Smith James, Jackson Gary, Orr-Walker Brandon, Jackson Rod, Sinclair Siniva, Thornley Simon, Riddell Tania, Chan Wing Cheuk
Counties Manukau District Health Board, 19 Lambie Drive, Manukau City, Private Bag 94052, South Auckland Mail Centre, Manukau 2240, New Zealand.
N Z Med J. 2010 Mar 5;123(1310):62-73.
This study estimated diabetes prevalence and utilisation of healthcare services in Counties Manukau using routinely collected administrative data and compared estimates with findings for three other district health boards (DHBs) in close geographic proximity.
Records of subsidy claims for pharmaceuticals and laboratory investigations were linked to records in a national hospital admissions database to 'reconstruct' populations of four DHBs--Counties Manukau, Northland, Waitemata and Auckland. Individuals were included in reconstructed populations if they had health events recorded between January 2006 and December 2007. Diabetes cases were identified using an algorithm based on claims for monitoring tests and pharmaceuticals, as well as clinical codes for diabetes in hospital admissions.
Reconstructed populations were only 6% lower than census population counts indicating that the vast majority of the population use health services in a two year period. The age- and sex-standardised prevalence of diabetes was 7.1% in Counties Manukau and 5.2% in the other three DHBs combined. Prevalence of diabetes was highest amongst Māori (10.6% in women and 12.2% in men) and Pacific peoples (15.0% for women and 13.5% for men). Maori diabetes cases had the highest hospital discharge rate of any ethnic group. Community pharmaceutical prescribing patterns and laboratory test frequency were similar between diabetes cases by ethnicity and deprivation.
Estimates of diabetes prevalence using linkage of routinely collected administrative data were consistent with epidemiological surveys, suggesting that linkage of pharmaceutical and laboratory subsidy databases with hospital admissions data can be used as an alternative to traditional surveys for estimating the prevalence of some long-term conditions. This study demonstrated substantial differences in the prevalence of diabetes and in hospitalisation rates by ethnicity, but measures of community diabetes care were similar by ethnicity and deprivation.
本研究利用常规收集的行政数据估算了马努考郡的糖尿病患病率及医疗服务利用情况，并将估算结果与地理位置相近的其他三个地区卫生委员会（DHBs）的调查结果进行了比较。
药品补贴申请记录和实验室检查记录与国家医院入院数据库中的记录相链接，以“重建”四个地区卫生委员会（马努考郡、北地、怀塔玛塔和奥克兰）的人口。如果个体在2006年1月至2007年12月期间有健康事件记录，则将其纳入重建人口。糖尿病病例通过基于监测检查和药品申请以及医院入院糖尿病临床编码的算法进行识别。
重建人口仅比人口普查人口数低6%，这表明绝大多数人口在两年内使用了医疗服务。马努考郡年龄和性别标准化的糖尿病患病率为7.1%，其他三个地区卫生委员会合并后的患病率为5.2%。糖尿病患病率在毛利人（女性为10.6%，男性为12.2%）和太平洋岛民（女性为15.0%，男性为13.5%）中最高。毛利糖尿病患者的出院率在所有种族群体中最高。不同种族和贫困程度的糖尿病患者在社区药品处方模式和实验室检查频率方面相似。
利用常规收集的行政数据进行关联分析得出的糖尿病患病率估计值与流行病学调查结果一致，这表明将药品和实验室补贴数据库与医院入院数据进行关联分析可作为传统调查的替代方法，用于估计某些长期疾病的患病率。本研究表明，不同种族之间糖尿病患病率和住院率存在显著差异，但不同种族和贫困程度的社区糖尿病护理措施相似。
