Identifying dementia outcomes in UK Biobank: a validation study of primary care, hospital admissions and mortality data
Identifying dementia outcomes in UK Biobank: a validation study of primary care, hospital admissions and mortality data
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DOI：
10.1007/s10654-019-00499-1
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发表时间：
2019-06-01
影响因子：
13.6
通讯作者：
Sudlow, Cathie L. M.
中科院分区：
文献类型：
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作者：
Wilkinson, Tim;Schnier, Christian;Sudlow, Cathie L. M.
招募中年参与者的前瞻性、基于人群的研究是痴呆症研究的宝贵资源。这些研究中的随访通常是通过链接到可靠收集的医疗数据集。我们在一项验证研究中调查了这些数据集用于痴呆病例确定的准确性，该研究使用了来自英国Biobankan开放获取的数据，基于人群的研究，该研究在2006-2010年招募了超过50万名40- 69岁的成年人。从爱丁堡招募的17，198名英国生物银行参与者中，我们确定了那些在相关的初级保健，住院或死亡数据中具有1个痴呆代码的人，并将他们的编码诊断与临床专家对其全文病历的裁定进行了比较。我们计算了每个数据集单独和组合的全因痴呆、阿尔茨海默病和血管性痴呆的阳性预测值（PPV，确定为真阳性的病例比例），并探索了改善PPV的算法代码组合。在120名参与者中，全因痴呆的PPV在初级保健，住院和死亡数据中分别为86.8%，87.3%和80.0%，在所有数据集中为82.5%。我们确定了三种算法，平衡了高PPV与合理的情况下查明。对于阿尔茨海默病，初级保健的PPV为74.1%，住院率为68.2%，死亡率数据为50.0%，合并为71.4%。所有来源中血管性痴呆的PPV为43.8%。英国收集的医疗保健数据可用于在前瞻性研究中识别全因痴呆症。阿尔茨海默病和血管性痴呆的PPV较低。需要进一步的研究来探索这些发现的地理普遍性。
Prospective, population-based studies that recruit participants in mid-life are valuable resources for dementia research. Follow-up in these studies is often through linkage to routinely-collected healthcare datasets. We investigated the accuracy of these datasets for dementia case ascertainment in a validation study using data from UK Biobankan open access, population-based study of>500,000 adults aged 40-69years at recruitment in 2006-2010. From 17,198 UK Biobank participants recruited in Edinburgh, we identified those with1 dementia code in their linked primary care, hospital admissions or mortality data and compared their coded diagnoses to clinical expert adjudication of their full-text medical record. We calculated the positive predictive value (PPV, the proportion of cases identified that were true positives) for all-cause dementia, Alzheimer's disease and vascular dementia for each dataset alone and in combination, and explored algorithmic code combinations to improve PPV. Among 120 participants, PPVs for all-cause dementia were 86.8%, 87.3% and 80.0% for primary care, hospital admissions and mortality data respectively and 82.5% across all datasets. We identified three algorithms that balanced a high PPV with reasonable case ascertainment. For Alzheimer's disease, PPVs were 74.1% for primary care, 68.2% for hospital admissions, 50.0% for mortality data and 71.4% in combination. PPV for vascular dementia was 43.8% across all sources. UK routinely-collected healthcare data can be used to identify all-cause dementia in prospective studies. PPVs for Alzheimer's disease and vascular dementia are lower. Further research is required to explore the geographic generalisability of these findings.