Existing Data Sources for Clinical Epidemiology: Database of the National Hospital Organization in Japan

Kanazawa, Natsuko; Tani, Takuaki; Imai, Shinobu; Horiguchi, Hiromasa; Fushimi, Kiyohide; Inoue, Norihiko

doi:10.2147/clep.s359072

Cited by 13 publications

(13 citation statements)

References 37 publications

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“…Individual informed consent was not required to conduct this study because the dataset was provided as anonymized data by NHO. 33 This study was approved by the Ethics Committee of Mie Hospital (Approval No. 2020-89).…”

Section: Methodsmentioning

confidence: 99%

“…MIA includes data related to patient characteristics and underlying diseases, medical interventions including oxygen administration and the use of respiratory ventilators, received therapy including administration of drugs, and outcomes such as discharge or death. 33 The database does not include data related to a patient’s vaccination history or the causative strain. For this study, we analyzed data from 60 representative NHO hospitals with available data.…”

Section: Introductionmentioning

confidence: 99%

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Risk of Underlying Diseases and Effectiveness of Drugs on COVID-19 Inpatients Assessed Using Medical Claims in Japan: Retrospective Observational Study

Mitsushima¹,

Horiguchi²,

Taniguchi³

2023

IJGM

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Background Results of earlier studies have demonstrated underlying diseases such as cancer, diabetes mellitus, immunodeficiency, hypertension and heart failure to be risk factors for severe outcomes and mortality. Furthermore, clinical trials have shown that drugs such as antiviral drugs, antibody cocktails, steroids and anti-inflammatory drugs can be expected to prevent severe COVID-19 outcomes and death. Methods This study, using inpatient records from the Medical Information Analysis Databank covering national hospital organizations in Japan, was conducted to evaluate the effects of underlying diseases and/or administered drugs on mortality. Subjects were all inpatients receiving oxygen administration and inpatients using respiratory ventilators, categorized by three age classes: all ages, patients 65 years old or older, and patients younger than 65 years old. We used logistic regression to analyze outcomes for underlying diseases, administered drugs, age, sex, the proportion of the mutated strains, and vaccine coverage. Results Patients with hypertension, except for younger inpatients, have a lower risk of mortality (estimated coefficient 0.67 among all inpatients ( p < 0.01): 0.77 among inpatients with oxygen therapy ( p = 0.02) and 0.57 among inpatients with respiratory ventilation w ( p = 0.01)). Except for younger inpatients, antibody cocktail (casirivimab/imdevimab or sotrovimab) administration was associated with a higher probability of survival (estimated coefficient 0.27 among all inpatients ( p < 0.01)). It raised the survival probability consistently, although other drugs might have reduced the probability of survival. Conclusion These findings suggest that antiviral drugs (remdesivir, estimated coefficient 1.44 ( p < 0.01)), steroids (dexamethasone, estimated coefficient 1.85 ( p < 0.01)), and anti-inflammatory drugs (baricitinib, estimated coefficient 1.62 ( p < 0.01), and tocilizumab, estimated coefficient 2.73 ( p < 0.01)) might not contribute to survival. These results have not been reported from earlier studies. More sophisticated estimation procedures, such as treatment effect models, are necessary to obtain conclusive results.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Risk of Underlying Diseases and Effectiveness of Drugs on COVID-19 Inpatients Assessed Using Medical Claims in Japan: Retrospective Observational Study

Mitsushima¹,

Horiguchi²,

Taniguchi³

2023

IJGM

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“…The NHO has been established in April 2004 and is the largest hospital organization in Japan, including general acute care hospitals and specialized long-term care hospitals. The NHO has the administrative claims database (Medical Information Analysis databank; MIA) and the clinical information database (NHO Clinical Data Archives; NCDA) [ 11 ]. The MIA is the claims database based on the Diagnosis Procedure Combination/Per-Diem Payment System (DPC/PDPS) of case-mix patient classification and a lump-sum payment system for patients in Japan [ 12 , 13 ].…”

Section: Methodsmentioning

confidence: 99%

Economic and clinical burden from carbapenem-resistant bacterial infections and factors contributing: a retrospective study using electronic medical records in Japan

2022

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Background Antimicrobial resistance is a major threat to global health and the world economy. The economic burden of carbapenem-resistant infections has not previously been evaluated. We aimed to compare the potential economic burden and clinical outcomes between carbapenem-resistant infections and carbapenem-susceptible infections in Japan. Methods We conducted a retrospective cohort study using electronic medical records. Patients aged 15 years or older and with the diagnosis of pneumonia, urinary tract infection, biliary infection, and sepsis were included. Multivariable regression models with random effects were used to estimate the impact of carbapenem resistance on cost, length of hospital stay, and in-hospital mortality. Results Among the 9,517 patients, 86 (0.9%) had carbapenem-resistant (CR) infections. Compared to carbapenem-susceptible (CS) infections, the patients with the CR infections were significantly more likely to receive mechanical ventilation (37.2 vs. 21.2%, P-value = 0.003), antibiotics (88.4 vs. 63.0%, P-value < 0.001), and especially carbapenem (31.4 vs. 8.3%, P-value < 0.001), before the bacterial culture test positive. Significantly higher median costs were found for the CR infections than the CS infections in the categories of medications (3477 US dollars vs. 1609 US dollars), laboratory tests (2498 US dollars, vs. 1845 US dollars), and hospital stay (14,307 US dollars vs. 10,560 US dollars). In the multivariable regression analysis, the length of stay was 42.1% longer and the cost was 50.4% higher in the CR infections than in the CS infections. The risk of in-hospital mortality did not differ between the two groups (odds ratio 1.24, 95% CI 0.72–2.11), due to the small sample size. The result was robust with a similar trend in the analysis using the inverse probability treatment weighting method. Conclusions Compared to carbapenem-susceptible infections, carbapenem-resistant infections were associated with a higher cost and a longer length of stay. Detailed cost analysis showed significant differences in the categories of medication, laboratory tests, and hospital stay. To our knowledge, this study is the first to assess the potential economic burden of carbapenem-resistant infections using a large hospital-based database.

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“…Individual informed consent was not required to conduct this study because the dataset was provided as anonymized data by National Hospital Organization. 15 This study was approved by the Ethics Committee of Mie Hospital (Approval No. 2020-89) on 23 October 2020.…”

Section: Ethical Considerationsmentioning

confidence: 99%

“…It includes inpatients' demographical characteristics, underlying diseases, medical interventions including oxygen administration, the use of respiratory ventilators, administration of drugs, and outcomes such as discharge or death. 15 We used MIA data of inpatients to verify drug effectiveness. MIA does not have the data on vaccination history or causative strain.…”

Section: Introductionmentioning

confidence: 99%

Drug effectiveness for COVID-19 inpatients inferred from Japanese medical claim data using propensity score matching

2023

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Background: Earlier studies and clinical trials have shown that the drugs such as antiviral drugs, antibody cocktails, and steroids and anti-inflammatory drugs are expected to prevent severe coronavirus 2019 (COVID-19) outcomes and death. Methods: We used observational data for Japan to assess the effectiveness of these drugs for COVID-19. We applied propensity scoring, which can treat the choice of administered drug as a random assignment to inpatients, to the Medical Information Analysis Databank operated by National Hospital Organization in Japan. The outcome was defined as mortality. Subjects were all inpatients, inpatients with oxygen administration, and inpatients using respiratory ventilators, classified by three age classes: all ages, 65 years old or older, and younger than 65 years old. Information about demographical characteristics, underlying disease, administered drug, the proportion of Alpha, Beta and Omicron variant strains, and vaccine coverage were used as explanatory variable in logistic regression. Results: Estimated results indicated that only an antibody cocktail (sotrovimab, casirivimab and imdevimab) raised the probability to save life consistently. By contrast, other drugs might reduce the probability of saving life. The results indicated that an antiviral drug (remdesivir), a steroid (dexamethasone), and an anti-inflammatory drug (baricitinib and tocilizumab) might not contribute to saving life even at the pseudo-situation of random assignment. However, this logistic regression at the first step might have only insufficient explanatory power. Conclusions: We found a high likelihood that antibody cocktails were consistently effective to raise the probability of saving life, though a lesser likelihood in other drugs for older patients with mild to severe severity and all age patients with moderate severity.

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Existing Data Sources for Clinical Epidemiology: Database of the National Hospital Organization in Japan

Cited by 13 publications

References 37 publications

Risk of Underlying Diseases and Effectiveness of Drugs on COVID-19 Inpatients Assessed Using Medical Claims in Japan: Retrospective Observational Study

Risk of Underlying Diseases and Effectiveness of Drugs on COVID-19 Inpatients Assessed Using Medical Claims in Japan: Retrospective Observational Study

Economic and clinical burden from carbapenem-resistant bacterial infections and factors contributing: a retrospective study using electronic medical records in Japan

Drug effectiveness for COVID-19 inpatients inferred from Japanese medical claim data using propensity score matching

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