Data Resources for Conducting Health Services and Policy Research

Blewett, Lynn A.; Call, Kathleen Thiede; Turner, Joanna; Hest, Robert

doi:10.1146/annurev-publhealth-040617-013544

Cited by 28 publications

(22 citation statements)

References 34 publications

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“…This study used de-identified administrative claims data from the OptumLabs® Data Warehouse (OLDW), which includes medical and pharmacy claims, laboratory results, and enrollment records for commercial and Medicare Advantage (MA) enrollees. The database contains longitudinal health information on over 200 million enrollees and patients, representing a diverse mix of ages, ethnicities, and geographical regions across the USA [19, 20]. New users of anticoagulant medication (either DOACs or warfarin) between October 1, 2010 and September 30, 2017 were identified via pharmacy claims with the first prescription date defined as the index anticoagulant date.…”

Section: Methodsmentioning

confidence: 99%

Cardiovascular and Bleeding Outcomes with Anticoagulants across Kidney Disease Stages: Analysis of a National US Cohort

Hsiung

Edgett

et al. 2021

Am J Nephrol

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Background: While direct oral anticoagulants (DOACs) are considered safe among patients without chronic kidney disease (CKD), the evidence is conflicting as to whether they are also safe in the CKD and end-stage kidney disease (ESKD) population. In this observational cohort study, we examined whether DOACs are a safe alternative to warfarin across CKD stages for a variety of anticoagulation indications. Methods: Individuals on DOACs or warfarin were identified from OptumLabs® Data Warehouse (OLDW), a longitudinal dataset with de-identified administrative claims, from 2010 to 2017. Cox models with sensitivity analyses were used to assess the risk of cardiovascular disease and bleeding outcomes stratified by CKD stage. Results: Among 351,407 patients on anticoagulation, 45% were on DOACs. CKD stages 3–5 and ESKD patients comprised approximately 12% of the cohort. The most common indications for anticoagulation were atrial fibrillation (AF, 44%) and venous thromboembolism (VTE, 23%). DOACs were associated with a 22% decrease in the risk of cardiovascular outcomes (HR 0.78, 95% CI: 0.77–0.80, p < 0.001) and a 10% decrease in the risk of bleeding outcomes (HR 0.90, 95% CI: 0.88–0.92, p < 0.001) compared to warfarin after adjustment. On stratified analyses, DOACs maintained a superior safety profile across CKD stages. Patients with AF on DOACs had a consistently lower risk of cardiovascular and bleeding events than warfarin-treated patients, while among other indications (VTE, peripheral vascular disease, and arterial embolism), the risk of cardiovascular and bleeding events was the same among DOAC and warfarin users. Conclusion: DOACs may be a safer alternative to warfarin even among CKD and ESKD patients.

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Section: Methodsmentioning

confidence: 99%

Cardiovascular and Bleeding Outcomes with Anticoagulants across Kidney Disease Stages: Analysis of a National US Cohort

Hsiung

Edgett

et al. 2021

Am J Nephrol

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“…Many population-based datasets have placed restrictions or moratoriums on accessing geographic-specific identifiers, including urban–rural status; however, in recent years, widely used datasets such as the National Health Interview Survey and BRFSS have begun incorporating such variables into their public-use files with minimal missingness. Unfortunately, many datasets are only available to access at federal Research Data Centers (RDCs), with costly data application/analysis fees, and some data remain masked because of privacy concerns (e.g., Medical Expenditures Panel Survey, Medicare data) [ 202 , 203 ]. Finally, because of administrative constraints and sampling approaches used in many population-based surveys, it is difficult to reach the sample sizes necessary to look at combinations of social strata (i.e., racial/ethnicity by rurality).…”

Section: Implications/recommendationsmentioning

confidence: 99%

The Intersection of Rural Residence and Minority Race/Ethnicity in Cancer Disparities in the United States

Zahnd

Murphy

Knoll

et al. 2021

IJERPH

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One in every twenty-five persons in America is a racial/ethnic minority who lives in a rural area. Our objective was to summarize how racism and, subsequently, the social determinants of health disproportionately affect rural racial/ethnic minority populations, provide a review of the cancer disparities experienced by rural racial/ethnic minority groups, and recommend policy, research, and intervention approaches to reduce these disparities. We found that rural Black and American Indian/Alaska Native populations experience greater poverty and lack of access to care, which expose them to greater risk of developing cancer and experiencing poorer cancer outcomes in treatment and ultimately survival. There is a critical need for additional research to understand the disparities experienced by all rural racial/ethnic minority populations. We propose that policies aim to increase access to care and healthcare resources for these communities. Further, that observational and interventional research should more effectively address the intersections of rurality and race/ethnicity through reduced structural and interpersonal biases in cancer care, increased data access, more research on newer cancer screening and treatment modalities, and continued intervention and implementation research to understand how evidence-based practices can most effectively reduce disparities among these populations.

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“…2). This is likely due to the absence of data from Kaiser Permanente, the largest healthcare insurer in California [17, 18]. The distribution of base sample population located within an MSA (urban or suburban region) or outside of an MSA (rural region) were 65.7% (66 million) and 10.2% (10 million) for MarketScan or 95.8% (259 million) and 3.9% (10 million) for IDV.…”

Section: Resultsmentioning

confidence: 99%

Current and Future Projections of Amyotrophic Lateral Sclerosis in the United States Using Administrative Claims Data

Miller¹,

Apple

Paige³

et al. 2021

Neuroepidemiology

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Background: Various methodologies have been reported to assess the real-world epidemiology of amyotrophic lateral sclerosis (ALS) in the United States. The aim of this study was to estimate the prevalence, incidence, and geographical distribution of ALS using administrative claims data and to model future trends in ALS epidemiology. Methods: We performed a retrospective analysis of deidentified administrative claims data for >100 million patients, using 2 separate databases (IBM MarketScan Research Databases and Symphony Health Integrated DataVerse [IDV]), to identify patients with ALS. We evaluated disease prevalence, annual incidence, age- and population-controlled geographical distribution, and expected future trends. Results: From 2013 to 2017, we identified 7,316 and 35,208 ALS patients from the MarketScan databases and IDV, respectively. Average annual incidence estimates were 1.48 and 1.37 per 100,000 and point prevalence estimates were 6.85 and 5.16 per 100,000 and in the United States for the MarketScan databases and IDV, respectively. Predictive modeling estimates are reported out to the year 2060 and demonstrate an increasing trend in both incident and prevalent cases. Conclusions: This study provides incidence and prevalence estimates as well as geographical distribution for what the authors believe to be the largest ALS population studied to date. By using 2 separate administrative claims data sets, confidence in our estimates is increased. Future projections based on either database demonstrate an increase in ALS cases, which has also been seen in other large-scale ALS studies. These results can be used to help improve the allocation of healthcare resources in the future.

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Data Resources for Conducting Health Services and Policy Research

Cited by 28 publications

References 34 publications

Cardiovascular and Bleeding Outcomes with Anticoagulants across Kidney Disease Stages: Analysis of a National US Cohort

Cardiovascular and Bleeding Outcomes with Anticoagulants across Kidney Disease Stages: Analysis of a National US Cohort

The Intersection of Rural Residence and Minority Race/Ethnicity in Cancer Disparities in the United States

Current and Future Projections of Amyotrophic Lateral Sclerosis in the United States Using Administrative Claims Data

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