title: Validity of diagnostic codes and prevalence of physician-diagnosed psoriasis and psoriatic arthritis in southern Sweden--a population-based register study.
abstract: OBJECTIVE
  To validate diagnostic codes for psoriasis and psoriatic arthritis (PsA) and estimate physician-diagnosed prevalence of psoriasis and PsA in the Skåne region, Sweden.
  
  
  METHODS
  In the Skåne Healthcare Register (SHR), all healthcare consultations are continuously collected for all inhabitants in the Skåne region (population 1.2 million). During 2005-2010 we identified individuals with ≥1 physician-consultations consistent with psoriasis (ICD-10). Within this group we also identified those diagnosed with PsA. We performed a validation by reviewing medical records in 100 randomly selected cases for psoriasis and psoriasis with PsA, respectively. Further, we estimated the pre- and post-validation point prevalence by December 31, 2010.
  
  
  RESULTS
  We identified 16 171 individuals (psoriasis alone: n = 13 185, psoriasis with PsA n = 2 986). The proportion of ICD-10 codes that could be confirmed by review of medical records was 81% for psoriasis and 63% for psoriasis with PsA with highest percentage of confirmed codes for cases diagnosed ≥2 occasions in specialized care. For 19% and 29% of the cases respectively it was not possible to determine diagnosis due to insufficient information. Thus, the positive predicted value (PPV) of one ICD-10 code for psoriasis and psoriasis with PsA ranged between 81-100% and 63-92%, respectively. Assuming the most conservative PPV, the post-validation prevalence was 1.23% (95% CI: 1.21-1.25) for psoriasis (with or without PsA), 1.02% (95% CI: 1.00-1.03) for psoriasis alone and 0.21% (95% CI: 0.20-0.22) for psoriasis with PsA. The post-validation prevalence of PsA in the psoriasis cohort was 17.3% (95% CI: 16.65-17.96).
  
  
  CONCLUSIONS
  The proportion of diagnostic codes in SHR that could be verified varied with frequency of diagnostic codes and level of care highlighting the importance of sensitivity analyses using different case ascertainment criteria. The prevalence of physician-diagnosed psoriasis and PsA confirm other population-based studies, also after adjustment due to misclassification of disease.
authors.affiliation: Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden; Epidemiology and Register Centre South, Skåne University Hospital, Lund, Sweden.
authors.forename: Sofia
authors.initials: S
authors.lastname: Löfvendahl
authors.affiliation: Department of Rheumatology, Skåne University Hospital Malmö, Lund University, Malmö, Sweden.
authors.forename: Elke
authors.initials: E
authors.lastname: Theander
authors.affiliation: Department of Dermatology, Skåne University Hospital Malmö, Lund University, Malmö, Sweden.
authors.forename: Åke
authors.initials: Å
authors.lastname: Svensson
authors.affiliation: Department of Clinical Sciences, Malmö, Lund University, Skåne University Hospital Malmö, Sweden.
authors.forename: Katarina Steen
authors.initials: KS
authors.lastname: Carlsson
authors.affiliation: Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden; Epidemiology and Register Centre South, Skåne University Hospital, Lund, Sweden; Clinical Epidemiology Research & Training Unit, Boston University School of Medicine, Boston, Massachusetts, United States of America.
authors.forename: Martin
authors.initials: M
authors.lastname: Englund
authors.affiliation: Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden; Epidemiology and Register Centre South, Skåne University Hospital, Lund, Sweden; Arthritis Research UK Primary Care Centre, Keele University, United Kingdom.
authors.forename: Ingemar F
authors.initials: IF
authors.lastname: Petersson
mesh_terms: D000328:Adult; D015535:Arthritis, Psoriatic / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D038801:International Classification of Diseases; D008297:Male; D008875:Middle Aged; D010820:Physicians; D011159:Population Surveillance; D015995:Prevalence; D011565:Psoriasis / Q000175:diagnosis* / Q000453:epidemiology*; D012042:Registries; D015203:Reproducibility of Results; D013548:Sweden / Q000453:epidemiology