著者

Hideo Yasunaga

出版者

Society for Clinical Epidemiology

雑誌

Annals of Clinical Epidemiology (ISSN:24344338)

巻号頁・発行日

vol.2, no.2, pp.33-37, 2020 (Released:2020-04-28)

参考文献数

27

被引用文献数

9 35

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Propensity score is defined as the probability of each individual being assigned to the treatment group. Propensity score analysis has recently become the sine qua non of comparative effectiveness studies using retrospective observational data. The present report provides useful information on how to use propensity score analysis as a tool for estimating treatment effects with observational data, including (i) assumptions for propensity score analysis, (ii) how to estimate propensity scores and evaluate propensity score distribution, and (iii) four methods of using propensity scores to control covariates: matching, adjustment, stratification, and inverse probability of treatment weighting.

著者

So Sato Hideo Yasunaga

出版者

Society for Clinical Epidemiology

雑誌

Annals of Clinical Epidemiology (ISSN:24344338)

巻号頁・発行日

vol.5, no.2, pp.58-64, 2023 (Released:2023-04-01)

参考文献数

31

被引用文献数

2

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BACKGROUNDAdministrative claims databases are increasingly being used worldwide for research purposes. We reviewed original published articles that used one of the four nationwide administrative claims databases in Japan: the National Database of Health Insurance Claims and Specific Health Checkups (NDB), NDB Open Data, the JMDC Claims Database, and the Diagnosis Procedure Combination (DPC) database.METHODSStudies published from January 2010 to July 2022 using the JMDC and DPC databases, and from January 2013 to July 2022 using the NDB and NDB Open Data were identified using PubMed. The number of original articles was divided into 19 fields. The annual growth rate of the number of studies was calculated using the four databases.RESULTSOverall, 1047 studies were included (95 for the NDB, 31 for the NDB Open Data, 222 for the JMDC database, and 699 for the DPC databases). Studies using one of these four databases increased from around 2010, and the average annual growth rate was approximately 41% from 2010 to 2021. DPC database studies had a higher proportion of articles on surgery (19.2%), urology (3.0%), neurosurgery (6.2%), anesthesiology (1.9%), and emergency medicine (14.0%), whereas the NDB and JMDC data had higher proportions of those regarding internal medicine.CONCLUSIONSSince 2010, these four databases have increasingly attracted attention, and the number of studies using them has grown rapidly. Our review suggests that each has unique features, and researchers should understand the database characteristics to operate their studies.

著者

Daisuke Shigemi Hiroki Matsui Kiyohide Fushimi Hideo Yasunaga

出版者

Society for Clinical Epidemiology

雑誌

Annals of Clinical Epidemiology (ISSN:24344338)

巻号頁・発行日

vol.1, no.1, pp.11-17, 2019 (Released:2020-06-12)

参考文献数

23

被引用文献数

2

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BACKGROUNDAnti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is an autoimmune disease with multiple neurologic symptoms with or without a tumor, including ovarian teratoma. In the present study, a national inpatient database in Japan was used to investigate the characteristics, treatment, and outcomes of hospitalized patients with anti-NMDAR encephalitis who received initial treatment.METHODSUsing the Diagnosis Procedure Combination database, we identified all patients who were diagnosed with anti-NMDAR encephalitis and received initial first-line treatments (methylprednisolone, intravenous immunoglobulin, plasma exchange, and tumor removal) and second-line treatments (cyclophosphamide and rituximab) from July 2010 to March 2017. We excluded patients who received no immunotherapy or surgical treatment and those for whom data were missing. We investigated the characteristics, treatment, and outcomes of eligible patients.RESULTSIn total, 163 eligible patients were identified. Of these patients, 116 (71%) were female and 44 (28%) were ≤19 years of age. Among the female patients, 44 (38%) had a tumor. Thirty-nine patients (24%) were admitted to the intensive care unit during their hospitalization. Methylprednisolone, intravenous immunoglobulin, and plasma exchange were used as initial therapy in 82%, 56%, and 34% of patients, respectively. Second-line treatments were rarely used. Most patients were alert or had a slight disturbance of consciousness upon discharge. The proportion of patients discharged to home was 55%.CONCLUSIONSThe results of this Japanese study on anti-NMDAR encephalitis suggest that patients’ characteristics and outcomes including the male-to-female ratio, proportion of associated tumors, treatment options, and consciousness disturbance may differ from those in previous reports from other countries.

著者

Naoki Hirose Miho Ishimaru Kojiro Morita Hideo Yasunaga

出版者

Society for Clinical Epidemiology

雑誌

Annals of Clinical Epidemiology (ISSN:24344338)

巻号頁・発行日

vol.2, no.1, pp.13-26, 2020 (Released:2020-05-14)

参考文献数

95

被引用文献数

7 40

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BACKGROUNDElectronic health databases are increasingly used for research purposes. The Japanese National Database of Health Insurance Claims and Specific Health Checkups (NDB) is a large national administrative claims database. We reviewed published original articles that used the NDB.METHODSStudies published from January 2011 to June 2019 using the NDB were identified through PubMed and the academic product lists of the NDB, following the PRISMA guidelines.RESULTS68 studies were included in our review (43 were in English and 25 were in Japanese). The first NDB study in English was published in 2015, which was 4 years after the NDB was released for research purposes. The average annual growth rate of the number of NDB studies in English was 237% after the first publication of an NDB study in English. Descriptive studies were the most common study design (n = 42), and the Clinical Medicine was the most common research area (n = 18). The study strength most frequently mentioned by authors of the NDB studies was the large sample size. In terms of limitations, authors most frequently mentioned the lack of important data and validation studies.CONCLUSIONSSince its release, the NDB has increasingly attracted attention, and the number of studies using the NDB has grown rapidly. The large sample size and wide array of health care data in the NDB enabled researchers to conduct health service research in various research areas with several study designs. Finally, our review suggests to policy makers that administrative database should be constructed and managed with the environment which promote researchers access to the database and link it to other databases. Although the protection of respondents’ privacy should be carefully considered, higher accessibility and data linkage may maximize the potential of the administrative database and may enable researchers to produce more valuable health service researches for policy making in health care.

著者

Akira Okada Hideo Yasunaga

出版者

Japan Medical Association / The Japanese Associaiton of Medical Sciences

雑誌

JMA Journal (ISSN:2433328X)

巻号頁・発行日

vol.5, no.2, pp.190-198, 2022-04-15 (Released:2022-05-16)

参考文献数

13

被引用文献数

8

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Introduction: Noncommunicable diseases (NCDs) are an ongoing public health problem globally. The present study aimed to estimate the prevalence of NCDs in Japan using a newly developed, commercially available administrative claims database covering young, middle-aged, and elderly people.Methods: We compared the age-stratified population distribution between the DeSC administrative claims database and the population estimates. We calculated the 1 year prevalence of several NCDs using the DeSC database and compared the prevalence of diabetes mellitus and hypertension between the DeSC database and the Japan National Health and Nutrition Survey.Results: The age distribution of the population included in the DeSC database was similar to that of the population estimates. The estimated prevalence rates were as follows: diabetes mellitus (12.2%), hypertension (20.9%), ischemic heart disease (5.6%), heart failure (5.3%), cerebral infarction (3.4%), stroke (3.7%), gastric cancer (0.6%), colorectal cancer (0.8%), breast cancer (1.5%), prostate cancer (0.6%), cataract (7.1%), depression (3.5%), and osteoporosis (6.3%). The estimated prevalence of diabetes and hypertension was comparable with that of the National Health and Nutrition Survey.Conclusions: The distribution of age and sex in the database was comparable with that of the population estimates. The prevalence of diabetes mellitus and hypertension was comparable with that in a previously reported national survey. Our data can be utilized as basic information for policymaking in clinical medicine and public health in Japan.

著者

Takaaki Konishi Haruhi Inokuchi Hideo Yasunaga

出版者

Society for Clinical Epidemiology

雑誌

Annals of Clinical Epidemiology (ISSN:24344338)

巻号頁・発行日

pp.24001, (Released:2023-06-10)

被引用文献数

4

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In Japan, a public long-term care insurance system was launched in 2000. Residents can receive long-term care according to their care needs, as determined by a nationally standardized certification system. The present report describes the details of the long-term care services covered by public insurance. The Long-Term Care Insurance Act categorizes services into three major types: in-home, nursing-home, and community-based long-term care services. In-home care services include visiting, commuting, short-stay, and other services. Welfare, health, and medical facilities provide nursing-home care services for the elderly. Community-based care services were categorized into visiting, commuting, nursing-home, and composite services.

著者

Shotaro Aso Hideo Yasunaga

出版者

Society for Clinical Epidemiology

雑誌

Annals of Clinical Epidemiology (ISSN:24344338)

巻号頁・発行日

vol.2, no.3, pp.69-74, 2020 (Released:2020-07-01)

参考文献数

19

被引用文献数

7 16

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In theory, instrumental variable (IV) analysis, like randomized controlled trials, can adjust for measured and unmeasured confounders. IVs need to meet the following three conditions: (i) they are associated with treatment assignment; (ii) they have no direct association with the outcome and are associated with the outcome exclusively through the treatment; and (iii) they are not associated with any of the measured confounders. Studies have presented several types of IV, including preferences of the facility or physician, differential distance, and days of the week. Two types of estimation method have been introduced: two-stage least squares and two-stage residual inclusion. The assumption of monotonicity limits the generalizability of estimates of causal effects in IV analysis because the target population of IV analysis is “compliers” (those who always comply with the assigned treatment). IV analysis using two or more IVs is feasible but requires the overidentifying restriction test. Despite several limitations, IV analysis is a feasible option that may be used for causal inference in comparative effectiveness studies using retrospective observational data.

著者

Satoshi Kutsuna Hiroyuki Ohbe Naoki Kanda Hiroki Matsui Hideo Yasunaga

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

pp.JE20230178, (Released:2023-12-16)

参考文献数

24

被引用文献数

1

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Background: Legionella pneumonia, a severe form of pneumonia, is caused by Legionella bacteria. The epidemiology of Legionnaires' disease in Japan, including seasonal trends, risk factors for severe disease, and fatality rates, is unclear. This study examined the epidemiology of Legionella pneumonia in Japan.Methods: This retrospective cohort study included data of adult patients hospitalized for Legionella pneumonia (identified using the ICD-10 code, A481) in the Japanese Diagnosis Procedure Combination inpatient database, from April 2011 to March 2021. We performed multivariable logistic regression analysis to explore the prognostic factors of in-hospital mortality.Results: Of 7370 enrolled hospitalized patients from 1140 hospitals (male, 84.4%; aged >50 years, 87.9%), 469 (6.4%) died during hospitalization. The number of hospitalized patients increased yearly, from 658 in 2016 to 975 in 2020. Multivariable logistic regression analysis revealed that higher in-hospital mortality was associated with older age, male sex, lower body mass index, worsened level of consciousness, comorbidities (congestive heart failure, chronic renal diseases, and metastasis), hospitalization from November to May, and ambulance use. However, lower in-hospital mortality was associated with comorbidity (liver diseases), hospitalization after 2013, and hospitalization in hospitals with higher case volume.Conclusions: The characterized epidemiology of Legionella pneumonia in Japan revealed a high mortality rate of 6.4%. To the best of our knowledge, this is the first study to demonstrate a higher mortality rate in winter and in patients with congestive heart failure and metastasis. Further research is needed to understand the complex interplay between the prognostic factors of Legionella pneumonia.

著者

Hidehiro Kaneko Hidetaka Itoh Haruki Yotsumoto Hiroyuki Kiriyama Tatsuya Kamon Katsuhito Fujiu Kojiro Morita Nobuaki Michihata Taisuke Jo Hiroyuki Morita Hideo Yasunaga Issei Komuro

出版者

The Japanese Circulation Society

雑誌

Circulation Reports (ISSN:24340790)

巻号頁・発行日

vol.2, no.8, pp.393-399, 2020-08-07 (Released:2020-08-07)

参考文献数

30

被引用文献数

15 19

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Background:Although the aged population is increasing in developed countries, clinical evidence on super-elderly heart failure (HF) patients is scarce. This study determined the characteristics and outcomes of Japanese hospitalized super-elderly HF patients (aged ≥90 years) using a nationwide inpatient database.Methods and Results:A comprehensive analysis was performed of 447,818 HF patients in the Diagnosis Procedure Combination database who were hospitalized and discharged between January 2010 and March 2018. Among the study population, 243,028 patients (54.3%) were aged ≥80 years and 64,628 patients (14.4%) were aged ≥90 years. The percentage of elderly patients increased over time. Elderly patients were more likely to be female and had a higher New York Heart Association functional class at admission. Invasive and advanced procedures were rarely performed, whereas infectious complications were more common in patients with older age. Length of hospital stay and in-hospital mortality increased with age. Multivariable logistic regression analysis fitted with a generalized estimating equation showed higher in-hospital mortality in patients aged ≥80 and ≥90 years (odds ratios 1.99 and 3.23, respectively) compared with those aged <80 years.Conclusions:The number of hospitalized super-elderly HF patients has increased, and these patients are associated with worse clinical outcomes. The results of this study may be useful in establishing an optimal management strategy for super-elderly HF patients in the era of HF pandemic.

著者

Atsushi Mizuno Hidehiro Kaneko Yuta Suzuki Akira Okada Norifumi Takeda Hiroyuki Morita Katsuhito Fujiu Koichi Node Hideo Yasunaga Issei Komuro

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-23-0292, (Released:2023-06-30)

参考文献数

13

被引用文献数

1

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Background: The applicability of the Stages of Change model for cardiovascular disease-related behaviors, such as smoking, exercise, diet, and sleep quality, is unclear.Methods and Results: Using a large-scale epidemiological dataset, we found that baseline behavior change intention, as per the transtheoretical model, was associated with modifications of unhealthy lifestyles including cigarette smoking, physical inactivity, skipping breakfast, and poor sleep quality.Conclusions: Our results suggest that an individual’s motivation to change assessed by a general questionnaire may contribute to lifestyle modification and potentially prevent subsequent cardiovascular disease.

著者

Hayato Yamana Sachiko Ono Nobuaki Michihata Taisuke Jo Hideo Yasunaga

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.5012-20, (Released:2020-07-21)

参考文献数

23

被引用文献数

14

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Objective Kampo is a traditional Japanese medicine using formulae of natural agents. Although Kampo is widely practiced, information regarding the current prescriptions of Kampo formulations is lacking. The aim of the study was to describe the outpatient use of Kampo formulations in the current Japanese health insurance system. Methods From the JMDC Claims Database, we identified subscribers with outpatient prescriptions of Kampo extract formulations between April 2017 and March 2018. Prescription records were summarized at the individual level to describe the pattern of each formula's use, such as the frequency of prescription and the number of days within a year that were covered by the prescriptions. We also examined whether or not Kampo formulations were prescribed in combination with other drugs. Results Of the 4.5 million subscribers, 13.5% received prescriptions of Kampo extracts within 1 year, and 54% of Kampo users were women. The most commonly prescribed Kampo formulae included kakkonto, shoseiryuto, and maoto, which were used for the short term covering a median of 5 to 7 days. There were also several formulae that were prescribed for longer periods. The median numbers of days covered by kamishoyosan and keishibukuryogan were 60 and 56, respectively. Kampo formulations were used in combination with Western drugs in 85% of prescriptions. Conclusion Kampo formulations are commonly prescribed under the Japanese insurance system and are frequently used in combination with Western drugs. The pattern of prescriptions varied across different formulae.

著者

Gojiro Nakagami Kojiro Morita Hiroki Matsui Hideo Yasunaga Kiyohide Fushimi Hiromi Sanada

出版者

Society for Clinical Epidemiology

雑誌

Annals of Clinical Epidemiology (ISSN:24344338)

巻号頁・発行日

vol.2, no.2, pp.38-50, 2020 (Released:2020-04-28)

参考文献数

31

被引用文献数

2 7

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BACKGROUNDSThe presence of pressure injuries may affect patient discharge destination; however, no related large-scale survey has been conducted in Japan. This study aimed to evaluate the association between pressure injury status and discharge to home from Japanese acute-care hospitals.METHODSThis retrospective observational cohort study used the Japanese Diagnosis Procedure Combination database from July 1 to 31, 2014. We assessed 340,124 inpatients aged 65 years or older admitted from home. To examine the association between pressure injury status (none, healed, healing, stable, worsened, or developed) and home discharge, we employed multivariable logistic regressions; these were adjusted for patient characteristics and within-hospital clustering using generalized estimating equations.RESULTSThe prevalence of pressure injuries on admission was 1.9%; the overall proportion of hospital-acquired pressure injuries was 1.1%. The logistic regression analyses showed patients with superficial or deep pressure injuries were less likely to be discharged to home. Furthermore, poor pressure injury status (developed < worsened < stable < healing < healed) was associated with lower likelihood of discharge to home.CONCLUSIONSPoor pressure injury status negatively affected hospital discharge destination among elderly patients admitted from home.

著者

Michimasa Fujiogi Nobuaki Michihata Hiroki Matsui Kiyohide Fushimi Hideo Yasunaga Jun Fujishiro

出版者

Society for Clinical Epidemiology

雑誌

Annals of Clinical Epidemiology (ISSN:24344338)

巻号頁・発行日

vol.2, no.2, pp.61-68, 2020 (Released:2020-04-28)

参考文献数

23

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BACKGROUNDOmphalocele is frequently detected prenatally worldwide. Nevertheless, little is known about patient demographics, practice pattern and outcomes.METHODSWe examined patient demographics, treatment options, and outcomes for patients with omphalocele with and without severe chromosomal abnormalities (trisomy 13 and 18), July 2010–March 2016, using a nationwide database in Japan.RESULTSOf 399 patients with omphalocele, 89 had trisomy 13 or 18. The average birthweight was 2,449 g, and the average gestational age was 35 weeks; 65% had other congenital associated anomalies, including circulatory and chromosomal anomalies. About 85% of the patients received abdominoplasty. The median length of mechanical ventilation was 5 (0–30) days. The median length of stay (interquartile range) was 45 (21–94) days. Overall, 52% of the patients were discharged to home without home medical care; this percentage was 65% among those without trisomy 13 or 18. In-hospital mortality was 20% for the total sample of patients, while it was 49% for those with trisomy 13 or 18.CONCLUSIONSThe present study revealed the patient demographics, treatment practices, and discharge status of infants with omphalocele in Japan. This information is useful in aiding decision making on therapeutic strategies by medical staffs and the families of patients with omphalocele.

著者

Yuki Miyamoto Hiroyuki Ohbe Miho Ishimaru Hiroki Matsui Kiyohide Fushimi Hideo Yasunaga

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.4308-19, (Released:2020-04-23)

参考文献数

13

被引用文献数

5

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Objective Carbazochrome sodium sulfonate (CSS) has been routinely used to treat bleeding; however, no study has examined the effect of CSS for gastrointestinal bleeding. Therefore, we aimed to investigate the effect of CSS for colonic diverticular bleeding. Methods We performed a nationwide observational study using the Japanese Diagnosis Procedure Combination inpatient database. We identified patients who were admitted for diverticular bleeding from July 2010 to March 2018. Patients who received CSS on the day of admission were defined as the CSS group, and those not receiving CSS were defined as the control group. The primary outcome was in-hospital mortality. Secondary outcomes were length of stay, total costs, and blood transfusion within 7 days of admission. Propensity score matching analyses were performed to compare outcomes between the two groups. Results A total of 59,965 patients met our eligibility criteria. Of these, 14,437 (24%) patients received CSS on the day of admission. One-to-one propensity score matching created 14,379 matched pairs. There was no significant difference in the in-hospital mortality between the CSS and control groups (0.6% vs. 0.5%, respectively; odds ratio: 0.96; 95% confidence interval: 0.72-1.29). The length of stay was longer in the CSS group than in the control group (11.4 vs. 11.0 days, respectively; difference: 0.44; 95% confidence interval: 0.14-0.73). There were no significant differences in the total costs or the proportion of patients receiving blood transfusion between the groups. Conclusions CSS may not reduce in-hospital mortality, length of stay, total costs, or the need for blood transfusion in patients with colonic diverticular bleeding.

著者

Hayato Yamana Akira Okada Sachiko Ono Nobuaki Michihata Taisuke Jo Hideo Yasunaga

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

pp.JE20220089, (Released:2023-01-14)

参考文献数

15

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Background: Despite the widespread practice of Japanese traditional Kampo medicine, the characteristics of patients receiving various Kampo formulations have not been documented in detail. We applied a machine learning model to a health insurance claims database to identify the factors associated with the use of Kampo formulations.Methods: A ten-percent sample of enrollees of the JMDC Claims Database in 2018 and 2019 was used to create the training and testing sets, respectively. Logistic regression with lasso regularization were performed in the training set to construct models with prescriptions of 10 commonly used Kampo formulations in one year as the dependent variable and data of the preceding year as independent variables. Models were applied to the testing set to calculate the C-statistics. Additionally, the performance of simplified scores using 10 or 5 variables were evaluated.Results: There were 338,924 and 399,174 enrollees in the training and testing sets, respectively. The commonly prescribed Kampo formulations included kakkonto, bakumondoto, and shoseityuto. Based on the lasso models, the C-statistics ranged from 0.643 (maoto) to 0.888 (tokishakuyakusan). The models identified both the common determinants of different Kampo formulations and the specific characteristics associated with particular Kampo formulations. The simplified scores were slightly inferior to full models.Conclusions: Lasso regression models showed good performance for explaining various Kampo prescriptions from claims data. The models identified the characteristics associated with Kampo formulation use.

著者

Taisuke Jo Daisuke Shigemi Takaaki Konishi Hayato Yamana Nobuaki Michihata Ryosuke Kumazawa Akira Yokoyama Hirokazu Urushiyama Hiroki Matsui Kiyohide Fushimi Takahide Nagase Hideo Yasunaga

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.1946-23, (Released:2023-07-26)

参考文献数

24

被引用文献数

1

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Objective The effect of Rikkunshito, a Japanese herbal Kampo medicine, on chemotherapy-induced nausea and vomiting (CINV) has been evaluated in several small prospective studies, with mixed results. We retrospectively evaluated the antiemetic effects of Rikkunshito in patients undergoing cisplatin-based chemotherapy using a large-scale database in Japan. Methods The Diagnosis Procedure Combination inpatient database from July 2010 to March 2019 was used to compare adult patients with malignant tumors who had received Rikkunshito on or before the day of cisplatin administration (Rikkunshito group) and those who had not (control group). Antiemetics on days 2 and 3 and days 4 and beyond following cisplatin administration were used as surrogate outcomes for CINV. Patient backgrounds were adjusted using the stabilized inverse probability of treatment weighting, and outcomes were compared using univariable regression models. Results We identified 669 and 123,378 patients in the Rikkunshito and control groups, respectively. There were significantly fewer patients using intravenous 5-HT3-receptor antagonists in the Rikkunshito group (odds ratio, 0.38; 95% confidence interval, 0.16-0.87; p=0.023) on days 2 and 3 of cisplatin-based chemotherapy. Conclusion The reduced use of antiemetics on day 2 and beyond of cisplatin administration suggested a beneficial effect of Rikkunshito in palliating the symptoms of CINV.

著者

Takaaki Konishi Hideo Yasunaga

出版者

Society for Clinical Epidemiology

雑誌

Annals of Clinical Epidemiology (ISSN:24344338)

巻号頁・発行日

vol.5, no.1, pp.1-4, 2023 (Released:2023-01-11)

参考文献数

14

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Health technology assessment (HTA) is implemented in the decision-making process for the reimbursement and pricing of drugs and medical devices around the world. This study presented the trend and characteristics of HTA research in Japan and worldwide. HTA research increased since the 2010s. Cancer was a prominent subject and the Markov model was a major analytical model in HTA research both globally and in Japan. In Japan, osteoporosis was a more popular topic, but there were fewer surgical research and review articles compared to the global trend. Since Japanese articles on HTA were much fewer than those from the United States, the United Kingdom, and China, various types of HTA research should be encouraged in Japan to promote product innovation and optimize medical expenditures.

著者

Michimasa Fujiogi Takaaki Konishi Nobuaki Michihata Yohei Hashimoto Hiroki Matsui Tetsuya Ishimaru Kiyohide Fushimi Hideo Yasunaga Jun Fujishiro

出版者

Society for Clinical Epidemiology

雑誌

Annals of Clinical Epidemiology (ISSN:24344338)

巻号頁・発行日

pp.23004, (Released:2022-09-29)

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Background: Little is known about perioperative outcomes after pediatric thyroidectomy. This study was performed to compare perioperative outcomes between children and adults undergoing thyroid cancer surgery using a nationwide inpatient database in Japan.Methods: Using the Japanese Diagnosis Procedure Combination database, we identified patients aged 0 to 40 years with thyroid cancer who underwent thyroidectomy from July 2010 to March 2020. To compare the occurrence of in-hospital morbidities including local complications (e.g., recurrent laryngeal nerve paralysis, postoperative bleeding), duration of anesthesia, postoperative length of stay, and total hospitalization costs between children (0–18 years) and adults (19–40 years), we used multivariable logistic regression analysis for the occurrence of in-hospital morbidities and linear regression for other outcomes. Results: For 16,016 eligible patients (666 children vs. 15,350 adults), no significant differences between the two groups were found in any in-hospital morbidity (5.4% vs. 5.9%; adjusted odds ratio [OR], 0.80; 95% confidence interval [CI], 0.57–1.14; P=0.23), local complications (5.0% vs. 5.5%; OR, 0.80; 95% CI, 0.55–1.15; P=0.22), recurrent laryngeal nerve paralysis (2.1% vs. 2.4%; OR, 0.78; 95% CI, 0.45–1.35; P=0.37), or postoperative bleeding (1.7% vs. 1.4%; OR, 0.99; 95% CI, 0.53–1.87; P=0.98). Children showed a longer duration of anesthesia (difference, 20 minutes; 95% CI, 13–27; P<0.001) and higher total costs (difference, 445 US dollars; 95% CI, 239–651; P<0.001) than adults.Conclusion: This large nationwide cohort study showed no significant difference in perioperative complications between children and adults undergoing thyroid cancer surgery.

著者

Sachiko Ono Yosuke Ono Daisuke Koide Hideo Yasunaga

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

vol.30, no.3, pp.116-120, 2020-03-05 (Released:2020-03-05)

参考文献数

19

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Background: Guidelines recommend against all codeine use in children for its common indications of analgesia and cough suppression because of uncertain benefits and potential risk of death. However, because of its rarity, the occurrence of severe respiratory depression associated with codeine-containing antitussives has been poorly investigated. The objective of this study was to investigate the association between codeine-containing antitussives and severe respiratory depression in children.Methods: We retrospectively identified Japanese children who were prescribed antitussives for respiratory diseases from a large Japanese administrative claims database (JMDC, Tokyo, Japan). We collected data on baseline characteristics including age, sex, and comorbidity. Each case was matched with four controls with the same sex and age in the same year from the same type of medical institution. We then examined the association between codeine-containing antitussives and subsequent severe respiratory depression using multivariable conditional logistic regression analysis.Results: Of 164,047 children, 18,210 (11.1%) were prescribed codeine-containing antitussives. Of the children who took codeine-containing drugs, seven experienced severe respiratory depression. After adjusting for confounding factors, there was no significant difference in the proportion of severe respiratory depression between children with and without codeine-containing antitussives (odds ratio 1.15; 95% confidence interval, 0.48–2.78).Conclusion: Occurrence of respiratory depression was very rare, and the association of codeine with respiratory depression was insignificant, even in a large sample of children in Japan.

著者

Sachiko Ono Yosuke Ono Daisuke Koide Hideo Yasunaga

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

pp.JE20180224, (Released:2019-03-02)

参考文献数

19

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Background: Guidelines recommend against all codeine use in children for its common indications of analgesia and cough suppression because of uncertain benefits and potential risk of death. However, because of its rarity, the occurrence of severe respiratory depression associated with codeine-containing antitussives has been poorly investigated. The objective of this study was to investigate the association between codeine-containing antitussives and severe respiratory depression in children.Methods: We retrospectively identified Japanese children who were prescribed antitussives for respiratory diseases from a large Japanese administrative claims database (JMDC, Tokyo, Japan). We collected data on baseline characteristics including age, sex, and comorbidity. Each case was matched with four controls with the same sex and age in the same year from the same type of medical institution. We then examined the association between codeine-containing antitussives and subsequent severe respiratory depression using a multivariable conditional logistic regression analysis.Results: Of 164,047 children, 18,210 (11.1%) were prescribed codeine-containing antitussives. Of the children who took codeine-containing drugs, seven experienced severe respiratory depression. After adjusting for confounding factors, there was no significant difference in the proportion of severe respiratory depression between children with and without codeine-containing antitussives (odds ratio: 1.15; 95% confidence interval: 0.48 - 2.78).Conclusion: Occurrence of respiratory depression was very rare, and the association of codeine with respiratory depression was insignificant, even in a large sample of children in Japan.