1. DR. MICHIEL CALLENS INTERMUTUALISTIC AGENCY (IMA-AIM) What can reimbursement data tell us about binge drinking in Belgian minors?

2. Objectives Is it possible to estimate prevalence of binge drinking in Belgian minors from administrative data?  “Binge drinking” =  > 5 (adult man) / 4 (adult woman) alcohol units per occasion*  No related code (“Nomenclature”) of reimbursed care! We will use an approximation, starting from code for determination of blood alcohol concentration” (BAC) * Wechsler H, Dowdall GW, Davenport A, Rimm EB. A gender-specific measure of binge drinking among college students. Am 3 Public Health 1995; 85: 982-985. November 8, 2013 What can administrative data tell us about binge drinking in Belgian minors? 2

3. Objectives Is it possible to estimate prevalence of binge drinking in Belgian minors from administrative data?  Exploration of approximative number of cases of alcohol intoxication per year in minors (12-17 years old)  Exploration of related reimbursed health care  Comparison of prevalence in minors (age 12-17) with young adults (age 18-29) November 8, 2013 What can administrative data tell us about binge drinking in Belgian minors? 3

4. Methodology : source data The InterMutualistic Agency (IMA-AIM) disposes of different databases  All insured persons (= 99% of Belgian population)  Data on age – gender – socio-economic status (proxy through preferential reimbursement) …  Claims data on reimbursed care and medication  Data collection for research purposes November 8, 2013 What can administrative data tell us about binge drinking in Belgian minors? 4

5. Methodology : source data The InterMutualistic Agency (IMA-AIM) disposes of different databases  April 2014: complete data on reimbursed health care starting from 2006  < 2013:  data on specific domains (general practitioners, hospital care, medication) collected by default  Other health care: project-specific data collection  2013: transition period  specific data collection “binge drinking” not feasible  Workarround: data of three largest sickness funds 88,5% of population November 8, 2013 What can administrative data tell us about binge drinking in Belgian minors? 5

6. Methodology: detection binge drinking Estimation of prevalence in minors (12-17)  By age, gender, socio-economic status  Data of 3 sickness funds  2008-2012 Comparison prevalence minors and young adults (18-29)  Data of 3 sickness funds  2008-2012 November 8, 2013 What can administrative data tell us about binge drinking in Belgian minors? 6

7. Methodology: detection binge drinking  Alcohol intoxication =  Detection of reimbursed “determination of blood alcohol concentration” (BAC)  Codes “Nomenclature”: 547035, 547046, 547050, 547061  Plus visit emergency unit (590531, 590575, 590656, 590693, 590774, 590811; 590516, 590553, 590634, 590671, 590752, 590796) OR 1(/2) day(s) hospital stay November 8, 2013 What can administrative data tell us about binge drinking in Belgian minors? 7

8. Methodology: exploration health care Minors with (supposed) alcohol intoxication/binge drinking  Exploration of health care on day = day BAC  Number of patients with reimbursed health care in specific health care categories (contacts, imaging, clinical biology,…)  Mean reimbursed health care per patient  Data of 1 sickness fund  2008-2012 November 8, 2013 What can administrative data tell us about binge drinking in Belgian minors? 8

9. Results: supposed binge drinking in minors November 8, 2013 What can administrative data tell us about binge drinking in Belgian minors? 9 No. cases of20082009201020112012 Determination blood alcohol concentration (BAC) [1] 2.6242.8032.7742.7452.749 BAC + emergency unit BAC + 1 day hospital BAC + 2 days hospital Binge-drinking(?) [2] (denominator = no. insured individuals age 12-17) [3] BAC: [1] * 10.000 insured individuals / [3] binge drinking (?): [2] * 10.000 insured individuals / [3]

10. Results: supposed binge drinking in minors November 8, 2013 What can administrative data tell us about binge drinking in Belgian minors? 10 No. cases of20082009201020112012 Determination blood alcohol concentration (BAC) [1] 2.6242.8032.7742.7452.749 BAC + emergency unit1.0711.0831.196 1.273 BAC + 1 day hospital702803686706676 BAC + 2 days hospital158171146 152 Binge-drinking(?) [2]1.9312.0572.0282.0482.101 (denominator = no. insured individuals age 12-17) [3] 669.518666.545662.359658.542659.919 BAC: [1] * 10.000 insured individuals / [3] binge drinking (?): [2] * 10.000 insured individuals / [3]

11. Results: supposed binge drinking in minors November 8, 2013 What can administrative data tell us about binge drinking in Belgian minors? 11 No. cases of20082009201020112012 Determination blood alcohol concentration (BAC) [1] 2.6242.8032.7742.7452.749 BAC + emergency unit1.0711.0831.196 1.273 BAC + 1 day hospital702803686706676 BAC + 2 days hospital158171146 152 Binge-drinking(?) [2]1.9312.0572.0282.0482.101 (denominator = no. insured individuals age 12-17) [3] 669.518666.545662.359658.542659.919 BAC: [1] * 10.000 insured individuals / [3] 3942 binge drinking (?): [2] * 10.000 insured individuals / [3] 2931 32

12. Results: comparison Dutch registration data Results registration data in the Netherlands (Van Zanten et al. 2013*) *van Zanten E, De Dooy J, Ramet J, van der Lelie N. 2013. Nederlandse ervaringen met alcoholintoxicaties bij minderjarigen: aankondiging van de Belgische registratie door kinderartsen. Tijdschr. voor Geneeskunde 69 (9). November 8, 2013 What can administrative data tell us about binge drinking in Belgian minors? 12

13. Results: comparison young adults November 8, 2013 What can administrative data tell us about binge drinking in Belgian minors? Period 2012  Age 12-17: 2.101 cases  in a group of 10.000 minors: 31,8  Age 18-29: 9.835 cases  in a group of 10.000 young adults: 67,6 (  2,1x) Methodology aspecific in case of young adults (car accidents … !) 13

14. Results: binge drinking by age November 8, 2013 What can administrative data tell us about binge drinking in Belgian minors? 14

15. Results: comparison Dutch registration data Results registration data in the Netherlands (Van Zanten et al. 2013*) *van Zanten E, De Dooy J, Ramet J, van der Lelie N. 2013. Nederlandse ervaringen met alcoholintoxicaties bij minderjarigen: aankondiging van de Belgische registratie door kinderartsen. Tijdschr. voor Geneeskunde 69 (9). November 8, 2013 What can administrative data tell us about binge drinking in Belgian minors? 15 Belgium 2011 58% 42% 1% 4% 10% 19% 30% 36%

16. Results: binge drinking in minors by gender November 8, 2013 What can administrative data tell us about binge drinking in Belgian minors? More frequent for boys than for girls 16

17. Results: binge drinking in minors by socio- economic status November 8, 2013 What can administrative data tell us about binge drinking in Belgian minors? 17 Most frequent in minors with preferential reimbursement (proxy lower socio-economic status)

18. Discussion: fine-tuning methodology? November 8, 2013 What can administrative data tell us about binge drinking in Belgian minors? Large numbers compared to Dutch registration (BE: 2.048 – NL: 762 in 2011)  A-specific? False positives?  Exclusion of (auto)intoxication / suicide attempts and accidents?  Explore number of patients with Trauma (identified by acts of medical imaging / ECG / suture) Intoxication (identified by acts of identification xenobiotica, e.g. medication, drugs, pesticides…) Trauma + intoxication 18

19. Results: exploration of other health care November 8, 2013 What can administrative data tell us about binge drinking in Belgian minors? Number of supposed BD events in minors 2008- 2012 : 3.809 (1 sickness fund) Exploration of health care = frequency of groups of nomenclature codes 19

20. Results: exploration of other health care November 8, 2013 What can administrative data tell us about binge drinking in Belgian minors? Groups of nomenclature with > 9 patientsNo. Patients (%) Clinical biology3.808 (26,9%) Medication2.966 (20,9%) Imaging1.619 (11,4%) Surgery 1.330 (9,4%) Reanimation1.259 (8,9%) Technical acts (lump sums) 1.017 (7,2%) Internal medicine708 (5,0%) Contacts631 (4,5%) Special acts and punctures (Art 11) 542 (3,8%) Technical medical acts133 (0,9%) Dentistry73 (0,5%) Anaesthesiology50 (0,4%) Plaster cast25 (0,2%) 20

21. Results: exploration of other health care November 8, 2013 What can administrative data tell us about binge drinking in Belgian minors? Proportion of cases of minor patients with supposed BD 2008-2012 outside ‘regular hours’ (night, weekend, ferials): 65% Contacts with psychiatricians: 8% of minor patients with supposed BD 2008-2012 Remarkable prestations (?): dosage of paracetamol for 12% of minor patients with supposed BD 2008- 2012 21

22. Discussion: fine-tuning methodology? November 8, 2013 What can administrative data tell us about binge drinking in Belgian minors? Number of supposed BD events in minors 2008- 2012 : 3.809 (1 sickness fund) After exclusion of cases with  ‘trauma’: 3.001 (-21%)  ‘intoxication’: 2.440 (-36%)  ‘trauma’ or ‘intoxication’: 1.814 (-52%) 22

23. Discussion: fine-tuning methodology? November 8, 2013 What can administrative data tell us about binge drinking in Belgian minors? Large numbers compared to Dutch registration 2011: BE: 2.048 – NL: 762  After exclusion of 52% of cases with ‘‘trauma’ or ‘intoxication’  2011: BE: 983 – NL: 762 23

24. Results: costs payed by public health insurance November 8, 2013 What can administrative data tell us about binge drinking in Belgian minors? Number of minors with supposed BD event in 2011- 2012 : 1.496 (1 sickness fund) Mean [CI] health care reimbursement per patient:  690 [646, 734] euro on day 1 + 2 following days  547 [518, 577] euro if only day of BAC is taken into account Median health care reimbursement per patient:  250 euro on day 1 + 2 following days  235 euro if only day of BAC is taken into account 24

25. Conclusion November 8, 2013 What can administrative data tell us about binge drinking in Belgian minors? Numbers should be validated against registration data of binge drinking in Belgium  fine tuning of methodology Monitor prevalence of binge drinking in Belgian minors through administrative data?  Low cost (APR2014: complete data available at IMA 2006-2012)  High reliability if specific (new) code for binge drinking 25

26. Questions - Acknowledgements November 8, 2013 What can administrative data tell us about binge drinking in Belgian minors? Researchers  Birgit Gielen (CM-MC)  Jérôme Vrancken (UNMS-NVSM)  Carine Pochet – Agnès Leclercq (ML-OZ) Experts  Dr Bernard Debbaut (CM-MC) http://www.ima-aim.be 26