Administrative Data Sources Research Articles

Mental Disorders Forecast Alzheimer’s Disease and Related Dementias in 1.7 Million New Zealanders

Neurodegenerative conditions, including Alzheimer’s disease and related dementias (ADRD), have an outsized impact on disability and loss of independence in older adults. As such, there is a growing need to identify modifiable risk factors for ADRD at the population level. We conducted a nationwide administrative-register study to investigate mental disorders as a potential preventable risk factor for later-life ADRD. Data were drawn from the New Zealand Integrated Data Infrastructure, a collection of whole-of-population administrative data sources linked at the individual level by a common spine. We identified all individuals born in New Zealand between 1928-1967 and followed them for three decades (N = 1,711,386; observation period = 1988-2018; age at baseline = 21-60 years). Diagnoses of mental disorders were ascertained from public-hospital records. Diagnoses of ADRD were ascertained from public-hospital records, mortality records, and pharmaceutical records. Individuals with a mental disorder were at elevated risk for developing Alzheimer’s disease and related dementias relative to those without a mental disorder. This prospective association was evident in both men and women, across age, and after accounting for pre-existing physical diseases. If associations are causal, ameliorating mental disorders could extend population healthspan and reduce the societal burden of neurodegenerative diseases.

Prescription opioid treatment for non-cancer pain and initiation of injection drug use: large retrospective cohort study

ObjectiveTo assess the association between long term prescription opioid treatment medically dispensed for non-cancer pain and the initiation of injection drug use (IDU) among individuals without a history of substance...

Minimally invasive surgery for suspected early-stage ovarian cancer; a cost-effectiveness study.

While there are a number of benefits to minimally invasive surgery (MIS) for women with ovarian cysts, there is an increased risk of ovarian capsule rupture during the procedure, which could potentially seed the abdominal cavity with malignant cells. We developed a decision model to compare the risks, benefits, effectiveness and cost of MIS versus laparotomy in women with ovarian masses. Cost-effectiveness study POPULATION: Hypothetical cohort of 10 000 women with ovarian masses who were undergoing surgical management. The initial decision point in the model was performance of surgery via laparotomy or a MIS approach. Model probabilities, costs and utility values were derived from published literature and administrative data sources. Extensive sensitivity analyses were conducted to assess the robustness of the findings. The primary outcome was the cost-effectiveness of MIS versus laparotomy for women with a pelvic mass measured by incremental cost-effectiveness ratios (ICERs). MIS was the least costly strategy at $7,732 per women on average, compared with $17,899 for laparotomy. In our hypothetical cohort of 10 000 women, there were 64 cases of ovarian rupture in the MIS group and 53 in the laparotomy group, while there were 26 cancer-related deaths in the MIS group and 25 in the laparotomy group. MIS was more effective than laparotomy (188 462 QALYs for MIS versus 187 631 quality adjusted life years [QALYs] for laparotomy). Thus, MIS was a dominant strategy, being both less costly and more effective than laparotomy. These results were robust in a variety of sensitivity analyses. MIS constitutes a cost-effective management strategy for women with suspicious ovarian masses. MIS is a cost-effective management strategy for women with suspicious ovarian masses.

On the magnitude, frequency, and nature of marriage dissolution in Italy: insights from vital statistics and life-table analysis

Legal separation is a crucial step in the dissolving of marriages in Italy. Marriage and legal separation data come from administrative data sources and have been part of the civil registration and vital statistics system for a long time. These data make it possible to constantly monitor evolution of marital unions formation and dissolution over time and space. This study highlights the potential of combining administrative data at a macro level, aggregated by selected characteristics of the marriage and of the spouses. Data collection on legal separations is a complex process that brings together records from different administrative sources that have different transmission procedures. The system has rapidly evolved in recent years because of important normative changes. Pooling the two exhaustive data sources on marriages and separations we calculate duration-specific separation rates by selected spouses’ and wedding characteristics and estimate survival curves for 1975 marriage cohorts onward. Although the propensity to separate is increasing across marriage cohorts, the most recent first-marriage cohorts—those celebrated since the beginning of the new millennium—show a decreasing tendency to separate after short marriage durations. The most fragile unions are those celebrated in a civil ceremony in the north of Italy and that choose the separation of property regime. Couples in which the bride is more educated than the groom show a higher risk of separating. Differences by geographical area and celebration rite tend to reduce over time. This study contributes to existing information about the propensity to separate in Italy and the role that some characteristics of weddings and spouses play. It shows the potential for integrating information from marriage and separation registers when dealing with a relatively rare phenomenon at the population level and with information not usually collected in social surveys.

Study protocol for WHO and UNICEF estimates of global, regional, and national preterm birth rates for 2010 to 2019.

BackgroundPreterm birth is a leading cause of death among children under five years. Previous estimates indicated global preterm birth rate of 10.6% (14.8 million neonates) in 2014. We aim to update preterm birth estimates at global, regional, and national levels for the period 2010 to 2019.MethodsPreterm birth is defined as a live birth occurring before 37 completed gestational weeks, or <259 days since a woman’s last menstrual period. National administrative data sources for WHO Member States with facility birth rates of ≥80% in the most recent year for which data is available will be searched. Administrative data identified for these countries will be considered if ≥80% of UN estimated live births include gestational age information to define preterm birth. For countries without eligible administrative data, a systematic review of studies will be conducted. Research studies will be eligible if the reported outcome is derived from an observational or intervention study conducted at national or sub-national level in population- or facility-based settings. Risk of bias assessments will focus on gestational age measurement method and coverage, and inclusion of special subgroups in published estimates. Covariates for inclusion will be selected a priori based on a conceptual framework of plausible associations with preterm birth, data availability, and quality of covariate data across many countries and years. Global, regional and national preterm birth rates will be estimated using a Bayesian multilevel-mixed regression model.DiscussionAccurate measurement of preterm birth is challenging in many countries given incomplete or unavailable data from national administrative sources, compounded by limited gestational age assessment during pregnancy to define preterm birth. Up-to-date modelled estimates will be an important resource to measure the global burden of preterm birth and to inform policies and programs especially in settings with a high burden of neonatal mortality.Trial registrationPROSPERO registration: CRD42021237861.

A composite tourism index for the competitiveness of marginal areas: a pilot application in a Southern Italy province

PurposeDifferently from traditional approaches that rely on the analysis of single dimensions of the tourism phenomenon, this study aims to experiment a systemic approach based on structured and unstructured data sources to elaborate a composite index to measure the tourist competitiveness of marginal areas, with the final aim to design and plan proper socio-economic development strategies.Design/methodology/approachThe methodology adopted to carry out the study follows a four-step process and relies on indicators that are both relevant and accessible. The first step concerns the analysis of the literature about the existing approaches to calculate a tourism index. The second step concerns the definition of the indicators and the collection of data by using both structured and unstructured sources. The third step focuses on the population of the data set. Finally, the fourth step aims at calculating the tourism index through a composite-based methodology and using it for a pilot application in a Southern Italy province.FindingsThe study calculates a synthetic tourism index for each of the 97 municipalities of the Province of Lecce (a city located in the southeast of Italy). The proposed index combines administrative, institutional and open data sources to derive a single indicator for each municipality, thus supporting decision-makers in understanding the complex reality and competitiveness level of territories in the tourism industry.Originality/valueThe main elements of originality of the study are the breadth and typology of data sources considered to calculate the composite indicator of tourism competitiveness (both structured and unstructured); and the use of weighting and aggregation procedures in the methodological issues.

Long-Term Trends and Ethnoracial Inequality in U.S. Foster Care: A Research Note.

This study combines and standardizes multiple sources of administrative data to calculate rates of children in foster care in the United States from 1961 to 2018, more than tripling the length of previously available time series. Results yield novel insights about historical, geographic, and ethnoracial variation in children's experience of living without parents under state supervision. National rates of children in foster care rose from 3 per 1,000 in 1963 to a peak of almost 8 per 1,000 in 1997 before declining to just under 6 per 1,000 in 2018. After stable or increasing racial inequality in the late twentieth century, disparities between Black/African American and White children began to decrease in the twenty-first century in nearly every state, closing entirely in several Southern states but remaining wide outside the South. In many Midwestern and Western states, the extreme overrepresentation of American Indian/Alaska Native children in foster care persisted or intensified.

Factors Associated with Re-Resection in T1 Bladder Cancer: Identifying Patients Who Do Not Receive Guideline-Concordant Care at the Population Level.

Prior research has shown that concordance with the guideline-endorsed recommendation to re-resect patients diagnosed with primary T1 bladder cancer (BC) is suboptimal. Therefore, the aim of this population-based study was to identify factors associated with re-resection in T1 BC. We linked province-wide BC pathology reports (January 2001 to December 2015) with health administrative data sources to derive an incident cohort of patients diagnosed with T1 BC in the province of Ontario, Canada. Re-resection was ascertained by a billing claim for transurethral resection within 2 to 8 weeks after the initial resection, accounting for system-related wait times. Multivariable logistic regression analysis accounting for the clustered nature of the data was used to identify various patient-level and surgeon-level factors associated with re-resection. P values <0.05 were considered statistically significant (2-sided). We identified 7,373 patients who fulfilled the inclusion criteria. Overall, 1,678 patients (23%) underwent re-resection. Patients with a more aggressive tumor profile and individuals without sufficiently sampled muscularis propria as well as younger, healthier and socioeconomically advantaged patients were more likely to receive re-resection (all p <0.05). In addition, more senior, lower volume and male surgeons were less likely to perform re-resection for their patients (all p <0.05). Only a minority of all patients received re-resection within 2 to 8 weeks after initial resection. To improve the access to care for potentially underserved patients, we suggest specific knowledge translation/exchange interventions that also include equity aspects besides further promotion of evidence-based instead of eminence-based medicine.

Editorial introduction: Social and spatial inequalities in health and mortality: The analysis of longitudinal register data from selected European countries

AbstractHealth inequalities—systematic differences in health outcomes between social groups and across spatial units—are ubiquitous, but not necessarily inevitable. They are the product of a complex interplay of social and economic processes operating at various scales. The unequal pattern of infection and death seen in the Covid‐19 pandemic has served to highlight the stark social gradient in health that exists within many European countries. Although the complex social determinants of health have been studied for many decades, there is still a great deal of work to do to elucidate explanations for health inequalities across time and space. To rise to the challenge, we need high‐quality, representative data capable of capturing multi‐scalar longitudinal processes. This special issue brings together eight new studies which all use national population register data linked with various other sources of administrative data (e.g., residence, tax and health records) to investigate different vectors of inequalities in health and mortality, covering spatial, socioeconomic, ethnic and migrant status. This editorial outlines their contributions, argues for the invaluable role of population register data to understand health inequalities and suggests promising future research avenues.

Cost-effectiveness of minimally invasive surgery for women with ovarian masses

<h3>Objectives:</h3> For women with suspicious ovarian cysts of varying risk of malignancy, treatment often involves minimally invasive surgery (MIS). While there are a number of benefits to MIS, there is an increased risk of ovarian capsule rupture during the procedure compared to laparotomy. Capsule rupture has the potential to seed the abdominal cavity with malignant cells. This upstaging is associated with a 10-15% decrease in progression free survival. As the utilization of MIS has increased, there has been a corresponding increase in capsule rupture. We developed a decision model to compare the risks, benefits and effectiveness of MIS versus laparotomy in women with ovarian masses. <h3>Methods:</h3> A decision model was created to simulate the clinical trajectory of a hypothetical cohort of 10,000 women aged 45 years with ovarian masses concerning for malignancy who were undergoing surgical management. The initial decision point in the model was performance of surgery via laparotomy or an MIS approach. The second node was whether the cyst ruptured intra-operatively. The base case analysis estimated outcomes if the risk of malignancy was 5%. Based on population data, the risk of rupture was 21% for those undergoing laparotomy versus 26% in those who underwent MIS. Model probabilities, costs and utility values were derived with assumptions drawn from published literature and administrative data sources. The effectiveness was calculated in terms of average quality adjusted life years (QALYs) gained. The primary outcome was incremental cost-effectiveness ratios (ICERs), expressed in 2018 US dollars/QALYs. One-way sensitivity analyses were performed to vary the assumptions across a range of plausible values. <h3>Results:</h3> MIS was the least costly strategy at $6,350, compared to a cost of $13,892 for laparotomy. In our hypothetical cohort, there were 64 cases of ovarian rupture in the MIS group and 53 in the open group (Table 1). There were 26 cancer related deaths in the MIS group and 25 in the laparotomy group. MIS was more effective than laparotomy (188,462 QALYs for MIS versus 187,631 QALYs for open) and MIS was cost-effective with an ICER of $-81,025/QALYs compared to laparotomy. In one-way sensitivity analyses, the probability of cancer and risk of rupture did not substantially impact the cost-effectiveness. <h3>Conclusions:</h3> MIS constitutes cost-effective management strategy for women with suspicious ovarian masses even though it is associated with both an increased risk of cyst rupture and death from ovarian cancer.

Preoperative wait times in high-grade endometrial cancer: do surgical delays impact patient survival?

<h3>Objectives:</h3> Practice guidelines advocating for the regionalization of endometrial cancer surgery to gynecologic oncologists practicing in designated gynecologic oncology centres were released by Cancer Care Ontario in June 2013. We sought to determine the impact this policy had on contemporary surgical wait times. Moreover, a discussion about the impact of delays in treatment has never been more timely than in the context of the current COVID19 pandemic, which has burdened health care systems around the world. Our primary objective was to establish whether longer wait time to surgery is a predictor of survival in patients with high grade endometrial cancer. <h3>Methods:</h3> This was a retrospective cohort study, which included patients diagnosed with non-endometrioid high-grade endometrial cancer (serous, carcinosarcoma, clear cell, and undifferentiated) between 2003 and 2017. A total of 2 regionalization periods were defined, before and after January 2014 to allow 6 months for knowledge translation after guideline publication. Patients were identified in population-based administrative provincial data sources. Multivariable Cox proportional hazards regression with a spline function was used to model the relationship between wait time and overall survival, as measured from time of surgery. <h3>Results:</h3> We identified 3518 patients with high grade endometrial cancer. Median wait time between diagnosis and surgery for the entire cohort did not significantly change with regionalization of care (50 vs 52 days, p=0.14). Patients who had surgery with a gynecologic oncologist had a median surgical wait time from diagnosis to hysterectomy of 55 days compared to 59 days pre-regionalization (p=0.0002), and from first gynecologic oncology consultation to hysterectomy of 29 days compared to 32 days pre-regionalization (p=0.0006). Survival was worst for patients who had surgery within 14 days of diagnosis (HR death 2.7, 95% CI 1.61-4.51 for 1-7 days and HR death 1.96, 95% CI 1.5-2.57 for 8-14 days), indicating disease severity. Decreased survival occurred with surgical wait times of more than 45 days from the patient's first gynecologic-oncology appointment (HR death 1.19, 95% CI 1.04-1.36 for 46-60 days and HR death 1.42, 95% CI 1.11-1.82). <h3>Conclusions:</h3> Regionalization of surgery for high grade endometrial cancer has not had a negative impact on surgical wait times. Impact on survival is seen with patients who have surgery more than 45 days after surgical consultation.

The Association Between Chronic Pain Conditions and Subclinical and Clinical Anxiety Among Community-Dwelling Older Adults Consulting in Primary Care.

To examine associations between chronic pain conditions, pain level, and subclinical/clinical anxiety in community-dwelling older adults. Cross-sectional associations were analyzed using multinomial logistic regression to compare the odds of having subclinical/clinical anxiety by painful condition and pain level, controlling for confounders. Participants were recruited in primary care waiting rooms to take part in the first wave of the Étude sur la Santé des Aînés (ESA)-Services study. In total, 1,608 older adults aged 65+. Clinical anxiety was assessed using DSM-IV criteria. Subclinical anxiety was considered present when participants endorsed symptoms of anxiety but did not fulfill clinical diagnostic criteria for an anxiety disorder. Painful chronic conditions included arthritis, musculoskeletal conditions, gastrointestinal problems, and headaches/migraines. Presence of painful conditions was assessed using combined self-report and health administrative data sources. Pain level was self-reported on an ordinal scale. Physical comorbidities were identified from ICD-9/10 diagnostic codes and depression was evaluated based on the DSM-IV. Sixty-six percent of home-living older adults suffer from a chronic pain condition. Older adults with clinical anxiety are more likely to experience musculoskeletal pain, gastrointestinal problems, headaches/migraines, and higher pain levels compared to those with no anxiety. Also, those with ≥3 painful conditions are at greater risk for subclinical and clinical anxiety compared to those with no painful condition. These results emphasize the need for assessing anxiety symptoms in older adults with chronic pain conditions. Comprehensive management of comorbid chronic pain and psychopathology might help reduce the burden for patients and the healthcare system.

Use of intravenous iron and risk of anaphylaxis: A multinational observational post‐authorisation safety study in Europe

PurposeThis post‐authorisation safety study estimated the risk of anaphylaxis in patients receiving intravenous (IV) iron in Europe, with interest in iron dextran and iron non‐dextrans. Studies conducted in the United States have reported risk of anaphylaxis to IV iron ranging from 2.0 to 6.8 per 10 000 first treatments.MethodsCohort study of IV iron new users, captured mostly through pharmacy ambulatory dispensing, from populations covered by health and administrative data sources in five European countries from 1999 to 2017. Anaphylaxis events were identified through an algorithm that used parenteral penicillin as a positive control.ResultsA total of 304 210 patients with a first IV iron treatment (6367 iron dextran), among whom 13–16 anaphylaxis cases were identified and reported as a range to comply with data protection regulations. The pooled unadjusted incidence proportion (IP) ranged from 0.4 (95% confidence interval [CI], 0.2–0.9) to 0.5 (95% CI, 0.3–1.0) per 10 000 first treatments. No events were identified at first dextran treatments. There were 231 294 first penicillin treatments with 30 potential cases of anaphylaxis (IP = 1.2; 95% CI, 0.8–1.7 per 10 000 treatments).ConclusionWe found an IP of anaphylaxis from 0.4 to 0.5 per 10 000 first IV iron treatments. The study captured only a fraction of IV iron treatments administered in hospitals, where most first treatments are likely to happen. Due to this limitation, the study could not exclude a differential risk of anaphylaxis between iron dextran and iron non‐dextrans. The IP of anaphylaxis in users of penicillin was consistent with incidences reported in the literature.

Health economic studies of colorectal cancer and the contribution of administrative data: A systematic review.

Several forces are contributing to an increase in the number of people living with and surviving colorectal cancer (CRC). However, due to the lack of available data, little is known about the implications of these forces. In recent years, the use of administrative records to inform research has been increasing. The aim of this paper is to investigate the potential contribution that administrative data could have on the health economic research of CRC. To achieve this aim, we conducted a systematic review of the health economic CRC literature published in the United Kingdom and Europe within the last decade (2009-2019). Thirty-seven relevant studies were identified and divided into economic evaluations, cost of illness studies and cost consequence analyses. The use of administrative data, including cancer registry, screening and hospital records, within the health economic research of CRC is commonplace. However, we found that this data often come from regional databases, which reduces the generalisability of results. Further, administrative data appear less able to contribute towards understanding the wider and indirect costs associated with the disease. We explore several ways in which various sources of administrative data could enhance future research in this area.

None for the Road? Stricter Drink Driving Laws and Road Accidents

Reducing drink drive limits is generally regarded an effective strategy to save lives on the road. Using several new administrative data sources, we evaluate the effect of a stricter limit introduced in Scotland in 2014. This reduction had no effect on drink driving and road collisions. Estimates from a supply-of-offenses function suggests that the reform did not have much ex-ante scope for sizeable effects. The unavailability of cheaper alternative means of transportation and weak law enforcement seem to have been the main channels behind the lack of an impact. We find no externality on a wide range of domains, from alcohol consumption to criminal activities other than drink driving.

Development of Quality Indicators for the Management of Acute Type A Aortic Dissection

In an effort to further improve surgical outcomes in patients with acute type A aortic dissection (ATAD), the Canadian Thoracic Aortic Collaborative (CTAC), with the support of the Canadian Society of Cardiac Surgeons (CSCS), endeavoured to develop quality indicators (QIs) for the management of patients with ATAD. After 2 successive consultations with the CTAC membership, 11 QIs were selected and separated into 5 broad categories: preoperative (time from presentation to diagnosis, time from presentation to the operating room), intraoperative (use of hypothermic circulatory arrest and antegrade cerebral perfusion), 30-day outcomes (30-day rates of all-cause mortality, 30-day rates of new postoperative stroke), 1-year outcomes (1-year rates of follow-up imaging, 1-year rates of all-cause mortality, and 1-year rates of surgical reintervention), and institutional (institutional surgical volumes, individual surgical volumes, and presence of institutional aortic disease teams). The purpose of this article is to describe the process by which QIs for the management of ATAD were developed and the feasibility by which they may be collected using existing clinical and administrative data sources. Furthermore, we demonstrate how they may be used to evaluate success following surgery for repair of ATAD and ultimately improve clinical outcomes.

Mapping chronic disease prevalence based on medication use and socio-demographic variables: an application of LASSO on administrative data sources in healthcare in the Netherlands

BackgroundPolicymakers generally lack sufficiently detailed health information to develop localized health policy plans. Chronic disease prevalence mapping is difficult as accurate direct sources are often lacking. Improvement is possible by adding extra information such as medication use and demographic information to identify disease. The aim of the current study was to obtain small geographic area prevalence estimates for four common chronic diseases by modelling based on medication use and socio-economic variables and next to investigate regional patterns of disease.MethodsAdministrative hospital records and general practitioner registry data were linked to medication use and socio-economic characteristics. The training set (n = 707,021) contained GP diagnosis and/or hospital admission diagnosis as the standard for disease prevalence. For the entire Dutch population (n = 16,777,888), all information except GP diagnosis and hospital admission was available. LASSO regression models for binary outcomes were used to select variables strongly associated with disease. Dutch municipality (non-)standardized prevalence estimates for stroke, CHD, COPD and diabetes were then based on averages of predicted probabilities for each individual inhabitant.ResultsAdding medication use data as a predictor substantially improved model performance. Estimates at the municipality level performed best for diabetes with a weighted percentage error (WPE) of 6.8%, and worst for COPD (WPE 14.5%)Disease prevalence showed clear regional patterns, also after standardization for age.ConclusionAdding medication use as an indicator of disease prevalence next to socio-economic variables substantially improved estimates at the municipality level. The resulting individual disease probabilities could be aggregated into any desired regional level and provide a useful tool to identify regional patterns and inform local policy.

Credibility of disability estimates from the 2011 population census in Poland

Abstract The problem of disability is perceived as one of the most serious social issues faced by the contemporary society. The number of people with disability is consistently rising for a variety of reasons, including the aging of the population. Data on disability are collected through numerous statistical surveys, among which censuses are the most wide-scale ones. In the period between the 2002 and 2011 censuses (the last two censuses conducted in Poland), a 14% decrease in the number of people with disabilities was observed. However, it should be emphasised that significant modifications were introduced to the methodology of the last census. Population census 2011 was the first census in Poland combing administrative data sources and the survey sampling method. The main objective of the study is to assess the quality of estimates relating to the number of disabled persons, obtained on the basis of the 2011 census data. It is a comparative study aimed at identifying the similarities and discrepancies between the estimates, and determining the size and source of these discrepancies. The analysis takes into account such aspects as the measurement methods, the definitions and criteria of disability, the voluntary nature of the question, and the quality of the information on disability obtained from various sources.

Data transparency for building a stronger healthcare system: A case study from Argentinean administrative drug utilization data sources.

In order to compile an inventory of national data sources for drug utilization research (DUR) in Argentina and to verify publicly available data sources, we performed a cross-sectional study that sought to identify national and provincial databases of drug use. In July 2020, we searched the websites of government institutions, carried out a systematic query of bibliographic databases for "drug utilization research" conducted in Argentina, and conducted a survey with local experts. Data collected included: the institution responsible for the database, population covered, accessibility, source of the data, healthcare setting, geographic information, and whether data were individual or aggregated. Descriptive analyses were then performed. We identified 31 data sources for DUR; only one was publicly and conveniently accessible. Five published aggregated data and provide more detailed access by formal request. Only seven sources (23%) reported national data, and most (n=29) included only data from the public healthcare sector. Although data sources for DUR have been found in Argentina, limited access by researchers and policymakers is still an significant obstacle. Increasing health data transparency by making data sources publicly available for the purpose of analyzing public health information is crucial for building a stronger health system.

Reading Between the Lines: A Pursuit of Estimating the Population Prevalence of Mental Illness Using Multiple Data Sources.

Population-based prevalence estimates of mental illness are foundational to health service planning, strategic resource allocation, and the development and evaluation of public mental health policy. Generating valid, reliable, and context-specific population-level estimates is of utmost importance and can be achieved by combining various data sources. This pursuit benefits from the right combination of theory, applied statistics, and the conceptualization of available data sources as a collective rather than in isolation. We believe there is a need to read between the lines as theory, methodology, and context (i.e., strengths and limitations) are what determines the meaningfulness of a combined prevalence estimate. Currently lacking is a gold standard approach to combining estimates from multiple data sources. Here, we compare and contrast various approaches to combining data and introduce an idea that leverages the strengths of pre-existing individually linked population-based survey and health administrative data sources currently available in Canada.