Successful linkage of French large-scale national registry populations to national reimbursement data: Improved data completeness and minimized loss to follow-up.

BACKGROUND: Registries, a cornerstone of contemporary medicine, frequently suffer from incomplete documentation and losses to follow-up. By linking data to a single-payer national claims database, national registries may be enriched and the quality enhanced. AIMS: To explore the value of data from the French Système National des Données de Santé (SNDS) as a resource to enhance the quality of registries when combined with data from electronic case report forms, and to assess the power to minimize data gaps and losses to follow-up. METHODS: A probabilistic algorithm was developed to link and match records in the SNDS with patient data from the electronic case report forms of two registries on transcatheter aortic valve implantation: FRANCE-2 and FRANCE-TAVI. The algorithm created patient profiles from transcatheter aortic valve implantation procedures in the SNDS, matching them as closely as possible to the profiles in the registry databases. The objective was to achieve 90% linkage of the populations. The linked database was analysed for completeness and loss to follow-up. For validation, mortality curves for the linked registry cohorts were compared with those for the original populations. RESULTS: A total of 34,397 unique registries entries were identified, and 89.9% of patients in the SNDS could be linked. Rates of losses to follow-up over 2 years were 1.0% in the linked FRANCE-TAVI population compared with 40.3% based on electronic case report form documentation. For FRANCE-2, 3-year rates of losses to follow-up were 1.7% and 6.1%, respectively. Mortality curves for populations based on SNDS and electronic case report form data were practically superimposable. CONCLUSIONS: Linking data from a single-payer national claims database to national registries using a probabilistic approach is feasible and can close data gaps and practically abolish losses to follow-up in the registry population.

Epidemiology of pelvic and acetabular fractures in France.

INTRODUCTION: Acetabular and pelvic fracture accounts for 1.5% of fractures in adults and 2-5% of fractures requiring hospital admission. Several national-level epidemiological studies have been conducted outside France, but French national data are not known. We therefore assessed all patients admitted for acetabular or pelvic fracture in France between 2006 and 2016. The study objectives were: 1) to determine incidence of acetabular and pelvic fracture, 2) to determine progression in incidence between 2006 and 2016, and 3) to determine progression in treatment. HYPOTHESIS: Incidence of acetabular and pelvic fracture in France is increasing. METHODS: The following data for the period 2006-2016 were collated from the French national health insurance (CPAM: Caisse Primaire d'Assurance Maladie) database: gender, age, type of treatment, and geographical distribution by administrative area (Département). Two-tailed Student tests were used for comparison of means for numerical variables between independent samples; linear regression was used to analyze correlations; and the Chi2 test was used to compare percentages of categoric variables. RESULTS: There were 32,614 acetabular and 164,694 pelvic fractures, with male predominance for the acetabulum and female predominance for the pelvis. Mean age at acetabular fracture was 66±22 years (range, 1-108 years), and 74±20 years (range, 1-112 years) for pelvic fracture. The rate of acetabular fracture increased to 3,301 in 2016 from 2,316 in 2006, with a strong increase in the rate of pelvic fracture, to 18,902 in 2016 from 10,806 in 2006. Incidence of acetabular fracture per 100,000 increased from 3.67 in 2006 to 4.95 in 2016, and from 17.06 to 23.18 in over-75 year-olds. Incidence of pelvic fracture per 100,000 increased from 17.1 to 28.33, and from 129.30 to 210.69 in over-75 year-olds. Linear regression predicts incidence per 100,000 of 5.9 for acetabular fracture and of 41 for pelvic fracture by 2030 in young subjects and 32 and 309 respectively in over-75 year-olds. Management was surgical for acetabular fracture in 12.31% of cases in 2006 and in 14.33% in 2016, and in 1.43% and 2.16% respectively for pelvic fracture. DISCUSSION: The present data agree with previous reports, with strong increase in incidence of fracture in young and especially in elderly subjects. In elderly subjects, such fractures may require surgery. LEVEL OF EVIDENCE: IV, retrospective study without control group.