Abstract
The identification of death is critical for epidemiological research. Despite recent developments in health insurance claims databases, the quality of death information in claims is not guaranteed because health insurance claims are collected primarily for reimbursement. We aimed to examine the usefulness and limitations of death information in claims data and to examine methods for improving the quality of death information for aged persons.We used health insurance claims data and enrollment data (as the gold standard) from September 2012 through August 2015 for nondependent persons aged 65–74 years enrolled in Japanese workplace health insurance. Overall, 3,710,538 insured persons were registered in the database during the study period. We analyzed 45,441 eligible persons. Inpatient and outpatient deaths were identified from the discharge/disease status in the claims, with sensitivities of 94.3% and 47.4%, specificities of 98.5% and 99.9%, and PPVs of 96.3% and 95.7%, respectively, using enrollment data as the gold standard. For outpatients, death defined as a combination of disease status and charge data for terminal care still indicated low sensitivity (54.7%).The validity of death information in inpatient claims was high, suggesting its potential usefulness for identifying death. However, given the low sensitivity for outpatient deaths, the use of death information obtained solely from records in outpatient claims is not recommended.
Highlights
Validation studies using the latest claims database are underway [14]. As part of this effort, we aimed to examine usefulness and limitations when using death information in claims databases and to examine methods for improving the quality of death information for aged persons. Study design This cross-sectional study validated death information from health insurance claims against that recorded in enrollment data for the health insurance union from the same month
As we do not intend to develop a system by which health insurance associations confirm death from claims, we examined methods for increasing the validity of death information for outpatients by combining disease status and charge data recorded in claims
We examined methods for increasing the sensitivity of death information by combining disease status and charge data recorded in claims, the sensitivity for identifying deaths is still limited
Summary
In Japan, an ultra-aging, high-mortality society, 33.0% of the population, were ≥ 60 years old in 2017 [1]. Deceased persons in Japan comprised approximately 1,200,000 in 2014; this is estimated to increase to approximately 1,670, 000 by 2040 [2]. In constructing a sustainable end-of-life care system, several challenges for research have emerged, surveying mortality and medical care practice for aged persons at the end of life [3–5]. The identification of Recent developments in the health insurance claims databases of government agencies and the private sector have transformed epidemiological research in Asia-Pacific countries [6–12]. In Japan, private companies have created health insurance claims databases for research. The National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) that contains almost 100% of the digitized health insurance claims for the entire country was constructed
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