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Updated: Nov 22, 2025
Author Spotlight: Advancements and Challenges in Hepatitis B Virus Detection
Published on: December 15, 2023
Validating viral hepatitis B and C diagnosis codes: a retrospective analysis using Ontario's health administrative
Abdool S Yasseen1,2,3, Jeffrey C Kwong1,2,3,4,5, Rafal Kustra1
1Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
Insights
Diagnosis codes for hepatitis B (HBV) and hepatitis C (HCV) have low sensitivity for identifying infections. Relying solely on these codes for population burden monitoring is insufficient, highlighting the need for robust laboratory surveillance.
Area of Science:
- Hepatology
- Infectious Diseases
- Public Health Surveillance
Background:
- Accurate identification of viral hepatitis infections is crucial for public health.
- Diagnosis codes are often used for epidemiological studies, but their validity needs assessment.
Purpose of the Study:
- To determine the criterion validity of using diagnosis codes for hepatitis B virus (HBV) and hepatitis C virus (HCV) to identify infections.
- To assess the performance of HBV and HCV diagnosis codes against laboratory-confirmed cases.
Main Methods:
- Linked laboratory and administrative data from Ontario, Canada (2004-2014).
- Validation of HBV/HCV diagnosis codes against laboratory-confirmed infections.
- Estimation of sensitivity, specificity, and positive predictive value using cross-validated logistic regression.
- Exploration of variations by time windows (1-5 years) and subgroup analyses.
Main Results:
- High specificity (99.9% HBV; 99.8% HCV) but low sensitivity (12.8% HBV; 30.8% HCV) for diagnosis codes within ±3 years of confirmation.
- Moderate positive predictive values (70.3% HBV; 85.8% HCV).
- Diagnostic models outperformed prognostic models; limited changes with time window variations. No significant subgroup differences.
Conclusions:
- HBV/HCV diagnosis codes alone are inadequate for monitoring population burden due to low sensitivity and moderate positive predictive values.
- Ongoing laboratory and reportable disease surveillance systems are essential for accurate viral hepatitis monitoring in Ontario.
Objective:
We aimed to determine the criterion validity of using diagnosis codes for hepatitis B virus (HBV) and hepatitis C virus (HCV) to identify infections.
Methods:
Using linked laboratory and administrative data in Ontario, Canada, from January 2004 to December 2014, we validated HBV/HCV diagnosis codes against laboratory-confirmed infections. Performance measures (sensitivity, specificity, and positive predictive value) were estimated via cross-validated logistic regression and we explored variations by varying time windows from 1 to 5 years before (i.e., prognostic prediction) and after (i.e., diagnostic prediction) the date of laboratory confirmation. Subgroup analyses were performed among immigrants, males, baby boomers, and females to examine the robustness of these measures.
Results:
A total of 1,599,023 individuals were tested for HBV and 840,924 for HCV, with a resulting 41,714 (2.7%) and 58,563 (7.0%) infections identified, respectively. HBV/HCV diagnosis codes ± 3 years of laboratory confirmation showed high specificity (99.9% HBV; 99.8% HCV), moderate positive predictive value (70.3% HBV; 85.8% HCV), and low sensitivity (12.8% HBV; 30.8% HCV). Varying the time window resulted in limited changes to performance measures. Diagnostic models consistently outperformed prognostic models. No major differences were observed among subgroups.
Conclusion:
HBV/HCV codes should not be the only source used for monitoring the population burden of these infections, due to low sensitivity and moderate positive predictive values. These results underscore the importance of ongoing laboratory and reportable disease surveillance systems for monitoring viral hepatitis in Ontario.
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