The influence of population characteristics on variation in general practice based morbidity estimations (original) (raw)
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Revista Panamericana De Salud Publica-pan American Journal of Public Health, 2008
Dungen, C. van den, Hoeymans, N., Gijsen, R., Akker, M. van den, Boesten, J., Brouwer, H., Smeets, H., Veen, W.J. van der, Verheij, R., Waal, M. de, Schellevis, F., Westert, G. What factors explain the differences in morbidity estimations among general practice registrations networks in the Netherlands? A first analysis.
BMC Public Health, 2011
Background: Estimates of disease incidence and prevalence are core indicators of public health. The manner in which these indicators stand out against each other provide guidance as to which diseases are most common and what health problems deserve priority. Our aim was to investigate how routinely collected data from different general practitioner registration networks (GPRNs) can be combined to estimate incidence and prevalence of chronic diseases and to explore the role of uncertainty when comparing diseases. Methods: Incidence and prevalence counts, specified by gender and age, of 18 chronic diseases from 5 GPRNs in the Netherlands from the year 2007 were used as input. Generalized linear mixed models were fitted with the GPRN identifier acting as random intercept, and age and gender as explanatory variables. Using predictions of the regression models we estimated the incidence and prevalence for 18 chronic diseases and calculated a stochastic ranking of diseases in terms of incidence and prevalence per 1,000. Results: Incidence was highest for coronary heart disease and prevalence was highest for diabetes if we looked at the point estimates. The between GPRN variance in general was higher for incidence than for prevalence. Since uncertainty intervals were wide for some diseases and overlapped, the ranking of diseases was subject to uncertainty. For incidence shifts in rank of up to twelve positions were observed. For prevalence, most diseases shifted maximally three or four places in rank.
What went and what came? Morbidity trends in general practice from the Netherlands
European Journal of General Practice, 2008
Background: Fourty years of morbidity registration in general practice is a milestone urging to present an overview of outcomes. This paper provides insight into the infrastructure and methods of the oldest practice-based research network in the Netherlands and offers an overview of morbidity in a general practice population. Changes in morbidity and some striking trends in morbidity are presented. Methods: The CMR (Continuous Morbidity Registration) collects morbidity data in four practices, in and around Nijmegen, the Netherlands. The recording is anchored in the Dutch healthcare system, which is primary care based, and where every citizen is listed with a personal GP. Trends over the period 1985Á2006 are presented as a three year moving average. As an indicator for 20-year prevalence trends we used the annual percentage change (APC). We restricted ourselves to morbidity, which is presented to the family physician on a frequent basis (overall prevalence rates 1.0/1000/year). Results: The age distribution of the CMR population is comparable to the general Dutch population. Overall incidence figures vary between 1500/1000 ptyrs (men) and 2000/1000 ptyrs (women). They are quite stable over the years, whereas overall prevalence figures are rising gradually to 1500/2500 ptyrs (men) and 2000/3500 ptyrs (women). Increase in prevalence rates for chronic conditions is diffuse and gradual with a few striking exceptions. Conclusion: For morbidity patterns, the CMR database serves as a mirror of general practice. Practice-based research networks are indispensable for the development and maintenance of general practice as an academic discipline.
BMC Medical Informatics and Decision Making, 2014
Background: Intego is the only operational computerized morbidity registration network in Belgium based on general practice data. Intego collects data from over 90 general practitioners. All the information is routinely collected in the electronic health record during daily practice. Methods: In this article we describe the design and methods used within the Intego network together with some of its basic results. The collected data, the quality control procedures, the ethical-legal aspects and the statistical procedures are discussed. Results: Intego contains longitudinal information on 285 357 different patients, corresponding to over 2.3% of the Flemish population representative in terms of age and sex. More than 3 million diagnoses, 12 million drug prescriptions and 29 million laboratory tests have been recorded. Conclusions: Intego enables us to present and compare data on health parameters, incidence and prevalence rates, laboratory results, and prescribed drugs for all relevant subgroups on a routine basis and is unique in Belgium.
BMJ, 1996
Objective-To identify the socioeconomic determinants ofconsultation rates in general practice. Design-Analysis of data from the fourth national morbidity survey of general practices (MSGP4) including sociodemographic details of individual patients and small area statistics from the 1991 census. Multilevel modelling techniques were used to take account of both individual patient data and small area statistics to relate socioeconomic and health status factors directly to a measure of general practitioner workload. Results-Higher rates of consultations were found in patients who were classified as permanently sick, unemployed (especially those who became unemployed during the study year), living in rented accommodation, from the Indian subcontinent, living with a spouse or partner (women only), children living with two parents (girls only), and living in urban areas, especially those living relatively near the practice. When characteristics of individual patients are known and controlled for the role of "indices of deprivation" is considerably reduced. The effect of individual sociodemographic characteristics were shown to vary between different areas. Conclusions-Demographic and socioeconomic factors can act as powerful predictors ofconsultation patterns. Though it will always be necessary to retain some local planning discretion, the sets of coefficients estimated for individual level factors, area level characteristics, and for practice groupings may be sufficient to provide an indicative level of demand for general medical services. Although the problems in using socioeconomic data from individual patients would be substantial, these results are relevant to the development of a resource allocation formula for general practice.
Cancer Epidemiology, 2013
Background: District-level cancer incidence estimation is an important issue in countries without a national cancer registry. This study aims to both evaluate the validity of district-level estimations in France for 24 cancer sites, using health insurance data (ALD demands-Affection de Longue Dure´e) and to provide estimations when considered valid. Incidence is estimated at a district-level by applying the ratio between the number of first ALD demands and incident cases (ALD/I ratio), observed in those districts with cancer registries, to the number of first ALD demands available in all districts. These district-level estimations are valid if the ratio does not vary greatly across the districts or if variations remain moderate compared with variations in incidence rates. Methods: Validation was performed in the districts covered by cancer registries over the period 2000-2005. The district variability of the ALD/I ratio was studied, adjusted for age (mixed-effects Poisson model), and compared with the district variability in incidence rate. The epidemiological context is also considered in addition to statistical analyses. Results: District-level estimation using the ALD/I ratio was considered valid for eight cancer sites out of the 24 studied (lip-oral cavity-pharynx, oesophagus, stomach, colon-rectum, lung, breast, ovary and testis) and incidence maps were provided for these cancer sites. Conclusion: Estimating cancer incidence at a sub-national level remains a difficult task without a national registry and there are few studies on this topic. Our validation approach may be applied in other countries, using health insurance or hospital discharge data as correlate of incidence.
Pharmacoepidemiology and drug safety, 2016
The UK Clinical Practice Research Datalink (CPRD) is increasingly being used by Dutch researchers in epidemiology and pharmacoepidemiology. It is however unclear if the UK CPRD is representative of the Dutch population and whether study results would apply to the Dutch population. Therefore, as first step, our objective was to compare the age and sex distribution of the CPRD with the total Dutch population. As a measure of representativeness, the age and sex distribution of the UK CPRD were visually and numerically compared with Dutch census data from the StatLine database of the Dutch National Bureau of Statistics in 2011. The age distribution of men and women in the CPRD population was comparable to the Dutch male and female population. Differences of more than 10% only occurred in older age categories (75+ in men and 80+ in women). Results from observational studies that have used CPRD data are applicable to the Dutch population, and a useful resource for decision making in the N...
Understanding and interpreting National Health Service hospital morbidity data, 2013
The need for information on health is well recognized and of particular importance in the monitoring of diseases present in the community. In recent years focus has shifted from infectious diseases towards chronic diseases and long term conditions due to improvements in health care and an ageing population. Population studies of hospital morbidity are of great importance for the whole community in order to understand and reflect on the evolution of the health care environment. Regular reporting of all diseases in the population is a challenge. In Portugal, morbidity reports have been regularly published since 2004, the amount of information and statistics on health available grew over time. In this article, we discuss this historical evolution of Portugal's morbidity information, of the respective statistics and discuss some of their properties. This article is aimed at individuals interested in health information, its objective is to show how successive publications of morbidity statistics have evolved and discuss the potential of this information for data analysis and research.