Exploring ownership of change and health equity implications in neighborhood change processes: A community-led approach to enhancing just climate resilience in Everett, MA.

Traditional planning processes have perpetuated the exclusion of historically marginalized communities, imposing vulnerability to climate (health) crises. We investigate how ownership of change fosters equitable climate resilience and community well-being through participatory action research. Our study highlights the detrimental effects of climate gentrification on community advocacy for climate security and health, negatively impacting well-being. We identify three key processes of ownership of change: ownership of social identity, development and decision-making processes, and knowledge. These approaches emphasize community-led solutions to counter climate health challenges and underscore the interdependence of social and environmental factors in mental health outcomes in climate-stressed communities.

"The trauma machine expands faster than our services": Health risks for unhoused people in an early-stage gentrifying area.

While homelessness continues to be a prevalent problem throughout the United States, many urban neighborhoods are also concurrently experiencing an influx of affluent neighbors through gentrification, exposing the stark inequalities in housing access nationwide. Gentrification-induced changes in neighborhood dynamics have also been shown to affect the health of low-income and non-white groups, with high risks of trauma from displacement and exposure to violent crime and criminalization. This study addresses risk factors for health among the most vulnerable, unhoused individuals, and provides a detailed case study on the potential exposures to emotional and physical traumas for unhoused people in early-stage gentrifying areas. By conducting 17 semi-structured interviews with people who work with the unhoused community - health providers, nonprofit employees, neighborhood representatives, and developers - in Kensington, Philadelphia, we analyze how early-stage gentrification impacts the risks for negative health consequences among unhoused groups. Results show that gentrification impacts the health of unhoused people in four main areas that, all together, create what we identify as a "trauma machine" - that is compounding traumas for unhoused residents by 1) reducing and compromising spaces of safety from violent crime, 2) decreasing public services, 3) threatening the quality of healthcare, and 4) increasing the likelihood of displacement and associated trauma.

Promoting Health Equity Through Preventing or Mitigating the Effects of Gentrification: A Theoretical and Methodological Guide.

Public health researchers are increasingly questioning the consequences of gentrification for population health and health equity, as witnessed in the rapid increase in public health publications on the health (equity) effects of gentrification. Despite methodological challenges, and mixed results from existing quantitative research, qualitative evidence to date points to the role of gentrification processes in exacerbating health inequities. Here we discuss past methodological and theoretical challenges in integrating the study of gentrification with public health research. We suggest taking an interdisciplinary approach, considering the conceptualization of gentrification in measurement techniques and conceiving this process as a direct exposure or as a part of broader neighborhood changes. Finally, we discuss existingpolicy approaches to mitigating and preventing gentrification and how these could be evaluated for effectiveness and as public health promotion and specifically as interventions to promote health equity.

The right to the unhealthy deprived city: An exploration into the impacts of state-led redevelopment projects on the determinants of mental health.

Research shows mental health is impacted by poor-quality physical and social-environmental conditions. Subsequently state-led redevelopment/regeneration schemes focus on improving the physical environment, to provide better social-environmental conditions, addressing spatial and socioeconomic inequities thus improving residents' health. However, recent research suggests that redevelopment/regeneration schemes often trigger gentrification, resulting in new spatial and socioeconomic inequalities that may worsen health outcomes, including mental health, for long-term neighborhood residents. Using the right to the city and situating this within the framework of accumulation by dispossession and capitalist hegemony, this paper explores the potential mechanisms in which poor mental health outcomes may endure in neighborhoods despite the implementation of redevelopment/regeneration projects. To do so, we explored two neighborhoods in the city of Glasgow - North Glasgow and East End - and conducted a strong qualitative study based on 25 in-depth semi-structured interviews with key stakeholders. The results show that postindustrial vacant and derelict land spaces and socioeconomic deprivation in North and East Glasgow are potential mechanisms contributing to the poor mental health of its residents. Where redevelopment/regeneration projects prioritize economic goals, it is often at the expense of social(health) outcomes. Instead, economic investment instigates processes of gentrification, where long-term neighborhood residents are excluded from accessing collective urban life and its (health) benefits. Moreover, these residents are continually excluded from participation in decision-making and are unable to shape the urban environment. In summary, we found a number of potential mechanisms that may contribute to enduring poor mental health outcomes despite the existence of redevelopment/regeneration projects. Projects instead have negative consequences for the determinants of mental health, reinforcing existing inequalities, disempowering original long-term neighborhood residents and only providing the "right" to the unhealthy deprived city. We define this as the impossibility to benefit from material opportunities, public spaces, goods and services and the inability to shape city transformations.

A Study to Compare a CHW-Led Versus Physician-Led Intervention for Prostate Cancer Screening Decision-Making among Black Men.

Introduction: Prostate cancer is the second leading cause of cancer deaths among men in the United States and harms Black men disproportionately. Most US men are uninformed about many key facts important to make an informed decision about prostate cancer. Most experts agree that it is important for men to learn about these problems as early as possible in their lifetime. Objectives: To compare the effect of a community health worker (CHW)-led educational session with a physician-led educational session that counsels Black men about the risks and benefits of prostate-specific antigen (PSA) screening. Methods: One hundred eighteen Black men recruited in 8 community-based settings attended a prostate cancer screening education session led by either a CHW or a physician. Participants completed surveys before and after the session to assess knowledge, decisional conflict, and perceptions about the intervention. Both arms used a decision aid that explains the benefits, risks, and controversies of PSA screening and decision coaching. Results: There was no significant difference in decisional conflict change by group: 24.31 physician led versus 30.64 CHW led (P=.31). The CHW-led group showed significantly greater improvement on knowledge after intervention, change (SD): 2.6 (2.81) versus 5.1 (3.19), P<.001). However, those in the physician-led group were more likely to agree that the speaker knew a lot about PSA testing (P<.001) and were more likely to trust the speaker (P<.001). Conclusions: CHW-led interventions can effectively assist Black men with complex health decision-making in community-based settings. This approach may improve prostate cancer knowledge and equally minimize decisional conflict compared with a physician-led intervention.

Green gentrification in European and North American cities.

Although urban greening is universally recognized as an essential part of sustainable and climate-responsive cities, a growing literature on green gentrification argues that new green infrastructure, and greenspace in particular, can contribute to gentrification, thus creating social and racial inequalities in access to the benefits of greenspace and further environmental and climate injustice. In response to limited quantitative evidence documenting the temporal relationship between new greenspaces and gentrification across entire cities, let alone across various international contexts, we employ a spatially weighted Bayesian model to test the green gentrification hypothesis across 28 cities in 9 countries in North America and Europe. Here we show a strong positive and relevant relationship for at least one decade between greening in the 1990s-2000s and gentrification that occurred between 2000-2016 in 17 of the 28 cities. Our results also determine whether greening plays a "lead", "integrated", or "subsidiary" role in explaining gentrification.

Patent foramen ovale closure: A prospective UK registry linked to hospital episode statistics.

AIMS: PFO closure is a percutaneous intervention, which aims to reduce risk of recurrent stroke by preventing paradoxical embolism. The objective of this study was to measure procedural safety and longer-term effectiveness of PFO closure in a UK setting. METHODS AND RESULTS: Prospective registry data from patients with cryptogenic stroke eligible for PFO closure were collected for up to 2 years and linked to routine data sources for additional follow-up. Outcomes of interest included procedural success rate, health related quality of life, and longer-term death and neurological event rates. A total of 973 PFO closure procedures in 971 patients were included in analysis. Successful device implantation was achieved in 99.4 [95% CI 98.6 to 99.8]% of procedures, with one in-hospital death. During median follow-up of 758 (Q1:Q3 527:968) days, 33 patients experienced a subsequent neurological event, 76% of which were ischaemic in origin. Neurological event rate was 2.7 [95%CI 1.6 to 3.9]% at 1-year (n = 751) and 4.1 [95% CI 2.6 to 5.5]% at 2-years (n = 463) using Kaplan-Meier analysis. Improvements in patient quality of life (utility and visual analogue scale) were observed at 6-weeks and 6-months follow-up. CONCLUSION: Our observational study demonstrates that PFO closure for prevention of recurrent stroke is a relatively safe procedure but in routine clinical practice is associated with a slightly higher risk of recurrent neurological events than in randomised trials. We hypothesize that our study enrolled unselected patients with higher baseline risk, who were excluded from randomised trials, but who may benefit from a similar relative reduction in risk from the intervention.

Title: advancing urban health equity in the United States in an age of health care gentrification: a framework and research agenda.

BACKGROUND: Access to health care has traditionally been conceptualized as a function of patient socio-demographic characteristics (i.e., age, race/ethnicity, education, health insurance status, etc.) and/or the system itself (i.e., payment structures, facility locations, etc.). However, these frameworks typically do not take into account the broader, dynamic context in which individuals live and in which health care systems function. PURPOSE: The growth in market-driven health care in the U.S. alongside policies aimed at improving health care delivery and quality have spurred health system mergers and consolidations, a shift toward outpatient care, an increase in for-profit care, and the closure of less profitable facilities. These shifts in the type, location and delivery of health care services may provide increased access for some urban residents while excluding others, a phenomenon we term "health care gentrification." In this commentary, we frame access to health care in the United States in the context of neighborhood gentrification and a concurrent process of changes to the health care system itself. CONCLUSIONS: We describe the concept of health care gentrification, and the complex ways in which both neighborhood gentrification and health care gentrification may lead to inequitable access to health care. We then present a framework for understanding health care gentrification as a function of dynamic and multi-level systems, and propose ways to build on existing models of health care access and social determinants of health to more effectively measure and address this phenomenon. Finally, we describe potential strategies applied researchers might investigate that could prevent or remediate the effects of health care gentrification in the United States.

Healthy cities after COVID-19 pandemic: the just ecofeminist healthy cities approach.

The COVID-19 pandemic crisis has compromised the 'healthy cities' vision, as it has unveiled the need to give more prominence to caring tasks while addressing intersectional social inequities and environmental injustices. However, much-needed transdisciplinary approaches to study and address post-COVID-19 healthy cities challenges and agendas have been scarce so far. To address this gap, we propose a 'just ecofeminist healthy cities' research approach, which would be informed by the caring city, environmental justice, just ecofeminist sustainability and the healthy cities paradigms and research fields. Our proposed approach aims to achieve the highest standards of human health possible for the whole population-yet putting the health of socially underprivileged residents in the centre-through preserving and/or improving the existing physical, social and political environment. Importantly, the proposed approach recognises all spheres of daily life (productive, reproductive, personal and political) and their connections with inequities, justice and power dynamics. Last, the just ecofeminist healthy cities approach understands human health as interconnected with the health of non-human animals and the ecosystem. We illustrate the proposed new approach focusing on the implications for women's health and public green spaces research and propose principles and practices for its operationalisation.

Sociodemographic determinants of intraurban variations in COVID-19 incidence: the case of Barcelona.

BACKGROUND: Intraurban sociodemographic risk factors for COVID-19 have yet to be fully understood. We investigated the relationship between COVID-19 incidence and sociodemographic factors in Barcelona at a fine-grained geography. METHODS: This cross-sectional ecological study is based on 10 550 confirmed cases of COVID-19 registered during the first wave in the municipality of Barcelona (population 1.64 million). We considered 16 variables on the demographic structure, urban density, household conditions, socioeconomic status, mobility and health characteristics for 76 geographical units of analysis (neighbourhoods), using a lasso analysis to identify the most relevant variables. We then fitted a multivariate Quasi-Poisson model that explained the COVID-19 incidence by neighbourhood in relation to these variables. RESULTS: Neighbourhoods with: (1) greater population density, (2) an aged population structure, (3) a high presence of nursing homes, (4) high proportions of individuals who left their residential area during lockdown and/or (5) working in health-related occupations were more likely to register a higher number of cases of COVID-19. Conversely, COVID-19 incidence was negatively associated with (6) percentage of residents with post-secondary education and (7) population born in countries with a high Human Development Index. CONCLUSION: Like other historical pandemics, the incidence of COVID-19 is associated with neighbourhood sociodemographic factors with a greater burden faced by already deprived areas. Because urban social and health injustices already existed in those geographical units with higher COVID-19 incidence in Barcelona, the current pandemic is likely to reinforce both health and social inequalities, and urban environmental injustice all together.

Gentrification pathways and their health impacts on historically marginalized residents in Europe and North America: Global qualitative evidence from 14 cities.

As global cities grapple with the increasing challenge of gentrification and displacement, research in public health and urban geography has presented growing evidence about the negative impacts of those unequal urban changes on the health of historically marginalized groups. Yet, to date comprehensive research about the variety of health impacts and their pathways beyond single case sites and through an international comparative approach of different gentrification drivers and manifestations remains scarce. In this paper, we analyze qualitative data on the pathways by which gentrification impacts the health of historically marginalized residents in 14 cities in Europe and North America. We build on 77 interviews with key neighborhood stakeholders. Data analysis indicates four main concurrent processes: Threats to housing and financial security; Socio-cultural displacement; Loss of services and amenities through institutional gentrification; and Increased risks of criminal behavior and compromised public safety. Gentrification is experienced as a chain of physical and emotional community and individual traumas - an overall shock for historically marginalized groups - because of permanent pressures of insecurity, loss, state of displaceability, and the associated exacerbation of socio-environmental disadvantages.

Mental Health Outcomes in Barcelona: The Interplay between Gentrification and Greenspace.

Greenspace is widely related to mental health benefits, but this relationship may vary by social group. Gentrification, as linked to processes of unequal urban development and conflict, potentially impacts health outcomes. This study explores the relationships between greenspace and mental health and between gentrification and mental health associations. It also further examines gentrification as an effect modifier in the greenspace-mental health association and SES as an effect modifier in the gentrification-mental health association. We used cross-sectional Barcelona (Spain) data from 2006, which included perceived mental health status and self-reported depression/anxiety from the Barcelona Health Survey. Greenspace exposure was measured as residential access to (1) all greenspace, (2) greenways and (3) parks in 2006. Census-tract level gentrification was measured using an index including changes in sociodemographic indicators between 1991 and 2006. Logistic regression models revealed that only greenways were associated with better mental health outcomes, with no significant relationship between mental health and parks or all greenspace. Living in gentrifying neighborhoods was protective for depression/anxiety compared to living in non-gentrifying neighborhoods. However, only residents of gentrifiable census tracts benefited from the exposure to greenways. SES was not found to be an effect modifier in the association between gentrification and mental health. Future research should tackle this study's limitations by incorporating a direct measure of displacement in the gentrification status indicator, accounting for qualitative aspects of greenspace and user's perceptions. Gentrification may undermine the health benefits provided by greenspace interventions.

Left atrial appendage occlusion in the UK: prospective registry and data linkage to Hospital Episode Statistics.

AIMS: Non-valvular atrial fibrillation (AF) greatly increases the risk of ischaemic stroke. For people with contraindications to oral anticoagulation, left atrial appendage occlusion (LAAO) provides a non-pharmacological management alternative. The aim of this study was to measure the procedural safety and longer-term effectiveness of LAAO for AF in a UK setting. METHODS AND RESULTS: This was a prospective, single-armed registry of patients with AF for whom anticoagulation was unsuitable. Registry data were collected between October 2014 and April 2018 and linked to routine data sources for follow-up. Data from 583 LAAO procedures were entered into the registry, of which 537 (from 525 patients) were eligible for inclusion (median CHA2DS2-VASc score 4). A closure device was successfully implanted in 93.4% of cases, with a procedural success rate (device implanted without major complication) of 88.9%. Five patients (1.0%) died in hospital. During follow-up [median 729 (Q1:Q3, 523:913) days] 45 patients experienced neurological events; 33 of which were ischaemic. The ischaemic neurological event rate was 3.3 (1.6-5.0)% at 1 year (n = 387) and 7.0 (4.3-9.6)% at 2 years (n = 196). There were significant improvements in overall patient health (via Visual Analogue Scale) measured at 6 weeks and 6 months, but no significant improvements observed in patient utility over time. CONCLUSION: The findings of our study suggest that LAAO is not without procedural risk, but that this risk may be justified in high-risk patients with AF who cannot take an anticoagulant. Moreover, the data do not provide support for more widespread use of LAAO as the complication rate was relatively high and would be difficult to justify in many patients with AF who tolerate anticoagulation.

Exposure to nature and mental health outcomes during COVID-19 lockdown. A comparison between Portugal and Spain.

BACKGROUND: To control the spread of the SARS-CoV-2 virus, countries around the world implemented lockdowns with varying intensities. Lockdowns, however, have been associated with a deterioration of mental health, including post-traumatic stress symptoms, anger and anxiety. Exposure to nature might reduce stress and provide relaxation opportunities. OBJECTIVE: Firstly, we aimed to determine which sociodemographic, housing and lockdown-related characteristics were associated with changes in exposure to nature during the COVID-19 lockdown in Portugal and Spain. Secondly, we sought to estimate the associations of these changes with mental health, and test whether these associations differed according to sociodemographic characteristics and between the two countries, which experienced different restrictions and epidemiological situations. METHODS: A cross-sectional study was conducted between March 27 and May 6, 2020, using an online questionnaire to measure changes in exposure to nature (including private green space and other greenery, views of nature from home and public natural spaces); sociodemographic, housing and lockdown-related characteristics; stress levels (visual stress scale); psychological distress (General Health Questionnaire - 12 items) and somatization (somatization scale). Adjusted regression models were fitted to estimate associations. RESULTS: This study included 3157 participants (1638 from Portugal, 1519 from Spain). In Portugal, maintaining/increasing the use of public natural spaces during the lockdown was associated with lower levels of stress (adjusted beta -0.29; 95%CI -0.49, -0.08) and maintaining/increasing the frequency of viewing nature from home was associated with reduced psychological distress (0.27; -0.51, -0.03), somatization (-0.79; -1.39, -0.20), and stress levels (-0.48; -0.74, -0.23). In Spain, maintaining/increasing contact with private green space and greenery was associated with lower stress levels: for contact with indoor plants (-0.52; -0.96, -0.07) and for use of private community green spaces (-0.82; -1.61, -0.03). CONCLUSION: Exposure to nature was associated with better mental health outcomes during lockdowns, but the natural features associated with improved mental health differed between the two countries. Nature should be incorporated into urban planning interventions and housing design and exposure to nature should be promoted during lockdowns.

Safety, effectiveness and costs of percutaneous mitral valve repair: A real-world prospective study.

AIMS: Percutaneous mitral valve leaflet repair is a treatment option for some people with severe mitral valve regurgitation for whom conventional mitral valve surgery is clinically inappropriate. This study aimed to determine the safety, efficacy, and costs of percutaneous mitral valve leaflet repair, using the MitraClip device in a UK setting. METHODS AND RESULTS: This was a prospective, single-armed registry with a follow-up of 2 years that reported a range of procedural, clinical and patient-orientated outcomes. Registry data were linked to routine data sources to allow for more comprehensive follow up concerning mortality and healthcare resource use. The registry received data for 199 mainly elective patients with mixed mitral regurgitation aetiology. A MitraClip device was implanted in 187 patients (94%), with a procedural success rate of 86%, with 8% of patients having a serious in-hospital adverse event (including 5% mortality). Percutaneous mitral valve leaflet repair reduced mitral regurgitation from 100% MR grade ≥ 3+ to 7% at discharge. There were corresponding improvements in New York Heart Association functional class, reducing from 92% (class ≥ 3) at baseline to 18% at 6 weeks. There were significant improvements in generic and disease specific quality of life indicators up to 2 years. The all-cause mortality rate was estimated to be 12.7% (95% CI 7.5 to 17.7%) at 1 year. Percutaneous mitral valve leaflet repair was associated with reduced hospital readmissions and potential cost-savings in post-procedural care. CONCLUSION: This study shows that percutaneous mitral valve leaflet repair using MitraClip is a relatively safe and effective treatment in patients unable to tolerate surgery and has the potential to reduce ongoing healthcare costs in the UK.

The relationship between residential proximity to outdoor play spaces and children's mental and behavioral health: The importance of neighborhood socio-economic characteristics.

Urban outdoor play spaces are reported to improve children's health. However, there is little empirical evidence on the impact of outdoor play spaces on childhood mental and behavioral health. To fill this gap, we investigated the associations between residential proximity to outdoor play spaces and the prevalence of diagnosed mental and behavioral disorders. We explored whether these associations differ by individual and area-level socio-economic status (SES). This cross-sectional study included 151 110 children who were 0-12 years old in 2014 and were visited in public primary health care centers in Barcelona (Spain). Each child's demographic and mental and behavioral disorders information was extracted for 2005-2014, including diagnoses on disorders of psychological development together with other four types of mental and behavioral disorders. The pediatrician diagnosed mental and behavioral disorders we explored in this study were: mood/affective; neurotic, stress-related and somatoform; psychological development; behavioral and emotional; and overall mental and behavioral disorders. We assessed 300 m network buffer residential proximity to overall outdoor play spaces (i.e., the overall sum of play spaces of any type), outdoor green play spaces, and to a diversity of outdoor play spaces. We used robust Poisson regression models to investigate the association between proximity to outdoor play spaces indicators and each health outcome. We tested interaction terms for indicators of proximity to outdoor play spaces and individual and area SES. For measures with significant interaction terms, we conducted stratified models. We found residential proximity to outdoor play spaces to be protective of disorders of psychological development. Proximity to overall outdoor play spaces, proximity to outdoor green play spaces and proximity to a greater diversity of outdoor play spaces were associated with a 4% (95% CI: 1,7), 4% (95% CI: 1,7) and 5% (95% CI: 2,9) lower prevalence rates of disorders of psychological development respectively. Most of the associations were found to be in the same direction-although more pronounced-in low SES areas, but in the opposite direction for children living in high SES areas. No differences in these associations were found by individual SES. Residential proximity to outdoor play spaces is protective of children's mental and behavioral health living in low SES areas.

Natural outdoor environments' health effects in gentrifying neighborhoods: Disruptive green landscapes for underprivileged neighborhood residents.

BACKGROUND: Cities are restoring existing natural outdoor environments (NOE) or creating new ones to address diverse socio-environmental and health challenges. The idea that NOE provide health benefits is supported by the therapeutic landscapes concept. However, several scholars suggest that NOE interventions may not equitably serve all urban residents and may be affected by processes such as gentrification. Applying the therapeutic landscapes concept, this study assesses the impacts of gentrification processes on the associations between NOE and the health of underprivileged, often long-term, neighborhood residents. METHODS: We examined five neighborhoods in five cities in Canada, the United States and Western Europe. Our case studies were neighborhoods experiencing gentrification processes and NOE interventions. In each city, we conducted semi-structured qualitative interviews on NOE interventions, equity/justice, gentrification and health (n = 117) with case study neighborhood residents, community-based organizations, neighborhood resident leaders and other stakeholders such as public agencies staff. RESULTS: Respondents highlighted a variety of interconnected and overlapping factors: the insufficient benefits of NOE to counterbalance other factors detrimental to health, the use of NOE for city branding and housing marketing despite pollution, unwelcomeness, increase of conflicts, threats to physical displacement for themselves and their social networks, unattractiveness, deficient routes, inadequate NOE maintenance and lack of safety in NOE. CONCLUSIONS: Our study demonstrated that underprivileged neighborhood residents were perceived to experience new or improved NOE as what we call "disruptive green landscapes" (i.e. non-therapeutic landscapes with which they were not physically or emotionally engaged) instead of as therapeutic landscapes.

Associations between Greenspace and Gentrification-Related Sociodemographic and Housing Cost Changes in Major Metropolitan Areas across the United States.

Neighborhood greenspace may attract new residents and lead to sociodemographic or housing cost changes. We estimated relationships between greenspace and gentrification-related changes in the 43 largest metropolitan statistical areas (MSAs) of the United States (US). We used the US National Land Cover and Brown University Longitudinal Tracts databases, as well as spatial lag models, to estimate census tract-level associations between percentage greenspace (years 1990, 2000) and subsequent changes (1990-2000, 2000-2010) in percentage college-educated, percentage working professional jobs, race/ethnic composition, household income, percentage living in poverty, household rent, and home value. We also investigated effect modification by racial/ethnic composition. We ran models for each MSA and time period and used random-effects meta-analyses to derive summary estimates for each period. Estimates were modest in magnitude and heterogeneous across MSAs. After adjusting for census-tract level population density in 1990, compared to tracts with low percentage greenspace in 1992 (defined as ≤50th percentile of the MSA-specific distribution in 1992), those with high percentage greenspace (defined as >75th percentile of the MSA-specific distribution) experienced higher 1990-2000 increases in percentage of the employed civilian aged 16+ population working professional jobs (ß: 0.18, 95% confidence interval (CI): 0.11, 0.26) and in median household income (ß: 0.23, 95% CI: 0.15, 0.31). Adjusted estimates for the 2000-2010 period were near the null. We did not observe evidence of effect modification by race/ethnic composition. We observed evidence of modest associations between greenspace and gentrification trends. Further research is needed to explore reasons for heterogeneity and to quantify health implications.

Comparison of identifiable and non-identifiable data linkage: health technology assessment of MitraClip using registry, administrative and mortality datasets.

OBJECTIVES: The UK MitraClip registry was commissioned by National Health Service (NHS) England to assess real-world outcomes from percutaneous mitral valve repair for mitral regurgitation using a new technology, MitraClip. This study aimed to determine longitudinal patient outcomes by linking to routine datasets: Hospital Episode Statistics (HES) Admitted Patient Care (APC) and Office of National Statistics. METHODS: Two methods of linkage were compared, using identifiable (NHS number, date of birth, postcode, gender) and non-identifiable data (hospital trust, age in years, admission, discharge and operation dates, operation and diagnosis codes). Outcome measures included: matching success, patient demographics, all-cause mortality and subsequent cardiac intervention. RESULTS: A total of 197 registry patients were eligible for matching with routine administrative data. Using identifiable linkage, a total of 187 patients (94.9%) were matched with the HES APC dataset. However, 21 matched individuals (11.2%) had inconsistencies across the datasets (eg, different gender) and were subsequently removed, leaving 166 (84.3%) for analysis. Using non-identifiable data linkage, a total of 170 patients (86.3%) were uniquely matched with the HES APC dataset.Baseline patient characteristics were not significantly different between the two methods of data linkage. The total number of deaths (all causes) identified from identifiable and non-identifiable linkage methods was 37 and 40, respectively, and the difference in subsequent cardiac interventions identified between the two methods was negligible. CONCLUSIONS: Patients from a bespoke clinical procedural registry were matched to routine administrative data using identifiable and non-identifiable methods with equivalent matching success rates, similar baseline characteristics and similar 2-year outcomes.