Clinical Epidemiology最新文献

{"title":"Risk of Cancer After a Hospital Contact for Dyspnea: A Nationwide Danish Cohort Study.","authors":"Usama Sikandar, Søren Korsgaard Martiny, Dóra Körmendiné Farkas, Eyal Oren, Hans Erik Bøtker, Henrik Toft Sørensen","doi":"10.2147/CLEP.S630951","DOIUrl":"10.2147/CLEP.S630951","url":null,"abstract":"<p><strong>Purpose: </strong>Dyspnea may be a symptom of undiagnosed cancer, but this association remains poorly understood. We examined cancer incidence among patients with a hospital contact for dyspnea compared with the general population.</p><p><strong>Patients and methods: </strong>Using nationwide Danish registries, we identified all patients with a hospital contact for dyspnea during 1994-2022 and followed them until a cancer diagnosis, emigration, death, or December 31, 2022. We computed cumulative cancer incidence treating death as a competing event, and standardized incidence ratios (SIR) with 95% confidence intervals (CIs), as the observed number of cancers relative to the expected number based on national cancer incidence rates.</p><p><strong>Results: </strong>Among 266,044 patients with dyspnea, 27,884 subsequent cancers were observed. The 1-year cumulative incidence of any cancer was 3.8%, rising to 12.7% at 10 years. At one year, cumulative incidence was highest for lung (1.4%), gastrointestinal (0.6%), hematological (0.5%), and prostate (0.5%) cancers. The 1-year SIR for any cancer was 3.17 (95% CI, 3.11-3.23), elevated across all cancer types, and highest for pleural (17.57; 95% CI, 15.32-20.05), lung (9.34; 95% CI, 9.05-9.64), and hematological (4.17; 95% CI, 3.94-4.41) cancers. Beyond one year, cancer incidence remained elevated (SIR, 1.14; 95% CI, 1.12-1.16), particularly for lung cancer (SIR, 1.56; 95% CI, 1.50-1.61).</p><p><strong>Conclusion: </strong>Patients with a hospital contact for dyspnea had a markedly higher incidence of thoracic and non-thoracic cancers than the general population, particularly during the first year of follow-up. These findings support consideration of an underlying cancer across organ systems as part of the diagnostic evaluation of patients presenting with dyspnea.</p>","PeriodicalId":10362,"journal":{"name":"Clinical Epidemiology","volume":"18 ","pages":"630951"},"PeriodicalIF":4.3,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13589962/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149012053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"One-Year Target Lesion Revascularization Prediction Shows Uncertain Incremental Accuracy After Competing-Death Exclusion [Letter].","authors":"Jiaqing Liu","doi":"10.2147/CLEP.S652901","DOIUrl":"10.2147/CLEP.S652901","url":null,"abstract":"","PeriodicalId":10362,"journal":{"name":"Clinical Epidemiology","volume":"18 ","pages":"652901"},"PeriodicalIF":4.3,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13588120/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149007704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in Tympanostomy Tube Insertion Among Children Aged 0-12 Years: A Register-Based Cohort Study in Denmark (2003-2023).","authors":"Michael Lüscher, Nikolaj B Pedersen, Steven A W Andersen, Thomas Qvist Barrett, Peter Tingsgaard, Lene Dahl Siggaard, Per Kallestrup, Anders Prior","doi":"10.2147/CLEP.S619479","DOIUrl":"https://doi.org/10.2147/CLEP.S619479","url":null,"abstract":"<p><strong>Purpose: </strong>Tympanostomy tube insertion (TTI) is one of the most frequently performed surgical procedures in children. Yet, substantial temporal and geographical variations persist across comparable healthcare systems. We aimed to describe nationwide trends in TTI among Danish children in 2003-2023, with particular attention to changes associated with the COVID-19 pandemic and regional differences in treatment patterns.</p><p><strong>Patients and methods: </strong>In this nationwide register-based cohort study, we included all Danish children aged 0-12 years between 2003 and 2023 (n=2,243,285). Data on TTIs were obtained from the Danish National Patient Register and the Danish National Health Service Register. Incidence rates, cumulative proportions, age at first procedure, and regional variation were analyzed using calendar year and birth cohorts.</p><p><strong>Results: </strong>We identified 704,013 TTI procedures performed in 371,818 children; 96.6% were conducted in ear, nose, and throat (ENT) practices. Annual procedure numbers peaked at 40,826 cases in 2010 and declined steadily to 29,846 cases in 2019. A marked reduction occurred during the COVID-19 pandemic in 2020-2021, followed by a rebound to the pre-pandemic level in 2022 and a further increase to 35,024 procedures in 2023. The proportion of children receiving at least one TTI increased from 3.11% in 2019 to 3.67% in 2023 (proportion ratio (PR) 1.18, 95% confidence interval (CI) 1.16-1.20). Median age at first TTI was 18.1 months, with persistent regional variation; rates were highest in the North Denmark Region and lowest in the Capital Region of Denmark.</p><p><strong>Conclusion: </strong>TTI rates in Danish children decreased substantially over the past decade, declined further during the COVID-19 pandemic, and subsequently returned to pre-pandemic levels. Persistent regional differences indicate variation in clinical practice that cannot be explained solely by underlying disease epidemiology. The long-term effects of the pandemic on TTI utilization remain uncertain.</p>","PeriodicalId":10362,"journal":{"name":"Clinical Epidemiology","volume":"18 ","pages":"619479"},"PeriodicalIF":4.3,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13580447/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148988548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Agreement Between ICD-10 Code-Only and Composite Definitions of Asthma Exacerbations in Electronic Health Records: A Multicenter Cohort Study in Taiwan, 2017-2023.","authors":"Chun-Tse Hung, Chen-Yen An, Chi-Won Suk","doi":"10.2147/CLEP.S640209","DOIUrl":"10.2147/CLEP.S640209","url":null,"abstract":"<p><strong>Background: </strong>Accurate identification of asthma exacerbations in electronic health records (EHRs) is essential for research and clinical decision-making. While composite definitions incorporating healthcare encounters and systemic corticosteroid use are commonly used, ICD-10 code-only definitions are often applied when detailed data are unavailable. However, their agreement remains unclear. This study aimed to (1) compare an ICD-10 code-only definition of asthma exacerbation with a composite definition, and (2) identify factors associated with concordance between both definitions in EHR data.</p><p><strong>Methods: </strong>We conducted a multicenter retrospective cohort study using the Taipei Medical University Clinical Research Database (2017-2023). Asthma exacerbations were identified using (1) an ICD-10 code-only definition and (2) a composite definition incorporating asthma-related emergency department visits, hospitalization, or systemic corticosteroid use. Episodes were defined using a seven-day gap rule. Agreement was assessed using overall percent agreement (OPA), positive predictive value (PPV), negative predictive value (NPV), positive percent agreement (PPA), and negative percent agreement (NPA), with generalized estimating equations accounting for within-patient clustering.</p><p><strong>Results: </strong>Among 1,486,449 episodes, 40,180 (2.7%) met the code-only definition and 35,875 (2.4%) met the composite definition. After covariate adjustment, OPA was 0.930 (95% CI, 0.926-0.933). PPV and PPA were 0.313 (95% CI, 0.293-0.334) and 0.309 (95% CI: 0.291-0.328), respectively, while NPV and NPA were high (0.968 and 0.962). Comorbidity burden, hospital, asthma severity, and index year were associated with concordance.</p><p><strong>Conclusion: </strong>ICD-10 code-only definition demonstrated high overall agreement with the composite definition, driven primarily by agreement on non-events, but limited agreement for identified exacerbations. These findings suggest that the two definitions may capture different levels of exacerbations. Several factors were associated with concordance between both definitions, highlighting the importance of accounting for these factors when analyzing EHR data. Code-only definitions may be used cautiously in EHR-based studies, given potential heterogeneity and misclassification.</p>","PeriodicalId":10362,"journal":{"name":"Clinical Epidemiology","volume":"18 ","pages":"640209"},"PeriodicalIF":4.3,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13576845/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148975571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic Accuracy of Simplified Prehospital Sepsis Screening Tools for Identifying Sepsis and Predicting 30-Day Mortality: A Retrospective Diagnostic Accuracy Study.","authors":"Thongpitak Huabbangyang, Gawin Tiyawat, Nitiporn Puysopa, Thapanee Wattanasaringkarn, Jiratchaya Khunjan, Warinthorn Inthanon, Nattanicha Duangkaew, Chanathip Wanphen, Adisak Nithimathachoke","doi":"10.2147/CLEP.S620744","DOIUrl":"10.2147/CLEP.S620744","url":null,"abstract":"<p><strong>Background: </strong>Early recognition of sepsis in prehospital settings remains challenging because emergency medical services (EMS) clinicians must make rapid triage decisions using limited physiological information before hospital arrival. Several sepsis screening tools have been validated in emergency department settings; however, comparative evidence in prehospital populations remains limited.</p><p><strong>Purpose: </strong>This study evaluated the diagnostic and prognostic performance of five simplified screening tools-mNEWS, qSOFA, mSIRS, mSOS, and MEWS-for identifying sepsis and predicting 30-day mortality in prehospital patients.</p><p><strong>Methods: </strong>This retrospective diagnostic accuracy study included 268 adult patients (≥18 years) transported by Vajira Emergency Medical Service, Bangkok, Thailand, to Vajira Hospital between January 2018 and October 2024. Prehospital clinical parameters recorded by paramedics and emergency nurse practitioners were analyzed against the final hospital diagnosis of sepsis and 30-day in-hospital mortality. Predefined thresholds (mSOS ≥4, MEWS ≥5, mNEWS ≥5, qSOFA ≥2, and mSIRS ≥2) were used for the primary analyses. Diagnostic performance was evaluated using the area under the receiver operating characteristic curve (AuROC), sensitivity, and specificity.</p><p><strong>Results: </strong>Among 268 patients, MEWS demonstrated the highest discrimination for identifying sepsis (AuROC 0.84; sensitivity 64.9%; specificity 79.1%). mSOS (AuROC 0.83) and mSIRS (AuROC 0.82) demonstrated high sensitivity (>96%) but lower specificity (~60%), while mNEWS showed the highest sensitivity (99.3%) but poor specificity (47.0%). qSOFA demonstrated the lowest discrimination (AuROC 0.72). For predicting 30-day mortality, MEWS demonstrated the highest performance (AuROC 0.70; sensitivity 72.2%; specificity 64.5%), followed by mNEWS and mSOS (AuROC 0.69 each), whereas qSOFA (AuROC 0.64) and mSIRS (AuROC 0.60) demonstrated lower discrimination.</p><p><strong>Conclusion: </strong>MEWS demonstrated the most balanced diagnostic performance for identifying sepsis and predicting 30-day mortality in prehospital patients. Highly sensitive tools may be useful for early screening, whereas MEWS may better support risk stratification. Further external validation is required before broader implementation.</p>","PeriodicalId":10362,"journal":{"name":"Clinical Epidemiology","volume":"18 ","pages":"620744"},"PeriodicalIF":4.3,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13555330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influence of Continuous Predictor Modelling Methods on Prediction Stability in Clinical Prediction Model Development: An Empirical Comparison Using Real Clinical Data.","authors":"Phichayut Phinyo, Pakpoom Wongyikul, Noraworn Jirattikanwong, Natthanaphop Isaradech, Wuttipat Kiratipaisarl, Suppachai Lawanaskol, Noppadon Seesuwan, Wachiranun Sirikul","doi":"10.2147/CLEP.S630518","DOIUrl":"10.2147/CLEP.S630518","url":null,"abstract":"<p><strong>Purpose: </strong>Prediction stability is increasingly recognised as important for reliable clinical prediction model development, but the effect of continuous predictor modelling choices remains unclear. This study examined how these choices influence prediction stability.</p><p><strong>Patients and methods: </strong>From a real clinical dataset of 19,418 emergency department patients we created five sample size scenarios (n = 437 to 8739), or 0.5 to 10 times the minimum required sample size. Seven modelling approaches were compared: median dichotomisation (DIC), tertiles (TER), linear (LIN), quadratic (QUA), restricted cubic splines (RCS), multivariable fractional polynomials (MFP), and extreme gradient boosting (XGB). For each scenario, 100 independent development samples were drawn from the full cohort to quantify Monte Carlo uncertainty, and within each, 200 bootstrap resamples served for internal validation and for assessing stability. For each individual, the mean absolute prediction error (MAPE) was the absolute difference between bootstrap-model and development-model predicted probabilities, averaged over the 200 resamples. A model met the stability criterion when at least 90% of individuals had MAPE ≤5%. Results were summarised across the 100 samples with Monte Carlo standard errors.</p><p><strong>Results: </strong>Prediction stability increased with sample size but differed by method. At n = 437, no method met the criterion in any development sample. LIN met it in all 100 samples from the base size (n = 874) onwards, and DIC in 79. QUA and RCS required approximately twice that size, MFP and XGB four times, and TER ten times. XGB ranked highest on optimism-corrected AUC at every size, but that value was greatest in the smallest samples; under out-of-bag correction XGB led only at the two largest. Its calibration slope reached 1.157 at n = 8739.</p><p><strong>Conclusion: </strong>In this empirical investigation, continuous predictor modelling methods appeared to influence prediction stability. LIN was consistently stable from the base sample size onwards, whereas more flexible approaches (eg, QUA, RCS, and MFP) and XGB generally required larger samples. These findings suggest that simpler methods may provide more stable predictions in smaller datasets, although borderline assessments of stability should be interpreted with caution.</p>","PeriodicalId":10362,"journal":{"name":"Clinical Epidemiology","volume":"18 ","pages":"630518"},"PeriodicalIF":4.3,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13551230/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148910933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and Risk Factors for Postoperative Delirium Following Robotic and Video-Assisted Pulmonary Lobectomy: Analysis of the Nationwide Inpatient Sample, 2005-2020.","authors":"Cheng-Hung How, Chor-Kuan Lim, Jia-Hao Zhang","doi":"10.2147/CLEP.S608013","DOIUrl":"10.2147/CLEP.S608013","url":null,"abstract":"<p><strong>Background: </strong>Postoperative delirium (POD) is a critical yet underrecognized complication following pulmonary lobectomy, particularly in older adults. While robotic-assisted thoracoscopic surgery (RATS) and video-assisted thoracoscopic surgery (VATS) offer advantages over open thoracotomy, their impact on POD is uncertain. This study aimed to determine the incidence and risk factors of POD following RATS or VATS pulmonary lobectomies.</p><p><strong>Methods: </strong>This retrospective study analyzed data from patients aged ≥50 years who underwent RATS or VATS lobectomies for lung cancer using the Nationwide Inpatient Sample (2005-2020). POD was identified using International Classification of Diseases (ICD) codes. Logistic regression was used to assess associations between patient demographics, comorbidities, perioperative complications, and POD risk.</p><p><strong>Results: </strong>Among 35,853 patients (mean age: 68.8 years; 55.9% female), 1.7% developed POD. POD risk was similar between patients receiving RATS and VATS. Key risk factors for POD included advanced age (RATS: adjusted odds ratio [aOR]=1.05, 95% confidence interval [CI]: 1.04-1.07; VATS: aOR=1.08, 95% CI: 1.06-1.09), pneumonia (RATS: aOR=2.23, 95% CI: 1.36-3.66; VATS: aOR=2.77, 95% CI: 1.98-3.86), and infection. Other factors associated with POD were persistent anemia, moderate/severe renal disease, and mechanical ventilation.</p><p><strong>Conclusion: </strong>POD risk was similar between RATS and VATS pulmonary lobectomies and was associated with several patient-related and perioperative factors. These findings may help inform perioperative risk assessment and postoperative monitoring in older adults undergoing minimally invasive pulmonary lobectomy.</p>","PeriodicalId":10362,"journal":{"name":"Clinical Epidemiology","volume":"18 ","pages":"608013"},"PeriodicalIF":4.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13546013/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148896408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Association Between Maternal Smoking During Pregnancy and Neonatal Intensive Care Unit Admission Among Full-Term Infants: A Finnish National Cohort Study.","authors":"Kalle Korhonen, Lotta S Holopainen, Mika Gissler, Mikael O Ekblad","doi":"10.2147/CLEP.S606988","DOIUrl":"10.2147/CLEP.S606988","url":null,"abstract":"<p><strong>Purpose: </strong>Maternal smoking during pregnancy (SDP) is associated with adverse neonatal outcomes, but the specific conditions contributing to morbidity among term infants are poorly characterized. We examined whether maternal SDP increases the risk of neonatal intensive care unit (NICU) admission and antibiotic treatment during the first week of life, and identified NICU diagnoses more common among exposed infants.</p><p><strong>Methods: </strong>This register-based cohort study included all full-term (≥ 37+0 weeks' gestation) singleton births in Finland from 2006 to 2018, using data from the Finnish Medical Birth Register and Hospital Discharge Register (n = 795,836; 95.2% of singleton births). Maternal smoking was categorized as no smoking, quit smoking during the first trimester (early smoking), or continued smoking after the first trimester. Primary outcomes were NICU admission and antibiotic treatment during the first week of life. Secondary outcomes included neonatal diagnoses and perinatal mortality. Stillbirths and early neonatal deaths were excluded from the analyses of treatments and diagnoses. Adjusted odds ratios (aORs) were estimated using logistic regression, adjusting for maternal age, parity, prepregnancy BMI, mode of delivery, and year of delivery.</p><p><strong>Results: </strong>Continued smoking was associated with increased odds of NICU admission (aOR 1.43) and antibiotic treatment (aOR 1.22), while early smoking was associated with more modest increases (aORs 1.17 and 1.19, respectively), compared with no exposure. Both smoking exposures were associated with an increased risk of bacterial sepsis or congenital pneumonia. Neonatal hypoglycemia was increased only with continued smoking. Continued smoking was also associated with an increased the risk stillbirth (aOR, 1.49) whereas early smoking was not associated with perinatal mortality.</p><p><strong>Conclusion: </strong>Maternal smoking during pregnancy was associated with an increased risk of infections and metabolic disturbances requiring intensive care among term infants. Continued smoking also increased the risk of stillbirth. These findings further support the importance of smoking cessation during pregnancy.</p>","PeriodicalId":10362,"journal":{"name":"Clinical Epidemiology","volume":"18 ","pages":"606988"},"PeriodicalIF":4.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13546015/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148896440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Evolving Burden of Age-Related Macular Degeneration in China (1990-2023): Insights from an Aging Society and the Anti-VEGF Era.","authors":"Zijian Chen, Jiangying Liu, Shizhou Cheng, Qihua Xu","doi":"10.2147/CLEP.S621990","DOIUrl":"10.2147/CLEP.S621990","url":null,"abstract":"<p><strong>Background: </strong>Age-related macular degeneration (AMD) is a leading cause of vision loss in the elderly. China bears the world's largest AMD burden. This study analyzes the evolving AMD burden in China (1990-2023) and the impact of anti-VEGF therapy.</p><p><strong>Methods: </strong>We analyzed data from the Global Burden of Disease (GBD) 2023 study using joinpoint regression, decomposition analysis, and Bayesian modeling. A supplementary meta-analysis of single-arm studies was conducted to assess anti-VEGF efficacy in Chinese patients.</p><p><strong>Results: </strong>From 1990 to 2023, China's age-standardized prevalence rate (ASPR) and disability-adjusted life year rate (ASDR) for AMD decreased by -0.67% and -1.48% annually, respectively. In 2023, China accounted for 35.82% of global cases and 30.25% of global DALYs. A supplementary meta-analysis of 13 single-arm observational studies showed a pooled efficacy rate of 74% for anti-VEGF drugs in China, albeit with substantial heterogeneity (I² = 93.07%), warranting cautious interpretation. The accelerated decline in ASDR after 2011 coincided temporally with the clinical introduction and subsequent insurance coverage of anti-VEGF therapy. Projections indicate a continued decline in burden through 2038.</p><p><strong>Conclusion: </strong>Despite a declining age-standardized burden, China's absolute AMD burden remains substantial due to rapid population aging and other challenges. The temporal association between anti-VEGF therapy availability and the accelerated burden decline suggests a potential contribution of this treatment, though causality cannot be directly inferred from this ecological analysis. The observed trends likely reflect multiple factors, including improved healthcare access, early diagnosis, socioeconomic development, and anti-VEGF therapy. Comprehensive strategies focusing on prevention and equitable healthcare access are needed.</p>","PeriodicalId":10362,"journal":{"name":"Clinical Epidemiology","volume":"18 ","pages":"621990"},"PeriodicalIF":4.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13546014/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148896363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regional Electronic Health Records in Denmark: Research Potential for Clinical Epidemiology.","authors":"Mette Kielsholm Thomsen, Helene Rask Dalby, Anders Schram, Simon Kok Jensen, Lise Skovgaard Svingel, Kasper Bonnesen, Morten Schmidt, Magnus Kirketerp Krusell, Matilde Slot, Ole Halfdan Larsen, Christian Fynbo Christiansen","doi":"10.2147/CLEP.S606435","DOIUrl":"10.2147/CLEP.S606435","url":null,"abstract":"<p><p>Denmark has a well-established tradition of utilizing national registries for epidemiological research. Healthcare services in Denmark are managed by five administrative regions and documented in electronic health records (EHRs). While certain EHR data are mandatorily transferred to national registries, the national registries capture only a fraction of the information available within regional EHR systems. In this review, we describe and discuss the context, content, and research potential of regional EHR data in Denmark for observational studies and pragmatic clinical trials. Throughout, examples and descriptions of data infrastructure primarily stem from one region (the Central Denmark Region). As each region governs its own healthcare delivery and IT systems, there are regional variations in EHR data sources and availability for research purposes. Overall, EHRs integrate clinical information, including structured entries (diagnoses, procedures, and treatments); semi-structured input of clinical information; free-text clinical notes; results from biochemical, microbiological, and pathological analyses; radiological images and descriptions; administered medicines; and administrative data such as appointment and procedure bookings. Regional EHRs include several data types unavailable or incompletely captured in national registries, including semi-structured and free-text clinical information, certain laboratory results, radiology descriptions, and hospital-administered or prescribed medicines before 2018. These data hold specific potential for research. Overall, the utilization of EHR data holds significant promise for improving both clinical trials and observational studies. In pragmatic trials, EHRs can facilitate patient recruitment and data collection on patient characteristics, outcomes, and adverse events within routine care, enabling larger, more generalizable study designs at lower costs. In observational research, EHR data can provide highly detailed clinical information and data types not captured in population-based registries. However, the use of regional EHR data also presents important challenges, including inter-regional heterogeneity in data systems and governance, variable data completeness, and methodological difficulties related to the extraction and analysis of unstructured clinical information. Despite these limitations, EHR data in Denmark provide large-scale, unique clinical information that complements population-based registries and represents an increasingly important resource for research. As data systems mature and the methods to utilize unstructured clinical information develop, the potential of these data to facilitate observational studies and pragmatic trials will continue to expand.</p>","PeriodicalId":10362,"journal":{"name":"Clinical Epidemiology","volume":"18 ","pages":"606435"},"PeriodicalIF":4.3,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13505535/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148817905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}