Piotr Tyszko

Influenza Vaccination Coverage Among Polish Patients with Chronic Diseases

Patients at a high-risk of severe influenza, because of their underlying health disorders, are recommended to receive a seasonal influenza vaccination. In Poland, influenza coverage rate in the general population is very low (3.4 %). However, there is little known about the coverage rate among high-risk patients. The aim of this study was to describe a general knowledge, perception, and influenza vaccination coverage rate among Polish patients with enhanced risk for influenza. We conducted a self-reported survey among 500 patients with chronic disorders: 120 pulmonary, 80 hemodialyzed, 100 thyroid cancer, and 200 cardiovascular patients. We found the following influenza vaccination coverage in the respective groups of patients: 58 % in pulmonary, 34 % in hemodialyzed, 32 % in cardiovascular, and 9 % in thyroid cancer patients. The difference between the coverage rate in pulmonary patients compared with the other risk groups was significant (p < 0.05). In pulmonary patients, the most important barrier for influenza vaccination was a lack of recommendations from healthcare workers, while a high awareness of influenza was the most powerful driver for vaccination (p < 0.05). We conclude that although the influenza vaccination coverage in Polish patients with chronic diseases is higher than that reported in the general population, this rate remains much below the recommended level and should be improved.

Incidence and prevalence of Systemic Sclerosis (SSc) in Poland – differences between rural and urban regions

[b] Abstract Introduction.[/b] Systemic sclerosis (SSc) is a rare and potentially severe connective tissue disease, characterized by skin fibrosis and involvement of internal organs. Because of its rarity and heterogeneous clinical presentation, reliable epidemiological studies on SSc have been particularly difficult to carry out. [b]Objectives[/b]. The purpose of this study was to present SSc epidemiology among hospitalized patients in Poland. MATERIALS AND METHOD The analysis was based on population-based administrative data, taken from a Polish hospital morbidity study carried out by the National Institute of Public Health between January 2008 - December 2012. [b]Results[/b]. Analyzed data covered 9,049 hospitalization records. The final sample comprised 3,653 patients with first-time hospitalizations for SSc. The average age of the sample was 53 years (SD 16.2; range 0-91 years); 84% of patients were female and 16% male. Based on hospitalization registers, the average SSc incidence was estimated to be 1.9/100,000 per year and peak age of incidence was 55 years. The point prevalence was estimated to be 9.4/100,000 at the end of 2012. SSc was more common in females, with F:M ratio ranging from 6.2:1-4.6:1 depending on the year. Analysis of hospitalization trends revealed that overall numbers of SSc hospitalizations increased, while first-time hospitalizations decreased between 2008-2012. Clusters of higher incidence were observed in more rural regions vs. urban regions. [b]Conclusion[/b]. Estimated incidence of SSc in Poland was comparable to reported incidence in other European countries. Analysis of demographic factors and reports of clusters of higher incidence may suggest the existence of environmental risk factors for the development of SSc. These observations may require further research.

Hospital Morbidity Database for Epidemiological Studies on Churg-Strauss Syndrome

Churg-Strauss syndrome or more accurately eosinophilic granulomatosis with polyangiitis (EGPA) is a small-vessel necrotizing vasculitis with a characteristic late-onset allergic rhinitis and asthma. The use of hospital morbidity database is an important element of the epidemiological analysis of this rare disease. The present study was undertaken to assess the incidence of EGPA and factors related to its epidemiology in Poland; the first analysis of the kind in Poland, enabling a comparison in the European context. This is a retrospective, population-based study using hospital discharge records with EGPA diagnosis, collected for a National Institute of Public Health survey covering the period from 2008 to 2013. The group consisted of 344 patients (206 females and 138 males) with the first-time hospitalization for EGPA. The major findings are that the annual incidence of EGPA in Poland was 1.5 per million (95% confidence intervals: 1.2-1.8), with the point prevalence of 8.8 per million at the end of 2013. A greater incidence of EGPA was observed in the regions with urban predominance. We conclude that discharge records may be a useful element of epidemiological studies on EGPA.

Kawasaki disease: increasing incidence in Poland.

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Transformation of the ownership structure in Polish healthcare and its effects

Poland, like other countries with previously dominant state healthcare systems, has introduced ownership transformation in the healthcare structure. These changes, however, are being accomplished without a clearly defined state policy in this area. The aim of the present study was to assess the course and effects of ownership transformation in outpatient healthcare and hospitals. Data were collected from publications of the Central Statistical Office, which provided information on the numbers of outpatient healthcare institutions, medical practices, general hospitals, and services they provided. The healthcare ownership transformation has divided the medical services market into public and nonpublic providers. In addition, privatization of outpatient healthcare facilities precedes privatization of hospitals, outpatient institutions providing primary healthcare were privatized first; the subsequent stage included those providing specialized services, at first privatization of ambulatory medical infrastructure preceded privatization of services in urban areas, whereas in rural areas, privatization of services preceded structural privatization, privatization provides favorable conditions to improve territorial availability of outpatient healthcare in urban areas, medical practices, although numerous, are of little importance in providing services, the hospital ownership transformation is at its initial stage, and structural ownership transformation in the Polish healthcare system is subject to market rules.

Epidemiology of Granulomatosis with Polyangiitis in Poland, 2011–2015

Granulomatosis with polyangiitis (GPA) is a form of vasculitis that affects small- and medium-sized vessels in many organs. The aim of the study was to describe the epidemiology of GPA in Poland in 2011-2015, including the incidence and prevalence rates. The authors conducted a retrospective, population-based study, using hospital discharge records with GPA diagnosis. GPA incidence was estimated on the basis of the data from the Polish hospital morbidity study carried out by the National Institute of Public Health. The final study group consisted of 1491 patients (749 females, 742 males) who were first time hospitalized with the diagnosis of GPA. The average annual incidence of GPA in Poland was 7.7/1,000,000 (95% CI, 4.1-11.4), and the point prevalence at the end of 2015 was 36/1,000,000. A statistically significant decrease in the GPA incidence was noticed in this study. A 1-year survival rate for GPA was 94%. In conclusion, the incidence and prevalence rates of GPA in Poland are similar to that reported in other European countries. The study provides recent epidemiological data on GPA in Poland, which may be useful for comparisons with other geographical regions.

Use of statistical data concerning hospital morbidity in epidemiological studies on rare rheumatic diseases

Introduction. Data validity constitutes a fundamental problem in epidemiology. An accurate estimate of the occurrence of a rare disease may require a large population study. In the case of rare diseases, all available data resources are used to estimate the occurrence rate, including statistical data concerning hospital morbidity. For life-threatening systemic vasculitides an analysis of its epidemiology is of particular importance. Objective. The main aim of the study was to present the possibilities for the use of data from hospital databases in an analysis of the epidemiology of rare diseases, using the example of particular systemic vasculitides. Results. The study shows the results of analyses performed on a population-based administrative data set concerning systemic vasculitides taken from the national hospital morbidity database prepared by the Polish National Institute of Public Health in 2004–2013. The study also discusses the main advantages and limitations of the adapted methodology. Furthermore, it proves that data from hospital databases can be used for analyzing disease incidence and prevalence, gender and territorial distribution, analysis of hospital mortality (fatality) rates, and trends in long-term observations. Conclusion. An analysis of the epidemiology of rare rheumatic diseases can contribute to a better understanding of their specificity, which can be useful in everyday clinical practice.

Takayasu’s arteritis: a rare disease in Poland

INTRODUCTION Takayasus arteritis (TA) is a rare and potentially life-threatening granulomatous large-vessel vasculitis that involves mostly in the aorta and its proximal branches, and occurs most commonly in young females. This study measures the incidence and prevalence of TA, and assesses the gender distribution and territorial differences in the occurrences of this disease in Poland over a five-year period. To the best of our knowledge, this is the first evaluation of this rare disease in Poland based on a hospital morbidity database. MATERIAL AND METHODS Analyses were performed with population-based administrative data obtained from a national hospital morbidity study carried out between January 2011 - December 2015 by the Polish National Institute of Public Health. Yearly incidence rates and prevalence of TA were calculated using the number of TA patients and corresponding census data for the overall Polish population. RESULTS Data included 660 hospitalization records. The final study sample comprised 177 patients: 154 female (87%) and 23 male (13%) with first-time hospitalization for TA. The mean age was 45.4years (95% CI: 42.9-47.8; SD 16.8; range 4-81 years), median 47. The incidence rate of TA was estimated at 0.92 per million per year (95% CI: 0.68-1.16). Five-year TA prevalence was estimated to be 4,6 per million. Incidence rates of TA did not vary significantly between more urban and more rural regions. CONCLUSIONS The incidence of TA in Poland was similar or lower to data reported by other European countries. The study provides epidemiological data on TA in Poland that may be useful while comparing it with other geographical regions.

Assessment of the incidence rate of end-stage renal disease in patients with and without diabetes in Poland

INTRODUCTION Several studies have suggested, that diabetes is very important factor of the risk of the chronic a renal disease. The paper aims to present a retrospective analysis of incidence of end-stage renal disease in subgroups of patients with and without diabetes in Poland. MATERIAL AND METHODS For assessing this problem an electronic search was performed using Polish National Health Fund data base from 01.01.2011 until 31.12.2013 in general population and from 01.01.2012 until 31.12.2012 in 2 populations: with diabetes and without diabetes mellitus. RESULTS The 43.70 % patients with end-stage renal disease was diabetic. The incidence rate in 2012 was: 292.48 ± 90.97 diabetic men / 100,000 diabetic population; 203.10 ± 90.97 diabetic women / 100,000 diabetic population; 23.44 ± 6.34 non-diabetic men / 100,000 non-diabetic population; 17.88 ± 6.33 non-diabetic women / 100,000 non-diabetic population. CONCLUSIONS The incidence rate of end-stage renal failure in diabetics was multiple times higher than the incidence rate in non-diabetics. The incidence rate of new ESRD cases in Poland estimated to be 36.17 per 100,000 of general populations in 2011, 35.28% in 2012 and 30.46 per 100,000 of general populations in 2013. In 2012, the incidence rate of new ESRD cases in male diabetics was 292.48 ± 90.97 per 100,000 of diabetes men population, and in women diabetics 203.10 ± 66.06 per 100,000 of diabetes women population. In the same 2012 year, the incidence of new ESRD cases in men non-diabetics was 3.44 ± 6.34 per 100,000 of non-diabetes, and in women non-diabetes 17.58 ± 6.33 per 100,000 of non-diabetes women population.

The impact of introducing a new hospital financing system (DRGs) in Poland on hospitalisations for atherosclerosis: An interrupted time series analysis (2004–2012)

OBJECTIVES Hospital payment based on diagnosis-related groups (DRGs) was introduced in Poland in July 2008. We evaluate the impact of this policy on the frequency of hospitalisation for atherosclerosis in internal medicine units of district hospitals and non-public hospitals in Poland. METHODS Data were collected between 2004 and 2012 from each district and non-public hospital participating in the General Hospital Morbidity Study (165 hospitals in total). Atherosclerosis was defined using the ICD-10 code I70. Hospitalisation patterns were examined using interrupted time series with segmented regression analysis. RESULTS were compared between public and non-public hospitals and across patient age groups. RESULTS The rate of hospitalisation for atherosclerosis rose by 27.05 per 10,000 total hospitalisations immediately following the implementation of DRGs in 2008. It then rose by 2.5 per 10,000 hospitalisations monthly between 2008-2012. The largest changes were observed for patients aged 85+ and 75-84. Rates rose by 117.5 and 54.2 per 10,000 hospitalisations in these two groups respectively following implementation of DRGs. The response to introduction of DRGs was less striking in non-public hospitals than in public hospitals. CONCLUSIONS Implementation of a DRG-based system in Poland was associated with substantial increases in atherosclerosis hospitalisation rates. Failing to take into account this change in financing and not accounting for long-term trends in hospitalisation rates may result in inaccurate epidemiological data.