scholarly journals Validation of a Parkinson Disease Predictive Model in a Population-Based Study

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Irene M. Faust ◽  
Brad A. Racette ◽  
Susan Searles Nielsen
Keyword(s):  
Parkinson Disease ◽  
Predictive Model ◽  
Sensitivity And Specificity ◽  
Claims Data ◽  
Cox Regression ◽  
Control Sample ◽  
Population Based ◽  
Case Control ◽  
Administrative Claims ◽  
Medicare Beneficiaries

Parkinson disease (PD) has a relatively long prodromal period that may permit early identification to reduce diagnostic testing for other conditions when patients are simply presenting with early PD symptoms, as well as to reduce morbidity from fall-related trauma. Earlier identification also could prove critical to the development of neuroprotective therapies. We previously developed a PD predictive model using demographic and Medicare claims data in a population-based case-control study. The area under the receiver-operating characteristic curve (AUC) indicated good performance. We sought to further validate this PD predictive model. In a randomly selected, population-based cohort of 115,492 Medicare beneficiaries aged 66–90 and without PD in 2009, we applied the predictive model to claims data from the prior five years to estimate the probability of future PD diagnosis. During five years of follow-up, we used 2010–2014 Medicare data to determine PD and vital status and then Cox regression to investigate whether PD probability at baseline was associated with time to PD diagnosis. Within a nested case-control sample, we calculated the AUC, sensitivity, and specificity. A total of 2,326 beneficiaries developed PD. Probability of PD was associated with time to PD diagnosis (p<0.001, hazard ratio = 13.5, 95% confidence interval (CI) 10.6–17.3 for the highest vs. lowest decile of probability). The AUC was 83.3% (95% CI 82.5%–84.1%). At the cut point that balanced sensitivity and specificity, sensitivity was 76.7% and specificity was 76.2%. In an independent sample of additional Medicare beneficiaries, we again applied the model and observed good performance (AUC = 82.2%, 95% CI 81.1%–83.3%). Administrative claims data can facilitate PD identification within Medicare and Medicare-aged samples.

scholarly journals A predictive model to identify Parkinson disease from administrative claims data

Neurology ◽  
2017 ◽  
Vol 89 (14) ◽  
pp. 1448-1456 ◽  
Author(s):  
Susan Searles Nielsen ◽  
Mark N. Warden ◽  
Alejandra Camacho-Soto ◽  
Allison W. Willis ◽  
Brenton A. Wright ◽  
...  
Keyword(s):  
Parkinson Disease ◽  
Predictive Model ◽  
Claims Data ◽  
Demographic Data ◽  
Area Under The Curve ◽  
Rem Sleep Behavior Disorder ◽  
Administrative Claims ◽  
Sleep Behavior ◽  
Administrative Claims Data ◽  
Procedure Codes

Objective:To use administrative medical claims data to identify patients with incident Parkinson disease (PD) prior to diagnosis.Methods:Using a population-based case-control study of incident PD in 2009 among Medicare beneficiaries aged 66–90 years (89,790 cases, 118,095 controls) and the elastic net algorithm, we developed a cross-validated model for predicting PD using only demographic data and 2004–2009 Medicare claims data. We then compared this model to more basic models containing only demographic data and diagnosis codes for constipation, taste/smell disturbance, and REM sleep behavior disorder, using each model's receiver operator characteristic area under the curve (AUC).Results:We observed all established associations between PD and age, sex, race/ethnicity, tobacco smoking, and the above medical conditions. A model with those predictors had an AUC of only 0.670 (95% confidence interval [CI] 0.668–0.673). In contrast, the AUC for a predictive model with 536 diagnosis and procedure codes was 0.857 (95% CI 0.855–0.859). At the optimal cut point, sensitivity was 73.5% and specificity was 83.2%.Conclusions:Using only demographic data and selected diagnosis and procedure codes readily available in administrative claims data, it is possible to identify individuals with a high probability of eventually being diagnosed with PD.

scholarly journals Neurodegenerative disease is associated with increased incidence of epilepsy: a population based study of older adults

2020 ◽  
Author(s):  
Leah J Blank ◽  
Emily K Acton ◽  
Dylan Thibault ◽  
Allison W Willis
Keyword(s):  
Neurodegenerative Disease ◽  
Cox Regression ◽  
Control Sample ◽  
Disease Status ◽  
Population Based ◽  
Medicare Beneficiaries ◽  
Alzheimer Dementia ◽  
Increased Risk ◽  
History Of ◽  
New Diagnosis

Abstract Objective To determine the incidence of epilepsy among Medicare beneficiaries with a new diagnosis of Alzheimer dementia (AD) or Parkinson disease (PD). Methods Retrospective cohort study of Medicare beneficiaries with an incident diagnosis of AD or PD in the year 2009. The 5-year incidence of epilepsy was examined by sociodemographic characteristics, comorbidities and neurodegenerative disease status. Cox regression models examined the association of neurodegenerative disease with incident epilepsy, adjusting for demographic characteristics and medical comorbidities. Results We identified 178,593 individuals with incident AD and 104,157 individuals with incident PD among 34,054,293 Medicare beneficiaries with complete data in 2009. Epilepsy was diagnosed in 4.45% (7,956) of AD patients and 4.81% (5,010) of PD patients between 2009 and 2014, approximately twice as frequently as in the control sample. Minority race/ethnicity was associated with increased risk of incident epilepsy. Among individuals with AD and PD, stroke was associated with increased epilepsy risk. Traumatic brain injury (TBI) was associated with increased epilepsy risk for individuals with PD. Depression was also associated with incident epilepsy (AD adjusted hazard ratio (AHR): 1.23 (1.17–1.29), PD AHR: 1.45 (1.37–1.54)). In PD only, a history of hip fracture (AHR, 1.35 (1.17–1.57)) and diabetes (AHR, 1.11 (1.05–1.18) were also associated with increased risk of epilepsy. Conclusion Incident epilepsy is more frequently diagnosed among neurodegenerative disease patients, particularly when preceded by a diagnosis of depression, TBI or stroke. Further studies into the differences in epilepsy risk between these two populations may help elucidate different mechanisms of epileptogenesis.

scholarly journals Patterns of Long-Term Prescription Opioid Use Among Older Adults in the United States: A Study of Medicare Administrative Claims Data

2020 ◽  
Vol 1;24 (1;1) ◽  
pp. 31-40
Keyword(s):  
Older Adults ◽  
Claims Data ◽  
The United States ◽  
Prescription Opioid ◽  
Administrative Claims ◽  
Medicare Beneficiaries ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Administrative Claims Data

BACKGROUND: Long-term opioid therapy was prescribed with increasing frequency over the past decade. However, factors surrounding long-term use of opioids in older adults remains poorly understood, probably because older people are not at the center stage of the national opioid crisis. OBJECTIVES: To estimate the annual utilization and trends in long-term opioid use among older adults in the United States. STUDY DESIGN: Retrospective cohort study. SETTING: Data from Medicare-enrolled older adults. METHODS: This study utilized a nationally representative sample of Medicare administrative claims data from the years 2012 to 2016 containing records of health care services for more than 2.3 million Medicare beneficiaries each year. Medicare beneficiaries who were 65 years of age or older and who were enrolled in Medicare Parts A, B, and D, but not Part C, for at least 10 months in a year were included in the study. We measured annual utilization and trends in new long-term opioid use episodes over 4 years (2013–2016). We examined claims records for the demographic characteristics of the eligible individuals and for the presence of chronic non-cancer pain (CNCP), cancer, and other comorbidities. RESULTS: From 2013 to 2016, administrative claims of approximately 2.3 million elderly Medicare beneficiaries were analyzed in each year with a majority of them being women (~56%) and white (~82%) with a mean age of approximately 75 years. The proportion of all eligible beneficiaries with at least one new opioid prescription increased from 6.64% in 2013, peaked at 10.32% in 2015, and then decreased to 8.14% in 2016. The proportion of individuals with long-term opioid use among those with a new opioid prescription was 12.40% in 2013 and 10.20% in 2016. Among new long-term opioid users, the proportion of beneficiaries with a cancer diagnosis during the study years increased from 13.30% in 2013 to 15.67% in 2016, and the proportion with CNCP decreased from 30.25% in 2013 to 27.36% in 2016. Across all years, long-term opioid use was consistently high in the Southern states followed by the Midwest region. LIMITATIONS: This study used Medicare fee-for-service administrative claims data to capture prescription fill patterns, which do not allow for the capture of individuals enrolled in Medicare Advantage plans, cash prescriptions, or for the evaluation of appropriateness of prescribing, or the actual use of medication. This study only examined long-term use episodes among patients who were defined as opioid-naive. Finally, estimates captured for 2016 could only utilize data from 9 months of the year to capture 90-day long-term-use episodes. CONCLUSIONS: Using a national sample of elderly Medicare beneficiaries, we observed that from 2013 to 2016 the use of new prescription opioids increased from 2013 to 2014 and peaked in 2015. The use of new long-term prescription opioids peaked in 2014 and started to decrease from 2015 and 2016. Future research needs to evaluate the impact of the changes in new and long-term prescription opioid use on population health outcomes. KEY WORDS: Long-term, opioids, older adults, trends, Medicare, chronic non-cancer pain, cancer, cohort study

scholarly journals Effectiveness of live attenuated monovalent human rotavirus vaccination in rural Ecuador, 2008-2013

2018 ◽  
Author(s):  
Alicia N. M. Kraay ◽  
Edward L. Ionides ◽  
Gwenyth O. Lee ◽  
William F. Cevallos Trujillo ◽  
Joseph N.S. Eisenberg
Keyword(s):  
Indirect Effects ◽  
Cox Regression ◽  
Age Groups ◽  
Community Setting ◽  
Population Level ◽  
Population Based ◽  
Case Control ◽  
Rotavirus Infection ◽  
Human Rotavirus ◽  
Overall Effectiveness

AbstractBackgroundWhile live attenuated monovalent human rotavirus vaccine (Rotarix) efficacy has been characterized through randomized studies, its effectiveness, especially in non-clinical settings, is unclear. In this study, we estimate direct, indirect, and overall effectiveness of Rotarix vaccination.MethodsWe analyze 29 months of all-cause diarrhea surveillance from a child cohort (n=376) and ten years of serial population-based case-control lab-confirmed rotavirus data (n=2489) from rural Ecuador during which Rotarix vaccination was introduced. We estimate: 1) the direct effect of vaccination from a cohort of children born from 2008-2013 using Cox regression to compare time to first all-cause diarrhea case by vaccine status; and 2) the overall effect on all-cause diarrheal and symptomatic and asymptomatic rotavirus infection for all age groups, including indirect effects on adults, from the case-control data using weighted logistic regression.ResultsRotarix vaccination provided direct protection against all-cause diarrhea among children 0.5 - 2 years (All-cause diarrhea reduction for receipt of 2 doses of Rotarix=57.1%, 95% CI: 16.6, 77.9%). Overall effectiveness against rotavirus infection was strong (Exposure to 100% coverage of Rotarix vaccination was associated with an 85.5% reduction, 95% CI: 61.1-94.6%) compared to 0% coverage. Indirect effects were observed among older, vaccine-ineligible children and adults (84.5% reduction, 95% CI: 48.2-95.4%). Vaccine effectiveness was high against both symptomatic (48.3% reduction,95% CI: 0.03-73.1%) and asymptomatic infection (90.1% reduction, 95% CI: 56.9-97.7%).ConclusionsRotarix vaccination suppresses overall transmission. It is highly effective among children in a rural community setting and provides population-level benefits through indirect protection among adults.

scholarly journals Genetic predisposition to longer telomere length and risk of childhood, adolescent and adult-onset ependymoma

2020 ◽  
Vol 8 (1) ◽  
Author(s):  
Chenan Zhang ◽  
◽  
Quinn T. Ostrom ◽  
Eleanor C. Semmes ◽  
Vijay Ramaswamy ◽  
...  
Keyword(s):  
Telomere Length ◽  
Genetic Predisposition ◽  
Control Sample ◽  
Population Based ◽  
Case Control ◽  
Telomere Maintenance ◽  
Adult Onset ◽  
Increased Risk ◽  
Sick Children ◽  
Control Study

Abstract Ependymoma is the third most common brain tumor in children, with well-described molecular characterization but poorly understood underlying germline risk factors. To investigate whether genetic predisposition to longer telomere length influences ependymoma risk, we utilized case–control data from three studies: a population-based pediatric and adolescent ependymoma case–control sample from California (153 cases, 696 controls), a hospital-based pediatric posterior fossa type A (EPN-PF-A) ependymoma case–control study from Toronto’s Hospital for Sick Children and the Children’s Hospital of Philadelphia (83 cases, 332 controls), and a multicenter adult-onset ependymoma case–control dataset nested within the Glioma International Case-Control Consortium (GICC) (103 cases, 3287 controls). In the California case–control sample, a polygenic score for longer telomere length was significantly associated with increased risk of ependymoma diagnosed at ages 12–19 (P = 4.0 × 10−3), but not with ependymoma in children under 12 years of age (P = 0.94). Mendelian randomization supported this observation, identifying a significant association between genetic predisposition to longer telomere length and increased risk of adolescent-onset ependymoma (ORPRS = 1.67; 95% CI 1.18–2.37; P = 3.97 × 10−3) and adult-onset ependymoma (PMR-Egger = 0.042), but not with risk of ependymoma diagnosed before age 12 (OR = 1.12; 95% CI 0.94–1.34; P = 0.21), nor with EPN-PF-A (PMR-Egger = 0.59). These findings complement emerging literature suggesting that augmented telomere maintenance is important in ependymoma pathogenesis and progression, and that longer telomere length is a risk factor for diverse nervous system malignancies.

scholarly journals Effect of childhood rotavirus vaccination on community rotavirus prevalence in rural Ecuador, 2008-13

2020 ◽  
Vol 49 (5) ◽  
pp. 1691-1701
Author(s):  
Alicia N M Kraay ◽  
Edward L Ionides ◽  
Gwenyth O Lee ◽  
William F Cevallos Trujillo ◽  
Joseph N S Eisenberg
Keyword(s):  
Case Control Study ◽  
Cox Regression ◽  
Age Groups ◽  
Community Setting ◽  
Population Level ◽  
Population Based ◽  
Case Control ◽  
Rotavirus Infection ◽  
The Impact ◽  
Control Study

Abstract Background Although live attenuated monovalent human rotavirus vaccine (Rotarix) efficacy has been characterized through randomized studies, its effectiveness, especially in non-clinical settings, is less clear. In this study, we estimate the impact of childhood Rotarix® vaccination on community rotavirus prevalence. Methods We analyse 10 years of serial population-based diarrhoea case-control study, which also included testing for rotavirus infection (n = 3430), and 29 months of all-cause diarrhoea active surveillance from a child cohort (n = 376) from rural Ecuador during a period in which Rotarix vaccination was introduced. We use weighted logistic regression from the case-control data to assess changes in community rotavirus prevalence (both symptomatic and asymptomatic) and all-cause diarrhoea after the vaccine was introduced. We also assess changes in all-cause diarrhoea rates in the child cohort (born 2008–13) using Cox regression, comparing time to first all-cause diarrhoea case by vaccine status. Results Overall, vaccine introduction among age-eligible children was associated with a 82.9% reduction [95% confidence interval (CI): 49.4%, 94.2%] in prevalence of rotavirus in participants without diarrhoea symptoms and a 46.0% reduction (95% CI: 6.2%, 68.9%) in prevalence of rotavirus infection among participants experiencing diarrhoea. Whereas all age groups benefited, this reduction was strongest among the youngest age groups. For young children, prevalence of symptomatic diarrhoea also decreased in the post-vaccine period in both the case-control study (reduction in prevalence for children &lt;1 year of age = 69.3%, 95% CI: 8.7%, 89.7%) and the cohort study (reduction in hazard for receipt of two Rotarix doses among children aged 0.5-2 years = 57.1%, 95% CI: 16.6, 77.9%). Conclusions Rotarix vaccination may suppress transmission, including asymptomatic transmission, in low- and middle-income settings. It was highly effective among children in a rural community setting and provides population-level benefits through indirect protection among adults.

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