Validation of Coding Algorithms for the Identification of Patients with Primary Biliary Cirrhosis Using Administrative Data

BACKGROUND: Large-scale epidemiological studies of primary biliary cirrhosis (PBC) have been hindered by difficulties in case ascertainment.OBJECTIVE: To develop coding algorithms for identifying PBC patients using administrative data – a widely available data source.METHODS: Population-based administrative databases were used to identify patients with a diagnosis code for PBC from 1994 to 2002. Coding algorithms for confirmed PBC (two or more of antimitochondrial antibody positivity, cholestatic liver biochemistry and/or compatible liver histology) were derived using chart abstraction data as the reference. Patients with a recorded PBC diagnosis but insufficient confirmatory data were classified as ‘suspected PBC’.RESULTS: Of 189 potential PBC cases, 119 (60%) had confirmed PBC and 28 (14%) had suspected PBC. The optimal algorithm including two or more uses of a PBC code had a sensitivity of 94% (95% CI 71% to 100%) and positive predictive values of 73% (95% CI 61% to 75%) for confirmed PBC, and 89% (95% CI 82% to 94%) for confirmed or suspected PBC. Sensitivity analyses revealed greater accuracy among women, and with the use of multiple data sources and one or more years of data. Inclusion of diagnosis codes for conditions frequently misclassified as PBC did not improve algorithm performance.CONCLUSIONS: Administrative databases can reliably identify patients with PBC and may facilitate epidemiological investigations of this condition.

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Abstract T P365: Childhood Stroke: ICD-9 Code Positive Predictive Values for Identifying Hemorrhagic and Ischemic Events

Stroke ◽

10.1161/str.46.suppl_1.tp365 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Jane C Khoury ◽

Kathleen Alwell ◽

J, Michael Taylor ◽

Heidi Sucharew ◽

Charles J Moomaw ◽

...

Keyword(s):

Temporal Trends ◽

Epidemiological Studies ◽

Population Based ◽

Incidence Rates ◽

Administrative Databases ◽

Childhood Stroke ◽

Stroke Event ◽

Primary Position ◽

Predictive Values ◽

Percent Correct

Introduction: Childhood stroke event rates have been reported both using administrative databases and population-based epidemiological studies. The latter include verification of stroke as a case and categorization of type. Administrative databases allow cheaper, quicker estimation of rates and possible extrapolation of estimated rates to population-based rates. However, these estimations rely on the accuracy and interpretation of the ICD-9 coding. Methods: The Greater Cincinnati/Northern Kentucky Stroke Study measures temporal trends in the incidence rates in a biracial population of 1.3 million. Discharge lists with primary and secondary ICD-9 codes 430-436 from 16 area hospitals for 2010 were obtained; 437-438, 674 and 747 were also included at the Children’s hospital. Detailed information from medical records of potential cases was abstracted by trained research nurses and reviewed by stroke physicians, who determined if the event was a case and, also the event type (hemorrhagic stroke, infarction or transient ischemic attack(TIA)). Results: A total of 89 potential events in children <20 years of age were reviewed, yielding 19 confirmed cases. Positive predictive values (PPV) for the primary ICD-9 codes for specific types varied from 0% to 100%. Primary and secondary ICD-9 codes, event types, and percent correct are presented in the Table. Conclusions: Childhood stroke cases captured through selected ICD-9 codes: 430-432, 434.x1, 434.9 and 435.9 (marked with an asterisk in the table) in the primary position would yield 14 strokes/TIAs, and underestimate the number of events by 26%. However, using both primary and secondary codes they would yield 34 strokes//TIAs, and overestimate the number of events by 79%. Population-based epidemiology studies are essential to monitor the validity of using ICD-9 codes to estimate childhood stroke/TIA incidence.

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Joint Analysis of Genetic Correlation, Mendelian Randomization and Colocalization Highlights the Bi-Directional Causal Association Between Hypothyroidism and Primary Biliary Cirrhosis

Frontiers in Genetics ◽

10.3389/fgene.2021.753352 ◽

2021 ◽

Vol 12 ◽

Author(s):

Yanjun Wang ◽

Ping Guo ◽

Yanan Zhang ◽

Lu Liu ◽

Ran Yan ◽

...

Keyword(s):

Primary Biliary Cirrhosis ◽

Genetic Correlation ◽

Large Scale ◽

Mendelian Randomization ◽

Association Studies ◽

Sensitivity Analyses ◽

Joint Analysis ◽

Biliary Cirrhosis ◽

Genome Wide Association Studies ◽

Causal Association

Background: Hypothyroidism and primary biliary cirrhosis (PBC) are often co-existed in observational epidemiological studies. However, the causal relationship between them remains unclear.Methods: Genetic correlation, Mendelian randomization (MR) and colocalization analysis were combined to assess the potential causal association between hypothyroidism and PBC by using summary statistics from large-scale genome-wide association studies. Various sensitivity analyses had been conducted to assess the robustness and the consistency of the findings.Results: The linkage disequilibrium score regression demonstrated significant evidence of shared genetic architecture between hypothyroidism and PBC, with the genetic correlation estimated to be 0.117 (p = 0.006). The OR of hypothyroidism on PBC was 1.223 (95% CI, 1.072–1.396; p = 2.76 × 10−3) in MR analysis with inverse variance weighted (IVW) method. More importantly, the results from other 7MR methods with different model assumptions, were almost identical with that of IVW, suggesting the findings were robust and convincing. On the other hand, PBC was also causally associated with hypothyroidism (OR, 1.049; 95% CI, 1.010–1.089; p = 0.012), and, again, similar results can also be obtained from other MR methods. Various sensitivity analyses regarding the outlier detection and leave-one-out analysis were also performed. Besides, colocalization analysis suggested that there existed shared causal variants between hypothyroidism and PBC, further highlighting the robustness of the results.Conclusion: Our results suggest evidence for the bi-directional causal association between hypothyroidism and PBC, which may provide insights into the etiology of hypothyroidism and PBC as well as inform prevention and intervention strategies directed toward both diseases.

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Epidemiology of pheochromocytoma and paraganglioma: population-based cohort study

Acta Endocrinologica ◽

10.1530/eje-20-0628 ◽

2021 ◽

Vol 184 (1) ◽

pp. 19-28

Author(s):

Alexander A Leung ◽

Janice L Pasieka ◽

Martin D Hyrcza ◽

Danièle Pacaud ◽

Yuan Dong ◽

...

Keyword(s):

Cohort Study ◽

Administrative Data ◽

Laboratory Data ◽

Population Based ◽

Incidence Rates ◽

Primary Objective ◽

Administrative Databases ◽

Secondary Objective ◽

True Frequency ◽

Clinical Records

Objective Despite the significant morbidity and mortality associated with pheochromocytoma and paraganglioma, little is known about their epidemiology. The primary objective was to determine the incidence of pheochromocytoma and paraganglioma in an ethnically diverse population. A secondary objective was to develop and validate algorithms for case detection using laboratory and administrative data. Design Population-based cohort study in Alberta, Canada from 2012 to 2019. Methods Patients with pheochromocytoma or paraganglioma were identified using linked administrative databases and clinical records. Annual incidence rates per 100 000 people were calculated and stratified according to age and sex. Algorithms to identify pheochromocytoma and paraganglioma, based on laboratory and administrative data, were evaluated. Results A total of 239 patients with pheochromocytoma or paraganglioma (collectively with 251 tumors) were identified from a population of 5 196 368 people over a period of 7 years. The overall incidence of pheochromocytoma or paraganglioma was 0.66 cases per 100 000 people per year. The frequency of pheochromocytoma and paraganglioma increased with age and was highest in individuals aged 60–79 years (8.85 and 14.68 cases per 100 000 people per year for males and females, respectively). An algorithm based on laboratory data (metanephrine >two-fold or normetanephrine >three-fold higher than the upper limit of normal) closely approximated the true frequency of pheochromocytoma and paraganglioma with an estimated incidence of 0.54 cases per 100 000 people per year. Conslusion The incidence of pheochromocytoma and paraganglioma in an unselected population of western Canada was unexpectedly higher than rates reported from other areas of the world.

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Use of Antiplatelet Agents Decreases the Positive Predictive Value of Fecal Immunochemical Tests for Colorectal Cancer but Does Not Affect Their Sensitivity

Journal of Personalized Medicine ◽

10.3390/jpm11060497 ◽

2021 ◽

Vol 11 (6) ◽

pp. 497

Author(s):

Yoonsuk Jung ◽

Eui Im ◽

Jinhee Lee ◽

Hyeah Lee ◽

Changmo Moon

Keyword(s):

Colorectal Cancer ◽

Large Scale ◽

Screening Program ◽

Antiplatelet Agents ◽

Population Based ◽

Small Sample ◽

Antithrombotic Agents ◽

Predictive Values ◽

Prescription Rates ◽

Small Sample Sizes

Previous studies have evaluated the effects of antithrombotic agents on the performance of fecal immunochemical tests (FITs) for the detection of colorectal cancer (CRC), but the results were inconsistent and based on small sample sizes. We studied this topic using a large-scale population-based database. Using the Korean National Cancer Screening Program Database, we compared the performance of FITs for CRC detection between users and non-users of antiplatelet agents and warfarin. Non-users were matched according to age and sex. Among 5,426,469 eligible participants, 768,733 used antiplatelet agents (mono/dual/triple therapy, n = 701,683/63,211/3839), and 19,569 used warfarin, while 4,638,167 were non-users. Among antiplatelet agents, aspirin, clopidogrel, and cilostazol ranked first, second, and third, respectively, in terms of prescription rates. Users of antiplatelet agents (3.62% vs. 4.45%; relative risk (RR): 0.83; 95% confidence interval (CI): 0.78–0.88), aspirin (3.66% vs. 4.13%; RR: 0.90; 95% CI: 0.83–0.97), and clopidogrel (3.48% vs. 4.88%; RR: 0.72; 95% CI: 0.61–0.86) had lower positive predictive values (PPVs) for CRC detection than non-users. However, there were no significant differences in PPV between cilostazol vs. non-users and warfarin users vs. non-users. For PPV, the RR (users vs. non-users) for antiplatelet monotherapy was 0.86, while the RRs for dual and triple antiplatelet therapies (excluding cilostazol) were 0.67 and 0.22, respectively. For all antithrombotic agents, the sensitivity for CRC detection was not different between users and non-users. Use of antiplatelet agents, except cilostazol, may increase the false positives without improving the sensitivity of FITs for CRC detection.

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922 INCREASED CANCER RISK IN A LARGE POPULATION-BASED COHORT OF PATIENTS WITH PRIMARY BILIARY CIRRHOSIS: FOLLOW-UP FOR UP TO 36 YEARS

Journal of Hepatology ◽

10.1016/s0168-8278(13)60924-1 ◽

2013 ◽

Vol 58 ◽

pp. S380

Author(s):

K. Boonstra ◽

P.H. Stadhouders ◽

H.A.R.E. Tuynman ◽

A.C. Poen ◽

C.M.J. van Nieuwkerk ◽

...

Keyword(s):

Primary Biliary Cirrhosis ◽

Cancer Risk ◽

Large Population ◽

Population Based ◽

Biliary Cirrhosis

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Classification algorithms to improve the accuracy of identifying patients hospitalized with community-acquired pneumonia using administrative data

Epidemiology and Infection ◽

10.1017/s0950268810002529 ◽

2010 ◽

Vol 139 (9) ◽

pp. 1296-1306 ◽

Cited By ~ 22

Author(s):

O. YU ◽

J. C. NELSON ◽

L. BOUNDS ◽

L. A. JACKSON

Keyword(s):

Administrative Data ◽

Regression Tree ◽

Epidemiological Studies ◽

Community Acquired Pneumonia ◽

Classification And Regression Tree ◽

Classification Algorithms ◽

Care Organization ◽

Discharge Diagnosis ◽

Diagnosis Code ◽

Predictive Values

SUMMARYIn epidemiological studies of community-acquired pneumonia (CAP) that utilize administrative data, cases are typically defined by the presence of a pneumonia hospital discharge diagnosis code. However, not all such hospitalizations represent true CAP cases. We identified 3991 hospitalizations during 1997–2005 in a managed care organization, and validated them as CAP or not by reviewing medical records. To improve the accuracy of CAP identification, classification algorithms that incorporated additional administrative information associated with the hospitalization were developed using the classification and regression tree analysis. We found that a pneumonia code designated as the primary discharge diagnosis and duration of hospital stay improved the classification of CAP hospitalizations. Compared to the commonly used method that is based on the presence of a primary discharge diagnosis code of pneumonia alone, these algorithms had higher sensitivity (81–98%) and positive predictive values (82–84%) with only modest decreases in specificity (48–82%) and negative predictive values (75–90%).

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Validation of Carotid Artery Revascularization Coding in Ontario Health Administrative Databases

Clinical & Investigative Medicine ◽

10.25011/cim.v39i2.26483 ◽

2016 ◽

Vol 39 (2) ◽

pp. 73 ◽

Cited By ~ 15

Author(s):

Mohamad A Hussain ◽

Muhammad Mamdani ◽

Gustavo Saposnik ◽

Jack V Tu ◽

David Turkel-Parrella ◽

...

Keyword(s):

Carotid Artery ◽

Administrative Data ◽

High Volume ◽

Population Based ◽

Administrative Databases ◽

Ontario Health Insurance Plan ◽

Stroke Registry ◽

Administrative Records ◽

Ischemic Attack ◽

Procedure Codes

Purpose: The positive predictive value (PPV) of carotid endarterectomy (CEA) and carotid artery stenting (CAS) procedure and post-operative complication coding were assessed in Ontario health administrative databases. Methods: Between 1 April 2002 and 31 March 2014, a random sample of 428 patients were identified using Canadian Classification of Health Intervention (CCI) procedure codes and Ontario Health Insurance Plan (OHIP) billing codes from administrative data. A blinded chart review was conducted at two high-volume vascular centers to assess the level of agreement between the administrative records and the corresponding patients’ hospital charts. PPV was calculated with 95% confidence intervals (CIs) to estimate the validity of CEA and CAS coding, utilizing hospital charts as the gold standard. Sensitivity of CEA and CAS coding were also assessed by linking two independent databases of 540 CEA-treated patients (Ontario Stroke Registry) and 140 CAS-treated patients (single-center CAS database) to administrative records. Results: PPV for CEA ranged from 99% to 100% and sensitivity ranged from 81.5% to 89.6% using CCI and OHIP codes. A CCI code with a PPV of 87% (95% CI, 78.8-92.9) and sensitivity of 92.9% (95% CI, 87.4-96.1) in identifying CAS was also identified. PPV for post-admission complication diagnosis coding was 71.4% (95% CI, 53.7-85.4) for stroke/transient ischemic attack, and 82.4% (95% CI, 56.6-96.2) for myocardial infarction. Conclusions: Our analysis demonstrated that the codes used in administrative databases accurately identify CEA and CAS-treated patients. Researchers can confidently use administrative data to conduct population-based studies of CEA and CAS.

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A population-based assessment of systemic lupus erythematosus incidence and prevalence results and implications of using administrative data for epidemiological studies

Rheumatology ◽

10.1093/rheumatology/kem233 ◽

2007 ◽

Vol 46 (12) ◽

pp. 1814-1818 ◽

Cited By ~ 90

Author(s):

S. Bernatsky ◽

L. Joseph ◽

C. A. Pineau ◽

R. Tamblyn ◽

D. E. Feldman ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Administrative Data ◽

Lupus Erythematosus ◽

Epidemiological Studies ◽

Population Based ◽

Systemic Lupus

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Racial differences in delay of treatment for localized prostate cancer (CaP): A population-based study.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.6037 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 6037-6037

Author(s):

William Allen Stokes ◽

Laura H Hendrix ◽

Trevor Joseph Royce ◽

Ian M. Allen ◽

Andrew Wang ◽

...

Keyword(s):

High Risk ◽

Racial Differences ◽

Large Scale ◽

Multivariable Analysis ◽

Risk Groups ◽

Population Based ◽

Sensitivity Analyses ◽

Treatment Delays ◽

Time To Treatment ◽

The Difference

6037 Background: African-Americans (AA) are diagnosed with more advanced CaP than Caucasians (CA) and are more likely to die from CaP. Treatment delay is a potentially modifiable obstacle to care and clinically may be more important in AA patients because of more aggressive cancer at diagnosis. We examined time from diagnosis to curative treatment (surgery or radiation) in AA and CA patients in the Surveillance, Epidemiologic and End Results (SEER)-Medicare linked database. Methods: 21,454 CA and 2,506 AA patients who were diagnosed with non-metastatic CaP from 2004-08 and received treatment within 12 months of diagnosis were included. Linear regression was used to examine factors associated with number of days from diagnosis to treatment initiation, and logistic regression to assess odds of treatment within 6 months of diagnosis. Results: AA patients were more likely to have high-risk CaP than CA patients (39 vs. 35%), and less likely to have low-risk CaP (27 vs. 31%) (p<.001). Time to treatment was significantly prolonged for AA patients in all risk groups of CaP, and the difference was most prominent for high-risk patients (median 105 days for AA vs. 96 days for CA, p=.002). Racial differences in time to treatment persisted in multivariable analysis (Table). Sensitivity analyses examining the proportion of AA and CA patients initiating treatment within 6 months of diagnosis revealed similar results. Conclusions: AA patients, especially those with high-risk CaP, experience longer treatment delays than CA patients. This is the first large-scale study to examine treatment delays in AA and CA patients with CaP. The differences found may contribute to our understanding of racial disparities in CaP treatment outcomes. [Table: see text]

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