Research Data Center Research Articles

Intracranial haemorrhage following treatment for pulmonary embolism: analysis of the german nationwide inpatient sample

Abstract Background Intracranial haemorrhage (ICH) can be a life-threatening complication of pulmonary embolism (PE) and its treatment during the acute phase. Purpose To characterize patients hospitalized with PE and ICH by identifying risk factors across different treatment groups, and to detect temporal trends in a large nationwide sample. Methods The German nationwide inpatient sample was screened for patients admitted with PE during the period 2005-2020. All hospitalizations were stratified based on the occurrence of ICH and accordingly, risk factors for ICH were investigated (source: Research data center [RDC] of the Federal Statistical Office and the Statistical Offices of the federal states, DRG Statistics 2005-2020, own calculations). Results Overall, 816,653 hospitalizations were included in the present study; among them, 2516 (0.3%) experienced an ICH event and 84,810 (10.4%) died in-hospital. The annual number of hospitalizations of patients admitted due to PE increased steadily from 38,749 in 2005 to 54,966 in 2020, whereas the incidence of ICH remained, despite annual fluctuations, largely stable over time, both in the entire study population and in the subgroup of patients with severe PE as defined by clinical and haemodynamic parameters (n=270,980 [33.2%]). ICH was overall more frequent after the seventh decade of life but, interestingly, no correlation with age was found amongst patients with severe PE (Figure 1). ICH in hospitalized PE patients was associated with an aggravated comorbidity burden mirrored by a higher Charlson Comorbidity Index (5.0 [interquartile range 4.0-7.0] vs. 4.0 [2.0-5.0], P<0.001). This was mainly driven by the higher prevalence of heart failure (27.3% vs. 19.4%, P<0.001) and acute or chronic kidney disease (27.6% vs. 18.1%, P<0.001) in patients with ICH. In addition, severe PE (OR 3.09 [95% CI 2.84-3.35], P<0.001), acute kidney injury (OR 3.60 [3.09-4.18], P<0.001), and particularly ischaemic stroke (OR 14.64 [12.61-17.00], P<0.001) were identified as independent predictors of ICH by multivariable logistic regressions. Overall, 27% of the ICH cases were related to systemic thrombolysis. In PE patients treated with systemic thrombolysis, age ≥70 years as well as female sex were independent predictors of ICH. Finally, ICH was independently associated with a substantial increase in case-fatality in patients hospitalized with PE (univariate OR: 5.38 [4.97-5.84], P<0.001; multivariable OR: 6.16 [5.64-6.72], P<0.001). Conclusions In this healthcare dataset of the German nationwide inpatient sample, the overall incidence of ICH remained low at 0.3% over the 15-year study period. Severe PE, age, comorbidity burden, kidney disease, heart failure and ischaemic stroke were independent risk factors for ICH.

Investigation of age-related in-hospital outcomes of left atrial appendage occlusion in germany

Abstract Background The aim of this study was to assess demographics, in-hospital mortality and baseline characteristics of hospital cases with a left atrial appendage occlusion (LAAO) procedure in relation to patient age. Methods This is a retrospective observational analysis of all German in-hospital cases from 2016 to 2022 with a coded LAAO procedure using the Diagnose Related Groups (DRG) statistics database of the Research Data Center of the Federal Statistical Office. Results In total 40435 cases were observed in the investigated time period. Over the 5 years studied we found a significant shift towards an older patient collective. Compared to 28,3% in 2016, in 2022 40,1% of all patients were over 80 years of age (a rise of 152 %). Cases of patients with over 85 years of age increased from 7.7 % to 11.4 % during the same time period. We observed an in-hospital death rate for patients <70, 70-75, 80-85 and >85 years of age in 0.8, 1.0, 1.4 and 2.2 % respectively. Further we saw significant higher rates of intensified care treatment, pericardial effusion, acute kidney injury and red blood cell transfusion for patients >80 years of age. In unadjusted and adjusted logistic regression models age was significantly associated with a higher rate of in-hospital death. Conclusions In this study we present real world data from a health-care-system level. Our main findings were an increasing age in patients undergoing LAAO procedures and an independent association of age with in-house mortality and complications. This data provides a further basis to balance risks and benefits of LAAO procedure as a preventive treatment.

Recent secular trends of catheter-directed therapy for treatment of pulmonary embolism: a retrospective cohort study based on German national data

Abstract Background Various approaches exist for treatment of pulmonary embolism, including systemic lysis, catheter-directed therapy, or anticoagulation. Purpose This study aimed to describe recent secular trends of treatment strategies for patients with pulmonary embolism. Methods Data were interrogated from the Research Data Centre of the German Federal Statistical Office by ICD- and OPS-codes. 800,119 patients with pulmonary embolism, who were treated in German hospitals between 2007 and 2021, were analyzed and grouped according to the therapeutic strategy: no lysis or intervention, systemic lysis, ultrasound-assisted thrombolysis, catheter-directed lysis without ultrasound, retriever system, other transluminal thrombus removal, or surgical thrombectomy. In-hospital outcomes were investigated with focus on the last 8 years. Results Of all patients examined, 37,885 were treated with systemic lysis, 1,383 with ultrasound-assisted thrombolysis, 2,520 with catheter-directed lysis without ultrasound, 181 with a retriever system, 695 with other transluminal thrombus removal, and 1,037 with surgical thrombectomy. There was an increase in all catheter-directed therapies between 2007 and 2021 (from 102 to 735 procedures per year) with more than twice as many procedures from 2019 to 2021 (from 343 to 735 procedures). Between 2014 and 2021, 453,893 patients with main diagnosis of pulmonary embolism were included in the analysis. Mean age was 58.4-68.1 years in the observed groups. 42.5-52.2% were female. Highest rates of cor pulmonale were observed in patients undergoing surgical thrombectomy (87.7%) and systemic lysis (80.1%), which also applied to shock (26.2% and 25.7%), while both rates were lowest in patients without lysis or intervention (cor pulmonale: 25.4%, shock: 1.8%). The overall in-hospital mortality rate was 8.3%, ranging between 6.5% in the ultrasound-assisted thrombolysis group and 38.4% in the systemic lysis group. In catheter-directed therapies, the rate of major bleeding (>5 units of red blood cells) was 4.9%, ranging from 3.1% for catheter-directed lysis without ultrasound to 10.1% for other transluminal thrombus removal. The rate of intracerebral bleeding was 1.4%, with 0.0% for ultrasound-assisted thrombolysis and 4.4% for treatment with a retriever system. Conclusion In recent years, the use of catheter-directed therapy for pulmonary embolism has steadily increased. Rates of in-hospital major bleeding events and intracerebral bleeding were low.

Neighborhood effects and consequences of criminal justice contact: a research framework

This paper proposes a framework to examine how neighborhood factors influence criminal justice (CJ) contact and contribute to disparities across multiple stages of the justice process. By conceptualizing the punishment process as a dynamic set of decision-making points, this study highlights the role of neighborhood context in shaping offenders’ CJ trajectories and post-CJ residential inequality. Using Harris County, Texas, as a case study, this research considers individual-, neighborhood-, and event-level variables to understand the cumulative effects of neighborhood characteristics on CJ outcomes. This study underscores the critical need to investigate neighborhood mobility and its broader implications for community development and public policy. The findings can be supported by extensive data from the Federal Statistical Research Data Centers and the Criminal Justice Administrative Records System, offering a robust analysis of offenders’ spatial patterns and economic transitions.

National Center for Health Statistics Data Linkage Program: Generating Synthetic Data to Support Tiered Access

The National Center for Health Statistics (NCHS) has a long-established data linkage program that links NCHS health survey data with vital and other administrative records to expand the analytic potential of both the survey and administrative data. Integrating survey and administrative data provides a powerful mechanism for creating policy-relevant data resources to support the examination of factors that can influence disability, chronic disease, health care utilization, morbidity, and mortality. However, data privacy concerns impact the accessibility of NCHS linked data and thus its utilization. Nearly all NCHS linked data files are available only through the NCHS and Federal Statistical Research Data Centers. To minimize this barrier to access, the NCHS Data Linkage Program is engaged in a pilot project to create NCHS' first public-use fully synthetic data files. This initiative supports Evidence Act requirements, including tiered access to federal data. The talk will include an overview of the steps taken to generate the synthetic linked data and provide a verification process to support its analytic utility. The talk will also include a summary of NCHS’ exploration of other privacy enhancing technologies to increase partnership and data access.

Age- and Sex-Specific Analysis of Stroke Hospitalization Rates, Risk Factors, and Outcomes From German Nationwide Data.

Significant age and sex differences have been reported at each stage of the stroke pathway, from risk factors to outcomes. However, there is some uncertainty in previous studies with regard to the role of potential confounders and selection bias. Therefore, using German nationwide administrative data, we aimed to determine the magnitude and direction of trends in age- or sex-specific differences with respect to admission rates, risk factors, and acute treatments of ischemic and hemorrhagic stroke. We obtained and analyzed data from the Research Data Centres of the Federal Statistical Office for the years 2010 to 2020 with regard to all acute stroke hospitalizations, risk factors, treatments, and in-hospital mortality, stratified by sex and stroke subtype. This database provides a complete national-level census of stroke hospitalizations combined with population census counts. All hospitalized patients ≥15 years with an acute stroke (diagnosis code: I60-64) were included in the analysis. Over the 11-year study period, there were 3 375 157 stroke events; 51.2% (n=1 728 954) occurred in men. There were higher rates of stroke admissions in men compared with women for both ischemic (378.1 versus 346.7/100 000 population) and hemorrhagic subtypes (75.6 versus 65.5/100 000 population) across all age groups. The incidence of ischemic stroke admissions peaked in 2016 among women (354.0/100 000 population) and in 2017 among men (395.8/100 000 population), followed by a consistent decline from 2018 onward. There was a recent decline in hemorrhagic stroke admissions observed for both sexes, reaching its nadir in 2020 (68.9/100 000 for men; 59.5/100 000 for women). Female sex was associated with in-hospital mortality for both ischemic (adjusted odds ratio, 1.11 [1.09-1.12]; P<0.001) and hemorrhagic stroke (adjusted odds ratio, 1.18 [95% CI, 1.16-1.20]; P<0.001). Despite improvements in stroke prevention and treatment pathways in the past decade, sex-specific differences remain with regard to hospitalization rates, risk factors, and mortality. Better understanding the mechanisms for these differences may allow us to develop a sex-stratified approach to stroke care.

Evolution of Robotic Urology in Clinical Practice from the Beginning to Now: Results from the GRAND Study Register

Background and objectiveMajor urological guidelines do not currently recommend robot-assisted surgery compared with laparoscopic or open surgery due to the lack of high-quality evidence. We aimed to provide real-world data on the evolution of robotic urology and to compare its perioperative outcomes with those of laparoscopic and open surgeries. MethodsWe used the GeRmAn Nationwide inpatient Data (GRAND), provided by the Research Data Center of the Federal Bureau of Statistics (2005–2021), and performed multiple patient-level analyses. We included patients undergoing major urological surgeries and report the largest study in the field with 993 276 patients. Key findings and limitationsAn open approach was performed in 733 416 cases, a laparoscopic approach in 109 428, and a robot-assisted approach in 150 432. Overall, 442 811 (45%) patients underwent radical prostatectomy, 129 943 (13%) radical cystectomy, 192 340 (19%) radical nephrectomy, 123 648 (12%) partial nephrectomy, 56 114 (5.6%) nephroureterectomy, and 48 420 (4.9%) pyeloplasty. The number of patients undergoing robot-assisted surgery increased exponentially, while the number of patients undergoing open surgery decreased substantially throughout the past few years. Patients undergoing minimally invasive surgery displayed slightly better, but clinically insignificant, baseline characteristics. After adjusting for the major risk factors in the multivariate regression analysis, robotic versus open surgery was associated with significantly lower odds of mortality for all five major oncological surgeries and with lower odds of intensive care unit admission, transfusion, and length of hospital stay for all six major urological surgeries. Conclusions and clinical implicationsRobotic surgery is becoming the mainstay in major urological operations. Patient summaryMajor urological guidelines prefer laparoscopic or open surgery to robot-assisted surgery due to the lack of high-quality evidence supporting the latter. However, robotic surgery is becoming the mainstay in major urological operations.

Perioperative Outcomes and Trends in Transurethral Resection of Bladder Tumors with Photodynamic Diagnosis: Results from the GeRmAn Nationwide Inpatient Data Study.

Background: Photodynamic diagnosis (PDD) during transurethral resection of bladder tumor (TURBT) is guideline recommended, as it improves bladder cancer detection rates. However, the extent to which PDD is implemented in everyday clinical practice has not been thoroughly assessed. We aimed to evaluate the current trends and major perioperative outcomes of TURBT with PDD. Methods: The present study evaluated the GeRmAn Nationwide inpatient Data (GRAND) from 2010 (the year when PDD started to be coded separately in Germany) to 2021, which were made available from the Research Data Center of the German Bureau of Statistics. We undertook numerous patient-level and multivariable logistic regression analyses. Results: Overall, 972,208 TURBTs [228,207 (23%) with PDD and 744,001 (77%) with white light] were performed. Patients offered PDD during TURBT were younger (p < 0.001), presented fewer comorbidities (p < 0.001) and were discharged earlier from hospital (p < 0.001). PDD was associated with additional costs of about EUR 500 compared to white-light TURBT (p < 0.001). The yearly TURBT cases remained relatively stable from 2010 to 2021, whereas utilization of PDD underwent a 2-fold increase. After adjusting for major risk factors in the multivariate regression analysis, PDD was related to lower rates of transfusion (1.4% vs. 5.6%, OR: 0.29, 95% CI: 0.28 to 0.31, p < 0.001), intensive care unit admission (0.7% vs. 1.4%, OR: 0.56, 95% CI: 0.53 to 0.59, p < 0.001) and 30-day in-hospital mortality (0.1% vs. 0.7%, OR: 0.24, 95% CI: 0.22 to 0.27, p < 0.001) compared to white-light TURBT. On the contrary, PDD was related to clinically insignificant higher rates of bladder perforation (0.6% versus 0.5%, OR: 1.3, 95% CI: 1.2 to 1.4, p < 0.001), and reoperation (2.6% versus 2.3%, OR: 1.2, 95% CI: 1.1 to 1.2, p < 0.001). Conclusions: The utilization of PDD with TURBT is steadily increasing. Nevertheless, the road toward the establishment of PDD as the standard of care for TURBT is still long, despite of the advantages of PDD.

Trends and outcomes of hospitalized patients with priapism in Germany: results from the GRAND study.

We aimed to provide evidence on the trends and in-hospital outcomes of patients with low- and high-flow priapism through the largest study in the field. We used the GeRmAn Nationwide inpatient Data (GRAND), provided by the Research Data Center of the Federal Bureau of Statistics (2008-2021), and performed multiple patient-level analyses. We included 6,588 men with low-flow and 729 with high-flow priapism. Among patients with low-flow priapism, 156 (2.4%) suffered from sickle cell disease, and 1,477 (22.4%) patients required shunt surgery. Of them, only 37 (2.5%) received a concomitant penile prosthesis implantation (30 inflatable and 7 semi-rigid prosthesis). In Germany, the total number of patients with low-flow priapism requiring hospital stay has steadily increased, while the number of patients with high-flow priapism requiring hospital stay has decreased in the last years. Among patients with high-flow priapism, 136 (18.7%) required selective artery embolization. In men with low-flow priapism, sickle cell disease was associated with high rates of exchange transfusion (OR: 21, 95% CI: 14-31, p < 0.001). The length of hospital stay (p = 0.06) and the intensive care unit admissions (p = 0.9) did not differ between patients with low-flow priapism due to sickle cell disease versus other causes of low-flow priapism. Accordingly, in men with high-flow priapism, embolization was not associated with worse outcomes in terms of length of hospital stay (p > 0.9), transfusion (p = 0.8), and intensive care unit admission (p = 0.5). Low-flow priapism is an absolute emergency that requires shunt surgery in more than one-fifth of all patients requiring hospital stay. On the contrary, high-flow priapism is still managed, in most cases, conservatively.

Temporal and regional trends of case-fatality in patients hospitalized with acute respiratory distress syndrome in Germany

Abstract Funding Acknowledgements None. Aims Significant progress has been made in understanding the pathophysiology of acute respiratory distress syndrome (ARDS). However, ARDS it is still a life-threatening medical condition with a high mortality rate. Little is known about temporal trends and regional variations in Germany. Methods We analyzed data on the characteristics, comorbidities and in-hospital outcomes for all hospitalized patients with ARDS in Germany between 2005 and 2019. Diagnoses were coded according to the International Classification of Diseases and Related Health Problems, 10th Revision with German Modification (ICD-10-GM), and diagnostic, surgical or interventional procedures according to the German Procedure Classification (OPS, surgery and procedures codes. The computed study analyses were performed on our behalf by the Research Data Center of the Federal Statistical Office and the Statistical Offices of the federal states in Wiesbaden, Germany. Results Overall, 8,369,723 inpatients aged ≥18 years were included in this analysis; among these, 155,872 (1.9%) were codes with the diagnosis of ARDS. The annual number of ARDS cases increased from 7,286 in 2005 to 13,722 in 2019 in parallel with a significant decrease of in-hospital mortality. Overall, 74,751 (48.0%) patients with ARDS died during the in-hospital stay and in-hospital case-fatality grew exponentially with age. Independent predictors of in-hospital fatality with an OR &amp;gt;2 were age ≥70 years, necessity of ECMO, severe liver disease, acute renal failure, dialysis, shock and cardio-pulmonary resuscitation. Most patients with ARDS were treated in hospitals in urban areas (n=56,582) with a high case-fatality rate (49.7%), but also with concomitant high proportion rate of mechanical ventilation (23.7%) compared to hospitals in suburban or rural areas. Conclusion The number of patients with ARDS increased markedly in Germany between 2005 and 2019, in parallel with a decrease of in-hospital fatality. Our findings may suggest that general management of ARDS have improved over time and might draw more attention to predictors for in-hospital fatality in patients hospitalized with ARDS. The need for mechanical ventilation and a poor outcome was more likely in urban areas – this might be accentuated by patient transfer to specialized high care centers usually located in urban settings.

The impact of health care on outcomes of suspected testicular torsion: results from the GRAND study

BackgroundSuspicion of testicular torsion represents a urological emergency, necessitating immediate surgery. Comprehensive data on the current trends and perioperative outcomes regarding surgical exploration are sparse. Therefore, we utilized nationwide data on the prevalence and results of this surgery, aiming to provide evidence on this matter.MethodsWe assessed the GeRmAn Nationwide inpatient Data (GRAND) from 2005 to 2021, provided by the Research Data Center of the Federal Bureau of Statistics. We performed multiple regression analyses to evaluate the perioperative outcomes (length of hospital stay, transfusion, and surgical wound infection) after surgical exploration due to suspected testicular torsion based on both the outcome of surgery (orchiectomy, detorsion with preservation of the testicle, and no testicular torsion) and on the department of operation (urological versus non-urological).ResultsA total of 81,899 males underwent surgical exploration due to suspected testicular torsion in Germany from 2005 to 2021. Of them, 11,725 (14%) underwent orchiectomy, 30,765 (38%) detorsion with preservation of the testicle and subsequent orchidopexy, and 39,409 (48%) presented no testicular torsion. Orchiectomy was significantly associated with longer length of hospital stay (day difference of 1.4 days, 95%CI: 1.3–1.4, p < 0.001), higher odds of transfusion (1.8, 95% CI: 1.2–2.6, p = 0.002) and surgical wound infections (1.8, 95%CI: 1.4–2.3, p < 0.001) compared to no testicular torsion. The proportion of patients undergoing orchiectomy was significantly lower in urological departments (14%) versus non-urological departments (16%) and the proportion of patients undergoing preservation of testicle after detorsion was significantly higher in urological departments (38%) versus non-urological departments (37%), p < 0.001. Patients undergoing treatment in a urological department were discharged earlier and presented lower odds of transfusion and surgical wound infection (p < 0.001) compared to patients undergoing treatment in a non-urological department.ConclusionsNearly half of patients who underwent surgery for suspected testicular torsion did not have intraoperatively the condition confirmed. Patients treated in urological departments had significantly better perioperative outcomes compared to those treated in non-urological departments. Therefore, we advise to refer patients to urological treatment as early as possible.

Treatment of Hirschsprung's Disease in Germany: Analysis of National Hospital Discharge Data From 2016 to 2022

BackgroundHirschsprung's disease (HD) is a rare and complex malformation. The corrective operation is challenging and schedulable. The complete care situation for the corrective surgery for HD in Germany is uninvestigated. MethodsFor the years 2016–2022, the microdata of the diagnosis-related groups (DRG) -statistics provided by the Research Data Center of the German Federal Statistical Office were accessed. All hospital stays for corrective surgery of HD in patients aged 0–17 were analyzed for patient's comorbidities, treatment characteristics and hospital structures. The occurrence of severe early postoperative complications during the hospital stay were documented. ResultsThe care structure for HD in Germany is decentralized with 109 hospitals performing 1199 corrective surgeries in 7 years. 75% of the participating hospitals performed three or less cases per year and 55 participating hospitals did not perform corrective surgery for HD each year. Early postoperative complications were common with at least one severe early complication in 18.6% of the cases. With an overall low case load per hospital, a volume outcome relationship cannot be established within Germany. Compared to international high volume centers the quality of outcomes for some of the investigated parameters was reduced. Despite the establishing of centers of expertise by the European reference network ERNICA for the treatment of HD no trend towards centralization occurred in Germany. ConclusionsThe corrective surgery for HD in Germany is decentralized and results in an overall high rate of early complications. The comparison with international studies from high-volume centers indicates potential for improvement for the corrective surgery of HD. Centralization remains essential for the improvement of care for patients with HD.

Production Chain Organization in the Digital Age: Information Technology Use and Vertical Integration in U.S. Manufacturing

Advances in information technology (IT) may affect the organizational design of production. Exploiting the rapid diffusion of the internet in the United States, we assess the sensitivity of production chain organization to this innovation in IT access and use. Extending theories of the firm that recognize the importance of downstream transfers (selling as opposed to sourcing) and plural governance in organizational design, we predict IT-driven shifts in downstream vertical integration. In a detailed panel of Census Bureau data for over 5,600 manufacturing plants, we observe the extent of a production unit’s downstream transactions within the firm alongside concurrent sales to external customers—a mix we refer to as plural selling. Our main finding is that the use of the internet for external coordination precipitated a significant decline in downstream vertical integration across the manufacturing sector. Instrumental variables estimation points to a causal relationship but also heterogeneous treatment effects. Key drivers of plural organization, such as complementarities and constraints across differently governed transactions, help explain such heterogeneity, as does concurrent use of internal production management IT. Our study is the first study to leverage a plural governance framework and large-scale microdata to understand how U.S. production chain organization shifted in response to this rapid and far-reaching technological change. This paper was accepted by David Simchi-Levi, information systems. Funding: This research was performed at the Atlanta, Boston, and Cornell (supported by the Cornell Center for the Social Sciences) Federal Statistical Research Data Centers [Project 1069 (CBDRB-FY22-279)]. Support for the Research Data Centers network from the National Science Foundation [Grant ITR-0427889] is gratefully acknowledged, as is support from the Social Sciences and Humanities Research Council of Canada. Supplemental Material: The online appendix is available at https://doi.org/10.1287/mnsc.2019.01586 .

A Practical Use Case: Lesson Learned From Social Science Research Data Centers

A Practical Use Case: Lesson Learned From Social Science Research Data Centers

U.S. Fertility in Life Course Context: A Research Note on Using Census-Held Linked Administrative Records for Geographic and Sociodemographic Subgroup Estimation

Fertility is a life course process that is strongly shaped by geographic and sociodemographic subgroup contexts. In the United States, scholars face a choice: they can situate fertility in a life course perspective using panel data, which is typically representative only at the national level; or they can attend to subnational contexts using rate schedules, which do not include information on life course statuses. The method and data source we introduce here, Census-Held Linked Administrative Records for Fertility Estimation (CLAR-FE), permits both. It derives fertility histories and rate schedules from U.S. Census Bureau–held data for the nation and by state, racial and ethnic subgroups, and the important life course status of parity. We generate three types of rates for 2000–2020 at the national and state levels by race and ethnicity: age-specific rates and both unconditional and conditional parity- and age-specific rates. Where possible, we compare these rates with those produced by the National Center for Health Statistics. Our new rate schedules illuminate state and racial and ethnic differences in transitions to parenthood, providing evidence of the important subgroup heterogeneity that characterizes the United States. CLAR-FE covers nearly the entire U.S. population and is available to researchers on approved projects through the Census Bureau's Federal Statistical Research Data Centers.

Abstract MP77: Both Racial/Ethnic Residential Segregation and Exposure to Outdoor Artificial Light at Night May Impact Cardiovascular Health but Perhaps Not Through Self-Reported Sleep

Introduction: Due to structural racism, minoritized racial/ethnic groups are overrepresented in racially segregated areas of concentrated disadvantage in which residences may be less protective against outdoor artificial light at night (ALAN). Both racial/ethnic residential segregation (RRS) and ALAN are associated with disparities in both sleep duration, potentially through ALAN exposures in segregated areas disrupting melatonin production, and cardiovascular health (CVH). However, few studies have investigated pathways between RRS and ALAN, sleep, and CVH. We sought to investigate sleep duration as a potential mediator between RRS and ALAN exposures and CVH among US adults. Hypothesis: We hypothesized that (1) ALAN would disproportionately burden minoritized racial/ethnic groups, (2) sleep duration would mediate associations between both RRS and ALAN and CVH, and (3) associations would vary by race/ethnicity. Methods: We used data collected from 2011 National Health Interview Survey adult participants reporting sleep duration (short [&lt;7 hours(h)]), recommended [7-9 h], long [&gt;9 h]) and CVH (defined as yes vs. no to all: never/former smoking, BMI 18-&lt;25 kg/m 2 , meets physical activity guidelines, and no prior diagnosis of dyslipidemia, hypertension, or pre-diabetes/diabetes). Participants’ home addresses were geographically linked to the 2012 American Community Survey 5-year estimates to assess RRS, measured by the local Getis-Ord G i * statistic (z-scores) categories: low (z&lt;0), medium (0≤z≤1.96), and high (z&gt;1.96). Quintiles of residential ALAN were estimated from 2010-2011 US Defense Meteorological Satellite Program’s Operational Linescan System values. We used robust Poisson regression adjusted for sociodemographic characteristics, estimated mediation through sleep duration with the Sobel’s test, and assessed effect modification by race/ethnicity. Results and Conclusions: Among 18,057 participants (mean age±SE =45±0.2 years); 35%, 44%, and 21% resided in low, medium, and highly segregated neighborhoods, respectively. ALAN was highest among non-Hispanic White adults. Prevalence of short and long sleep duration overall were 31% and 3% and highest among Black adults (39% and 4%). High (vs. low) RRS was associated with a higher prevalence of CVH (PR=1.13 [95% CI:1.01-1.26]). However, higher ALAN (Q5 vs. Q1) was associated with a lower prevalence of CVH (PR=0.79 [95% CI:0.66-0.95]). Sleep did not appear to mediate associations, which did not vary by race/ethnicity. In conclusion, self-reported sleep did not mediate associations between RRS or ALAN and CVH. Nonetheless, further study using objective measures is warranted given the biological plausibility. The findings/conclusions in this research are those of the authors and do not necessarily represent the views of the Research Data Center, National Center for Health Statistics, or CDC.

The effect of hospital caseload on perioperative mortality, morbidity and costs in bladder cancer patients undergoing radical cystectomy: results of the German nationwide inpatient data

ObjectivesTo determine a data-based optimal annual radical cystectomy (RC) hospital volume threshold and evaluate its clinical significance regarding perioperative mortality, complications, length of hospital stay, and hospital revenues.Material and methodsWe used the German Nationwide inpatient Data, provided by the Research Data Center of the Federal Bureau of Statistics (2005–2020). 95,841 patients undergoing RC were included. Based on ROC analyses, the optimal RC threshold to reduce mortality, ileus, sepsis, transfusion, hospital stay, and costs is 54, 50, 44, 44, 71 and 76 cases/year, respectively. Therefore, we defined an optimal annual hospital threshold of 50 RCs/year, and we also used the threshold of 20 RCs/year proposed by the EAU guidelines to perform multiple patient-level analyses.Results28,291 (29.5%) patients were operated in low- (< 20 RC/year), 49,616 (51.8%) in intermediate- (20–49 RC/year), and 17,934 (18.7%) in high-volume (≥ 50 RC/year) centers. After adjusting for major risk factors, high-volume centers were associated with lower inpatient mortality (OR 0.72, 95% CI 0.64–0.8, p < 0.001), shorter length of hospital stay (2.7 days, 95% CI 2.4–2.9, p < 0.001) and lower costs (457 Euros, 95% CI 207–707, p < 0.001) compared to low-volume centers. Patients operated in low-volume centers developed more perioperative complications such as transfusion, sepsis, and ileus.ConclusionsCentralization of RC not only improves inpatient morbidity and mortality but also reduces hospital stay and costs. We propose a threshold of 50 RCs/year for optimal outcomes.

Optimized spatial information for 1990, 2000, and 2010 U.S. census microdata

We report on the successful completion of a project to upgrade the positional accuracy of every response to the 1990, 2000, and 2010 U.S. decennial censuses. The resulting data set, called Optimized Spatial Census Information Linked Across Time (OSCILAT), resides within the restricted-access data warehouse of the Federal Statistical Research Data Center (FSRDC) system where it is available for use with approval from the U.S. Census Bureau. OSCILAT greatly improves the accuracy and completeness of spatial information for older censuses conducted prior to major quality improvements undertaken by the Bureau. Our work enables more precise spatial and longitudinal analysis of census data and supports exact tabulations of census responses for arbitrary spatial units, including tabulating responses from 1990, 2000, and 2010 within 2020 block boundaries for precise measures of change over time for small geographic areas.

Research on the Construction of Statistical Data Management Platform under Big Data

Purpose: Under the construction of Statistical data management platform, the problems such as low accuracy of data, difficult effective integration of data, low efficiency, etc., are solved, and the clinical research workflow is improved. Methods: Based on the integration platform and big data related technologies, multi-source heterogeneous data are integrated and cleaned to form a scientific research data center. What's more, the scientific research retrieval system is used for high-speed retrieval, analysis and utilization of the data in the scientific research data center. Results: The built scientific research retrieval system has the functions of integrating statistical methods, flexibly configuring statistical indicators, customizing queries, etc., which reduces the pressure of scientific researchers in data collection, statistics and analysis, and improves the statistical analysis quality of scientific research data. Conclusion: It has improved the quality and efficiency of scientific research, accelerated the transformation of scientific research achievements, and indirectly promoted the improvement of medical quality.

Surgical Trends and Complications in Partial and Radical Nephrectomy: Results from the GRAND Study.

We aimed to evaluate the current trends in renal cancer surgery, as well as to compare the perioperative outcomes of partial versus radical nephrectomy. We used the GeRmAn Nationwide inpatient Data (GRAND), provided by the Research Data Center of the Federal Bureau of Statistics (2005-2021). We report the largest study in the field, with 317,843 patients and multiple patient-level analyses. Overall, 123,924 (39%) patients underwent partial and 193,919 (61%) underwent radical nephrectomy in Germany from 2005 to 2021. Of them, 57,308 (18%) were operated on in low-, 142,702 (45%) in intermediate-, and 117,833 (37%) in high-volume centers. A total of 249,333 (78%) patients underwent open, 44,994 (14%) laparoscopic, and 23,516 (8%) robotic nephrectomy. The number of patients undergoing renal surgery remained relatively stable from 2005 to 2021. Over the study period, the utilization of partial nephrectomy increased threefold, while radical nephrectomy decreased by about 40%. After adjusting for major risk factors in the multivariate regression analysis, radical nephrectomy was associated with 3.2-fold higher odds (95% CI: 3.2 to 3.9, p < 0.001) of 30-day mortality, longer hospitalization by 1.9 days (95% CI: 1.9 to 2, p < 0.001), and higher inpatient costs by EUR 1778 (95% CI: 1694 to 1862, p < 0.001) compared to partial nephrectomy. Furthermore, radical nephrectomy had a higher risk of in-hospital transfusion (p < 0.001), sepsis (p < 0.001), acute respiratory failure (p < 0.001), acute kidney disease (p < 0.001), acute thromboembolism (p < 0.001), surgical wound infection (p < 0.001), ileus (p < 0.001), intensive care unit admission (p < 0.001), and pancreatitis (p < 0.001). More patients are offered partial nephrectomy in Germany. Patients undergoing radical nephrectomy present with a higher rate of concomitant risk factors and have increased perioperative morbidity and mortality, prolonged hospitalization, and increased in-hospital costs.