15 research outputs found
Time trends in incidence, treatment, and clinical outcomes according to socioeconomic position in patients with acute coronary syndrome
Get PDFEducational status affects prognosis of patients with heart failure with reduced ejection fraction- a post‐hoc analysis from the WARCEF trial
Get PDFAims
The influence of social determinants of health (SDOH) on the prognosis of Heart Failure and reduced Ejection Fraction (HFrEF) is increasingly reported. We aim to evaluate the contribution of educational status on outcomes in patients with HFrEF.
Methods
We used data from the WARCEF trial, which randomized HFrEF patients with sinus rhythm to receive Warfarin or Aspirin; educational status of patients enrolled was collected at baseline. We defined three levels of education: low, medium and high level, according to the highest qualification achieved or highest school grade attended. We analysed the impact of the educational status on the risk of the primary composite outcome of all-cause death, ischemic stroke (IS) and intracerebral haemorrhage (ICH); components of the primary outcome were also analysed as secondary outcomes.
Results
2295 patients were included in this analysis; of these, 992 (43.2%) had a low educational level, 947 (41.3%) had a medium education level and the remaining 356 (15.5%) showed a high educational level. Compared to patients with high educational level, those with low educational status showed a high risk of the primary composite outcome (adjusted hazard ratio [aHR]: 1.31, 95% confidence intervals [CI] 1.02–1.69); a non-statistically significant association was observed in those with medium educational level (aHR: 1.20, 95%CI: .93–1.55). Similar results were observed for all-cause death, while no statistically significant differences were observed for IS or ICH.
Conclusion
Compared to patients with high educational levels, those with low educational status had worse prognosis. SDOH should be considered in patients with HFrEF
Sundhedsvæsenets Kvalitetsinstituts undersøgelsesdesign vedrørende Prioritering og differentierede indsatser i sundhedsvæsenet
No full textMisuse of multinomial logistic regression in Stroke related health research: A systematic review of methodology
Get PDFMultinomial logistic regression (MLR) is often used to model the association between a nominal outcome variable and one or more covariates. The results of MLR are interpreted as relative risk ratios (RRR) and warrant a more coherent interpretation than ordinary logistic regression. Some authors compare the results of MLR to ordinal logistic regression (OLR), irrespective of the fact that these estimate different quantities. We aim to investigate the time trends in the use and misuse of MLR in studies including stroke patients, specifically the extent to which (1) the results are denoted as anything other than RRR, (2) comparisons are made of results with results of OLR and (3) results have been interpreted coherently. Secondarily, we examine the use of model validation techniques in studies with predictive aims. We searched EMBASE and PubMed for articles using MLR on populations of stroke patients. Identified studies were screened, and information pertaining to our aims was extracted. A total of 285 articles were identified through a systematic literature search, and 68 of these were included in the review. Of these, 60 articles (88%) did not denote exponentiated coefficients of MLR as relative risk ratios but rather some other measure. Additionally, 63 articles (93%) interpreted the results of MLR in a non-coherent manner. Two articles attempted to compare MLR results with those of OLR. Nine studies attempted to use MLR for predictive means, and three used relevant validation techniques. From these findings, it is clear that the interpretation of MLR is often suboptimal.</p
Associations between socioeconomic position, acute coronary syndrome, and outcomes: a Systematic review
No full text
Socioeconomic inequity in incidence, outcomes and care for acute coronary syndrome: A systematic review
No full textBACKGROUND: Socioeconomic inequities in acute coronary syndrome (ACS) epidemiology and care have been reported for at least 30-40 years. However, an up-to-date overview of evidence reflecting current clinical practice is not available. This systematic review aimed to summarize literature published in the last decade, regarding the association between socioeconomic position (SEP), incidence and prevalence of ACS, post-ACS medical care, and mortality. METHODS: The systematic search was performed in PubMed and Embase restricted to publication year (2009-2021), according to predefined methods (PROSPERO: CRD42020197654). Results were classified according to outcomes and socioeconomic exposures, and the risk of bias was evaluated. RESULTS: In total, 181 studies were included, mainly from high-income countries (81%). The majority showed an association between lower SEP (i.e. education, income, occupation, insurance, or composite SEP) and increased ACS incidence (89%)(incidence rate ratios: 1.1-4.7), increased ACS prevalence (88%)(odds ratios (ORs): 1.8-3.9), receiving suboptimal ACS-related medical care (46%)(ORs: 1.1-10.0), or increased post-ACS mortality (71%)(hazard rate ratios: 1.1-4.13). Studies with a lower risk of bias appeared more likely to describe inequity in favor of higher SEP than studies with a higher risk of bias. CONCLUSIONS: Across studies from the last decade, lower SEP is associated with higher risks of ACS, subsequent suboptimal medical care, and mortality among the ACS patients, in particular in studies with a lower risk of bias. This indicates considerable socioeconomic inequity among ACS patients internationally, despite low- and middle-low-income countries being inadequately represented. Thus, efforts are warranted to continuously monitor ACS-related socioeconomic inequity.</p
Quality indicators and development targets in the national clinical quality registries in cancer care and screening
Get PDFBACKGROUND: The Danish clinical quality registries monitor and improve the quality of care, using quality indicators and defined development targets referred to as 'standards'. This study aims to investigate the fulfilment of standards in the Danish clinical quality registries in cancer care and screening.METHODS: Data was included from annual reports in the 27 Danish clinical quality registries in cancer care and screening. The most recent report from each registry was downloaded the 13 December 2023. Indicators were included if: evaluating care or screening over 12 months, presenting a well-defined standard with a desired direction and presenting the proportion and number of individuals for which the standard was fulfilled. Data were extracted on national and regional levels for the last 3 years, and fulfilment of standards was presented as the proportion of indicators that fulfilled the standard within each unit of comparison.RESULTS: In total, 216 quality indicators were included. At the national and regional level, standards were fulfilled for 75% and 71%, respectively. Fulfilment within the registries varied from 5% to 100% on national and 12% to 99% on regional level. Standards were more often fulfilled for result (than process indicators) and for established (than supplemental indicators). Altogether, 43% of the standards were fulfilled across all regions delivering data for the specific indicator.CONCLUSIONS: The approach to defining standards for clinical quality indicators as conservative minimum or ambitious development targets varied in the Danish clinical quality registries in cancer care and screening. This deviating behaviour seriously restrains possibilities for comparing clinical quality across cancers despite the robust infrastructure of the quality registries, limiting the possibilities for overview and prioritising resources and attention to the most urgent cancers.</p
Disparity in health care in end-of-life among patients with lung cancer and pre-existing mental disorders:A nationwide cohort study
Get PDFBackground: Research focusing on health care in end-of-life among cancer patients with mental disorders is limited and presents inconsistent findings. Aim: To investigate disparities in health care in end-of-life among patients who died from lung cancer according to pre-existing mental disorders. Design: A Danish nationwide cohort study linking nationwide registries on health care in end-of-life including specialist palliative care (including hospice admissions), ‘drug reimbursement for terminal illness’, high-intensity-treatment during the last 30 days before death and death at hospital, analysed using Poisson regression, adjusted for sociodemographic and clinical factors. Setting/participants: All adult decedents who died of lung cancer in Denmark from 2011 through 2020, including individuals with mental diagnoses prior to their cancer diagnosis. Results: Among 36,323 patients dying from lung cancer, 12% had pre-existing mental disorders. Patients with mental disorders were less likely to receive specialist palliative care (adjusted risk ratio (RR) 0.90; 95% CI: 0.87; 0.94), hospice admissions (RR: 0.86; 95% CI: 0.80; 0.94), chemotherapy (RR: 0.66; 95% CI: 0.57; 0.76), radiotherapy (RR: 0.82; 95% CI: 0.74; 0.92), surgery (RR: 0.47; 95% CI: 0.22; 1.00), hospital admissions (RR: 0.96; 95% CI: 0.92; 0.99) and to die in a hospital (RR: 0.88; 95% CI: 0.85; 0.91), compared to patients without mental disorders. No disparities were observed in receiving drug reimbursement, admissions to intensive care units or emergency care. Conclusion: Pre-existing mental disorders were associated with a lower probability of specialist palliative care, but also some high-intensity-treatments in end-of-life. These patients may be deprived of optimal palliative care but also appeared less subjected to possible overtreatment in end-of-life compared to patients without mental disorders.</p
Årsrapport 2024:Dansk Center for Sundhedstjenesteforskning
Get PDFSundhedsvæsenets udfordringer er omfattende og komplekse. Det vil derfor også blive en stor samfundsmæssig opgave at finde og gennemføre de mest effektive løsninger, som kan sikre et mere sammenhængende, patientcentreret og ressourcemæssigt bæredygtigt sundhedsvæsen. Gode løsninger forudsætter imidlertid at beslutningstagere og sundhedsprofessionelle får det bedst mulige vidensgrundlag. Sundhedstjenesteforskning er defineret som forskning i sundhedsvæsenet som organisation, dvs. dets opgaver, resurser, aktiviteter og resultater; desuden samspillet mellem befolkningens behov og sundhedsvæsenets funktioner og ydelser. Forskningen er multidisciplinær og omfatter eksempelvis epidemiologi, statistik, datavidenskab, sundhedsøkonomi og sociologi.Forskningsområdet har traditionelt set haft en mere perifer rolle sammenlignet med den traditionelle biomedicinske forskning, men vil spille en central rolle i forhold til at afklare centrale spørgsmål i fremtidens sundhedsvæsen, f.eks. hvordan kan tværsektorielle patientforløb bedst organiseres mhp. på at sikre høj kvalitet, patientinddragelse og omkostningseffektivitet? Hvordan kan hastigheden i implementeringen af politiske og ledelsesmæssige beslutninger øges? Hvordan kan vi bedst modvirke ulighed i sundhedsvæsenet?Dansk Center for Sundhedstjenesteforskning er etableret for at skabe en kompetent, professionel og robust forskningsinstitution, der i samarbejde med sundhedsvæsenets øvrige aktører, inklusiv patienter, klinikere, og beslutningstagere, kan bidrage med at skabe den nødvendige viden.2024 har været et meget begivenhedsrigt og positivt år for centret med et stort og stigende antal videnskabelige publikationer, flere afsluttede ph.d.-kandidater og initiering af flere nye samarbejder. Særligt to begivenheder skiller sig dog ud i 2024. Det gælder dels centrets nye status som nationalt center for sundhedstjenesteforskning, der blev annonceret af forligspartierne bag sundhedsreformen i november og offentliggørelsen i september af det ambitiøst anlagte missionsdrevne forskningsprojekt for en bedre dansk børne- og ungdomspsykiatri, Bedst for Os. Disse to begivenheder er markante begivenheder i centrets historie og markerer både, hvor langt centrets udvikling er nået, og hvor stort potentialet og behovet er for sundhedstjenesteforskning. Der skal i den forbindelse lyde en stor tak til først og fremmest centrets fantastiske personale, som dagligt yder en kæmpe indsats for at udleve centrets mission om at bidrage til bedre kvalitet for patienterne i det danske sundhedsvæsen. En stor tak skal også gå til de mange højt værdsatte samarbejdspartnere i ind- og udland samt det helt afgørende nordjyske bagland i form af Aalborg Universitet og Region Nordjylland, repræsenteret ved Aalborg Universitetshospital og Psykiatrien
