Misclassification of incident conditions using claims data: impact of varying the period used to exclude pre-existing disease.
Misclassification of incident conditions using claims data: impact of varying the period used to exclude pre-existing disease.
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DOI：
10.1186/1471-2288-13-32
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发表时间：
2013-03-06
影响因子：
4
通讯作者：
Danese MD
中科院分区：
文献类型：
--
作者：
Griffiths RI;O'Malley CD;Herbert RJ;Danese MD
使用索赔数据估计医疗状况的发生率通常需要构建一个流行期，该流行期早于感兴趣的事件，例如癌症的诊断，以从发生率风险集中排除那些预先存在的疾病。在流行期间遗漏的那些状况可能在感兴趣的事件之后被错误地分类为事件状况（假阳性）。使用医疗保险索赔，我们研究了选择较短与较长的患病期对老年人12种相对常见疾病的发生率和错误分类的影响。这项研究的数据来源是国家癌症研究所的监测，流行病学和最终结果癌症登记与医疗保险索赔。两个队列的女性被包括在内：33，731名在2000年至2002年期间被诊断患有乳腺癌，在癌症之前有≥ 36个月的医疗保险资格，以及101，649名符合相同医疗保险资格标准的非癌症患者。癌症患者从癌症诊断前36个月（流行期）到诊断后3个月（发病期）进行随访。非癌症患者在医疗保险资格开始后随访长达39个月。36个月后插入一个假日期，以区分患病率和发病率时期。使用36个月作为金标准，然后以6个月为增量缩短患病期，以检查对发病期内首次检测到的疾病数量的影响。在乳腺癌队列中，将患病期从36个月缩短至6个月增加了发病率（每1 000名患者）;例如：高血压196至243人;糖尿病34至76人;慢性阻塞性肺病29至46人;骨关节炎27至36人;充血性心力衰竭20至36人;骨质疏松症22至29人;脑血管疾病13到21。缩短流行期对那些没有癌症的人影响较小。选择一个短的流行期，以排除预先存在的条件，可以通过错误的分类，大大夸大估计的事件条件。在基于医疗保险索赔的发病率研究中，选择≥24个月的患病期平衡了排除既存疾病与保留最大可能队列的需要。
Estimating the incidence of medical conditions using claims data often requires constructing a prevalence period that predates an event of interest, for instance the diagnosis of cancer, to exclude those with pre-existing conditions from the incidence risk set. Those conditions missed during the prevalence period may be misclassified as incident conditions (false positives) after the event of interest. Using Medicare claims, we examined the impact of selecting shorter versus longer prevalence periods on the incidence and misclassification of 12 relatively common conditions in older persons. The source of data for this study was the National Cancer Institute’s Surveillance, Epidemiology, and End Results cancer registry linked to Medicare claims. Two cohorts of women were included: 33,731 diagnosed with breast cancer between 2000 and 2002, who had ≥ 36 months of Medicare eligibility prior to cancer, the event of interest; and 101,649 without cancer meeting the same Medicare eligibility criterion. Cancer patients were followed from 36 months before cancer diagnosis (prevalence period) up to 3 months after diagnosis (incidence period). Non-cancer patients were followed for up to 39 months after the beginning of Medicare eligibility. A sham date was inserted after 36 months to separate the prevalence and incidence periods. Using 36 months as the gold standard, the prevalence period was then shortened in 6-month increments to examine the impact on the number of conditions first detected during the incidence period. In the breast cancer cohort, shortening the prevalence period from 36 to 6 months increased the incidence rates (per 1,000 patients) of all conditions; for example: hypertension 196 to 243; diabetes 34 to 76; chronic obstructive pulmonary disease 29 to 46; osteoarthritis 27 to 36; congestive heart failure 20 to 36; osteoporosis 22 to 29; and cerebrovascular disease 13 to 21. Shortening the prevalence period has less impact on those without cancer. Selecting a short prevalence period to rule out pre-existing conditions can, through misclassification, substantially inflate estimates of incident conditions. In incidence studies based on Medicare claims, selecting a prevalence period of ≥24 months balances the need to exclude pre-existing conditions with retaining the largest possible cohort.
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影响因子：
120.7
作者：
Baxter, NN;Habermann, EB;Virnig, BA
通讯作者：
Virnig, BA
影响因子：
3
作者：
Warren, JL;Feuer, E;Lynch, CF
通讯作者：
Lynch, CF
影响因子：
7.2
作者：
Klabunde, CN;Potosky, AL;Warren, JL
通讯作者：
Warren, JL
影响因子：
--
作者：
Stein, Joshua D.;Zacks, David N.;Sloan, Frank A.
通讯作者：
Sloan, Frank A.
影响因子：
7.2
作者：
Freeman, JL;Zhang, D;Goodwin, JS
通讯作者：
Goodwin, JS