title: De-identifying a public use microdata file from the Canadian national discharge abstract database.
abstract: BACKGROUND
  The Canadian Institute for Health Information (CIHI) collects hospital discharge abstract data (DAD) from Canadian provinces and territories. There are many demands for the disclosure of this data for research and analysis to inform policy making. To expedite the disclosure of data for some of these purposes, the construction of a DAD public use microdata file (PUMF) was considered. Such purposes include: confirming some published results, providing broader feedback to CIHI to improve data quality, training students and fellows, providing an easily accessible data set for researchers to prepare for analyses on the full DAD data set, and serve as a large health data set for computer scientists and statisticians to evaluate analysis and data mining techniques. The objective of this study was to measure the probability of re-identification for records in a PUMF, and to de-identify a national DAD PUMF consisting of 10% of records.
  
  
  METHODS
  Plausible attacks on a PUMF were evaluated. Based on these attacks, the 2008-2009 national DAD was de-identified. A new algorithm was developed to minimize the amount of suppression while maximizing the precision of the data. The acceptable threshold for the probability of correct re-identification of a record was set at between 0.04 and 0.05. Information loss was measured in terms of the extent of suppression and entropy.
  
  
  RESULTS
  Two different PUMF files were produced, one with geographic information, and one with no geographic information but more clinical information. At a threshold of 0.05, the maximum proportion of records with the diagnosis code suppressed was 20%, but these suppressions represented only 8-9% of all values in the DAD. Our suppression algorithm has less information loss than a more traditional approach to suppression. Smaller regions, patients with longer stays, and age groups that are infrequently admitted to hospitals tend to be the ones with the highest rates of suppression.
  
  
  CONCLUSIONS
  The strategies we used to maximize data utility and minimize information loss can result in a PUMF that would be useful for the specific purposes noted earlier. However, to create a more detailed file with less information loss suitable for more complex health services research, the risk would need to be mitigated by requiring the data recipient to commit to a data sharing agreement.
authors.affiliation: CHEO Research Institute, 401 Smyth Road, Ottawa, Ontario. kelemam@uottawa.ca
authors.forename: Khaled
authors.initials: K
authors.lastname: El Emam
authors.forename: David
authors.initials: D
authors.lastname: Paton
authors.forename: Fida
authors.initials: F
authors.lastname: Dankar
authors.forename: Gunes
authors.initials: G
authors.lastname: Koru
mesh_terms: D000465:Algorithms; D002170:Canada; D016208:Databases, Factual; D006801:Humans; D016247:Information Storage and Retrieval; D007902:Length of Stay; D010351:Patient Discharge / Q000706:statistics & numerical data*