School of Population and Global Health, The University of Western Australia, Perth, Australia.
Unit of Health-Care Epidemiology, Nuffield Department of Public Health, University of Oxford, Oxford, UK.
BMJ Open. 2017 Nov 12;7(11):e019217. doi: 10.1136/bmjopen-2017-019217.
To determine the utility of International Classification of Diseases (ICD) codes in investigating trends in ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) using person-linked electronic hospitalisation data in England and Western Australia (WA).
All hospital admissions with myocardial infarction (MI) as the principal diagnosis were identified from 2000 to 2013 from both jurisdictions. Fourth-digit ICD-10 codes were used to delineate all MI types-STEMI, NSTEMI, unspecified and subsequent MI. The annual frequency of each MI type was calculated as a proportion of all MI admissions. For all MI and each MI type, age-standardised rates were calculated and age-adjusted Poisson regression models used to estimate annual percentage changes in rates.
In 2000, STEMI accounted for 49% of all MI admissions in England and 59% in WA, decreasing to 35% and 25% respectively by 2013. Less than 10% of admissions were recorded as NSTEMI in England throughout the study period, whereas by 2013, 70% of admissions were NSTEMI in WA. Unspecified MI comprised 60% of all MI admissions in England by 2013, compared with <1% in WA. Trends in age-standardised rates differed for all MI (England, -2.7%/year; WA, +1.7%/year), underpinned by differing age-adjusted trends in NSTEMI (England, -6.1%/year; WA, +10.2%/year).
Differences between the proportion and trends for MI types in English and WA data were observed. These were consistent with the coding standards in each country. This has important implications for using electronic hospital data for monitoring MI and identifying MI types for outcome studies.
利用英格兰和西澳大利亚（WA）的人员关联电子住院数据，确定国际疾病分类（ICD）代码在调查 ST 段抬高型心肌梗死（STEMI）和非 ST 段抬高型心肌梗死（NSTEMI）趋势中的作用。
从两个管辖区 2000 年至 2013 年确定所有以心肌梗死（MI）为主要诊断的住院治疗。使用 ICD-10 第四位数代码来划定所有 MI 类型-STEMI、NSTEMI、未指定和随后的 MI。每年每种 MI 类型的频率计算为所有 MI 入院的比例。对于所有 MI 和每种 MI 类型，计算年龄标准化率，并使用年龄调整泊松回归模型估计率的年百分比变化。
2000 年，STEMI 占英格兰所有 MI 入院的 49%，WA 占 59%，到 2013 年分别降至 35%和 25%。在整个研究期间，英格兰有不到 10%的入院记录为 NSTEMI，而到 2013 年，WA 有 70%的入院为 NSTEMI。2013 年，未指定 MI 占英格兰所有 MI 入院的 60%，而 WA 则不到 1%。所有 MI 的年龄标准化率趋势不同（英格兰，-2.7%/年；WA，+1.7%/年），这主要是由于 NSTEMI 的年龄调整趋势不同（英格兰，-6.1%/年；WA，+10.2%/年）。
在英格兰和 WA 数据中观察到 MI 类型的比例和趋势存在差异。这些差异与每个国家的编码标准一致。这对使用电子住院数据监测 MI 和确定 MI 类型以进行预后研究具有重要意义。
