Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, USA.
Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
Pharmacoepidemiol Drug Saf. 2018 Aug;27(8):829-838. doi: 10.1002/pds.4550. Epub 2018 Jun 26.
To replicate the well-established association between angiotensin-converting enzyme inhibitors versus beta blockers and angioedema in the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) era.
We conducted a retrospective, inception cohort study in a large insurance database formatted to the Sentinel Common Data Model. We defined study periods spanning the ICD-9-CM era only, ICD-10-CM era only, and ICD-9-CM and ICD-10-CM era and conducted simple-forward mapping (SFM), simple-backward mapping (SBM), and forward-backward mapping (FBM) referencing the General Equivalence Mappings to translate the outcome (angioedema) and covariates from ICD-9-CM to ICD-10-CM. We performed propensity score (PS)-matched and PS-stratified Cox proportional hazards regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).
In the ICD-9-CM and ICD-10-CM eras spanning April 1 to September 30 of 2015 and 2016, there were 152 017 and 145 232 angiotensin-converting enzyme inhibitor initiators and 115 073 and 116 652 beta-blocker initiators, respectively. The PS-matched HR was 4.19 (95% CI, 2.82-6.23) in the ICD-9-CM era, 4.37 (2.92-6.52) in the ICD-10-CM era using SFM, and 4.64 (3.05-7.07) in the ICD-10-CM era using SBM and FBM. The PS-matched HRs from the mixed ICD-9-CM and ICD-10-CM eras ranged from 3.91 (2.69-5.68) to 4.35 (3.33-5.70).
The adjusted HRs across different diagnostic coding eras and the use of SFM versus SBM and FBM produced numerically different but clinically similar results. Additional investigations as ICD-10-CM data accumulate are warranted.
在国际疾病分类第十版临床修订版（ICD-10-CM）时代复制血管紧张素转换酶抑制剂与β受体阻滞剂和血管性水肿之间已建立的关联。
我们在一个大型保险数据库中进行了回顾性、起始队列研究，该数据库采用 Sentinel 通用数据模型格式化。我们定义了仅涵盖 ICD-9-CM 时代、ICD-10-CM 时代以及 ICD-9-CM 和 ICD-10-CM 时代的研究期，并进行了简单前向映射（SFM）、简单后向映射（SBM）和前后向映射（FBM），参考通用等价映射将结局（血管性水肿）和协变量从 ICD-9-CM 转换为 ICD-10-CM。我们进行倾向评分（PS）匹配和 PS 分层 Cox 比例风险回归，以估计风险比（HR）和 95%置信区间（CI）。
在 2015 年 4 月 1 日至 2016 年 9 月 30 日期间的 ICD-9-CM 和 ICD-10-CM 时代，血管紧张素转换酶抑制剂的起始者分别为 152017 人和 145232 人，β受体阻滞剂的起始者分别为 115073 人和 116652 人。在 ICD-9-CM 时代，PS 匹配的 HR 为 4.19（95%CI，2.82-6.23），在 ICD-10-CM 时代使用 SFM 为 4.37（2.92-6.52），在 ICD-10-CM 时代使用 SBM 和 FBM 为 4.64（3.05-7.07）。在混合 ICD-9-CM 和 ICD-10-CM 时代，PS 匹配的 HR 范围为 3.91（2.69-5.68）至 4.35（3.33-5.70）。
在不同的诊断编码时代和使用 SFM 与 SBM 和 FBM 进行调整后，HR 存在数值差异，但临床结果相似。随着 ICD-10-CM 数据的积累，需要进行进一步的研究。
