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

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

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

Kojiro Morita

出版者

Society for Clinical Epidemiology

雑誌

Annals of Clinical Epidemiology (ISSN:24344338)

巻号頁・発行日

vol.3, no.4, pp.97-100, 2021 (Released:2021-10-01)

参考文献数

11

被引用文献数

2

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Survival analysis is often used in studies of clinical epidemiology, but the existence of competing risks has not been adequately considered. Competing risks may hinder observation of the outcome of interest or modify the occurrence of the outcome. In the presence of competing risks, conventional survival analysis leads to biased results. To conduct a survival analysis in the presence of competing risks, researchers should select an appropriate method from the following two options: cause-specific hazard model and subdistribution hazard model. This article explains the issues raised by the presence of competing risks and describes methods to account for competing risks in survival analysis.