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Identification of Dutch children diagnosed with atopic diseases using prescription data: a validation study
B Mulder1, F Groenhof2, L I Kocabas3
1Department of PharmacoEpidemiology and PharmacoEconomics University Centre of Pharmacy, University of Groningen, P.O. Box XB45, A. Deusinglaan 1, 9713 AV, Groningen, The Netherlands. b.mulder@rug.nl.
Insights
Medication proxies reliably identify children with asthma using prescription data. However, using these proxies for identifying children with atopic dermatitis or allergic rhinitis is questionable due to low sensitivity.
Area of Science:
- Pediatric Epidemiology
- Pharmacological Research
- Public Health
Background:
- Atopic disorders, including asthma, atopic dermatitis, and allergic rhinitis, are common in children.
- Accurate identification of these conditions is crucial for epidemiological research and healthcare planning.
- Medication prescription data offers a potential resource for identifying affected children in large populations.
Purpose of the Study:
- To validate medication prescription data as proxies for identifying children diagnosed with atopic disorders.
- To assess the reliability of these proxies across different atopic conditions and age groups.
- To determine optimal criteria for using medication proxies in epidemiological studies.
Main Methods:
- Utilized a general practitioner database (Registration Network Groningen) in the Netherlands.
- Analyzed records of 7439 children aged 0-10 years from 2001-2010.
- Calculated sensitivity and positive predictive value (PPV) for 22 medication proxies against registered diagnoses, testing various prescription capture periods.
Main Results:
- A proxy of ≥2 anti-asthma prescriptions within 1 year, including an inhaled steroid, showed high PPV (0.84) and sufficient sensitivity (0.54) for asthma identification.
- These asthma proxies performed better in older children (6-10 years).
- Proxies for atopic dermatitis and allergic rhinitis had high PPVs but low sensitivity, questioning their utility.
Conclusions:
- Medication prescription data can reliably identify children diagnosed with asthma.
- The use of prescription data as proxies for identifying children with atopic dermatitis and allergic rhinitis is questionable due to poor sensitivity.
- Further research may be needed to refine proxies for non-asthma atopic conditions.
Purpose:
The aim of this study is to validate medication proxies for the identification of children diagnosed with atopic disorders that can be applied in various types of epidemiological research.
Methods:
Records of 7439 children, aged between 0 and 10 years, in the period 2001 until 2010, were retrieved from the Registration Network Groningen database, a general practitioners database in the north-eastern part of the Netherlands. The sensitivity and positive predictive value (PPV) of 22 medication proxies for the identification of children diagnosed with atopic disorders (asthma, atopic dermatitis, and allergic rhinitis) were computed using the registered diagnoses as gold standards. In addition, different capture periods (1 year, half year, and length of study period) for the detection of prescriptions were tested for all the medication proxies.
Results:
The highest PPV (0.84, 95 % CI 0.81-0.87) in combination with a sufficient sensitivity value (0.54, 95 % CI 0.50-0.57) for the identification of children diagnosed with asthma was yielded for the medication proxy, ≥2 prescriptions for anti-asthma medication within 1 year, including 1 inhaled steroid. PPV and sensitivity were even higher in the age group 6-10 years. The proxies designed for the identification of children diagnosed with atopic dermatitis and allergic rhinitis yielded only high PPVs (≥0.75) in combination with low sensitivity values (≤0.22). Altering the capture period for the detection of prescriptions to half a year or the length of the study period only affected sensitivity values.
Conclusion:
Children diagnosed with asthma can be identified reliably with a range of medication proxies. The use of prescription data for the identification of children diagnosed with atopic dermatitis and allergic rhinitis is questionable.
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