NH residents as compared with non-NH residents for: pneumonia (adjusted odds ratio (aOR): 5.01, 95% confidence interval (CI) 4.50–5.58); UTI (aOR: 4.44, 95% CI 3.97–4.98); sepsis (aOR: 3.54, 95% CI 3.06–4.10); and tuberculosis (aOR: 2.44, 95% CI 1.63–3.65). Here we examined the ACSC-related ED care and found that, among the six ACSCs studied, pneumonia, UTI and sepsis were the leading causes of ED visits, subsequent hospital admissions, related mortality, health care costs and DALYs in Taiwanese NH elderly adults. Our findings suggest that efficient monitoring and reinforcing of quality of care in the residential and community setting might substantially reduce the number of preventable elderly ED visits and alleviate strain on the health care system.

Colorectal cancer screening by colonoscopy and trends in disease-specific mortality: a population-based ecological study of 358 German districts.

Screening for colorectal cancer (CRC) by colonoscopy was implemented in Germany in 2002. Although the procedure has proven to be effective in reducing disease-specific mortality in numerous clinical studies, its effect at the population level is unclear. We performed an ecological study at the level of 358 German districts, testing the hypothesis that a higher participation rate in screening colonoscopy is associated with a stronger decline in CRC mortality from 2001 to 2012. Information on the use of colonoscopy in each district was extracted from settlement data, used for the remuneration of physicians of the ambulant sector from 2008 to 2011. Yearly mortality rates for each district from 2001 to 2012 were derived from the official mortality statistics. A spatial model was fitted, considering other factors which might influence early detection of CRC (fecal occult blood test (FOBT), diagnostic colonoscopy, material and social area deprivation, and rural-urban disparities). The population-weighted mean annual participation rate during 2008-2011 in screening colonoscopy was 2.0% (range 0.6 to 3.9%). The weighted mean annual percentage change (APC) of CRC mortality was - 2.9% (range - 7.8 to 1.2%). According to the fully adjusted model, a 1% higher annual participation rate in colonoscopy screening was associated with an additional annual change in CRC mortality rate of - 0.34% (p = 0.015). Given an annual 2.0% participation rate, colonoscopy screening attributed 23% to the observed decline. Our real-world data from Germany provide first evidence that colonoscopy screening for CRC is effective in reducing disease-specific mortality at the population level.

Performance of leprosy case-contact surveillance: a space-time analysis in Bahia State, Northeast Brazil

The aim was to analyze the space-time trend in the proportion of contacts examined among those recorded, according to demographic profile of new leprosy cases in the State of Bahia, Brazil, in the 2003-2014 cohort. This was a state population-based ecological study with temporal and spatial analyses of the proportion of contacts examined among those recorded, according to characteristics of the reference leprosy case, based on the Information System for Notifiable Diseases of the Brazilian Ministry of Health. The time trend analysis was based on Poisson regression (Joinpoints). Spatial analysis used spatial autocorrelation by local indicators of spatial association. Over the course of the historical series, 52.9% (55,116/104,142) of the recorded contacts were examined, with lower proportions in persons < 60 years of age, indigenous individuals, and residents of large cities (especially the state capital Salvador). There was an upward trend in the proportion of contacts examined, less evident when the reference leprosy case was a male, black, living in the rural area, and in small towns or the state capital. Spatial distribution showed that the majority of the municipalities showed precarious performance, with clusters identified in the North and Far South of the state. Bahia shows precarious performance on contact surveillance, particular in conditions of greater social vulnerability. Additional strategies should be implemented in order to overcome the operational obstacles to contact surveillance, considered essential for interrupting leprosy transmission in the state.

Mobile phone use and incidence of brain tumour histological types, grading or anatomical location: a population-based ecological study

ObjectiveSome studies have reported increasing trends in certain brain tumours and a possible link with mobile phone use has been suggested. We examined the incidence time trends of brain tumour...

920. A Sharp Fall in Antibiotic Use in Infants Is Correlated With a Population-Wide Reduction in Asthma Incidence for Children Under 5

BackgroundAntibiotic use in infants <1 is associated with increased relative risk (~1.5) for childhood asthma in cohort studies. This may be mediated by removal from the infant microbiome of organisms shown to protect against asthma, a hypothesis supported by experiment. We launched this study to see whether reductions in antibiotic use at population level are associated with benefit by way of asthma reduction.MethodsWe obtained antibiotic prescribing data from BC PharmaNet, a population-based database that captures all outpatient prescribing for British Columbia, Canada (n = 4.7 million). We focused on prescriptions in children <1 and calculated prescription rate per 1,000 population per year. We obtained asthma incidence data from the BC Ministry of Health Chronic Disease Registry. Asthma case identification uses a standard case definition making use of community and hospital diagnostic codes as well as asthma drug data from BC’s universal physician billing, hospital and drug databases. We focused on age-stratified asthma incidence for children aged 1–4. The correlation between antibiotic prescription rate in children < 1 and asthma incidence in the following year was estimated using the Spearman test.ResultsAntibiotic prescribing for all age groups fell 9.5% between 1999 and 2013. The rate for infants <1 dropped 58% from 1,014 to 427 prescriptions per 1,000 population/year. Between 2000 and 2014, asthma incidence (ages 1–4) fell 26% from 27.3 (95% CI: 26.5–28.0) to 20.2 (95% CI: 19.5–20.8) per 1,000 population/year. These trends were strongly correlated: Spearman’s rho = 0.81 (P = 0.0002). The magnitude of fall in asthma incidence is slightly greater than that predicted based on calculated population attributable risk for antibiotic exposure.ConclusionThe population health benefit from antibiotic stewardship in infants may not be confined to slowing the emergence of resistance and could include a reduced risk of asthma. As this is a population-based ecological study, a reduction in other risk factors may also have contributed to the fall in asthma incidence. This promising trend should be further studied at individual level within a large cohort study. Disclosures All authors: No reported disclosures.

Differences in infant and child mortality before and after the Great East Japan Earthquake and Tsunami: a large population-based ecological study

ObjectivesTo examine associations between access to medical care, geological data, and infant and child mortality in the area of North-Eastern Japan that was impacted by the Great East Japan Earthquake...

Upper respiratory tract infections and bipolar affective and obsessive-compulsive disorders in Colombia, 2009-2016: An ecological study

Background: Streptococcal infection has been linked with the development of obsessive-compulsive disorder (OCD) and other mental disorders, a concept termed pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS). Most studies of this association have been small with conflicting results. The aim of this study was to investigate this association, at an ecological level, in Colombia. Methods & Materials: A population-based ecological study was conducted using data from the nationwide Colombian health information system RIPS (Health Services Provision Individual Record), from 1-January-2009 to 31-December-2016, assessing incidence rates of upper respiratory tract infections (URTI)(B95.0-J01.9-J02.0-J02.9-J03.0) and OCD (F42.9) and bipolar affective disorder (BAD)(F31.9). We used reference populations to calculate incidence rates(cases/100,000pop.). Nonlinear regression models were run between URTIs (independent variables) and OCD/BAD (dependent variables)(p < 0.05), using licensed StataIC14®. Results: A total of 74,019 BAD and 7,093 OCD cases were considered. We analyzed data of 69,090 URTI cases. BAD rates varied from 0.0-480.2 cases/100,000pop, OCD 0.0-33.46, URTI: 0.0-3679 acute sinusitis, 7.15-8438.77 acute pharyngitis and 0.0-5436.06 streptococcal amygdalitis. Variation in OCD and BAD incidence showed a significant association in all models (r2 > 0.32;p < 0.001), higher between acute pharyngitis(J02.9) and OCD (r2 = 0.7920), followed by acute pharyngitis(J02.9) and BAD (r2 = 0.7352), acute sinusitis(J01.9) and OCD (r2 = 0.7082), acute sinusitis(J01.9) and BAD (r2 = 0.6771), streptococcal pharyngitis(J02.0) and OCD (r2 = 0.4258), streptococcal amygdalitis(J03.0) and OCD (r2 = 0.4051), streptococcal pharyngitis(J02.0) and BAD (r2 = 0.3800), streptococcal amygdalitis(J03.0) and BAD (r2 = 0.3624), Streptococcus group A infection(B95.0) and BAD (r2 = 0.3469) and Streptococcus group A infection(B95.0) and OCD (r2 = 0.3261), among others. Conclusion: This large-data study investigating key aspects of the PANDAS hypothesis found, as has been also recently raised from a large Danish study (JAMA 2017), that individuals with a streptococcal throat, but also other URT infections are associated with different mental disorders. They find it with OCD, which we also did, and we also added BAD. As suggested, this support important elements of the diagnostic concept of pediatric acute-onset neuropsychiatric syndrome.

Variations in osteoporosis medication utilization. A population-based ecological cross-sectional study in the region of Valencia, Spain

Little is known about the contextual variability in osteoporosis medication utilization. Our aims were 1) to describe variations in utilization and spending on osteoporotic medication between the Primary Care Health Zones (PHZ) of the Valencia region, Spain, 2) to analyze observed variations using Small Area Variation Analysis methods, and 3) to quantify the influence of the specialized care level on variations in utilization. We conducted a population-based cross-sectional ecological study of expenditure and utilization of five therapeutic groups marketed as osteoporosis treatments in Spain in 2009. The unit of analysis was the PHZ (in total 240) nested in the 23 Hospital Healthcare Departments (HHD) of the region of Valencia, covering a population of about 4.9 million inhabitants. Drug utilization was measured by dispensed Defined Daily Dose per 1000 women aged 50 years old and over and day (DID) per PHZ and cost was measured by the annual osteoporosis drug cost per woman aged 50 and older as well as the average price of DDD (Defined Daily Dose) in each PHZ. We calculated Indirect Standardized Drug Utilization Ratios (ISR) and we used Spearman’s correlation to analyze associations between the ISRs of the different therapies. The average osteoporosis drug consumption was 119.1 DID, ranging from 77.6 to 171.3 DID (2.2 times higher) between PHZs in the 5th and 95th percentiles. Annual expenditure also showed a two-fold variation among PHZs. Average prices of the DDD by therapeutic group showed very low or no variation, although they differed substantially among therapeutic groups. Regarding the standardized consumption of osteoporotic drugs, HHDs explained a substantial part (39%) of the variance among PHZs. In conclusion, there is considerable variability in the volume and choice of anti-osteoporotic treatments between PHZs. with HHDs explaining an important proportion of the variation in utilization. Interventions aimed at reducing variation to improve appropriate care should take into account both the PHZ and HHD levels of care.

Variation in Antiosteoporotic Drug Prescribing and Spending Across Spain. A Population-Based Ecological Cross-Sectional Study.

Introduction: Evidence has shown that utilization of antiosteoporotic medications does not correspond with risk, and studies on other therapies have shown that adequacy of pharmaceutical prescribing might vary between regions. Nevertheless, very few studies have addressed the variability in osteoporotic drug consumption. We aimed to describe variations in pharmaceutical utilization and spending on osteoporotic drugs between Health Areas (HA) in Spain.Methods: Population-based cross-sectional ecological study of expenditure and utilization of the five therapeutic groups marketed for osteoporosis treatment in Spain in 2009. Small area variation analysis (SAVA) methods were used. The units of analysis were the 168 HA of 13 Spanish regions, including 7.2 million women aged 50 years and older. The main outcomes were the defined daily dose (DDD) per 1000 inhabitants and day (DDD/1000/Day) dispensed according to the pharmaceutical claims reimbursed, and the expenditure on antiosteoporotics at retail price per woman ≥50 years old and per year.Results: The average osteoporosis drug consumption was 116.8 DDD/1000W/Day, ranging from 78.5 to 158.7 DDD/1000W/Day between the HAs in the 5th and 95th percentiles. Seventy-five percent of the antiosteoporotics consumed was bisphosphonates, followed by raloxifene, strontium ranelate, calcitonins, and parathyroid hormones including teriparatide. Regarding variability by therapeutic groups, biphosphonates showed the lowest variation, while calcitonins and parathyroid hormones showed the highest variation. The annual expenditure on antiosteoporotics was €426.5 million, translating into an expenditure of €59.2 for each woman ≥50 years old and varying between €38.1 and €83.3 between HAs in the 5th and 95th percentiles. Biphosphonates, despite accounting for 79% of utilization, only represented 63% of total expenditure, while parathyroid hormones with only 1.6% of utilization accounted for 15% of the pharmaceutical spending.Conclusion: This study highlights a marked geographical variation in the prescription of antiosteoporotics, being more pronounced in the case of costly drugs such as parathyroid hormones. The differences in rates of prescribing explained almost all of the variance in drug spending, suggesting that the difference in prescription volume between territories, and not the price of the drugs, is the main source of variation in this setting. Data on geographical variation of prescription can help guide policy proposals for targeting areas with inadequate antiosteoporotic drug use.

Impact of Pneumococcal Vaccination on Pneumonia Hospitalizations and Related Costs in Ontario: A Population-Based Ecological Study.

In Ontario, Canada, pneumococcal conjugate vaccine (PCV) was approved for infants in 2001 and became part of the publicly funded routine immunization schedule in 2005. We assessed the population-level impact of PCV on pneumonia hospitalizations and related costs. We used the difference-in-differences approach to evaluate the impact of pneumococcal vaccination on pneumonia hospitalizations and related costs, using nonpneumonia hospitalization as the control condition. We extracted monthly hospitalization costs, stratified by age group, from population-based health administrative data between April 1992 and March 2014. The study period was divided into 5 intervals: prevaccine period, availability of 7-valent PCV (PCV7) for private purchase, public funding for PCV7, replacement of PCV7 with 10-valent PCV (PCV10), and replacement of PCV10 with 13-valent PCV (PCV13). A total of 1063700 pneumonia hospitalizations were recorded during the study period. In the vaccine-eligible age group, pneumonia hospitalizations declined by 34% (95% confidence interval, 32%-37%), 38% (32%-43%), and 45% (40%-51%) and hospitalization-related costs declined by 38% (25%-51%), 39% (33%-45%), and 46% (41%-52%) after public funding for PCV7, PCV10, and PCV13, respectively. Pneumonia hospitalizations and related costs also declined substantially for PCV-ineligible older children and elderly persons (aged >65 years). Our results suggest that the publicly funded PCV immunization program is responsible for substantial reductions in pneumonia hospitalizations and related healthcare costs, among both young children eligible for publicly funded vaccination and other age groups not included in the publicly funded program.