Abstract
BackgroundAdministrative database research is widely applied in the field of epidemiology. However, the results of the studies depend on the type of database used and the algorithms applied for case ascertainment. The optimal methodology for identifying patients with rheumatic diseases from administrative databases is yet not known. Our aim was to describe an administrative database as a source for estimation of epidemiological characteristics on an example of systemic lupus erythematosus (SLE, ICD-10 code M32) prevalence assessment in the database of the Estonian Health Insurance Fund (EHIF).MethodsCode M32 billing episodes were extracted from the EHIF database 2006–2010. For all cases where M32 was assigned by a rheumatologist less than four times during the study period, diagnosis verification process using health care providers’ (HCP) databases was applied. For M32 cases assigned by a rheumatologist four times or more, diagnoses were verified for a randomly selected sample.ResultsFrom 677 persons with code M32 assigned in EHIF database, 404 were demonstrated having “true SLE”. The code M32 positive predictive value (PPV) for the whole EHIF database was 60%; PPV varies remarkably by specialty of a physician and repetition of the code assignment. The false positive M32 codes were predominantly initial diagnoses which were not confirmed afterwards; in many cases, a rheumatic condition other than SLE was later diagnosed.ConclusionsFalse positive codes due to tentative diagnoses may be characteristic for conditions with a complicated diagnosis process like SLE and need to be taken into account when performing administrative database research.
Highlights
Administrative database research is widely applied in the field of epidemiology
In 2017 we published the results of prevalence and incidence estimation of systemic lupus erythematosus (SLE) in Estonia based on the Estonian Health Insurance Fund (EHIF) and the Estonian Health Care Providers’ (HCP) databases [7]
The General practitioner (GP) could not be reached in 19 cases, no electronic data was available for 6 cases of other specialists and for 9 cases of rheumatologist assignment category; in the current analysis these cases were treated as disproved cases
Summary
Administrative database research is widely applied in the field of epidemiology. Our aim was to describe an administrative database as a source for estimation of epidemiological characteristics on an example of systemic lupus erythematosus (SLE, ICD-10 code M32) prevalence assessment in the database of the Estonian Health Insurance Fund (EHIF). Remarkable work has been (2019) 3:26 done by Sasha Bernatsky and colleagues on the epidemiology of rheumatic diseases using Canadian health care databases, as well as on reviewing the validity of rheumatology-connected administrative database research [3,4,5,6]. In 2017 we published the results of prevalence and incidence estimation of systemic lupus erythematosus (SLE) in Estonia based on the Estonian Health Insurance Fund (EHIF) and the Estonian Health Care Providers’ (HCP) databases [7]. We briefly summarize the previously presented information with the focus on the EHIF database
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