Abstract
Administrative health data have been used in hypertension surveillance using the 1H2P method: the International Classification of Disease (ICD) hypertension diagnosis codes were recorded in at least 1 hospitalization or 2 physician claims within 2 year-period. Accumulation of false positive cases over time using the 1H2P method could result in the overestimation of hypertension prevalence. In this study, we developed and validated a new reclassification method to define hypertension cases using regularized logistic regression with the age, sex, hypertension and comorbidities in physician claims, and diagnosis of hypertension in hospital discharge data as independent variables. A Bayesian method was then used to adjust the prevalence estimated from the reclassification method. We evaluated the hypertension prevalence in data from Alberta, Canada using the currently accepted 1H2P method and these newly developed methods. The reclassification method with Bayesian adjustment produced similar prevalence estimates as the 1H2P method. This supports the continued use of the 1H2P method as a simple and practical way to conduct hypertension surveillance using administrative health data.
Highlights
Hypertension is an important risk factor for renal, cerebrovascular, and cardiovascular diseases and can lead to premature mortality [1]
1H2P, two physician claims for hypertension within two year-period or one recording of hypertension in hospital discharge data; CI, confidence interval; PPV, positive predictive value; NPV, negative predictive value. a The validity reported here were calculated based on the probability cutoff of 0.25
We found that the reclassification method using multiple data features from administrative health data improved sensitivity for identifying hypertension cases with slight loss of specificity
Summary
Hypertension is an important risk factor for renal, cerebrovascular, and cardiovascular diseases and can lead to premature mortality [1]. The Framingham Heart Study found that 91% of heart failure, 84% of strokes, and 70% of myocardial infarctions occurred in patients with hypertension [2,3,4,5]. An accurate estimate of hypertension prevalence is critical for evaluation of population based hypertension prevention, detection, and management programs. Many countries have been developing hypertension surveillance programs. Using administrative health data and a previously validated cases definition based on International Classification of Disease (ICD) codes, the Public Health Agency of Canada (PHAC) reported that in PLOS ONE | DOI:10.1371/journal.pone.0119186. Using administrative health data and a previously validated cases definition based on International Classification of Disease (ICD) codes, the Public Health Agency of Canada (PHAC) reported that in PLOS ONE | DOI:10.1371/journal.pone.0119186 March 24, 2015
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