title: Can healthcare utilization data reliably capture cases of chronic respiratory diseases? a cross-sectional investigation in Italy.
abstract: Healthcare utilization data are increasingly used for chronic disease surveillance. Nevertheless, no standard criteria for estimating prevalence of high-impact diseases, such as chronic obstructive pulmonary disease (COPD) and asthma, are available. In this study an algorithm for recognizing COPD/asthma cases from HCU data is developed and implemented in the HCU databases of the Italian Lombardy Region (about 10 million residents). The impact of diagnostic misclassification for reliably estimating prevalence was also assessed.
  
  
  
  Disease-specificdrug codes, hospital discharges together with co-payment exemptions when available, and a combination of them according with patient's age, were used to create the proposed algorithm. Identified cases were considered for prevalence estimation. An external validation study was also performed in order to evaluate systematic uncertainty of prevalence estimates.
  
  
  
  Raw prevalence of COPD and asthma in 2010 was 3.6 and 3.3% respectively. According to external validation, sensitivity values were 53% for COPD and 39% for asthma. Adjusted prevalence estimates were respectively 6.8 and 8.5% for COPD (among person aged 40 years or older) and asthma (among person aged 40 years or younger).
  
  
  
  COPD and asthma prevalence may be estimated from HCU data, albeit with high systematic uncertainty. Validation is recommended in this setting.
authors.affiliation: Laboratory of Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Via Bicocca degli Arcimboldi, 8, Edificio U7, 20126, Milan, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Biffi
authors.affiliation: Laboratory of Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Via Bicocca degli Arcimboldi, 8, Edificio U7, 20126, Milan, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Comoretto
authors.affiliation: Laboratory of Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Via Bicocca degli Arcimboldi, 8, Edificio U7, 20126, Milan, Italy.|Department of Decision Sciences, Bocconi University, Milan, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Arfè
authors.affiliation: Laboratory of Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Via Bicocca degli Arcimboldi, 8, Edificio U7, 20126, Milan, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Scotti
authors.affiliation: Operative Unit of Territorial Health Services, Region Lombardia, Milan, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Merlino
authors.affiliation: Division of Pneumology, "Guido Salvini" Hospital, Garbagnate Milanese, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Vaghi
authors.affiliation: Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.|Division of Pneumology, "San Gerardo" Hospital, Monza, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Pesci
authors.affiliation: Unit of Epidemiology and Medical Statistics, University of Verona, Verona, Italy.
authors.forename: R
authors.initials: R
authors.lastname: de Marco
authors.affiliation: Laboratory of Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Via Bicocca degli Arcimboldi, 8, Edificio U7, 20126, Milan, Italy. giovanni.corrao@unimib.it.
authors.forename: G
authors.initials: G
authors.lastname: Corrao
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001249:Asthma / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology*; D012680:Sensitivity and Specificity; D035501:Uncertainty; D055815:Young Adult
keywords: Algorithms; Asthma; Chronic obstructive pulmonary disease; Healthcare utilization database; Prevalence