Daien Vincent, Korobelnik Jean-Francois, Delcourt Cécile, Cougnard-Gregoire Audrey, Delyfer Marie Noelle, Bron Alain M, Carrière Isabelle, Villain Max, Daures Jean Pierre, Lacombe Sandy, Mariet Anne Sophie, Quantin Catherine, Creuzot-Garcher Catherine
Department of Ophthalmology, Montpellier University Hospital, Montpellier, France.
Ophthalmic Res. 2017;58(2):67-73. doi: 10.1159/000456721. Epub 2017 Apr 4.
Medical-administrative databases are an important source of big data to assess the epidemiology of diseases and interventions, compare drugs, and investigate rare adverse events. We describe the French national health insurance system databases and the Epidemiology and Safety (EPISAFE) collaboration program in ophthalmology and illustrate the paper with recent studies that used the databases to investigate cataract surgery. The Système national d'information inter-régime de l'assurance maladie (SNIIR-AM) is one of the largest databases of medical and administrative data for a general population, covering nearly 65 million people. The SNIIR-AM database links data for all outpatient-reimbursed health expenditures, hospitalization in all 1,546 French private or public healthcare facilities, and date of death. The use of this database provides information at the scale of the entire country, allowing measurement of the impact of changes in practices and new guidelines. Between 2009 and 2012, a total of 2,717,203 eyes in 1,817,865 patients underwent cataract surgery in France, and the incidence of cataract surgery increased from 9.86 to 11.08/1,000 person-years. The 4-year cumulative risk of retinal detachment was 0.99%, and patients <60 years of age were at higher risk of retinal detachment. The incidence of pseudophakic cystoid macular edema was 0.95%. From 2005 to 2014, from data including more than 6 million procedures, the incidence of endophthalmitis after cataract surgery decreased from 0.15 to 0.05%. The EPISAFE collaboration program encompasses the key issues facing ophthalmology, including public health and public policy concerning disease incidence and prevalence, safety and adverse event monitoring, and clinical guidelines.
医疗管理数据库是评估疾病流行病学和干预措施、比较药物以及调查罕见不良事件的重要大数据来源。我们描述了法国国家医疗保险系统数据库以及眼科领域的流行病学与安全（EPISAFE）合作项目，并用近期利用这些数据库调查白内障手术的研究举例说明。国家跨制度疾病保险信息系统（SNIIR-AM）是针对普通人群的最大医疗和管理数据数据库之一，覆盖近6500万人。SNIIR-AM数据库将所有门诊报销医疗费用、法国1546家私立或公立医疗机构的住院情况以及死亡日期的数据关联起来。使用该数据库可在全国范围内提供信息，从而能够衡量实践变化和新指南的影响。2009年至2012年期间，法国共有1817865名患者的2717203只眼睛接受了白内障手术，白内障手术的发病率从每1000人年9.86例增至11.08例。视网膜脱离的4年累积风险为0.99%，60岁以下患者发生视网膜脱离的风险更高。人工晶状体性黄斑囊样水肿的发病率为0.95%。2005年至2014年期间，根据包含600多万例手术的数据，白内障手术后眼内炎的发病率从0.15%降至0.05%。EPISAFE合作项目涵盖了眼科面临的关键问题，包括有关疾病发病率和患病率、安全与不良事件监测以及临床指南的公共卫生和公共政策。
