151 - Big Data Analyses Can Identify Epidemiologic Features of Kawasaki Disease in Japan: a Study Based on the National Database of Health Insurance Claims and Specific Health Checkups Data of Japan
Researcher National Center for Child Health and Development Setagaya, Tokyo, Japan
Background: Kawasaki disease (KD) is a vascular inflammatory syndrome of unknown cause that predominantly occurs during childhood. In Japan, the Nationwide survey of KD (NSKD) has been conducted biennially since 1970, and epidemiological features of KD have been clarified gradually. However, the feasibility of extracting a clinical, epidemiological profile similar to NSKD from the medical information database remains unexplored. Objective: To investigate the KD incidence and acute phase treatment in Japan using medical information databases, and to examine the consistency with NSKD data. Design/Methods: We used two databases, i.e., the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) and NSKD. Currently, NDB is implemented in 99% of healthcare institutions in Japan and includes detailed medical data on diagnosis, treatment, and other aspects of KD. We used NDB data from January 2013 to December 2020 to identify all children ( < 18 years) diagnosed with KD, excluding the following patients: (1) suspected patients with KD, (2) patients who did not receive inpatient care, and (3) patients who did not receive intravenous immunoglobulin (≥700 mg/kg) or cyclooxygenase inhibitor. Using the drug, disease name, and procedure records in NDB, we extracted information regarding similar variables from the NSKD. We compared the clinical information extracted from NDB from January 2013 to December 2020 with that derived from patients registered in NSKD databases. Results: During the study period, 137,242 patients with KD (110% of NSKD) were identified from NDB. The male/female ratio, age at diagnosis, chronological change of KD onset, and ecological distribution were identical in both databases. Moreover, the proportion of patients who received intravenous immunoglobulin, prednisolone, methylprednisolone, infliximab, cyclosporin A, ulinastatin, and plasma exchange during initial or additional treatment was nearly identical in both databases. Conversely, the proportions of incomplete KD cases, KD-induced coronary artery, myocardial infarction, and valvular disease derived from the disease name information of NDB differed from the NSKD results. The proportion of patients with KD who received either warfarin, clopidogrel, or ticlopidine was similar to the proportion of patients with coronary artery abnormalities at 30 days of illness in the NSKD.
Conclusion(s): Similar to NSKD, NDB allows the extraction of epidemiological characteristics and treatment courses. Further investigations are needed to determine the accuracy of diagnosis and clinical outcomes.
