Zusammenfassung
Hintergrund
In den letzten Jahren wird verstärkt gefordert, Forschungsdaten gemäß den sog. FAIR-Prinzipien für eine Nachnutzung aufzubereiten. Dadurch könnten zukünftige Projekte auf ...einer breiteren Datengrundlage durchgeführt sowie durch Verknüpfung verschiedener Datenquellen neue Fragestellungen untersucht werden.
Fragestellung
Eruiert werden soll, inwieweit Abrechnungsdaten gesetzlicher Krankenversicherungen mit den Daten der Landeskrebsregister (LKR) überregional verknüpft werden können, um die in den Abrechnungsdaten fehlenden Informationen zu Krebserkrankungen ergänzen und die Validität der dortigen Angaben zur Tumordiagnose beurteilen zu können. Der Fokus liegt dabei auf der Beschreibung der länderspezifischen Anforderungen für einen solchen Datenabgleich.
Material und Methoden
Als Datenquellen wurden die Pharmakoepidemiologische Forschungsdatenbank GePaRD des Leibniz-Instituts für Präventionsforschung und Epidemiologie – BIPS und sechs Krebsregister herangezogen. Zur Verknüpfung wurden vergleichend das logistisch aufwendige direkte Linkage- und ein weniger aufwendiges indirektes Linkage-Verfahren angewandt. Dazu mussten für GePaRD und für jedes LKR die Genehmigungen der jeweils zuständigen Behörde eingeholt werden.
Ergebnisse
Hinsichtlich der Verknüpfung von LKR-Daten mit GePaRD zeigten sich gravierende Unterschiede in der Datenbereitstellung (vollständige Ablehnung bis hin zu einer unkomplizierten Umsetzung).
Diskussion
In Deutschland müssen einheitliche Rahmenbedingungen geschaffen werden, um eine angemessene Nachnutzung und eine Verknüpfung von personenbezogenen Gesundheitsdaten zu Forschungszwecken im Sinne der FAIR-Prinzipien zu ermöglichen. Bezüglich der Verknüpfung von LKR-Daten mit anderen Datenquellen könnte das neue Gesetz zur Zusammenführung von Krebsregisterdaten Abhilfe schaffen.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Purpose
Epidemiological and health care research frequently rely on diagnoses from routine care, but the intra‐individual stability of diagnoses of Alzheimer's disease (AD), vascular dementia (VD) or ...other forms of dementia (oD) in patients over time is understudied. More data on the diagnostic stability is needed to appraise epidemiological findings from such studies.
Methods
Using health claims data of the years 2004–2016 from the German Pharmacoepidemiological Research Database, 160 273 patients aged ≥50 with incident dementia were identified and followed for 4 years. According to the incident ICD‐10 codes patients were assigned to the categories AD, VD or oD. Changes between categories during follow‐up were calculated.
Results
Overall, 18.8% had incident AD (VD: 21.5%, oD: 59.7%). Fifteen thousand eight hundred forty‐two patients had only one dementia diagnosis during 4 years (AD: 7.4%, VD: 12.4%, oD: 9.8%). Among those with more than one diagnosis, the incident diagnosis matched the last diagnosis in 65.1% (AD), 53.9% (VD) and 73.8% (oD) of patients. Changes in the diagnostic category were higher in patients with AD (mean: 5.1) than in patients with VD (3.6) or oD (3.3). Patients with stable AD diagnoses during the observation period were younger (median: 76 vs. 79 years) and had less inpatient treatment days (median: 14 days) than patients with changes from an AD diagnosis to another category or from another category to AD (27 days).
Conclusions
While health claims data are feasible for estimating the incidence of dementia in general, the substantial number of changes in dementia diagnoses during the course of the disease warrant caution on the interpretation of epidemiological data on specific dementia types.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
The exact prevalence of psoriatic arthritis (PsA) among patients with psoriasis is still not conclusive. Data in the literature vary between 5.8 and 30 %. Objective of this study was to gain more ...information on the prevalence of PsA among patients with psoriasis in Germany. Between 09/2010 and 05/2011, consecutive patients from dermatological private practices and a university hospital with psoriasis were asked to fill out the validated German Psoriatic Arthritis Diagnostic (GEPARD) Questionnaire. Patients who answered ≥4 questions with “yes” were invited to come for a rheumatological check up. Those patients who refused a rheumatological examination were counted as “absence of PsA”. Laboratory tests for inflammatory markers as well as the severity of skin manifestations were assessed. The diagnosis of PsA was made according to the CASPAR criteria, and imaging was performed in addition. A total of 404 questionnaires were evaluated; 50.5 % answered ≥4 questions positively; 19.3 % had a history of PsA confirmed by a rheumatologist; and in 10.9 %, PsA or spondyloarthritis was newly diagnosed during the present study. This leads to an overall prevalence of PsA in patients with psoriasis of 30.2 %. The frequency of psoriatic arthritis in the present study is higher than expected from previous studies in Germany. The prevalence is consistent with findings of a large observational survey from Scandinavia. Using the CASPAR criteria and imaging in all patients, certainty of the diagnosis is very high. The GEPARD Questionnaire is a helpful tool to identify people at risk for psoriatic arthritis.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Early detection of psoriatic arthritis (PsA) remains a challenge in clinical practice. Tools such as the German Psoriasis Arthritis Diagnostic (GEPARD) questionnaire have been developed for this ...purpose. The aim of this study was to determine the performance of the GEPARD questionnaire in the detection of PsA in psoriasis patients following rheumatology evaluation in daily clinical practice in Germany. This was a multicenter study involving 59 dermatology units (university/general hospital/office based), and the GEPARD questionnaire was distributed to psoriasis patients. Patients who had a sum score of ≥4 positive answers were referred to a rheumatologist for evaluation of PsA. We recruited 1,512 patients, of whom approximately 50% were referred. One third of the referred patients were classified as having PsA after rheumatological assessment. Rates of PsA in university/general hospital settings were higher than those observed in a doctor's office-based setting (43.7 vs. 25.8%). The GEPARD questionnaire demonstrated easy screening of psoriasis patients for PsA.
Herpes zoster (HZ; shingles) is a common viral disease that affects the nerves and surrounding skin causing a painful dermatomal rash and leading to debilitating complications such as, mainly, ...post-herpetic neuralgia (PHN). Currently, there is no effective treatment for HZ and PHN. The objective of this study was to assess the cost-effectiveness of a HZ vaccination program in Germany. An existing Markov Model was adapted to the German healthcare setting to compare a vaccination policy to no vaccination on a lifetime time-horizon, considering 2 scenarios: vaccinating people starting at the age of 50 or at the age of 60 years, from the perspective of the statutory health insurance (SHI) and the societal perspective. According to the perspective, vaccinating 20% of the 60+ German population resulted in 162,713 to 186,732 HZ and 31,657 to 35,793 PHN cases avoided. Corresponding incremental cost-effectiveness ratios (ICER) were 39,306 €/QALY from the SHI perspective and 37,417 €/QALY from a societal perspective. Results for the 50+ German population ranged from 336,468 to 394,575 HZ and from 48,637 to 56,087 PHN cases avoided from the societal perspective. Corresponding ICER were 39,782 €/QALY from a SHI perspective and 32,848 €/QALY from a societal perspective. Sensitivity analyses showed that results are mainly impacted by discount rates, utility values and use of alternative epidemiological data.The model indicated that a HZ vaccination policy in Germany leads to significant public health benefits and could be a cost-effective intervention. The results were robust and consistent with local and international existing literature.
The Caucasian black grouse (CBG) is classified as “data deficient” by the IUCN. Lack of information to guide conservation measures is mainly due to the bird's elusive behaviour for much of the year ...and to its remote distribution at higher altitudes of the Caucasus Mountains. In order to fill some of the knowledge gaps, we mapped potential suitable habitat across the Turkish part of the Lesser Caucasus using a spatial regression model, and estimated the total CBG population from alternative assumptions on population density and habitat separation. The CBG model was derived from 167 CBG records obtained during a survey in representative areas of the Turkish Caucasus, in conjunction with a supervised habitat classification of satellite images and with topographic parameters calculated from a digital elevation model. In total, approx. 5,000 km² of suitable habitat were predicted to exist within the borders of Turkey, including areas where the CBG has not previously been searched for. Under conservative assumptions, this area can carry more than 4,800 individuals, which is higher than previously estimated. The predicted distribution map can be used to select priority areas for conservation and to specify additional survey locations of the species in areas, which so far have been less well sampled.
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