Health administrative data can be a valuable tool for disease surveillance and research. Few studies have rigorously evaluated the accuracy of administrative databases for identifying rheumatoid arthritis (RA) patients. Our aim was to validate administrative data algorithms to identify RA patients in Ontario, Canada.
We performed a retrospective review of a random sample of 450 patients from 18 rheumatology clinics. Using rheumatologist-reported diagnosis as the reference standard, we tested and validated different combinations of physician billing, hospitalization, and pharmacy data.
One hundred forty-nine rheumatology patients were classified as having RA and 301 were classified as not having RA based on our reference standard definition (study RA prevalence 33%). Overall, algorithms that included physician billings had excellent sensitivity (range 94-100%). Specificity and positive predictive value (PPV) were modest to excellent and increased when algorithms included multiple physician claims or specialist claims. The addition of RA medications did not significantly improve algorithm performance. The algorithm of "(1 hospitalization RA code ever) OR (3 physician RA diagnosis codes [claims] with =1 by a specialist in a 2-year period)" had a sensitivity of 97%, specificity of 85%, PPV of 76%, and negative predictive value of 98%. Most RA patients (84%) had an RA diagnosis code present in the administrative data within ±1 year of a rheumatologist's documented diagnosis date.
We demonstrated that administrative data can be used to identify RA patients with a high degree of accuracy. RA diagnosis date and disease duration are fairly well estimated from administrative data in jurisdictions of universal health care insurance.
The paper examines age-related accident risks faced by Swedish male iron-ore miners. A retrospective longitudinal analysis of national registers was conducted over a ten-year period using three times periods of five years and five age categories. Age-related accident frequency, characteristics and severity were examined. High accident ratios were rare among older miners whatever the time period, but some accident patterns became substantially more frequent in some older age cohorts over the years. Injuries tended to be more severe in older age groups, all accidents aggregated as well as by accident pattern. It is concluded that inequality in risk exposure between age groups may explain the lower accident ratios found among older workers, but also that the aging of a working population may lead to the application of task-assignment principles that penalize older workers, at least with regard to certain specific accident risks.
The article contains evaluation of physical and chemical properties of mine aerosol in mines using self-propelled diesel devices, information on the aerosol and exhaust gases components concentrations in the workplace air. Dispersed phase of the aerosol is presented by mineral and organic components, mineral and soot particles absorb gaseous exhaust components. Feature of occupational pulmonary diseases in highly-mechanized mine workers is toxic dust affection of bronchi, mostly with asthmatic course and chronic obstructive type of respiratory dysfunction, relatively short-term disease development.
The association between cumulative radon exposure and coronary heart disease mortality was studied in a retrospective cohort investigation of Newfoundland fluorspar miners.
Multivariate Poisson regression techniques were used to estimate relative risks of coronary heart disease mortality by level of radon exposure. Relative risks (RR) were adjusted by attained age, calendar period, duration of exposure, and smoking status. Death from coronary heart disease was the outcome measure of interest and was identified by record linkage to the Canadian Mortality Database.
An elevated risk of mortality from coronary heart disease was observed among miners with a cumulative radon exposure exceeding 1000 working-level months [RR 1.5, 95% confidence interval (95% CI) 0.77-2.75]. The association between radon exposure and coronary heart disease was not statistically significant according to a test for trend across exposure categories (P = 0.09). The smokers were 1.8 times more likely than the nonsmokers to die from coronary heart disease (95% CI 1.1-2.8).
These results suggest a positive association between coronary heart disease and radon exposure. However, these findings should be interpreted cautiously due to the inability to control for the confounding influence of other known risk factors of coronary heart disease.
The article deals with evaluation of occupational risk, based on thorough analysis of occupational morbidity among coal miners of East Donbass, considering results of periodic medical examinations conducted by specialists of Rostov regional Occupational pathology center. Those results form a basis of mathematic modelling for a posteriori occupational risk.
In the development of new drugs for severe asthma, it is a challenge from an ethical point of view to randomize severe asthma patients to placebo, and to obtain long-term safety data due to discontinuations. The aim of this study was to evaluate the feasibility of using electronic health record (EHR) data to create a real-world reference population of uncontrolled asthmatic patients to supplement the concurrent control/placebo group in long-term studies of asthma.
EHR data from 36 primary care centres and a University hospital in Sweden were linked to Swedish mandatory health registers (2005-2013), creating a population covering 33 890 asthma patients, including data on co-morbidities, risk factors and laboratory/respiratory measurements. A severe asthma EHR reference cohort was established. We used logistic regression to estimate the propensity score (probability) of each RCT or EHR patient existing in the EHR cohort given their covariates.
We created an EHR-derived reference cohort of 240 patients, matching the placebo group (N?=?151) in an RCT of severe asthma. The exacerbation rate during follow-up in the EHR study population was 1.24 (weighted) compared to 0.9 in the RCT placebo group. Patients in the EHR cohort were of similar age as in the RCT placebo group, 50.6 years versus 50.1 years; had slightly higher body mass index 27.0 kg/m2 versus 27.3 kg/m2; and consisted of 40% versus 34% males.
The results indicate that EHRs provide an opportunity to supplement the control group in RCTs of severe diseases.
The author analyzed changes in occupational morbidity among workers of leading economic branches of Russian Federation, gave prognosis of occupational morbidity level for recent and distant future. The morbidity level is characterized by reliable decreasing trend--that is due to long decline in diagnostic rate of occupational diseases in periodic medical examinations. The author specified mathematic model to evaluate a posteriori occupational risk, based on materials concerning periodic medical examinations in coal miners.
The results of a retrospective dynamic monitoring in 1976-2014 of the workers of coal mines of main (n = 1732) and auxiliary (n = 1059) occupations, with diagnosed occupational sciatica (OS) in the center of occupational medicineare viewed. It was found that the workers of the main occupationson average of 3 years earlier than initially treated at the center of occupational medicine, and occupational disease OS sets for them 1.5-2 years earlier. The analysis of the formation of risk groups depending on the diagnosis and treatment of the primary analysis of the incidence of OS.