Impact of data source choice on multimorbidity measurement: a comparison study of 2.3 million individuals in the Welsh National Health Service.
Impact of data source choice on multimorbidity measurement: a comparison study of 2.3 million individuals in the Welsh National Health Service.
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DOI：
10.1186/s12916-023-02970-z
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发表时间：
2023-08-15
期刊：
影响因子：
9.3
通讯作者：
Guthrie, Bruce
中科院分区：
文献类型：
--
作者：
MacRae, Clare;Morales, Daniel;Mercer, Stewart W.;Lone, Nazir;Lawson, Andrew;Jefferson, Emily;McAllister, David;van den Akker, Marjan;Marshall, Alan;Seth, Sohan;Rawlings, Anna;Lyons, Jane;Lyons, Ronan A.;Mizen, Amy;Abubakar, Eleojo;Dibben, Chris;Guthrie, Bruce
研究中多重发病率的测量是可变的，包括用于确定条件的数据源的选择。我们使用不同的数据来源比较了估计的多病患病率及其与死亡率的关系。对SAIL数据库数据的横断面研究，包括2019年1月1日居住在威尔士的所有年龄段的2,340,027人。使用来自初级保健（PC）、住院病人（HI）和相关PC-HI数据源的数据比较多病患病率和构成条件47，并检查条件计数与12个月死亡率之间的关系。与仅使用HI数据相比，使用关联PC-HI数据时，多重发病更为普遍（32.2%对16.5%），并且被确定为多重发病的人群更年轻（平均年龄62.5岁对66.8岁），包括更多的女性（54.2%对52.6%）。在PC和HI数据中具有多重发病的个体与死亡率的关联比仅在HI数据中具有多重发病的个体更强(校正优势比为8.34 [95% CI 8.02-8.68] vs . 6.95 （95%CI 6.79-7.12]）。仅使用PC与仅使用HI数据确定的疾病患病率在37/47中显著高于10/47，在10/47中显著低于PC/HI比率：最高的PC/HI比率是抑郁症（14.2 [95% CI 14.1-14.4]），最低的是动脉瘤（0.51 [95% CI 0.5-0.5]）。两种数据来源在确定病情方面的一致性差异很大，5种情况的一致性为轻微（kappa < 0.20）， 12种情况的一致性为一般（kappa 0.21-0.40）， 16种情况的一致性为中等（kappa 0.41-0.60）， 12种情况的一致性为显著（kappa 0.61-0.80），精神和行为障碍的身体系统一致性最低。在PC和HI数据中都有症状的个体中，焦虑症的比例最低（4.6%），冠状动脉疾病的比例最高（62.9%）。在衡量多重发病和许多重要病症（特别是精神和行为障碍）时，使用单一数据来源可能低估了患病率。在解释使用单一数据源检查个人和多种长期条件的研究结果时应谨慎。在可能的情况下，使用电子卫生数据的研究人员应将初级保健和医院住院患者数据联系起来，以产生更有力的证据，支持多病患者的循证卫生保健规划决策。在线版本包含补充材料，可在10.1186/s12916-023-02970-z获得。
Measurement of multimorbidity in research is variable, including the choice of the data source used to ascertain conditions. We compared the estimated prevalence of multimorbidity and associations with mortality using different data sources. A cross-sectional study of SAIL Databank data including 2,340,027 individuals of all ages living in Wales on 01 January 2019. Comparison of prevalence of multimorbidity and constituent 47 conditions using data from primary care (PC), hospital inpatient (HI), and linked PC-HI data sources and examination of associations between condition count and 12-month mortality. Using linked PC-HI compared with only HI data, multimorbidity was more prevalent (32.2% versus 16.5%), and the population of people identified as having multimorbidity was younger (mean age 62.5 versus 66.8 years) and included more women (54.2% versus 52.6%). Individuals with multimorbidity in both PC and HI data had stronger associations with mortality than those with multimorbidity only in HI data (adjusted odds ratio 8.34 [95% CI 8.02-8.68] versus 6.95 (95%CI 6.79-7.12] in people with ≥ 4 conditions). The prevalence of conditions identified using only PC versus only HI data was significantly higher for 37/47 and significantly lower for 10/47: the highest PC/HI ratio was for depression (14.2 [95% CI 14.1–14.4]) and the lowest for aneurysm (0.51 [95% CI 0.5–0.5]). Agreement in ascertainment of conditions between the two data sources varied considerably, being slight for five (kappa < 0.20), fair for 12 (kappa 0.21–0.40), moderate for 16 (kappa 0.41–0.60), and substantial for 12 (kappa 0.61–0.80) conditions, and by body system was lowest for mental and behavioural disorders. The percentage agreement, individuals with a condition identified in both PC and HI data, was lowest in anxiety (4.6%) and highest in coronary artery disease (62.9%). The use of single data sources may underestimate prevalence when measuring multimorbidity and many important conditions (especially mental and behavioural disorders). Caution should be used when interpreting findings of research examining individual and multiple long-term conditions using single data sources. Where available, researchers using electronic health data should link primary care and hospital inpatient data to generate more robust evidence to support evidence-based healthcare planning decisions for people with multimorbidity. The online version contains supplementary material available at 10.1186/s12916-023-02970-z.
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