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What can reimbursement data tell us about binge drinking in Belgian minors?

What can reimbursement data tell us about binge drinking in Belgian minors?. Dr. Michiel Callens Intermutualistic Agency (IMA-AIM). Objectives. Is it possible to estimate prevalence of binge drinking in Belgian minors from administrative data? “ Binge drinking ” =

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What can reimbursement data tell us about binge drinking in Belgian minors?

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  1. What can reimbursement data tell us about binge drinking in Belgian minors? Dr. Michiel Callens IntermutualisticAgency (IMA-AIM)

  2. Objectives • Is itpossible to estimateprevalence of bingedrinking in Belgian minors fromadministrative data? • “Bingedrinking” = • > 5 (adult man) / 4 (adultwoman) alcohol units per occasion* • No related code (“Nomenclature”) of reimbursed care! • We willuseanapproximation, startingfrom code for determination of blood alcohol concentration” (BAC) * Wechsler H, Dowdall GW, Davenport A, Rimm EB. A gender-specific measure of binge drinking among college students. Am 3 Public Health 1995; 85: 982-985. What can administrative data tell us about binge drinking in Belgian minors?

  3. Objectives • Is itpossible to estimateprevalence of bingedrinking in Belgian minors fromadministrative data? • Exploration of approximativenumber of cases of alcohol intoxication per year in minors (12-17 yearsold) • Exploration of relatedreimbursedhealth care • Comparison of prevalence in minors (age 12-17) withyoungadults (age 18-29) What can administrative data tell us about binge drinking in Belgian minors?

  4. Methodology : source data • The InterMutualistic Agency (IMA-AIM) disposes of different databases • All insuredpersons (= 99% of Belgianpopulation) • Data onage – gender – socio-economic status (proxy throughpreferentialreimbursement) … • Claims data onreimbursed care and medication • Data collection for research purposes What can administrative data tell us about binge drinking in Belgian minors?

  5. Methodology : source data • The InterMutualistic Agency (IMA-AIM) disposes of different databases • April 2014: complete data onreimbursedhealth care startingfrom 2006 • < 2013: • data onspecificdomains (generalpractitioners, hospital care, medication) collectedbydefault • Otherhealth care: project-specific data collection • 2013: transitionperiod • specific data collection “bingedrinking” notfeasible • Workarround: data of threelargestsicknessfunds • 88,5% of population What can administrative data tell us about binge drinking in Belgian minors?

  6. Methodology: detectionbingedrinking • Estimation of prevalence in minors (12-17) • Byage, gender, socio-economic status • Data of 3 sicknessfunds • 2008-2012 • Comparisonprevalence minors and youngadults (18-29) • Data of 3 sicknessfunds • 2008-2012 What can administrative data tell us about binge drinking in Belgian minors?

  7. Methodology: detectionbingedrinking •  Alcohol intoxication = • Detection of reimbursed “determination of blood alcohol concentration” (BAC) • Codes “Nomenclature”: 547035, 547046, 547050, 547061 • Plus visitemergency unit (590531, 590575, 590656, 590693, 590774, 590811; 590516, 590553, 590634, 590671, 590752, 590796) OR 1(/2) day(s) hospitalstay What can administrative data tell us about binge drinking in Belgian minors?

  8. Methodology: explorationhealth care • Minors with (supposed) alcohol intoxication/bingedrinking • Exploration of health care onday = day BAC • Number of patientswithreimbursedhealth care in specifichealth care categories (contacts, imaging, clinicalbiology,…) • Meanreimbursedhealth care per patient • Data of 1 sicknessfund • 2008-2012 What can administrative data tell us about binge drinking in Belgian minors?

  9. Results: supposedbingedrinking in minors What can administrative data tell us about binge drinking in Belgian minors?

  10. Results: supposedbingedrinking in minors What can administrative data tell us about binge drinking in Belgian minors?

  11. Results: supposedbingedrinking in minors What can administrative data tell us about binge drinking in Belgian minors?

  12. Results: comparison Dutch registration data Resultsregistration data in the Netherlands (Van Zanten et al. 2013*) *van Zanten E, De Dooy J, Ramet J, van der Lelie N. 2013. Nederlandse ervaringen met alcoholintoxicaties bij minderjarigen: aankondiging van de Belgische registratie door kinderartsen. Tijdschr. voor Geneeskunde 69 (9). What can administrative data tell us about binge drinking in Belgian minors?

  13. Results: comparisonyoungadults • Period 2012 • Age 12-17: 2.101 cases • in a group of 10.000 minors: 31,8 • Age 18-29: 9.835 cases • in a group of 10.000 youngadults: 67,6 ( 2,1x) • Methodologyaspecific in case of youngadults (caraccidents … !) What can administrative data tell us about binge drinking in Belgian minors?

  14. Results: bingedrinkingbyage What can administrative data tell us about binge drinking in Belgian minors?

  15. Results: comparison Dutch registration data Resultsregistration data in the Netherlands (Van Zanten et al. 2013*) *van Zanten E, De Dooy J, Ramet J, van der Lelie N. 2013. Nederlandse ervaringen met alcoholintoxicaties bij minderjarigen: aankondiging van de Belgische registratie door kinderartsen. Tijdschr. voor Geneeskunde 69 (9). What can administrative data tell us about binge drinking in Belgian minors?

  16. Results: bingedrinking in minors bygender • More frequent for boys thanforgirls What can administrative data tell us about binge drinking in Belgian minors?

  17. Results: bingedrinking in minors bysocio-economic status • Most frequent in minors withpreferentialreimbursement (proxy lowersocio-economic status) What can administrative data tell us about binge drinking in Belgian minors?

  18. Discussion: fine-tuningmethodology? • Largenumberscompared to Dutch registration (BE: 2.048 – NL: 762 in 2011) • A-specific? Falsepositives? • Exclusion of (auto)intoxication / suicideattempts and accidents? • Explorenumber of patientswith • Trauma (identifiedby acts of medicalimaging / ECG / suture) • Intoxication (identifiedby acts of identificationxenobiotica, e.g. medication, drugs, pesticides…) • Trauma + intoxication What can administrative data tell us about binge drinking in Belgian minors?

  19. Results: exploration of otherhealth care Number of supposed BD events in minors 2008-2012 : 3.809 (1 sicknessfund) Exploration of health care = frequency of groups of nomenclature codes What can administrative data tell us about binge drinking in Belgian minors?

  20. Results: exploration of otherhealth care What can administrative data tell us about binge drinking in Belgian minors?

  21. Results: exploration of otherhealth care Proportion of cases of minor patientswithsupposed BD 2008-2012 outside ‘regularhours’ (night, weekend, ferials): 65% Contactswithpsychiatricians: 8% of minor patientswithsupposed BD 2008-2012 Remarkable prestations (?): dosage of paracetamol for 12% of minor patientswithsupposed BD 2008-2012 What can administrative data tell us about binge drinking in Belgian minors?

  22. Discussion: fine-tuningmethodology? • Number of supposed BD events in minors 2008-2012 : 3.809 (1 sicknessfund) • Afterexclusion of cases with • ‘trauma’: 3.001 (-21%) • ‘intoxication’: 2.440 (-36%) • ‘trauma’ or ‘intoxication’: 1.814 (-52%) What can administrative data tell us about binge drinking in Belgian minors?

  23. Discussion: fine-tuningmethodology? • Largenumberscompared to Dutch registration 2011: BE: 2.048 – NL: 762 • Afterexclusion of 52% of cases with ‘‘trauma’ or ‘intoxication’ • 2011: BE: 983 – NL: 762 What can administrative data tell us about binge drinking in Belgian minors?

  24. Results: costspayedby public healthinsurance • Number of minors withsupposed BD event in 2011-2012 : 1.496 (1 sicknessfund) • Mean [CI] health care reimbursement per patient: • 690 [646, 734] euro onday 1 + 2 followingdays • 547 [518, 577] euro ifonlyday of BAC is taken into account • Medianhealth care reimbursement per patient: • 250 euro onday 1 + 2 followingdays • 235 euro ifonlyday of BAC is taken into account What can administrative data tell us about binge drinking in Belgian minors?

  25. Conclusion • Numbersshouldbevalidatedagainstregistration data of bingedrinking in Belgium fine tuning of methodology • Monitor prevalence of bingedrinking in Belgian minors throughadministrative data? • Low cost (APR2014: complete data available at IMA 2006-2012) • High reliabilityifspecific (new) code forbingedrinking What can administrative data tell us about binge drinking in Belgian minors?

  26. Questions - Acknowledgements • Researchers • Birgit Gielen (CM-MC) • Jérôme Vrancken (UNMS-NVSM) • Carine Pochet – Agnès Leclercq (ML-OZ) • Experts • Dr Bernard Debbaut (CM-MC) http://www.ima-aim.be What can administrative data tell us about binge drinking in Belgian minors?

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