Payne S M, Seage G R, Oddleifson S, Gallagher K, vanBeuzekom M, Losina H, Hertz T
Health Services Department, Boston University School of Public Health, MA 02118, USA.
Ann Epidemiol. 1995 Sep;5(5):337-46. doi: 10.1016/1047-2797(94)00102-y.
The objectives of this study were twofold: to improve methods of identifying possible and acquired immunodeficiency syndrome (AIDS)-related hospital discharges in administrative databases and to measure AIDS-reporting completeness in Massachusetts both overall and by subgroup. We used fiscal year 1988 discharge data from the Massachusetts Rate Setting Commission (RSC) and data from the Massachusetts AIDS Reporting System (ARS). We identified 3362 discharges of adult patients (> 12 years old) from the RSC file that had diagnosis codes which are human immunodeficiency virus (HIV)-specific (042.x, 043.x, 044.x, or 795.8) or pertain to AIDS-defining "manifestations." Medical records of 650 patients apparently not reported to the ARS were reviewed. THe best set of codes overall consisted of either (a) the 042.x code or (b) the 043.x, 044.x, or 795.8 code plus selected manifestation codes (sensitivity, 93%; specificity, 86%; predictive value positive, 71%). Of the 927 AIDS cases identified from the 3362 discharges, only 36 had not been reported. AIDS cases among women (odds ratio (OR) = 2.9; 95% confidence interval (CI): 1.33 to 6.33), intravenous drug users (OR = 4.2; 95% CI: 2.20 to 8.02), and persons residing outside the Boston metropolitan area (OR = 2.3; 95% CI: 1.18 to 4.57) were more likely to be unreported than those among comparison groups.
一是改进在行政数据库中识别可能与获得性免疫缺陷综合征（艾滋病）相关的医院出院病例的方法，二是全面及按亚组衡量马萨诸塞州艾滋病报告的完整性。我们使用了马萨诸塞州费率设定委员会（RSC）1988财年的出院数据以及马萨诸塞州艾滋病报告系统（ARS）的数据。我们从RSC文件中识别出3362例成年患者（>12岁）的出院病例，这些病例具有人类免疫缺陷病毒（HIV）特异性诊断代码（042.x、043.x、044.x或795.8）或与艾滋病定义的“表现”相关。对650例显然未向ARS报告的患者的病历进行了审查。总体而言，最佳的代码组合包括（a）042.x代码或（b）043.x、044.x或795.8代码加上选定的表现代码（敏感性为93%；特异性为86%；阳性预测值为71%）。在从3362例出院病例中识别出的927例艾滋病病例中，只有36例未被报告。女性（优势比（OR）=2.9；95%置信区间（CI）：1.33至6.33）、静脉吸毒者（OR = 4.2；95%CI：2.20至8.02）以及居住在波士顿大都市区以外的人（OR = 2.3；95%CI：1.18至4.57）中的艾滋病病例比对照组中的病例更有可能未被报告。
