ZiMM: a deep learning model for long term adverse events with non-clinical claims data

This paper considers the problem of modeling long-term adverse events following prostatic surgery performed on patients with urination problems, using the French national health insurance database (SNIIRAM), which is a non-clinical claims database built around healthcare reimbursements of more than 65 million people. This makes the problem particularly challenging compared to what could be done using clinical hospital data, albeit a much smaller sample, while we exploit here the claims of almost all French citizens diagnosed with prostatic problems (with between 1.5 and 5 years of history). We introduce a new model, called ZiMM (Zero-inflated Mixture of Multinomial distributions) to capture such long-term adverse events, and we build a deep-learning architecture on top of it to deal with the complex, highly heterogeneous and sparse patterns observable in such a large claims database. This architecture combines several ingredients: embedding layers for drugs, medical procedures, and diagnosis codes; embeddings aggregation through a self-attention mechanism; recurrent layers to encode the health pathways of patients before their surgery and a final decoder layer which outputs the ZiMM’s parameters.