Bernatsky Sasha, Dekis Alaa, Hudson Marie, Pineau Christian A, Boire Gilles, Fortin Paul R, Bessette Louis, Jean Sonia, Chetaille Ann L, Belisle Patrick, Bergeron Louise, Feldman Debbie Ehrmann, Joseph Lawrence
Division of Clinical Epidemiology, McGill University Health Centre, 687 Pine Avenue West, V-Building, V2.09, Montreal, QC, H3A 1A1, Canada.
Division of Rheumatology, McGill University Health Centre, Montreal, Quebec, Canada.
BMC Res Notes. 2014 Dec 19;7:937. doi: 10.1186/1756-0500-7-937.
To estimate rheumatoid arthritis (RA) prevalence in Quebec using administrative health data, comparing across regions.
Cases of RA were ascertained from physician billing and hospitalization data, 1992-2008. We used three case definitions: 1) ≥ 2 billing diagnoses, submitted by any physician, ≥ 2 months apart, but within 2 years; 2) ≥ 1 diagnosis, by a rheumatologist; 3) ≥1 hospitalization diagnosis (all based on ICD-9 code 714, and ICD-10 code M05). We combined data across these three case definitions, using Bayesian hierarchical latent class models to estimate RA prevalence, adjusting for the imperfect sensitivity and specificity of the data. We compared urban versus rural regions.
Using our case definitions and no adjustment for error, we defined 75,760 cases for an over-all RA prevalence of 9.9 per thousand residents. After adjusting for the imperfect sensitivity and specificity of our case definition algorithms, we estimated Quebec RA prevalence at 5.6 per 1000 females and 4.1 per 1000 males. The adjusted RA prevalence estimates for older females were the highest for any demographic group (9.9 cases per 1,000), and were similar in rural and urban regions. In younger males and females, and in older males, RA prevalence estimates were lower in rural versus urban areas.
Without adjustment for error inherent in administrative databases, RA prevalence in Quebec was approximately 1%, while adjusted estimates are approximately half that. The lower prevalence in rural areas, seen for most demographic groups, may suggest either true regional variations in RA risk, or under-ascertainment of cases in rural Quebec.
利用行政卫生数据估算魁北克类风湿性关节炎（RA）的患病率，并进行地区间比较。
通过1992 - 2008年医生计费和住院数据确定RA病例。我们使用了三种病例定义：1）由任何医生提交的≥2次计费诊断，间隔≥2个月，但在2年内；2）由风湿病学家做出的≥1次诊断；3）≥1次住院诊断（均基于ICD - 9编码714和ICD - 10编码M05）。我们使用贝叶斯分层潜在类别模型合并这三种病例定义的数据，以估算RA患病率，并对数据的不完美敏感性和特异性进行调整。我们比较了城市和农村地区。
使用我们的病例定义且未对误差进行调整时，我们确定了75,760例病例，总体RA患病率为每千名居民9.9例。在对病例定义算法的不完美敏感性和特异性进行调整后，我们估计魁北克女性RA患病率为每1000人中有5.6例，男性为每1000人中有4.1例。老年女性经调整后的RA患病率估计在任何人口群体中最高（每1000人中有9.9例），且在农村和城市地区相似。在年轻男性和女性以及老年男性中，农村地区的RA患病率估计低于城市地区。
在未对行政数据库中固有的误差进行调整的情况下，魁北克的RA患病率约为1%，而调整后的估计约为该数值的一半。大多数人口群体在农村地区的患病率较低，这可能表明RA风险存在真正的地区差异，或者魁北克农村地区病例报告不足。
