Linking hospital discharge and death records - accuracy and sources of bias
Linking hospital discharge and death records - accuracy and sources of bias
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DOI：
10.1016/s0895-4356(03)00250-6
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发表时间：
2004-01-01
影响因子：
7.2
通讯作者：
Liu, HH
中科院分区：
文献类型：
--
作者：
Zingmond, DS;Ye, ZS;Liu, HH
背景和目的：本研究的目的是开发和应用自动关联算法对加州10年(1990-1999)的住院出院摘要和死亡记录进行关联，评估关联的准确性，并找出偏差的来源。方法：在1个有代表性的出院年份(1997年)的1,858,458个具有唯一社会保障号码(SSN)的急性出院记录中，69,757例死亡病例中有66,410例(95%)发生在医院内，1,788,701例活着出院的个人中的66,998例(3.7%)与死亡记录关联。关联敏感度和特异度估计为0.9524 9和0.9998，阳性预测值和阴性预测值分别为0.994和0.998(对应于院外死亡记录关联中的400个不正确的死亡关联和未关联的出院中的3,300个未识别的记录对)。结果：根据金标准关联比率，1岁及以上没有SSN的出院记录在入院后1年可能额外有2,520例未统计的感染后死亡。SSNS患者的黄金标准比较显示，女性、老年人、西班牙裔和非西班牙裔黑人的住院死亡记录更多，尽管绝对差异很小。如果SSN与患者的疾病严重程度和合并症有不同的关系，那么传统上脆弱人群的出院记录中不明联系的集中可能会导致低估这些人群的死亡率和其他估计(即，具有竞争死亡风险的事件)。结论：由于院外死亡病例的识别在过去十年中有所改善，在这段时间内观察到的患者存活率的改善可能是保守的。(C)2004 Elsevier Inc.保留所有权利。
Background and Objective: The aim of this study was to develop and apply an automated linkage algorithm to 10 years of California hospitalization discharge abstracts and death records (1990 to 1999), evaluate linkage accuracy, and identify sources of bias.Methods: Among the 1,858,458 acute hospital discharge records with unique social security numbers (SSNs) from 1 representative year of discharge data (1997), which had at least 2 years of follow-up, 66,410 of 69,757 deaths occurring in the hospital (95%) and 66,998 of 1,788,701 of individuals discharged alive (3.7%) linked to death records. Linkage sensitivity and specificity were estimated as 0.9524 9 and 0.9998 and positive and negative predictive values as 0.994 and 0.998 (corresponding to 400 incorrect death linkages among out-of-hospital death record linkages and 3,300 unidentified record pairs among unlinked live discharges).Results: Based upon gold standard linkage rates, discharge records for those of age 1 year and older without SSNs may have 2,520 additional uncounted posthospitalization deaths at 1 year after admission. Gold standard comparison for those with SSNs showed women, the elderly, and Hispanics and non-Hispanic Blacks had more unlinked hospital death records, although absolute differences were small. The concentration of unidentified linkages among discharge records of traditionally vulnerable populations may result in understating mortality rates and other estimates (i.e., events with competing hazard of death) for these populations if SSN is differentially related to a patient's disease severity and comorbidities.Conclusion: Because identification of cases of out-of-hospital deaths has improved over the past decade, observed improvements in patient survival over this time are likely to be conservative. (C) 2004 Elsevier Inc. All rights reserved.