Validity of International Classification of Diseases, Tenth Revision, Codes for Cirrhosis

Ramrakhiani, Nathan S.; Le, Michael; Yeo, Yee Hui; Le, An K.; Maeda, Manabu; Nguyen, Mindie H.

doi:10.1159/000510981

Cited by 23 publications

(35 citation statements)

References 7 publications

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“…( 18 ) We also included K71.7, which includes toxic liver disease with fibrosis and cirrhosis of the liver and is very specific for cirrhosis. ( 19 ) A group of patients with HCC (C22.0) was also analyzed irrespective of their status of having ESLD. We included only states that had active LT centers for the duration of the study.…”

Section: Methodsmentioning

confidence: 99%

“…The decision to include ages 25-64 was to ensure that we identified adults within the typical LT age range within the confines of the given CDC WONDER age ranges. The age range below (15)(16)(17)(18)(19)(20)(21)(22)(23)(24) included children and the range above (65-74) included too many older patients who may not be considered for LT at an advanced age. We defined death due to ESLD as any diagnosis of cirrhosis (K74.4, K74.5, K74.6, K70.3, K71.7) or hepatic failure (K72*, K70.4).…”

Section: Databases and Study Samplesmentioning

confidence: 99%

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Black Patients Have Unequal Access to Listing for Liver Transplantation in the United States

et al. 2021

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BaCKgRoUND aND aIMS:The Model for End-Stage Liver Disease score may have eliminated racial disparities on the waitlist for liver transplantation (LT), but disparities prior to waitlist placement have not been adequately quantified. We aimed to analyze differences in patients who are listed for LT, undergo transplantation, and die from end-stage liver disease (ESLD), stratified by state and race/ethnicity. appRoaCH aND ReSUltS: We analyzed two databases retrospectively, the Center for Disease Control Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) and the United Network for Organ Sharing (UNOS) databases, from 2014 to 2018. We included patients aged 25-64 years who had a primary cause of death of ESLD and were listed for transplant in the CDC WONDER or UNOS database. Our primary outcome was the ratio of listing for LT to death from ESLD-listing to death ratio (LDR). Our secondary outcome was the transplant to listing and transplant to death ratios. Chi-squared and multivariable linear regression evaluated for differences between races/ethnicities. There were 135,367 patients who died of ESLD, 54,734 patients who were listed for transplant, and 26,571 who underwent transplant. Patients were mostly male and White. The national LDR was 0.40, significantly lowest in Black patients (0.30), P < 0.001. The national transplant to listing ratio was 0.48, highest in Black patients (0.53), P < 0.01. The national transplant to death ratio was 0.20, lowest in Black patients (0.16), P < 0.001. States that had an above-mean LDR had a lower transplant to listing ratio but a higher transplant to death ratio. Multivariable analysis confirmed that Black race is significantly associated with a lower LDR and transplant to death ratio.CoNClUSIoNS: Black patients face a disparity in access to LT due to low listing rates for transplant relative to deaths from ESLD.

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Section: Methodsmentioning

confidence: 99%

Section: Databases and Study Samplesmentioning

confidence: 99%

Black Patients Have Unequal Access to Listing for Liver Transplantation in the United States

et al. 2021

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“…( 22 ) We also included K71.7, which includes toxic liver disease with fibrosis and cirrhosis of the liver and is very specific for cirrhosis. ( 23 ) A group of patients with hepatocellular carcinoma (HCC) (C22.0) was also analyzed irrespective of their status of having ESLD. Furthermore, a sensitivity analysis was performed that included all patients with liver disease (K70‐K76).…”

Section: Methodsmentioning

confidence: 99%

National Trends in Location of Death in Patients With End‐Stage Liver Disease

et al. 2021

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Despite improvement in the care of patients with end‐stage liver disease (ESLD), mortality is rising. In the United States, patients are increasingly choosing to die at hospice and home, but data in patients with ESLD are lacking. Therefore, this study aimed to describe the trends in location of death in patients with ESLD. We conducted a retrospective cross‐sectional analysis using the Centers for Disease Control and Prevention Wide‐Ranging OnLine Data for Epidemiologic Research from 2003 to 2018. Death location was categorized as hospice, home, inpatient facility, nursing home, or other. Comparisons were made between sex, age, ethnicity, race, region, and other causes of death. Comparisons were also made between rates of change (calculated as annual percent change), proportion of deaths in 2018, and multivariable logistic regression. A total of 535,261 deaths were attributed to ESLD—most were male, non‐Hispanic, and White. The proportion of deaths at hospice and home increased during the study period from 0.2% to 10.6% and 20.3% to 25.7%, respectively. Whites had the highest proportion of deaths in hospice and home. In multivariable analysis, elderly patients were more likely to die in hospice or home (odds ratio [OR], 1.20; 95% confidence interval [CI], 1.07‐1.35), whereas Black patients were less likely (OR, 0.58; 95% CI, 0.46‐0.73). Compared with other causes of death, ESLD had the second highest proportion of deaths in hospice but lagged behind non–hepatocellular carcinoma malignancy. Deaths in patients with ESLD are increasingly common at hospice and home overall, and although the rates have been increasing among Black patients, they are still less likely to die at hospice or home. Efforts to improve this disparity, promote end‐of‐life care planning, and enhance access to death at hospice and home are needed.

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“…The use of administrative data to identify patients is therefore dependent on the validation of the codes utilized. Algorithms for the identification of cirrhosis have been established by a number of investigators for a variety of datasets by using chart review to confirm the positive and negative predictive values of diagnostic coding schema [7][8][9][10][11][12]. In general, most approaches involve requiring a specific set of codes and multiple (>1) entries of the codes in outpatient records (or one entry in inpatient records).…”

Section: Identifying Cirrhosis With Administrative Datamentioning

confidence: 99%

“…Most studies have done this by identifying cirrhosis or a common cause of chronic liver disease, such as hepatitis C virus infection. As described above, algorithms for identifying cirrhosis have been validated in multiple datasets by multiple authors [7][8][9]. Coding algorithms have also been used to successfully identify cohorts with alcohol liver disease [8], non-alcoholic fatty liver disease [14,36], hepatitis C virus infection [8,[37][38][39], and-with slightly less success-chronic hepatitis B virus infection [8,38,39].…”

Section: Identifying Risk Factors For Hepatic Encephalopathymentioning

confidence: 99%

The Use of Administrative Data to Investigate the Population Burden of Hepatic Encephalopathy

Bloom

Tapper

2020

JCM

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Hepatic encephalopathy (HE) is a devastating complication of cirrhosis with an increasing footprint in global public health. Although the condition is defined using a careful history and examination, we cannot accurately measure the true impact of HE relying on data collected exclusively from clinical studies. For this reason, administrative data sources are necessary to study the population burden of HE. Administrative data is generated with each health care encounter to account for health care resource utilization and is extracted into a dataset for the secondary purpose of research. In order to utilize such data for valid analysis, several pitfalls must be avoided—specifically, selecting the particular database capable of meeting the needs of the study’s aims, paying careful attention to the limits of each given database, and ensuring validity of case definition for HE specific to the dataset. In this review, we summarize the types of data available for and the results of administrative data studies of HE.

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Validity of International Classification of Diseases, Tenth Revision, Codes for Cirrhosis

Cited by 23 publications

References 7 publications

Black Patients Have Unequal Access to Listing for Liver Transplantation in the United States

Black Patients Have Unequal Access to Listing for Liver Transplantation in the United States

National Trends in Location of Death in Patients With End‐Stage Liver Disease

The Use of Administrative Data to Investigate the Population Burden of Hepatic Encephalopathy

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