Claims-based definition of death in Japanese claims database: validity and implications.
Claims-based definition of death in Japanese claims database: validity and implications.
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DOI：
10.1371/journal.pone.0066116
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发表时间：
2013
期刊：
影响因子：
3.7
通讯作者：
Kubota K
中科院分区：
文献类型：
--
作者：
Ooba N;Setoguchi S;Ando T;Sato T;Yamaguchi T;Mochizuki M;Kubota K
对于日本悬而未决的国家索赔数据库，研究人员将无法访问登记文件中的死亡信息。我们开发并评估了一种基于索赔的死亡定义。我们使用了2005年1月至2009年8月期间3个私人医疗保险工会的195,193名年龄在20岁至74岁之间的受益人的医疗索赔和参保数据。我们开发了基于声明的死亡定义，使用出院或疾病状态和Charlson共病指数(CCI)。我们使用登记数据作为总体人口和按人口统计和其他因素划分的亚组的黄金标准，计算了敏感性、特异性和阳性预测值(PPV)。我们还在两个样本研究中评估了偏差和精确度，这些研究的结果是死亡。基于出院/疾病状态和CCI的联合定义提供了中等的敏感性(约60%)、高的特异性(99.99%)和高的PPV(94.8%)。在大多数亚组中，首选定义的敏感度也在60%左右，但从28%到91%不等。在一项比较两类抗癌药物死亡率的示例研究中，基于声明的定义提供了有效和准确的风险比(HR)。在另一项比较两类抗抑郁药的实例研究中，基于声明的定义的HR是有偏见的，其精确度低于黄金标准的定义。本研究中建立的基于索赔的死亡定义具有很高的特异度和PPV，而敏感度约为60%。这些定义在未来的研究中将是有用的，当注意到某些亚群中可能出现的敏感性波动时。
For the pending National Claims Database in Japan, researchers will not have access to death information in the enrollment files. We developed and evaluated a claims-based definition of death. We used healthcare claims and enrollment data between January 2005 and August 2009 for 195,193 beneficiaries aged 20 to 74 in 3 private health insurance unions. We developed claims-based definitions of death using discharge or disease status and Charlson comorbidity index (CCI). We calculated sensitivity, specificity and positive predictive values (PPVs) using the enrollment data as a gold standard in the overall population and subgroups divided by demographic and other factors. We also assessed bias and precision in two example studies where an outcome was death. The definition based on the combination of discharge/disease status and CCI provided moderate sensitivity (around 60%) and high specificity (99.99%) and high PPVs (94.8%). In most subgroups, sensitivity of the preferred definition was also around 60% but varied from 28 to 91%. In an example study comparing death rates between two anticancer drug classes, the claims-based definition provided valid and precise hazard ratios (HRs). In another example study comparing two classes of anti-depressants, the HR with the claims-based definition was biased and had lower precision than that with the gold standard definition. The claims-based definitions of death developed in this study had high specificity and PPVs while sensitivity was around 60%. The definitions will be useful in future studies when used with attention to the possible fluctuation of sensitivity in some subpopulations.
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