Weiss Scott L
Division of Critical Care, Department of Pediatrics at Nemours Children's Hospital, Wilmington, Delaware, United States.
Department of Pediatrics and Pathology, Anatomy and Cell Biology at Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, United States.
Am J Epidemiol. 2025 Jun 3;194(6):1496-1498. doi: 10.1093/aje/kwae099.
Hypertension is a common "silent killer" in adult medicine, but epidemiologic estimates of elevated blood pressure in children and adolescents are challenged by under-diagnosis and resultant low utilization of relevant administrative or billing codes. In the article by Horgan et al (Am J Epidemiol 2025;194(2):407-419), children and adolescents with hypertension and elevated blood pressure were identified using direct assessment of blood pressure measurements available in the electronic health record from both inpatient and outpatient visits ("clinical cohort") in comparison to diagnosis codes ("claims-based cohort"). The study population included 3.75 million pediatric healthcare visits available in the US Food and Drug Administration's Sentinel System. While the study applied a relatively novel methodology to interrogate available clinical data within the EHR to better understand the prevalence of pediatric hypertension and raised concern for a higher occurrence of hypertension among children and adolescents than previously realized using claims codes, the utility of the prevalence estimates may be limited by the potential for misclassification bias inherent in electronic health records data. However, these data raise important concerns about relaying solely on ICD-9-CM/ICD-10-CM codes to quantify the epidemiology of pediatric hypertension and highlight opportunities to address elevated blood pressure in children that could improve long-term cardiovascular health.
高血压是成人医学中常见的“沉默杀手”，但儿童和青少年高血压的流行病学估计受到诊断不足以及相关行政或计费代码使用率低的挑战。在Horgan等人的文章（《美国流行病学杂志》2025年；194(2):407 - 419）中，与诊断代码（“基于索赔的队列”）相比，通过直接评估电子健康记录中住院和门诊就诊时可用的血压测量值（“临床队列”）来识别患有高血压和血压升高的儿童和青少年。研究人群包括美国食品药品监督管理局哨兵系统中375万次儿科医疗就诊。虽然该研究应用了一种相对新颖的方法来询问电子健康记录中的可用临床数据，以更好地了解儿童高血压的患病率，并引发了对儿童和青少年高血压发生率高于此前使用索赔代码所认识到的情况的关注，但患病率估计的效用可能受到电子健康记录数据中固有分类错误偏差可能性的限制。然而，这些数据引发了对仅依靠ICD - 9 - CM/ICD - 10 - CM代码来量化儿童高血压流行病学的重要担忧，并突出了应对儿童血压升高的机会，这可能改善长期心血管健康。
