Validation of diagnosis codes in healthcare databases in Taiwan, a literature review

Huang, Yue-Ton; Wei, Tiffaney; Huang, Ya-Ling; Wu, Yu-Pu; Chan, K. Arnold

doi:10.1002/pds.5608

Cited by 17 publications

(11 citation statements)

References 106 publications

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“…The diagnostic codes used for identifying acute ischemic stroke included the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes 433 and 434 and International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes I63 and I64. The diagnostic accuracy of acute ischemic stroke using these codes in the NHIRD has been validated previously . The index date was defined as the date that patients were diagnosed with ischemic stroke in the emergency department.…”

Section: Methodsmentioning

confidence: 99%

“…The diagnostic accuracy of acute ischemic stroke using these codes in the NHIRD has been validated previously. 14,[17][18][19] The index date was defined as the date that patients were diagnosed with ischemic stroke in the emergency department. Index hospitalization was defined as the corresponding hospitalization with the date of admission within 3 days after the index date.…”

Section: Study Populationmentioning

confidence: 99%

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Risk of Bleeding Following Non–Vitamin K Antagonist Oral Anticoagulant Use in Patients With Acute Ischemic Stroke Treated With Alteplase

Tsai,

Liu,

Huang

et al. 2024

JAMA Intern Med

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ImportanceCurrent guidelines advise against intravenous alteplase therapy for treatment of acute ischemic stroke in patients previously treated with non–vitamin K antagonist oral anticoagulants (NOACs).ObjectiveTo evaluate the risk of bleeding and mortality after alteplase treatment for acute ischemic stroke among patients treated with NOACs compared to those not treated with NOACs.Design, Setting, and ParticipantsThis nationwide, population-based cohort study was conducted in Taiwan using data from Taiwan’s National Health Insurance Research Database from January 2011 through November 2020 and included 7483 patients treated with alteplase for acute ischemic stroke. A meta-analysis incorporating the results of the study with those of previous studies was performed, and the review protocol was prospectively registered with PROSPERO.ExposuresNOAC treatment within 2 days prior to stroke, compared to either no anticoagulant treatment or warfarin treatment.Main Outcomes and MeasuresThe primary outcome was intracranial hemorrhage after intravenous alteplase during the index hospitalization (the hospitalization subsequent to alteplase administration). Secondary outcomes were major bleeding events and mortality during the index hospitalization. Propensity score matching was used to control potential confounders. Logistic regression was used to estimate the odds ratio (OR) of outcome events. Meta-analysis was performed using a random-effects model.ResultsOf the 7483 included patients (mean [SD] age, 67.4 [12.7] years; 2908 [38.9%] female individuals and 4575 [61.1%] male individuals), 91 (1.2%), 182 (2.4%), and 7210 (96.4%) received NOACs, warfarin, and no anticoagulants prior to their stroke, respectively. Compared to patients who were not treated with anticoagulants, those treated with NOACs did not have significantly higher risks of intracranial hemorrhage (risk difference [RD], 2.47% [95% CI, −4.23% to 9.17%]; OR, 1.37 [95% CI, 0.62-3.03]), major bleeding (RD, 4.95% [95% CI, −2.56% to 12.45%]; OR, 1.69 [95% CI, 0.83-3.45]), or in-hospital mortality (RD, −4.95% [95% CI, −10.11% to 0.22%]; OR, 0.45 [95% CI, 0.15-1.29]) in the propensity score–matched analyses. Furthermore, the risks of bleeding and mortality were not significantly different between patients treated with NOACs and those treated with warfarin. Similar results were obtained in the meta-analysis.Conclusions and RelevanceIn this cohort study with meta-analysis, compared to no treatment with anticoagulants, treatment with NOACs prior to stroke was not associated with a higher risk of intracranial hemorrhage, major bleeding, or mortality in patients receiving intravenous alteplase for acute ischemic stroke.

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Section: Methodsmentioning

confidence: 99%

Section: Study Populationmentioning

confidence: 99%

Risk of Bleeding Following Non–Vitamin K Antagonist Oral Anticoagulant Use in Patients With Acute Ischemic Stroke Treated With Alteplase

Tsai,

Liu,

Huang

et al. 2024

JAMA Intern Med

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“…For instance, in the National Health Insurance Research Database (NHIRD) in Taiwan, validation studies for various diseases have been conducted to validate the coding algorithms based on ICD codes, such as myocarditis. 25,26 In previous real-world studies utilizing administrative codes, autoimmune diseases were widely set as study population, interventions, and outcomes. 13,24,27 In the field of autoimmune diseases, the validation of these ICD codes was lacking, and the applied coding algorithms vary from studies to studies.…”

Section: Discussionmentioning

confidence: 99%

“…To address the potential misclassification bias, validation studies were conducted to validate the algorithms utilized in real‐world studies. For instance, in the National Health Insurance Research Database (NHIRD) in Taiwan, validation studies for various diseases have been conducted to validate the coding algorithms based on ICD codes, such as myocarditis 25,26 . In previous real‐world studies utilizing administrative codes, autoimmune diseases were widely set as study population, interventions, and outcomes 13,24,27 .…”

Section: Discussionmentioning

confidence: 99%

Validation of diagnosis algorithms for ankylosing spondylitis in claim‐based database

Gau,

Tsai,

Wang

et al. 2024

Int J of Rheum Dis

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BackgroundClaims‐based algorithms using International Classification of Diseases (ICD) codes have become a common approach for researchers to define ankylosing spondylitis (AS) in studies. To address potential misclassification bias caused by the claim‐based algorithms, we conducted the current study to validate whether these algorithms of medical claims could accurately represent AS diagnoses.MethodsPatients diagnosed with AS based on ICD codes were retrieved from the electronic medical records database at a Taiwanese medical center (Chung Shan University Hospital, Taiwan). After random sampling and stratification based on age and sex, the medical information of participants was appraised based on the 2009 ASAS guideline to evaluate the actual status of ICD codes claim‐based AS patients. Positive predict values (PPV) of different algorithms of ICD codes were also calculated.ResultsWithin the 4160 patients with claim‐based AS diagnosis, 387 eligible patients were finally included in the study design after random sampling. The PPV of the diagnostic algorithm of having at least 4 outpatient or 1 inpatient ICD record was 72.77 (95% CI, 66.79–78.75), whereas the PPV increased to 85.64 when the diagnoses were restricted to be made by rheumatologists (95% CI, 80.53–90.74).ConclusionsWhile performing database studies, researchers should be aware of the low PPV of specific algorithms when defining AS. Algorithms with higher PPV were recommended to be adopted to avoid misclassification biases.

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“…Briefly, the database contains comprehensive records of diagnoses, drug prescriptions and dispensations, procedures, and healthcare use in different healthcare settings such as hospitals, clinics, and contracted community pharmacies. Major disease diagnoses have been validated by previous studies, including acute myocardial infarction,18 ischaemic stroke,19 haemorrhagic stroke,20 hypertension,21 heart failure,22 and other comorbidities 1723. We linked the database to the National Cause of Death registry to obtain information about the dates and causes of death.…”

Section: Methodsmentioning

confidence: 99%

Association between recently raised anticholinergic burden and risk of acute cardiovascular events: nationwide case-case-time-control study

Huang,

Yang,

Tsai

et al. 2023

BMJ

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Objective To evaluate the association between recently raised anticholinergic burden and risk of acute cardiovascular events in older adults. Design Case-case-time-control study (ie, incorporating a case crossover design and a control crossover design consisting of future cases). Setting Taiwan’s National Health Insurance Research Database. Participants 317 446 adults aged ≥65 who were admitted to hospital because of an incident acute cardiovascular event between 2011 and 2018. Acute cardiovascular events included myocardial infarction, strokes, arrhythmias, conduction disorders, and cardiovascular death. Main outcome measures The anticholinergic burden was measured for each participant by adding up the anticholinergic scores for individual drugs using the Anticholinergic Cognitive Burden Scale. Scores were classified into three levels (0 points, 1-2 points, and ≥3 points). For each participant, anticholinergic burden levels during hazard periods (day −1 to −30 before the cardiovascular event) were compared with randomly selected 30 day reference periods (ie, periods between days −61 and −180). Conditional logistic regression determined odds ratios with 95% confidence intervals to evaluate the association between acute cardiovascular events and recently raised anticholinergic burden. Results The crossover analyses included 248 579 current cases. Participants’ average age on the index date was 78.4 years (standard deviation 0.01), and 53.4% were men. The most frequently prescribed drugs with anticholinergic activity were antihistamines (68.9%), gastrointestinal antispasmodics (40.9%), and diuretics (33.8%). Among patients with varying levels of anticholinergic burden in different periods, more patients carried higher levels of anticholinergic burden during hazard periods than during reference periods. For example, 17 603 current cases had 1-2 points of anticholinergic burden in the hazard period with 0 points in the reference period, while 8507 current cases had 0 points in the hazard period and 1-2 points in the reference period. In the comparison of 1-2 points versus 0 points of anticholinergic burden, the odds ratio was 1.86 (95% confidence interval 1.83 to 1.90) in the case crossover analysis and 1.35 (1.33 to 1.38) in the control crossover analysis, which yielded a case-case-time-control odds ratio of 1.38 (1.34 to 1.42). Similar results were found in the comparison of ≥3 versus 0 points (2.03, 1.98 to 2.09) and ≥3 versus 1-2 points (1.48, 1.44 to 1.52). The findings remained consistent throughout a series of sensitivity analyses (eg, cut-off points for anticholinergic burden categories were redefined and different scales were used to measure anticholinergic burden). Conclusions An association was found between recently raised anticholinergic burden and increased risk of acute cardiovascular events. Furthermore, a greater increase in anticholinergic burden was associated with a higher risk of acute cardiovascular events.

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Validation of diagnosis codes in healthcare databases in Taiwan, a literature review

Cited by 17 publications

References 106 publications

Risk of Bleeding Following Non–Vitamin K Antagonist Oral Anticoagulant Use in Patients With Acute Ischemic Stroke Treated With Alteplase

Risk of Bleeding Following Non–Vitamin K Antagonist Oral Anticoagulant Use in Patients With Acute Ischemic Stroke Treated With Alteplase

Validation of diagnosis algorithms for ankylosing spondylitis in claim‐based database

Association between recently raised anticholinergic burden and risk of acute cardiovascular events: nationwide case-case-time-control study

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