The surveys and register data

Aims: Future research on health inequality relies on data that cover life-course exposure, different birth cohorts and variation in policy contexts. Nordic register data have long been celebrated as a ‘gold mine’ for research, and fulfil many of these criteria. However, access to and use of such data are hampered by a number of hurdles and bottlenecks. We present and discuss the experiences of an ongoing Nordic consortium from the process of acquiring register data on socio-economic conditions and health in Denmark, Finland, Norway and Sweden. Methods: We compare experiences of data-acquisition processes from a researcher’s perspective in the four countries and discuss the comparability of register data and the modes of collaboration available to researchers, given the prevailing ethical and legal restrictions. Results: The application processes we experienced were time-consuming, and decision structures were often fragmented. We found substantial variation between the countries in terms of processing times, costs and the administrative burden of the researcher. Concerned agencies differed in policy and practice which influenced both how and when data were delivered. These discrepancies present a challenge to comparative research. Conclusions: We conclude that there are few signs of harmonisation, as called for by previous policy documents and research papers. Ethical vetting needs to be centralised both within and between countries in order to improve data access. Institutional factors that seem to facilitate access to register data at the national level include single storage environments for health and social data, simplified ethical vetting and user guidance.

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P.2.38 Occupational exposure and incidence of asthma based on prescription of drugs

Occupational and Environmental Medicine ◽

10.1136/oem-2019-epi.265 ◽

2019 ◽

Vol 76 (Suppl 1) ◽

pp. A97.1-A97

Author(s):

Jesper Bælum ◽

Lars Rauff Skadhauge ◽

Trine Thilsing ◽

Jesper Rønhild Davidsen ◽

Øjvind Omland ◽

...

Keyword(s):

Lung Diseases ◽

Register Data ◽

Low Molecular Weight ◽

Job Exposure Matrix ◽

Cleaning Agents ◽

Occupational Information ◽

Incident Asthma ◽

Changes In Risk ◽

Incident Cases ◽

Prevalent Asthma

Prescription of drugs for obstructive lung diseases (ATC code R03) has previously been shown to be an indicator of actual asthma. In this cohort study, we have combined occupational information with data from redeemed prescriptions between 2000 and 2013 extracted from the National Danish Prescription register.In 2003 a total of 7255 persons aged 20 and 44 years fulfilled a questionnaire, which among other things, included information on their longest held job. The jobs of 6470 were coded according to ISCO-88 and an asthma Job Exposure Matrix (JEM) was applied. Prevalent asthma was defined as at least two redeemed prescriptions of a R03 drug within 2 years. Incident asthma between 2003 and 2013 was defined as not having redeemed a R03 prescription in the previous years. Data was analyzed separately for each gender using multivariate logistic regression and presented as odds ratios (OR) with 95% confidence intervals (CI).Among those having a job 327 (5.1%) were identified as incident cases and 467 (7.2%) as prevalent cases. In females increased incidences were seen in exposures to reactive low molecular weight (LMW) substances (OR1.47 (95% CI 1.04–2.07)), cleaning agents (OR 1.52 (1.05–2.18)), metals (OR 3.31 (1.63–6.64)), while increased prevalence was seen with mite exposure (OR 4.41 (1.74–11.2)) and irritant gases (OR 1.76 (1.16–2.69)). In males no increased incidences were seen and only an increased prevalence with mixed environments (OR 2.24 (1.13–4.43)).In jobs increased prevalence and incidence were seen in female cleaners and drivers. Increased prevalence was seen in male printing workers.Meaningful associations with well-known asthmagenic exposures in young adults with asthma can be identified in administrative register data, and implementing the analyses of register data from larger populations will have the power to detect potential increased risks due to rare exposures or changes in risk over time.

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Evaluation of health system readiness and coverage of intermittent preventive treatment of malaria in infants (IPTi) in Kambia district to inform national scale-up in Sierra Leone

Malaria Journal ◽

10.1186/s12936-021-03615-3 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Maria Lahuerta ◽

Roberta Sutton ◽

Anthony Mansaray ◽

Oliver Eleeza ◽

Brigette Gleason ◽

...

Keyword(s):

Sierra Leone ◽

Phase 1 ◽

Scale Up ◽

Intermittent Preventive Treatment ◽

Vaccine Dose ◽

Preventive Treatment ◽

Household Survey ◽

Register Data ◽

Phase 2 ◽

Pentavalent Vaccine

Abstract Background Intermittent preventive treatment of malaria in infants (IPTi) with sulfadoxine-pyrimethamine (SP) is a proven strategy to protect infants against malaria. Sierra Leone is the first country to implement IPTi nationwide. IPTi implementation was evaluated in Kambia, one of two initial pilot districts, to assess quality and coverage of IPTi services. Methods This mixed-methods evaluation had two phases, conducted 3 (phase 1) and 15–17 months (phase 2) after IPTi implementation. Methods included: assessments of 18 health facilities (HF), including register data abstraction (phases 1 and 2); a knowledge, attitudes and practices survey with 20 health workers (HWs) in phase 1; second-generation sequencing of SP resistance markers (pre-IPTi and phase 2); and a cluster-sample household survey among caregivers of children aged 3–15 months (phase 2). IPTi and vaccination coverage from the household survey were calculated from child health cards and maternal recall and weighted for the complex sampling design. Interrupted time series analysis using a Poisson regression model was used to assess changes in malaria cases at HF before and after IPTi implementation. Results Most HWs (19/20) interviewed had been trained on IPTi; 16/19 reported feeling well prepared to administer it. Nearly all HFs (17/18 in phase 1; 18/18 in phase 2) had SP for IPTi in stock. The proportion of parasite alleles with dhps K540E mutations increased but remained below the 50% WHO-recommended threshold for IPTi (4.1% pre-IPTi [95%CI 2–7%]; 11% post-IPTi [95%CI 8–15%], p < 0.01). From the household survey, 299/459 (67.4%) children ≥ 10 weeks old received the first dose of IPTi (versus 80.4% for second pentavalent vaccine, given simultaneously); 274/444 (62.5%) children ≥ 14 weeks old received the second IPTi dose (versus 65.4% for third pentavalent vaccine); and 83/217 (36.4%) children ≥ 9 months old received the third IPTi dose (versus 52.2% for first measles vaccine dose). HF register data indicated no change in confirmed malaria cases among infants after IPTi implementation. Conclusions Kambia district was able to scale up IPTi swiftly and provide necessary health systems support. The gaps between IPTi and childhood vaccine coverage need to be further investigated and addressed to optimize the success of the national IPTi programme.

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On the Structure of Wealth-Holding in Pre-Famine Ireland

Irish Economic and Social History ◽

10.1177/0332489320984348 ◽

2021 ◽

pp. 033248932098434

Author(s):

Neil Cummins ◽

Cormac Ó Gráda

Keyword(s):

Register Data ◽

The Past

Very little is known about wealth-holding and its distribution in Ireland in the past. Here we employ death duty register data to analyse and identify a sample of the top wealth-holders in Ireland between the early 1820s and late 1830s. We examine the sources of their wealth and its regional spread, and compare them with their British counterparts. We also discuss the share of Catholics and Quakers among top wealth-holders.

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Citizenship acquisition and spatial stratification: Analysing immigrant residential mobility in the Netherlands

Urban Studies ◽

10.1177/00420980211006030 ◽

2021 ◽

pp. 004209802110060

Author(s):

Christophe Leclerc ◽

Maarten Vink ◽

Hans Schmeets

Keyword(s):

The Netherlands ◽

Housing Market ◽

Labour Market ◽

Residential Mobility ◽

Home Ownership ◽

Register Data ◽

Median Income ◽

High Concentrations ◽

The Relationship ◽

Spatial Stratification

Whereas the so-called ‘citizenship premium’ in the labour market has been widely studied, we know little about how naturalisation affects immigrants’ lives beyond work and income. Focusing on the Netherlands, this paper analyses the relationship between citizenship acquisition and immigrant residential mobility, in particular the propensity of immigrants to move away from areas with high concentrations of migrants. We draw on register data from Statistics Netherlands ( N = 234,912). We argue that possessing Dutch citizenship reduces spatial stratification by diminishing the risk of housing market discrimination, thereby facilitating mobility outside of migrant-concentrated areas. Our findings show that naturalised immigrants are 50% more likely to move out of concentrated neighbourhoods, all else constant. The effect of naturalisation is especially relevant for renting without housing benefits and for home ownership, and for mid-risk immigrants who earn around the median income and hold permanent jobs, whose applications face strong scrutiny from landlords, rental agencies and mortgage lenders.

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Integrating data from multiple Finnish biobanks and national health-care registers for retrospective studies: Practical experiences

Scandinavian Journal of Public Health ◽

10.1177/14034948211004421 ◽

2021 ◽

pp. 140349482110044

Author(s):

Jaakko Lähteenmäki ◽

Anna-Leena Vuorinen ◽

Juha Pajula ◽

Kari Harno ◽

Mika Lehto ◽

...

Keyword(s):

Health Care ◽

Statistical Power ◽

Data Exchange ◽

Register Data ◽

Genotype Data ◽

Multiple Sources ◽

Hospital Data ◽

National Register ◽

National Register Data ◽

Health Care Encounters

Aim: This case study aimed to investigate the process of integrating resources of multiple biobanks and health-care registers, especially addressing data permit application, time schedules, co-operation of stakeholders, data exchange and data quality. Methods: We investigated the process in the context of a retrospective study: Pharmacogenomics of antithrombotic drugs (PreMed study). The study involved linking the genotype data of three Finnish biobanks (Auria Biobank, Helsinki Biobank and THL Biobank) with register data on medicine dispensations, health-care encounters and laboratory results. Results: We managed to collect a cohort of 7005 genotyped individuals, thereby achieving the statistical power requirements of the study. The data collection process took 16 months, exceeding our original estimate by seven months. The main delays were caused by the congested data permit approval service to access national register data on health-care encounters. Comparison of hospital data lakes and national registers revealed differences, especially concerning medication data. Genetic variant frequencies were in line with earlier data reported for the European population. The yearly number of international normalised ratio (INR) tests showed stable behaviour over time. Conclusions: A large cohort, consisting of versatile individual-level phenotype and genotype data, can be constructed by integrating data from several biobanks and health data registers in Finland. Co-operation with biobanks is straightforward. However, long time periods need to be reserved when biobank resources are linked with national register data. There is a need for efforts to define general, harmonised co-operation practices and data exchange methods for enabling efficient collection of data from multiple sources.

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Labour market disadvantage or poor health upon arrival? An examination of the native–immigrant gap in early retirement on a disability pension

Acta Sociologica ◽

10.1177/00016993211022801 ◽

2021 ◽

pp. 000169932110228

Author(s):

Jeevitha Yogachandiran Qvist ◽

Hans-Peter Y Qvist

Keyword(s):

Labour Market ◽

Disability Pension ◽

Early Retirement ◽

Register Data ◽

Labour Markets ◽

Poor Health ◽

Health Differences ◽

A Minor ◽

Efficiency And Productivity ◽

Advanced Capitalist

Non-Western immigrants in Scandinavia have a higher risk of early retirement on a disability pension than natives, but the reasons are unclear. One theory is that increased demands for standardization, efficiency and productivity in advanced capitalist labour markets, such as the Scandinavian market, cause expulsion of the weakest and least qualified individuals from the labour market, including a disproportionate share of non-Western immigrants. Another theory is that non-Western immigrants already have poorer health than natives upon arrival in Scandinavia. This article examines the extent to which the native–immigrant gap in early retirement on a disability pension is explained by non-Western immigrants’ disadvantaged position in the labour market when pre-existing health differences are controlled for. To this end, we draw on Danish register data, including all disability pensions granted in 2003–2012 to natives and non-Western immigrants who arrived in Denmark in 1998. Our results suggest that a minor proportion of the native–immigrant gap in disability pensions is explained by non-Western immigrants’ health upon arrival, whereas the vast majority of the gap is explained by non-Western immigrants’ disadvantaged position in the labour market.

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Comparison of data sources on alcohol problems: An exploratory exercise using surveys vs. national healthcare registers

Nordic Studies on Alcohol and Drugs ◽

10.1177/1455072520968021 ◽

2020 ◽

pp. 145507252096802

Author(s):

Pia Mäkelä ◽

Kristiina Kuussaari ◽

Airi Partanen ◽

Elina Rautiainen

Keyword(s):

Health Care ◽

Substance Abuse ◽

Healthcare Service ◽

Service Use ◽

Basic Education ◽

Alcohol Problems ◽

Register Data ◽

Data Sources ◽

National Healthcare ◽

Healthcare Service Use

Aims: Both survey and healthcare register data struggle as data sources to capture the phenomenon of alcohol problems. We study a large group of people for whom survey data and two types of register data are available, and examine the overlaps of similar or related measures in the different data sources to learn about potential weaknesses in each. We also examine how register-based data on the prevalence of alcohol problems change depending on which register data are used. Design: We use data from the Regional Health and Wellbeing Study (ATH) of the adult Finnish population collected in 2013 and 2014 ( n = 69,441), individually linked with data on two national healthcare registers (Care Register for Health Care; Register of Primary Health Care visits) for the survey year and previous year. Results: The prevalence of substance-abuse-related healthcare was almost two-fold if data on outpatient primary care visits were included in addition to hospitalisations. Forty-six per cent of the survey respondents self-reporting substance-abuse-related healthcare service use were identified in the registers, and 22% of all respondents with such service use according to registers reported this in the survey. Records of substance-abuse-related healthcare service use, controlled for self-reported alcohol use and self-reported substance-abuse-related service use, were found more often for men, the middle-aged, people with basic education only, and the non-employed. Conclusions: The results are suggestive of underreporting in both data sources. There is an evident need to develop recording practices in the healthcare registers regarding substance use disorders.

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Regional variation in appropriate care for ST-elevation myocardial infarction in Finland

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.1108 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

E Reissell ◽

S Lumme ◽

M Satokangas ◽

K Manderbacka

Keyword(s):

Myocardial Infarction ◽

Regional Variation ◽

Regional Differences ◽

Coronary Intervention ◽

Register Data ◽

St Elevation Myocardial Infarction ◽

Academic Affiliation ◽

Episode Of Care ◽

Appropriate Care ◽

St Elevation

Abstract Background Timely primary percutaneous coronary intervention (PCI) is currently the treatment of choice for ST-elevation myocardial infarction (STEMI). Although cardiac units were established in all central hospitals in late 1990s for sparsely populated Finland, studies have shown that regional variation has increased. Additionally, the dense Finnish hospital network includes non-cardiac facilities where patients may be inappropriately admitted and then transferred for PCI. We aim to investigate the current regional differences in receiving timely PCI, determinants of these variations and the effect of hospital transfers. Methods Finnish Hospital Discharge Register data on PCIs for STEMI patients in 2015-17 were linked to register data on socio-demographics. In these preliminary analyses we used logistic regression modelling. Results Our results suggest that there were significant regional differences both for timely PCI in STEMI patients and in the probability of hospital transfers during an episode of care. The regional odds ratios (OR) for receiving PCI on time varied from 0.41 (95% confidence interval 0.33-0.52) to 2.73 (2.09-3.57) compared with the capital region when controlling for age, gender and hospital transfers. The ORs for being transferred during an episode of care varied from 0.26 (0.15-0.44) to 16.6 (11.6-23.6). Patients not transferred were more likely to receive PCI (OR 1.89 (1.67-2.15)). Men received PCI on time more often (OR 1.31 (1.18-1.46)) and women were more likely to be transferred (OR 1.29 (1.15-1.45)). Conclusions The probability for receiving PCI on time was related to the size of the hospital's population base and academic affiliation and inversely to transfers between hospitals. Hospital transfers during care episode and atypical symptoms often seen in women may cause critical delays for PCI. Other determinants for variation of timely PCI and its effects on equity will be analysed using multilevel modelling. Key messages Appropriate care for STEMI varies across regions and reflects inept practices in provider network. These findings are more pronounced in women showing persisting gender-related inequity.

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