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BackgroundThe linking of administrative data across agencies provides the capability to investigate many health and social issues with the potential to deliver significant public benefit. Despite its advantages, the use of cloud computing resources for linkage purposes is scarce, with the storage of identifiable information on cloud infrastructure assessed as high risk by data custodians. ObjectiveThis study aims to present a model for record linkage that utilizes cloud computing capabilities while assuring custodians that identifiable data sets remain secure and local. MethodsA new hybrid cloud model was developed, including privacy-preserving record linkage techniques and container-based batch processing. An evaluation of this model was conducted with a prototype implementation using large synthetic data sets representative of administrative health data. ResultsThe cloud model kept identifiers on premises and uses privacy-preserved identifiers to run all linkage computations on cloud infrastructure. Our prototype used a managed container cluster in Amazon Web Services to distribute the computation using existing linkage software. Although the cost of computation was relatively low, the use of existing software resulted in an overhead of processing of 35.7% (149/417 min execution time). ConclusionsThe result of our experimental evaluation shows the operational feasibility of such a model and the exciting opportunities for advancing the analysis of linkage outputs.

Background: In Australia, diabetes is the fastest growing chronic condition, with prevalence trebling over the past three decades. Despite reported sex differences in diabetes outcomes, disparities in management and health targets remain unclear. This population-based retrospective study used MedicineInsight primary healthcare data to investigate sex differences in diabetes prevalence, incidence, management, and achievement of health targets. Methods: Adults (aged ≥ 18 years) attending 39 general practices in Western Australia were included. Diabetes incidence and prevalence were estimated by age category. Health targets assessed included body mass index (BMI), blood pressure, blood lipids, and glycated haemoglobin (HbA1c) levels. Medical management of diabetes-associated conditions was also investigated. Time-to-incident diabetes was modelled using a Weibull regression. A multilevel mixed-effects logistic regression model investigated risk-adjusted sex differences in achieving the HbA1c health target (HbA1c ≤ 7.0% (≤ 53 mmol/mol)). Results: Records of 668,891 individuals (53.4% women) were analysed. Diabetes prevalence ranged from 1.3% (95% confidence interval (CI) 1.2%-1.3%) in those aged < 50 years to 7.2% (95% CI 7.1%-7.3%) in those aged ≥ 50 years and was overall higher in men. In patients younger than 30 years, incidence was higher in women, with this reversing after the age of 50. Among patients with diabetes, BMI ≥ 35 kg/m2 was more prevalent in women, whereas current and past smoking were more common in men. Women were less likely than men to achieve lipid health targets and less likely to receive prescriptions for lipid, blood pressure, or glucose-lowering agents. Men with incident diabetes were 21% less likely than women to meet the HbA1c target. Similarly, ever recorded retinopathy, nephropathy, neuropathy, hypertension, dyslipidaemia, coronary heart disease, heart failure, peripheral vascular disease and peripheral artery disease were higher in men than women. Conclusions: This research underscores variations in diabetes epidemiology and management based on sex. Tailoring diabetes management should consider the patient's sex. [ABSTRACT FROM AUTHOR]

Purpose: Medications are commonly used during pregnancy to manage pre‐existing conditions and conditions that arise during pregnancy. However, not all medications are safe to use in pregnancy. This study utilized privacy‐preserving record linkage (PPRL) to examine medications dispensed under the national Pharmaceutical Benefits Scheme (PBS) to pregnant women in Western Australia (WA) overall and by medication safety category. Methods: In this retrospective, cross‐sectional, population‐based study, state perinatal records (Midwives Notification Scheme) were linked with national PBS dispensing data using PPRL. Live and stillborn neonates born between 2012 and 2019 in WA were included. The proportion of pregnancies during which the mother was dispensed a PBS medication was calculated, overall and by medication safety category. Factors associated with PBS medication dispensing were examined using logistic regression. Results: PPRL linkage identified matching records for 97.4% of women with perinatal records. A total of 271 739 pregnancies were identified, with 158 585 (58.4%) pregnancies involving the dispensing of at least one PBS medication. Category A medications (those considered safe in pregnancy) were the most commonly dispensed (n = 119 126, 43.8%) followed by B3 (n = 51 135, 18.8%) and B1 (n = 42 388, 15.6%) medication (those with unknown safety). Over the study period, the dispensing of PBS medications in pregnancy increased (OR: 1.06, 95%CI: 1.06, 1.07). The strongest predictor of medication dispensing in pregnancy was pre‐pregnancy dispensing (OR: 3.61, 95%CI: 3.54, 3.68). Other factors associated with medication use in pregnancy were smoking, older maternal age, obesity, and prior pregnancies. Conclusion: Privacy preserving record linkage provides a way to link cross‐jurisdictional data while preserving patient confidentiality and data security. The dispensing of PBS medication in pregnancy was common and increased over time, with approximately 60% of women dispensed at least one medication during pregnancy. [ABSTRACT FROM AUTHOR]

Objective To assess if burn injury in older adults is associated with changes in long-term all-cause mortality and to estimate the increased risk of death attributable to burn injury. Methods We conducted a population-based matched longitudinal study--based on administrative data from Western Australia's hospital morbidity data system and death register. A cohort of 6014 individuals who were aged at least 45 years when hospitalized for a first burn injury in 1980-2012 was identified. A non-injury comparison cohort, randomly selected from Western Australia's electoral roll (n=25 759), was matched to the patients. We used Kaplan-Meier plots and Cox proportional hazards regression to analyse the data and generated mortality rate ratios and attributable risk percentages. Findings For those hospitalized with burns, 180 (3%) died in hospital and 2498 (42%) died after discharge. Individuals with burn injury had a 1.4-fold greater mortality rate than those with no injury (95% confidence interval, CI: 1.3-1.5). In this cohort, the long-term mortality attributable to burn injury was 29%. Mortality risk was increased by both severe and minor burns, with adjusted mortality rate ratios of 1.3 (95% CI: 1.1-1.9) and 2.1 (95% CI: 1.9-2.3), respectively. Conclusion Burn injury is associated with increased long-term mortality. In our study population, sole reliance on data on in-hospital deaths would lead to an underestimate of the true mortality burden associated with burn injury. [TEXT NOT REPRODUCIBLE IN ASCII] [TEXT NOT REPRODUCIBLE IN ASCII] Objectif Evaluer si les brulures, chez les adultes ages, sont associees a un changement de la mortalite a long terme toutes causes confondues et estimer la majoration du risque de deces attribuable aux brulures. Methodes Nous avons realise une etude longitudinale appariee en population, a partir de donnees administratives extraites des registres de deces et du systeme de donnees sur la morbidite des hopitaux d'Australie occidentale. Une cohorte de 6 014 Individus, ages d'au moins 45 ans au moment de leur premiere hospitalisation pour brulures, sur la periode de 1980 a 2012, a ete identifiee. Une cohorte comparative d'individus n'ayant pas souffert de brulures a ete aleatoirement selectionnee dans les listes electorales d'Australie occidentale (n = 25 759) pour appariement avec la cohorte des patients victimes de brulures. Nous avons utilise des courbes de Kaplan-Meier et une regression des risques proportionnels de Cox pour analyser les donnees et obtenir les ratios des taux de mortalite et les pourcentages de risque attribuable. Resultats Dans la cohorte des personnes hospitalisees pour brulures, 180 personnes (3 %) sont decedees a l'hopital et 2 498 personnes (42 %) sont decedees apres leur sortie de l'hopital. Nous avons trouve un taux de mortalite 1,4 fois superieur pour les victimes de brulures comparativement aux individus non victimes de brulures (intervalle de confiance de 95 % : 1,3-1,5). Dans cette cohorte, la mortalite a long terme attribuable aux brulures a ete de 29 %. Le risque de mortalite a ete majore a la fois en cas de brulures graves et de brulures mineures, avec des ratios de taux de mortalite ajustes de 1,3 (IC de 95 % : 1,1-1,9) et 2,1 (IC de 95 % : 1,9-2,3) respectivement. Conclusion Les brulures sont associees a une majoration de la mortalite a long terme. Dans la population etudiee, l'utilisation exclusive des donnees relatives aux deces survenus dans les hopitaux aurait entraine une sous-estimation de la vraie charge de mortalite associee aux brulures. [TEXT NOT REPRODUCIBLE IN ASCII] Objetivo Evaluar si las quemaduras en adultos de edad avanzada estan asociadas con los cambios en la mortalidad por todas las causas a largo plazo y estimar el aumento del riesgo de muerte atribuible a las quemaduras. Metodos Se llevo a cabo un estudio poblacional longitudinal emparejado sobre la base de datos administrativos proporcionados por el sistema de datos de morbilidad y el registro de defunciones de los hospitales de Australia Occidental. Se identifico una cohorte de 6014 individuos que tenian como minimo 45 anos cuando fueron hospitalizados por una primera quemadura entre 1980 y 2012. Se comparo una cohorte de personas que no habian sufrido quemaduras seleccionadas aleatoriamente del censo electoral de Australia Occidental (n=25 759) con los pacientes. Se utilizaron el metodo de Kaplan-Meier y la regresion de Cox de riesgos proporcionales para analizar los datos, las razones de tasas de mortalidad generados y los porcentajes de riesgo atribuible. Resultados De todos los hospitalizados con quemaduras, 180 (el 3%) murieron en el hospital y 2498 (el 42%) murieron despues de haber sido dados de alta. Los individuos con quemaduras tenian una tasa de mortalidad 1,4 veces mayor a la de los individuos sin quemaduras (intervalo de confianza, IC, del 95%: 1,3-1,5). En esta cohorte, la mortalidad a largo plazo atribuible a las quemaduras resulto ser del 29%. El riesgo de mortalidad se incremento tanto por quemaduras graves como por quemaduras leves, con unas razones de tasas de mortalidad ajustadas de 1,3 (IC del 95%: 1,1-1,9) y 2,1 (IC del 95%: 1,92,3), respectivamente. Conclusion Las quemaduras estan asociadas al aumento de la mortalidad a largo plazo. En nuestra poblacion de estudio, confiar exclusivamente en los datos relativos a las muertes en hospitales llevaria a una subestimacion de la verdadera carga de mortalidad asociada con las quemaduras., Mortalite a long terme des adultes ages victimes de brulures : une etude en population menee en Australie La mortalidad a largo plazo entre los adultos de edad avanzada con [...]

The article focuses on transitions out of institutional settings such as inpatient mental health care, residential substance use services, out-of-home care (OHC), and corrections that are associated with significant risks of housing insecurity which can be greatly reduced by more effective service coordination. Topics include examines that effective service coordination is especially critical between separate service systems.