The burden of clostridium difficile infection: estimates of the incidence of CDI from U.S. Administrative databases.
The burden of clostridium difficile infection: estimates of the incidence of CDI from U.S. Administrative databases.
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DOI：
10.1186/s12879-016-1501-7
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发表时间：
2016-04-22
影响因子：
3.7
通讯作者：
Dubberke ER
中科院分区：
文献类型：
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作者：
Olsen MA;Young-Xu Y;Stwalley D;Kelly CP;Gerding DN;Saeed MJ;Mahé C;Dubberke ER
许多管理数据源可用于研究传染病的流行病学，包括艰难梭菌感染 (CDI)，但很少有出版物使用类似的方法比较不同数据库的 CDI 事件发生率。我们使用多个管理数据库的可比方法来比较美国老年人和年轻人的 CDI 发病率。我们使用三个纵向数据源（Medicare、OptumInsight LabRx 和医疗保健成本和利用项目州住院数据库 (SID)）和两个医院遭遇级别数据源（全国住院患者样本 (NIS) 和 Premier Perspective 数据库）进行了一项回顾性研究，通过计算 CDI 发病率/100,000 人观察年 (pyo) 和 CDI 分类（发病和发病时间）来识别 18 岁及以上成年人中的 CDI。协会）。 CDI 的发病率范围为 65 岁以下人群 (LabRx) 的 66/100,000、老年人 (SID) 的 383/100,000 和老年人 (Medicare) 的 677/100,000。 LabRx 人群中 90% 的 CDI 发作被定性为社区发病，而 Medicare 人群中这一比例为 41%。 Medicare 和 LabRx 数据库中的大多数 CDI 发作仅根据 CDI 诊断来识别，而 Premier 医院数据中近 3/4 编码为 CDI 的病例是通过阳性检测结果加上甲硝唑或口服万古霉素治疗得到证实的。仅使用 Medicare 住院患者数据来计算遭遇级别的 CDI 事件，结果为 553 起 CDI 事件/100,000 人，几乎与使用 NIS 计算的遭遇比例（544/100,000 人）相同。我们发现，与仅缺乏门诊诊断和治疗信息的住院患者数据相比，当所有医疗索赔都用于识别 CDI 时，医疗保险数据中的 CDI 发病率高出 35%，并且由医院获取的事件较少。与老年医疗保险人群相比，私人保险的年轻 LabRx 人群中 CDI 的发病率低 10 倍，社区发病的 CDI 比例要高得多。我们开发的识别 CDI 事件的方法可供其他研究人员使用大型通用管理数据集来研究其他传染病和不良事件的发生率。本文的在线版本 (doi:10.1186/s12879-016-1501-7) 包含补充材料，可供授权用户使用。
Many administrative data sources are available to study the epidemiology of infectious diseases, including Clostridium difficile infection (CDI), but few publications have compared CDI event rates across databases using similar methodology. We used comparable methods with multiple administrative databases to compare the incidence of CDI in older and younger persons in the United States. We performed a retrospective study using three longitudinal data sources (Medicare, OptumInsight LabRx, and Healthcare Cost and Utilization Project State Inpatient Database (SID)), and two hospital encounter-level data sources (Nationwide Inpatient Sample (NIS) and Premier Perspective database) to identify CDI in adults aged 18 and older with calculation of CDI incidence rates/100,000 person-years of observation (pyo) and CDI categorization (onset and association). The incidence of CDI ranged from 66/100,000 in persons under 65 years (LabRx), 383/100,000 in elderly persons (SID), and 677/100,000 in elderly persons (Medicare). Ninety percent of CDI episodes in the LabRx population were characterized as community-onset compared to 41 % in the Medicare population. The majority of CDI episodes in the Medicare and LabRx databases were identified based on only a CDI diagnosis, whereas almost ¾ of encounters coded for CDI in the Premier hospital data were confirmed with a positive test result plus treatment with metronidazole or oral vancomycin. Using only the Medicare inpatient data to calculate encounter-level CDI events resulted in 553 CDI events/100,000 persons, virtually the same as the encounter proportion calculated using the NIS (544/100,000 persons). We found that the incidence of CDI was 35 % higher in the Medicare data and fewer episodes were attributed to hospital acquisition when all medical claims were used to identify CDI, compared to only inpatient data lacking information on diagnosis and treatment in the outpatient setting. The incidence of CDI was 10-fold lower and the proportion of community-onset CDI was much higher in the privately insured younger LabRx population compared to the elderly Medicare population. The methods we developed to identify incident CDI can be used by other investigators to study the incidence of other infectious diseases and adverse events using large generalizable administrative datasets. The online version of this article (doi:10.1186/s12879-016-1501-7) contains supplementary material, which is available to authorized users.