Verifying a questionnaire diagnosis of asthma in children using health claims data

Yang, Connie L.; To, Teresa; Foty, Richard; Stieb, David M.; Dell, Sharon D.

doi:10.1186/1471-2466-11-52

Cited by 53 publications

(42 citation statements)

References 22 publications

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“…Yang et al recently reported that when compared to an asthma diagnosis based on claims data, parental report of a doctor diagnosis of asthma was not sensitive (59%) but was specific (95.9%). (37) A larger sample size would have improved the precision of the associations in the subgroups. Some of our associations could be spurious findings.…”

Section: Discussionmentioning

confidence: 99%

Association between vitamin D levels and allergy-related outcomes vary by race and other factors

Wegienka

Havstad

Zoratti

et al. 2015

Journal of Allergy and Clinical Immunology

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Background Allergy-related studies that include biological measurements of vitamin D preceding well-measured outcomes are needed. Objective Examine the associations between early life vitamin D levels and the development of allergy-related outcomes in the racially diverse WHEALS birth cohort. Methods 25-hydroxyvitamin D [25(OH)D] was measured in stored blood samples from pregnancy, cord blood and age 2 years. Logistic regression models were used to calculate odds ratios (OR) with 95% confidence intervals (CI) for a 5 ng/ml increase in 25(OH)D level for the outcomes at age 2 years: eczema, skin prick tests (SPT), elevated allergen-specific IgE (sIgE≥0.35IU/ml), and doctor diagnosis of asthma (3–6 years). Results Prenatal 25(OH)D was inversely associated with eczema (OR=0.85, 95% CI 0.75, 0.96). The association was stronger in White children (White: OR=0.79, 95% CI 0.57, 1.09; Black: OR=0.96, 95% CI 0.82, 1.12), although this was not statistically significant. Cord blood 25(OH)D was inversely associated with having ≥1 positive SPT and aeroallergen sensitization. Both associations were statistically significant in White children (SPT: OR=0.50, 95% CI 0.32, 0.80; ≥1 aeroallergen: OR=0.50, 95% CI 0.28, 0.92) in contrast with Black children (SPT:OR=0.88, 95% CI 0.68, 1.14; aeroallergen: OR=0.85, 95% CI 0.65, 1.11). 25(OH)D measured concurrent with outcome assessment was inversely associated with aeroallergen sensitization (OR=0.79, 95% CI 0.66, 0.96) only among Black children (White children: OR=1.21, 95% CI 0.87, 1.69). Conclusions Prenatal and cord 25(OH)D were associated with some allergy-related outcomes with a general pattern indicating that children with higher 25(OH)D tend to have fewer allergy-related outcomes.

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Section: Discussionmentioning

confidence: 99%

Association between vitamin D levels and allergy-related outcomes vary by race and other factors

Wegienka

Havstad

Zoratti

et al. 2015

Journal of Allergy and Clinical Immunology

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“…One study reported a sensitivity of 76.9% and a specificity of 97.5% for current doctor-diagnosed asthma, as determined from medical records 17. Two recent studies of the cumulative incidence of childhood asthma determined from GP (UK-based) or health claims data (Canada) compared with parent-reported diagnosis reported high specificities but relatively low sensitivities 22 23. Finally, de Marco et al 8 found that the question ‘Have you ever had asthma?’ agreed most closely with clinical diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Validating childhood asthma in an epidemiological study using linked electronic patient records

et al. 2014

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ObjectiveTo investigate the performance of parent-reported data in identifying physician-confirmed asthma.Design and settingValidation study using linkage between the Avon Longitudinal Study of Parents and Children (ALSPAC) and electronic patient records held within the General Practice Research Database (GPRD).ParticipantsParticipants were those eligible to participate in ALSPAC who also had a record in the GPRD; this included 765 individuals, just under 4% of ALSPAC-eligible participants. The analysis was based on 141 participants with complete parent-reported asthma data.Primary and secondary outcome measuresThe main GPRD outcome measure was whether a child had a diagnosis of asthma before they were nine. Parent-reported measures were doctor diagnosis of asthma (before mean age 7.5 years), various outcomes based on wheezing and breathlessness recorded longitudinally between 6 months and 8.5 years. Secondary outcomes were bronchial hyper-responsiveness (BHR), forced expiratory volume in 1 s/forced vital capacity ratio and skin prick test responses.ResultsAmong the 141 participants with complete parent-reported data, 26 (18%) had an asthma diagnosis before age nine. Using general practitioner (GP)-recorded asthma as the gold standard, the question ‘Has a doctor ever diagnosed your child with asthma?’ was both sensitive (88.5%) and specific (95.7%). ‘Ever wheezed’ had the highest sensitivity (100%) but low specificity (60%). More specific definitions were obtained by restricting to those who had wheezed on more than one occasion, experienced frequent wheeze and/or wheezed after the age of 3, but these measures had low sensitivities. BHR only identified 50% of those with a GP-recorded diagnosis.ConclusionsParental reports of a doctor's diagnosis agree well with a GP-recorded diagnosis. High specificity for asthma can be achieved by using detailed wheezing questions, although these definitions are likely to exclude mild cases of asthma. Our study shows that linkage between observational studies and electronic patient records has the potential to enhance epidemiological research.

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“…8 Our algorithm yielded higher specificity and lower sensitivity when compared with a case validation for children with asthma that utilised a single diagnosis code from primary-care administrative data in Ontario, Canada (sensitivity of 91.4% and specificity of 82.9%). 7 In a more comparable study, Xi et al .…”

Section: Discussionmentioning

confidence: 87%

Development of a validated algorithm for the diagnosis of paediatric asthma in electronic medical records

Cave

Davey

Ahmadi

et al. 2016

npj Prim Care Resp Med

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An accurate estimation of the prevalence of paediatric asthma in Alberta and elsewhere is hampered by uncertainty regarding disease definition and diagnosis. Electronic medical records (EMRs) provide a rich source of clinical data from primary-care practices that can be used in better understanding the occurrence of the disease. The Canadian Primary Care Sentinel Surveillance Network (CPCSSN) database includes cleaned data extracted from the EMRs of primary-care practitioners. The purpose of the study was to develop and validate a case definition of asthma in children 1–17 who consult family physicians, in order to provide primary-care estimates of childhood asthma in Alberta as accurately as possible. The validation involved the comparison of the application of a theoretical algorithm (to identify patients with asthma) to a physician review of records included in the CPCSSN database (to confirm an accurate diagnosis). The comparison yielded 87.4% sensitivity, 98.6% specificity and a positive and negative predictive value of 91.2% and 97.9%, respectively, in the age group 1–17 years. The algorithm was also run for ages 3–17 and 6–17 years, and was found to have comparable statistical values. Overall, the case definition and algorithm yielded strong sensitivity and specificity metrics and was found valid for use in research in CPCSSN primary-care practices. The use of the validated asthma algorithm may improve insight into the prevalence, diagnosis, and management of paediatric asthma in Alberta and Canada.

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Verifying a questionnaire diagnosis of asthma in children using health claims data

Cited by 53 publications

References 22 publications

Association between vitamin D levels and allergy-related outcomes vary by race and other factors

Association between vitamin D levels and allergy-related outcomes vary by race and other factors

Validating childhood asthma in an epidemiological study using linked electronic patient records

Development of a validated algorithm for the diagnosis of paediatric asthma in electronic medical records

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