Systèmes de soins et de santé publique, Centre de recherche en santé publique, Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, Québec, H3N 1X9, Canada.
Laboratoire Transformation Numérique en Santé (LabTNS), Montréal, Québec, H2X 0A9, Canada.
J Am Med Inform Assoc. 2024 May 20;31(6):1219-1226. doi: 10.1093/jamia/ocae046.
This study aimed to support the implementation of the 11th Revision of the International Classification of Diseases (ICD-11). We used common comorbidity indices as a case study for proactively assessing the impact of transitioning to ICD-11 for mortality and morbidity statistics (ICD-11-MMS) on real-world data analyses.
Using the MIMIC IV database and a table of mappings between the clinical modification of previous versions of ICD and ICD-11-MMS, we assembled a population whose diagnosis can be represented in ICD-11-MMS. We assessed the impact of ICD version on cross-sectional analyses by comparing the populations' distribution of Charlson and Elixhauser comorbidity indices (CCI, ECI) across different ICD versions, along with the adjustment in comorbidity weighting.
We found that ICD versioning could lead to (1) alterations in the population distribution and (2) changes in the weight that can be assigned to a comorbidity category in a reweighting initiative. In addition, this study allowed the creation of the corresponding ICD-11-MMS codes list for each component of the CCI and the ECI.
In common with the implementations of previous versions of ICD, implementation of ICD-11-MMS potentially hinders comparability of comorbidity burden on health outcomes in research and clinical settings.
Further research is essential to enhance ICD-11-MMS usability, while mitigating, after identification, its adverse effects on comparability of analyses.
本研究旨在为国际疾病分类第 11 次修订版（ICD-11）的实施提供支持。我们以常见的合并症指数为案例研究，主动评估向 ICD-11 过渡对死亡率和发病率统计（ICD-11-MMS）对真实世界数据分析的影响。
我们使用 MIMIC-IV 数据库和 ICD 各版本临床修正版与 ICD-11-MMS 之间的映射表，构建了一个可以用 ICD-11-MMS 表示诊断的人群。我们通过比较不同 ICD 版本下 Charlson 和 Elixhauser 合并症指数（CCI、ECI）在人群中的分布，以及合并症权重的调整，评估了 ICD 版本对横断面分析的影响。
我们发现 ICD 版本化可能导致（1）人群分布的改变，（2）在重新加权计划中，一个合并症类别可以赋予的权重的改变。此外，本研究为 CCI 和 ECI 的每个组成部分创建了相应的 ICD-11-MMS 代码列表。
与 ICD 各版本的实施情况一样，ICD-11-MMS 的实施可能会阻碍研究和临床环境中对健康结果的合并症负担的可比性。
进一步的研究对于提高 ICD-11-MMS 的可用性至关重要，同时在确定其对分析可比性的不利影响后，减轻这些影响。
