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健保資料庫之應用經驗分享 精神部 研究醫師 鄭晴.

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Presentation on theme: "健保資料庫之應用經驗分享 精神部 研究醫師 鄭晴."— Presentation transcript:

1 健保資料庫之應用經驗分享 精神部 研究醫師 鄭晴

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4 資料描述及代碼說明

5 High-Tech Lab NHIRD vs. 步槍 自動步槍 機關槍 軍團 團隊 陳曾基教授, 2011”健保資料庫之應用與未來發展”

6 NHIRD Papers Increase In Both Quantity and Quality
陳曾基教授, 2011”健保資料庫之應用與未來發展”

7 Average IF in SCI Fields
SCI category No. of article Average IF HEALTH CARE SCIENCES & SERVICES 51 1.798 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH 47 2.625 PSYCHIATRY 41 3.272 HEALTH POLICY & SERVICES 39 1.868 PHARMACOLOGY & PHARMACY 34 2.740 MEDICINE, GENERAL & INTERNAL 33 1.541 CLINICAL NEUROLOGY 3.153 OBSTETRICS & GYNECOLOGY 21 2.202 SURGERY 17 2.349 PEDIATRICS 15 3.216 CARDIAC & CARDIOVASCULAR SYSTEMS 14 2.463 ENDOCRINOLOGY & METABOLISM 13 4.671 GASTROENTEROLOGY & HEPATOLOGY 3.669 OPHTHALMOLOGY 12 2.791 IMMUNOLOGY 3.804 NEUROSCIENCES 11 2.153 RESPIRATORY SYSTEM 3.148 PERIPHERAL VASCULAR DISEASE 10 5.532 MEDICINE, RESEARCH & EXPERIMENTAL 2.366 陳曾基教授, 2011”健保資料庫之應用與未來發展”

8 Design of Claims-Based Studies
Observational studies Descriptive studies Analytic studies - Ecological - Cross-sectional - Case-control - Cohort 單純 複雜 低臨床 相關 高臨床 陳曾基教授, 2011”健保資料庫之應用與未來發展”

9 Types of Study Designs Simple Description Association / Relationship
Complex computation (Data mining)

10 Simple Description Disease Drug Sector
Epidemiologic features of Kawasaki disease in Taiwan, A nationwide survey on epidemiological characteristics of childhood Henoch-Schonlein purpura in Taiwan. Prevalence and risks of chronic airway obstruction: a population cohort study in Taiwan. Seasonal variations in urinary calculi attacks and the association with climate: a population-based study. Drug Utilization of hepatoprotectants within the National Health Insurance in Taiwan. Use frequency of traditional Chinese medicine in Taiwan. Sector Patterns of ambulatory care utilization in Taiwan. Pediatrics : IF 4.789, Ranking 2 / 86 Rheumatology : IF 4.136, Ranking 7 / 22 Chest : IF 5.154, Ranking 4 / 40 J Urology : IF 3.952, Ranking 9 / 57 (Urology …) 陳曾基教授, 2011”健保資料庫之應用與未來發展”

11 Association / Relationship
Stroke : IF 6.499, Ranking 6 / 156 (Clinical Neurology) A  B (no temporal consideration) Association between physician volume and hospitalization costs for patients with stroke in Taiwan: a nationwide population-based study. A => B (temporal sequence) Risk of extrapyramidal syndrome in schizophrenic patients treated with antipsychotics: a population-based study. Sudden sensorineural hearing loss increases the risk of stroke: A 5-year follow-up study Does elective caesarean section increase utilization of postpartum maternal medical care? Clin Pharmacol Ther : IF 7.586, Ranking 9 / 219 temporal change 時序的變化 是否與觀察值 有相關性 ,不一定有先後關係 temporal sequence 時序上因果的先後關係 驗證 Stroke : IF 6.499, Ranking 6 / 156 (Clinical Neurology) Med Care : IF 3.194, Ranking 5 / 62 (Health Care Sciences ...) 陳曾基教授, 2011”健保資料庫之應用與未來發展”

12 TIPS & STEPS Familiar with the NHIRD codebooks and NHI regulations
- 資料庫量大、追蹤時間長 - 瞭解健保資料先天的限制 Ideas Literature review & Discussion with colleagues Fellows familiar with data processing - 嚴謹的研究設計和精準的分析方法 Motivation, courage, Tolerance, Endurance

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14 ~ Sample Research ~ PUBLICATIONS RESIDENTS’ WORK

15 Simple Description

16 Methods Simple Description Sample Definition - NHI enrollment database
- Inclusion: age, sex… - Exclusion: foreigners… Definition - Schizophrenia: inclusion, exclusion - Prevalence: definition of “prevalent cases”? - Incidence: definition of “new cases”?

17 Simple Description Associations
IF 4.458, Ranking 18 / 117 (Psychiatry)

18 Methods Simple Description Sample
- Case: 59,257 schizophrenia patients - Control: 178,156 age- and gender-matched individuals without schizophrenia Follow-up period: 9 years ( ) Outcome measure - cancer incidence and survival time after cancer diagnosis

19 Results Simple Description Cancer incidence
patients with schizophrenia: 1145 (1.93%) control group: 5294 (2.97%) for all types of cancer except breast and cervical/uterine cancer Male: OR=0.50 (95% CI, 0.46–0.55); Female: OR=0.81 (95% CI, 0.74–0.88) adjusted hazard ratio 0.71 (95% CI, 0.66–0.76)

20 Association / Relationship
IF 4.224, Ranking 3 / 26 (Anesthesiology )

21 Hypothesis Methods Association / Relationship
General anesthesia is associated with a higher odds of acquiring a surgical site infection in women following caesarean delivery Methods January 2002 to December 2006 Definition 0371A (CS delivery) 0373B (maternally requested CS delivery) Only the first CS was counted: 303,834 CS cases. The mode of anaesthetic procedure (order codes) 96020C-96022C for general anaesthesia 96007C and 96008C for spinal anaesthesia 96005C and 96006C for epidural anaesthesia

22 Results

23 Association / Relationship
IF , Ranking 1 / 117 (Psychiatry)

24 Association / Relationship
Hypothesis Acute exposure to antidepressant would increase stroke risk Study Design A matched case-cross study

25 Association / Relationship
Case-crossover Study Index date of event Drug prescription + Control time window Case time window 28 day 14 1day - + A B C D Odds ratio= A/B

26 Association / Relationship
Methods Definition Cerebrovascular events - Hemorragic stroke: ICD-9 code: 430, 431, 432 - Ischemic stroke: ICD-9 code: 433, 434, 435 - Other type: ICD-9 code: 436 - Exclusion: Head injury, ICD-9 code 800.x-804.x, 850.x- 854.x or 959.x Antidepressants Confounding factors The index date - diagnosed as having a first hospitalization for a stroke

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28 台中榮總的 住院醫師 正在做的NHRI研究…

29 Simple Description Birth Seasonality in Schizophrenia:
effect of latitude, gender, and income Chin Cheng, Ching-Heng Lin, El-Wui Loh, Tsuo-Hung Lan Taichung Veterans General Hospital, Taiwan Under Review

30 Methods Study Sample - Case: 5,047 schizophrenia patients
- Control: 631,911 general population - Data retrieved for 2005 - Data for year of birth ranged from 1950 to 1989 (age20-59) - Data obtained from the inpatient, outpatient, and ambulatory claims database. Measurement - Birth seasonality in schizophrenia, considering influences of gender, and income status

31 Results A gender difference with female predominance
A significant winter/spring birth excess in schizophrenia in Taiwan, a low latitude area A gender difference with female predominance More pronounced in low income status

32 Association / Relationship
The Correlation of Antidepressants use and Mortality of End-Stage Renal Disease Chia-Jui Tsai, Ching-Heng Lin, El-Wui Loh, Tsuo-Hung Lan Taichung Veterans General Hospital, Taiwan IF 1.25, Ranking / (Nephrology)

33 Methods Definition ESRD : ICD-9-CM code 585 : total 2312 patients
Diagnosis of depression : ICD 296.2, Major depression ICD dysthymic disorder ICD 311-Depressive disorder, NOS

34 Methods Definition Antidepressants exposure
- All kinds of antidepressants prescriptions - At least two consecutive months (outpatients) or inpatients one year before receiving their diagnosis of ESRD or after the diagnosis New onset ESRD during the year , > 30 y/o Exclusion: depression diagnosed before new onset ESRD Endpoint : Occurrence of death, or end of study

35 Confounding Factors Well known risk of mortality : * CVD * DM
* Hypertension * Hyperlipidemia Currently well known diseases that contribute to the risk of mortality :

36 Survival Curves

37 Association / Relationship
The Association of SSRI Use and Stoke in Geriatric Population Chia-Chun Hung, Ching-Heng Lin, El-Wui Loh, Chin-Hong Chan, Tsuo-Hung Lan Taichung Veterans General Hospital, Taiwan Under Review

38 Methods Definition of stroke
The stroke diagnosis was identified by meeting the occurrence of ICD-9, codes from 430 to 438 (cerebro-vascular disease) in any inpatient treatment or outpatient treatments during the 9-years period. Patients who had accompanied diagnosis of head injury (ICD-9 code: , ) and stroke within two weeks of head injury events were excluded. The endpoint of follow-up was occurrence of first stroke event, death, or end of study on December 31, 2009.

39 METHODS Definition of co-morbidities
Co-morbidities for stroke, including myocardial infarction (MI), angina pectoris (AP), atrial fibrillation (AF), peripheral arterial occlusive disease (PAOD), congestive heart failure (CHF), diabetes mellitus (DM), hypertension, hyperlipidemia, and renal diseases in the last 12 months before first SSRI prescription were included in analysis. MI (ICD-9 code: ), AP (ICD-9 code: 413), AF (ICD-9 code: 427), PAOD (ICD-9 code: 444), CHF (ICD-9 code: 428), DM (ICD-9 code: 250), hypertension (ICD-9 code: 401 to 405) and hyperlipidemia (ICD-9 code: 272) were confirmed by the records of one or more prescriptions for the diagnoses, while renal diseases were confirmed when ICD-9 code or 585 appeared in the NHI records.

40 Baseline Characteristics

41 Results

42 Research in Residency IDEAS Consultation, Teamwork Supervisor Peer
Diligence, Persistence

43 ~ Thank You ~


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