Validation Study of Medicare Claims to Identify Older US Adults With CKD Using the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Background: Administrative claims are used to conduct epidemiology research. However, few studies have compared results using administrative claims versus primary data collection. Objective: To compare myocardial infarction (MI) rates using primary data collection and Medicare claims in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study. Methods: We included 9,951 REGARDS study participants ≥65 years of age with Medicare Part A (inpatient) fee-for-service coverage at baseline in 2003-2007. Participants were asked every 6 months to report heart-related hospitalizations which were subsequently adjudicated to detect definite or probable MIs (MI Definition 1, see Table footnotes). Events detected through surveillance in REGARDS were supplemented with adjudicated definite or probable MIs detected through Medicare inpatient claims with a diagnosis code for MI (i.e., ICD-9 code 410.x0 or 410.x1) in any position (Definition 2) and in the primary position (Definition 3). MIs were also defined by a Medicare inpatient claim with a code for MI in any position (Definition 4) and in the primary position (Definition 5), without further adjudication. MIs were ascertained through December 2012. Results: REGARDS study procedures detected and adjudicated 669 definite or probable MIs over a mean follow-up of 6.3 years, representing 10.7 MIs per 1,000 person-years (Definition 1, Table ). Supplementing adjudicated MIs with Medicare inpatient claims resulted in a 12% (any diagnosis position, Definition 2) and 6% (primary diagnosis position, Definition 3) higher rate for MI. Using only Medicare claims without adjudication underestimated the rate for MI by 8% (any diagnosis position, Definition 4) and 32% (primary diagnosis position, Definition 5), compared with REGARDS study procedures. Conclusion: Supplementing MIs detected through participant self-report with those identified in claims could improve event detection. Using only Medicare claims to identify events may underestimate MI rates.

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Abstract P321: Assembly and Validation of a Heart Failure Free Cohort From the Reasons for Geographic and Racial Differences in Stroke Study

Circulation ◽

10.1161/circ.141.suppl_1.p321 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Lauren Balkan ◽

Matthew Mefford ◽

Ligong Chen ◽

Madeline R Sterling ◽

Raegan W Durant ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Negative Predictive Value ◽

Racial Differences ◽

Predictive Value ◽

Enzyme Inhibitor ◽

Gender Diversity ◽

Medicare Claims ◽

Regards Study ◽

And Gender

Introduction: Studies of incident heart failure (HF) have provided insights into key risk factors for the disease but have been limited to select populations that often lack geographic, racial, and gender diversity. There is a need to assemble a HF-free cohort using a contemporary, geographically diverse sample. Aim: To develop and validate a strategy for assembling a HF-free cohort from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study. Methods: To assemble a HF-free cohort, we identified and excluded REGARDS participants who were taking HF-specific medications at baseline including: digoxin without atrial fibrillation, angiotensin converting enzyme inhibitor/angiotensin receptor blocker plus beta-blocker in the absence of hypertension, carvedilol, spironolactone, loop diuretic or a combination of hydralazine and nitrates. We then examined the subgroup of REGARDS participants with at least 6 months of Medicare claims at the time of the baseline assessment; we evaluated diagnostic performance (negative predictive value, positive predictive value, sensitivity and specificity) using three Medicare claims-based definitions of HF as the referent standard: Hospitalization for HF, Principal Diagnosis of HF, and Any Diagnosis of HF. Results: Among 28,884 eligible participants, 3,125 used HF-specific medications at baseline, leaving 25,759 (89%) participants in the proposed HF-free cohort. Participants in the HF-free cohort had a lower prevalence of coronary disease, atrial fibrillation, and diabetes compared to excluded participants. Depending on the Medicare definition used as the referent, the percent of the HF-free cohort without evidence of HF based on Medicare claims (the negative predictive value) ranged from 95.0-99.2% (Table 1). Negative predictive value was stable across age, sex, and race strata. Conclusions: This medication-based strategy to assembling a HF-free cohort in REGARDS can serve as a basis for future studies to examine incident HF in REGARDS and similar studies.

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Abstract P109: Consistency of Self-reported Prior Diagnosis of Atrial Fibrillation and Medicare Claims Diagnoses: The Reasons for Geographic and Racial Differences in Stroke

Circulation ◽

10.1161/circ.141.suppl_1.p109 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Oluseun O Akinyele ◽

Elsayed Z Soliman ◽

Ligong Chen ◽

Hooman Kamel ◽

Emily B Levitan

Keyword(s):

Atrial Fibrillation ◽

Health Professional ◽

Racial Differences ◽

High Specificity ◽

Cognitive Status ◽

Self Report ◽

Fee For Service ◽

Medicare Claims ◽

Regards Study ◽

Low Sensitivity

Introduction: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. Although self-reported prior diagnosis is a widely used method for ascertainment of AF in population studies, recall bias may impact the accuracy of this method. Objective: To examine the consistency of self-reported AF as compared to diagnoses recorded in Medicare claims. Methods: Among 30,239 black and white adults aged 45 years and older who enrolled in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study, 8,588 participants aged 65 years and older with a minimum of 6 months of Medicare fee-for-service coverage at the time of enrollment were included in this analysis. Using AF diagnosis codes from Medicare claims as the “gold standard”, we calculated sensitivity, specificity, positive predictive value (PPV), and negative predicted value (NPV) of self-reported prior diagnosis of AF by a physician or other health professional. Results: The average age of the study population was 73.4 years, 50.5% were women, 31.6% were black, and 10.1% reported a prior diagnosis of AF. The prevalence of Medicare claims diagnoses for AF ranged from 28.6% to 32.5% depending on definition ( Table ). Compared to Medicare claims, self-reported prior diagnosis of AF had 22.4-24.5% sensitivity, 95.6-95.7% specificity, 68.8-71.5% PPV, and 71.9-76.0% NPV. Results were consistent across strata defined by age, gender, race, and cognitive status. Conclusion: Compared to Medicare claims, self-reported prior diagnosis by a physician or other health professional had low sensitivity but high specificity to detect AF. This suggests that an approach utilizing only self-report to detect AF would not be ideal. However, most participants who reported a prior diagnosis of AF had Medicare claims supporting this diagnosis.

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Enrolling Incident Caregivers and Matched Controls From a Nationwide Epidemiological Study

Innovation in Aging ◽

10.1093/geroni/igaa057.2272 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 658-658

Author(s):

David Roth ◽

William Haley ◽

Orla Sheehan ◽

J David Rhodes ◽

Virginia Howard

Keyword(s):

Blood Sample ◽

Epidemiological Study ◽

Racial Differences ◽

Family Caregiving ◽

Regards Study

Abstract Participants in the national Reasons for Geographic and Racial Differences in Stroke (REGARDS) study were asked about family caregiving responsibilities at enrollment (2003-2007). Among the 88% of participants who were not caregivers at enrollment, 1,229 reported becoming caregivers before a follow-up interview 12 years later. The Caregiving Transitions Study screened these participants and enrolled 251 as incident caregivers. All reported 5 or more hours of care per week, provided assistance with at least one ADL or IADL, and were caregivers for at least 3 months before a 2nd blood sample was obtained in the REGARDS study. A total of 251 noncaregiving control participants who reported no caregiving responsibilities over this 12-year period were also enrolled. Each control was matched to a caregiver on age (+ 5 years), sex, race, other demographics, and baseline (pre-caregiving) health variables. Descriptive analyses confirm the unique comparability of the samples compared to previous caregiving studies.

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Physical Activity Patterns After Retirement: The REGARDS Study

Innovation in Aging ◽

10.1093/geroni/igaa057.1704 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 528-529

Author(s):

Eric Shiroma ◽

J David Rhodes ◽

Aleena Bennet ◽

Monika M Safford ◽

Leslie MacDonald ◽

...

Keyword(s):

Physical Activity ◽

Light Intensity ◽

Racial Differences ◽

Activity Patterns ◽

Accelerometer Data ◽

Tv Viewing ◽

Major Life Events ◽

Major Life ◽

Physical Activity Patterns ◽

Regards Study

Abstract Major life events, such as retirement, may lead to dramatic shifts in physical activity (PA) patterns. However, there are limited empirical data quantifying the magnitude of these changes. Our aims were to objectively measure PA before and after retirement and to describe changes in participation in various types of PA. Participants were employed black and white men and women enrolled in REGARDS (REasons for Geographic and Racial Differences in Stroke), a national prospective cohort study (n=581, mean age 64 years, 25% black, 51% women). Participants met inclusion criteria if they retired between their first and second accelerometer wearing (2009-2013 and 2017-2018, respectively) and had valid accelerometer data (>4 days with >10 hours/day pre- and post-retirement). Accelerometer-based PA was categorized into average minutes per day spent in sedentary, light-intensity, and moderate-to-vigorous PA. Participants reported changes (less, same, more) in 12 types of PA. After retirement, participants decreased both sedentary time (by 36.3 minutes/day) and moderate-to-vigorous PA (by 5.6 minutes/day). Conversely, there was an increase in light-intensity PA (+18.1 minutes/day) after retirement. Participants reported changes in their participation level in various PA activities. For example, 41% reported an increased amount of TV viewing, 42% reported less walking, and 31% reported increased participation in volunteer activities. Findings indicate that retirement coincides with a change in the time spent in each intensity category and the time spent across a range of activity types. Further research is warranted to examine how these changes in physical activity patterns influence post-retirement health status.

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Perception Versus Reality: Subjective and Objective Neighborhood Characteristics and Cognitive Function in REGARDS

Innovation in Aging ◽

10.1093/geroni/igaa057.2470 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 703-703

Author(s):

Jessica Finlay ◽

Philippa Clarke ◽

Lisa Barnes

Keyword(s):

Older Adults ◽

Cognitive Function ◽

Racial Differences ◽

Secondary Data ◽

Well Being ◽

Daily Basis ◽

Cognitive Status ◽

Functional Mobility ◽

Neighborhood Size ◽

Regards Study

Abstract Does the world shrink as we age? The neighborhood captures a spatial area someone inhabits and moves through on a daily basis. It reflects a balance between internal perceptions and abilities, and the external environment which may enable or restrict participation in everyday life. We frequently hear that older adults have shrinking neighborhoods given declining functional mobility. This is associated with declines in physical and cognitive functioning, depression, poorer quality of life, and mortality. Knowledge of the interplay between objective and subjective neighborhood measurement remains limited. This symposium will explore these linked yet distinct constructs based on secondary data analyses of the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, a racially diverse sample of 30,000+ aging Americans. Finlay investigates how someone’s perceived neighborhood size (in number of blocks) varies by individual and geographic characteristics including age, cognitive function, self-rated health, and urban/rural context. Esposito’s analyses focus on neighborhood size in relation to race and residential segregation. Clarke compares subjective perceptions of neighborhood parks and safety from crime to objective indicators, and examines variations by health and cognitive status. Barnes will critically consider implications for how older adults interpret and engage with their surrounding environments. The symposium questions the validity of neighborhood-based metrics to reflect the perspectives and experiences of older residents, particularly those navigating cognitive decline. It informs policy-making efforts to improve physical neighborhood environments and social community contexts, which are critical to the health and well-being of older adults aging in place.

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Racial differences in sleep duration intersect with sex, socioeconomic status, and U.S. geographic region: The REGARDS study

Sleep Health ◽

10.1016/j.sleh.2020.05.004 ◽

2020 ◽

Vol 6 (4) ◽

pp. 442-450 ◽

Cited By ~ 1

Author(s):

Megan E. Petrov ◽

D. Leann Long ◽

Michael A. Grandner ◽

Leslie A. MacDonald ◽

Matthew R. Cribbet ◽

...

Keyword(s):

Socioeconomic Status ◽

Racial Differences ◽

Sleep Duration ◽

Geographic Region ◽

Regards Study

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Abstract P316: Prehypertension and Incident Acute Coronary Heart Disease in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Circulation ◽

10.1161/circ.127.suppl_12.ap316 ◽

2013 ◽

Vol 127 (suppl_12) ◽

Author(s):

Stephen P Glasser ◽

Yulia Khodneva ◽

Daniel Lackland ◽

Ronald Prineas ◽

Monika Safford

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Racial Differences ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Community Dwelling ◽

Cox Proportional Hazards Models ◽

Chd Risk ◽

Regards Study ◽

Chd Risk Factors

Objective: The independent prognostic value of prehypertension (preHTN) for incident coronary heart disease (CHD) remains unsettled. Using the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort study, we examined associations between preHTN and incident acute CHD and CVD death. Methods: REGARDS includes 30,239 black and white community-dwelling adults age 45 and older at baseline. Recruitment occurred from 2003-7, with baseline interviews and in-home data collection for physiologic measures. Follow-up is conducted by telephone every 6 months to detect events and deaths, which are adjudicated by experts. Systolic BP was categorized into <120 mmHg (n=4385), 120-129 mmHg (n=4000), 130-139 (n=2066), and hypertension was categorized into controlled (<140/90 mmHg on treatment) (n=8378), and uncontrolled (>140/90 mmHg) (n=5364). Incident acute CHD was defined as definite or probable myocardial infarction (MI) or acute CHD death. CVD death was defined as acute CHD, stroke, heart failure or other cardiovascular disease related. Cox proportional hazards models estimated the hazard ratios (HR) for incident CHD by BP categories, adjusting for sociodemographics and CHD risk factors. Results: The 23,393 participants free of CHD at baseline were followed for a median of 4.4 years. Mean age was 64.1, 58% were women and 42% were black. There was a significant interaction between sex and BP categories, therefore analyses were stratified by sex. There were 252 non-fatal and fatal acute CHD events among women and 407 among men. Among women, compared with SBP<120 mmHg, BP categories above SBP 120 mmHg were associated with incident CHD (adjusted HR for SBP120-129 mmHg=1.94 {95% CI 1.04-3.62]; SBP 130-139 mmHg=1.92 {0.95-3.87}; controlled HTN=2.16 {1.25-3.75}; uncontrolled HTN=3.25 {1.87-5.65}) in fully adjusted models. Among men, only uncontrolled HTN was associated with incident CHD (HR=1.55 {1.11-2.17}). Conclusion: In this sample, preHTN may be associated with incident CHD among women but not men.

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Abstract T P146: Vitamin D Deficiency is Associated With Stroke in Black and White Participants of the REGARDS Study

Stroke ◽

10.1161/str.45.suppl_1.tp146 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Suzanne E Judd ◽

Virginia J Howard ◽

Paul Muntner ◽

Brett M Kissela ◽

Bhupesh Panwar ◽

...

Keyword(s):

Vitamin D ◽

Vitamin D Deficiency ◽

Racial Differences ◽

Sex Education ◽

The United States ◽

Dietary Vitamin ◽

Equal Distribution ◽

Black And White ◽

Increased Risk ◽

Regards Study

Objective: Black Americans are at greater risk of both stroke and vitamin D deficiency than white Americans. We have previously shown that both higher dietary vitamin D and sunlight exposure are associated with decreased risk of stroke; however, serum 25(OH) is thought to be a better marker of vitamin D status. Methods: Using a case cohort design, we examined the association of plasma 25(OH)D with incident stroke in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study, a cohort of black and white participants from across the United States enrolled between 2003 and 2007. Medical records were reviewed by physicians and strokes were classified on the basis of symptoms and neuroimaging. Strokes through July 1, 2011 were included. A stratified cohort sample was selected to ensure approximately equal numbers of black and white participants and an equal distribution across ages. We used Cox proportional hazards models weighted back to the original 30,239 participants, excluding those with history of stroke. Serum 25(OH)D was measured by Immunodetection Systems ELISA. Results: Over mean follow-up of 4.4 years, there were 539 ischemic and 71 hemorrhagic strokes. The stroke-free sub-cohort included 939 participants. After adjustment for age, race, sex, education, diabetes, hypertension, smoking, atrial fibrillation, heart disease, physical activity, kidney function, calcium and phosphorous, 25(OH)D level 30 ng/mL. The direction of association was similar for hemorrhagic stroke though not statistically significant (HR=1.59; 95%CI=0.78, 3.24). Vitamin D deficiency was associated with an increased risk of all stroke (HR=1.54; 95%CI=1.05, 2.23). This effect was greater in blacks (HR=2.09; 95%CI=1.09, 3.99) than whites (HR=1.38; 95%CI=0.78, 2.42). Results were not as strong when we modeled 25(OH)D as a continuous variable (HR=0.99 per 1 ng/ml change in 25(OH)D; 95%CI=0.98, 1.01). Discussion: Similar to low vitamin D intake, vitamin D deficiency is a risk factor for incident stroke. These findings support evidence from cardiovascular and cancer epidemiology that treating low 25(OH)D may prevent strokes.

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