Lee Dong Hee, Kim Ye-Jee, Kim Hyangkyoung, Lee Hyung Seok
Division of Nephrology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea.
Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Kidney Res Clin Pract. 2024 Mar;43(2):156-164. doi: 10.23876/j.krcp.22.077. Epub 2023 Feb 23.
Health Insurance Review and Assessment Service's (HIRA) claims data have been used in studies of hemodialysis patients even though information about mortality is not provided in this database. Mortality analysis using HIRA data has been conducted using various operational definitions that have not been validated. This study aimed to validate operational definitions of mortality for maintenance hemodialysis patients that have been used when analyzing the Korean HIRA database.
This study utilized claims data of the Korean National Health Insurance Service (NHIS) between January 2008 and December 2019. We estimated mortality based on operational definitions applied in previous studies using the HIRA database and compared it with NHIS mortality information to validate accuracy.
A total of 128,876 patients who started maintenance hemodialysis between January 2009 and December 2019 were analyzed. The accuracy of estimated mortality was the highest at 96% in the group where mortality was defined as an absence of claims data for 150 days. If the period of no claims data was set to 90 days or less, there was a risk of overestimating the mortality for the entire study period. When it was set to 180 days or more, there was a risk of underestimating the mortality, as the follow-up time was close to the end of the study period.
When mortality analysis of maintenance hemodialysis patients is performed using HIRA data, it is most accurate to set the operational definition period as the absence of claims data for 150 days.
尽管健康保险审查与评估服务机构（HIRA）的理赔数据未提供死亡率信息，但仍被用于血液透析患者的研究。使用HIRA数据进行的死亡率分析采用了各种未经验证的操作定义。本研究旨在验证在分析韩国HIRA数据库时所使用的维持性血液透析患者死亡率的操作定义。
本研究利用了2008年1月至2019年12月期间韩国国民健康保险服务（NHIS）的理赔数据。我们根据先前使用HIRA数据库的研究中应用的操作定义估算死亡率，并将其与NHIS的死亡率信息进行比较，以验证准确性。
对2009年1月至2019年12月期间开始维持性血液透析的128,876名患者进行了分析。在将死亡率定义为无理赔数据150天的组中，估计死亡率的准确性最高，为96%。如果无理赔数据的时间段设定为90天或更短，则在整个研究期间存在高估死亡率的风险。当设定为180天或更长时间时，由于随访时间接近研究期结束，存在低估死亡率的风险。
当使用HIRA数据对维持性血液透析患者进行死亡率分析时，将操作定义期设定为无理赔数据150天最为准确。
