Kohda Masakazu, Okada Akira, Yasunaga Hideo
DeSC Healthcare, Inc., Tokyo, Japan.
Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
JMA J. 2025 Apr 28;8(2):411-416. doi: 10.31662/jmaj.2024-0281. Epub 2025 Feb 14.
Administrative claims data are used in clinical studies. However, individuals insured by different insurance systems have different backgrounds, ages, and disease prevalences. This study aimed to examine the crude and adjusted prevalence of diseases between employee and nonemployee health insurance in Japan.
We conducted a cross-sectional study using the DeSC database, an administrative claims database covering multiple insurers. We calculated the prevalence of 10 disease categories and 6 specific cancers with and without adjustments for age and sex and compared them between the employee (Kempo) and nonemployee (Kokuho) insurance systems.
We identified 740,217 and 3,312,042 individuals covered by Kempo and Kokuho, respectively. The Kokuho group showed a higher crude prevalence of malignancies, endocrinological diseases, mental disorders, neurological diseases, cardiovascular diseases, and kidney or genitourinary diseases. The adjusted prevalence differed in mental disorders (7.2% vs. 10.6%), neurological diseases (10.5% vs. 14.0%), and gastrointestinal diseases (50.1% vs. 34.1%) between the Kempo and Kokuho groups.
While using administrative claims data, researchers should consider differences in patient backgrounds and disease prevalence among insurance providers.
行政索赔数据用于临床研究。然而，不同保险系统覆盖的人群具有不同的背景、年龄和疾病患病率。本研究旨在调查日本职工医保和非职工医保之间疾病的粗患病率和校正患病率。
我们使用DeSC数据库进行了一项横断面研究，该数据库是一个覆盖多家保险公司的行政索赔数据库。我们计算了10种疾病类别和6种特定癌症在调整和未调整年龄及性别情况下的患病率，并在职工医保（Kempo）和非职工医保（Kokuho）系统之间进行比较。
我们分别确定了740,217名和3,312,042名参保Kempo和Kokuho的个体。Kokuho组在恶性肿瘤、内分泌疾病、精神障碍、神经疾病、心血管疾病以及肾脏或泌尿生殖系统疾病方面的粗患病率较高。Kempo组和Kokuho组在精神障碍（7.2%对10.6%）、神经疾病（10.5%对14.0%）和胃肠道疾病（50.1%对34.1%）方面的校正患病率有所不同。
在使用行政索赔数据时，研究人员应考虑保险提供者之间患者背景和疾病患病率的差异。
