Department of Psychiatry, Vanderbilt University School of Medicine, Nashville, TN 37212, USA.
BMC Med Res Methodol. 2012 Aug 24;12:128. doi: 10.1186/1471-2288-12-128.
We developed and validated an automated database case definition for diabetes in children and youth to facilitate pharmacoepidemiologic investigations of medications and the risk of diabetes.
The present study was part of an in-progress retrospective cohort study of antipsychotics and diabetes in Tennessee Medicaid enrollees aged 6-24 years. Diabetes was identified from diabetes-related medical care encounters: hospitalizations, outpatient visits, and filled prescriptions. The definition required either a primary inpatient diagnosis or at least two other encounters of different types, most commonly an outpatient diagnosis with a prescription. Type 1 diabetes was defined by insulin prescriptions with at most one oral hypoglycemic prescription; other cases were considered type 2 diabetes. The definition was validated for cohort members in the 15 county region geographically proximate to the investigators. Medical records were reviewed and adjudicated for cases that met the automated database definition as well as for a sample of persons with other diabetes-related medical care encounters.
The study included 64 cases that met the automated database definition. Records were adjudicated for 46 (71.9%), of which 41 (89.1%) met clinical criteria for newly diagnosed diabetes. The positive predictive value for type 1 diabetes was 80.0%. For type 2 and unspecified diabetes combined, the positive predictive value was 83.9%. The estimated sensitivity of the definition, based on adjudication for a sample of 30 cases not meeting the automated database definition, was 64.8%.
These results suggest that the automated database case definition for diabetes may be useful for pharmacoepidemiologic studies of medications and diabetes.
我们开发并验证了一种针对儿童和青少年糖尿病的自动化数据库病例定义，以促进药物和糖尿病风险的药物流行病学研究。
本研究是田纳西州医疗补助计划中 6-24 岁接受抗精神病药物治疗的糖尿病患者进行的正在进行的回顾性队列研究的一部分。糖尿病是通过与糖尿病相关的医疗保健接触来确定的：住院、门诊就诊和处方。该定义需要至少有一个主要的住院诊断或至少有两个不同类型的其他接触，最常见的是门诊诊断并伴有处方。1 型糖尿病的定义是胰岛素处方最多有一个口服降糖药处方；其他病例被认为是 2 型糖尿病。该定义在距离调查人员最近的 15 个县的队列成员中进行了验证。对符合自动数据库定义的病例以及其他有糖尿病相关医疗保健接触的人员进行了医疗记录审查和裁决。
该研究包括 64 例符合自动数据库定义的病例。对其中 46 例（71.9%）进行了记录裁决，其中 41 例（89.1%）符合新诊断糖尿病的临床标准。1 型糖尿病的阳性预测值为 80.0%。对于 2 型和未明确糖尿病的综合病例，阳性预测值为 83.9%。基于对未满足自动数据库定义的 30 例病例样本进行裁决，该定义的估计敏感性为 64.8%。
这些结果表明，糖尿病的自动化数据库病例定义可能对药物和糖尿病的药物流行病学研究有用。
