The SPHIS Project
(Southern Population Health Information System)
Stroke Admissions 1999-2001
A Data Model to inform Health Policy
and Prevention in a Regional Area
Fabrizio Carinci
Director, Centre for Health Systems Research
Paul Talman
Director, Stroke Unit
The SH 1999-2001 Stroke Cohort: Flow Chart
Stroke Admissions 1st July 1998 –30th June 2001 - N=4,032 (1.1%)
Yes
No
First
Admission
Stroke Patients
N=3,356
Stroke readmissions
N=676 (17%)
COHORT HISTORY
Select all admissions (any diagnosis) with same UR_NO
and date of admission>date of discharge first stroke admission (N=8,287)
X
Deaths at First Admission: 316/3356 (9%)
X
Survivors Died at Readmission: 141/3040 (5%)
X
Admissions
1/06/1998
Survivors Readmitted: 1194/3040 (39%)
Survivors Never Readmitted:
1705/3040 (56%)
30/06/2001
TIME
Geographical Variability
Stroke Patients
x 1.000
(N=3324)
3-Year Overall LOS per Subject
Dandenong Hospital
0
0-1
1.1-2.9
3-4.9
5.1-6.2
6.9-7.5
Sum LOS per Subject
80
60
40
20
0
Postcodes
Practice Variability
LOS>26 (75%) by Discharge Unit
OVERALL
3356
NCST
1036
MDGA
716
MCED
281
NJUN
262
MDED
197
MSGA
121
NCBS
115
MSED
91
SCVS
91
NCUN
63
SDVS
62
MCGA
50
SJVS
37
MDGG
31
MSGP
29
0
10
20
30
40
50
60
70
80
FREQUENCY
LOS>26
No
Yes
90
100
SH 1999-2001 - Event Rates by Department of Discharge
(Mortality, Readmissions and LOS observed anywhere)
ALL PATIENTS
Mortality
LOS
> 26
Overall
Emergency Clayton
Emergency Dandenong
Medicine Clayton
Medicine Dandenong
Neurosciences (incl. NCST)
NCST only
Surgery Clayton
Surgery Dandenong
Other
2.9
3.0
31.0
18.4
15.1
9.6
15.8
16.4
6.3
1.9
2.0
16.9
13.1
6.1
10.5
8.4
7.6
1.9
STROKE PATIENTS
LOS
> 26
Overall
7.7
8.2
41.3
31.7
27.3
14.2
3.2
24.7
9.0
4.2
40.5
18.2
14.3
4.4
3.2
12.9
Emergency Clayton
Emergency Dandenong
Medicine Clayton
Medicine Dandenong
Neurosciences
Surgery Clayton
Surgery Dandenong
Other
Readmission
1ST Adm. Readm.
0.6
0.9
8.1
6.0
4.3
9.9
3.9
3.8
0.8
Mortality
1.3
1.1
8.8
7.1
1.8
0.6
4.5
4.8
1.1
1st Adm. Readm.
4.4
3.1
21.3
6.4
10.8
7.5
4.6
1.1
18.6
11.8
3.5
4.4
3.2
5.4
Overall
28.4
26.9
51.5
44.9
32.7
3.5
43.8
38.2
27.2
7 days
8.5
6.1
4.4
3.3
3.5
0.5
2.5
2.8
3.2
Readmission
Overall
35.5
30.5
59.3
56.8
43.5
39.6
25.8
36.7
7 days
11.6
2.1
5.1
5.0
4.4
3.3
4.8
4.6
Modelling
Outcomes= Subject-Level Adjustments +
Practice-Level Adjustments +
Subject Level Covariates +
Practice-Level Risk Covariates +
Population-Level Factors
SH Stroke Patients 1999-2001
Outcome: Overall LOS26
Variable (HR;95% CI)
Cox Regression Results (Events / N = 829 / 3,321)
Age > 65 (1.443;1.198-1.738)
Male (0.902;0.779-1.045)
Respiratory (1.13;0.864-1.477)
Cancer (1.116;0.741-1.683)
History of
Comorbidity
Heart Disease (1.258;0.998-1.585)
At First
Circulatory (1.115;0.889-1.398)
Stroke
Diabetes (1.202;0.932-1.549)
Admission
Renal (1.476;1.024-2.128)
TIA (0.422;0.323-0.55)
Stroke
Hemorragic
(1.355;1.106-1.661)
Diagnosis
Cerebral Infarction (0.86;0.71-1.043)
Discharge
Clayton (1.5;1.188-1.893)
Hospital
Dandenong (1.448;1.134-1.85)
Neurosciences (0.77;0.614-0.965)
Emergency Clayton (0.436;0.268-0.711)
Discharge
Unit
Emergency Dandenong (0.586;0.346-0.989)
Separated/Divorced/Widow (1.238;1.06-1.446)
Discharge
Kingston (3.657;3.099-4.315)
Destination
Hampton (5.111;4.038-6.469)
Procedures Carotid Endarterectomy (0.245;0.132-0.454)
CT Scan (1.217;1.034-1.432)
Postcodes
Springvale (3171) (1.543;1.088-2.188)
0.01
Predictive at Subject level
0.25
0.5
1
Decreased Risk
2
5
Increased Risk
HAZARD RATIO
10
SH Stroke Patients 1999-2001
Outcome: Overall Mortality
Cox Regression Results (Events / N = 435 / 3,321)
Variable (HR;95% CI)
History of
Comorbidity
At First
Stroke
Admission
Stroke
Diagnosis
Discharge
Hospital
Discharge Unit
Procedures
Age > 65 (2.59 ; 1.96 - 3.44)
Male (0.96 ; 0.79 - 1.16)
Respiratory (1.29 ; 0.90 - 1.86)
Cancer (1.44 ; 0.82 - 2.55)
Heart Disease (0.98 ; 0.69 - 1.39)
Circulatory (1.18 ; 0.83 - 1.67)
Diabetes (0.96 ; 0.66 - 1.39)
Renal (1.56 ; 0.98 - 2.47)
TIA (0.17 ; 0.11 - 0.25)
Hemorragic (2.67 ; 2.11 - 3.37)
Cerebral Infarction (0.94 ; 0.72 - 1.22)
Clayton (2.39 ; 1.67 - 3.41)
Dandenong (1.36 ; 0.96 - 1.93)
Neurosciences (0.57 ; 0.41 - 0.78)
Emergency Clayton (0.57 ; 0.34 - 0.94)
Carer Unknown or NA (3.81 ; 1.42 -10.25)
Planned Admission (0.38 ; 0.23 - 0.63)
Hospital Transfer (0.24 ; 0.18 - 0.31)
Carotid Endarterectomy (0.19 ; 0.07 - 0.49)
Magnetic Resonance (0.49 ; 0.32 - 0.73)
0.01
0.25
0.5
1
Decreased Risk
2
5
Increased Risk
HAZARD RATIO
10
SH Stroke Patients 1999-2001
Outcome: In-hospital Mortality at First Admission
Logistic Regression Results (Events / N=316 / 3,356)
Variable (OR;95% CI)
History of
Comorbidity
At First
Stroke
Admission
Stroke
Diagnosis
Discharge
Hospital
Discharge
Unit
Procedures
Age > 65 (2.40 ; 1.70 - 3.38)
Male (1.02 ; 0.79 - 1.31)
Respiratory (1.19 ; 0.70 - 2.01)
Cancer (1.23 ; 0.53 - 2.89)
Heart Disease (1.06 ; 0.66 - 1.71)
Circulatory (0.75 ; 0.46 - 1.23)
Diabetes (1.07 ; 0.64 - 1.81)
Renal (2.15 ; 1.11 - 4.17)
TIA (0.04;0.015-0.11)
Hemorragic (3.59 ;2.65 - 4.87)
Cerebral Infarction (0.84 ; 0.59 - 1.17)
Clayton (1.87 ; 1.25 - 2.78)
Dandenong (1.54 ;1.01 -2.35)
Emergency Clayton (0.36 ; 0.19 - 0.68)
Medicine Clayton (1.95 ; 1.02 - 3.70)
NE Asian / N American (1.57 ; 1.05 - 2.33)
Planned Admission (0.28 ; 0.14 - 0.56)
Carotid Endarterectomy (0.09 ; 0.01 - 0.68)
CT Scan (0.68 ; 0.48 - 0.95)
CT Scan Intrav. (0.38 ; 0.23 - 0.64)
Magnetic Resonance (0.26 ; 0.15 - 0.46)
0.01
0.25
0.5
1
Decreased Risk
Predictive at Subject level
2
5
Increased Risk
ODDS RATIO
10
SH Stroke Patients 1999-2001
Outcome: Overall Readmissions
Variable (HR;95% CI)
History of
Comorbidity
At First
Stroke
Admission
Stroke
Diagnosis
Discharge
Hospital
Discharge Unit
Discharge
Destination
Procedures
Postcode
Cox Regression Results (Events / N =1,335 / 3,027)
Age > 65 (1.26 ; 1.10 - 1.43)
Male (0.96 ; 0.86 - 1.07)
Respiratory (1.22 ; 0.98 - 1.51)
Cancer (1.30 ; 0.94 - 1.79)
Heart Disease (1.17 ; 0.97 - 1.42)
Circulatory (1.07 ; 0.89 - 1.30)
Diabetes (1.09 ; 0.88 - 1.34)
Renal (1.27 ; 0.93 - 1.74)
TIA (0.83 ; 0.71 - 0.98)
Hemorragic (1.04 ; 0.86 - 1.26)
Cerebral Infarction (0.95 ; 0.81 - 1.10)
Clayton (1.88 ; 1.57 - 2.25)
Dandenong (6.54 ; 2.06 -20.75)
Neurosciences (0.80 ; 0.69 - 0.94)
Emergency Dandenong (0.23 ; 0.07 - 0.75)
Medicine Dandenong (0.31 ; 0.10 - 0.98)
Surgery Dandenong (0.22 ; 0.06 - 0.76)
NE Asian / N American (0.59 ; 0.46 - 0.76)
Kingston (2.42 ; 2.09 - 2.80)
Hampton (3.53 ; 2.91 - 4.29)
Carotid Endarter. (0.65 ; 0.46 - 0.92)
CT Scan (1.19 ; 1.05 - 1.35)
Bentleigh East (3165) (1.37 ; 1.04 - 1.80)
Oakleigh South (3167) (1.65 ; 1.19 - 2.28)
Springvale (3171) (1.52 ; 1.16 - 1.99)
0.01
0.25
0.5
1
Decreased Risk
Predictive at Subject level
2
5
Increased Risk
HAZARD RATIO
10
SH Stroke Patients 1999-2001
Outcome: Readmissions within 7 days
Variable (OR;95% CI)
Logistic Regression Results (Events / N = 153 / 3,040)
Age > 65 (0.92 ; 0.61 – 1.37)
Male (1.04 ; 0.74 - 1.46)
Respiratory (0.68 ; 0.31 - 1.46)
History of
Comorbidity
At First
Stroke
Admission
Cancer (1.57 ; 0.59 - 4.15)
Heart Disease (1.62 ; 0.88 - 3.01)
Circulatory (0.86 ; 0.45 - 1.64)
Diabetes (0.66 ; 0.31 - 1.40)
Renal (1.54 ; 0.58 - 4.10)
TIA (1.10 ; 0.69 - 1.77)
Stroke
Diagnosis
Hemorragic (0.85 ; 0.47 - 1.56)
Cerebral Infarction (0.88 ; 0.55 -1.41)
Clayton (1.28 ; 0.74 - 2.19)
Discharge
Hospital
Dandenong (1.07 ; 0.60 - 1.90)
Discharge Unit
Discharge Destination
Emergency Clayton (2.25 ; 1.31 - 3.86)
Hampton (1.86 ; 1.04 - 3.34)
Hospital Transfer (3.06 ; 2.04 - 4.58)
Procedures
Postcode
CT Scan Intrav. (0.52 ; 0.27 - 0.98)
Dandenong (3175) (2.37 ; 1.34 - 4.20)
0.01
0.25
Decreased Risk
Predictive at Subject level
0.5
1
ODDS RATIO
2
Increased Risk
5
10
Outline
Strategies for Stroke Care and Prevention
Targets to reduce the impact of Overall Mortality:
•Aged patients
•Subjects with Hemorragic diagnoses
•Assess presence of Carer at home
Targets to reduce the impact of Mortality at First Admission:
•Aged patients
•Subjects with Hemorragic diagnoses
•Patients born in North-East Asia or North America
•Discharges from Medicine Clayton
Targets to reduce the impact of Overall Readmissions:
•Aged patients
•Subjects with Hemorragic diagnoses
•Residents in Springvale, Bentleigh East, Oakleigh
Targets to reduce the impact of Readmissions within 7 days after first discharge:
•Discharges from Emergency Clayton
•Residents in Dandenong
Targets to reduce the impact of Long Stay:
•Patients Separated, divorced or widowed
•Aged patients
•Subjects with Hemorragic diagnoses
•Residents in Springvale
SH All Patients 1999-2001
Outcome:Overall LOS>26 (75% Stroke)
Variable (HR;95% CI)
Cox Regression Results (Events / N = 11,719 / 174,614)
Age > 65 (1.65 ; 1.57 - 1.73)
Male (1.09 ; 1.05 - 1.13)
Respiratory (1.84 ; 1.76 - 1.91)
History of
Cancer (2.16 ; 2.06 - 2.27)
Comorbidity
Heart Disease (1.27 ; 1.21 - 1.33)
At First
Circulatory (1.63 ; 1.55 - 1.71)
Stroke
Cerebrovascular (1.58 ; 1.49 - 1.68)
Diabetes (1.10 ; 1.05 - 1.16)
Admission
Renal (2.07 ; 1.97 - 2.18)
Clayton (1.12 ; 1.06 - 1.17)
Discharge
Dandenong (0.53 ; 0.49 - 0.57)
Hospital
NE Asian / N American (0.65 ; 0.59 - 0.71)
Separated/Divorced/Widow (1.44 ; 1.38 - 1.51)
Carer Unknown or NA (1.16 ; 1.06 - 1.27)
Stroke
TIA (1.65 ; 1.50 - 1.81)
Cerebral Infarction (0.73 ; 0.60 - 0.89)
Diagnosis
Planned Admission (1.52 ; 1.45 - 1.60)
Discharge
Kingston (2.39 ; 2.20 - 2.59)
Hampton (6.30 ; 5.58 - 7.10)
Destination
Waiting List (0.29 ; 0.27 - 0.31)
Hospital Transfer (2.24 ; 2.12 - 2.38)
Neurosciences (0.58 ; 0.53 - 0.63)
Emergency Clayton (0.36 ; 0.33 - 0.39)
Emerg. Dandenong (0.80 ; 0.72 - 0.90)
Discharge
Medicine Clayton (1.09 ; 1.01 - 1.19)
Unit
Medicine Dandenong (1.59 ; 1.45 - 1.74)
Surgery Clayton (0.78 ; 0.63 - 0.96)
Surgery Dandenong (2.42 ; 1.90 - 3.09)
Carotid Endarter. (0.33 ; 0.17 - 0.63)
CT Scan (1.37 ; 1.27 - 1.47)
Procedures
CT Scan Intrav. (1.33 ; 1.17 - 1.45)
Mount Waverley (3149) (0.81 ; 0.70 - 0.94)
Glen Waverley (3150) (0.76 ; 0.67 - 0.86)
Carnegie (3163) (0.79 ; 0.69 - 0.91)
Postcodes
Springvale (3171) (1.19 ; 1.07 - 1.31)
Noble Park (3174) (1.21 ; 1.11 - 1.31)
Dandenong (3175) (1.38 ; 1.29 - 1.49)
0.01
Predictive at Subject level
0.25
0.5
1
Decreased Risk
2
5
Increased Risk
HAZARD RATIO
10
SH All Patients 1999-2001
Outcome: Overall In-hospital Mortality
Cox Regression Results (Events / N = 4,314 / 174,614)
Variable (HR;95% CI)
Age > 65 (3.77 ; 3.45 - 4.12)
Male (1.19 ; 1.12 - 1.27)
Respiratory (2.09 ; 1.95 - 2.23)
History of
Cancer (3.52;3.28 - 3.77)
Comorbidity
Heart Disease (2.12 ; 1.96 - 2.28)
Circulatory (1.23 ; 1.14 - 1.32)
At First
Cerebrovascular (1.72 ; 1.58 - 1.88)
Stroke
Diabetes (0.85 ; 0.79 - 0.91)
Admission
Renal (2.40 ; 2.23 - 2.58)
Clayton (1.47 ; 1.35 - 1.61)
Discharge
Dandenong (0.99 ; 0.87 - 1.13)
Hospital
NE Asian / N American (1.46 ; 1.31 - 1.63)
Married (1.19 ; 1.09 - 1.31)
Separated, Widowed, Divorced (1.43 ; 1.29 - 1.58)
Carer Unknown or NA (2.83 ; 2.28 - 3.52)
Stroke
TIA (0.72 ; 0.58 - 0.89)
Hemorragic (3.94 ; 3.15 - 4.93)
Diagnosis
Planned Admission (1.13 ; 1.03 - 1.23)
Discharge Destination
Kingston (0.50 ; 0.26 - 0.93)
Waiting List (0.31 ; 0.27 - 0.36)
Hospital Transfer (0.67 ; 0.61 - 0.74)
Emergency Clayton (0.68 ; 0.60 - 0.77)
Discharge
Emergency Dandenong (1.24 ; 1.06 - 1.45)
Unit
Medicine Clayton (1.17 ; 1.04 - 1.33)
Medicine Dandenong (1.60 ; 1.40 - 1.83)
Surgery Clayton (1.64 ; 1.21 - 2.21)
Surgery Dandenong (2.59 ; 1.84 - 3.65)
Carotid Endarter. (0.19 ; 0.07 - 0.51)
CT Scan (1.647;1.482-1.83)
Procedures
CT Scan Intrav. (1.34 ; 1.14 - 1.59)
Magnetic Resonance (0.66 ; 0.50 - 0.88)
Springvale (3171) (1.21 ; 1.04 - 1.41)
Noble Park (3174) (1.23 ; 1.09 - 1.40)
Postcodes
Dandenong (3175) (1.18 ; 1.06 - 1.32)
0.01
Predictive at Subject level
0.25
0.5
1
Decreased Risk
2
5
Increased Risk
HAZARD RATIO
10
SH All Patients 1999-2001
Outcome: In-hospital Mortality at First Admission
Logistic Regression Results (Events / N = 1,938 / 176,148)
Variable (OR;95% CI)
History of
Comorbidity
At First
Stroke
Admission
Discharge
Hospital
Stroke
Diagnosis
Discharge
Unit
Procedures
Age > 65 (5.78 ; 5.07 - 6.60)
Male (1.29 ; 1.16 - 1.42)
Respiratory (1.44 ; 1.30 - 1.60)
Cancer (2.03 ; 1.78 - 2.32)
Heart Disease (2.22 ; 1.98 - 2.48)
Circulatory (0.88 ; 0.79 - 0.98)
Cerebrovascular (1.30 ; 1.11 - 1.51)
Diabetes (0.67 ; 0.59 - 0.76)
Renal (1.72 ; 1.51 - 1.96)
Clayton (1.76 ; 1.53 - 2.03)
Dandenong (0.91 ; 0.74 - 1.13)
NE Asian / N American (2.23 ; 1.94 - 2.57)
Separated/Divorced/Widow (1.17 ; 1.05 - 1.31)
TIA (0.48 ; 0.35 - 0.68)
Hemorragic (5.70 ; 4.15 - 7.82)
Waiting List (0.11 ; 0.08 - 0.16)
Neurosciences (1.63 ; 1.32 - 2.02)
Emergency Clayton (0.31 ; 0.25 - 0.39)
Emergency Dandenong (1.28 ; 1.00 - 1.65)
Medicine Clayton (1.35 ; 1.12 - 1.63)
Medicine Dandenong (2.53 ; 2.02 - 3.16)
Surgery Clayton (2.00 ; 1.26 - 3.17)
Surgery Dadenong (4.30 ; 2.49 - 7.43)
CT Scan (2.33 ; 2.01 - 2.71)
CT Scan Intrav. (1.48 ; 1.13 - 1.92)
Magnetic Resonance (0.47 ; 0.31 - 0.72)
0.01
Predictive at Subject level
0.25
0.5
1
Decreased Risk
2
5
Increased Risk
ODDS RATIO
10
SH All Patients 1999-2001
Outcome:Overall Readmissions
Cox Regression Results (Events / N = 49,461 / 172,755)
Variable (HR;95% CI)
History of
Comorbidity
At First
Stroke
Admission
Discharge
Hospital
Stroke
Diagnosis
Discharge
Destination
Discharge
Unit
Procedures
Postcodes
Age > 65 (0.94 ; 0.92 - 0.97)
Male (0.92 ; 0.91 - 0.94)
Respiratory (1.56 ; 1.52 - 1.59)
Cancer (1.97 ; 1.91 - 2.02)
Heart Disease (1.29 ; 1.26 - 1.32)
Circulatory (1.27 ; 1.24 - 1.30)
Stroke (1.24 ; 1.19 - 1.30)
Diabetes (1.13 ; 1.10 - 1.16)
Renal (1.31 ; 1.27 - 1.36)
Clayton (1.36 ; 1.32 - 1.39)
Dandenong (1.15 ; 1.12 - 1.18)
NE Asian / N American (0.66 ; 0.63 - 0.69)
Married (1.35 ; 1.32 - 1.38)
Separated/Divorced/Widow (1.37 ; 1.33 - 1.41)
Carer Unknown or NA (1.04 ; 1.01 - 1.08)
TIA (1.31 ; 1.24 - 1.39)
Cerebral Infarction (0.80 ; 0.69 - 0.93)
Planned Admission (1.13 ; 1.10 - 1.16)
Kingston (1.76 ; 1.65 - 1.88)
Hampton (3.03 ; 2.76 - 3.32)
Waiting List (0.79 ; 0.76 - 0.81)
Hospital Transfer (1.64 ; 1.59 - 1.70)
Neurosciences (0.71 ; 0.67 - 0.75)
Emergency Clayton (0.92 ; 0.89 - 0.95)
Medicine Clayton (0.90 ; 0.85 - 0.96)
Carotid Endarterectomy (0.53 ; 0.38 - 0.75)
Oakleigh (3166) (1.11 ; 1.05 - 1.17)
Clayton (3168) (1.10 ; 1.05 - 1.16)
Springvale (3171) (1.18 ; 1.13 - 1.25)
Noble Park (3174) (1.16 ; 1.11 - 1.21)
Dandenong (3175) (1.21 ; 1.16 - 1.25)
Mordialloc (3195) (1.10 ; 1.04 - 1.16)
Bentleigh (3204) (1.10 ; 1.03 - 1.17)
0.01
0.25
0.5
1
Decreased Risk
Predictive at Subject level
2
5
Increased Risk
HAZARD RATIO
10
SH All Patients 1999-2001
Outcome: Readmission within 7 days
Logistic Regression Results (Events / N = 7,076 / 174,210)
Variable (OR;95% CI)
Age > 65 (0.54 ; 0.50 - 0.58)
Male (0.94 ; 0.89 - 0.99)
Respiratory (1.26 ; 1.18 - 1.34)
History of
Cancer (1.97 ; 1.81 - 2.15)
Comorbidity
Heart Disease (0.93 ; 0.87-1.01)
At First
Circulatory (1.23 ; 1.14 - 1.32)
Stroke
Cerebrovascular
(1.06 ; 0.93 - 1.22)
Admission
Diabetes (1.06 ; 0.98 - 1.16)
Renal (1.81 ; 1.62 - 2.02)
Clayton
(0.94 ; 0.87 - 1.01)
Discharge
Dandenong (0.96 ; 0.88 - 1.05)
Hospital
NE Asian / N American (0.57 ; 0.51 - 0.64)
Married (1.32 ; 1.25 - 1.40)
Separated/Divorced/Widow (1.20 ; 1.10 - 1.31)
Carer Unknown or NA (1.32 ; 1.18 - 1.47)
Planned (1.20 ; 1.10 - 1.31)
Kingston
(0.55 ; 0.44 - 0.67)
Discharge Destination
Waiting List (0.46 ; 0.41 - 0.51)
Hospital Transfer (6.76 ; 6.35 - 7.19)
Neurosciences (0.64 ; 0.54 - 0.76)
Emergency Clayton (1.99 ; 1.85 - 2.16)
Discharge
Emergency Dandenong (1.55 ; 1.41 - 1.71)
Unit
Medicine Dandenong (0.69 ; 0.58 - 0.82)
Procedures
CT Scan (0.84 ; 0.73 - 0.96)
Mount Waverley (3149) (0.79 ; 0.66 - 0.96)
Springvale (3171) (1.16 ; 1.01 - 1.34)
Postcodes
Noble Park (3174) (1.19 ; 1.06 - 1.33)
Dandenong (3175) (1.17 ; 1.05 - 1.29)
0.01
Predictive at Subject level
0.25
0.5
1
Decreased Risk
2
5
Increased Risk
ODDS RATIO
10