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      Incidence of chronic wounds in Singapore, a multiethnic Asian country, between 2000 and 2017: a retrospective cohort study using a nationwide claims database


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          Chronic wounds are common, costly and impair quality of life, yet epidemiological data are scarce. We aimed to estimate the incidence trend of a multiethnic Asian population.


          Retrospective cohort study.


          Singapore’s nationwide claims database.


          Singaporeans and permanent residents.


          Patients were identified by International Classification of Disease, Ninth Revision, Australian Modification (ICD-9-AM) and ICD-10-AM codes from all admissions between 2000 and 2017, and categorised according to aetiology: venous, arterial, diabetic and pressure. Comorbidities were extracted from a national database of Charlson Comorbidity Index scores.


          Between 2000 and 2017, 124 023 wound-related claims among 86 631 patients were identified. Age-specific rate (ASR) and age-adjusted incidence rates of all wounds increased over 18 years, with greatest increases among those aged ≥80. In 2017, the median age of patients was 74 (IQR 63–84). Half were male (51%). 70% were ethnic Chinese, 15% Malay and 9% Indian. In 2017, the crude incidence rate (CIR) was 15 per 100 000 persons (95% CI 14 to 16) for venous wounds, 56 (95% CI 53 to 58) for arterial, 168 (95% CI 164 to 173) for diabetic and 183 (95% CI 179 to 188) for pressure wounds. The CIR of any chronic wound was 296 (95% CI 291 to 301). ASRs were greatest in patients aged ≥80: 92 (95% CI 74 to 112) for venous, 478 (95% CI 436 to 522) for arterial, 1791 (95% CI 1710 to 1876) for diabetic, 3647 (95% CI 3530 to 3766) for pressure and 4277 (95% CI 4151 to 4407) for any wound. Compared with the Chinese, Indians had thrice the ASRs of venous and arterial wounds and double the ASR of diabetic wounds. Malays had double the ASRs of arterial and diabetic wounds.


          Chronic wounds are common in the elderly with significant ethnic disparities in this Asian cohort. With the incidence expected to rise with ageing populations, it is crucial to address health disparities and evaluate utilisation and cost to inform clinical practice and health policy.

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          Most cited references 20

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          Prevalence of chronic wounds in the general population: systematic review and meta-analysis of observational studies

          Chronic wounds are a major public health challenge, but little is known about the true burden with studies reporting different estimates because of disparities in study designs and measurement methods. This hampers efficient resource allocation, planning, and improvement of wound care.
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            Epidemiology of chronic wounds in Germany: Analysis of statutory health insurance data.

            Epidemiologic analyses in routine care of chronic wounds are scarce, and published studies show wide variations. This study analyzes the population-based prevalence and incidence of chronic wounds in Germany. Secondary analyses of data from a German statutory health insurance with about 9 million insured persons were examined (2010 to 2012). Internal diagnostic validations were used to control for different inclusion criteria. In 2012, 1.04% (95% CI 1.03-1.05) of insured patients had a wound diagnosis, including 0.70% with leg ulcers and 0.27% with diabetic ulcers. Wound treatment was received by 0.43% (0.43-0.44) of patients. Prevalence and incidence increased over 3 years. Extrapolated to the German population, there were 786,407 prevalent and 196,602 incident chronic wounds, including 326,334/172,026 patients who underwent wound-relevant treatment in 2012. There is an annually increasing frequency of chronic wounds in Germany. Chronic wound epidemiology is sensitive to wound treatment as a filter criterion.
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              Estimating Disease Prevalence and Incidence Using Administrative Data: Some Assembly Required


                Author and article information

                BMJ Open
                BMJ Open
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                25 September 2020
                : 10
                : 9
                [1 ]departmentPolicy and Research Division , Ministry of Health , Singapore
                [2 ]departmentDepartment of Internal Medicine , Singapore General Hospital , Singapore
                [3 ]departmentSingHealth Duke-NUS Medicine Academic Clinical Programme , SingHealth Duke-NUS Academic Medical Centre , Singapore
                [4 ]Johns Hopkins Bloomberg School of Public Health , Baltimore, United States
                [5 ]departmentHealth Services & Systems Research , Duke-NUS Medical School , Singapore
                [6 ]departmentWound Care Innovation for the Tropics Programme , Skin Research Institute of Singapore, A*STAR , Singapore
                [7 ]Saw Swee Hock School of Public Health, National University of Singapore , Singapore
                Author notes
                [Correspondence to ] Dr Orlanda Q Goh; orlanda.goh@ 123456gmail.com
                © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/.

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