意大利拉齐奥地区慢性肾脏病的患病率：基于健康信息系统的分类算法。
Prevalence of chronic kidney disease in the Lazio region, Italy: a classification algorithm based on health information systems.
机构信息
Department of Epidemiology Lazio Regional Health Service, Via Cristoforo Colombo, 112, 00147, Roma, Italy.
U.O.C. Nefrologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli, 8, 00168, Roma, Italy.
出版信息
BMC Nephrol. 2020 Jan 28;21(1):23. doi: 10.1186/s12882-020-1689-z.
BACKGROUND
Estimating CKD prevalence is difficult. Information on CKD prevalence is rather scanty in Italy and available figures come from surveys in selected geographical areas. Administrative data have been already demonstrated to be an effective tool in estimating the epidemiological burden of diseases, however there is limited experience in literature as far as CKD is concerned.
METHODS
The aim of this study is to develop an algorithm based on regional Health Administrative Databases to identify individuals with CKD and provide estimates of disease prevalence in Lazio Region (Italy); about 5.500.000 inhabitants in 2017. A population-level analysis based on a record-linkage strategy using data from Health Administrative Databases has been applied in Lazio Region. CKD cases were identified between January 1, 2012 and December 31, 2017 using Outpatient Specialist Service Information System, Hospital Discharge Registry, Ticket Exemption Registry and Drug Dispensing Registry. Age-specific and standardized prevalence rates were calculated by gender. CKD cases were classified as higher and lower severity.
RESULTS
The algorithm identified 99,457 individuals with CKD (mean age 71 years, 55.8% males). The exclusive contributions of each regional source used were: 35,047 (35.2%) from Outpatient Specialist Service Information System, 27,778 (27.9%) from Hospital Discharge Registry, 4143 (4.2%) from Ticket Exemption Registry and 463 (0.5%) from Drug Dispensing Registry; 5.1% of cases were found in all databases. The standardized prevalence rate at December 31, 2017 was 1.76, 2.06% for males and 1.50% for females. The prevalence increased with age, rising from 0.33% (age 0-18) up to 14.18% (age 85+) among males and from 0.25% up to 8.18% among females. The proportion of CKD individuals with lower severity disease was 78.7% in both genders.
CONCLUSIONS
The proposed algorithm represents a novel tool to monitor the burden of CKD disease, that can be used by the regional government to guide the development and implementation of evidence-based pathways of care for CKD patients. The high prevalence of people with CKD of lower severity should be carefully considered in order to promote diagnosis and optimal management at early stages.
背景
估算 CKD 患病率较为困难。意大利 CKD 患病率相关信息十分有限，现有数据来自于特定地理区域的调查。行政数据已被证实是估算疾病流行程度的有效工具，但在 CKD 方面，文献中相关经验有限。
方法
本研究旨在开发一种基于区域卫生行政数据库的算法，以识别 CKD 患者，并提供拉齐奥地区（意大利）疾病流行率的估计值；该地区 2017 年约有 550 万居民。在拉齐奥地区，采用基于记录链接策略的人群水平分析，使用卫生行政数据库中的数据。使用门诊专科服务信息系统、医院出院登记处、免票登记处和药物配药登记处，于 2012 年 1 月 1 日至 2017 年 12 月 31 日期间确定 CKD 病例。按性别计算特定年龄和标准化患病率。将 CKD 病例分为高严重程度和低严重程度。
结果
该算法共确定了 99457 例 CKD 患者（平均年龄 71 岁，55.8%为男性）。每个区域来源的独立贡献分别为：门诊专科服务信息系统 35047 例（35.2%）、医院出院登记处 27778 例（27.9%）、免票登记处 4143 例（4.2%）和药物配药登记处 46 例（0.5%）；5.1%的病例存在于所有数据库中。2017 年 12 月 31 日的标准化患病率为 1.76%，男性为 2.06%，女性为 1.50%。患病率随年龄增长而增加，男性从 0.33%（0-18 岁）增加到 14.18%（85 岁以上），女性从 0.25%增加到 8.18%。两种性别中，低严重程度 CKD 患者的比例均为 78.7%。
结论
本研究提出的算法是一种用于监测 CKD 疾病负担的新工具，可由地区政府用于指导 CKD 患者循证护理路径的制定和实施。应谨慎考虑低严重程度 CKD 患者的高患病率，以促进早期诊断和优化管理。
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