Validity of COPD diagnoses reported through nationwide health insurance systems in the People's Republic of China

Om P Kurmi; Julien Vaucher; Dan Xiao; Michael V Holmes; Yu Guo; Kourtney J Davis; Chen Wang; Haiyan Qin; Iain Turnbull; Peng Peng; Zheng Bian; Robert Clarke; Liming Li; Yiping Chen; Zhengming Chen

doi:10.2147/COPD.S100736

Validity of COPD diagnoses reported through nationwide health insurance systems in the People's Republic of China

Om P Kurmi, Julien Vaucher, Dan Xiao, Michael V Holmes, Yu Guo, Kourtney J Davis, Chen Wang, Haiyan Qin, Iain Turnbull, Peng Peng, Zheng Bian, Robert Clarke, Liming Li, Yiping Chen, Zhengming Chen

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Abstract

BACKGROUND: COPD is the fourth leading cause of death worldwide, with particularly high rates in the People's Republic of China, even among never smokers. Large population-based cohort studies should allow for reliable assessment of the determinants of diseases, which is dependent on the quality of disease diagnoses. We assessed the validity of COPD diagnoses collected through electronic health records in the People's Republic of China.

METHODS: The CKB study recruited 0.5 million adults aged 30-79 years from ten diverse regions in the People's Republic of China during the period 2004-2008. During 7 years of follow-up, 11,800 COPD cases were identified by linkage with mortality registries and the national health insurance system. We randomly selected ~10% of the reported COPD cases and then undertook an independent adjudication of retrieved hospital medical records in 1,069 cases.

RESULTS: Overall, these 1,069 cases were accrued over a 9-year period (2004-2013) involving 153 hospitals across ten regions. A diagnosis of COPD was confirmed in 911 (85%) cases, corresponding to a positive predictive value of 85% (95% confidence interval [CI]: 83%-87%), even though spirometry testing was not widely used (14%) in routine hospital care. The positive predictive value for COPD did not vary significantly by hospital ranking or calendar period, but was higher in men than women (89% vs 79%), at age ≥70 years than in younger people (88%, 95% CI: 85%-91%), and when the cases were reported from both death registry and health insurance systems (97%, 95% CI: 94%-100%). Among the remaining cases, 87 (8.1%) had other respiratory diseases (chiefly pneumonia and asthma; n=85) and 71 (6.6%) cases showed no evidence of any respiratory disease on their clinical records.

CONCLUSION: In the People's Republic of China, COPD diagnoses obtained from electronic health records are of good quality and suitable for large population-based studies and do not warrant systematic adjudication of all the reported cases.

Original language	English
Pages (from-to)	419-430
Number of pages	12
Journal	International Journal of Chronic Obstructive Pulmonary Disease
Volume	11
DOIs	https://doi.org/10.2147/COPD.S100736
Publication status	Published - 1 Mar 2016
Externally published	Yes

Bibliographical note

This work is published by Dove Medical Press Limited, and licensed under a Creative Commons Attribution License. The full terms of the License are available at http://creativecommons.org/licenses/by/4.0/. The license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Keywords

Adult
Aged
China
Female
Humans
Insurance, Health
Male
Middle Aged
Pulmonary Disease, Chronic Obstructive/diagnosis
Reproducibility of Results

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10.2147/COPD.S100736Licence: CC BY

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Cite this

Kurmi, O. P., Vaucher, J., Xiao, D., Holmes, M. V., Guo, Y., Davis, K. J., Wang, C., Qin, H., Turnbull, I., Peng, P., Bian, Z., Clarke, R., Li, L., Chen, Y., & Chen, Z. (2016). Validity of COPD diagnoses reported through nationwide health insurance systems in the People's Republic of China. International Journal of Chronic Obstructive Pulmonary Disease, 11, 419-430. https://doi.org/10.2147/COPD.S100736

Kurmi, OP, Vaucher, J, Xiao, D, Holmes, MV, Guo, Y, Davis, KJ, Wang, C, Qin, H, Turnbull, I, Peng, P, Bian, Z, Clarke, R, Li, L, Chen, Y & Chen, Z 2016, 'Validity of COPD diagnoses reported through nationwide health insurance systems in the People's Republic of China', International Journal of Chronic Obstructive Pulmonary Disease, vol. 11, pp. 419-430. https://doi.org/10.2147/COPD.S100736

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title = "Validity of COPD diagnoses reported through nationwide health insurance systems in the People's Republic of China",

abstract = "BACKGROUND: COPD is the fourth leading cause of death worldwide, with particularly high rates in the People's Republic of China, even among never smokers. Large population-based cohort studies should allow for reliable assessment of the determinants of diseases, which is dependent on the quality of disease diagnoses. We assessed the validity of COPD diagnoses collected through electronic health records in the People's Republic of China.METHODS: The CKB study recruited 0.5 million adults aged 30-79 years from ten diverse regions in the People's Republic of China during the period 2004-2008. During 7 years of follow-up, 11,800 COPD cases were identified by linkage with mortality registries and the national health insurance system. We randomly selected ~10% of the reported COPD cases and then undertook an independent adjudication of retrieved hospital medical records in 1,069 cases.RESULTS: Overall, these 1,069 cases were accrued over a 9-year period (2004-2013) involving 153 hospitals across ten regions. A diagnosis of COPD was confirmed in 911 (85%) cases, corresponding to a positive predictive value of 85% (95% confidence interval [CI]: 83%-87%), even though spirometry testing was not widely used (14%) in routine hospital care. The positive predictive value for COPD did not vary significantly by hospital ranking or calendar period, but was higher in men than women (89% vs 79%), at age ≥70 years than in younger people (88%, 95% CI: 85%-91%), and when the cases were reported from both death registry and health insurance systems (97%, 95% CI: 94%-100%). Among the remaining cases, 87 (8.1%) had other respiratory diseases (chiefly pneumonia and asthma; n=85) and 71 (6.6%) cases showed no evidence of any respiratory disease on their clinical records.CONCLUSION: In the People's Republic of China, COPD diagnoses obtained from electronic health records are of good quality and suitable for large population-based studies and do not warrant systematic adjudication of all the reported cases.",

keywords = "Adult, Aged, China, Female, Humans, Insurance, Health, Male, Middle Aged, Pulmonary Disease, Chronic Obstructive/diagnosis, Reproducibility of Results",

author = "Kurmi, {Om P} and Julien Vaucher and Dan Xiao and Holmes, {Michael V} and Yu Guo and Davis, {Kourtney J} and Chen Wang and Haiyan Qin and Iain Turnbull and Peng Peng and Zheng Bian and Robert Clarke and Liming Li and Yiping Chen and Zhengming Chen",

note = "This work is published by Dove Medical Press Limited, and licensed under a Creative Commons Attribution License. The full terms of the License are available at http://creativecommons.org/licenses/by/4.0/. The license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.",

year = "2016",

month = mar,

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doi = "10.2147/COPD.S100736",

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T1 - Validity of COPD diagnoses reported through nationwide health insurance systems in the People's Republic of China

AU - Kurmi, Om P

AU - Vaucher, Julien

AU - Xiao, Dan

AU - Holmes, Michael V

AU - Guo, Yu

AU - Davis, Kourtney J

AU - Wang, Chen

AU - Qin, Haiyan

AU - Turnbull, Iain

AU - Peng, Peng

AU - Bian, Zheng

AU - Clarke, Robert

AU - Li, Liming

AU - Chen, Yiping

AU - Chen, Zhengming

N1 - This work is published by Dove Medical Press Limited, and licensed under a Creative Commons Attribution License. The full terms of the License are available at http://creativecommons.org/licenses/by/4.0/. The license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PY - 2016/3/1

Y1 - 2016/3/1

N2 - BACKGROUND: COPD is the fourth leading cause of death worldwide, with particularly high rates in the People's Republic of China, even among never smokers. Large population-based cohort studies should allow for reliable assessment of the determinants of diseases, which is dependent on the quality of disease diagnoses. We assessed the validity of COPD diagnoses collected through electronic health records in the People's Republic of China.METHODS: The CKB study recruited 0.5 million adults aged 30-79 years from ten diverse regions in the People's Republic of China during the period 2004-2008. During 7 years of follow-up, 11,800 COPD cases were identified by linkage with mortality registries and the national health insurance system. We randomly selected ~10% of the reported COPD cases and then undertook an independent adjudication of retrieved hospital medical records in 1,069 cases.RESULTS: Overall, these 1,069 cases were accrued over a 9-year period (2004-2013) involving 153 hospitals across ten regions. A diagnosis of COPD was confirmed in 911 (85%) cases, corresponding to a positive predictive value of 85% (95% confidence interval [CI]: 83%-87%), even though spirometry testing was not widely used (14%) in routine hospital care. The positive predictive value for COPD did not vary significantly by hospital ranking or calendar period, but was higher in men than women (89% vs 79%), at age ≥70 years than in younger people (88%, 95% CI: 85%-91%), and when the cases were reported from both death registry and health insurance systems (97%, 95% CI: 94%-100%). Among the remaining cases, 87 (8.1%) had other respiratory diseases (chiefly pneumonia and asthma; n=85) and 71 (6.6%) cases showed no evidence of any respiratory disease on their clinical records.CONCLUSION: In the People's Republic of China, COPD diagnoses obtained from electronic health records are of good quality and suitable for large population-based studies and do not warrant systematic adjudication of all the reported cases.

AB - BACKGROUND: COPD is the fourth leading cause of death worldwide, with particularly high rates in the People's Republic of China, even among never smokers. Large population-based cohort studies should allow for reliable assessment of the determinants of diseases, which is dependent on the quality of disease diagnoses. We assessed the validity of COPD diagnoses collected through electronic health records in the People's Republic of China.METHODS: The CKB study recruited 0.5 million adults aged 30-79 years from ten diverse regions in the People's Republic of China during the period 2004-2008. During 7 years of follow-up, 11,800 COPD cases were identified by linkage with mortality registries and the national health insurance system. We randomly selected ~10% of the reported COPD cases and then undertook an independent adjudication of retrieved hospital medical records in 1,069 cases.RESULTS: Overall, these 1,069 cases were accrued over a 9-year period (2004-2013) involving 153 hospitals across ten regions. A diagnosis of COPD was confirmed in 911 (85%) cases, corresponding to a positive predictive value of 85% (95% confidence interval [CI]: 83%-87%), even though spirometry testing was not widely used (14%) in routine hospital care. The positive predictive value for COPD did not vary significantly by hospital ranking or calendar period, but was higher in men than women (89% vs 79%), at age ≥70 years than in younger people (88%, 95% CI: 85%-91%), and when the cases were reported from both death registry and health insurance systems (97%, 95% CI: 94%-100%). Among the remaining cases, 87 (8.1%) had other respiratory diseases (chiefly pneumonia and asthma; n=85) and 71 (6.6%) cases showed no evidence of any respiratory disease on their clinical records.CONCLUSION: In the People's Republic of China, COPD diagnoses obtained from electronic health records are of good quality and suitable for large population-based studies and do not warrant systematic adjudication of all the reported cases.

KW - Adult

KW - Aged

KW - China

KW - Female

KW - Humans

KW - Insurance, Health

KW - Male

KW - Middle Aged

KW - Pulmonary Disease, Chronic Obstructive/diagnosis

KW - Reproducibility of Results

U2 - 10.2147/COPD.S100736

DO - 10.2147/COPD.S100736

M3 - Article

C2 - 27042034

SN - 1176-9106

VL - 11

SP - 419

EP - 430

JO - International Journal of Chronic Obstructive Pulmonary Disease

JF - International Journal of Chronic Obstructive Pulmonary Disease

ER -

Validity of COPD diagnoses reported through nationwide health insurance systems in the People's Republic of China

Abstract

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Keywords

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