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How many people have had a myocardial infarction? Prevalence estimated using historical hospital data.

Manuel DG, Lim JJ, Tanuseputro P, Stukel TA - BMC Public Health (2007)

Bottom Line: All 17 years of data were needed to create a reasonably complete registry (90% of estimated prevalent cases).The estimated prevalence using both DisMod and self-reported "heart attack" was higher (2.5% and 2.7% respectively).There was poor agreement between self-reported "heart attack" and the likelihood of having an observed AMI admission (sensitivity = 63.5%, positive predictive value = 54.3%).

View Article: PubMed Central - HTML - PubMed

Affiliation: Institute for Clinical Evaluative Sciences, G106-2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada. doug.manuel@ices.on.ca

ABSTRACT

Background: Health administrative data are increasingly used to examine disease occurrence. However, health administrative data are typically available for a limited number of years - posing challenges for estimating disease prevalence and incidence. The objective of this study is to estimate the prevalence of people previously hospitalized with an acute myocardial infarction (AMI) using 17 years of hospital data and to create a registry of people with myocardial infarction.

Methods: Myocardial infarction prevalence in Ontario 2004 was estimated using four methods: 1) observed hospital admissions from 1988 to 2004; 2) observed (1988 to 2004) and extrapolated unobserved events (prior to 1988) using a "back tracing" method using Poisson models; 3) DisMod incidence-prevalence-mortality model; 4) self-reported heart disease from the population-based Canadian Community Health Survey (CCHS) in 2000/2001. Individual respondents of the CCHS were individually linked to hospital discharge records to examine the agreement between self-report and hospital AMI admission.

Results: 170,061 Ontario residents who were alive on March 31, 2004, and over age 20 years survived an AMI hospital admission between 1988 to 2004 (cumulative incidence 1.8%). This estimate increased to 2.03% (95% CI 2.01 to 2.05) after adding extrapolated cases that likely occurred before 1988. The estimated prevalence appeared stable with 5 to 10 years of historic hospital data. All 17 years of data were needed to create a reasonably complete registry (90% of estimated prevalent cases). The estimated prevalence using both DisMod and self-reported "heart attack" was higher (2.5% and 2.7% respectively). There was poor agreement between self-reported "heart attack" and the likelihood of having an observed AMI admission (sensitivity = 63.5%, positive predictive value = 54.3%).

Conclusion: Estimating myocardial infarction prevalence using a limited number of years of hospital data is feasible, and validity increases when unobserved events are added to observed events. The "back tracing" method is simple, reliable, and produces a myocardial infarction registry with high estimated "completeness" for jurisdictions with linked hospital data.

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Completeness of the MI Registry, 1 to 17 years of observational years Caption: The completeness of the MI registry.
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Figure 5: Completeness of the MI Registry, 1 to 17 years of observational years Caption: The completeness of the MI registry.

Mentions: The estimated prevalence appears reliable and stable after 5 to 10 years of data (Figure 4). The estimated prevalence changed very little if we used different Poisson models for extrapolation (Pseudo R2 greater than 0.98 for all methods, not shown). Figure 5 plots the completeness ratio of the registry with increasing number of years of hospital data. With 5 years of hospital data, the completeness was 47%, slowly leveling off but continually increasing (90% at 17 years of data).


How many people have had a myocardial infarction? Prevalence estimated using historical hospital data.

Manuel DG, Lim JJ, Tanuseputro P, Stukel TA - BMC Public Health (2007)

Completeness of the MI Registry, 1 to 17 years of observational years Caption: The completeness of the MI registry.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC1994682&req=5

Figure 5: Completeness of the MI Registry, 1 to 17 years of observational years Caption: The completeness of the MI registry.
Mentions: The estimated prevalence appears reliable and stable after 5 to 10 years of data (Figure 4). The estimated prevalence changed very little if we used different Poisson models for extrapolation (Pseudo R2 greater than 0.98 for all methods, not shown). Figure 5 plots the completeness ratio of the registry with increasing number of years of hospital data. With 5 years of hospital data, the completeness was 47%, slowly leveling off but continually increasing (90% at 17 years of data).

Bottom Line: All 17 years of data were needed to create a reasonably complete registry (90% of estimated prevalent cases).The estimated prevalence using both DisMod and self-reported "heart attack" was higher (2.5% and 2.7% respectively).There was poor agreement between self-reported "heart attack" and the likelihood of having an observed AMI admission (sensitivity = 63.5%, positive predictive value = 54.3%).

View Article: PubMed Central - HTML - PubMed

Affiliation: Institute for Clinical Evaluative Sciences, G106-2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada. doug.manuel@ices.on.ca

ABSTRACT

Background: Health administrative data are increasingly used to examine disease occurrence. However, health administrative data are typically available for a limited number of years - posing challenges for estimating disease prevalence and incidence. The objective of this study is to estimate the prevalence of people previously hospitalized with an acute myocardial infarction (AMI) using 17 years of hospital data and to create a registry of people with myocardial infarction.

Methods: Myocardial infarction prevalence in Ontario 2004 was estimated using four methods: 1) observed hospital admissions from 1988 to 2004; 2) observed (1988 to 2004) and extrapolated unobserved events (prior to 1988) using a "back tracing" method using Poisson models; 3) DisMod incidence-prevalence-mortality model; 4) self-reported heart disease from the population-based Canadian Community Health Survey (CCHS) in 2000/2001. Individual respondents of the CCHS were individually linked to hospital discharge records to examine the agreement between self-report and hospital AMI admission.

Results: 170,061 Ontario residents who were alive on March 31, 2004, and over age 20 years survived an AMI hospital admission between 1988 to 2004 (cumulative incidence 1.8%). This estimate increased to 2.03% (95% CI 2.01 to 2.05) after adding extrapolated cases that likely occurred before 1988. The estimated prevalence appeared stable with 5 to 10 years of historic hospital data. All 17 years of data were needed to create a reasonably complete registry (90% of estimated prevalent cases). The estimated prevalence using both DisMod and self-reported "heart attack" was higher (2.5% and 2.7% respectively). There was poor agreement between self-reported "heart attack" and the likelihood of having an observed AMI admission (sensitivity = 63.5%, positive predictive value = 54.3%).

Conclusion: Estimating myocardial infarction prevalence using a limited number of years of hospital data is feasible, and validity increases when unobserved events are added to observed events. The "back tracing" method is simple, reliable, and produces a myocardial infarction registry with high estimated "completeness" for jurisdictions with linked hospital data.

Show MeSH
Related in: MedlinePlus