Can Administrative Health Data Improve the Gold Standard? Evidence from a Model of the Progression of Myocardial Infarction.
Son Hong NghiemJonathan P WilliamsClifford AfoakwahQuan HuynhShu-Kay NgJoshua ByrnesPublished in: International journal of environmental research and public health (2021)
Background: Myocardial infarction (MI), remains one of the leading causes of death and disability globally but publications on the progression of MI using data from the real world are limited. Multistate models have been widely used to estimate transition rates between disease states to evaluate the cost-effectiveness of healthcare interventions. We apply a Bayesian multistate hidden Markov model to investigate the progression of MI using a longitudinal dataset from Queensland, Australia. Objective: To apply a new model to investigate the progression of myocardial infarction (MI) and to show the potential to use administrative data for economic evaluation and modeling disease progression. Methods: The cohort includes 135,399 patients admitted to public hospitals in Queensland, Australia, in 2010 treatment of cardiovascular diseases. Any subsequent hospitalizations of these patients were followed until 2015. This study focused on the sub-cohort of 8705 patients hospitalized for MI. We apply a Bayesian multistate hidden Markov model to estimate transition rates between health states of MI patients and adjust for delayed enrolment biases and misclassification errors. We also estimate the association between age, sex, and ethnicity with the progression of MI. Results: On average, the risk of developing Non-ST segment elevation myocardial infarction (NSTEMI) was 8.7%, and ST-segment elevation myocardial infarction (STEMI) was 4.3%. The risk varied with age, sex, and ethnicity. The progression rates to STEMI or NSTEMI were higher among males, Indigenous, or elderly patients. For example, the risk of STEMI among males was 4.35%, while the corresponding figure for females was 3.71%. After adjustment for misclassification, the probability of STEMI increased by 1.2%, while NSTEMI increased by 1.4%. Conclusions: This study shows that administrative health data were useful to estimate factors determining the risk of MI and the progression of this health condition. It also shows that misclassification may cause the incidence of MI to be under-estimated.
Keyphrases
- st segment elevation myocardial infarction
- healthcare
- percutaneous coronary intervention
- end stage renal disease
- public health
- newly diagnosed
- chronic kidney disease
- ejection fraction
- mental health
- cardiovascular disease
- heart failure
- big data
- prognostic factors
- left ventricular
- st elevation myocardial infarction
- multiple sclerosis
- coronary artery disease
- acute coronary syndrome
- metabolic syndrome
- artificial intelligence
- smoking cessation
- climate change
- patient safety
- social media
- health insurance
- replacement therapy