Measuring misclassification and sample bias in passive surveillance systems: Improving prevalence estimates of critical congenital heart defects in state-based passive surveillance systems

IF 1.6 4区 医学 Q4 DEVELOPMENTAL BIOLOGY Birth Defects Research Pub Date : 2024-08-01 DOI:10.1002/bdr2.2386
Chris Barnett, James Christiansen, Monica Mills, Jordyn Lord, Jared Parrish
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Abstract

Objectives

We assessed reporting misclassification for 12 critical congenital heart defects (CCHDs) identified through administrative diagnosis codes within a passive surveillance system. We measured the effect of misclassification on prevalence estimation. Lastly, we investigated a sample-based review strategy to estimate surveillance misclassification resulting from administrative diagnosis codes for case detection.

Methods

We received 419 reports of CCHDs between 2007 and 2018; 414 were clinically reviewed. We calculated confirmation probabilities to assess misclassification and adjust prevalence estimates. Random samples of reported cases were taken at proportions between 20% and 90% for each condition to assess sample bias. Sampling was repeated 1000 times to measure sample-estimate variability.

Results

Misclassification ranged from a low of 19% (n = 4/21) to a high of 84% (n = 21/25). Unconfirmed prevalence rates ranged between one and six cases per 10,000 live births, with some conditions significantly higher than national estimates. However, confirmed rates were either lower or comparable to national estimates.

Conclusion

Passive birth defect surveillance programs that rely on administrative diagnosis codes for case identification of CCHDs are subject to misclassification that bias prevalence estimates. We showed that a sample-based review could improve the prevalence estimates of 12 cardiovascular conditions relative to their unconfirmed prevalence rates.

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测量被动监测系统中的分类错误和样本偏差:改进以州为基础的被动监测系统中先天性心脏病患病率的估算。
目的:我们评估了被动监测系统中通过行政诊断代码确定的 12 种严重先天性心脏缺陷 (CCHD) 的报告分类错误。我们测量了错误分类对患病率估算的影响。最后,我们研究了一种基于样本的审查策略,以估计行政诊断代码在病例检测中导致的监测分类错误:2007 年至 2018 年间,我们收到了 419 份儿童疾病报告;其中 414 份进行了临床审查。我们计算了确认概率,以评估误分类并调整患病率估计值。对报告病例进行随机抽样,每种情况的抽样比例介于 20% 和 90% 之间,以评估样本偏差。重复抽样 1000 次,以测量样本估计值的变异性:分类错误率最低为 19%(n = 4/21),最高为 84%(n = 21/25)。未经证实的患病率介于每 10,000 例活产中 1 例到 6 例之间,其中一些病例明显高于全国估计值。然而,确诊率要么较低,要么与全国估计值相当:结论:被动式出生缺陷监测项目依赖于行政诊断代码来识别儿童慢性疾病病例,可能会造成分类错误,从而使患病率估计值出现偏差。我们的研究表明,与未经证实的患病率相比,基于样本的审查可以提高 12 种心血管疾病的患病率估计值。
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来源期刊
Birth Defects Research
Birth Defects Research Medicine-Embryology
CiteScore
3.60
自引率
9.50%
发文量
153
期刊介绍: The journal Birth Defects Research publishes original research and reviews in areas related to the etiology of adverse developmental and reproductive outcome. In particular the journal is devoted to the publication of original scientific research that contributes to the understanding of the biology of embryonic development and the prenatal causative factors and mechanisms leading to adverse pregnancy outcomes, namely structural and functional birth defects, pregnancy loss, postnatal functional defects in the human population, and to the identification of prenatal factors and biological mechanisms that reduce these risks. Adverse reproductive and developmental outcomes may have genetic, environmental, nutritional or epigenetic causes. Accordingly, the journal Birth Defects Research takes an integrated, multidisciplinary approach in its organization and publication strategy. The journal Birth Defects Research contains separate sections for clinical and molecular teratology, developmental and reproductive toxicology, and reviews in developmental biology to acknowledge and accommodate the integrative nature of research in this field. Each section has a dedicated editor who is a leader in his/her field and who has full editorial authority in his/her area.
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