Guilcher Sara J T, Voth Jennifer, Ho Chester, Noonan Vanessa K, McKenzie Nicole, Thorogood Nancy P, Craven B Catharine, Cronin Shawna, Jaglal Susan B
Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.
Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada.
Top Spinal Cord Inj Rehabil. 2017 Fall;23(4):343-352. doi: 10.1310/sci2304-343.
There is a paucity of studies using administrative health data to examine the epidemiology, health care utilization, and outcomes for non-traumatic spinal cord dysfunction (NTSCD). The purpose of this study is to characterize discrete NTSCD cohorts using decision algorithms with Canadian health administrative databases. Data were provided by the Canadian Institute for Health Information that included all acute care hospital, day surgery, ambulatory, and inpatient rehabilitation records of patients with neurological impairment between April 1, 2004 and March 31, 2011. Diagnostic codes for neurological impairment and NTSCD etiology were used to identify cases and classify 3 NTSCD groups (most likely, probable, and possible). Logistic regression identified factors related to inpatient rehabilitation admission within 7 days of discharge among the preferred group. The most likely NTSCD group ( = 6,362) was significantly older and had a greater proportion of women and individuals with cauda equina lesions compared to the other 2 NTSCD groups (probable [ = 2,777] and possible [ = 11,179]; s < .001). Factors associated with the likelihood of an inpatient rehabilitation admission included being older (odds ratio [OR], 1.01; 95% CI, 1.00-1.01), being female (OR, 1.18; 95% CI, 1.06-1.32), having paraplegia diagnosis compared to cauda equina (OR, 1.24; 95% CI, 1.09-1.41), residing in an urban area compared to a rural area (OR, 1.34; 95% CI, 1.13-1.58), having degenerative etiology compared to other (OR, 1.59; 95% CI, 1.41-1.80), and having an MRI on record compared to not (OR = 1.57; 95% CI, 1.39-1.76). Administrative data allow for ongoing surveillance of a population in a relatively cost-effective manner. Advancing our knowledge of NTSCD epidemiology, health outcomes, and system performance can inform policy and system planning.
利用行政卫生数据来研究非创伤性脊髓功能障碍(NTSCD)的流行病学、医疗保健利用情况及预后的研究较为匮乏。本研究的目的是使用决策算法和加拿大卫生行政数据库来描述不同的NTSCD队列特征。数据由加拿大卫生信息研究所提供,包括2004年4月1日至2011年3月31日期间神经功能障碍患者的所有急性护理医院、日间手术、门诊及住院康复记录。使用神经功能障碍和NTSCD病因的诊断代码来识别病例并将3个NTSCD组(极可能、很可能和可能)进行分类。逻辑回归确定了首选组中出院后7天内住院康复入院相关的因素。与其他2个NTSCD组(很可能组[n = 2777]和可能组[n = 11179])相比,极可能NTSCD组(n = 6362)年龄显著更大,马尾神经损伤的女性和个体比例更高(P <.001)。与住院康复入院可能性相关的因素包括年龄较大(优势比[OR],1.01;95%置信区间[CI],1.00 - 1.01)、女性(OR,1.18;95% CI,1.06 - 1.32)、与马尾神经相比有截瘫诊断(OR,1.24;95% CI,1.09 - 1.41)、与农村地区相比居住在城市地区(OR,1.34;95% CI,1.13 - 1.58)、与其他病因相比有退行性病因(OR,1.59;95% CI,1.41 - 1.80)以及有MRI记录与无MRI记录相比(OR = 1.57;95% CI,1.39 - 1.76)。行政数据能够以相对经济有效的方式对人群进行持续监测。增进我们对NTSCD流行病学、健康结局及系统性能的了解可为政策和系统规划提供信息。