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How to find datasets from your own country

How to find datasets from your own country I ntroduction to WHO HFA, EUROCISS, MONICA and AMI/ACS registers. Introduction. Reliable indicators for monitoring CVD and for which data are available on a comparable basis across EU countries are currently limited

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How to find datasets from your own country

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  1. How to find datasets from your own country Introduction to WHO HFA, EUROCISS, MONICA and AMI/ACS registers

  2. Introduction Reliable indicators for monitoring CVD and for which data are available on a comparable basis across EU countries are currently limited Even mortality is scarcely comparable since the diagnostic criteria for coding death certificates are not standardized at international level and diagnostic information is not based on uniform criteria

  3. Common data sources in Europe • WHO-mortality (Health For All, HFA) • WHO-MONICA • EUROCISS inventory of population-based registers Except for the MONICA, data presented are extremely variable

  4. WHO-Time trends in IHD mortality in 1970–2000 men and women aged 45–74 years WOMEN MEN WE, Western Europe : Austria, Belgium, Denmark, England and Wales, Finland, France, Germany, Greece, Ireland, Italy, The Netherlands, Norway, Portugal, Scotland, Spain, Switzerland, Sweden ELL. Estonia, Lithuania, Latvia Kesteloot, Sans, Kromhout. European Heart Journal (2006) 27, 107–113

  5. WHO-Time trends in stroke mortality in 1970–2000 men and women aged 45–74 years WOMEN MEN WE, Western Europe : Austria, Belgium, Denmark, England and Wales, Finland, France, Germany, Greece, Ireland, Italy, The Netherlands, Norway, Portugal, Scotland, Spain, Switzerland, Sweden ELL. Estonia, Lithuania, Latvia Kesteloot, Sans, Kromhout. European Heart Journal (2006) 27, 107–113

  6. Mortality data available WHO HFA, EUROSTAT Age: 0-64, 65+, 25-64, 0-14, 15-29, 30-44, 45-59, 60-74, 75+; from WHO-HFA 0-84 by 5-year age groups, 85+, 0-64 from EUROSTAT for IHD and STROKE

  7. K. Steinbach BELGIUM M AUSTRIA M. Kornitzer DENMARK M. Madsen FINLAND V. Salomaa france S. Paterniti GERMANY A. Doring ITALY S. Giampaoli, L. Palmieri, S. Panico, F. Seccareccia, D. Vanuzzo ICELAND V. Gudnason GREECE A. Trichopoulou M. Verschuren NORWAY POLAND A. Pajak PORTUGAL E. Rocha SPAIN S. Sans SWEDEN N. Hammar UK P. Primatesta EUROPEAN HEART NETWORK Participating countries the NETHERLANDS S. Graff-Iversen P. Primatesta

  8. The map….

  9. Main objectives • To prioritise cardiovascular disease of major interest in EU countries • To provide a list of specific indicators and sources of information for monitoring CVD • To prepare the Manual of Operations for the implementation of population-based registers of acute myocardial infarction/acute coronary syndrome, stroke and of CVD surveys

  10. EUROCISS Recommendations for mortality indicators AMI: ICD10 codes I20-I21 (ICD9: 410) IHD: ICD10 codes I20-I25 (ICD9: 410-414) CVA : ICD10 codes I60-I69 (ICD9: 430-438) Ischaemic STROKE : ICD10 code I64 (ICD9: 434) Haemorragic STROKE : (Intracerebral) ICD10 codes I61, I62 (ICD9: 431, 432) (Subarachnoid) ICD10 code I60 (ICD9: 430) Age:35-44, 45-54, 55-64, 65-74 and 75-84 Indicators should be standardised by age and gender using the European standard population

  11. Trend in coronary events

  12. Trend in case fatality

  13. MONICA Project Limits: • Coverage (only some areas of country) • Age range (35-64) • Cost • 10 years out of date Advantages: • Comparable and reliable data • Hot-cold pursuit to identify suspected events in all countries • All events validated during registration period

  14. Tools for monitoring AMI/ACS

  15. Registers based on administrative • data-bases • Identification of events: record linkage between mortality and hospital discharge records • Coverage: the whole country area, all age groups • Data collection: large number of events • Resource consuming: economical • Objectives: to plan health services and health care expenditure; to provide internationally comparable data on mortality, causes of death and hospital admissions • Indicators: attack rate, (incidence), treatment

  16. NATIONAL AMI/ACS Population-based Registers in Europe: From Administrative Databases (*) all codes are presented in the ICD-9 revision to facilitate the comparison

  17. Registers based on specific data collection • Identification of events: hot/cold pursuit; validation of each event applying standardized diagnostic criteria • Coverage: may not be representative of the whole country; covering selected age-ranges, implemented for a limited period of time, in a defined population of reasonable size • Resource consuming: expensive • Indicators: attack rate, incidence, prevalence, case fatality, treatment, years of life lived with disability (YLDS), estimate of long-term care needs

  18. Population-based specific AMI Registers:based on specific data collection

  19. AMI/ACS Population–based Registers in Europe: (continued) case definition (*) all codes are presented in the ICD-9 revision to facilitate the comparison

  20. AMI/ACS Population-based RegistersObjectives • monitoring disease occurrence (attack and incidence rates) • understanding differences between genders, age groups, social classes, ethnic groups, etc. • identifying vulnerable groups • monitoring in- and out-of-hospital case fatality • monitoring the consequences of disease in terms of treatment and rehabilitation • tracing the utilization and impact of new diagnostic tools and treatments

  21. AMI/ACS Population-based Registers Manuals of Operations Quality control Quality control is extremely important for a valid monitoring and comparison and depends: • completeness of cases • completeness of information

  22. AMI/ACS Population-based Registers Manuals of Operations Internal validity Validation evaluates the sensitivity, specificity and predictive value of the registered diagnosis compared to a golden standard To validate coronary events, the New Criteria of the Joint ESC/ACC or the MONICA diagnostic criteria may be applied as golden standard

  23. AMI/ACS Population-based Registers Manuals of Operations External validity • All events occurring in the target population must be registered • It is important to know how representative is the area for the whole country according to: • IHD mortality rate • distribution of risk factors (socioeconomic status and health behaviour) • distribution of health service (specialized hospitals, GPs)

  24. AMI/ACS Population-based Registers Manuals of Operations Validation provides the means to: • take into account bias from diagnostic practices and changes in coding systems • trace the impact of new diagnostic tools and re-definition of events • ensure data comparability within the register (i.e. different sub-populations, different time points, etc) • ensure data comparability with other registers within and between countries

  25. K. Steinbach BELGIUM M AUSTRIA M. Kornitzer DENMARK M. Madsen FINLAND V. Salomaa france S. Paterniti GERMANY A. Doring ITALY S. Giampaoli, L. Palmieri, S. Panico, F. Seccareccia, D. Vanuzzo ICELAND V. Gudnason GREECE A. Trichopoulou M. Verschuren NORWAY POLAND A. Pajak PORTUGAL E. Rocha SPAIN S. Sans SWEDEN N. Hammar UK P. Primatesta EUROPEAN HEART NETWORK Participating countries the NETHERLANDS S. Graff-Iversen P. Primatesta

  26. Conclusions • CVD is responsible of a great number of hospitalisation and deaths • A surveillance system based on the collection of comparable and valid data is essential for evaluating the burden of CVD, time trends and geographical distribution and for planning and implementing appropriate preventive actions. • Population-based registers represent the best data source for surveillance of acute coronary events as they include morbidity and in- and out-of-hospital mortality • Unfortunately, today they are still very rare in Europe and cover only a small portion of the European population, mainly in the Nordic countries • Attack rate for acute events from population-based registers and prevalence of chronic conditions from CVD surveys are the indicators recommended in the ECHIM Project (European Community Health Indicators and Monitoring)

  27. Acknowledgements • Prof Simona Giampaoli for the use of these slides – Presented at EUROPREVENT Madrid 2007. Useful websites for data sources EUROCISS project http://www.cuore.iss.it/eurociss/en/progetto/progetto.asp WHO Monica project http://www.ktl.fi/monica/ European Health for All (HFA) database http://www.euro.who.int/hfadb

  28. Homework • Find data sources for CHD mortality and morbidity for your own country for the next event in Liverpool.

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