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The Spatio-Temporal Information System on Myocardial Infarction
(SIST-IM)
GEOIDE Annual ConferenceMay 2003
2
• SIST-IM* (Vanasse et al.)– Acute Coronary Syndrome (ACS)– Provincial Level
• SIST-OS* (Vanasse et al.)– Osteoporosis– Provincial Level
• SIST-STAT* (Niyonsenga et al.)– Spatial Statistics– Fundamental Research
SIST Program
* Financed by: GEOIDE networks and Merck Frosst Canada Ltd
Principal investigatorA. Vanasse M.D. Ph.D.
Co-researchersT. Niyonsenga Ph.D.G. Bénié Ph.D.J.-P. Grégoire Ph.D.K. Goïta Ph.D.C. Dean Ph.D.P. Dagenais M.D. FRCP Ph.D.A. Ciampi Ph.D.
Research AssistantsJ. Courteau Ph.D.A. Hemiari Ph.D. M. Yergeau M.Sc.
StudentsM. Pomerleau M.Sc. (c)J. Loslier M.D. M.Sc. (c)J. Autmizguine
SIST-IM Project
7
SIST-IM Objectives
• For patients hospitalized for ACS in Quebec between 1991 and 2001: – Describe and compare the profile of
revascularization and the profile of mortality/morbidity
– Describe and compare short and long term treatments for patients aged 65 and older
– Identify possible factors explaining spatio-temporal heterogeneity
• Ethical considerations– Approved by the ethical committee of CHUS and CAI
8
Aspatial Database
MSSS
Inclusion criteria
Cohort constitution
NAM RAMQ
ExtractionMED-ECHOVital statistics
Patient ID number=
ExtractionPharmaceutical services
GEOMEDUS GEOMEDUS
Patient ID number
MSSS
Inclusion criteria
Cohort constitution
NAM RAMQ
ExtractionMED-ECHOVital statistics
Patient ID number=
ExtractionPharmaceutical services
GEOMEDUS GEOMEDUS
Patient ID number
Codes ICD-9: 410-4141991-2001
9
Variables
VARIABLES 1. Patient ID number 2. Cause of death 3. Date of death
VARIABLES 1. Patient ID number 2. Age 3. Gender 4. Postal code 5. RSS-DSC-CLSC of patient 6. Type of establishment 7. RSS-DSC-CLSC of establishment 8. Admission date 9. Principal diagnosis (410 - 411) 10. Secondary diagnoses 11. Treatment code 12. Death type 13. Death 48 hours 14. Discharge date 15. Length of stay 16. Destination type 17. Destination code
MED-ECHO (MSSS) Vital Statistics (MSSS)
Pharmaceutical Services (RAMQ)
VARIABLES 1. Patient ID number 2. Drug identification number (DIN) 3. Common denomination code 4. AHF class 5. Quantity of drug 6. Duration of treatment 7. Code of renewal 8. Specialty of prescribing physician 9. Date of claim
10
Specific Question
• For patients hospitalized for ACS in year 2000:– Can we observe a regional variation in
standardized revascularization ratios?
11
Conceptual model
DA1.5
Region
DA1.12
Discharge date
DA1.6
Admission date
DA1.2
Date of Birth
DA1.3
Gender
DA1.1
Patient I D number
DI1.1
Revascularisation (0/1)
DI1.2
Age/sex category
DI2.1
Number revascularizations byage/sex and region
DI2.2
Number hospitalizations byage/sex and region
DI3.1
Number revasc. by region
DI3.2
Number revasc. by age/sex
f6f5
f2f1
f4
DI3.3
Number hospitalizations byage/sex
f7
DI5.1
Expected number ofrevascularizations
f8
DT1.1
Standardizedrevascularization ratios
f9
Standardized revascularizationratios by region
C1
DA1.9
Treatment code
f3
12
RevascularizationStandardized revascularization ratios and 95%-confidence intervals
Bas-Saint-Laurent 0.589Saguenay-LacSt-Jean 1.067
Québec 0.883Mauricie,Centre-Qc 1.000
Estrie 0.924Montréal-centre 1.334
Outaouais 1.094Abitibi-Témisc 0.608
Côte-Nord 0.593Nord-du-Québec 0.691
Gaspésie, îles 0.483Chaudière-Appalaches 0.511
Laval 1.222Lanaudière 1.091Laurentides 0.877Montérégie 1.030
2,01,51,0,50,0
14
Thresholding: standardized ratios
Dendrogram: Standardized revascularization ratios
Outaouais 7 Lanaudière 14 Saguenay-Lac St-Jean 2 Mauricie, Centre-du-Québec 4 Montérégie 16 Québec 3 Laurentides 15 Estrie 5 Montréal-Centre 6 Laval 13 Gaspésie, Îles-madeleine 11 Chaudière-Appalaches 12 Bas-St-Laurent 1 Côte-Nord 9 Abitibi-Témiscamingue 8 Nord-du-Québec 10
4 groups
1.043
0.892
1.314
0.549
16
Discussion
• Is there any relation between access to tertiary cardiology centers and revascularization?
18
Discussion
YES NO
YES 5395 2159 7554
NO 7450 5157 12,607
12,845 7316 20,161
Revascula-rization
Access to tertiary cardiology center
Odds Ratio = 1.73p < 0.0001