Mitchell M. Conover

Lifetime risk of stress urinary incontinence or pelvic organ prolapse surgery.

OBJECTIVE: To estimate the lifetime risk of stress urinary incontinence (SUI) surgery, pelvic organ prolapse (POP) surgery, or both using current, population-based surgical rates from 2007 to 2011. METHODS: We used a 2007–2011 U.S. claims and encounters database. We included women aged 18–89 years and estimated age-specific incidence rates and cumulative incidence (lifetime risk) of SUI surgery, POP surgery, and either incontinence or prolapse surgery with 95% confidence intervals (CIs). We estimated lifetime risk until the age of 80 years to be consistent with prior studies. RESULTS: From 2007 to 2011, we evaluated 10,177,480 adult women who were followed for 24,979,447 person-years. Among these women, we identified 65,397 incident, or first, SUI and 57,755 incident prolapse surgeries. Overall, we found that the lifetime risk of any primary surgery for SUI or POP was 20.0% (95% CI 19.9–20.2) by the age of 80 years. Separately, the cumulative risk for SUI surgery was 13.6% (95% CI 13.5–13.7) and that for POP surgery was 12.6% (95% CI 12.4–2.7). For age-specific annual risk, SUI demonstrated a bimodal peak at age 46 years and then again at age 70–71 years with annual risks of 3.8 and 3.9 per 1,000 women, respectively. For POP, the risk increased progressively until ages 71 and 73 years when the annual risk was 4.3 per 1,000 women. CONCLUSION: Based on a U.S. claims and encounters database, the estimated lifetime risk of surgery for either SUI or POP in women is 20.0% by the age of 80 years. LEVEL OF EVIDENCE: III

Incidence of opioid-managed pelvic pain after hysteroscopic sterilization versus laparoscopic sterilization, US 2005-2012.

Compare incidence of opioid‐managed pelvic pain within 12 months after hysteroscopic and laparoscopic sterilization.

Trends and Patterns of Urodynamic Studies in U.S. Women, 2000–2012

OBJECTIVE: To estimate utilization rates for cystometrograms and describe trends in urodynamic procedures among U.S. women from 2000 to 2012. METHODS: We analyzed outpatient administrative health care claims for women aged 18 years or older from 2000 to 2012. The database contains deidentified and adjudicated claims from approximately 150 U.S. payers for employees, spouses, and retirees. We identified cystometrograms, which occur during bladder filling and represent a major component of complex urodynamics, and concurrent procedures; we also assessed age, year, region, health care provider specialty, and associated diagnosis codes. We estimated standardized cystometrogram utilization rates per 10,000 person-years and 95% confidence intervals (CIs) and used stratified Poisson models to estimate the independent (adjusted) effects of year and region. RESULTS: During 142,928,847 person-years of observation among 57,629,961 eligible women, we identified 561,823 cystometrograms for an overall utilization rate of 39.3 per 10,000 person-years (95% CI 39.2–39.4). Cystometrogram utilization increased with age with a peak at age 76 years (86.6/10,000 person-years, 95% CI 84.5–88.7). Standardized rates were relatively constant from 2000 to 2004 and then increased and peaked in 2009 (43.3/10,000 person-years, 95% CI 43.0–43.7). In 2012, they were substantially lower (27.6/10,000 person-years, 95% CI 27.4–27.9). CONCLUSION: Urodynamic procedures were more commonly performed in women aged 65 years or older. Utilization peaked in 2009 and declined sharply in 2012. Clinically, we need to assess the underlying reasons for these trends (ie, whether they reflect a decrease in urodynamics before stress urinary incontinence surgery) and whether these trends reflect appropriate use of this diagnostic study. LEVEL OF EVIDENCE: II

Bias from restricting to live births when estimating effects of prescription drug use on pregnancy complications: A simulation

Administrative claim databases are increasingly being used to study the safety of medication exposures during pregnancy. These studies are restricted to live births due to a reliance on algorithms for estimating gestational age that are based on codes associated with live delivery. Conditioning on live birth may induce selection bias when studying the effect of a drug on a pregnancy complication if fetal death is a competing risk for the complication or is caused by the complication.

Classifying medical histories in US Medicare beneficiaries using fixed vs all-available look-back approaches

Evaluate use of fixed and all‐available look‐backs to identify eligibility criteria and confounders among Medicare beneficiaries.

Trends in Pharmacotherapy for Bladder Dysfunction Among Children in the United States, 2000 to 2013

Bladder-related issues such as nocturnal enuresis and incontinence have long been a part of general pediatric practice. Increasingly, clinicians are prescribing medications directed at a variety of types of bladder dysfunction, but no prior population-based data exist. We used MarketScan health care claims data on 32 074 638 insured children to estimate utilization patterns by age, sex, year, and geographic region in the United States from 2000 to 2013, and to assess related diagnosis codes. Approximately 1 in 500 children filled an antimuscarinic prescription. The most common prescriptions were for oxybutynin (78%) and tolterodine (17%). Rates were highest at ages 6 to 10 years (65/100 000 person-months), 31% higher for girls versus boys, peaked in 2011 (44/100 000 person-months), and were highest in the Midwest (59/100 000 person-months). Seventy-three percent of children with prescriptions had diagnosis codes for genitourinary symptoms, and 13% had codes for congenital anomalies. Research is needed regarding the comparative effectiveness and safety of these drugs in children.

Impact of New Medications and

Background: Despite several new medications being Food and Drug Administration-approved for overactive bladder (OAB) and new prescription drug payment programs, there are limited population-based data regarding OAB medication use among older adults. Objectives: To examine: (1) impacts of new medications and

4 Generic Programs on Overactive Bladder Treatment among Older Adults in the United States, 2000-2015

4 generic programs on time trends for OAB-related medication dispensing for older adults in the United States; (2) differences by age and sex; and (3) temporal changes in OAB-related medication payments. Methods: Using Truven Health Analytics’ Medicare Supplemental Database (2000–2015), we analyzed OAB-related medication claims for 9,477,061 Medigap beneficiaries age 65–104. We estimated dispensing rates (per 1000 person-months), assessed dispensing trends using interrupted time-series methods, compared dispensing rates by age and sex, and summarized payment trends. Results: From 2000 to 2015, 771,609 individuals filled 13,863,998 OAB-related prescriptions. During 2000–2007, 3 new extended-release medications became available (tolterodine, darifenacin, solifenacin), leading to increases in overall OAB-related dispensing rates by 19.1 (99% confidence interval, 17.0–21.2), a 92% increase since 2000; overall rates remained stable during 2008–2015. By 2015, the most common medications were oxybutynin (38%), solifenacin (20%), tolterodine (19%), and mirabegron (12%). Dispensing rates peaked at age 90 (rate, 53.4; 99% confidence interval, 53.1–53.7). Women had higher rates than men at all ages (average ratewomen−ratemen, 22.0). The gap between upper and lower percentiles of medication payments widened between 2008–2015; by 2015, 25% of reimbursed dispensed prescriptions had total payments exceeding

Measurement Error and Misclassification in Electronic Medical Records: Methods to Mitigate Bias

250. Conclusions: Medication-specific dispensing rates for OAB changed when new alternatives became available. Recent changes in utilization and cost of OAB medications have implications for clinical guidelines, pharmacoepidemiologic studies, and payment policies.

Medication Use in Women and Men With Sudden Unexpected Death

Purpose of ReviewWe sought to (1) examine common sources of measurement error in research using data from electronic medical records (EMR), (2) discuss methods to assess the extent and type of measurement error, and (3) describe recent developments in methods to address this source of bias.Recent FindingsWe identified eight sources of measurement error frequently encountered in EMR studies, the most prominent being that EMR data usually reflect only the health services and medications delivered within the specific health facility/system contributing to the EMR data. Methods for assessing measurement error in EMR data usually require gold standard or validation data, which may be possible using data linkage. Recent methodological developments to address the impact of measurement error in EMR analyses were particularly rich in the multiple imputation literature.SummaryPresently, sources of measurement error impacting EMR studies are still being elucidated, as are methods for assessing and addressing them. Given the magnitude of measurement error that has been reported, investigators are urged to carefully evaluate and rigorously address this potential source of bias in studies based in EMR data.