Incidence rates of health outcomes of interest among Chinese children exposed to selected vaccines in Yinzhou Electronic Health Records: A population-based retrospective cohort study

Huang, Kui; Tao, Sha; Zhou, Xiaofeng; Mo, Jingping; Zhu, Bowen; Shen, Peng; Lin, Hongbo; Arena, Patrick J; He, Na

doi:10.1016/j.vaccine.2020.03.013

Cited by 14 publications

(18 citation statements)

References 27 publications

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“…This was further supported by subsequently published studies (in progress at the time of our assessment) reporting on the capacity to record a broad range of outcomes in the large resident population captured in the YRHIP. 38,45,[47][48][49][50][51] These include studies evaluating vaccine uptake and safety, either as a discrete platform, 45,56 or when contributing to the broader Ningbo City Regional Health Care Information Platform. [52][53][54][55] However, there is some uncertainty to which extent more recent and future data may vary, which could hinder robust evidence generation on HPV vaccine safety and effectiveness.…”

Section: Discussionmentioning

confidence: 99%

“…20 A number of studies in progress at the time of this assessment are now published, confirming the capability to generate RWE from large populations in the YRHIP (Table 1). 38,45,[47][48][49][50][51][52][53][54][55][56] The CHERRY 38,47 and CK-NET studies 49,50 each performed analyses in cohorts of approximately 1 million adults, with a wide range of outcomes identified via ICD-10 codes over prolonged time frames. Other large-scale studies include a diabetes study, 48 a herpes zoster incidence study conducted to generate baseline data in view of the introduction of the zoster vaccine in China, 51 and rheumatoid arthritis epidemiology.…”

Section: Disease Area Reference Study Period Key Observationsmentioning

confidence: 99%

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A feasibility assessment of real‐world data capabilities for monitoring vaccine safety and effectiveness in China: Human papillomavirus vaccination in the Yinzhou district as a use case

Welby

Feng

Tang

et al. 2023

Pharmacoepidemiology and Drug

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BackgroundReal‐world data (RWD) are increasingly used to generate real‐world evidence (RWE) of vaccine safety and effectiveness for regulatory purposes. Assessing feasibility of using RWD sources prior to implementing observational studies is recommended. As a use case, we described the process and findings of a feasibility assessment to identify reliable and relevant data sources for monitoring the safety and effectiveness of the AS04‐HPV‐16/18 human papillomavirus (HPV) vaccine in China.MethodsIterative multi‐step process: (1) targeted literature review and data source mapping; (2) expert opinion from national RWD experts; (3) survey to evaluate the identified data source operational infrastructure; and (4) continuous appraisal of published studies using the identified data source.ResultsThe Yinzhou Regional Health Information Platform (YRHIP) was identified as a data source of main interest, based on its large population coverage, high cervical cancer screening rates, and availability of adult electronic immunization records. Field meetings with national RWD experts confirmed its suitability for post‐authorization vaccine studies. Survey results showed that exposure data and relevant safety and effectiveness endpoints were recorded and linkable at the individual level across the platform. Iterative appraisal of emerging evidence from the literature corroborated these findings.ConclusionsThis feasibility assessment indicates that the YRHIP has the capacity to capture demographic, exposure, outcome and other data required to generate RWE on HPV vaccine safety and effectiveness in China. Studies using the YRHIP to monitor the AS04‐HPV‐16/18 vaccine in routine use building on this feasibility assessment are ongoing.

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Section: Discussionmentioning

confidence: 99%

Section: Disease Area Reference Study Period Key Observationsmentioning

confidence: 99%

A feasibility assessment of real‐world data capabilities for monitoring vaccine safety and effectiveness in China: Human papillomavirus vaccination in the Yinzhou district as a use case

Welby

Feng

Tang

et al. 2023

Pharmacoepidemiology and Drug

View full text Add to dashboard Cite

show abstract

“… 20 In 2020, the database was approved and awarded a Five Grade Class B, which was the second-leading level of the Standardization and Maturity Measurement of Regional Health Information Interconnection by the National Health Commission of China. Furthermore, the high-quality, practical data in this platform has already been applied for studies of chronic noncommunicable disease 20–22 and safety and effectiveness of vaccine 23 , 24 and drugs, 18 , 25 proving the reliability and accurateness of the data source for performing future researches.…”

Section: Methodsmentioning

confidence: 99%

The effectiveness of influenza vaccine among elderly Chinese: A regression discontinuity design based on Yinzhou regional health information platform

Liu

Zhao

et al. 2022

Human Vaccines & Immunotherapeutics

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In China, a free influenza vaccination policy is being implemented among individuals aged 70 years and over in Zhejiang province during the COVID-19 pandemic. The objective was to assess the effectiveness of influenza vaccine in reducing hospitalization and mortality in the elderly. We used data from the Regional Health Information Platform in Yinzhou located in Zhejiang province and applied a regression discontinuity design to estimate the intention-to-treat effect on admission and mortality rates by month of age in the population who was near the age of 70 years threshold. At age 70 years, the influenza vaccination rate increased by 29.1% (95% CI, 28.2% to 29.9%) compared to those under 70 in the study population. When turning age 70 years, the potential effectiveness of receiving influenza vaccine was 8.2% (95% CI, −36.8% to 51.3%) for total hospitalization and the evaluation of vaccine effectiveness was 13.1% (95% CI, −34.2 to 61.8) for the all-cause mortality. An increase in the influenza vaccination rate was associated with a weak decline in most outcomes, but no significance was found for all outcomes. Influenza vaccination had a limited effect on hospital admission and mortality for the free influenza vaccination program that can be related to the low vaccination rate among the Chinese elderly. Supplementation strategies and future studies may be needed to expand immunization coverage and validate this finding, and further provide a reference for other cities to promote the free influenza vaccination policy in China, especially under circumstances of the COVID-19 pandemic.

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“…As the largest district in Ningbo, Yinzhou had a population of 1.34 million in 2018. [23] In 2014, Yinzhou introduced its HMS policy package, including three intertwined actions ( gure 1): (1) Residents were encouraged to sign a one-year contract with a PCP to appoint the PCP as the resident's family doctor, who would act as a gatekeeper of specialist care. The resident shall visit the PCP for an initial diagnosis, and visit a specialist doctor at higher-tier hospitals with a referral letter from the PCP.…”

Section: Study Settingmentioning

confidence: 99%

Understanding the Implementation of Hierarchical Medical System Policy: An Interrupted Time Series Analysis of a Pilot Scheme in China

Han

et al. 2021

Preprint

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Background The Chinese healthcare system faces a dilemma between its hospital-centric approach to healthcare delivery and a rapidly aging population that requires strong primary care. To improve system efficiency and continuity of care, the Hierarchical Medical System (HMS) policy package was implemented in 2015 in Zhejiang province, China. This paper investigated the impact of HMS on the local healthcare system.MethodsWe conducted a repeated cross-sectional study with quarterly data collected between 2010 and 2018 from Yinzhou district, Ningbo. The data was analyzed with an interrupted time series (ITS) design to assess the impact of HMS on the changes of three outcome variables: primary care physicians (PCPs) patient encounter ratio (i.e., the mean quarterly number of patient encounters of PCPs divided by that of all other physicians), PCP degree ratio (i.e., the mean degree of PCPs divided by that of all other physicians), PCP betweenness centrality ratio (i.e., the mean betweenness centrality of PCPs divided by that of all other physicians). Results272,267 patients visited doctors for hypertension between 2010 and 2018. Compared to the counterfactual in the fourth quarter of 2018, the PCP patient encounter ratio rose by 42.7% (95%CI: 27.1—58.2, p<0.001), the PCP degree ratio increased by 23.6% (95%CI: 8.6—38.5, p<0.01), and the PCP betweenness centrality ratio grew by 129.4% (95%CI: 87.1—171.7, p<0.001).ConclusionsThe HMS policy can incentivize patients to visit primary care facilities and enhance the centrality of PCPs within their professional network. Local policymakers should sustain HMS policy efforts to obtain long-term and large-scale benefits.

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Incidence rates of health outcomes of interest among Chinese children exposed to selected vaccines in Yinzhou Electronic Health Records: A population-based retrospective cohort study

Cited by 14 publications

References 27 publications

A feasibility assessment of real‐world data capabilities for monitoring vaccine safety and effectiveness in China: Human papillomavirus vaccination in the Yinzhou district as a use case

A feasibility assessment of real‐world data capabilities for monitoring vaccine safety and effectiveness in China: Human papillomavirus vaccination in the Yinzhou district as a use case

The effectiveness of influenza vaccine among elderly Chinese: A regression discontinuity design based on Yinzhou regional health information platform

Understanding the Implementation of Hierarchical Medical System Policy: An Interrupted Time Series Analysis of a Pilot Scheme in China

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