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Purpose：The older population in Japan is increasing faster than that in the rest of the world. As a result of the increasing number of elderly patients, rehabilitation treatment has become very important, resulting in rehabilitation-related medical expenses increasing, However, it is unclear which age groups are administered rehabilitation treatments. In this study, we investigated the age distribution of patients receiving rehabilitation treatment in Japan.Methods：We investigated the age distribution of patients receiving rehabilitation treatment using insurance data.Results：Rehabilitation fees for cardiovascular, cerebrovascular, and musculoskeletal diseases peaked in the early 80 years age group, whereas those of disuse syndrome, respiratory diseases, and cancer peaked in the late 80 years. Male patients with cardiovascular diseases were twice as common until 80 years of age. Regarding cerebrovascular diseases, the number of male patients peaked in the late 70s, and there were more male patients in the following age groups. More female patients in the late 80 years age group had disuse syndrome. Rehabilitation fees for musculoskeletal diseases had the highest number of units calculated, with 2.5 times as many female patients as male patients. As for respiratory diseases, more male patients were present in the late 80 years age group. Among patients with cancer, males were about twice as common as females.Conclusion：The peak age of patients receiving rehabilitation treatment was in the 80 years age group, and the number of patients increased every year.
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Objective: Many countries have recently established registration databases in the field of rehabilitation to clarify their current status. However, these databases are primarily created for inpatients, with only a few large-scale databases for outpatients. The present study aimed to clarify secular changes, age distribution, and regional disparities in the implementation of outpatient rehabilitation in Japan using the National Database of Health Insurance Claims.Materials and Methods: Using the National Database of Health Insurance Claims Open Data published by the Ministry of Health, Labor, and Welfare, the number of outpatient rehabilitation units from 2014 to 2018 were extracted and examined.Results: The total number of units for outpatient rehabilitation increased gradually from 2014 to 2018. Orthopedic rehabilitation accounted for more than 80% of the total number of units for outpatient rehabilitation in 2018. The total number of units for outpatient rehabilitation according to age was highest among those in their late 70s, while cerebrovascular and dysphagia rehabilitation had the highest number of units in children.Conclusion: The total number of units for outpatient rehabilitation gradually increased from 2014 to 2018; whereas the number of total units for outpatient rehabilitation according to age was the highest among those in their late 70s. However, cerebrovascular rehabilitation and dysphagia rehabilitation had the highest number of units in children. The implementation status of rehabilitation in each region varied greatly among prefectures, suggesting the need for policy planning to eliminate regional disparities.
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In recent years,colorectal surgery has developed rapidly in China,and great progress has been made both in clinical practice and clinical research.However,there are still many imbalances and non-standardization.In 2018,Chinese Society of Colorectal Surgery led the establishment of two national databases-the database of transanal total mesorectal excision surgery for rectal cancer and the database of colorectal cancer surgery cases.Through retrospective and prospective collection of relevant data,statistical analysis showed that the standardization of colorectal cancer diagnosis and treatment,and the standardization of data management required to be improved,and the awareness of clinical research required to be further improved.Therefore,in the era of "evidence-based medicine",how to carry out database construction based on Chinese colorectal cancer patients,and how to carry out clinical research related to colorectal cancer surgery in China and obtain high-level evidence to form Chinese colorectal cancer guidelines for surgical treatment are the most severe test for colorectal surgery in China.
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<b>Objective: </b>We previously showed that interstitial lung disease, pneumonia, abnormal liver function, and anaphylactic reactions were frequent adverse events, and we analyzed outcomes, suspected causative drugs, and the onset of adverse events using information derived from the “Japanese Adverse Drug Event Report” (JADER) database. Here, we aimed to determine the status of actual adverse reactions to carbamazepine (CBZ) and lamotrigine (LTG) using national public databases.<br><b>Methods: </b>Data from the “Information on Decision on Payment/non-payment of Adverse Reaction Relief Benefits” (IARRB; April 2012-March 2016) and JADER (April 2012-March 2016) databases were downloaded from the website of the Pharmaceuticals and Medical Devices Agency. Information from the national database of the “Health Insurance Claims and Specific Health Checkups of Japan” (NDB) (April 2014-March 2015) was downloaded from the website of the Ministry of Health, Labour and Welfare.<br><b>Results: </b>The numbers of females and males in the IARRB were 169 and 229, respectively, for CBZ and 135 and 56, respectively, for LTG. Those in JADER were 1,152 and 1,352, respectively, for CBZ and 1,358 and 806, respectively, for LTG. The respective ratios of males and females prescribed CBZ and LTG in the NDB were 46.2 and 53.8%, and 56.3 and 43.7%, respectively. Both CBZ and LTG were identified as very high-risk drugs associated with extreme skin reactions such as drug-induced hypersensitivity syndrome (DIHS), toxic epidermal necrolysis (TEN), Stevens-Johnson syndrome (SJS), erythema multiforme type drug eruption (EM), and disseminated papuloerythematous drug eruption (DPE). CBZ induced DIHS, EM, and DPE more frequently among elderly men (over 60 years old), whereas LTG induced these reactions in women of reproductive age.<br><b>Conclusions: </b>Elderly men prescribed CBZ and women of reproductive age prescribed LTG should be advised about extreme adverse skin reactions.
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<b>Objective</b>: Medical information databases provide useful Real World Evidence (RWE) and a comprehensive view of medical activities. However, since each database has limited coverage and cannot be self-sufficient, combining information from multiple databases is a useful research technique. In this study, we examined methods of estimating patient numbers by combining information from multiple databases in order to assess the respective databases and identify the respective characteristics, biases and idiosyncrasies. This process also allowed us to propose improvements in the grand design of medical information databases in Japan.<br><b>Design</b>: Retrospective observational cohort study<br><b>Methods</b>: We attempted to estimate the numbers of patients treated for certain diseases and the numbers prescribed a drug by three methods: i) We estimated patient numbers for seven diseases using an insurance claims database, adjusting the proportion of elderly patients according to a hospital medical records database; ii) Sales information for drug X was combined with the prescribed volume per person estimated from pharmacy claims databases to estimate the number of patients administered X; this number was divided by the prescription rate obtained from a medical claims database to calculate patient numbers for the associated disease; and iii) We examined two surveys of the National Institute of Infectious Diseases (NIID) for timely estimation of patient numbers for influenza, referring to estimates from an insurance claims database.<br><b>Results</b>: In Method i)-iii), we proved that it is possible to estimate patient numbers for many diseases and administered drugs by effectively combining multiple medical information databases. Validation could be claimed when multiple methods lead to similar results.<br><b>Conclusion</b>: These databases provided by government agencies and private corporations are separately managed, and there is no grand plan to integrate them into one platform. It is crucial that databases, rather than being designed to stand alone, are standardized according to widely used systems under a solid master data management strategy. This will make it easier to combine information from multiple databases and to maximize their values. Mutual use of these databases by academic researchers for epidemiological and clinical studies and by government policy makers and data scientists of pharmaceutical companies may improve the usefulness of these databases and expand their application in research.
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Over the last several years, a number of health insurance claims have been electronically submitted and entered into the national database(NDB) by the Ministry of Health, Labor & Welfare(MHLW). A trial was initiated where the NDB would be evaluated for its utility in quality improvement of healthcare services. I had the opportunity to perform the drug utilization study using the NDB, and in this article, I review the procedures by which MHLW make the NDB available and report on issues in analyzing the NDB and in using the NDB for pharmacoepidemiological studies. The NDB is much larger and more encompassing than other medical databases and its findings are expected to havea great influence on a pharmacoepidemiological studies in Japan in providing valuable information on the rational use of drugs. (Jpn J Pharmacoepidemiol 2012; 17(2): 155-162)
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As the number of electronically submitted health insurance claims increases, so does the potential for the effective use of such valuable health data to improve quality health care. The Ministry of Health, Labor & Welfare (MHLW), thanks to the IT reform initiative in 2006 calling for creation of a national database (NDB) and its effective use for epidemiological studies, is developing NDB containing health insurance claims data as well as health checks and guidance data individually linked by encryption techniques. Procurement of the software (system development) and the hardware will be completed by the end of FY2008, and gradual collection of data will start in FY2009. In the first phase (FY2009-10), the analysis of the evaluation of Health Care Cost Containment Plans (HCCCP) will be the top priority and the economic evaluation of health checks and guidance may pose methodological challenges. In the second phase (FY2011-), after a full on-line submission of health insurance claims, MHLW will start to publish the findings of the analysis. Although the governing law limits the purpose of NDB to "development, implementation and evaluation of HCCCP", a report by the committee studying the use of health insurance claims data for the improvement of quality health care called for wider use of NDB for public interests in February 2008. Also, JSPE submitted a statement to the Minister in late 2007 calling for the use of NDB for pharmacoepidemiological purposes. For the opinions and demands of JSPE to materialize, continued support and effort from the members is greatly appreciated.