Health Data Repositories Research Articles

Abstract 19277: Neither Comorbidities nor Socioeconomic Differences Explain the Association Between Higher Altitude of Residence and Better Coronary Artery Disease Survival

Background: Previous studies have linked higher altitude of residence with lower mortality from coronary artery disease, but were limited by incomplete ascertainment of co-morbidities, including hypertension, dyslipidemia, diabetes, and smoking, as well as lack of adjustment for socioeconomic variables such as education status and household income. Methods: We tested whether comorbidities and socioeconomic variables alter the association between altitude of residence and both results of coronary angiography and survival of those with coronary artery disease using the APPROACH database, a prospective cohort of all subjects undergoing coronary angiography in the Province of Alberta. Co-morbidities and mortality are ascertained by periodic linkage with Alberta Health, the provincial repository of administrative health data. The population was stratified by altitude of residence into quartiles based on residence postal codes, and logistic regression was used to calculate odds ratios for high risk or left main disease at coronary angiography, with the lowest quartile the reference. A Cox proportional hazard model was used to calculate hazard ratios for mortality, with the lowest quartile the reference. Results: A total of 105,093 consecutive subjects referred for coronary angiography between 1995 and 2010 were included, spanning elevations between 210 meters to 2,164 meters. After adjustment for comorbidities and socioeconomic variables, the odds ratio for the highest quartile having high risk or left main coronary disease at angiography was 0.86 (0.82-0.90). Survival analysis was restricted to 78,349 subjects with at least one >50% coronary lesion. The hazard ratio for mortality for the highest quartile was 0.88 (0.84-0.93) adjusting for all variables except coronary anatomy, and 0.95 (0.90-0.99) after adjusting for all variables. Conclusion: Higher altitude of residence was associated with lower odds of having high risk or left main coronary artery disease at coronary angiography and better survival, even after adjustment for comorbidities and socioeconomic variables.

Blood pressure control among US veterans: a large multiyear analysis of blood pressure data from the Veterans Administration health data repository.

Hypertension treatment and control remain low worldwide. Strategies to improve blood pressure control have been implemented in the United States and around the world for several years. This study was designed to assess improvement in blood pressure control over a 10-year period in a large cohort of patients in the Department of Veterans Affairs. A cohort of 582 881 hypertensive patients and 260 924 normotensive individuals treated in 15 Department of Veterans Affairs medical centers between 2000 and 2010 were examined. Strategies used system-wide included blood pressure control as a performance measure, automatic notification to healthcare providers, electronic reminders, and a systematic revisit schedule. The main outcome measure was the percentage of hypertensive patients whose hypertension was controlled and the level of blood pressure each month. In the hypertensive cohort (mean age 62.9±13.4 years, 96.0% male), 52.3% of patients were white, 25.1% were black, and 21.1% were Hispanic. Blood pressure control rates improved from 45.7% in September 2000 to 76.3% in August 2010. Improvements were similar across ethnic, racial, age, and sex groups. Average systolic/diastolic blood pressure decreased from 142.6/77.1 mm Hg in 2000 to 131.2/74.8 mm Hg in 2010, a decrease of 11.3/2.3 mm Hg (P<0.0001 for both). Systolic and diastolic blood pressures were lower in summer than in winter, and this trend continued through 2010. On average, control rates increased by 3.0% per year and were 6.8% higher in summer than in winter. High rates of blood pressure control can be achieved in all age and ethnic groups and in both sexes.

Erratum: Personal medicine—the new banking crisis

Nat. Biotechnol. 30, 141–147 (2012); published online 8 February 2012; corrected after print 24 February 2012 In the version of the article originally published, the citation in Figure 1 was given as ref. 14; it should be ref. 2. In Table 1, CARTaGENE was misspelled, and the descriptions in column 3of this repository, BioVu's and the International HapMap were incorrect: CARTaGENE should be described as “A repository of socio-demographic, health data and biological samples from 20,000 citizens of the province of Quebec in Canada”; BioVu's description should read “Repository of DNA samples and de-identified health information from the Vanderbilt University Medical Center's electronic system”; and the International HapMap description should read “International collaboration with the ultimate goal of developing a haplotype map of the human genome.

Does osteoporosis therapy invalidate FRAX for fracture prediction?

Ten-year fracture risk assessment with the fracture risk assessment system (FRAX) is increasingly used to guide treatment decisions. Osteoporosis pharmacotherapy reduces fracture risk, but the effect is greater than can be explained from the increase in bone mineral density (BMD). Whether this invalidates fracture predictions with FRAX is uncertain. A total of 35,764 women (age ≥50 years) and baseline BMD testing (1996–2007) had FRAX probabilities retroactively calculated. A provincial pharmacy database was used to identify osteoporosis medication use. Women were categorized as untreated, current high adherence users [medication possession ratio (MPR) ≥0.80 in the year after BMD testing], current low adherence users (MPR <0.80), and past users. Fractures outcomes to 10 years were established form a population-based health data repository. FRAX and femoral neck BMD alone stratified major osteoporotic and hip fracture risk within untreated and each treated subgroup (all p-values <0.001) with similar area under the receiver operating characteristic curve. In untreated and each treated subgroup, a stepwise gradient in observed 10-year major osteoporotic and hip fracture incidence was found as a function of the predicted probability tertile (all p-values <0.001 for linear trend). Concordance (calibration) plots for major osteoporotic fractures and hip fractures showed good agreement between the predicted and observed 10-year fracture incidence in untreated women and each treated subgroup. Only in the highest risk tertile of women highly adherent to at least 5 years of bisphosphonate use was observed hip fracture risk significantly less than predicted, though major osteoporotic fracture risk was similar to predicted. In summary, this work suggests that the FRAX tool can be used to predict fracture probability in women currently or previously treated for osteoporosis. Although FRAX should not be used to assess the reduction in fracture risk in individuals on treatment, it may still have value for guiding the need for continued treatment or treatment withdrawal

Straw into Gold: Lessons Learned (and Still Being Learned) at the Manitoba Centre for Health Policy

What lessons have we learned at the Manitoba Centre for Health Policy (MCHP) about knowledge translation (KT) over the past 20 years, and what is our vision for the future? How does that KT interrelate with our other activities - research and the Population Health Data Repository? Who first noticed that "there's gold in them thar hills," and what did they do about it? How did we weave administrative database "straw" into gold, how have we panned for gold and how do we look for the pot of gold in the future? This paper describes how MCHP began with an integrated KT research relationship with government, and through The Need to Know Team, extended KT to regional health authority planners. It describes the various push-pull KT mechanisms that MCHP has used, including dissemination of research to planners through interactive workshops, and to other researchers through Web-based resources.

Nationwide Health Data Management System: A Novel Approach for Integrating Biomarker Measurements with Comprehensive Health Records in Large Populations Studies

The nation-wide electronic health record database acts as an interoperable repository of health data obtained throughout citizen contacts with health care providers. This system improves accessibility for citizens and researchers to health data with the ability to assign context to disease development. In that system, individual patients who are members of the large population-based health database can be assessed as individuals or as a population in prospective studies of prospective diseases.

Applying Dynamic Causal Mining in Health Service Management

This article describes an application that illustrates the role of data mining technology in identifying hidden causal knoledge from health and medical data repositories. Across the health care and medical enterprises, a wide variety of data is being generated at a rapid rate. Current information technologies tends to focus on a more statical side of causal knowledge and do not address the dynamic causal knowledge. This article shows that the dynamic causal relation data can be captured for treatment, payment, operations purposes and administrative directed insights. Accessing this currently unrealized knowledge potential would enable the delivery of actionable knowledge to medical practitioners, healthcare system managers, policy planners and even patients to make a significant difference in overall healthcare.

Strategic constraints in health informatics: are expectations realistic?

In response to demands to enhance the efficiency and accountability of health systems, a range of different information technologies are being promoted. These technologies include integrated hospital systems, community health information networks and data repositories. However, the record of such technologies inside and outside the health industry suggest that such technologies cannot necessarily be relied on. The reason identified is that information systems are inherently logical and rational systems, and often come into conflict with the less rational social systems of organizations. Health information is identified in terms of three basic dimensions of information; that associated with managers; with professionals; and, with patients. The information of these dimensions are focused on very different objectives, have different structures and functions and are controlled by very different social processes. The information is also very complex and diverse within the dimensions. In the clinical encounter the clinician draws on specialist expertise, satisfies administrative requirements, and provides a clinical record. Thus, these dimensions converge at that point. However, collecting information is costly, and an efficient service demands economy in data collection. However, the technologies being promoted demand 'complete' data acquisition based on consistent and stable data definitions and data structures. The article argues that there is, thus, a conflict between the requirements of these technologies, and the realities of providing efficient services within a changing organizational, professional and social environment.