Validation of case identification for alopecia areata using international classification of diseases coding

Lavian, Jonathan; Li, Sara J.; Lee, Eunice Yoojin; Bordone, Lindsey; Polubriaginof, Fernanda; Christiano, Angela M.; Mostaghimi, Arash

doi:10.4103/ijt.ijt_67_20

Cited by 21 publications

(22 citation statements)

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“…Diagnoses of AT/AU were imputed forward within each patient based on the presence of at least 1 claim with a diagnosis of AT or AU during the data period available after the first AT/AU diagnosis. Specifically, if a patient had at least 1 diagnosis for AT or AU, all other AA diagnoses for that patient occurring after the first AT or AU diagnosis were considered to be AT/AU, which was consistent with previously published approaches …”

Section: Methodssupporting

confidence: 71%

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Trends in Prevalence and Incidence of Alopecia Areata, Alopecia Totalis, and Alopecia Universalis Among Adults and Children in a US Employer-Sponsored Insured Population

et al. 2023

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ImportanceAlopecia areata (AA) is characterized by nonscarring hair loss of the scalp, face, and/or body. Alopecia totalis (AT) and alopecia universalis (AU) involve complete loss of the scalp and body hair, respectively. The epidemiology of AA in the US remains unclear, having previously been extrapolated from older studies that were limited to specific geographic areas or clinical settings, or from self-reported data.ObjectiveTo estimate the annual prevalence and incidence of AA and AT and/or AU (AT/AU) in the US.Design, Setting, and ParticipantsThis retrospective, population-based cohort study was conducted from January 2016 to December 2019 and included enrollees in the IBM MarketScan Commercial Claims and Encounters and Medicare Supplemental databases and their dependents, with plan enrollment during each study calendar year and the year prior.ExposuresPrevalent cases were identified by 1 or more claims for AA or AT/AU (International Statistical Classification of Diseases, Tenth Revision, Clinical Modification [ICD-10-CM] codes L63.x, L63.0, L63.1) during each year of interest or the year prior. Incident cases were identified by 1 or more claims for AA or AT/AU during a specific year and no diagnosis the year prior.Main Outcomes and MeasuresAnnual incidence and prevalence rates were calculated and stratified by age, sex, and region. National employer-sponsored insurance population estimates were obtained using population-based weights.ResultsAmong eligible patients (2016: n = 18 368 [mean (SD) age, 40.6 (17.9) years; 12 295 women (66.9%)]; 2017: n = 14 372 [mean (SD) age, 39.6 (17.7) years; 9195 women (64.0%)]; 2018: n = 14 231 [mean (SD) age, 38.9 (17.3) years; 8998 women (63.2%)]; 2019: n = 13 455 [mean (SD) age, 39.1 (17.4) years; 8322 women (61.9%)]), AA prevalence increased from 0.199% (95% CI, 0.198%-0.200%) in 2016 to 0.222% (95% CI, 0.221%-0.223%) in 2019. Roughly 5% to 10% of prevalent and incident cases of AA were AT/AU. The prevalence of AT/AU increased from 0.012% (95% CI, 0.012%-0.013%) to 0.019% (95% CI, 0.018%-0.019%) from 2016 to 2019. Incidence of AA per 100 000 person-years ranged from 87.39 (95% CI, 86.84-87.96) in 2017 to 92.90 (95% CI, 92.35-93.45) in 2019. Incidence of AT/AU ranged from 7.09 (95% CI, 6.94-7.25) in 2017 to 8.92 (95% CI, 8.75-9.09) in 2016. Prevalence and incidence of AA and AT/AU were higher among female vs male individuals, adults vs children and adolescents, and in the Northeast vs other regions.Conclusions and RelevanceThe results of this cohort study suggest that these recent AA prevalence and incidence estimates could help improve current understanding of the disease burden. Further research is warranted to elucidate subpopulation differences and trends in AA in the broader US population.

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Section: Methodssupporting

confidence: 71%

“…Specifically, if a patient had at least 1 diagnosis for AT or AU, all other AA diagnoses for that patient occurring after the first AT or AU diagnosis were considered to be AT/AU, which was consistent with previously published approaches. 25…”

Section: Study Design and Patient Selectionmentioning

confidence: 99%

Trends in Prevalence and Incidence of Alopecia Areata, Alopecia Totalis, and Alopecia Universalis Among Adults and Children in a US Employer-Sponsored Insured Population

et al. 2023

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“…The first challenge was a clear separation of homogeneous patient groups. A diagnosis of a CISD by a dermatologist is reliable, particularly if this diagnosis is confirmed over more than 1 visit . Although, to our knowledge, no ICD-10 code validation study has been conducted for AD, a US validation study investigating ICD-9 codes for AD found that 1 code for AD by a dermatologist had a positive predictive value of 67.7% (for definite or probable AD) .…”

Section: Discussionmentioning

confidence: 99%

“…A diagnosis of a CISD by a dermatologist is reliable, particularly if this diagnosis is confirmed over more than 1 visit. [49][50][51][52] Although, to our knowledge, no ICD-10 code validation study has been conducted for AD, a US validation study investigating ICD-9 codes for AD found that 1 code for AD by a dermatologist had a positive predictive value of 67.7% (for definite or probable AD). 53 We additionally required a second dermatologist visit with an AD code, which should have further increased the positive predictive value; however, we cannot completely rule out any misclassification of the underlying condition.…”

Section: Limitationsmentioning

confidence: 98%

Incidence of Venous Thromboembolism in Patients With Dermatologist-Diagnosed Chronic Inflammatory Skin Diseases

et al. 2021

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IMPORTANCE Several studies have linked chronic inflammatory skin diseases (CISDs) with venous thromboembolism (VTE) in a range of data sources with mixed conclusions. OBJECTIVE To examine the incidence of VTE in patients with vs without CISD. DESIGN, SETTING, AND PARTICIPANTSA cohort study using commercial insurance claims data from a nationwide US health care database from January 1, 2004, through 2019 was conducted. A total of 158 123 patients with dermatologist-recorded psoriasis, atopic dermatitis, alopecia areata, vitiligo, or hidradenitis suppurativa were included. Risk-set sampling identified patients without a CISD. Patient follow-up lasted until the first of the following occurred: VTE, death, disenrollment, or end of data stream. EXPOSURES Patients with vs without CISD.MAIN OUTCOMES AND MEASURES Venous thromboembolism events were identified with validated algorithms. Incidence rates were computed before and after 1:1 propensity-score matching to account for VTE risk factors. Hazard ratios were estimated to compare the incidence of VTE in the CISD vs non-CISD cohorts.RESULTS A total of 158 123 patients were identified with CISD: with psoriasis (n = 96 138), atopic dermatitis (n = 30 418), alopecia areata (n = 17 889), vitiligo (n = 7735), or HS (n = 5934); 9 patients had 2 of these conditions. A total of 1 570 387 patients were without a CISD. The median follow-up time was 1.9 years (interquartile range, 0.8-4.0 years) in patients with CISD. The incidence rate (per 1000 person-years) of outpatient or inpatient VTE was 1.57 in psoriasis, 1.83 in atopic dermatitis, 0.94 in alopecia areata, 0.93 in vitiligo, 1.65 in HS and 1.53 in CISD overall, compared with 1.76 in patients without a CISD. Incidence rates increased in patients aged 50 years or older (2.3 per 1000 person-years) and decreased in those aged 18 to 49 years (0.8 per 1000 person-years). After propensity-score matching to patients without a CISD, the hazard ratio (HR) of VTE was 0.86 (95% CI, 0.75-0.99) in psoriasis, 1.19 (95% CI, 0.95-1.48) in atopic dermatitis, 0.97 (95% CI, 0.65-1.46) in alopecia areata, 0.90 (95% CI, 0.49-1.65) in vitiligo, 1.64 (95% CI, 0.82-3.27) in hidradenitis suppurativa, and 0.94 (95% CI, 0.84-1.05) in CISD overall. CONCLUSIONS AND RELEVANCEIn this large-scale cohort study, CISDs were not associated with an increased incidence of VTE after controlling for relevant VTE risk factors in a representative dermatology patient population.

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“…This case identification method was found to have a positive predictive value of 89% for overall AA, 64% for AT, and 86% for AU. 11 The composite outcome of AT or AU was analyzed in the primary analysis given small numbers of patients with each individual diagnosis, particularly within subgroups. In a sensitivity analysis, we defined prevalent cases of AA (any subtype) according to at least 2 ICD-9 or ICD-10 codes.…”

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confidence: 99%

Overall and Racial and Ethnic Subgroup Prevalences of Alopecia Areata, Alopecia Totalis, and Alopecia Universalis

Mastacouris

Strunk

et al. 2023

JAMA Dermatol

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ImportancePrevalences of alopecia areata (AA), alopecia totalis (AT), and alopecia universalis (AU) are poorly established.ObjectiveTo estimate overall and subgroup prevalences of AA and its subtypes.Design, Setting, and ParticipantsThis cross-sectional study using electronic records comprising the Explorys database (Watson Health, IBM Corporation) included children, adolescents, and adults seeking healthcare across the 4 census regions in the US between January 1, 2019, and December 31, 2019. The statistical analysis was conducted between July 21, 2022, and December 22, 2022.Main Outcomes and MeasuresPrevalent cases of AA, AT, and AU.ResultsOf the 1 093 176 patients who met inclusion criteria, 1812 had at least 1 code for AA, 1216 female (67%) and 596 male (33%) patients. Overall age-and-sex standardized prevalences among adults and among children and adolescents were observed to be 0.18% and 0.10%, respectively. The age-standardized prevalence ratio in women to men was 1.32. Standardized prevalence was highest in those aged 30 to 39 (297 per 100 000; 95% CI, 263-335) and 40 to 49 (270 per 100 000; 95% CI, 240-303) years. The highest standardized prevalence was observed among Asian patients (414 per 100 000; 95% CI, 306-548), followed by patients reporting another race or multiple races (314 per 100 000; 95% CI, 266-368), Black (226 per 100 000; 95% CI, 199-255), and Hispanic/Latino (212 per 100 000; 95% CI, 129-328) patients. White patients had the lowest standardized prevalence (168 per 100 000; 95% CI, 157-179) among racial and ethnic subgroups. Relative to White patients, standardized prevalence ratios for Asian, Black, and Hispanic/Latino patients were 2.47 (95% CI, 2.17-2.81), 1.35 (95% CI, 1.26-1.44), and 1.26 (95% CI, 1.03-1.55), respectively. Cases of AT and AU comprised approximately 9% of patients diagnosed with AA.Conclusions and RelevanceThe findings of this cross-sectional study suggest that there is a significant burden of AA, AT, and AU in the US in which people of color, particularly Asian Americans, appear to be disproportionately affected.

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Validation of case identification for alopecia areata using international classification of diseases coding

Cited by 21 publications

References 5 publications

Trends in Prevalence and Incidence of Alopecia Areata, Alopecia Totalis, and Alopecia Universalis Among Adults and Children in a US Employer-Sponsored Insured Population

Trends in Prevalence and Incidence of Alopecia Areata, Alopecia Totalis, and Alopecia Universalis Among Adults and Children in a US Employer-Sponsored Insured Population

Incidence of Venous Thromboembolism in Patients With Dermatologist-Diagnosed Chronic Inflammatory Skin Diseases

Overall and Racial and Ethnic Subgroup Prevalences of Alopecia Areata, Alopecia Totalis, and Alopecia Universalis

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