‘What about the dads?’ Linking fathers and children in administrative data: A systematic scoping review

Research has shown that paternal involvement positively impacts on child health and development. We aimed to develop a conceptual model of dimensions of fatherhood, identify and categorise methods used for linking fathers with their children in administrative data, and map these methods onto the dimensions of fatherhood. We carried out a systematic scoping review to create a conceptual framework of paternal involvement and identify studies exploring the impact of paternal exposures on child health and development outcomes using administrative data. We identified four methods that have been used globally to link fathers and children in administrative data based on family or household identifiers using address data, identifiable information about the father on the child's birth registration, health claims data, and Personal Identification Numbers. We did not identify direct measures of paternal involvement but mapping linkage methods to the framework highlighted possible proxies. The addition of paternal National Health Service numbers to birth notifications presents a way forward in the advancement of fatherhood research using administrative data sources.

Real-World Anticoagulatory Treatment After Transcatheter Aortic Valve Replacement: A Retrospective, Observational Study on 4,800 Patients

Background: Transcatheter aortic valve replacement (TAVR) has developed to the therapy of choice for patients with symptomatic severe aortic stenosis who are unsuitable for surgical aortic valve replacement and elderly patients with intermediate or high operative risk. However, the optimal anticoagulant therapy post-TAVR still remains a matter of debate.Aims: This study sought to investigate current anticoagulant treatment patterns and clinical outcome in patients undergoing TAVR.Methods: In a retrospective study based on anonymized health claims data of approximately seven million Germans with statutory health insurance (InGef database), anticoagulant treatment regimens were assessed using any drug prescription post discharge within the first 90 days after TAVR procedure. Clinical events between 30 days and 6 months were examined by treatment regime.Results: The study population comprised 4,812 patients with TAVR between 2014 and 2018: 29.4% received antiplatelet monotherapy, 17.8% dual antiplatelet therapy, 17.4% oral anticoagulation (OAC) plus antiplatelet therapy, 12.9% OAC monotherapy, 2.2% triple therapy and 19.2% did not receive any anticoagulatory drugs. Sixty-four percentage of patients with OAC received direct oral anticoagulants (DOAC). Hence, 68% of all patients were treated non-adherent to current guidelines. Forty percentage of patients with OAC prior to TAVR did not have any OAC after TAVR. The adjusted risk of all-cause mortality was significantly increased in patients with OAC (HR 1.40, 95% CI 1.03–1.90, p = 0.03) and no anticoagulatory treatment (HR 3.95, 95% CI 2.95–5.27, p < 0.0001) when compared to antiplatelet monotherapy.Conclusions: This large real-world data analysis demonstrates substantial deviations from guideline recommendations and treatment after TAVR. Considering relevant differences in clinical outcome across treatment groups, major effort is warranted to examine underlying causes and improve guideline adherence.

Prevalence of multimodal treatment in children and adolescents with ADHD in Germany: a nationwide study based on health insurance data

Background Attention-deficit hyperactivity disorder (ADHD) ranks top among neurodevelopmental disorders in children and adolescents. Due to a large number of unfavorable outcomes including psychiatric comorbidities, school problems, and lower socioeconomic status, early and effective treatment of ADHD is essential. Multimodal treatment has become the gold standard in ADHD management, comprising pharmacotherapy and psychosocial interventions, e.g., psychotherapy. Yet, little is known about the prevalence of multimodal treatment in routine care. Methods Based on German health claims data for the years 2009–2017, we identified children and adolescents aged 3–17 years diagnosed with ADHD and characterized them cross-sectionally (per calendar year) in terms of treatment status and psychiatric comorbidities. The detection of pharmacotherapy was based on dispensations of drugs to treat ADHD (e.g., methylphenidate); psychotherapeutic treatment was based on corresponding billing codes. Multimodal treatment was assumed if ADHD medication and psychotherapeutic treatment were coded within the same calendar year. Psychiatric comorbidities were based on outpatient and inpatient diagnoses. Prevalences of ADHD and proportions of different treatment options were calculated and standardized by age and sex. Results In 2017, 91,118 children met the study criteria for ADHD (prevalence: 42.8/1000). Of these, 25.2% had no psychiatric comorbidity, 28.8% had one, 21.6% had two, and 24.5% had three or more. Regarding overall treatment status, 36.2% were treated only pharmacologically, 6.5% received multimodal treatment, and 6.8% were treated with psychotherapy only (neither treatment: 50.2%). With increasing numbers of psychiatric comorbidities, the proportions of patients with multimodal treatment increased from 2.2% (no psychiatric comorbidities) to 11.1% (three or more psychiatric comorbidities) while the proportions of untreated (from 56.8% to 42.7%) or only pharmacologically treated patients (38.4% to 35.0%) decreased. From 2009 to 2017, prevalences were stable and the proportion of patients with only pharmacotherapy decreased from 48% to 36.5%. Concurrently, the proportion of patients with neither pharmacotherapy nor psychotherapy increased from 40.5% to 50.2%. The fraction of patients with multimodal treatment ranged between 6.5% (2017) and 7.4% (2013). Conclusions Multimodal treatment, although recommended as the standard of treatment, is rather the exception than the rule. It is, however, increasingly common in ADHD patients with psychiatric comorbidities.

Sex-Specific Differences in Mortality of Patients with a History of Bariatric Surgery: a Nation-Wide Population-Based Study

Purpose Bariatric surgery reduces mortality in patients with severe obesity and is predominantly performed in women. Therefore, an analysis of sex-specific differences after bariatric surgery in a population-based dataset from Austria was performed. The focus was on deceased patients after bariatric surgery. Materials and Methods The Austrian health insurance funds cover about 98% of the Austrian population. Medical health claims data of all Austrians who underwent bariatric surgery from 01/2010 to 12/2018 were analyzed. In total, 19,901 patients with 107,806 observed years postoperative were eligible for this analysis. Comorbidities based on International Classification of Diseases (ICD)-codes and drug intake documented by Anatomical Therapeutical Chemical (ATC)-codes were analyzed in patients deceased and grouped according to clinically relevant obesity-associated comorbidities: diabetes mellitus (DM), cardiovascular disease (CV), psychiatric disorder (PSY), and malignancy (M). Results In total, 367 deaths were observed (1.8%) within the observation period from 01/2010 to 04/2020. The overall mortality rate was 0.34% per year of observation and significantly higher in men compared to women (0.64 vs. 0.24%; p < 0.001(Chi-squared)). Moreover, the 30-day mortality was 0.19% and sixfold higher in men compared to women (0.48 vs. 0.08%; p < 0.001). CV (82%) and PSY (55%) were the most common comorbidities in deceased patients with no sex-specific differences. Diabetes (38%) was more common in men (43 vs. 33%; p = 0.034), whereas malignant diseases (36%) were more frequent in women (30 vs. 41%; p = 0.025). Conclusion After bariatric surgery, short-term mortality as well as long-term mortality was higher in men compared to women. In deceased patients, diabetes was more common in men, whereas malignant diseases were more common in women. Graphical abstract

Risk of ischaemic stroke in patients with transient global amnesia: a propensity-matched cohort study

BackgroundThe exact pathophysiological mechanism of transient global amnesia (TGA) is unknown. It is debatable whether TGA is a risk factor for stroke. Therefore, here we investigated the possibility of TGA as a risk factor for stroke in a real-world setting using large-scale nationwide health claims data.MethodsWe used health claims data from the Korean National Health Insurance Service (NHIS). Patients diagnosed with TGA between 2007 and 2013 were selected. We initially extracted patients without TGA who were preferentially matched for age and sex with the patients with TGA at a ratio of 10:1 from the whole dataset. Further, we performed 1:2 propensity score matching analysis to balance the baseline characteristics between the two groups. In the propensity score-matched dataset, we performed multivariable Cox regression analysis to investigate the association between TGA and stroke type, including ischaemic, haemorrhagic and all stroke types.ResultsPatients with TGA (n=14 673) were selected from the NHIS database. After extracting from the whole database (n=140 486) and propensity score matching their data at a 1:2 ratio, a total of 10 448 and 20 442 patients were finally assigned to the TGA and control groups, respectively. The multivariable Cox regression analysis demonstrated that the TGA group had a higher risk of ischaemic stroke and all types of stroke (adjusted HR=1.194; 95% CI: 1.043 to 1.368; and HR=1.197; 95% CI: 1.056 to 1.357, respectively).ConclusionsAnalysis of the nationwide claims database showed that TGA could be an important risk factor for stroke, especially for ischaemic stroke.

A nationwide survey on participation in cardiac rehabilitation among patients with coronary heart disease using health claims data in Japan

Poor implementation and variable quality of cardiac rehabilitation (CR) for coronary heart disease (CHD) have been a global concern. This nationwide study aimed to clarify the implementation of and participation in CR among CHD patients and associated factors in Japan. We conducted a retrospective cohort study using data extracted from the National Database of Health Insurance Claims and Specific Health Checkups of Japan. Patients who underwent percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in 2017–2018 were included. Aspects of CR were assessed in terms of (1) participation in exercise-based CR, (2) pharmacological education, and (3) nutritional education. Of 87,829 eligible patients, 32% had participated in exercise-based CR, with a mean program length of 40 ± 71 days. CABG was associated with higher CR participation compared to PCI (OR 10.2, 95% CI 9.6–10.8). Patients living in the Kyushu region were more likely to participate in CR (OR 2.59, 95% CI 2.39–2.81). Among patients who participated in CR, 92% received pharmacological education, whereas only 67% received nutritional education. In Japan, the implementation of CR for CHD is insufficient and involved varying personal, therapeutic, and geographical factors. CR implementation needs to be promoted in the future.

Recurring Gastrointestinal Infections Increase the Risk of Dementia

Background: Gastrointestinal infections cause significant health problems, including those affecting the immune, musculoskeletal, and nervous system, and are one of the leading causes for death worldwide. Recent findings suggest that microbiota of the gastrointestinal tract contribute to dementia. Objective: In this nested case-control study we investigated the role of common gastrointestinal infections on the subsequent risk of dementia. Methods: We used a longitudinal sample of 202,806 individuals from health claims data of the largest German health insurer and applied a nested case-control design with 23,354 initial dementia cases between 2006 and 2014 and 23,354 matched controls. We used conditional logistic regression to compute odds ratios (ORs) for dementia and corresponding 95%confidence intervals (CIs), adjusting for potential confounders. Results: The risk of dementia was increased in patients with recurring incidences of quarters with diagnosed gastrointestinal infections when compared to the unexposed population (one quarter: OR = 1.49, 95%CI = 1.40–1.58; two quarters: OR = 1.70, 95%CI = 1.51–1.91; three or more quarters: OR = 1.64, 95%CI = 1.40–1.93), adjusted for potential confounders. Conclusion: Our findings suggest that recurring gastrointestinal infections are associated with an increased risk of subsequent dementia.

807Association between diabetes and adjuvant chemotherapy implementation among patients with stage III colorectal cancer

Background Preexisting diabetes may contribute to the indication for adjuvant chemotherapy among patients with colorectal cancer (CRC); however, the association between diabetes and its implementation is largely unknown. Methods We analyzed the hospital-based cancer registry and health claims data of patients with stage III CRC who received curative surgery in 2013 in Japan (n = 6,344). Chemotherapy and diabetes was identified based on procedure, prescription, and diabetes codes in claims data. We examined the association between diabetes and implementation rate of adjuvant chemotherapy using the generalized linear model adjusted for age, sex, and updated Charlson Comorbidity Index, hospital type, and prefecture. We further applied a mediation analysis to examine the extent to which postoperative complications mediated the association. Results Of these, 1,236 (19.5%) had diabetes. Compared with those without diabetes, patients with diabetes were less likely to receive adjuvant chemotherapy (crude rate: 58.9% and 49.8%; adjusted percentage point difference: 4.7% [95% confidence limits: 1.7, 7.5]). Mediation analysis indicated that postoperative complications explained 9.4% of the association between diabetes and adjuvant chemotherapy implementation. Conclusions Our findings suggest that patients with stage III CRC and diabetes are less likely to receive adjuvant chemotherapy than those without diabetes, and postoperative complications may partially account for the association. Key messages Concomitant diabetes might negatively impact the implementation rate of adjuvant chemotherapy in patients with stage III CRC.

Initiation of insulin therapy in patients with type 2 diabetes: An observational study

The aim of the study was to assess the initiation of insulin therapy in patients with type 2 diabetes using health claims data on prescription medicines. The study evaluated time to insulin initiation and prescribing patterns of other anti-diabetic medicines before and after insulin initiation. Five years after starting non-insulin antidiabetic therapy, 6.4 % of patients were prescribed insulin, which is substantially lower compared to other similar studies. Among all patients who initiated insulin therapy in 2013, 30 % did not continue any other antidiabetic therapy. However, this proportion was lowered to 20 % in 2018. Before insulin initiation in 2018, metformin was prescribed in only 67 % of patients and sulfonylureas in 78 % of patients. Moreover, metformin and sulfonylureas were discontinued after insulin initiation in 26 and 37 % of patients, resp. More attention should be paid to the continuation of oral anti-diabetics, particularly metformin, after insulin initiation.