title: Differences in the Prevalence of Obesity, Smoking and Alcohol in the United States Nationwide Inpatient Sample and the Behavioral Risk Factor Surveillance System.
abstract: BACKGROUND
  The lack of adequate and standardized recording of leading risk factors for morbidity and mortality in medical records have downstream effects on research based on administrative databases. The measurement of healthcare is increasingly based on risk-adjusted outcomes derived from coded comorbidities in these databases. However inaccurate or haphazard assessment of risk factors for morbidity and mortality in medical record codes can have tremendous implications for quality improvement and healthcare reform.
  
  
  OBJECTIVE
  We aimed to compare the prevalence of obesity, overweight, tobacco use and alcohol abuse of a large administrative database with a direct data collection survey.
  
  
  METHODS
  We used the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for four leading risk factors in the United States Nationwide Inpatient Sample (NIS) to compare them with a direct survey in the Behavioral Risk Factor Surveillance System (BRFSS) in 2011. After confirming normality of the risk factors, we calculated the national and state estimates and Pearson's correlation coefficient for obesity, overweight, tobacco use and alcohol abuse between NIS and BRFSS.
  
  
  RESULTS
  Compared with direct participant questioning in BRFSS, NIS reported substantially lower prevalence of obesity (p<0.01), overweight (p<0.01), and alcohol abuse (p<0.01), but not tobacco use (p = 0.18). The correlation between NIS and BRFSS was 0.27 for obesity (p = 0.06), 0.09 for overweight (p = 0.55), 0.62 for tobacco use (p<0.01) and 0.40 for alcohol abuse (p<0.01).
  
  
  CONCLUSIONS
  The prevalence of obesity, overweight, tobacco smoking and alcohol abuse based on codes is not consistent with prevalence based on direct questioning. The accuracy of these important measures of health and morbidity in databases is critical for healthcare reform policies.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America.
authors.forename: Elie S
authors.initials: ES
authors.lastname: Al Kazzi
authors.affiliation: Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America.|Division of Health Sciences Informatics, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America.|Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland, United States of America.
authors.forename: Brandyn
authors.initials: B
authors.lastname: Lau
authors.affiliation: Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
authors.forename: Tianjing
authors.initials: T
authors.lastname: Li
authors.affiliation: Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America.
authors.forename: Eric B
authors.initials: EB
authors.lastname: Schneider
authors.affiliation: Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America.|Department of Health Policy and Management, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
authors.forename: Martin A
authors.initials: MA
authors.lastname: Makary
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America.|Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
authors.forename: Susan
authors.initials: S
authors.lastname: Hutfless
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000437:Alcoholism / Q000453:epidemiology*; D040343:Behavioral Risk Factor Surveillance System; D015992:Body Mass Index; D005260:Female; D015438:Health Behavior; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology*; D011159:Population Surveillance; D012907:Smoking / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D055815:Young Adult