BACKGROUND: Suicide is a significant public health issue. Many risk prediction tools have been developed to estimate an individual\'s risk of suicide. Risk prediction models can go beyond individual risk assessment; one important application of risk prediction models is population health planning. Suicide is a result of the interaction among the risk and protective factors at the individual, health care system, and community levels. Thus, policy and decision makers can play an important role in suicide prevention. However, few prediction models for the population risk of suicide have been developed.
OBJECTIVE: This study aims to develop and validate prediction models for the population risk of suicide using health administrative data, considering individual-, health system-, and community-level predictors.
METHODS: We used a case-control study design to develop sex-specific risk prediction models for suicide, using the health administrative data in Quebec, Canada. The training data included all suicide cases (n=8899) that occurred from January 1, 2002, to December 31, 2010. The control group was a 1% random sample of living individuals in each year between January 1, 2002, and December 31, 2010 (n=645,590). Logistic regression was used to develop the prediction models based on individual-, health care system-, and community-level predictors. The developed model was converted into synthetic estimation models, which concerted the individual-level predictors into community-level predictors. The synthetic estimation models were directly applied to the validation data from January 1, 2011, to December 31, 2019. We assessed the performance of the synthetic estimation models with four indicators: the agreement between predicted and observed proportions of suicide, mean average error, root mean square error, and the proportion of correctly identified high-risk regions.
RESULTS: The sex-specific models based on individual data had good discrimination (male model: C=0.79; female model: C=0.85) and calibration (Brier score for male model 0.01; Brier score for female model 0.005). With the regression-based synthetic models applied in the validation data, the absolute differences between the synthetic risk estimates and observed suicide risk ranged from 0% to 0.001%. The root mean square errors were under 0.2. The synthetic estimation model for males correctly predicted 4 of 5 high-risk regions in 8 years, and the model for females correctly predicted 4 of 5 high-risk regions in 5 years.
CONCLUSIONS: Using linked health administrative databases, this study demonstrated the feasibility and the validity of developing prediction models for the population risk of suicide, incorporating individual-, health system-, and community-level variables. Synthetic estimation models built on routinely collected health administrative data can accurately predict the population risk of suicide. This effort can be enhanced by timely access to other critical information at the population level.

OBJECTIVE: Data supporting routine infectious diseases (ID) consultation in Gram-negative bloodstream infection (GN-BSI) are limited. We evaluated the association between ID consultation and mortality in patients with GN-BSI in a retrospective population-wide cohort study in Ontario using linked health administrative databases.
METHODS: Hospitalized adult patients with GN-BSI between April 2017 and December 2021 were included. The primary outcome was time to all-cause mortality censored at 30 days, analyzed using a mixed effects Cox proportional hazards model with hospital as a random effect. ID consultation 1-10 days after the first positive blood culture was treated as a time-varying exposure.
RESULTS: Of 30,159 patients with GN-BSI across 53 hospitals, 11,013 (36.5%) received ID consultation. Median prevalence of ID consultation for patients with GN-BSI across hospitals was 35.0% with wide variability (range 2.7-76.1%, interquartile range 19.6-41.1%). 1041 (9.5%) patients who received ID consultation died within 30 days, compared to 1797 (9.4%) patients without ID consultation. In the fully-adjusted multivariable model, ID consultation was associated with mortality benefit (adjusted HR 0.82, 95% CI 0.77-0.88, p < 0.0001; translating to absolute risk reduction of -3.8% or NNT of 27). Exploratory subgroup analyses of the primary outcome showed that ID consultation could have greater benefit in patients with high-risk features (nosocomial infection, polymicrobial or non-Enterobacterales infection, antimicrobial resistance, or non-urinary tract source).
CONCLUSIONS: Early ID consultation was associated with reduced mortality in patients with GN-BSI. If resources permit, routine ID consultation for this patient population should be considered to improve patient outcomes.

BACKGROUND: Geriatric patients requiring rehabilitation and admitted to short-term care after an acute inpatient hospital stay seldom receive rehabilitative services later. Rehabilitative short-term care (REKUP) supplements short-term care with rehabilitative measures, aiming to prevent functional restrictions and long-term care.
OBJECTIVE: To conduct a cost and cost-effectiveness analyses of REKUP and provide data for a nationwide rollout.
METHODS: A non-randomized controlled prospective study was carried out. The intervention group (IG) was paired 1:2 with a control group (KG), resulting in the formation of three collectives with follow-up periods of either 30, 90 or 180 days (each with IG and KG). Using administrative claims data from the AOK Baden-Württemberg, the mean total costs from the perspective of the health insurance were calculated. A potential impact of the intervention on costs was analyzed using the difference in differences approach.
RESULTS: The analysis comprised 129 patients (IG 43; KG 86). During the follow-up periods, the IG presented higher rates of rehabilitation and lower rates of long-term care and mortality. Regarding costs, no statistically significant differences were found between the IG and KG in any of the three collectives. For nursing care and medication costs, costs were significantly higher in the follow-up period for the KG, whereas costs for rehabilitation were significantly higher for the IG (p < 0.001).
CONCLUSIONS: Patients receiving REKUP utilize rehabilitation services more often and have a lower likelihood of requiring nursing care or dying with no statistically significant differences in costs. There are potential advantages of REKUP in the target population, which warrant further investigation due to methodological limitations.
UNASSIGNED: HINTERGRUND: Geriatrische Patient:innen mit Rehabilitationsbedarf, die im Anschluss an einen akutstationären Aufenthalt in Kurzzeitpflege (KZP) gehen, erhalten selten Rehabilitation. Die rehabilitative Kurzzeitpflege (REKUP) erweitert die KZP um rehabilitative Maßnahmen, u. a. um Dauerpflege (DP) zu vermeiden.
UNASSIGNED: Eine Kosten- und Kosten-Effektivität-Analyse sollen Informationen für eine flächendeckende Anwendung liefern.
METHODS: Mittels einer nichtrandomisierten, kontrollierten prospektiven Studie wurde REKUP erprobt. Der Interventionsgruppe (IG) wurde eine Kontrollgruppe (KG) mittels 1:2-Matching zugewiesen, wobei 3 Kollektive (jeweils IG und KG) gebildet wurden, mit Nachbeobachtungszeiträumen von 30, 90 und 180 Tagen. Die durchschnittlichen Gesamtkosten aus Kostenträgerperspektive wurden anhand von Abrechnungsdaten der AOK Baden-Württemberg ermittelt. Ein möglicher Einfluss der Intervention auf die Kosten wurde unter Verwendung des Difference-in-difference-Ansatzes analysiert.
UNASSIGNED: Die Analyse schließt 43 (IG) und 86 (KG) geriatrische Patient:innen ein. Im Postzeitraum nahmen Patient:innen der IG häufiger eine Reha in Anspruch und gingen weniger häufig in DP bzw. verstarben. Die Analyse der Kosten im Postzeitraum zeigte in allen Kollektiven keinen statistisch signifikanten Unterschied zwischen IG und KG. Für Pflege und Arzneimittel waren im Postzeitraum die Kosten der KG, im Bereich der Rehabilitation die Kosten der IG statistisch signifikant höher (p < 0,001).
CONCLUSIONS: Patient:innen der IG hatten bei gleichen Kosten Vorteile in Bezug auf die Inanspruchnahme von Rehabilitation, Vermeidung von DP und Versterben. Dies weist auf eine mögliche Vorteilhaftigkeit von REKUP in der Zielpopulation hin, die aufgrund methodischer Einschränkungen weiter erforscht werden sollte.

UNASSIGNED: There is ongoing uncertainty about whether cannabis use increases the risk of developing an anxiety disorder. In this study we estimated the risk of having an incident healthcare visit for an anxiety disorder following an emergency department (ED) visit for cannabis use and explored factors associated with increased risk.
UNASSIGNED: We used health administrative data to perform a population-based cohort study of all individuals aged 10-105 years with no previous healthcare visits for anxiety disorders in Ontario, Canada, between January 2008 and March 2019. We compared the risk of having an incident healthcare visit for an anxiety disorder in the ED or hospital (primary analysis) or additionally in an outpatient setting (secondary analysis) for individuals with an incident ED visit for cannabis to members of the general population using cumulative incidence functions and cause-specific hazard models adjusted for relevant confounders.
UNASSIGNED: Our study included 12,099,144 individuals aged 10-105 without prior care for an anxiety disorder in the ED or hospital, of which 34,822 (0.29%) had an incident ED visit due to cannabis. Within 3-years of an incident ED visit due to cannabis, 12.3% (n = 4294) of individuals had an incident ED visit or hospitalization for an anxiety disorder-a 3.7-fold (adjusted Hazard Ratio [aHR] 3.69 95% CI 3.57-3.82) increased risk relative to the general population (1.2%). In secondary analysis, further excluding individuals with prior outpatient care for anxiety disorders, 23.6% of individuals with an ED visit due to cannabis had an incident outpatient visit, ED visit, or hospitalization for an anxiety disorder within 3-years compared to 5.6% of individuals in the general population (aHR 3.88 95% CI 3.77-2.99). The risk of having an incident healthcare visit for an anxiety disorder was higher in individuals with ED visits for cannabis use compared to the general population across all age and sex strata. However, younger males with ED visits for cannabis use (aHR 5.67 95% CI 5.19-6.21) had a greater risk relative to the general population than younger women with cannabis use (aHR 3.22 95% CI 2.95-3.52).
UNASSIGNED: ED visits for cannabis use were associated with an increased risk of having an incident healthcare visit for an anxiety disorder, particularly in young males. These findings have important clinical and policy implications given the increasing use of cannabis over time and trend towards legalization of cannabis.
UNASSIGNED: Canadian Institutes for Health Research.

OBJECTIVE: Health administrative data can be used to improve the health of people who inject drugs by informing public health surveillance and program planning, monitoring, and evaluation. However, methodological gaps in the use of these data persist due to challenges in accurately identifying injection drug use (IDU) at the population level. In this study, we validated case-ascertainment algorithms for identifying people who inject drugs using health administrative data in Ontario, Canada.
METHODS: Data from cohorts of people with recent (past 12 months) IDU, including those participating in community-based research studies or seeking drug treatment, were linked to health administrative data in Ontario from 1992 to 2020. We assessed the validity of algorithms to identify IDU over varying look-back periods (ie, all years of data [1992 onwards] or within the past 1-5 years), including inpatient and outpatient physician billing claims for drug use, emergency department (ED) visits or hospitalizations for drug use or injection-related infections, and opioid agonist treatment (OAT).
RESULTS: Algorithms were validated using data from 15,241 people with recent IDU (918 in community cohorts and 14,323 seeking drug treatment). An algorithm consisting of ≥1 physician visit, ED visit, or hospitalization for drug use, or OAT record could effectively identify IDU history (91.6% sensitivity and 94.2% specificity) and recent IDU (using 3-year look back: 80.4% sensitivity, 99% specificity) among community cohorts. Algorithms were generally more sensitive among people who inject drugs seeking drug treatment.
CONCLUSIONS: Validated algorithms using health administrative data performed well in identifying people who inject drugs. Despite their high sensitivity and specificity, the positive predictive value of these algorithms will vary depending on the underlying prevalence of IDU in the population in which they are applied.

UNASSIGNED: The incidence of childhood-onset inflammatory bowel disease (IBD) is rising. We described variation in health services utilization and need for surgery among children with IBD between six and 60 months following IBD diagnosis across Canadian pediatric centers and evaluated the associations between care provided at diagnosis at each center and the variation in these outcomes.
UNASSIGNED: Using population-based deterministically-linked health administrative data from four Canadian provinces (Alberta, Manitoba, Nova Scotia, Ontario) we identified children diagnosed with IBD <16 years of age using validated algorithms. Children were assigned to a pediatric center of care using a hierarchical approach based on where they received their initial care. Outcomes included IBD-related hospitalizations, emergency department (ED) visits, and IBD-related abdominal surgery occurring between 6 and sixty months after diagnosis. Mixed-effects meta-analysis was used to pool results and examine the association between center-level care provision and outcomes.
UNASSIGNED: We identified 3784 incident cases of pediatric IBD, of whom 2937 (77.6%) were treated at pediatric centers. Almost a third (31.4%) of children had ≥1 IBD-related hospitalization and there were 0.66 hospitalizations per person during follow-up. More than half (55.8%) of children had ≥1 ED visit and there were 1.64 ED visits per person. Between-center heterogeneity was high for both outcomes; centers where more children visited the ED at diagnosis had more IBD-related hospitalizations and more ED visits during follow-up. Between-center heterogeneity was high for intestinal resection in Crohn\'s disease but not colectomy in ulcerative colitis.
UNASSIGNED: There is variation in health services utilization among children with IBD and risk of undergoing intestinal resection in those with Crohn\'s disease, but not colectomy among children with ulcerative colitis, across Canadian pediatric tertiary-care centers. Improvements in clinical care pathways are needed to ensure all children have equitable and timely access to high quality care.

BACKGROUND: Patterns of health services utilization among children with inflammatory bowel disease (IBD) are important to understand as the number of children with IBD continues to increase. We compared health services utilization and surgery among children diagnosed <10 years of age (Paris classification: A1a) and between 10 and <16 years of age (A1b).
METHODS: Incident cases of IBD diagnosed <16 years of age were identified using validated algorithms from deterministically linked health administrative data in 5 Canadian provinces (Alberta, Manitoba, Nova Scotia, Ontario, Quebec) to conduct a retrospective cohort study. We compared the frequency of IBD-specific outpatient visits, emergency department visits, and hospitalizations across age groups (A1a vs A1b [reference]) using negative binomial regression. The risk of surgery was compared across age groups using Cox proportional hazards models. Models were adjusted for sex, rural/urban residence location, and mean neighborhood income quintile. Province-specific estimates were pooled using random-effects meta-analysis.
RESULTS: Among the 1165 (65.7% Crohn\'s) children with IBD included in our study, there were no age differences in the frequency of hospitalizations (rate ratio [RR], 0.88; 95% confidence interval [CI], 0.74-1.06) or outpatient visits (RR, 0.95; 95% CI, 0.78-1.16). A1a children had fewer emergency department visits (RR, 0.70; 95% CI, 0.50-0.97) and were less likely to require a Crohn\'s-related surgery (hazard ratio, 0.49; 95% CI, 0.26-0.92). The risk of colectomy was similar among children with ulcerative colitis in both age groups (hazard ratio, 0.71; 95% CI, 0.49-1.01).
CONCLUSIONS: Patterns of health services utilization are generally similar when comparing children diagnosed across age groups.
Among 1165 children with inflammatory bowel disease, health services utilization was similar for children diagnosed <10 years of age and those diagnosed ≥10 years of age, except younger children had fewer emergency department visits and Crohn’s disease–related surgeries.

OBJECTIVE: This study aimed to describe the association between socioeconomic inequalities and the prevalence and incidence of pharmacologically-treated type 2 diabetes in European France over the 2010-2020 period.
METHODS: Diabetes cases were identified using a validated algorithm from the French National Health Data System. Analysis was restricted to adults aged 45 years and older to focus on type 2 diabetes. Socioeconomic inequalities were measured for all years in European France using the French deprivation index (FDep, 2015 version), which is an area-based deprivation indicator using population-weighted quintiles (Q1 corresponds to the least deprived municipalities). The relative risks of diabetes prevalence and incidence associated with FDep quintiles (Q1 as the reference) were estimated by sex using a log-linear Poisson model adjusted for year, age and French department. The study population was the French health consumers aged 45 years and over (from 24,228,526 in 2010 to 29,772,928 in 2020).
RESULTS: A positive gradient was observed in the relative risks of type 2 diabetes prevalence and incidence by FDep quintiles over the study period. The strength of the estimated associations increased over the last decade for prevalence among men and women and for incidence among men in the two most deprived quintiles.
CONCLUSIONS: Thus, type 2 diabetes prevention should include a proportionate universalism approach, proposing actions of greater intensity in the most deprived areas.

UNASSIGNED: Chronic kidney disease (CKD) in agricultural communities is a significant public health issue. We aimed to investigate the epidemiology of CKD among Taiwanese farmers and its association with outdoor heat exposure.
UNASSIGNED: A nested case-control study was conducted on participants in the National Adult Health Examination (NAHE) from 2012 to 2018. The farming occupation was identified through National Health Insurance data. The primary outcomes of interest were the development of CKD, defined as a decreased estimated glomerular filtration rate (eGFR) with diagnosis by physicians, and CKD of undetermined etiology (CKDu), defined as CKD excluding common traditional etiologies. We calculated the county-wide average ambient temperature from a climate reanalysis dataset (ERA5-Land). All CKD cases were matched 1:2 to non-CKD participants by age and biological sex. We estimated the odds ratios (ORs) of CKD and CKDu for farmers and changes in mean ambient temperature (°C) before the examination.
UNASSIGNED: We identified 844,412 farmers and 3,750,273 nonfarmers. Among 24.9% of farmers and 7.4% of nonfarmers with reduced kidney function, only 1 in 7 received a diagnosis of CKD. The farming occupation was independently predictive of CKDu (OR = 1.09, 95% confidence interval [CI] = 1.001-1.18) but not CKD. Increased ambient temperature (°C) was associated with a higher risk of CKD (OR = 1.023, 95% CI = 1.017-1.029), with particularly strong associations observed among middle-aged participants and diabetics.
UNASSIGNED: Taiwanese farmers might have a higher risk of developing CKDu. Outdoor heat exposure is associated with the development of CKD, and middle-aged participants and those with diabetes are more vulnerable than the general population.

OBJECTIVE: Access to a primary care physician in early psychosis facilitates help-seeking and engagement with psychiatric treatment. We examined access to a regular primary care physician in people with early psychosis, compared to the general population, and explored factors associated with access.
METHODS: Using linked health administrative data from Ontario (Canada), we identified people aged 14-35 years with a first diagnosis of nonaffective psychotic disorder (n = 39 449; 2005-2015). We matched cases to four randomly selected general population controls based on age, sex, neighbourhood, and index date (n = 157 796). We used modified Poisson regression to estimate prevalence ratios (PR) for access to a regular primary care physician in the year prior to first diagnosis of psychotic disorder, and the sociodemographic and clinical factors associated with access.
RESULTS: A larger proportion of people with early psychosis had a regular primary care physician, relative to the general population (89% vs. 68%; PR = 1.30, 95%CI = 1.30-1.31). However, this was accounted for by a higher prevalence of comorbidities among people with psychosis, and this association was no longer present after adjustment (PR = 0.97, 95%CI = 0.97, 0.98). People with early psychosis who were older, male, refugees and those residing in lower income or high residential instability neighbourhoods were less likely to have a regular primary care physician.
CONCLUSIONS: Approximately one in ten young people with early psychosis in Ontario lack access to a regular primary care physician. Strategies to improve primary care physician access are needed for management of physical comorbidities and to ensure continuity of care.