Publications by authors named "Roberta Picariello"

16 Publications

  • Page 1 of 1

Validation of an Algorithm to Detect Multiple Sclerosis Cases in Administrative Health Databases in Piedmont (Italy): An Application to the Estimate of Prevalence by Age and Urbanization Level.

Neuroepidemiology 2021 10;55(2):119-125. Epub 2021 Mar 10.

Epidemiology Unit, ASL TO3 Regione Piemonte, Grugliasco, Italy.

Introduction: Italy is considered a high-risk country for multiple sclerosis (MS). Exploiting electronic health archives (EHAs) is highly useful to continuously monitoring the prevalence of the disease, as well as the care delivered to patients and its outcomes. The aim of this study was to validate an EHA-based algorithm to identify MS patients, suitable for epidemiological purposes, and to estimate MS prevalence in Piedmont (North Italy).

Methods: MS cases were identified, in the period between January 1, 2012 and December 31, 2017, linking data from 4 different sources: hospital discharges, drug prescriptions, exemptions from co-payment to health care, and long-term care facilities. Sensitivity of the algorithm was tested through record linkage with a cohort of 656 neurologist-confirmed MS cases; specificity was tested with a cohort of 2,966,293 residents presumably not affected by MS. Undercount was estimated by a capture-recapture method. We calculated crude, and age- and gender-specific prevalence. We also calculated age-adjusted prevalence by level of urbanization of the municipality of residence.

Results: On December 31, 2017, the algorithm identified 8,850 MS cases. Sensitivity was 95.9%, specificity was 99.97%, and the estimated completeness of ascertainment was 91.9%. The overall prevalence, adjusted for undercount, was 152 per 100,000 among men and 286 among women; it increased with increasing age and reached its peak value in the 45- to 54-year class, followed by a progressive reduction. The age-adjusted prevalence of residents in cities was 15% higher than in those living in the countryside.

Discussion/conclusion: We validated an algorithm based on EHAs to identify cases of MS for epidemiological use. The prevalence of MS, adjusted for undercount, was among the highest in Italy. We also found that the prevalence was higher in highly urbanized areas.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000513763DOI Listing
March 2021

Therapy With Agents Acting on the Renin-Angiotensin System and Risk of Severe Acute Respiratory Syndrome Coronavirus 2 Infection.

Clin Infect Dis 2020 11;71(16):2291-2293

Epidemiology Unit, Azienda Sanitaria Locale TO3  , Regione Piemonte, Grugliasco, Italy.

Exposure to agents acting on the renin-angiotensin system was not associated with a risk increase of COVID-19 infection in 2 Italian matched case-control studies, 1 nested in hypertensive patients and the other in patients with cardiovascular diseases or diabetes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/cid/ciaa634DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7543878PMC
November 2020

Incretin-based therapy and risk of cholangiocarcinoma: a nested case-control study in a population of subjects with type 2 diabetes.

Acta Diabetol 2020 Apr 5;57(4):401-408. Epub 2019 Nov 5.

Epidemiology Unit, ASL TO3, Regione Piemonte, Grugliasco, Italy.

Background And Aims: One cohort and several basic science studies have raised suspicion about an association between incretin therapies and cholangiocarcinoma. Our aim was to verify the occurrence of CC in relation to incretin-based medication use versus any antidiabetic treatment in an unselected population of diabetic patients.

Methods: A population-based matched case-control study was conducted using administrative data from the Region of Piedmont (4,400,000 inhabitants), Italy. From a database of 312,323 patients treated with antidiabetic drugs, we identified 744 cases hospitalized for cholangiocarcinoma from 2010 to 2016 and 2976 controls matched for gender, age and initiation of antidiabetic therapy; cases and controls were compared for exposure to incretin-based medications. All analyses were adjusted for risk factors for CC, as ascertained by hospital discharge records. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated by fitting a conditional logistic model.

Results: The mean age of the sampled population (cases and controls, 75 years) was very high, with no gender prevalence. Five per cent was treated with incretin-based medications. After adjusting for possible confounders, we found no increased risk of cholangiocarcinoma associated with the use of either DPP4i (OR 0.98, 95% CI 0.75-1.29: p = 0.89) or GLP-1-RA (OR 1.09, 95% CI 0.63-1.89; p = 0.76) in the 24 months before hospital admission. Neither the duration of the therapy nor the dose modified the risk of cholangiocarcinoma.

Conclusions: Our findings suggest that, in an unselected population, the use of both classes of incretin-based medications is not associated with an increased risk of cholangiocarcinoma.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00592-019-01444-0DOI Listing
April 2020

Ten-year comparative analysis of incidence, prognosis, and associated factors for dialysis and renal transplantation in type 1 and type 2 diabetes versus non-diabetes.

Acta Diabetol 2018 Jul 20;55(7):733-740. Epub 2018 Apr 20.

Epidemiology Unit, ASL TO3, Regione Piemonte, Grugliasco, TO, Italy.

Aims: To study the incidence of and the factors associated with renal dialysis and transplantation in type 1 (T1DM) and type 2 diabetes (T2DM).

Methods: Data on individuals who had received dialysis treatment or renal transplant between 1 January 2004 and 31 December 2013 were extracted from the regional administrative database (Piedmont, Italy), and the crude (cumulative) incidence of dialysis was calculated. Overall cumulative survival was estimated using the Kaplan-Meier method and compared using the log-rank test. Poisson regression was used to estimate adjusted rate ratios for potential predictors of renal transplant or death.

Results: A total of 7401 persons started dialysis treatment during the decade, with a 10-year cumulative crude incidence of 16.8/100,000. Incidence was stable and consistently eightfold higher in persons with T2DM (tenfold higher in T1DM) compared to those without diabetes. The risk of dialysis in T1DM was about double that of T2DM. The mortality rate was significantly higher in diabetics than in non-diabetes (241.4/1000 vs. 153.99/1000 person-years). During the decade 2004-2013, 893 patients underwent a kidney transplant. Transplantation rates were significantly lower for diabetics than non-diabetics (16.5/1000 vs. 42.9/1000 person-years).

Conclusions: In the past decade, the incidence of dialysis has stabilized in both the general population and in diabetics in whom it remains far higher by comparison. Also mortality rates are higher, with a worse prognosis for T1DM. Diabetes poses a barrier to allotransplantation, and efforts should be made to overcome this limitation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00592-018-1142-yDOI Listing
July 2018

Is the choice of the statistical model relevant in the cost estimation of patients with chronic diseases? An empirical approach by the Piedmont Diabetes Registry.

BMC Health Serv Res 2015 Dec 30;15:582. Epub 2015 Dec 30.

Department of Medical Sciences, University of Turin, corso Dogliotti 14, 10126, Turin, Italy.

Background: Chronic diseases impose large economic burdens. Cost analysis is not straightforward, particularly when the goal is to relate costs to specific patterns of covariates, and to compare costs between diseased and healthy populations. Using different statistical methods this study describes the impact on results and conclusions of analyzing health care costs in a population with diabetes.

Methods: Direct health care costs of people living in Turin were estimated from administrative databases of the Regional Health System. Patients with diabetes were identified through the Piedmont Diabetes Registry. The effect of diabetes on mean annual expenditure was analyzed using the following multivariable models: 1) an ordinary least squares regression (OLS); 2) a lognormal linear regression model; 3) a generalized linear model (GLM) with gamma distribution. Presence of zero cost observation was handled by means of a two part model.

Results: The OLS provides the effect of covariates in terms of absolute additive costs due to the presence of diabetes (€ 1,832). Lognormal and GLM provide relative estimates of the effect: the cost for diabetes would be six fold that for non diabetes patients calculated with the lognormal. The same data give a 2.6-fold increase if calculated with the GLM. Different methods provide quite different estimated costs for patients with and without diabetes, and different costs ratios between them, ranging from 3.2 to 5.6.

Conclusions: Costs estimates of a chronic disease vary considerably depending on the statistical method employed; therefore a careful choice of methods to analyze data is required before inferring results.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12913-015-1241-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4696194PMC
December 2015

Hospitalisation for heart failure and mortality associated with dipeptidyl peptidase 4 (DPP-4) inhibitor use in an unselected population of subjects with type 2 diabetes: a nested case-control study.

BMJ Open 2015 Jun 5;5(6):e007959. Epub 2015 Jun 5.

Epidemiology Unit, ASL TO3, Regione Piemonte, Grugliasco, Italy.

Objective: The SAVOR TIMI-53 study reported a significant increase in the risk of hospitalisation for heart failure (HF) in patients treated with a DPP-4 inhibitor (DPP-4i) in comparison with placebo. A recent case-control study in part confirmed this risk signal. Our aim was to compare the occurrence of HF in relation to DPP-4i use versus any antidiabetic treatment.

Design: Population-based matched case-control study conducted using administrative data.

Setting: The Italian Region of Piedmont (4.4 million inhabitants).

Participants: From a database of 282,000 patients treated with antidiabetic drugs, we identified 14,613 hospitalisations for HF, 7212 incident cases, and 1727 hospital re-admissions between 2008 and 2012; each case was matched for gender, age and antidiabetic therapy with 10 controls; cases and controls were compared for exposure to DPP-4i.

Outcome Measures: ORs and 95% CIs were calculated by fitting a conditional logistic model. All analyses were adjusted for available risk factors for HF.

Results: We found no increased risk of hospitalisation for HF associated with the use of DPP-4i (OR for admission for HF 1.00 (0.94 to 1.07), incident HF1.01 (0.92 to 1.11), recurrent HF 1.02 (0.84 to 1.22)). All-cause mortality was 6% lower in DPP-4i users (p<0.001), whereas insulin users showed an excess of risk for any type of hospital admission (19%) and death (20%) (p<0.001).

Conclusions: Our findings suggest that, in an unselected population of diabetic patients, the use of DPP-4i is not associated with an increased risk of HF. The favourable impact on all-cause mortality should be viewed with caution and also other explanations investigated.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bmjopen-2015-007959DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4458680PMC
June 2015

Incretin therapies and risk of hospital admission for acute pancreatitis in an unselected population of European patients with type 2 diabetes: a case-control study.

Lancet Diabetes Endocrinol 2014 Feb 12;2(2):111-5. Epub 2013 Nov 12.

Epidemiology Unit, ASL TO3, Regione Piemonte, Grugliasco, Italy.

Background: Previous studies have yielded conflicting results about the association between incretin therapies and acute pancreatitis. We aimed to compare the occurrence of acute pancreatitis in a population of patients with type 2 diabetes who received incretins compared with those who received other antidiabetic treatment.

Methods: In our population-based matched case-control study, we extracted information from an administrative database from Piedmont, Italy (containing data for 4·4 million inhabitants). From a dataset of 282,429 patients receiving treatment with antidiabetic drugs for type 2 diabetes, we identified 1003 cases older than 41 years who had been admitted to hospital for acute pancreatitis between Jan 1, 2008, and Dec 31, 2012, and 4012 controls who were matched for sex, age, and time of start of antidiabetic therapy. We compared incretin exposure in cases and controls with a conditional logistic regression model, expressed as odds ratios (ORs [95% CI]). We adjusted all analyses for risk factors of acute pancreatitis, as ascertained by hospital discharge records, and concomitant use of metformin or glibenclamide.

Findings: The mean age of cases and controls (72·2 years [SD 11·1]) was high, as expected in an unselected diabetic population in Europe. After adjustment for available confounders, use of incretins in the 6 months before hospital admission was not associated with increased risk of acute pancreatitis (OR 0·98, 95% CI 0·69-1·38; p=0·8958).

Interpretation: Our findings suggest that, in an unselected population, use of incretins is not associated with an increased risk of acute pancreatitis. Larger studies are needed to clarify whether age or type of incretin therapy could affect the risk of acute pancreatitis in patients with type 2 diabetes.

Funding: Chaira Medica Association, Chieri, Italy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/S2213-8587(13)70147-5DOI Listing
February 2014

Care of acute myocardial infarction in the coronary care units of Piedmont in 2007: results from the 'PRIMA_sweet' region-wide survey.

J Cardiovasc Med (Hagerstown) 2013 May;14(5):354-63

SSD Emodinamica, Dipartimento Cardiovascolare AO S. Croce, Via Coppino 26, 12100 Cuneo, Italy.

Background: The treatment of acute myocardial infarction (AMI), both with ST-segment elevation [ST-elevation myocardial infarction (STEMI)] and non-ST-segment elevation [non-ST-elevation myocardial infarction (NSTEMI)], is evolving in Piedmont, with an increase in interventional procedures and hub-and-spoke networks. This new region-wide survey provides updated assessment of the management of STEMI and unprecedented data on NSTEMI.

Methods: In 30 coronary care units in Piedmont, all patients with AMI symptoms of duration less than 48 h, between January and March 2007, were included.

Results: Of 921 patients, 447 had STEMI and 474 NSTEMI. Diabetes was present in 35% and chronic kidney disease in 38%. Hospital mortality was 4.7% [95% confidence interval (CI) 3.3-6.1]: age 75 years or older, Killip class higher than 1 and known diabetes or abnormal blood glucose on admission were multivariate predictors. Thrombolysis and primary percutaneous transluminal coronary angioplasty (pPTCA) were performed in 17.6 and 53.1% of 391 patients, respectively, with STEMI of 12 h or less, and 29.3% had no reperfusion therapy, notably 52% of patients aged 75 years or older and 51% of those reaching non-24/24 h interventional centres. Mortality after pPTCA was 2.5% and onsite door-to-balloon time was less than 90 min in 67.5%. Overall mortality after STEMI was 5.4% (95% CI 3.2-7.6). In NSTEMI, use of antithrombotic treatments was extensive, but invasive treatment within 72 h was limited to 8% of patients in centres without interventional facilities and independent of patient's risk profile. Mortality after NSTEMI was 4.0% (95% CI 2.2-5.8) and was predicted by both the Global Registry of Acute Coronary Events risk score and diabetes.

Conclusion: There is room for improvement in the treatment of AMI in our region, with more extensive use of reperfusion therapy in STEMI, especially in the elderly, and early revascularization and optimal medical treatment in higher-risk NSTEMI.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2459/JCM.0b013e32835422f8DOI Listing
May 2013

Early life socioeconomic indicators and risk of type 1 diabetes in children and young adults.

J Pediatr 2013 Mar 17;162(3):600-605.e1. Epub 2012 Oct 17.

Department of Medical Sciences, University of Turin, Turin, Italy.

Objective: To examine the potential role of 2 early-life socioeconomic indicators, parental education, and crowding index, on risk of type 1 diabetes (T1DM) in patients up to age 29 years to test heterogeneity by age at onset according to the hygiene hypothesis.

Study Design: The study base was 330 950 individuals born from 1967 to 2006 who resided in the city of Turin at any time between 1984 and 2007. Data on their early life socioeconomic position were derived from the Turin Longitudinal Study; 414 incident cases of T1DM up to age 29 years were derived from the Turin T1DM registry.

Results: Socioeconomic indicators had opposing effects on risk of T1DM in different age at onset subgroups. In a Poisson regression model that included both socioeconomic indicators, there was a 3-fold greater risk of T1DM (relative risk 2.91, 95% CI 0.99-8.56) in children age 0-3 years at diagnosis living in crowded houses. In the 4- to 14-year subgroup, a low parental educational level had a protective effect (relative risk 0.50, 95% CI 0.29-0.84), and the effect of crowding nearly disappeared. In the 15- to 29-year subgroup, neither crowding nor parental educational level was clearly associated with the incidence of T1DM.

Conclusions: We provide evidence of heterogeneity by age at onset of the association between early-life socioeconomic indicators and the risk of T1DM. This finding is consistent with the hypothesis that infectious agents in the perinatal period may increase the risk, whereas in the following years they may become protective factors (hygiene hypothesis).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jpeds.2012.09.010DOI Listing
March 2013

The impact of adherence to screening guidelines and of diabetes clinics referral on morbidity and mortality in diabetes.

PLoS One 2012 3;7(4):e33839. Epub 2012 Apr 3.

Metabolism and Diabetes Unit, ASL TO5, Regione Piemonte, Chieri, Italy.

Despite the heightened awareness of diabetes as a major health problem, evidence on the impact of assistance and organizational factors, as well as of adherence to recommended care guidelines, on morbidity and mortality in diabetes is scanty. We identified diabetic residents in Torino, Italy, as of 1st January 2002, using multiple independent data sources. We collected data on several laboratory tests and specialist medical examinations to compare primary versus specialty care management of diabetes and the fulfillment of a quality-of-care indicator based on existing screening guidelines (GCI). Then, we performed regression analyses to identify associations of these factors with mortality and cardiovascular morbidity over a 4 year-follow-up. Patients with the lowest degree of quality of care (i.e. only cared for by primary care and with no fulfillment of GCI) had worse RRs for all-cause (1.72 [95% CI 1.57-1.89]), cardiovascular (1.74 [95% CI 1.50-2.01]) and cancer (1.35 [95% CI 1.14-1.61]) mortality, compared with those with the highest quality of care. They also showed increased RRs for incidence of major cardiovascular events up to 2.03 (95% CI 1.26-3.28) for lower extremity amputations. Receiving specialist care itself increased survival, but was far more effective when combined with the fulfillment of GCI. Throughout the whole set of analysis, implementation of guidelines emerged as a strong modifier of prognosis. We conclude that management of diabetic patients with a pathway based on both primary and specialist care is associated with a favorable impact on all-cause mortality and CV incidence, provided that guidelines are implemented.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0033839PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3317933PMC
August 2012

Determinants of quality in diabetes care process: The population-based Torino Study.

Diabetes Care 2009 Nov 12;32(11):1986-92. Epub 2009 Aug 12.

Epidemiology Unit, ASL TO3, Regione Piemonte, Grugliasco, Italy.

Objective: To investigate the role of clinical and socioeconomic variables as determinants of adherence to recommended diabetes care guidelines and assess differences in the process of care between diabetologists and general practitioners.

Research Design And Methods: We identified diabetic residents in Torino, Italy, as of 31 July 2003, using multiple independent data sources. We collected data on several laboratory tests and specialist medical examinations registered during the subsequent 12 months and performed regression analyses to identify associations with quality-of-care indicators based on existing guidelines.

Results: After 1 year, only 35.8% of patients had undergone a comprehensive assessment. In the multivariate models, factors independently and significantly associated with lower quality of care were age >or=75 years (prevalence rate ratio [PRR] 0.66 [95% CI 0.61-0.70]) and established cardiovascular disease (0.89 [0.86-0.93]). Disease severity (PRR for insulin-treated patients 1.45 [1.38-1.53]) and diabetologist consultation (PRR 3.34 [3.17-3.53]) were positively associated with high quality of care. No clear association emerged between sex and socioeconomic status. These differences were strongly reduced in patients receiving diabetologist care compared with patients receiving general practitioner care only.

Conclusions: Despite widespread availability of guidelines and simple screening procedures, a nonnegligible portion of the diabetic population, namely elderly individuals and patients with less severe forms of the disease, are not properly cared for. As practitioners in diabetes centers are more likely to adhere to guidelines than general practitioners, quality in the diabetes care process can be improved by increasing the intensity of disease management programs, with greater participation by general practitioners.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2337/dc09-0647DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2768191PMC
November 2009

Toward a needs based mechanism for capitation purposes in Italy: the role of socioeconomic level in explaining differences in the use of health services.

Int J Health Care Finance Econ 2010 Mar 14;10(1):29-42. Epub 2009 Jun 14.

Epidemiology Unit, Piemonte Region, Via Sabaudia, 164, 10095, Grugliasco, TO, Italy.

The paper investigated differences in the use of hospital care, out-patient care and pharmaceutical care in Piemonte, a region of northern Italy with 4,000,000 inhabitants, taking into account factors of need and supply, for capitation purposes. The study used a geographical design, with the municipalities as statistical units, and was based on integrated data from health and health service information systems, the population census and on the geographical distances among municipalities. Hierarchical regression models were fitted with the utilisation of services as the outcome variable and a set of direct and indirect factors of need and supply indicators as covariates. Higher health service consumption rates were observed for the most disadvantaged employment categories, in addition to the elderly. Distance from hospital was inversely correlated with the hospitalisation rate. A formula for determining capitation can be developed using age and indirect factors of need as weights.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10754-009-9069-zDOI Listing
March 2010

[Acute stroke incidence estimated using a standard algorithm based on electronic health data in various areas of Italy].

Epidemiol Prev 2008 May-Jun;32(3 Suppl):38-45

Laziosanita Agenzia di sanita pubblica.

Aim: to define an algorithm and implement it in various areas of Italy, in order to evaluate acute stroke incidence through current databases.

Setting: Lazio, Tuscana , Venezia AULSS 12, Torino ASL 5.

Participants: resident-based population in the above mentioned 4 areas during 2002-2004.

Main Outcome: Annual and triennal incidence rate (crude and standardized per 100,000 inhabitants with 95% CI) by sex and age classes (0-14, 15-34, 35-54, 55-64, 65-74, 75-84, 85+), standardized rate of mortality by sex and areas.

Methods: acute stroke incident cases during 2002-2004 in the 4 Italian areas were identified through hospitalization databases (SDO) and death causes (CM). The selection was made including hospitalization cases (no outpatients) and deceased people with a discharge or death code ICD9-CM 430*, 431*, 434*, 436* with no hospitalization for stroke diagnosis in the previous 60 months. Moreover, patients with 438* codes in secondary diagnoses and patients with hospital discharge from rehabilitation or long-hospital units were excluded.

Results: men have a higher crude incidence rate than women (+30%). The age-specific rates show a large variability among the areas for elderly people (65+ for men and 75+ for women), with higher rates in Toscana in both genders (cases per 100,000 inhabitants: 260.1 men; 193.1 women). Intermediate values were found in Torino and in Lazio; the lowest values are reported in Venezia (men: 182.5; women: 1368). Standardized mortality rates also present higher mortality levels in the two regional areas (Lazio and Toscana) and lower levels in the two urban areas (Torino and Venezia).

Conclusions: It is not easy to evaluate the algorithm. Results seem compatible enough with other studies and show a certain consistency with current mortality data. Different socio-economical characteristics could account for differences in the estimated incidence among areas. However, diferences in the quality indicators suggest that a validation study with standardized diagnostic criteria will make quality evaluation of the algorithm possible.
View Article and Find Full Text PDF

Download full-text PDF

Source
December 2008

[Acute myocardial infarction incidence estimated using a standard algorithm based on electronic health data in different areas of Italy].

Epidemiol Prev 2008 May-Jun;32(3 Suppl):30-7

Unità di epidemiologia, Azienda sanitaria 10, Firenze.

Aim: to define and implement an algorithm, based on current databases, in order to estimate acute myocardial infarction (AMI) incidence in six Italian areas.

Setting: Local Health Units of Firenze and Venezia, and the municipalities of Pisa, Roma, Taranto, and Torino.

Participants: residents in the above mentioned six areas in the period 2002-2004, for a total of about 4,447,000 subjects (30th June 2003).

Methods: acute myocardial infarction incident cases were identified through hospitalization databases and causes of death. Hospital discharges (excluding outpatient discharges) with ICD9-CM code 410* as primary discharge diagnosis, or as secondary diagnosis when associated with selected codes suggestive of ischemic symptoms in primary diagnosis, and deaths with the ICD9-CM code 410* as underlying cause were selected. Patients without a previous hospitalization for ICD9-CM codes 410* and 412* during the previous 60 months were considered as incident cases. Crude, age-specific and age-standardized incidence rates (standard: total Italian population at the 2001 census) were calculated. A number of data quality indicators were also evaluated.

Results: age-standardized incidence rates show different levels of incidence in the areas included in the study. Both for males and females, higher incidence is observed in Rome and Turin (males: respectively 260.5 and 260.2 cases/100,000; females: 105.6 cases/100,000 in both areas). The lowest incidence is observed in Taranto (males: 219.5 cases/100,000; females: 87.0 cases/100,000). Quality indicators suggest a good comparability of incidence estimates among the studied areas. In particular, in both genders, the differences observed in the incidence rates are consistent with the differences of current AMI mortality rates.

Conclusions: although limitations in data comparability among the studied areas and in the quality of disease coding cannot be completely excluded, results suggest that the algorithm we used provides estimates of AMI incidence rates comparable among the studied areas. Only a validation study with standardized criteria will make it possible to more closely evaluate the diagnostic quality and comparability of AMI cases identified through this algorithm.
View Article and Find Full Text PDF

Download full-text PDF

Source
December 2008

[Ischemic heart disease prevalence estimated using a standard algorithm based on electronic health data in various areas of Italy].

Epidemiol Prev 2008 May-Jun;32(3 Suppl):22-9

Unità di epidemiologia, Azienda sanitaria 10, Firenze, Italy.

Aim: to define an algorithm to estimate prevalence of ischemic heart disease from health administrative datasets.

Setting: four Italian areas: Venezia, Treviso, Torino, Firenze.

Participants: resident population in the four areas in the period 2002-2004 (only 2003 for Firenze) for a total of 2,350,000 inhabitants in 2003.

Main Outcomes: annual crude and standardized prevalence rate (x100 inhabitants), 95% confidence intervals by area. Quality (comparability and coherence) indicators are also reported

Methods: the algorithm is based on record linkage of hospital discharges (SDO), pharmacological prescriptions (PF), exemptions from health-tax exemptions (ET) and causes of mortality (CM). From SDO we extracted discharges for ICD9-CM codes 410*-414* in all diagnoses in the estimation year and during the four years immediately preceding. We selected from PF subjects with at least two prescriptions of organic nitrates (ATC = C01DA*) in the estimation year. From ET subjects with a new exemption for ischemic heart disease (002.414) or who obtained exemption in the three years preceding, were selected. We also considered all deaths in the year for ischemic heart disease (ICD9 CM 410-414). Cases were defined as ischemic heart disease prevalent cases if they were extracted at least once from one of the datasets and if they were alive on January 1 of the estimation year.

Results: estimated crude prevalence ranges from 2.5 to 4%. The standardized prevalence led to a narrower range of values (2.8-3.3%). Venezia and Firenze show a higher standardized prevalence in both sexes (men 4.7% and 4.4%; women 2.3% and 2.2% respectively); Treviso and Torino present a lower standardized prevalence (men: 3.9%; women: 1.9%). The hospital discharges are the main source to identify prevalent subjects (34-48% of subjects are solely identified by SDO), pharmacological prescriptions are a relevant source in Firenze and Torino (27-28%), while they are less relevant in Venezia and Treviso (13-15%). ET shows a different contribution to prevalent case identification in the four areas: Venezia (8%), Treviso (3.2%), Firenze (1.3%), whereas in Torino this source was not available at all. Subjects classified as prevalent cases only through causes of death are less than 2%. The percentage of subjects simultaneously identified by multiple sources is high in Venezia (43%) and low in Torino (30%).

Conclusions: patterns in use of pharmaceuticals and exemptions from prescription charges appear to be heterogeneous in the different areas under study. These two aspects make a proper comparison between areas difficult. The algorithm could be applied only in areas with a similar use of organic nitrates and with a good comparability of the exemptions dataset.
View Article and Find Full Text PDF

Download full-text PDF

Source
December 2008

Management of acute ST-elevation myocardial infarction in the coronary care units of Piedmont in 2005: results from the PRIMA regionwide survey.

J Cardiovasc Med (Hagerstown) 2008 Feb;9(2):169-77

Catheterisation Laboratory, S. Croce Hospital, Cuneo, Italy.

Objective: In Piedmont (north-western Italy) a network for emergency treatment of acute ST-elevation myocardial infarction is being implemented. To provide a baseline for care assessment and quality improvement, a regionwide survey was conducted. We describe the clinical characteristics, treatment and outcomes of patients admitted to the coronary care units (CCUs) of the Regional Health System.

Methods: All patients with acute ST-elevation myocardial infarction <12 h of symptom onset, admitted to any of the 31 CCUs (13 with full-time interventional facilities) between February and May 2005, were enrolled in the study.

Results: Of 818 patients (28.1% female, mean age 66 +/- 12 years), 14.3% had diabetes mellitus and 39.7% anterior myocardial infarction; 77% had their first medical contact within 3 h of symptom onset, and 53% reached full-time interventional CCUs. The 118 emergency medical system was used by 50% of patients. Median door-to-electrocardiogram time was 9 min (<10 min in 60%). Reperfusion treatment was attempted in 682 patients (83.4%) as follows: lysis in 254 (31.1%), lysis-angioplasty in 95 (11.6%), and primary angioplasty in 333 (40.7%); 136 patients (16.6%) received no reperfusion treatment. Median door-to-needle time was 35 min (<30 min in 43%). Emergency angioplasty was performed on site in 356 patients, with a median door-to-balloon time of 84 min (<90 min and <60 min in 50% and 23%, respectively). Emergency transfer to a full-time interventional centre was required in 93 patients (24% of candidates), regardless of their risk profile, with median decision-to-door out and travel times of 45 min and 52 min, respectively. In-hospital death, reinfarction and stroke occurred in 62 (7.6%), 13 (1.6%) and 10 patients (1.2%), respectively. Mortality was 5.9% and 16.7% in patients with and without reperfusion treatment, respectively. At multivariate analysis, the type of reperfusion treatment was not a predictor of mortality, whereas this was the case for the absence of reperfusion treatment (odds ratio 2.16; 95% confidence interval 1.17-4.02), TIMI risk index >33 (odds ratio 6.78; 95% confidence interval 3.70-12.40), and chronic renal failure (odds ratio 4.96; 95% confidence interval 1.82-13.55).

Conclusions: In Piedmont, candidates for myocardial reperfusion treatment admitted to the CCUs of the Regional Health System are about 600 per million inhabitants/year. The 118 emergency medical system is used by about half of them, and medical contact occurs within 3 h of symptom onset in most cases. Use of reperfusion treatment is frequent, the choice is related to on-site availability rather than to risk profile, and door-to-treatment times can be improved. Use of emergency transfer is limited, poorly selected, and slow.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2459/JCM.0b013e3281ac210cDOI Listing
February 2008
-->