MacDonald Sarah C, Hernán Miguel A, McElrath Thomas F, Hernández-Díaz Sonia
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Paediatr Perinat Epidemiol. 2018 May;32(3):281-286. doi: 10.1111/ppe.12459. Epub 2018 Mar 22.
Pre-existing conditions are imperfectly recorded in health care databases. We assessed whether pre-existing neurologic conditions (epilepsy, multiple sclerosis [MS]) were differentially recorded in the presence of major obstetric outcomes (Caesarean delivery, preterm delivery, preeclampsia) in delivery records. We also evaluated the impact of differential recording on measures of frequency and association between the conditions and outcomes.
The 2011-2014 Truven Health MarketScan® Commercial Claims Dataset was used to identify pregnancies. We calculated the relative recording of epilepsy and MS at delivery hospitalization compared with a 270-day pre-delivery window both overall and by the presence of major obstetric outcomes. We estimated risk ratios for the association between epilepsy and MS with the outcomes for each ascertainment window.
We identified 909 065 pregnancies in women continuously enrolled from 270-days before the delivery date. Of women with epilepsy identified in the pre-delivery window, 73% had the condition coded at delivery. For MS, the proportion was 60%. MS recording at delivery did not vary by obstetric outcomes, however, delivery-coded epilepsy was less likely confirmed in the pre-delivery window in the presence of preeclampsia. Generally, the period of ascertainment did not meaningfully impact risk ratios, however, the risk ratio for preeclampsia associated with epilepsy was 1.67 (95% CI 1.47, 1.90) when epilepsy was ascertained at delivery and 1.26 (95% CI 1.07, 1.48) when epilepsy was ascertained in the pre-delivery window (heterogeneity, P = .007).
Ascertainment of epilepsy and MS in delivery hospitalization records underestimated prevalence. However, the window of recording generally did not impact risk ratio estimates of associations with obstetric outcomes.
既往疾病在医疗保健数据库中的记录并不完善。我们评估了在分娩记录中，当存在主要产科结局（剖宫产、早产、先兆子痫）时，既往神经系统疾病（癫痫、多发性硬化症[MS]）的记录是否存在差异。我们还评估了差异记录对疾病与结局之间频率和关联测量的影响。
使用2011 - 2014年Truven Health MarketScan®商业索赔数据集来识别妊娠情况。我们计算了分娩住院时癫痫和MS的相对记录情况，并与分娩前270天的时间段进行比较，整体以及按主要产科结局的存在情况进行比较。我们估计了每个确定窗口中癫痫和MS与结局之间关联的风险比。
我们识别出从分娩日期前270天开始连续参保的女性中有909065例妊娠。在分娩前窗口中被识别出患有癫痫的女性中，73%在分娩时有该疾病编码。对于MS，这一比例为60%。分娩时MS的记录不因产科结局而有所不同，然而，在出现先兆子痫的情况下，分娩时编码的癫痫在分娩前窗口中被确认的可能性较小。一般来说，确定时期对风险比没有显著影响，但是，当在分娩时确定癫痫时，与癫痫相关的先兆子痫的风险比为1.67（95%CI 1.47, 1.90），而当在分娩前窗口中确定癫痫时，该风险比为1.26（95%CI 1.07, 1.48）（异质性，P = 0.007）。
分娩住院记录中癫痫和MS的确定低估了患病率。然而，记录窗口通常不会影响与产科结局关联的风险比估计。
