Limits...
Prefectural difference in spontaneous intracerebral hemorrhage incidence in Japan analyzed with publically accessible diagnosis procedure combination data: possibilities and limitations

View Article: PubMed Central - PubMed

ABSTRACT

Objectives:: Annually reported, publically accessible Diagnosis Procedure Combination (DPC) data from the Japanese government is a part of the total DPC database of the Japanese medical reimbursement system for hospitalization. Although medical issues can be evaluated with these data promptly, the applicability of these data in epidemiological analyses has not been assessed.

Methods:: We performed analyses using only statistical indices reported on the a government website. As a preliminary step, the prefectural consistency of spontaneous intracerebral hemorrhage (sICH) was examined with prefectural mortality over 20 years. Then the prefectural incidence of sICH for four years was calculated, utilizing publically accessible DPC data. To determine its reliability, the consistency was examined, and correlations were analyzed with three prefectural factors expected to have an effect: the elderly rate, mortality due to sICH, and the non-DPC bed rate. In addition, a comparison model between prefectures with this method was developed by analyzing other prefecture-specific factors.

Results:: Prefectural mortality due to sICH and prefectural sICH incidence in the DPC database were both consistent over the years. Prefectural sICH incidence had a constant positive correlation with the elderly rate, a partial correlation with mortality due to sICH, but no correlation with the non-DPC bed rate, which is one of the major biases when utilizing the DPC database. In the comparison model, the factors of low income and alcohol consumption showed increased sICH incidence.

Conclusions:: Although careful attention to its limitations is required, publically accessible DPC data will provide insights into epidemiological issues.

No MeSH data available.


Related in: MedlinePlus

Conceptional diagram indicating the relation between sICH incidence and mortality due to sICH. sICH, spontaneous intracerebral hemorrhage; DPC, Diagnosis Procedure Combination. 1Sampling errors in obtaining patients in the DPC database include misdiagnosis and inappropriate coding or double counts of the same patients. 2Unreported sICH patients from publically accessible DPC data include patients who died or were discharged within 24 hours. 3Masked patients are unreported patients treated at hospitals with fewer than 10 patients in a year. Specifically, for sICH patients, patients with ICH due to arteriovenous malformation rupture will be involved due to the lack of corresponding codes.
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f1-epih-38-e2016028: Conceptional diagram indicating the relation between sICH incidence and mortality due to sICH. sICH, spontaneous intracerebral hemorrhage; DPC, Diagnosis Procedure Combination. 1Sampling errors in obtaining patients in the DPC database include misdiagnosis and inappropriate coding or double counts of the same patients. 2Unreported sICH patients from publically accessible DPC data include patients who died or were discharged within 24 hours. 3Masked patients are unreported patients treated at hospitals with fewer than 10 patients in a year. Specifically, for sICH patients, patients with ICH due to arteriovenous malformation rupture will be involved due to the lack of corresponding codes.

Mentions: However, in utilizing publically accessible DPC data, careful attention should be paid to the limitations of the data [5]. As illustrated in Figure 1, the actual sICH incidence in Japan is unknown because of uncaptured sICH patients at hospitals that do not submit DPC data (non-DPC hospitals). Although the number of sICHs at DPC hospitals is known by JMHLW, patients who died within 24 hours are not reported to the public; thus the number of sICHs that can be gathered from publically accessible DPC data is smaller than the number contained by the whole DPC database. In publically accessible DPC data, numbers fewer than 10 in the segmentalized fields of each hospital according to the DPC codes are masked, although the total patient numbers of DPC hospitals are reported. When obtaining prefectural patient numbers by summing up the patient numbers of the hospitals in the same prefectures, this masking will result in a further reduction in the number of patients compared with the total patient number in the DPC database [2].


Prefectural difference in spontaneous intracerebral hemorrhage incidence in Japan analyzed with publically accessible diagnosis procedure combination data: possibilities and limitations
Conceptional diagram indicating the relation between sICH incidence and mortality due to sICH. sICH, spontaneous intracerebral hemorrhage; DPC, Diagnosis Procedure Combination. 1Sampling errors in obtaining patients in the DPC database include misdiagnosis and inappropriate coding or double counts of the same patients. 2Unreported sICH patients from publically accessible DPC data include patients who died or were discharged within 24 hours. 3Masked patients are unreported patients treated at hospitals with fewer than 10 patients in a year. Specifically, for sICH patients, patients with ICH due to arteriovenous malformation rupture will be involved due to the lack of corresponding codes.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5037357&req=5

f1-epih-38-e2016028: Conceptional diagram indicating the relation between sICH incidence and mortality due to sICH. sICH, spontaneous intracerebral hemorrhage; DPC, Diagnosis Procedure Combination. 1Sampling errors in obtaining patients in the DPC database include misdiagnosis and inappropriate coding or double counts of the same patients. 2Unreported sICH patients from publically accessible DPC data include patients who died or were discharged within 24 hours. 3Masked patients are unreported patients treated at hospitals with fewer than 10 patients in a year. Specifically, for sICH patients, patients with ICH due to arteriovenous malformation rupture will be involved due to the lack of corresponding codes.
Mentions: However, in utilizing publically accessible DPC data, careful attention should be paid to the limitations of the data [5]. As illustrated in Figure 1, the actual sICH incidence in Japan is unknown because of uncaptured sICH patients at hospitals that do not submit DPC data (non-DPC hospitals). Although the number of sICHs at DPC hospitals is known by JMHLW, patients who died within 24 hours are not reported to the public; thus the number of sICHs that can be gathered from publically accessible DPC data is smaller than the number contained by the whole DPC database. In publically accessible DPC data, numbers fewer than 10 in the segmentalized fields of each hospital according to the DPC codes are masked, although the total patient numbers of DPC hospitals are reported. When obtaining prefectural patient numbers by summing up the patient numbers of the hospitals in the same prefectures, this masking will result in a further reduction in the number of patients compared with the total patient number in the DPC database [2].

View Article: PubMed Central - PubMed

ABSTRACT

Objectives:: Annually reported, publically accessible Diagnosis Procedure Combination (DPC) data from the Japanese government is a part of the total DPC database of the Japanese medical reimbursement system for hospitalization. Although medical issues can be evaluated with these data promptly, the applicability of these data in epidemiological analyses has not been assessed.

Methods:: We performed analyses using only statistical indices reported on the a government website. As a preliminary step, the prefectural consistency of spontaneous intracerebral hemorrhage (sICH) was examined with prefectural mortality over 20 years. Then the prefectural incidence of sICH for four years was calculated, utilizing publically accessible DPC data. To determine its reliability, the consistency was examined, and correlations were analyzed with three prefectural factors expected to have an effect: the elderly rate, mortality due to sICH, and the non-DPC bed rate. In addition, a comparison model between prefectures with this method was developed by analyzing other prefecture-specific factors.

Results:: Prefectural mortality due to sICH and prefectural sICH incidence in the DPC database were both consistent over the years. Prefectural sICH incidence had a constant positive correlation with the elderly rate, a partial correlation with mortality due to sICH, but no correlation with the non-DPC bed rate, which is one of the major biases when utilizing the DPC database. In the comparison model, the factors of low income and alcohol consumption showed increased sICH incidence.

Conclusions:: Although careful attention to its limitations is required, publically accessible DPC data will provide insights into epidemiological issues.

No MeSH data available.


Related in: MedlinePlus