title: Validity of type 2 diabetes diagnosis in a population-based electronic health record database.
abstract: The increasing burden of type 2 diabetes mellitus makes the continuous surveillance of its prevalence and incidence advisable. Electronic health records (EHRs) have great potential for research and surveillance purposes; however the quality of their data must first be evaluated for fitness for use. The aim of this study was to assess the validity of type 2 diabetes diagnosis in a primary care EHR database covering more than half a million inhabitants, 97% of the population in Navarra, Spain.
  
  
  
  In the Navarra EPIC-InterAct study, the validity of the T90 code from the International Classification of Primary Care, Second Edition was studied in a primary care EHR database to identify incident cases of type 2 diabetes, using a multi-source approach as the gold standard. The sensitivity, specificity, positive predictive value, negative predictive value and the kappa index were calculated. Additionally, type 2 diabetes prevalence from the EHR database was compared with estimations from a health survey.
  
  
  
  The sensitivity, specificity, positive predictive value and negative predictive value of incident type 2 diabetes recorded in the EHRs were 98.2, 99.3, 92.2 and 99.8%, respectively, and the kappa index was 0.946. Overall prevalence of type 2 diabetes diagnosed in the EHRs among adults (35-84 years of age) was 7.2% (95% confidence interval [CI] 7.2-7.3) in men and 5.9% (95% CI 5.8-5.9) in women, which was similar to the prevalence estimated from the health survey: 8.5% (95% CI 7.1-9.8) and 5.5% (95% CI 4.4-6.6) in men and women, respectively.
  
  
  
  The high sensitivity and specificity of type 2 diabetes diagnosis found in the primary care EHRs make this database a good source for population-based surveillance of incident and prevalent type 2 diabetes, as well as for monitoring quality of care and health outcomes in diabetic patients.
authors.affiliation: Navarra Public Health Institute, Leyre 15, 31003, Pamplona, Spain. mmorenoi@cfnavarra.es.|Research Network for Health Services in Chronic Diseases (REDISSEC), Madrid, Spain. mmorenoi@cfnavarra.es.|Navarra Institute for Health Research (IdiSNA), Pamplona, Spain. mmorenoi@cfnavarra.es.
authors.forename: Conchi
authors.initials: C
authors.lastname: Moreno-Iribas
authors.affiliation: Department of Preventive Medicine and Public Health, Navarra Hospital Complex, Pamplona, Spain.|Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Sayon-Orea
authors.affiliation: Biomedical Research Center Network for Epidemiology and Public Health (CIBERESP), Madrid, Spain.
authors.forename: Josu
authors.initials: J
authors.lastname: Delfrade
authors.affiliation: Navarra Public Health Institute, Leyre 15, 31003, Pamplona, Spain.|Navarra Institute for Health Research (IdiSNA), Pamplona, Spain.|Biomedical Research Center Network for Epidemiology and Public Health (CIBERESP), Madrid, Spain.
authors.forename: Eva
authors.initials: E
authors.lastname: Ardanaz
authors.affiliation: Department of Health, Navarra Regional Government, Pamplona, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Gorricho
authors.affiliation: Biomedical Research Center Network for Epidemiology and Public Health (CIBERESP), Madrid, Spain.
authors.forename: Rosana
authors.initials: R
authors.lastname: Burgui
authors.affiliation: Primary Healthcare Directorate, Navarra Health Service, Pamplona, Spain.
authors.forename: Marian
authors.initials: M
authors.lastname: Nuin
authors.affiliation: Navarra Public Health Institute, Leyre 15, 31003, Pamplona, Spain.|Navarra Institute for Health Research (IdiSNA), Pamplona, Spain.|Biomedical Research Center Network for Epidemiology and Public Health (CIBERESP), Madrid, Spain.
authors.forename: Marcela
authors.initials: M
authors.lastname: Guevara
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis* / Q000453:epidemiology; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013030:Spain / Q000453:epidemiology
keywords: Electronic health records; Incidence; Primary care; Type 2 diabetes mellitus; Validity