Record Linkage Research Articles

Decline in the Incidence of Distant Recurrence of Breast Cancer: A Population-Based Health Record Linkage Study, Australia 2001-2016.

We investigated differences in cumulative incidence of first distant recurrence (DR) following non-metastatic breast cancer over a time period when new adjuvant therapies became available in Australia. We conducted a health record linkage study of females with localized (T1-3N0) or regional (T4 or N+) breast cancer in the New South Wales Cancer Registry in 2001 to 2002 and 2006 to 2007. We linked cancer registry records with administrative records from hospitals, dispensed medicines, radiotherapy services, and death registrations to estimate the 9-year cumulative incidence of DR and describe use of adjuvant treatment. The study included 13,170 women (2001-2002 n = 6,338, 2006-2007 n = 6,832). The 9-year cumulative incidence of DR was 3.6% [95% confidence interval (CI), 2.3%-4.9%] lower for 2006-2007 diagnoses (15.0%) than 2001-2002 (18.6%). Differences in the annual hazard of DR between cohorts were largest in year two. DR incidence declined for localized and regional disease. Decline was largest for ages <40 years (absolute difference, 14.4%; 95% CI, 8.3%-20.6%), whereas their use of adjuvant chemotherapy (2001-2002 49%, 2006-2007 75%) and HER2-targeted therapy (2001-2002 0%, 2006-2007 16%) increased. DR did not decline for ages ≥70 years (absolute difference, 0.9%; 95% CI, -3.6%-1.8%) who had low use of adjuvant chemotherapy and HER2-targeted therapy. This whole-of-population study suggests that DR incidence declined over time. Decline was largest for younger ages, coinciding with changes to adjuvant breast cancer therapy. Study findings support the need for trials addressing questions relevant to older people and cancer registry surveillance of DR to inform cancer control programs.

MRD Assessment in Patients with Newly Diagnosed Multiple Myeloma Using Tokenized Real World Data Sources

Introduction The depth of response in multiple myeloma (MM) after therapy is closely related to the prognosis of the disease. Robust data supports minimal residual disease (MRD) as prognostic after induction, auto-SCT, consolidation; during maintenance therapy; and in the R/R treatment setting. MRD is also prognostic despite unfavorable cytogenetics or transplant eligibility. Accordingly, clinical practice guidelines recommend the assessment of MRD after each phase of treatment, and MRD negativity is increasingly considered an important treatment goal. However, understanding how MRD is currently utilized in routine clinical practice across institutional and community settings is challenging. We have adopted an existing claims-based algorithm and linked MRD test results to explore assessment patterns and attainment of MRD negativity across lines of treatment and patient transplant status in the real-world setting. Methods The study uses Adaptive's internal MRD data linked with HealthVerity closed payer claims data through privacy-preserving record linkage (PPRL) tokenization. PPRL allows for private patient records across different data sources to be linked and shared without transmitting protected health information (PHI). The data source used is Source 20 from the Healthverity Marketplace, representing the largest available source of closed medical and pharmacy claims from health insurers. The data covers 120 million total individuals from over 120 unique payers including commercial, Medicare, and Medicaid, providing a comprehensive treatment journey of the patients. Newly diagnosed MM patients (NDMM) were identified as adults with a diagnosis of MM between January 2015 and December 2022 (the first observed MM diagnosis as Index Diagnosis), with continuous Medical and Pharmacy coverage at least 6 months during pre-index and 12 months during post-index periods. Patients were further required to have initiated MM treatment within 60 days of Index Diagnosis, had at least one MRD assessment using NGS MRD (clonoSEQ® Assay - Adaptive Biotechnologies), and no enrollment in clinical trials nor prior MM treatment pre-index. Lines of therapy were identified following an established algorithm (Fonseca, 2020). We describe patient characteristics, treatment journey, and assessment of MRD test results at a sensitivity of 10 -5 in accordance with IMWG guidance. Results The study identified 244 NDMM patients meeting the above criteria, of which 79 received transplant. Median age was 63 for transplant patients and 65 for non-transplant patients, 60% of all patients were male, and 80% were diagnosed before 2021. The percentage moving to next treatment was greater for transplant patients compared to non-transplant patients (2L: 46%, 3+ line: 19% vs. 2L: 35%, 3+ line: 12%). In both cohorts, front-line therapy usually consisted of an IMiD + dex doublet. For transplant patients, 62% and 46% achieved MRD- at some point during treatment at 10 -5 and 10 -6 thresholds, respectively. Similar MRD- attainment was seen in the non-transplant group (70% and 50%). A total of 562 MRD assessments were performed for these cohorts with a mean of ~2 per patient. The number of patients with &amp;gt;=2 MRD was 50 (63.3%) for transplant, and 91 (55.2%) for non-transplant. Among transplant patients, 88.8% of the MRD tests were performed post-transplant. Among non-transplant patients, 92.9% of the MRD tests were performed on 2L or later. Conclusion This analysis allows us to understand attainment of MRD negativity by transplant status and line of treatment in the real-world setting. Additional data sources are required to confirm outcomes. This study represents the first effort to enrich MRD test results with external claims data sources though tokenized linkage and provides additional patient treatment journey information as identified by the claims data.

Risk of myocardial infarction among pigeon breeders: A follow-up study

Pigeon breeders are exposed to high levels of fine particulate organic matter in the pigeon lofts. A total of 6,704 pigeon breeders and their 1:30 sex and age-matched referents from the general Danish population were followed from 1980 or first year of membership in the Danish Racing Pigeon Association, until first event of myocardial infarction, emigration, death, or end of study, on December 31, 2013. Information on outcomes and covariates was obtained by record linkage with national registers. Stratified Cox regression models estimated the hazard ratio of myocardial infarction, adjusted for occupation and residence at the start of follow-up. Compared with referents, pigeon breeders had an adjusted hazard ratio of 1.14 (95% CI: 1.05–1.22) for myocardial infarction. Exposure to pigeon-derived organic dust may increase the risk of myocardial infarction, but this finding needs to be corroborated.

Outdoor light at night and mortality in the UK Biobank: a prospective cohort study

BackgroundMore than 83% of the world’s population lives under light-polluted skies while information about health effects of outdoor light at night (LAN) is limited. We examined the association of LAN...

Radiomics of pericardial fat: a new frontier in heart failure discrimination and prediction

ObjectivesTo use pericardial adipose tissue (PAT) radiomics phenotyping to differentiate existing and predict future heart failure (HF) cases in the UK Biobank.MethodsPAT segmentations were derived from cardiovascular magnetic resonance (CMR) studies using an automated quality-controlled model to define the region-of-interest for radiomics analysis. Prevalent (present at time of imaging) and incident (first occurrence after imaging) HF were ascertained using health record linkage. We created balanced cohorts of non-HF individuals for comparison. PyRadiomics was utilised to extract 104 radiomics features, of which 28 were chosen after excluding highly correlated ones (0.8). These features, plus sex and age, served as predictors in binary classification models trained separately to detect (1) prevalent and (2) incident HF. We tested seven modeling methods using tenfold nested cross-validation and examined feature importance with explainability methods.ResultsWe studied 1204 participants in total, 297 participants with prevalent (60 ± 7 years, 21% female) and 305 with incident (61 ± 6 years, 32% female) HF, and an equal number of non-HF comparators. We achieved good discriminative performance for both prevalent (voting classifier; AUC: 0.76; F1 score: 0.70) and incident (light gradient boosting machine: AUC: 0.74; F1 score: 0.68) HF. Our radiomics models showed marginally better performance compared to PAT area alone.Increased PAT size (maximum 2D diameter in a given column or slice) and texture heterogeneity (sum entropy) were important features for prevalent and incident HF classification models.ConclusionsThe amount and character of PAT discriminate individuals with prevalent HF and predict incidence of future HF.Clinical relevance statementThis study presents an innovative application of pericardial adipose tissue (PAT) radiomics phenotyping as a predictive tool for heart failure (HF), a major public health concern. By leveraging advanced machine learning methods, the research uncovers that the quantity and characteristics of PAT can be used to identify existing cases of HF and predict future occurrences. The enhanced performance of these radiomics models over PAT area alone supports the potential for better personalised care through earlier detection and prevention of HF.Key Points•PAT radiomics applied to CMR was used for the first time to derive binary machine learning classifiers to develop models for discrimination of prevalence and prediction of incident heart failure.•Models using PAT area provided acceptable discrimination between cases of prevalent or incident heart failure and comparator groups.•An increased PAT volume (increased diameter using shape features) and greater texture heterogeneity captured by radiomics texture features (increased sum entropy) can be used as an additional classifier marker for heart failure.

Use of Tokens to Unlock Greater Data Sharing in Health Care

This Viewpoint discusses the use of privacy-preserving record linkage, a token-based record linkage system, as a promising avenue for building a data infrastructure system that bridges isolated data.

Cox regression with linked data.

Record linkage is increasingly used, especially in medical studies, to combine data from different databases that refer to the same entities. The linked data can bring analysts novel and valuable knowledge that is impossible to obtain from a single database. However, linkage errors are usually unavoidable, regardless of record linkage methods, and ignoring these errors may lead to biased estimates. While different methods have been developed to deal with the linkage errors in the generalized linear model, there is not much interest on Cox regression model, although this is one of the most important statistical models in clinical and epidemiological research. In this work, we propose an adjusted estimating equation for secondary Cox regression analysis, where linked data have been prepared by a third-party operator, and no information on matching variables is available to the analyst. Through a Monte Carlo simulation study, the proposed method is shown to lead to substantial bias reductions in the estimation of the parameters of the Cox model caused by false links. An asymptotically unbiased variance estimator for the adjusted estimators of Cox regression coefficients is also proposed. Finally, the proposed method is applied to a linked database from the Brest stroke registry in France.

Incompleteness and misclassification of maternal death recording: a systematic review and meta-analysis

ObjectiveTo quantify the extent of incompleteness and misclassification of maternal and pregnancy related deaths, and to identify general and context-specific factors associated with incompleteness and/or misclassification of maternal death data.MethodsWe conducted a systematic review of incompleteness and/or misclassification of maternal and pregnancy-related deaths. We conducted a narrative synthesis to identify methods used to capture and classify maternal deaths, as well as general and context specific factors affecting the completeness and misclassification of maternal death recording. We conducted a meta-analysis of proportions to obtain estimates of incompleteness and misclassification of maternal death recording, overall and disaggregated by income and surveillance system types.FindingsOf 2872 title-abstracts identified, 29 were eligible for inclusions in the qualitative synthesis, and 20 in the meta-analysis. Included studies relied principally on record linkage and review for identifying deaths, and on review of medical records and verbal autopsies to correctly classify cause of death. Deaths to women towards the extremes of the reproductive age range, those not classified by a medical examiner or a coroner, and those from minority ethnic groups in their setting were more likely misclassified or unrecorded. In the meta-analysis, we found maternal death recording to be incomplete by 34% (95% CI: 28–48), with 60% sensitivity (95% CI: 31–81.). Overall, we found maternal mortality was under-estimated by 39% (95% CI: 30–48) due to incompleteness and/or misclassification. Reporting of deaths away from the intrapartum, due to indirect causes or occurring at home were less complete than their counterparts. There was substantial between and within group variability across most results.ConclusionMaternal deaths were under-estimated in almost all contexts, but the extent varied across settings. Countries should aim towards establishing Civil Registration and Vital Statistics systems where they are not instituted. Efforts to improve the completeness and accuracy of maternal cause of death recording, such as Confidential Enquiries into Maternal Deaths, are needed even where CRVS is considered to be well-functioning.

Exploring community mental health service use following hospital-treated intentional self-harm among older Australians: a survival analysis.

This study aimed to examine the impact of community mental health (CMH) care following index hospital-treated intentional self-harm (ISH) on all-cause mortality. A secondary aim was to describe patterns of CMH care surrounding index hospital-treated ISH. A longitudinal whole-of-population record linkage study was conducted (2014-2019), with index ISH hospitalization (Emergency Department and/or hospital admissions) linked to all available hospital, deaths/cause of death, and CMH data. Australia's most populous state, New South Wales (NSW) comprised approximately 7.7 million people during the study period. CMH services are provided statewide, to assess and treat non-admitted patients, including post-discharge review. Individuals with an index hospital presentation in NSW of ISH during the study period, aged 45 years or older. CMH care within 14 days from index, versus not. Cox-proportionate hazards regression analysis evaluated all-cause mortality risk, adjusted for relevant covariates. Totally, 24,544 persons aged 45 years or older experienced a nonfatal hospital-treated ISH diagnosis between 2014 and 2019. CMH care was received by 56% within 14 days from index. Survival analysis demonstrated this was associated with 34% lower risk of death, adjusted for age, sex, marital status, index diagnosis, and 14-day hospital readmission (HR 0.66, 95% CI 0.58, 0.74, p < 0.001). Older males and chronic injury conveyed significantly greater risk of death overall. CMH care within 14 days of index presentation for self-harm may reduce the risk of all-cause mortality. Greater effort is needed to engage older males presenting for self-harm in ongoing community mental health care.

Association of seafood consumption with cardiovascular disease among adults in Qingdao, China

Background and aimsThe relationship between seafood consumption and cardiovascular disease (CVD) is controversial, and studies have not considered competing risk events. Our study examined the association between a full range of seafood consumption and CVD incidence and mortality based on the Qingdao Diabetes Prevention Program. Methods and resultsWe followed up 5285 participants without CVD at baseline until December 31, 2021. CVD cases and deaths were identified through record linkage with the Qingdao CVD Surveillance System and the Qingdao Death Surveillance System, respectively. Information on seafood consumption was obtained using a food frequency questionnaire. We used the Cox proportional hazard model and the competing risk model to evaluate the association between all types of seafood consumption and CVD incidence and mortality. During a median follow-up of 11.4 years, 122 CVD cases and 75 deaths occurred. After adjustment for potential confounders, compared with nonconsumers, seafood consumption of 300–500 and > 500 g/week was associated with a lower risk of CVD incidence [hazards ratio and 95 % confidence interval (CI): 0.54 (0.29–0.99) and 0.49 (0.26–0.91), respectively]. However, seafood consumption of >500 g/week had a significantly lower risk of CVD mortality [subdistribution hazard ratio and 95 % CI: 0.40 (0.17–0.95)], but it was insignificant in other groups. ConclusionSeafood consumption of 300–500 g/week and >500 g/week was associated with a lower CVD incidence and mortality. Our findings provide evidence of the recommendations of the 2022 Dietary Guidelines for Chinese residents and may guide the promotion of strategies for CVD prevention.

The Australian Genetic Heart Disease Registry: Insights into healthcare utilisation and outcomes for genetic heart disease

Abstract Background Genetic heart diseases, such as inherited cardiomyopathies and primary arrhythmia syndromes, cause significant morbidity and mortality, including sudden cardiac death at a young age. However, it is not well understood how these patients use health care services. Linking disease registry data to routinely collected health data can provide a more complete and unbiased clinical dataset. Purpose To investigate the health service use of individuals with genetic heart disease by linking a well-characterised cohort of patients from the Australian Genetic Heart Disease Registry (AGHDR) with routinely collected statewide health datasets. Descriptive analysis was used to compare participants by their genetic heart disease diagnosis. Methods Demographic, clinical, and genetic data for AGHDR participants recruited in New South Wales, between 2007-2019 were linked to statewide hospitalisations (available 2001-2019), emergency department (ED) presentations (2005-2019) and mortality registry (2007-2019) by the Centre for Health Record Linkage (CHeReL). Descriptive statistics were used to compare participants by their genetic heart disease diagnosis. Results A total of 1311 AGHDR participants were included, with the following diagnoses: hypertrophic cardiomyopathy (n=898), dilated cardiomyopathy (n=89), arrhythmogenic cardiomyopathy (n=46), left ventricular non-compaction (n=62), long QT syndrome (n=110), Brugada syndrome (n=65), and catecholaminergic polymorphic ventricular tachycardia (n=41). Mean age at diagnosis was 42 years (±18), and 585 (58%) were male. Participants had 8483 hospital admissions, with a median of 16 admissions per participant accounting for intra-hospital transfers (range 1-98). Mean age at first admission was 42 years (±17) (See Table 1 for breakdown by clinical diagnosis). Approximately one-third of hospital admissions were for circulatory system issues, with the remaining for other systems such as the digestive system (12%), musculoskeletal system and connective tissues (8%) and respiratory (5%). There was a total of 5213 ED presentations, with 32% of the cohort presenting &amp;gt;7 times (See Table 2 for breakdown by clinical diagnosis). Episodes were generally of suspected cardiac origin, with top diagnoses including chest pain (n=341, 43%), atrial fibrillation (n=190, 24%), palpitations (n=96, 12%), abdominal pain (n=74, 9%) and syncope (n=64, 8%). There were 49 deaths identified from the mortality registry, of which three occurred &amp;lt;50 years of age, 16 at 50-69 years and 30 at &amp;gt;70 years. Participants with a diagnosis of hypertrophic cardiomyopathy accounted for the majority of deaths (n=45 (92%)). Conclusion We provide important insights into real-world health service utilisation for individuals with genetic heart disease in Australia. Understanding the reasons for hospital admissions or ED presentations may help to identify potential disparities and opportunities for greater surveillance.

SLCO1B1*5 is protective against non-senile cataracts in cohort prescribed statins: analysis in a British-South Asian cohort

Abstract Background Reported association between statin use and cataract risk is controversial. The SLCO1B1 gene encodes a transport protein responsible for statin clearance. The SLCO1B1*5 reduced function variant is known to increase systemic exposure to statins. The aim of this study was to investigate a possible association between the SLCO1B1*5 reduced function variant and cataract risk in statin users of South Asian ethnicity. Methods The Genes &amp; Health cohort consists of UK participants of Bangladeshi and Pakistani ancestry. SLCO1B1*5 genotype was assessed with the Illumina GSAMD-24v3-0-EA chip. Medication data from primary care health record linkage was used to compare those who had regularly used statins compared to those who had not. Multivariable logistic regression was used to test for association between statin use and cataracts, adjusting for population characteristics and potential confounders in 36,513 participants. Multivariable logistic regression was used to test association between SLCO1B1*5 heterozygotes or homozygotes and cataracts, in subgroups having been regularly prescribed statins versus not. Results Statins were prescribed to 35% (12,704) of participants (average age 41 years old, 45% male). Non-senile cataract was diagnosed in 5% (1686) of participants. An apparent association between statins and non-senile cataract (12% in statin users and 0.8% in non-statin users) was negated by inclusion of confounders. In those prescribed a statin, presence of the SLCO1B1*5 genotype was independently associated with a decreased risk of non-senile cataract (OR 0.7 (CI 0.5-0.9, p 0.007)). Conclusions Our findings suggest that there is no independent association between statin use and non-senile cataract risk after adjusting for confounders. Among statin users, the SLCO1B1*5 genotype is associated with a 30% risk reduction of non-senile cataracts. Stratification of on-drug cohorts by validated pharmacogenomic variants is a useful tool to support or repudiate adverse drug events in observational cohorts.Study results overview

Abstract 12519: Biomarker Characterisation of Heart Failure Subtypes: A Population-Based Bioresource Linked Study

Background: Deep learning (DL)-based interpretation of echocardiographic images can help create pragmatic cohort studies to validate novel biomarkers. In this study, we have characterised biomarkers implicated in heart failure (HF) pathophysiology across the ejection fraction (EF) range in a DL-supported pragmatic cohort study. Methods: We used electronic health record data from Tayside, representing 20% of the Scottish population, between 1993 and 2021. Utilising record linkage to DL automated reading of echocardiographic DICOM images, we identified patients with HFrEF or HFpEF and patients without HF. We then linked identified patients to available plasma samples from the Go-SHARE BioBank. We analysed multi-panel biomarkers, such as NT-proBNP, high-sensitivity cardiac troponin-T (hs-cTnT), growth differentiation factor-15 (GDF-15), insulin-like growth factor-binding protein-7 (IGFBP-7), bone morphogenetic protein-10 (BMP-10), Dickkopf WNT Signaling Pathway Inhibitor-3 (DKK-3), fibroblast growth factor-23 (FGF-23), angiopoietin-2 (Ang2), and fatty acid-binding protein-3 (FABP-3), all with electrochemiluminescence immunoassays (Roche Diagnostics, Germany). Results: We identified 236 patients with HFpEF, 156 with HFrEF, and 185 patients without HF with available plasma samples from 3680 patient records linked to echocardiographic DICOMs and blood samples. Patients with HFrEF and HFpEF had significantly higher median values of hs-cTnT, GDF-15, NT-proBNP, IGFBP-7, DKK-3, and FGF-23 than controls. The diagnostic accuracy (AUC) of NT-proBNP, hs-cTnT, GDF-15, IGFBP-7, and FABP-3 was &gt;0.8 for identifying patients with HFrEF or HFpEF from controls. DL-algorithm-based interpretation of DICOM images provided further coverage of echocardiographic parameters relevant for diagnosis of HF subtypes. All biomarkers were associated with all-cause mortality and HF-related hospitalisation during a median follow-up of 1089 days. Conclusions: In this population-based study, we demonstrated a novel approach utilising a bioresource linked to a DL-supported pragmatic study to explore biomarkers in HF and demonstrated that multiple biomarkers to have diagnostic and prognostic significance for patients with HFrEF and HFpEF.

Digital population and housing census – the experience of Serbia

The aim of the paper is to present the experience of the Republic of Serbia in conducting the 2022 Census of Population, Households and Dwellings, focusing on the employment, legal framework and financing of the census as well as on its successful implementation. It discusses strategic decisions on data collection and the integration of information technology – including geospatial data, data collection techniques, machine learning, record linkage and monitoring system – to overcome the challenges posed by the census. The paper addresses the census undercoverage, explores the use of administrative data for item imputation, and examines the development of a statistical population register. The study demonstrates the benefits of adopting a digital-census approach: significant improvement of accuracy, cost reduction and acquired expeditiousness. The Statistical Office of the Republic of Serbia conducted a digital census combined with traditional methods, excluding self-enumeration, along with the use of administrative data for item imputation, and recommends this approach as the most effective way to obtain precise and comprehensive information about a population, including its demographic characteristics, geographic distribution and overall size.

Persistence of Detectable Anti-Pneumococcal Antibodies 4 Years After Pneumococcal Polysaccharide Vaccination in a Randomised Controlled Trial: The Australian Study for the Prevention through Immunisation of Cardiovascular Events (AUSPICE)

Mouse models have indicated that the pneumococcal polysaccharide vaccine (PPV) can reduce atherosclerosis. This is probably through a process of molecular mimicry, where phosphorylcholine in the capsular polysaccharide of the vaccine elicits antibodies that cross-react with oxidised low-density lipoprotein and reduce plaque. We investigated whether a similar mechanism occurs in humans. A large national blinded, randomised, placebo-controlled trial of the PPV (Australian Study for the Prevention through Immunisation of Cardiovascular Events [AUSPICE]) is underway with fatal and nonfatal cardiovascular disease (CVD) events as the primary outcome. Participants at one centre agreed to a substudy measuring a number of biomarkers and surrogates of CVD over 4 years, including anti-pneumococcal antibodies (immunoglobulin G and immunoglobulin M), C-reactive protein, carotid intima-media thickness, pulse wave velocity, insulin, fasting blood glucose, glycated haemoglobin, and hepatorenal index. Antipneumococcal immunoglobulin G and immunoglobulin M were both present and statistically significantly increased in the treated group compared to control at 4 years. However, there were no differences in any of the surrogate measures of CVD or metabolic markers at 4 years. While there were prolonged differences in anti-pneumococcal antibody titres following PPV vaccination, these did not appear to provide any cardioprotective effect, as measured by a range of markers. Final results using the fatal and nonfatal CVD events await the completion of national health record linkage next year. ACTRN12615000536561.

Overdose and mortality risk following a non-fatal opioid overdose treated by Emergency Medical Services in King County, Washington

BackgroundEmergency Medical Services (EMS) agencies respond to hundreds of thousands of acute overdose events each year. We conducted a retrospective cohort study of EMS patients who survived a prior opioid overdose in 2019–2021 in King County, Washington. MethodsA novel record linkage algorithm was applied to EMS electronic health records and the state vital statistics registry to identify repeat overdoses and deaths that occurred up to 3 years following the index opioid overdose. We measured overdose incidence rates and applied survival analysis techniques to assess all-cause and overdose-specific mortality risks. ResultsIn the year following the index opioid overdose, the overdose (fatal or non-fatal) incidence rate was 23.3 per 100 person-year, overdose mortality rate was 2.7 per 100 person-year, and all-cause mortality rate was 5.2 per 100 person-year in this cohort of overdose survivors (n=4234). Overdose incidence was highest in the first 30 days following the index overdose (43 opioid overdoses and 4 fatal overdoses per 1000 person-months), declined precipitously, and then plateaued from the third month onwards (10–15 opioid overdoses and 1–2 fatal overdoses per 1000 person-months). Overdose incidence rates, measured at 30 days, were highest among overdose survivors who were young, male, and experienced a low severity index opioid overdose, but these differences diminished when measured at 12 months. ConclusionsAmong EMS patients who survived an opioid overdose, the risk of subsequent overdose is high, especially in the weeks following the index opioid overdose. Non-fatal overdose may represent a pivotal time to connect patients with harm-reduction, treatment, and other support services.

Association between 5-min Apgar score and attention deficit hyperactivity disorder: a Scotland-wide record linkage study of 758,423 school children

BackgroundAttention-deficit hyperactivity disorder (ADHD) affects around 1 in 20 children and is associated with life-long sequelae. Previous studies of the association between Apgar score and ADHD have reported inconsistent findings.MethodsRecord linkage of maternity, prescribing and school pupil census databases was used to conduct a population e-cohort study of singleton children born in Scotland and attending school in Scotland at any point between 2009 and 2013. Binary logistic regression analysis was used to investigate the association between 5-min Apgar score and treated ADHD adjusting for sociodemographic and maternity confounders.ResultsOf the 758,423 children, 7,292 (0.96%) received ADHD medication. The results suggested a potential dose–response relationship between Apgar score and treated ADHD independent of confounders. Referent to an Apgar score of 10, risk of treated ADHD was higher for scores of 0–3 (adjusted OR 1.76, 95% CI 1.32–2.34), 4–6 (adjusted OR 1.50, 95% CI 1.21–1.86) and even 7–9 (adjusted OR 1.26, 95% CI 1.18–1.36) which are traditionally considered within the normal range.ConclusionsIn addition to reinforcing the need to maximise Apgar score through good obstetric practice, the findings suggest that Apgar score may be useful in predicting future risk of ADHD and therefore facilitating early diagnosis and treatment.

Digital musculoskeletal program is associated with decreased joint replacement rates.

To compare 12-month total knee arthroplasty (TKA) and total hip arthroplasty (THA) rates for digital musculoskeletal (MSK) program members vs patients who received traditional care for knee or hip osteoarthritis (OA). Retrospective, longitudinal study with propensity score-matched comparison group that used commercial medical claims data representing more than 100million commercially insured lives. Study participants with hip OA (M16.x) or knee OA (M17.x) International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes were identified in the medical claims database. Digital MSK program members were identified using record linkage tokens. The comparison group had hip- or knee-related physical therapy identified via ICD-10-CM and Current Procedural Terminology codes. Respectively in each knee and hip OA group, digital members were matched to control group patients with similar demographics, comorbidities, and baseline MSK-related medical care use. TKA and THA at 12 months post participation were compared. In the knee OA group, 739 of 56,634 control group patients were matched to 739 digital members. At 12months, 3.79% of digital members and 14.21% of control group patients had TKA (difference, 10.42%; P < .001). In the hip OA group, 141 of 20,819 control group patients were matched to 141 digital members. At 12 months, 16.31% of digital members and 32.62% of control group patients had THA (difference, 16.31%; P = .001). These findings suggest that patients who participated in a digital MSK program to manage OA have lower rates of total joint arthroplasty in the 12 months afterenrollment.

8.D. Workshop: The German National Cohort (NAKO): Design, current state, and selected results

Abstract This workshop aims to provide an overview on the current state and on selected results of the German National Cohort (NAKO) - the largest multidisciplinary, population-based cohort study in Germany. The session will include one overview presentation and three presentations on selected topics: use of secondary and registry data, environmental exposures, and COVID-19. NAKO aims to investigate the development and aetiology of diseases, and to identify risk factors and enhance early detection and prevention of diseases with a focus on diabetes, cancer, cardiovascular, pulmonary, neurological, psychiatric, and infectious diseases. Between 2014 and 2019, 205,415 participants aged 20-74 years were recruited and examined at 18 study centres across Germany. During their visit to the study centre, they participated in an extensive examination programme including a face-to-face interview, self-administered, computer-based questionnaires, in-depth biomedical examinations, and the collection of various bio-samples. In addition, a subgroup of 30,861 participants received whole-body Magnet Resonance Imaging (MRI) with a focus on brain and cardiac structures, the musculoskeletal system, and body fat distribution. All study participants are re-invited for examinations at the study centres at 4-5 year intervals. The programme for the first re-examination is similar to the baseline programme to detect changes in risk factor profiles and in vascular, cardiac, metabolic, neurocognitive, pulmonary and sensory function. By 31.03.23, 100,822 participants were re-examined, including 14,950 with MRI re-examination. A third examination will start in 2024. Additional information on morbidity, drug use, health care utilization, rehabilitation, cancer diagnoses and therapies, as well as employment and occupational history is obtained by record linkage with secondary data from health insurance companies, the statutory pension insurance, the unemployment fund, as well as through cancer registries and mortality follow-up. Information on environmental exposures (e.g., air pollution, traffic noise, climatic conditions) is linked to residential addresses of the participants to analyse the association with health and development of chronic diseases and to elucidate long-term effects of environmental stressors on health and disease. Two supplemental questionnaires focusing on COVID-19 pandemic-related aspects were provided to all NAKO participants. The second COVID-19 questionnaire was offered online between October 2022 and February 2023 and included questions on general state of health, psychosocial factors, Sars-CoV-2 and long-/post COVID symptoms. It was completed by &amp;gt; 110,000 NAKO participants. Due to its large sample size, the broad examination programme and the longitudinal design, NAKO provides a valuable resource for epidemiologic research and international scientific cooperations. Key messages • The workshop provides information on current state, and selected results of NAKO to facilitate harmonization of data collection between cohort studies and cooperations between scientists. • The workshop will be informative for researchers aiming to work with NAKO data as data access within the European Union is expected to be possible by the end of 2023.

Life's Simple 7 for cardiovascular health is associated with cancer risk in the Moli-sani Study

Abstract Background Cardiovascular disease and cancer share modifiable risk factors and, potentially, molecular mechanisms of disease, as postulated by the “common soil” hypothesis. We examined whether the American Heart Association's Life's Simple 7 (LS7) metrics to assess and promote cardiovascular health, is associated with cancer risk, defined as first hospital admission for any cancer obtained through record linkage with hospital discharge forms. Methods Longitudinal analyses on 21,705 apparently cancer-free participants (mean age 55.2±11.6; 51.9% women) at cohort entry in the Moli-sani Study (2005-2010). Components of the LS7 include cigarette smoking, physical activity, diet, body mass index, blood pressure, cholesterol and glucose: each ideal CV health metric was assigned 2 points, and all points were summed to compute a CV health score ranging between 0 to 14 points. CV health scores were then classified as poor (0 to 6), average (7 to 9), and ideal (10 to 14). Results Over a median follow up of 13 y, a total of 1,918 hospital admissions for any cancer were recorded. The proportion of poor, intermediate and ideal CV health were respectively 33.2%, 47.6%, and 19.2%. In a multivariable-adjusted COX analysis controlled for known risk factors, participants in the ideal CV health category experienced 29% lower risk of cancer hospitalization (HR = 0.71; 95%CI 0.61-0.83) compared with the poor CV health category. These associations tended to be stronger in men (HR = 0.60; 95%CI 0.48-0.76) than in women (HR = 0.80; 95%CI 0.64-0.99), but were of the same magnitude in both the elderly (aged ≥65 y; HR = 0.74; 0.55-0.99) and younger participants (aged &amp;lt;65 y; HR = 0.75; 95%CI 0.63-0.90). Conclusions Results from this large cohort of middle-aged and elderly Italians suggest that improving cardiovascular health could also reduce the future burden of cancer, supporting the hypothesis of a common soil of underlying risk factors for these two groups of diseases. Key messages • The Life’s Simple 7 metric initially developed to promote cardiovascular health is associated with future cancer risk in a large population of middle-aged and elderly Italians. • These findings reinforce the notion of a “common soil” of underlying risk factors for cardiovascular disease and cancer, and support common public health strategies for prevention.