Validating ICD-10-CM Diagnostic Codes with Laboratory Test Results for Use in Identifying Chlamydial and Gonococcal Infections Among American Indians and Alaska Natives: Indian Health Service, 2016-2021.

Abstract

National case rates of chlamydia and gonorrhea (CT/GC) among American Indian and Alaska Native (AI/AN) persons are disproportionately high. The Indian Health Service (IHS), which provides healthcare to members of federally recognized tribes, does not currently have a dedicated CT/GC surveillance system. The purpose of this study was to validate the use of CT/GC diagnostic codes for estimating diagnosed CT/GC infections among AI/AN persons that use IHS services. We conducted a retrospective study using IHS medical records from all persons aged 15 years and older from 2016 to 2021. We linked records with CT (A56, A74) and GC (A54, O98.2) ICD-10-CM diagnostic codes to laboratory results within 30 days for each person. We calculated the sensitivity, specificity, and positive and negative predictive values (PPV, NPV) of CT/GC diagnostic codes using laboratory test results as the reference standard. We identified over 1.6 million CT/GC laboratory tests, and 52,815 CT and 19,971 GC diagnostic codes. Diagnostic code sensitivity was slightly higher for CT (54%) than GC (50%). Specificity, PPV, and NPV were high for CT and GC (range: 83.3-99.8%). About one-third of CT/GC diagnostic codes could not be linked to a test result. The validation indicates that diagnostic codes align well with linked laboratory test results. However, due to the relatively large number of diagnostic codes and positive tests that could not be linked, combining the two would inform more reliable estimates of diagnosed CT/GC infections among AI/AN persons who use IHS for healthcare.