Epidemiology, Medical Devices, Johnson & Johnson, New Brunswick, NJ, USA.
Pharmacoepidemiol Drug Saf. 2018 Oct;27(10):1092-1100. doi: 10.1002/pds.4617. Epub 2018 Jul 12.
To quantify the sensitivity and positive predictive value (PPV) of body mass index (BMI)-related ICD-9-CM and ICD-10-CM diagnosis codes in claims data.
De-identified electronic health record (EHR) and claims data were obtained from the Optum Integrated Claims-Clinical Database for cross-sections of commercial and Medicare Advantage health plan members age ≥ 20 years in 2013, 2014, and 2016. In each calendar year, health plan members' BMI as coded in the insurance claims data (error-prone measure) was compared with their BMI as recorded in the EHR (gold standard) to estimate the sensitivity and PPV of BMI-related ICD-9-CM and ICD-10-CM diagnosis codes. The unit of analysis was the person-year.
The study sample included 746 763 distinct health plan members who contributed 1 116 283 eligible person-years (median age 56 years; 57% female; 65% commercially insured and 35% with Medicare Advantage). BMI-related diagnoses were coded for 14.6%. The sensitivity of BMI-related diagnoses codes for the detection of underweight, normal weight, overweight, and obesity was 10.1%, 3.7%, 6.0%, and 25.2%, and the PPV was 49.0% for underweight, 89.6% for normal weight, 73.4% for overweight, and 92.4% for obesity, respectively. The sensitivity of BMI-related diagnosis codes was higher in the ICD-10-CM era relative to the ICD-9-CM era.
The PPV of BMI-related diagnosis codes for normal weight, overweight, and obesity was high (>70%) but the sensitivity was low (<30%). BMI-related diagnoses were more likely to be coded in patients with class II or III obesity (BMI ≥35 kg/m ), and in 2016 relative to 2013 or 2014.
定量分析医疗保险索赔数据中与身体质量指数（BMI）相关的国际疾病分类第 9 版（ICD-9-CM）和国际疾病分类第 10 版（ICD-10-CM）诊断代码的灵敏度和阳性预测值（PPV）。
从 Optum 综合索赔-临床数据库中获取 2013 年、2014 年和 2016 年各年龄段（≥20 岁）商业保险和医疗保险优势计划成员的去标识电子健康记录（EHR）和索赔数据。在每个日历年中，将保险索赔数据中编码的 BMI（易出错的指标）与 EHR 中记录的 BMI（金标准）进行比较，以估计 BMI 相关 ICD-9-CM 和 ICD-10-CM 诊断代码的灵敏度和 PPV。分析单位为人-年。
研究样本包括 746763 名不同的健康计划成员，他们提供了 1116283 人-年的合格数据（中位年龄 56 岁；57%为女性；65%商业保险，35%有医疗保险优势）。BMI 相关诊断编码占 14.6%。BMI 相关诊断代码检测体重不足、正常体重、超重和肥胖的灵敏度分别为 10.1%、3.7%、6.0%和 25.2%，PPV 分别为体重不足 49.0%、正常体重 89.6%、超重 73.4%和肥胖 92.4%。与 ICD-9-CM 时代相比，ICD-10-CM 时代 BMI 相关诊断代码的灵敏度更高。
BMI 相关诊断代码检测正常体重、超重和肥胖的 PPV 较高（>70%），但灵敏度较低（<30%）。BMI 相关诊断在 BMI≥35kg/m2 的 II 类或 III 类肥胖患者中更易编码，并且在 2016 年比 2013 年或 2014 年更易编码。
