Validation of secondary data sources to identify Parkinson disease against clinical diagnostic criteria.
Validation of secondary data sources to identify Parkinson disease against clinical diagnostic criteria.
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DOI：
10.1093/aje/kwu326
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发表时间：
2015-02-01
影响因子：
5
通讯作者：
Frank, Samuel A
中科院分区：
文献类型：
--
作者：
Jain, Samay;Himali, Jayandra;Frank, Samuel A
帕金森病（Parkinson disease，PD）是第二常见的神经退行性疾病。其诊断仅依赖于临床检查，并且由于没有诊断测试存在而不简单。旨在检查比PD更常见的其他结局的大型、基于人群的前瞻性队列研究可能为研究该疾病提供具有成本效益的替代方案。然而，大多数队列研究尚未对PD进行严格的系统筛查。大多数采用基于人群的前瞻性设计的流行病学研究依赖于二级数据源来识别PD病例。缺乏对这些二级来源的临床诊断标准的直接验证。心脏病研究根据临床诊断标准对参与者进行了前瞻性筛选和评估。我们评估了与Frachial Heart研究（2001 - 2012）中的临床诊断标准相比，PD识别的次要来源的预测价值。我们发现从自我报告、使用抗帕金森病药物和医疗保险索赔中识别出的PD的阳性预测值分别为1.0（95%置信区间：0.868，1.0）、1.0（95%置信区间：0.839，1.0）和0.50（95%置信区间：0.307，0.694）。阴性预测值均大于0.99。我们的研究结果强调了仅使用医疗保险索赔数据的局限性，并表明基于人群的队列可用于通过自我报告或药物库存确定的PD研究，同时保持对PD病例识别有效性的高度信心。
Parkinson disease (PD) is the second most common neurodegenerative disorder. Its diagnosis relies solely on a clinical examination and is not straightforward because no diagnostic test exists. Large, population-based, prospective cohort studies designed to examine other outcomes that are more common than PD might provide cost-efficient alternatives for studying the disease. However, most cohort studies have not implemented rigorous systematic screening for PD. A majority of epidemiologic studies that utilize population-based prospective designs rely on secondary data sources to identify PD cases. Direct validation of these secondary sources against clinical diagnostic criteria is lacking. The Framingham Heart Study has prospectively screened and evaluated participants for PD based on clinical diagnostic criteria. We assessed the predictive value of secondary sources for PD identification relative to clinical diagnostic criteria in the Framingham Heart Study (2001-2012). We found positive predictive values of 1.0 (95% confidence interval: 0.868, 1.0), 1.0 (95% confidence interval: 0.839, 1.0), and 0.50 (95% confidence interval: 0.307, 0.694) for PD identified from self-report, use of antiparkinsonian medications, and Medicare claims, respectively. The negative predictive values were all higher than 0.99. Our results highlight the limitations of using only Medicare claims data and suggest that population-based cohorts may be utilized for the study of PD determined via self-report or medication inventories while preserving a high degree of confidence in the validity of PD case identification.