Evaluation of Left Truncation and Censoring When Changing the Use of the International Classification of Diseases Eighth Revision Codes to Tenth Revision Codes in the Danish National Patient Registry

IF 3.4 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Clinical Epidemiology Pub Date : 2024-05-18 DOI:10.2147/clep.s456171

Søren Korsgaard, Frederikke Schønfeldt Troelsen, Katalin Veres, Cecilia Hvitfeldt Fuglsang, Henrik Toft Sørensen

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Abstract

Purpose: In the Danish National Patient Registry (DNPR), covering all Danish hospitals and widely used in research, diseases have been recorded using International Classification of Diseases (ICD) codes, transitioning from the Eighth to the Tenth revision in 1994. Uncertainty exists regarding whether including ICD-8 codes alongside ICD-10 is needed for complete disease identification. We assessed the extent of left-truncation and left-censoring in the DNPR arising from omitting ICD-8 codes.
Patients and Methods: We sampled 500,000 Danes ≥ 40 years of age in 1995, 2010, and 2018. From the DNPR, we identified cardiovascular, endocrine, gastrointestinal, neurological, pulmonary, rheumatic, and urogenital diseases as well as fractures. We obtained the number of people with a disease recorded with ICD-8 codes only (ie, the ICD-8 record would be left-truncated by not using ICD-8 codes), ICD-8 plus ICD-10 codes (ie, the ICD-8 record would be left-censored by not using ICD-8 codes), and ICD-10 codes only. For each ICD group, we calculated the proportion of people with the disease relative to the total sample (ie, 500,000 people) and the total number of people with the disease across all ICD groups.
Results: Overall, the left-truncation issue decreased over the years. Relative to all people with a disease, the left-truncated proportion was for example 59% in 1995 and < 2% in 2018 for diabetes mellitus; 93% in 1995, and 54% in 2018 for appendicitis. The left-truncation issue increased with age group for most diseases. The proportion of disease records left-censored by not using ICD-8 codes was generally low but highest for chronic diseases.
Conclusion: The left-truncation issue diminished over sample years, particularly for chronic diseases, yet remained rather high for selected surgical diseases. The left-truncation issue increased with age group for most diseases. Left-censoring was overall a minor issue that primarily concerned chronic diseases.

Keywords: epidemiology, methodology, bias, left-truncation, left-censoring

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在丹麦国家患者登记处将国际疾病分类第八修订版代码改为第十修订版代码时对左截断和删减的评估

目的：丹麦国家患者登记处（Danish National Patient Registry，DNPR）覆盖了丹麦所有医院，并被广泛用于研究，该登记处使用国际疾病分类（International Classification of Diseases，ICD）代码记录疾病，并于 1994 年从第八版过渡到第十版。关于是否需要将 ICD-8 代码与 ICD-10 代码一起纳入完整的疾病识别，目前还存在不确定性。我们评估了因省略 ICD-8 代码而导致的 DNPR 左截断和左删减的程度：我们在 1995 年、2010 年和 2018 年对 50 万年龄≥ 40 岁的丹麦人进行了抽样调查。从 DNPR 中，我们确定了心血管、内分泌、胃肠道、神经、肺、风湿和泌尿生殖系统疾病以及骨折。我们获得了仅使用 ICD-8 编码（即不使用 ICD-8 编码会对 ICD-8 记录进行左截断）、ICD-8 加 ICD-10 编码（即不使用 ICD-8 编码会对 ICD-8 记录进行左截断）和仅使用 ICD-10 编码记录的疾病患者人数。对于每个 ICD 组，我们都计算了患病人数占样本总数（即 500,000 人）的比例，以及所有 ICD 组的患病总人数：总体而言，左截断问题逐年减少。例如，相对于所有患病人数，1995 年和 < 的左截断比例分别为 59%；2018 年糖尿病的左截断比例为 2%；1995 年阑尾炎的左截断比例为 93%，2018 年为 54%。大多数疾病的左截断问题随着年龄组的增加而增加。因未使用 ICD-8 编码而被左截断的疾病记录比例普遍较低，但慢性病的比例最高：结论：左截断问题随着样本年的增加而减少，尤其是慢性病，但部分外科疾病的左截断问题仍然很严重。在大多数疾病中，左截断问题随年龄组而增加。关键词：流行病学、方法学、偏差、左截断、左删减

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来源期刊

Clinical Epidemiology Medicine-Epidemiology

CiteScore

6.30

自引率

5.10%

发文量

169

审稿时长

16 weeks

期刊介绍： Clinical Epidemiology is an international, peer reviewed, open access journal. Clinical Epidemiology focuses on the application of epidemiological principles and questions relating to patients and clinical care in terms of prevention, diagnosis, prognosis, and treatment. Clinical Epidemiology welcomes papers covering these topics in form of original research and systematic reviews. Clinical Epidemiology has a special interest in international electronic medical patient records and other routine health care data, especially as applied to safety of medical interventions, clinical utility of diagnostic procedures, understanding short- and long-term clinical course of diseases, clinical epidemiological and biostatistical methods, and systematic reviews. When considering submission of a paper utilizing publicly-available data, authors should ensure that such studies add significantly to the body of knowledge and that they use appropriate validated methods for identifying health outcomes. The journal has launched special series describing existing data sources for clinical epidemiology, international health care systems and validation studies of algorithms based on databases and registries.