Differences in the Prevalence of Obesity, Smoking and Alcohol in the United States Nationwide Inpatient Sample and the Behavioral Risk Factor Surveillance System

Abstract

BackgroundThe lack of adequate and standardized recording of leading risk factors for morbidity and mortality in medical records have downstream effects on research based on administrative databases. The measurement of healthcare is increasingly based on risk-adjusted outcomes derived from coded comorbidities in these databases. However inaccurate or haphazard assessment of risk factors for morbidity and mortality in medical record codes can have tremendous implications for quality improvement and healthcare reform.ObjectiveWe aimed to compare the prevalence of obesity, overweight, tobacco use and alcohol abuse of a large administrative database with a direct data collection survey.Materials and MethodsWe used the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for four leading risk factors in the United States Nationwide Inpatient Sample (NIS) to compare them with a direct survey in the Behavioral Risk Factor Surveillance System (BRFSS) in 2011. After confirming normality of the risk factors, we calculated the national and state estimates and Pearson’s correlation coefficient for obesity, overweight, tobacco use and alcohol abuse between NIS and BRFSS.ResultsCompared with direct participant questioning in BRFSS, NIS reported substantially lower prevalence of obesity (p<0.01), overweight (p<0.01), and alcohol abuse (p<0.01), but not tobacco use (p = 0.18). The correlation between NIS and BRFSS was 0.27 for obesity (p = 0.06), 0.09 for overweight (p = 0.55), 0.62 for tobacco use (p<0.01) and 0.40 for alcohol abuse (p<0.01).ConclusionsThe prevalence of obesity, overweight, tobacco smoking and alcohol abuse based on codes is not consistent with prevalence based on direct questioning. The accuracy of these important measures of health and morbidity in databases is critical for healthcare reform policies.

Modifiable Risk Factors for Hospital Readmission Among Patients with Inflammatory Bowel Disease in a Nationwide Database

“…33 There is also potential for misclassification of UC and CDI given the, given the nature of ICD-9-CM coding and the common term colitis. This misclassification is a potential explanation for the significant relationship between CDI and readmission among patients with CD but not UC.…”

Hospitalizations for Acute Myocardial Infarction Are Decreased Among Patients with Inflammatory Bowel Disease Using a Nationwide Inpatient Database

“…50,51 There also exists the potential for underdiagnosis of other risk factors, particularly tobacco use and obesity. 52 …”

Relation of Obesity to Survival After In-Hospital Cardiac Arrest

“…12,28 In fact, it has actually been shown that obesity as a comorbid condition is significantly underrported in NIS compared with databases based on direct clinical surveys. 29 Second, although we conducted subgroup analyses in those with a primary CV or non-CV diagnosis, it must be noted that the primary discharge diagnosis may not reliably represent the condition responsible for hospital admission. Third, since data on cerebral performance category on admission and at discharge are not available in NIS, we could not determine the differences in survival to discharge with a favorable neurological prognosis between obese and non-obese patients.…”