Callhoff Johanna, Albrecht Katinka, Marschall Ursula, Strangfeld Anja, Hoffmann Falk
Epidemiology and Health Services Research, German Rheumatism Research Centre, Berlin, Germany.
Institute for Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Pharmacoepidemiol Drug Saf. 2023 May;32(5):517-525. doi: 10.1002/pds.5562. Epub 2022 Dec 8.
To evaluate different algorithms for the identification of rheumatoid arthritis (RA) in claims data using patient-reported diagnosis as reference.
Within longitudinal data from a large German statutory health insurance, we selected a random sample of persons with ICD-10 code for RA (M05/M06) in ≥2 quarters in 2013. The sample was stratified for age, sex, and M05/M06. Persons were asked to confirm RA diagnosis (gold standard), which was linked to claims data given consent. Analyses were weighted to represent the total RA population of the database. Positive predictive values (PPVs) and discriminative properties were calculated for different algorithms: ICD-10 code only, additional examination of inflammatory markers, prescription of specific medication, rheumatologist appointment, or combination of these.
Of 6193 persons with a claims diagnosis of RA, 3184 responded (51%). Overall, PPV for the ICD-10 code was 81% (95% confidence interval 79%-83%) with 94% (92%-95%) for M05 and 76% (73%-79%) for M06. PPVs increased (with loss of case numbers) if inflammatory markers (82% [80%-84%]), rheumatology visits (85% [82%-87%]) or specific medication (89% [87%-91%]) had been used in addition. Specific medication had the best discriminative properties (diagnostic odds ratio of 3.0) among persons with RA diagnosis.
The ICD-10 codes M05 and (less optimal) M06 have high PPVs and are valuable to identify RA in German claims data. Depending on the respective research question, researchers should use different criteria for identification of RA.
以患者报告的诊断为参照，评估在理赔数据中识别类风湿性关节炎（RA）的不同算法。
在来自德国大型法定医疗保险的纵向数据中，我们随机抽取了2013年至少两个季度有RA的ICD-10编码（M05/M06）的人员样本。样本按年龄、性别和M05/M06进行分层。要求这些人员确认RA诊断（金标准），在获得同意后将其与理赔数据相联系。分析采用加权法以代表数据库中的RA总体人群。计算不同算法的阳性预测值（PPV）和鉴别特性：仅使用ICD-10编码、额外检查炎症标志物、特定药物处方、风湿科医生预约或这些方法的组合。
在6193名有理赔诊断为RA的人员中，3184人做出回应（51%）。总体而言，ICD-10编码的PPV为81%（95%置信区间79%-83%），M05为94%（92%-95%），M06为76%（73%-79%）。如果另外使用炎症标志物（82% [80%-84%]）、风湿科就诊（85% [82%-87%]）或特定药物（89% [87%-91%]），PPV会增加（病例数减少）。在有RA诊断的人员中，特定药物具有最佳的鉴别特性（诊断比值比为3.0）。
ICD-10编码M05和（不太理想的）M06具有较高的PPV，对在德国理赔数据中识别RA很有价值。根据各自的研究问题，研究人员应使用不同的标准来识别RA。
