Department of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, TX.
Department of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, TX.
Chest. 2011 Mar;139(3):497-504. doi: 10.1378/chest.10-0837. Epub 2010 Aug 19.
Database studies have reported several associations between the diagnosis of idiopathic pulmonary arterial hypertension (IPAH) and mortality attributable to IPAH, including older age, black race, and diabetes.
We investigated reported deaths and hospital discharges coded as IPAH and compared these with other forms of pulmonary hypertension. Three databases were used: the US National Center for Health Statistics database (1979-2006), queried for mortality data; the Nationwide Inpatient Sample database (1993-2007), queried for hospital discharge data; and the University of Texas Southwestern Hospital-Zale Lipshy discharge database (1999, 2002).
Marked increases in mortality attributable to IPAH and to pulmonary hypertension (all codes combined) generally were reported from 1979 until 2002 in the National Center for Health Statistics database. In 2003, reported IPAH mortality fell sharply while total pulmonary hypertension deaths increased. The Nationwide Inpatient Sample database showed a similar pattern of changes beginning approximately 2 years earlier. In both cases, the timing of these observations corresponded with changes made to the International Classification of Diseases (ICD) coding system in use for pulmonary hypertension in that particular database. Review of pulmonary hypertension discharge data from the University of Texas Southwestern Hospital-Zale Lipshy showed similar changes in diagnosis code use.
Sudden shifts in reported IPAH mortality and hospital discharges were seen in all databases, likely related to coding changes. These findings raise questions about the accuracy of pulmonary hypertension diagnosis codes. Studies based on International Classification of Diseases, Ninth Revision and International Classification of Diseases, 10th Revision codes may have inadvertently included patients with other forms of pulmonary hypertension and should be reevaluated in this context. Validation studies of the IPAH diagnosis code are needed, and changes to the ICD coding system should be considered.
数据库研究报告了特发性肺动脉高压（IPAH）的诊断与 IPAH 死亡率之间的几种关联，包括年龄较大、黑种人和糖尿病。
我们调查了报告的死亡和以 IPAH 编码的住院出院，并将这些数据与其他形式的肺动脉高压进行了比较。使用了三个数据库：美国国家卫生统计中心数据库（1979-2006 年），查询死亡率数据；全国住院患者样本数据库（1993-2007 年），查询住院出院数据；以及德克萨斯大学西南医院-Zale Lipshy 出院数据库（1999 年、2002 年）。
从 1979 年到 2002 年，国家卫生统计中心数据库报告的 IPAH 死亡率和肺动脉高压（所有编码组合）死亡率普遍增加。2003 年，报告的 IPAH 死亡率急剧下降，而总肺动脉高压死亡人数增加。全国住院患者样本数据库显示了类似的变化模式，大约早了 2 年开始。在这两种情况下，这些观察结果的时间与特定数据库中肺动脉高压使用的国际疾病分类（ICD）编码系统的变化时间相对应。对德克萨斯大学西南医院-Zale Lipshy 的肺动脉高压出院数据进行审查，发现诊断代码使用情况也发生了类似的变化。
所有数据库中都观察到报告的 IPAH 死亡率和住院出院率的突然变化，可能与编码变化有关。这些发现引发了对肺动脉高压诊断代码准确性的质疑。基于国际疾病分类第 9 修订版和国际疾病分类第 10 修订版的研究可能无意中包括了其他形式的肺动脉高压患者，因此应在此背景下重新评估。需要对 IPAH 诊断代码进行验证研究，并应考虑对 ICD 编码系统进行更改。
