Validation of a Pediatric Diabetes Case Definition Using Administrative Health Data in Manitoba, Canada

Dart, Allison; Martens, Patricia J.; Sellers, Elizabeth; Brownell, Marni; Rigatto, Claudio; Dean, Heather

doi:10.2337/dc10-1572

Cited by 65 publications

(75 citation statements)

References 20 publications

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“…This registry has been previously described in detail (13,14). In brief, it is the only tertiary-care pediatric diabetes referral center for Manitoba, Canada, as well as northwestern Ontario and part of Saskatchewan.…”

Section: Der-ca Registrymentioning

confidence: 99%

“…In brief, it is the only tertiary-care pediatric diabetes referral center for Manitoba, Canada, as well as northwestern Ontario and part of Saskatchewan. In the province of Manitoba, the DER-CA follows 86.1% of youth with diabetes who are ,18 years of age (14). All patients followed from January 1986 to present have been prospectively entered into the computerized registry, which contains unique personal health identification numbers (PHINs) and clinical, genetic (HNF-1a polymorphism), and laboratory data.…”

Section: Der-ca Registrymentioning

confidence: 99%

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Earlier Onset of Complications in Youth With Type 2 Diabetes

Dart¹,

Martens

Rigatto³

et al. 2014

Diabetes Care

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216

231

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OBJECTIVE To evaluate the risk of complications in youth with type 2 diabetes. RESEARCH DESIGN AND METHODS Population-based cohorts of 342 youth (1–18 years of age) with prevalent type 2 diabetes, 1,011 youth with type 1 diabetes, and 1,710 nondiabetic control youth were identified between 1986 and 2007 from a clinical registry and linked to health care records to assess long-term outcomes using ICD-9CM and ICD-10CA codes. RESULTS Youth with type 2 diabetes had an increased risk of any complication (hazard ratio 1.47 [95% CI 1.02–2.12]). Significant adverse clinical factors included age at diagnosis (1.08 [1.02–2.12]), HbA1c (1.06 [1.01–1.12]), and, surprisingly, renin-angiotensin-aldosterone system (RAAS) inhibitor use (1.75 [1.27–2.41]). HNF-1α G319S polymorphism was protective in the type 2 diabetes cohort (0.58 [0.34–0.99]). Kaplan-Meier statistics revealed an earlier diagnosis of renal and neurologic complications in the type 2 diabetes cohort, manifesting within 5 years of diagnosis. No difference in retinopathy was seen. Cardiovascular and cerebrovascular diseases were rare; however, major complications (dialysis, blindness, or amputation) started to manifest 10 years after diagnosis in the type 2 diabetes cohort. Youth with type 2 diabetes had higher rates of all outcomes than nondiabetic control youth and an overall 6.15-fold increased risk of any vascular disease. CONCLUSIONS Youth with type 2 diabetes exhibit complications sooner than youth with type 1 diabetes. Younger age at diagnosis is potentially protective, and glycemic control is an important modifiable risk factor. The unexpected adverse association between RAAS inhibitor use and outcome is likely a confounder by indication; however, further evaluation in young people is warranted.

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Section: Der-ca Registrymentioning

confidence: 99%

Section: Der-ca Registrymentioning

confidence: 99%

Earlier Onset of Complications in Youth With Type 2 Diabetes

Dart¹,

Martens

Rigatto³

et al. 2014

Diabetes Care

Self Cite

216

231

View full text Add to dashboard Cite

show abstract

“…Indeed, validated case definitions have been developed and applied to a number of conditions, such as asthma, diabetes and chronic obstructive pulmonary disease, to identify cohorts of affected people. [7][8][9] The validity of diagnostic codes for cerebral palsy used in administrative databases has not yet been established. As data from health administrative databases can potentially influence the formulation of health policy decisions, affecting resource allocation, the validation of diagnostic codes for cerebral palsy is required.…”

mentioning

confidence: 99%

Accuracy of administrative claims data for cerebral palsy diagnosis: a retrospective cohort study

Oskoui

Dorais

et al. 2017

CMAJ Open

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Background: Cerebral palsy is the most common cause of childhood physical disability, with multiple associated comorbidities. Administrative claims data provide population-level prevalence estimates for cerebral palsy surveillance; however, their diagnostic accuracy has never been validated in Quebec. This study aimed to assess the accuracy of administrative claims data for the diagnosis of cerebral palsy. Methods:We conducted a retrospective cohort study of children with cerebral palsy born between 1999 and 2002 within 6 health administrative regions of Quebec. Provincial cerebral palsy registry data (reference standard) and administrative physician claims were linked. We explored differences between true-positive and false-negative cases using subgroup sensitivity analysis.Results: A total of 301 children were identified with confirmed cerebral palsy from the provincial registry, for an estimated prevalence of 1.8 (95% confidence interval [CI] 1.6-2.1) per 1000 children 5 years of age. The sensitivity and specificity of administrative claims data for cerebral palsy were 65.5% (95% CI 59.8%-70.8%) and 99.9% (95% CI 99.9%-99.9%), respectively, yielding a prevalence of 2.0 (95% CI 1.9-2.3) per 1000 children 5 years of age. The positive and negative predictive values were 58.8% (95% CI 53.3%-64.1%) and 99.9% (95% CI 99.9%-99.9%), respectively. The κ value was 0.62 (95% CI 0.57-0.67). Administrative claims data were more sensitive for children from rural regions, born preterm, with spastic quadriparesis and with higher levels of motor impairment.Interpretation: Administrative claims data do not capture the full spectrum of children with cerebral palsy. This suggests the need for a more sensitive case definition and caution when using such data without validation. AbstractResearch Research CMAJ OPENCMAJ OPEN, 5(3) E571 bursement mechanisms. 6 These databases are not without their limitations, including potential inaccuracy in diagnostic code entry that may reflect biases in recall, multiple entries from varying sources, a lack of clear, universally accepted case definitions and "diagnostic undershadowing," wherein only 1 diagnosis is entered for a child with multiple comorbidities. Such databases do have potential advantages related to a large sampling frame (population), lower costs associated with a lack of direct additional patient contact and assessment for case ascertainment, and the ability to obtain records over a longitudinal time frame from multiple sources. This convenience has been translated into a preference for using such administrative databases for surveillance and health outcomes research. Indeed, validated case definitions have been developed and applied to a number of conditions, such as asthma, diabetes and chronic obstructive pulmonary disease, to identify cohorts of affected people. 7-9The validity of diagnostic codes for cerebral palsy used in administrative databases has not yet been established. As data from health administrative databases can potentially influence the formulation of hea...

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“…22 Additionally, we considered the following three binary markers of health care utilization as measured over the past 12 months: (1) the presence of five or more outpatient visits; (2) one or more inpatient visits; and (3) dispensing of two or more prescription medication other than lipid lowering therapy. 23 …”

Section: Methodsmentioning

confidence: 99%

Patterns of Lipid Lowering Therapy among Children Ages 8-20 Years

Joyce

Wellenius

Dore

et al. 2015

The Journal of Pediatrics

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Objectives Pediatric guidelines in 2008 and 2011 recommended lipid lowering therapy in children ≥ 8 with high-risk cardiovascular conditions, such as familial hypercholesterolemia (FH). Our objective was to describe the patterns and predictors of LLT initiation in commercially insured children between 2005 and 2010. Study design Using commercial health plan data on children ages 8–20 from 2004 to 2010, we estimated rates of LLT initiation overall and stratified by age. Using a nested case-control design, we used multivariable logistic regression to identify temporal, demographic, clinical and health utilization characteristics associated with LLT initiation. Results Among >13 million children, 665 initiated LLT for an incidence rate 2.6/100,000 person-years (PY). Incidence rates were highest in 2005 (4.1/100,000 PY) and 2008 (3.9/100,000 PY), with no discernable secular trend. Rates of LLT initiation were significantly greater in children ≥15 years (Odds Ratio (OR) 2.9 [95% CI 5.2 – 13.0]), males (2.1[1.7–2.4]), and those with a diagnosis of FH (165.2[129.0–211.6]), other dyslipidemia (175.5 [143.2–215.3]), diabetes type I (7.7[4.7–12.4]), diabetes type II (13.6[8.5–21.7]), hypertension (8.1[4.9–13.3]), obesity (7.8[4.7[12.7]), and ≥ 5 outpatient visits (1.5[1.2–1.7]), and children with dispensing of ≥2 non-LLT prescriptions were less likely to initiate LLT (0.2[0.2–0.3]). Conclusions Despite new guidelines, LLT initiation in children is low and has not increased through 2010. Although diagnosis of FH and other dyslipidemias was associated with higher probability of LLT initiation, our findings suggest LLT is underutilized in this population given the prevalence of these disorders.

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Validation of a Pediatric Diabetes Case Definition Using Administrative Health Data in Manitoba, Canada

Cited by 65 publications

References 20 publications

Earlier Onset of Complications in Youth With Type 2 Diabetes

Earlier Onset of Complications in Youth With Type 2 Diabetes

Accuracy of administrative claims data for cerebral palsy diagnosis: a retrospective cohort study

Patterns of Lipid Lowering Therapy among Children Ages 8-20 Years

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