From the CHOICE Institute, University of Washington School of Pharmacy, Seattle, WA.
Department of Rehabilitation Medicine, University of Washington, Seattle, WA.
Epidemiology. 2020 Sep;31(5):687-691. doi: 10.1097/EDE.0000000000001185.
Linked birth certificate-hospital discharge records are a valuable resource for examining pregnancy outcomes among women with disability conditions. Few studies relying on these data have been able to assess the accuracy of identification of preexisting disability conditions. We assessed the accuracy of International Classification of Diseases version 9 (ICD9) codes for identifying selected physical, sensory, and intellectual conditions that may result in disability. As ICD9 codes were utilized until recently in most states, this information is useful to inform analyses with these records.
We reviewed 280 of 311 (90%) medical records of pregnant women with disabilities based on ICD9 codes and 390 of 8,337 (5%) records of pregnant women without disabilities who had deliveries at a large university medical center. We estimated sensitivity, specificity, and positive predictive values (PPV) using the medical record as gold standard. We adjusted for verification bias using inverse probability weighting and imputation.
The estimated sensitivity of ICD9 codes to identify women with disabilities with deliveries 2009-2012 was 44%; PPV was 98%, improving over time. Although sensitivity was <50% for some conditions, PPVs were 87%-100% for all conditions except intellectual disability (67%). Many physical conditions had complete verification and no underreporting.
These results are helpful for new studies using historical data comparing outcomes among women with and without these conditions and to inform interpretation of results from earlier studies. Assessment of the accuracy of disabilities as identified by ICD version 10 codes is warranted.
与医院出院记录相关联的出生证明是检查残疾女性妊娠结局的宝贵资源。很少有研究能够依赖这些数据来评估预先存在的残疾状况的识别准确性。我们评估了国际疾病分类第 9 版（ICD9）代码用于识别可能导致残疾的特定身体、感觉和智力状况的准确性。由于 ICD9 代码在最近之前在大多数州都在使用，因此这些信息对于使用这些记录进行分析很有用。
我们根据 ICD9 代码审查了 311 名残疾孕妇中有 280 名（90%）和 8337 名无残疾孕妇中有 390 名（5%）的病历，这些孕妇在一所大型大学医疗中心分娩。我们使用病历作为金标准来估计敏感性、特异性和阳性预测值（PPV）。我们使用逆概率加权和插补来调整验证偏差。
2009-2012 年，ICD9 代码识别残疾孕妇分娩的估计敏感性为 44%；PPV 为 98%，随时间推移而提高。虽然某些情况下的敏感性<50%，但所有情况下的 PPV 均为 87%-100%，除智力残疾（67%）外。许多身体状况的验证完全，不存在漏报。
这些结果对于使用历史数据比较有和无这些状况的女性的结局的新研究以及告知对早期研究结果的解释很有帮助。评估 ICD 第 10 版代码识别的残疾的准确性是有必要的。
