关节炎监测病例定义的验证

Validation of a surveillance case definition for arthritis.

作者信息

Sacks Jeffrey J, Harrold Leslie R, Helmick Charles G, Gurwitz Jerry H, Emani Srinivas, Yood Robert A

机构信息

Division of Adult and Community Health (DACH), National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA.

出版信息

J Rheumatol. 2005 Feb;32(2):340-7.

DOI:

PMID:15693097

Abstract

OBJECTIVE

To assess whether self-reports of chronic joint symptoms or doctor-diagnosed arthritis can validly identify persons with clinically verifiable arthritis.

METHODS

The Behavioral Risk Factor Surveillance System (BRFSS), a telephone health survey, defines a case of arthritis as a self-report of chronic joint symptoms (CJS) and/or doctor-diagnosed arthritis (DDx). A sample of health plan enrollees aged 45-64 years and >/= 65 years with upcoming annual physical examinations were surveyed by telephone using the 2002 BRFSS CJS and DDx questions. Based on responses (CJS+, DDx-; CJS-, DDx+; CJS+, DDx+; CJS-, DDx-), respondents were recruited to undergo a standardized clinical history and physical examination for arthritis (the gold standard for clinical validation). Weighted sensitivities and specificities of the case definition were calculated to adjust for sampling.

RESULTS

Of 2180 persons completing the telephone questionnaire, 389 were examined; of these, 258 met the case definition and 131 did not. For those examined and aged 45 to 64 years (n = 179), 96 persons had arthritis confirmed, of whom 76 met the case definition. Among those examined and aged >/= 65 (n = 210), 150 had arthritis confirmed, of whom 124 met the case definition. Among those without clinical arthritis, 45 of 83 of those aged 45 to 64 years and 40 of 60 of those aged >/= 65 did not meet the case definition. For those aged 45 to 64 years, the weighted sensitivity of the case definition in this sample was 77.4% and the weighted specificity was 58.8%; for those aged >/= 65, the sensitivity was 83.6% and specificity 70.6%. CJS+ had higher sensitivity and lower specificity than DDx+ in the younger age group; CJS+ and DDx+ behaved more comparably in the older age group.

CONCLUSION

The case definition based on self-reported CJS and/or DDx appeared to be sensitive in identifying arthritis, but specificity was lower than desirable for those under age 65 years. Better methods of ascertaining arthritis by self-report are needed. Until then, a change in the surveillance case definition for arthritis appears warranted.

摘要

目的

评估慢性关节症状的自我报告或医生诊断的关节炎能否有效识别出经临床验证的关节炎患者。

方法

行为危险因素监测系统（BRFSS）是一项电话健康调查，将关节炎病例定义为慢性关节症状（CJS）的自我报告和/或医生诊断的关节炎（DDx）。使用2002年BRFSS的CJS和DDx问题，通过电话对即将进行年度体检的45 - 64岁和≥65岁的健康计划参保者样本进行调查。根据回答情况（CJS +，DDx -；CJS -，DDx +；CJS +，DDx +；CJS -，DDx -），招募受访者接受针对关节炎的标准化临床病史和体格检查（临床验证的金标准）。计算病例定义的加权敏感性和特异性以调整抽样情况。