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Poor record linkage sensitivity biased outcomes in a linked cohort analysis
Cecilia L Moore1, Heather F Gidding2, Matthew G Law1
1The Kirby Institute, UNSW Medicine, The University of New South Wales, Sydney 2052, Australia.
Journal of Clinical Epidemiology
|February 3, 2016
Summary
Deterministic record linkage significantly underestimates hospitalization risks in HIV-positive and HIV-negative men, missing vulnerable individuals. Probabilistic linkage is recommended for accurate health outcome assessment.
Area of Science:
- Epidemiology
- Biostatistics
- Public Health
Background:
- Accurate ascertainment of hospitalizations is crucial for understanding population health trends, particularly in vulnerable groups like men who have sex with men (MSM).
- Record linkage methods, deterministic and probabilistic, are used to connect individuals across different health datasets.
- The choice of linkage method can significantly impact study outcomes and the validity of health risk calculations.
Purpose of the Study:
- To compare the accuracy of deterministic versus probabilistic record linkage for identifying hospitalizations in two cohorts of HIV-negative and HIV-positive MSM.
- To assess the impact of different linkage strategies on the estimation of hospitalization risks and incidence rates.
Main Methods:
- Two linked cohorts of HIV-negative (n=1,325) and HIV-positive (n=557) gay and bisexual men in Sydney were probabilistically and deterministically linked to a statewide hospital registry from July 2000 to June 2012.
- Probabilistic linkage was used as the reference standard to evaluate the performance of deterministic linkage.
- Standardized incidence ratios (SIRs) and incidence rate ratios (IRRs) were calculated and compared between the two linkage methods.
Main Results:
- Deterministic linkage exhibited higher specificity but substantially lower sensitivity (34.67%) compared to probabilistic linkage.
- Individuals with poorer socioeconomic and health indicators, including HIV status, were disproportionately missed by deterministic linkage.
- Deterministic linkage significantly underestimated hospitalization risks for both HIV-positive (SIR=0.46) and HIV-negative (SIR=0.29) men compared to the general male population, whereas probabilistic linkage showed higher estimates (HIV+ve SIR=1.45; HIV-ve SIR=0.72).
- Discrepancies in IRRs were more pronounced for diagnostic categories with low event rates or differential linkage sensitivity between cohorts.
Conclusions:
- Record linkage methods lacking proven high sensitivity and specificity require careful consideration.
- Standardized incidence ratios should not be calculated when linkage sensitivity is undetermined due to potential underestimation.
- Comparisons of linked events within or between cohorts are more robust to linkage misclassification, but selection bias must be addressed.
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