The Impact of the Choice of Data Source in Record Linkage Studies Estimating Mortality in Venous Thromboembolism
The Impact of the Choice of Data Source in Record Linkage Studies Estimating Mortality in Venous Thromboembolism
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DOI：
10.1371/journal.pone.0148349
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发表时间：
2016-02-10
期刊：
影响因子：
3.7
通讯作者：
de Vries, Frank
中科院分区：
文献类型：
--
作者：
Gallagher, Arlene M.;Williams, Tim;de Vries, Frank
链接的电子医疗数据库越来越多地用于观察性研究。本研究的目的是研究数据源的选择对估算VTE后死亡率的影响，次要目的是研究分母定义的影响。我们使用英国临床实践研究数据链（CPRD）识别18岁以上静脉血栓栓塞（VTE）患者。确定了多个队列，以评估死亡率与一系列数据来源的差异。对于每个队列，计算每1000人年（/1000 py）的发病率和全因死亡率的相对率（RR）。当暴露（VTE）和结局（死亡）仅使用初级保健数据时，发现死亡率最低（108.4/1000 py）。在二级护理中诊断的患者死亡率最高（237.2/1000 py）。当将符合条件的患者的初级和二级医疗数据和数据收集的重叠期相关联时，发现死亡率为173.2/1000 py，不同分母定义的敏感性分析提供了一系列结果（140.6-164.3/1000 py）。所有队列中按性别和年龄列出的相对死亡率相当。根据数据来源的选择，研究的人群可能会有所不同。这可能对主要结果产生重大影响，特别是对VTE后死亡率的影响。
Linked electronic healthcare databases are increasingly being used in observational research. The objective of this study was to investigate the impact of the choice of data source in estimating mortality following VTE, with a secondary aim to investigate the influence of the denominator definition. We used the UK Clinical Practice Research Datalink (CPRD) to identify patients aged 18+ with venous thromboembolism (VTE). Multiple cohorts were identified in order to assess how mortality rates differed with a range of data sources. For each of the cohorts, incidence rates per 1,000 person years (/1000py) and relative rates (RRs) of all-cause mortality were calculated. The lowest mortality rate was found when only primary care data were used for both the exposure (VTE) and the outcome (death) (108.4/1000py). The highest mortality rate was found for patients diagnosed in secondary care (237.2/1000py). When linked primary and secondary care data were included for eligible patients and for the overlapping period of data collection, a mortality rate of 173.2/1000py was found. Sensitivity analyses varying the denominator definition provided a range of results (140.6-164.3/1000py). The relative rates of mortality by gender and age were comparable across all cohorts. Depending on the choice of data source, the population studied may be different. This may have substantial impact on the main findings, in particular on incidence rates of mortality following VTE.