Validation of coding algorithms for the identification of patients with primary biliary cirrhosis using administrative data.
BACKGROUND
Large-scale epidemiological studies of primary biliary cirrhosis (PBC) have been hindered by difficulties in case ascertainment.


OBJECTIVE
To develop coding algorithms for identifying PBC patients using administrative data--a widely available data source.


METHODS
Population-based administrative databases were used to identify patients with a diagnosis code for PBC from 1994 to 2002. Coding algorithms for confirmed PBC (two or more of antimitochondrial antibody positivity, cholestatic liver biochemistry and/or compatible liver histology) were derived using chart abstraction data as the reference. Patients with a recorded PBC diagnosis but insufficient confirmatory data were classified as 'suspected PBC'.


RESULTS
Of 189 potential PBC cases, 119 (60%) had confirmed PBC and 28 (14%) had suspected PBC. The optimal algorithm including two or more uses of a PBC code had a sensitivity of 94% (95% CI 71% to 100%) and positive predictive values of 73% (95% CI 61% to 75%) for confirmed PBC, and 89% (95% CI 82% to 94%) for confirmed or suspected PBC. Sensitivity analyses revealed greater accuracy among women, and with the use of multiple data sources and one or more years of data. Inclusion of diagnosis codes for conditions frequently misclassified as PBC did not improve algorithm performance.


CONCLUSIONS
Administrative databases can reliably identify patients with PBC and may facilitate epidemiological investigations of this condition.
Myers
Robert P
RP
Liver Unit, Division of Gastroenterology, Department of Medicine, University of Calgary, 3280 Hospital Drive Northwest, Calgary, Alberta. rpmyers@ucalgary.ca
Shaheen
Abdel Aziz M
AA
Fong
Andrew
A
Wan
Alex F
AF
Swain
Mark G
MG
Hilsden
Robert J
RJ
Sutherland
Lloyd
L
Quan
Hude
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D016208:Databases, Factual; D004812:Epidemiologic Methods; D015340:Epidemiologic Research Design; D005260:Female; D005568:Forms and Records Control / Q000379:methods; D006801:Humans; D008105:Liver Cirrhosis, Biliary / Q000175:diagnosis* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D055815:Young Adult