Enhancing case ascertainment of Parkinson's disease using Medicare claims data in a population‐based cohort: the Cardiovascular Health Study

Ton, Thanh G.N.; Biggs, Mary L.; Comer, Diane; Curtis, Lesley H.; Hu, Shu Ching; Thacker, Evan L.; Nielsen, Susan Searles; Delaney, Joseph A.; Landsittel, Douglas; Longstreth, W. T.; Checkoway, Harvey; Jain, Samay

doi:10.1002/pds.3552

Cited by 10 publications

(10 citation statements)

References 28 publications

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“…evaluating independently all potential cases with epilepsy who screened positive for epilepsy on the basis of self-report, medication use, ICD-9 hospitalization diagnosis code, or CMS claims. Similar to a previously published study, 11 we placed greater credibility of an epilepsy diagnosis on ICD-9 claims submitted by a neurologist than a nonneurologist. Reviewers preliminarily classified participants as having probable epilepsy, possible epilepsy, or no epilepsy according to the criteria summarized in table 2.…”

supporting

confidence: 67%

Predictors of incident epilepsy in older adults

et al. 2017

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Objective: To determine the prevalence, incidence, and predictors of epilepsy among older adults in the Cardiovascular Health Study (CHS). Methods:We analyzed data prospectively collected in CHS and merged with data from outpatient Medicare administrative claims. We identified cases with epilepsy using self-report, antiepileptic medication, hospitalization discharge ICD-9 codes, and outpatient Medicare ICD-9 codes. We used Cox proportional hazards regression to identify factors independently associated with incident epilepsy.Results: At baseline, 42% of the 5,888 participants were men and 84% were white. At enrollment, 3.7% (215 of 5,888) met the criteria for prevalent epilepsy. During 14 years of follow-up totaling 48,651 person-years, 120 participants met the criteria for incident epilepsy, yielding an incidence rate of 2.47 per 1,000 person-years. The period prevalence of epilepsy by the end of follow-up was 5.7% (335 of 5,888). Epilepsy incidence rates were significantly higher among blacks than nonblacks: 4.44 vs 2.17 per 1,000 person-years (p , 0.001). In multivariable analyses, risk of incident epilepsy was significantly higher among blacks compared to nonblacks (hazard ratio [HR] 4.04, 95% confidence interval [CI] 1.99-8.17), those 75 to 79 compared to those 65 to 69 years of age (HR 2.07, 95% CI 1.21-3.55), and those with history of stroke (HR 3.49, 95% CI 1.37-8.88).Conclusions: Epilepsy in older adults in the United States was common. Blacks, the very old, and those with history of stroke have a higher risk of incident epilepsy. The association with race remains unexplained. Neurology ® 2017;88:870-877 GLOSSARY CHF 5 congestive heart failure; CHS 5 Cardiovascular Health Study; CI 5 confidence interval; CMS 5 Centers for Medicare & Medicaid Services; HR 5 hazard ratio; ICD-9 5 International Classification of Diseases, ninth revision; TIA 5 transient ischemic attack.

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confidence: 67%

Predictors of incident epilepsy in older adults

et al. 2017

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“…Also, as noted by Ton et al who investigated enhanced case ascertainment from Medicare beneficiary data, there are certain services not captured in Medicare, especially in those enrolled in managed care programs, which could limit the potential claims made by patients with PD. 27 Also to this point, in Willis et al the areas with the highest prevalence of PD were seen in the Midwest and Northeast with lower rates being in areas of the West including Colorado. 26 One of the main findings of this study is that the spatial distribution of measured pesticides levels in groundwater is in predominantly agrarian land, and this coincided with areas with higher age-standardized PD prevalence rations.…”

Section: Discussionmentioning

confidence: 94%

Groundwater Pesticide Levels and the Association With Parkinson Disease

James

Hall

2015

Int J Toxicol

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It is unclear whether exposure to environmentally relevant levels of pesticides in groundwater is associated with an increased risk of Parkinson disease (PD). The purpose of this study was to examine the relationship between PD and pesticide levels in groundwater. This cross-sectional study included 332 971 Medicare beneficiaries, including 4207 prevalent cases of PD from the 2007 Colorado Medicare Beneficiary Database. Residential pesticide levels were estimated from a spatial model based on 286 well water samples with atrazine, simazine, alachlor, and metolachlor measurements. A logistic regression model with known PD risk factors was used to assess the association between residential groundwater pesticide levels and prevalent PD. We found that for every 1.0 µg/L of pesticide in groundwater, the risk of PD increases by 3% (odds ratio = 1.03; 95% confidence interval: 1.02-1.04) while adjusting for age, race/ethnicity, and gender suggesting that higher age-standardized PD prevalence ratios are associated with increasing levels of pesticides in groundwater.

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“…However, most cohort studies have not implemented rigorous systematic screening for PD and have necessarily relied on secondary data sources to identify participants with PD. Common secondary sources of data used to identify PD include self-report, use of antiparkinsonian medication, and International Classification of Diseases, Ninth Revision (ICD-9) codes on forms for Medicare claims (3). Direct validation of these secondary data sources against clinical diagnostic criteria in prospective population-based cohorts is needed.…”

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confidence: 99%

Validation of Secondary Data Sources to Identify Parkinson Disease Against Clinical Diagnostic Criteria

Jain¹,

Himali²,

Beiser³

et al. 2014

American Journal of Epidemiology

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Parkinson disease (PD) is the second most common neurodegenerative disorder. Its diagnosis relies solely on a clinical examination and is not straightforward because no diagnostic test exists. Large, population-based, prospective cohort studies designed to examine other outcomes that are more common than PD might provide cost-efficient alternatives for studying the disease. However, most cohort studies have not implemented rigorous systematic screening for PD. A majority of epidemiologic studies that utilize population-based prospective designs rely on secondary data sources to identify PD cases. Direct validation of these secondary sources against clinical diagnostic criteria is lacking. The Framingham Heart Study has prospectively screened and evaluated participants for PD based on clinical diagnostic criteria. We assessed the predictive value of secondary sources for PD identification relative to clinical diagnostic criteria in the Framingham Heart Study (2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012). We found positive predictive values of 1.0 (95% confidence interval: 0.868, 1.0), 1.0 (95% confidence interval: 0.839, 1.0), and 0.50 (95% confidence interval: 0.307, 0.694) for PD identified from self-report, use of antiparkinsonian medications, and Medicare claims, respectively. The negative predictive values were all higher than 0.99. Our results highlight the limitations of using only Medicare claims data and suggest that population-based cohorts may be utilized for the study of PD determined via self-report or medication inventories while preserving a high degree of confidence in the validity of PD case identification. Parkinson disease (PD) is the second most common neurodegenerative disorder after Alzheimer disease. PD afflicts more than 4 million people worldwide and is projected to affect 9 million people by 2030 (1). The etiology for most sporadic cases remains unknown, as genetic variants account for only approximately 10% of cases (2). PD has a low incidence (8-18 per 100,000 person-years), and it is impractical to conduct a prospective, longitudinal epidemiologic study on a condition that relies on a clinical examination for a diagnosis because there is no biomarker or simple laboratory test that can confirm a PD diagnosis except autopsy. Registries for PD that cover large populations do not exist. Case-control studies are often limited by retrospective recall or ascertainment of exposures.Large, population-based, prospective cohort studies designed to examine more common diseases might provide cost-effective ways to study PD within a longitudinal framework. Such studies have accumulated sufficient numbers of patients with incident PD to allow examinations of the associations with multiple potential risk factors and associations that develop over long periods of time. Indeed, the use of existing cohorts to study PD has resulted in numerous significant findings (2). However, most cohort studies have not implemented rigorous systematic screening for PD and have necessarily re...

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Enhancing case ascertainment of Parkinson's disease using Medicare claims data in a population‐based cohort: the Cardiovascular Health Study

Cited by 10 publications

References 28 publications

Predictors of incident epilepsy in older adults

Predictors of incident epilepsy in older adults

Groundwater Pesticide Levels and the Association With Parkinson Disease

Validation of Secondary Data Sources to Identify Parkinson Disease Against Clinical Diagnostic Criteria

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