International Classification of Diseases (ICD)-coded obesity predicts risk of incident osteoporotic fracture

Abstract

International Classification of Diseases (ICD) codes have been used to ascertain individuals who are obese. There has been limited research about the predictive value of ICD-coded obesity for major chronic conditions at the population level. We tested the utility of ICD-coded obesity versus measured obesity for predicting incident major osteoporotic fracture (MOF), after adjusting for covariates (i.e., age and sex). In this historical cohort study (2001–2015), we selected 61,854 individuals aged 50 years and older from the Manitoba Bone Mineral Density Database, Canada. Body mass index (BMI) ≥30 kg/m2 was used to define measured obesity. Hospital and physician ICD codes were used to ascertain ICD-coded obesity and incident MOF. Average cohort age was 66.3 years and 90.3% were female. The sensitivity, specificity and positive predictive value for ICD-coded obesity using measured obesity as the reference were 0.11 (95% confidence interval [CI]: 0.10, 0.11), 0.99 (95% CI: 0.99, 0.99) and 0.79 (95% CI: 0.77, 0.81), respectively. ICD-coded obesity (adjusted hazard ratio [HR] 0.83; 95% CI: 0.70, 0.99) and measured obesity (adjusted HR 0.83; 95% CI: 0.78, 0.88) were associated with decreased MOF risk. Although the area under the receiver operating characteristic curve (AUROC) estimates for incident MOF were not significantly different for ICD-coded obesity versus measured obesity (0.648 for ICD-coded obesity versus 0.650 for measured obesity; P = 0.056 for AUROC difference), the category-free net reclassification index for ICD-coded obesity versus measured obesity was -0.08 (95% CI: -0.11, -0.06) for predicting incident MOF. ICD-coded obesity predicted incident MOF, though it had low sensitivity and reclassified MOF risk slightly less well than measured obesity.

Number, Location, and Time Since Prior Fracture as Predictors of Future Fracture in the Elderly From the General Population

“…Information on predictors included in FRAX was also extracted. Based on previous studies using similar data, we used obesity diagnosis as proxy for body mass index, chronic obstructive pulmonary disease diagnosis as proxy for smoking, and alcohol abuse diagnosis as proxy for high alcohol intake . Comorbidities (obesity, chronic obstructive pulmonary disease, rheumatoid arthritis, diabetes, and diagnosis of alcohol abuse) were assessed in the 3 years prior to the beginning of follow‐up, and major glucocorticoids use in the year before.…”

Data Talks: Obesity-Related Influences on US Mortality Rates

“…Due to healthcare’s cumbersome workflow nature, inaccuracies in ICD-10 coding with misrepresentation in patient data (Lebovitz et al, 2018) are known to occur. Nonetheless, sensitivities of ICD-10 coding for overweight and obesity have proven to be reasonably accurate and helpful (George et al, 2018; Flegal et al, 2007; Keller et al, 2018; Yang et al, 2017). In addition, studies that assessed the accuracy of the ICD-diagnostic codes determined their conspicuous usefulness in empirical research (O’Malley et al, 2005), and in chronic disease management programs (Krueger et al, 2001; Vandyk et al, 2015).…”

“…Acknowledging the ICD-10 coding limitations (Lebovitz et al, 2018), but spurred on by its merits in obesity reports and studies (D’Souza et al, 2017; George et al, 2018, Flegal et al, 2007; Keller et al, 2018; O’Malley et al, 2005; Yang et al, 2017), this observational retrospective undertaking, uses the CDC WONDER database (Friede et al, 1993), to evaluate the 1999–2016 multiple causes of death information, to pursue important insights, associations, and shifting trends in the US death rates where there was any mention of overweight and obesity on the death certificate. Information from such a study is helpful as it can enhance public perceptions on body fat for inducing positive, individual, behavioral change.…”

Sex differences in the longitudinal associations between body composition and bone stiffness index in European children and adolescents

“…Effects of body composition on bone development are of increasing interest recently. In adulthood, adiposity serves as a protective factor against osteoporotic fractures [1,2], whereas studies investigating the effect of adiposity on bone growth in children and adolescents still appear to be diverse [3]. In previous pediatric studies, the most widely used category of excess adiposity is body mass index (BMI).…”