WHO ICD-10 Research Articles

Integrating AI in cause-of-death regular statistical production with human and expert system codings

Abstract Background Cause-of-death (CoD) statistics are key indicators in epidemiology and public health. These statistics are derived from death certificates completed by physicians and are usually coded by official statistics authorities according to the standards of the WHO ICD-10 classification to construct time- and cross-country-comparable statistics. For coding causes of death in free-text format in France according to ICD-10, predictions by deep neural networks (DNNs) are employed in addition to fully automatic batch coding by a rule-based expert system and to interactive coding by the coding team. Methods Seq-to-seq DNNs are trained from scratch on previously coded data to ICD-10 code multiple causes and underlying causes of death. Human coding is focused on certificates with a special public health interest or with low confidence in AI prediction quality to maximize the quality of the overall statistics disseminated when human resources are limited. DNNs also directly predict multiple causes and underlying causes of death for part of the certificates. Hence, the coding campaign aims to optimally allocate a coding mode to a given certificate. Results For deaths in 2021, 63% of the certificates are automatically batch coded by the expert system, 14% by the coding team, and 23% by DNNs. Compared to a traditional campaign that would have relied on automatic batch coding and manual coding, the present campaign reaches an accuracy of 95.7% for ICD-10 coding of the underlying cause (97.3% at the European shortlist level). Conclusions The 3-coding mode approach enables timeliness of dissemination of CoD statistics and may lead in the future to more responsive surveillance. Key messages • Deep neural networks trained on already coded data can be integrated into the regular statistical production of the CoD database in a fully controlled way. • The allocation between the different modes of coding can be optimized to achieve best quality and timeliness under the constraint of limited human resources.

Mortality in type 1 diabetes mellitus: A single centre experience from the ICMR – Youth onset diabetes registry in India

IntroductionThe prevalence of youth onset diabetes is rising globally along with a greater burden of complications and mortality in them. The current study was undertaken to examine the mortality and causes of death in patients with youth onset diabetesregistered in a tertiary care hospital in North India. MethodsWe analyzed mortality and causes of death in 1088 patients with youth onset diabetes registered from 2006 to 2019 at University College of Medical Sciences, Delhi. Information of death was obtained telephonically or by home visit or from hospital records wherever available. Verbal autopsy according to ICMR questionnaire was performed and cause of death determined as per WHO ICD-10/11. ResultsAmong 898 youth onset type 1 diabetes mellitus (T1D) patients who had a mean follow up of 6.4 years, 105 deaths (11.6 %) occurred. Forty three percent of deaths had diabetes onset at 15 years or below, and 75.6 % had HbA1C > 10 %. Deaths occurred in 24.2 % within 2 years and in 53.6 % within 3 years of diagnosis. Chronic Kidney disease, infections and ketoacidosis were the commonest causes. ConclusionWe found poor glycaemic control and high mortality in people with youth onset T1D being treated at a tertiary care hospital in north India.

The comorbidity profiles and medication issues of patients with multiple system atrophy: a systematic cross-sectional analysis

BackgroundMultiple system atrophy (MSA) is a complex and fatal neurodegenerative movement disorder. Understanding the comorbidities and drug therapy is crucial for MSA patients’ safety and management.ObjectivesTo investigate the pattern of comorbidities and aspects of drug therapy in MSA patients.MethodsCross-sectional data of MSA patients according to Gilman et al. (2008) diagnostic criteria and control patients without neurodegenerative diseases (non-ND) were collected from German, multicenter cohorts. The prevalence of comorbidities according to WHO ICD-10 classification and drugs administered according to WHO ATC system were analyzed. Potential drug-drug interactions were identified using AiDKlinik®.ResultsThe analysis included 254 MSA and 363 age- and sex-matched non-ND control patients. MSA patients exhibited a significantly higher burden of comorbidities, in particular diseases of the genitourinary system. Also, more medications were prescribed MSA patients, resulting in a higher prevalence of polypharmacy. Importantly, the risk of potential drug-drug interactions, including severe interactions and contraindicated combinations, was elevated in MSA patients. When comparing MSA-P and MSA-C subtypes, MSA-P patients suffered more frequently from diseases of the genitourinary system and diseases of the musculoskeletal system and connective tissue.ConclusionsMSA patients face a substantial burden of comorbidities, notably in the genitourinary system. This, coupled with increased polypharmacy and potential drug interactions, highlights the complexity of managing MSA patients. Clinicians should carefully consider these factors when devising treatment strategies for MSA patients.

ICD-10 WHO Search With RAKE Algorithm

In most cases, clinicians do not use the ICD-10 standard established by the WHO for diagnosing diseases. These issues may result in outcomes that are undesirable from the standpoints of patient safety and the law. The WHO ICD-10 standard collection of diagnoses that can’t be effectively searched using MySQL’s native search mechanism. Therefore, in order to automatically produce several keywords for each ICD-10 code, academics are interested in analyzing the natural language analysis of WHO ICD-10 data. When diagnosing illnesses, it is envisaged that the availability of numerous types of keywords can lead to more fruitful search results. Natural language analysis, a technique for removing stop words from sentences and simultaneously assessing the semantics of the language from which the keywords will be extracted, makes it possible to do this. Keywords: Natural Language Analysis ; ICD-10 ; Stop Words ; Semantics.

Insights of Validating Death Certificates through Clinical Autopsies

Background: With decreasing autopsy numbers, the cause of death listed in the death certificate is only based on an external inspection, which is increasingly criticized as insufficient. This investigation analyses 447 death certificates from the archives of the University Hospital of Koeln, Germany and their corresponding autopsy reports from the Institute of Pathology. Methods: For this analysis, quality assurance protocols, death certificates, clinical/autopsy notes, and final autopsy reports were used. Cases were categorized: 1. in four validation classes (Goldman criteria, identifying unknown diseases with therapeutic relevance as cause of death); 2) in four nosological causal chains (WHO ICD10; type: linear/ divergent/ convergent/ complex). Results: Differences in diagnoses between death certificate and autopsy report occurred in 32% (143/447 cases). In 7%, only the autopsy identified the cause of death (Goldman, type 2a). Nosological causal chains were established in 21% (linear/divergent) vs 28% (convergent/complex). Myocardial infarct, septicemia and cardiac insufficiency caused death in more than two thirds of cases. Diabetes and obesity did not play a major role as cause of death. Conclusion: Autopsies are highly advisable if death occurs within 48 hrs. of admission and as sudden death in the hospital setting. Regular interdisciplinary autopsy conferences are important for quality control, assessing cases of the convergent/ complex type. The position of an autopsy commissioner as mediator between relatives, clinicians and pathologists seems recommendable in a hospital setting. While an electronic patient file is still controversial, medical data collection as source of information in emergencies by the patient’s medical practitioner seems advantageous.

The comorbidity and co-medication profile of patients with progressive supranuclear palsy

BackgroundProgressive supranuclear palsy (PSP) is usually diagnosed in elderly. Currently, little is known about comorbidities and the co-medication in these patients.ObjectivesTo explore the pattern of comorbidities and co-medication in PSP patients according to the known different phenotypes and in comparison with patients without neurodegenerative disease.MethodsCross-sectional data of PSP and patients without neurodegenerative diseases (non-ND) were collected from three German multicenter observational studies (DescribePSP, ProPSP and DANCER). The prevalence of comorbidities according to WHO ICD-10 classification and the prevalence of drugs administered according to WHO ATC system were analyzed. Potential drug–drug interactions were evaluated using AiDKlinik®.ResultsIn total, 335 PSP and 275 non-ND patients were included in this analysis. The prevalence of diseases of the circulatory and the nervous system was higher in PSP at first level of ICD-10. Dorsopathies, diabetes mellitus, other nutritional deficiencies and polyneuropathies were more frequent in PSP at second level of ICD-10. In particular, the summed prevalence of cardiovascular and cerebrovascular diseases was higher in PSP patients. More drugs were administered in the PSP group leading to a greater percentage of patients with polypharmacy. Accordingly, the prevalence of potential drug–drug interactions was higher in PSP patients, especially severe and moderate interactions.ConclusionsPSP patients possess a characteristic profile of comorbidities, particularly diabetes and cardiovascular diseases. The eminent burden of comorbidities and resulting polypharmacy should be carefully considered when treating PSP patients.

Drug-Related Poisonings among Chilean Adult Population.

Poisonings is a preventable public health problem that globally affects the population. We aimed to characterize drug-related acute poisonings occurred in Chile between the years of 2016 and 2020. A retrospective study of poisonings among hospitalized patients was carried out. Data were obtained from the Medical Outcome Statistical Report database. Inclusion criteria were cases of patients admitted into either public or private healthcare settings with diagnosis of drug-related poisoning according to the WHO ICD-10 codes T30-T50. Statistical analyses were run to establish either significant associations or differences between variables selected in the study. Overall, 12,975 poisonings were identified during the 2016-2020 period. These events corresponded to 0.16% of all national hospital admissions in the study period. Women represented 71.1% of the cases. 76.7% of events were related to intentional poisonings while 7.3% and 16% were accidental and undetermined poisonings respectively. 44.6% of accidental and intentional poisonings occurred at the age of 18-29 yr old. Benzodiazepines (22.8%), antidepressants (11.2%), and acetaminophen (5.1) were the most common drugs associated with poisonings. Average length of hospitalization was between 3.3 and 8.2 days. 0.6% of poisonings resulted in deaths. Poisonings were characterized by patients' sex and age, circumstance of exposure, length of hospitalization, and outcome. Poisoning rates were stable along the years with a slight decrease in 2020. Intentional poisonings among young women and men were more common. Most of the cases had favorable outcome for patients.

Relationship Between Healthy Life Expectancy (HALE) and Mortality Levels of Malignant Melanoma of Skin: A Comparative Analysis of Multiple Countries Reported at WHO ICD-10 List

Relationship Between Healthy Life Expectancy (HALE) and Mortality Levels of Malignant Melanoma of Skin: A Comparative Analysis of Multiple Countries Reported at WHO ICD-10 List

A multi country comparison of the Tuberculosis and Endocrine related mortality in public health perspective

Introduction: The aim of the study is to examine tuberculosis and endocrine-related deaths worldwide from WHO ICD-10 data with multi-country comparisons. Material and Method: ICD-10 mortality data of WHO was used. Given mortality codes were examined, and mortality data records for 14 countries between 1996 and 2017 were used. Results: For people over 60 ages, the most common mortality was reported for endocrine, nutritional and metabolic diseases, followed by respiratory related deaths. Respiratory related mortality is the most dominant mortality among other tuberculosis mortality and endocrine, nutrition and metabolic diseases related mortality. The most frequent mortality was reported in 2005, followed by 2004 and 2003. Infant deaths and 60 and above age mortality differences between gender groups were statistically insignificant for all mortality causes of the research (p>0.05). For under 60 ages, respiratory and other tuberculosis related mortalities were significantly higher in the male patients (p<0.05). Cause, year and country parameters were determinants of infant mortality with statistically significant rates (p<0.05). However, effect of gender on infant mortality for research causes was insignificant (p>0.05). For under 60 age group; cause, gender, year and country parameters had significant effect on mortality rates (p<0.05). Cause, gender, year and country parameters were not effective on mortalities above 60 ages (p>0.05). Conclusion: Although there is no sufficient data to establish a direct relationship on TB-related deaths and endocrine-related deaths, the occurrence of both diseases in similar countries according to the World Bank development evaluation with same trends indicates the questioning of the relationship between these two disease groups.

Associations between the COMT rs4680 Gene Polymorphism and Personality Dimensions and Anxiety in Patients with a Diagnosis of Other Stimulants Dependence.

Background: Research on the hypodopaminergic hypothesis of addictions showed that hypodopaminergic activity in males predicted the number of drugs used and is associated with drug-seeking behavior. Variant alleles may cause hypodopaminergic functioning as a result of the reduced density of dopamine receptors, decreased response to dopamine, increased dopamine clearance or metabolism in the reward system. The catechol-O-methyltransferase (COMT) is involved in the metabolism of dopamine. Personality traits may mediate the genetic predisposition to substance use disorders additively by various motivations associated with reward-seeking and regulating negative emotions, and also relate to self-control and environment selection. The aim of the study: The aim of this study was to investigate the association of the rs4680 polymorphism of COMT with personality dimensions and anxiety in patients addicted to stimulants other than cocaine (F15 according to WHO ICD-10 nomenclature) in the case of examined patients amphetamine. Methods: The study was conducted among patients addicted to stimulants other than cocaine (amphetamine). The study group included 247 patients addicted to stimulants (amphetamine) and the control group comprised 280 healthy male volunteers. The real-time PCR method was used to carry out genetic tests; personality dimensions were assessed using the standardized NEO-FFI and state and trait anxiety were assessed with STAI. All analyses were performed using STATISTICA 13. Results: The results of the 2 × 3 factorial ANOVA showed a statistically significant effect of the combined factor COMT rs4680 genotype on the group of patients diagnosed with other stimulants dependence/control (F2,252 = 3.11, p = 0.0465, η2 = 0.024). Additionally, we observed that the results of the 2 × 3 factorial ANOVA showed a statistically significant influence of the combined factor COMT rs4680 on the genotype in the group of patients diagnosis with other stimulants dependence/control (F2,252 = 6.16, p = 0.0024, η2 = 0.047). Conclusions: In our research, the polymorphism G/G COMT rs4680 genotype was associated with higher scores of STAI traits and STAI states in the patients dependent on amphetamine. In the control group we observed no such interactions.

Patterns of homelessness and housing instability and the relationship with mental health disorders among young people transitioning from out-of-home care: Retrospective cohort study using linked administrative data.

ObjectivesThe study examined the relationship between mental health, homelessness and housing instability among young people aged 15–18 years old who transitioned from out-of-home in 2013 to 2014 in the state of Victoria, Australia with follow-up to 2018. We determined the various mental health disorders and other predictors that were associated with different levels of homelessness risk, including identifying the impact of dual diagnosis of mental health and substance use disorder on homelessness.MethodologyUsing retrospective de-identified linked administrative data from various government departments we identified various dimensions of homelessness which were mapped from the European Topology of Homelessness (ETHOS) framework and associated mental health variables which were determined from the WHO ICD-10 codes. We used ordered logistic regression and Poisson regression analysis to estimate the impact of homelessness and housing instability respectively.ResultsA total homelessness prevalence of 60% was determined in the care-leaving population. After adjustment, high risk of homelessness was associated with dual diagnosis of mental health and substance use disorder, intentional self-harm, anxiety, psychotic disorders, assault and maltreatment, history of involvement with the justice system, substance use prior to leaving care, residential and home-based OHC placement and a history of staying in public housing.ConclusionsThere is clearly a need for policy makers and service providers to work together to find effective housing pathways and integrated health services for this heterogeneous group of vulnerable young people with complex health and social needs. Future research should determine longitudinally the bidirectional relationship between mental health disorders and homelessness.

Medical Causes of Death’s Profile Based on ICD-10 Standards in Confirmed Covid-19 Patients in Tertiary Hospital in Padang, Indonesia

Medical causes of death written by a doctor are important to be documented for each death, especially in relation to public health, research, surveys, epidemiology, prevention programs, public safety, medicine, and health administration. This is a retrospective descriptive study that aims to describe the causes of medical death in confirmed Covid-19 deaths, as well as compare the writing of causes of medical death based on the WHO International Classification of Disease (ICD) 10 standard. From this study, it is known that more than half of the information on the medical cause of death form written by doctors still does not comply with the WHO ICD-10 standard. The most common medical causes of death that have a direct impact on the death of confirmed Covid-19 patients was acute respiratory distress syndrome. Writing the cause of death according to the WHO ICD 10 standard is very necessary in obtaining accurate information on deaths related to COVID-19.

Analysis of the relationship between tuberculosis-related mortality and nitrous oxide emission levels in the world with the environmental Kuznets curve method.

It was aimed to analyze the relationship between tuberculosis-related mortality and nitrous oxide emission levels in the world with the Environmental Kuznets Curve (EKC) Method. WHO ICD-10 mortality list data and the World Bank Country Data (WBCD) were used between 1997 and 2017 for 12 countries. Cubic regression analysis was used for EKC Analysis. The difference between male and female deaths between 1996 and 1998 has increased sharply since 1999. Male deaths consistently occurred significantly more than female deaths. There was a significant and negative correlation between Nitrous oxide emissions (% change from 1990) and tuberculosis-related deaths, whereas there were significant and positive correlations between Nitrous oxide emissions in the energy sector (% of total) and tuberculosis-related deaths (p < 0.01). EKC analysis results showed that there is a U shaped between tuberculosis-related mortality and nitrous oxide emission levels in the world. Research results show that the relationship between nitrous oxide change and mortality is negative in the short term and positive in the long term. Therefore, although nitrous oxide gases cause respiratory diseases and mortality, it may be possible to transform a harmful environmental factor into a positive by developing devices or methods that will convert these gases into free radicals.

Acetaminophen poisonings in Chilean healthcare settings: a 20-year story that does not end.

BackgroundAcetaminophen (Paracetamol) is one of the most used and prescribed anti-inflammatory and analgesic drugs worldwide. It has become one of the main drugs related to accidental and intentional overdoses in many countries, including Chile. The objective of this work was to characterize acetaminophen poisonings occurred in Chile between the years 2001 and 2020.MethodsA retrospective study of acetaminophen poisonings among patients who were hospitalized in Chilean public and private hospitals was carried out between the years 2001 and 2020. Data was obtained from the Medical Outcome Statistical Report database. Inclusion criteria were cases of patients who were admitted into either public or private healthcare settings with diagnosis of acetaminophen poisoning according to the WHO ICD-10. Statistical analyses were run to establish associations between variables selected in the study.ResultsA total of 2,929 cases were included in the study. 77 % of the cases corresponded to female patients (p<0.05). Patients’ age range went from 0 to 81 years old. Adolescents and young adults resulted more involved in reported cases during the 2001-2020 period (p<0.001). During the first period of the study, accidental poisonings were more commonly reported, however in the recent years intentional cases increased their occurrence, especially among female patients (p<0.05). A multivariate logistic regression model considered as statistically significant (p<0.05) the interaction between the variables age, gender and year of the event.ConclusionThe present study identified a large number of acetaminophen poisonings reported in Chile during the 2001-2020 period. Cases were characterized including patients’ gender, age, and poisoning intent. Health authorities should consider these findings as an opportunity to improve public health associated with the use and misuse of over-the-counter drugs, including acetaminophen.

Social Inferences as Mediators of Wellbeing in Depression.

BackgroundDepression is an increasingly prevalent chronic mental health condition that involves a range of potentially negative implications, in the long term. Theory of Mind (ToM) serves to form and maintain social relationships, by accurately identifying thoughts and emotions in others. Defective ToM abilities have been noted in people with a history of clinical depression.PurposeTo identify whether impairments of emotion recognition are correlated with a lower subjective feeling of wellbeing in people diagnosed with a chronic depressive illness.Patients and MethodsIn a cross-sectional analysis of a recurrent depressive disorder (RDD, as per WHO ICD-10 nosology) cohort (n=57), the BECK depression scale and the “Reading the mind in the eyes” test were employed for the diagnosis of clinical symptoms, and for the evaluation of individual ToM skills, respectively. Wellbeing was quantified using the FANLCT scale.ResultsThe wellbeing of service-users decreased significantly, in correlation with their defective emotion recognition abilities. Additionally, a low capacity for the correct perception of emotions in other people appears to significantly influence the social relationships status, with scores of 14.00 (10.00–18.50) at low capacity vs 23.00 (17.58–24.75) at normal capacity (Mann–Whitney U-test, p < 0.001). Our study findings indicate that a normal ability for a correct recognition of emotions in others is significantly and strongly correlated with adequate social relationships (Spearman r = 0.757, p < 0.05).ConclusionWellbeing is significantly correlated with the individual ability for a correct recognition of emotions in others.

Retrospective sequential trend analysis of neoplasms reported in a tertiary care hospital of district Etawah, Uttar Pradesh

Introduction:An estimated 2.25 million new cancer cases with 7 lakh cancer deaths were reported, according to GLOBOCAN 2018 in India. There is a steady rise in cancer cases, but trends and patterns vary within the state depending on the geographic region.Objectives:To study the proportion and site-wise distribution of neoplasm reported at a tertiary care hospital in district Etawah, Uttar Pradesh, India.Material and Methods:A record based retrospective study was conducted at a tertiary care hospital in district Etawah, Uttar Pradesh. Total four years (from 2015 to 2018) hospital-based retrospective data were collected from the Medical Record Department. Identification and distribution of malignant neoplasm were done according to the WHO ICD-10 classification.Results:Total cases diagnosed with malignancy from January 2015 to December 2018 were 3614. Cancer cases reported over the years was 932 (25.8%) in 2015, 1031 (28.5%) cases in 2016, 897 (24.8%) in 2017 and 754 (20.9%) in 2018. It was found that breast carcinoma (24.0%) accounted for the maximum number of cases diagnosed, followed by lung carcinoma (10.9%), cervical cancer (8.7%), gall bladder carcinoma (8%), and oral cavity cancer (7.9%).Conclusion:The present study reveals that the malignancy of the breast is most common, followed by malignancies of lung, cervix, and gall bladder among the patients who were seeking care in a tertiary care hospital of the district Etawah Uttar Pradesh, India.

Iodine, thyroglobulin and thyroid gland.

Iodine is essential in the biosynthesis of thyroid hormones that affect metabolic processes in the organism from the prenatal state to the elderly. The immediate indicator of iodine intake is the concentration of iodine in urine, but the indicator of iodine intake in the longer term of several months is thyroglobulin (Tg). Tg negatively correlated with increasing intake of iodine in population that do not suffer from thyroid disease, while a more than adequate to excessive iodine intake leads to an increase in Tg. The dependence of Tg on iodine can be described by a U-shaped curve. Thyroglobulin in serum is elevated in thyroid disease mainly in hyperthyroidism (diagnosis E05 of WHO ICD-10 codes) and in goiter (diagnosis E04 of WHO ICD-10 codes). Tg values decrease below 20 microg/l after effective treatment of patients with thyroid disease. Thyroglobulin may thus be an indicator of thyroid stabilization and the success of the thyroid gland treatment.

Exploring why global health needs are unmet by research efforts: the potential influences of geography, industry and publication incentives

BackgroundIt has been well established that research is not addressing health needs in a balanced way — much more research is conducted on diseases with more burden in high-income countries than on those with more burden in lower-income countries. In this study, we explore whether these imbalances persist and inquire about the possible influence of three factors, namely geography, industry and publication incentives.MethodsWe use WHO data on the Global Burden of Disease as a proxy measure of health needs and bibliometric information as a proxy for research efforts. Scientific publications on diseases were collected from MEDLINE using MeSH terms to identify relevant publications. We used Web of Science to collect author affiliations and citation data. We developed a correspondence table between WHO ICD-10 and MeSH descriptors to compare global health needs and research efforts. This correspondence table is available as supplementary material.ResultsResearch output is heavily concentrated in high-income countries and is mainly focused on their health needs, resulting in a relative lack of attention to diseases in lower income countries. A new finding is that diseases with a similar burden in high- and middle-income countries are also under-researched, both globally and in relation to disease burden in high- and middle-income countries. Global industrial R&D is found to be very similar to the focus of public research. Diseases more prevalent in high-income countries generate ten-fold more research attention than those in low-income countries. We find no discernible preference towards diseases of high-income countries versus those of low-income countries in the top 25% most prestigious journals. However, in middle-income countries, citation rates are substantially lower for diseases most prevalent in low- and middle-income countries.ConclusionsFrom a global perspective, the imbalance between research needs and research efforts persists as most of the research effort concentrates on diseases affecting high-income countries. Both pharmaceutical companies and the public sector also tend to focus on diseases with more burden in high-income countries. Our findings indicate that researchers in middle-income countries receive more citations when researching diseases more prevalent in high-income countries, and this may divert the attention of researchers in these countries from diseases more prevalent in their contexts.

Comorbidity Patterns Among Patients with Peripheral Arterial Occlusive Disease in Germany: A Trend Analysis of Health Insurance Claims Data

Patients suffering from peripheral arterial occlusive disease (PAOD) are a central target population for multidisciplinary vascular medicine. This study aimed to highlight trends in treatment patterns and comorbidities using up to date longitudinal patient related data from Germany. This study is a retrospective health insurance claims data analysis of patients insured by the second largest health insurance provider in Germany, BARMER. All PAOD patient hospitalisations between 2008 and 2016 were included. The comorbidities were categorised with Elixhauser groups using WHO ICD-10 codes and summarised as the linear van Walraven score (vWS). A trend analysis of the comorbidities was performed after standardisation by age and sex. A total of 156 217 patients underwent 202 961 hospitalisations (49.4% for chronic limb threatening ischaemia in 2016) with PAOD during the study period. Although the estimated annual incidence of PAOD among the BARMER cohort decreased slightly (− 4.4%), an increase was observed in the prevalence of PAOD (+ 23.1%), number of hospitalisations (+ 25.1%), peripheral vascular interventions (PVI, + 61.1%), and disease related reimbursement costs (+ 31%) from 2008 to 2016. Meanwhile, the number of major amputations decreased (− 15.1%). The proportion of patients aged 71–80 years increased about +10% among PAOD patients and the mean vWS also increased by two points during the study period. Considerable increases were found in the rates of hypertension, renal failure, and hypothyroidism, whereas the rates of diabetes and congestive heart failure decreased over time. Increasing numbers of PVI performed on these ageing and sicker patients lead to rising costs but correlate with decreasing major amputation rates.

Editor's Choice - Comorbidity Patterns Among Patients with Peripheral Arterial Occlusive Disease in Germany: A Trend Analysis of Health Insurance Claims Data.

Patients suffering from peripheral arterial occlusive disease (PAOD) are a central target population for multidisciplinary vascular medicine. This study aimed to highlight trends in treatment patterns and comorbidities using up to date longitudinal patient related data from Germany. This study is a retrospective health insurance claims data analysis of patients insured by the second largest health insurance provider in Germany, BARMER. All PAOD patient hospitalisations between 2008 and 2016 were included. The comorbidities were categorised with Elixhauser groups using WHO ICD-10 codes and summarised as the linear van Walraven score (vWS). A trend analysis of the comorbidities was performed after standardisation by age and sex. A total of 156217 patients underwent 202961 hospitalisations (49.4% for chronic limb threatening ischaemia in 2016) with PAOD during the study period. Although the estimated annual incidence of PAOD among the BARMER cohort decreased slightly (- 4.4%), an increase was observed in the prevalence of PAOD (+ 23.1%), number of hospitalisations (+ 25.1%), peripheral vascular interventions (PVI,+ 61.1%), and disease related reimbursement costs (+ 31%) from 2008 to 2016. Meanwhile, the number of major amputations decreased (- 15.1%). The proportion of patients aged 71-80 years increased about+10% among PAOD patients and the mean vWS also increased by two points during the study period. Considerable increases were found in the rates of hypertension, renal failure, and hypothyroidism, whereas the rates of diabetes and congestive heart failure decreased over time. Increasing numbers of PVI performed on these ageing and sicker patients lead to rising costs but correlate with decreasing major amputation rates.