Horgan Casie E, Burk Jillian, Eworuke Efe, Stojanovic Danijela, Lyons Jennifer G, Moyneur Èrick, McMahon Ann, Maro Judith C
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, United States.
Office of Surveillance and Epidemiology, Center for Drug and Evaluation, U.S. Food and Drug Administration, Silver Spring, MD, United States.
Am J Epidemiol. 2025 Feb 5;194(2):407-419. doi: 10.1093/aje/kwae233.
We conducted retrospective public health surveillance using data from 2006 to 2016 in 7 integrated delivery systems from the US Food and Drug Administration's Sentinel System. We identified pediatric hypertensive patients by clinical and claims-based definitions and compared demographics, baseline profiles, and follow-up time profiles. Among 3 757 803 pediatric patients aged 3 to 17 years, we identified 781 722 children and 551 246 teens with at least 3 blood pressure measurements over 36 months. Of these, 70 315 children (9%) and 47 928 teens (8.7%) met the clinical definition for hypertension, and 22 465 (2.8%) children and 60 952 (11%) of teens met the clinical definition for elevated, nonhypertensive blood pressure. Of the 3.7 million patients, we identified 3246 children and 7293 teens with any claim for hypertension (claims definition). Evidence of hypertension claims among those meeting our clinical definition was poor; 2.2% and 7.3% of clinically hypertensive children and teens had corresponding claims for hypertension. Baseline profiles for patients with claims-based hypertension suggest greater severity of disease compared with clinical patients. Claims-based patients had higher rates of all-cause mortality during follow-up. Pediatric hypertension in claims-based data sources is under-captured but may serve as a marker for greater disease severity. Investigators should understand coding practices when selecting real-world data sources for pediatric hypertension work.
我们利用美国食品药品监督管理局哨兵系统中7个综合医疗服务体系2006年至2016年的数据进行了回顾性公共卫生监测。我们通过临床定义和基于索赔记录的定义来识别小儿高血压患者，并比较了人口统计学特征、基线资料和随访时间资料。在3757803名3至17岁的儿科患者中，我们识别出781722名儿童和551246名青少年在36个月内至少进行了3次血压测量。其中，70315名儿童（9%）和47928名青少年（8.7%）符合高血压的临床定义，22465名儿童（2.8%）和60952名青少年（11%）符合血压升高但非高血压的临床定义。在这370万患者中，我们识别出3246名儿童和7293名青少年有任何高血压索赔记录（基于索赔记录的定义）。在符合我们临床定义的患者中，高血压索赔记录的证据不足；临床诊断为高血压的儿童和青少年中，分别只有2.2%和7.3%有相应的高血压索赔记录。基于索赔记录的高血压患者的基线资料表明，与临床诊断患者相比，疾病严重程度更高。基于索赔记录的患者在随访期间全因死亡率更高。基于索赔记录的数据源中，小儿高血压的诊断不足，但可能作为疾病严重程度更高的一个标志。研究人员在选择用于小儿高血压研究的真实世界数据源时，应了解编码方法。
