Lindström U, Exarchou S, Sigurdardottir V, Sundström B, Askling J, Eriksson J K, Forsblad-d'Elia H, Turesson C, Kristensen L E, Jacobsson L
a Department of Rheumatology and Inflammation Research , Sahlgrenska Academy at the University of Gothenburg , Gothenburg.
b Section of Rheumatology, Department of Clinical Sciences , Lund University , Malmö
Scand J Rheumatol. 2015;44(5):369-76. doi: 10.3109/03009742.2015.1010572. Epub 2015 Mar 23.
Epidemiological studies of spondyloarthritis (SpA), using ICD codes from the Swedish National Patient Register (NPR), offer unique possibilities but hinge upon an understanding of the validity of the codes. The aim of this study was to validate the ICD codes for ankylosing spondylitis (AS) and undifferentiated SpA (uSpA) in the NPR against the established classification criteria [modified New York (mNY), Assessment of SpondyloArthritis international Society (ASAS), Amor, and European Spondyloarthropathy Study Group (ESSG) criteria].
All patients with an ICD-8/9/10 code of AS or uSpA in the NPR 1966-2009 at a visit to a specialist in rheumatology or internal medicine or corresponding hospitalization, alive and living in Sweden 2009, were identified (n=20,089). Following a structured procedure to achieve geographical representativeness, 500 random patients with a diagnosis of AS or uSpA in 2007-2009 were selected. Based on a structured review of clinical records, positive predictive values (PPVs) for fulfilling the criteria sets were calculated.
For those having received an ICD code for AS, the PPVs for fulfilling the mNY criteria or any set of SpA criteria were 70% and 89%, respectively. For those with an uSpA diagnosis (and never an AS diagnosis), the corresponding PPVs were 20% and 79%. The subset with both AS and uSpA diagnoses (overlap=12%) were as likely to fulfil the mNY criteria as the group that had been coded as AS only.
The diagnosis codes for AS or uSpA had high PPVs, suggesting that our case identification in the Swedish NPR can be used for nationwide, population-based, epidemiological studies of these diseases.
利用瑞典国家患者登记处（NPR）的国际疾病分类（ICD）编码对脊柱关节炎（SpA）进行流行病学研究，虽提供了独特的可能性，但取决于对编码有效性的理解。本研究的目的是对照既定的分类标准[改良纽约（mNY）、国际脊柱关节炎评估协会（ASAS）、阿穆尔（Amor）和欧洲脊柱关节病研究组（ESSG）标准]，验证NPR中强直性脊柱炎（AS）和未分化脊柱关节炎（uSpA）的ICD编码。
确定1966 - 2009年期间在NPR中有AS或uSpA的ICD - 8/9/10编码、于2009年在瑞典生活且在世、曾就诊于风湿病或内科专科医生或相应住院治疗的所有患者（n = 20,089）。按照结构化程序以实现地理代表性，选取了2007 - 2009年期间诊断为AS或uSpA的500名随机患者。基于对临床记录的结构化审查，计算符合各标准集的阳性预测值（PPV）。
对于那些被赋予AS的ICD编码者，符合mNY标准或任何一组SpA标准的PPV分别为70%和89%。对于那些诊断为uSpA（且从未诊断为AS）者，相应的PPV分别为20%和79%。同时有AS和uSpA诊断的亚组（重叠率 = 12%）与仅被编码为AS的组一样有可能符合mNY标准。
AS或uSpA的诊断编码具有较高的PPV，表明我们在瑞典NPR中的病例识别可用于这些疾病的全国性、基于人群的流行病学研究。
