Prevalence and Characteristics of Chronic Cough in Adults Identified by Administrative Data
Robert S Zeiger1, Fagen Xie1, Michael Schatz1
1Departments of Allergy and Research and Evaluation, Kaiser Permanente Southern California, San Diego and Pasadena, CA.
Context:
International Classification of Diseases-9/10 codes for chronic cough (CC) do not exist, limiting investigation.
Objective:
To develop a computerized algorithm to determine CC prevalence and its characteristics.
Design:
This observational study using administrative data identified hierarchically patients aged 18 to 85 years with CC from 2013 to 2016. First, a specialist-diagnosed CC group was identified using an internal CC encounter code during an outpatient visit to a pulmonologist, allergist, otolaryngologist, or gastroenterologist. Subsequently, an event-diagnosed CC group was identified based on clinical notes through natural language processing, ICD-9/ICD-10 cough codes, and dispensed antitussives.
Main Outcome Measures:
Prevalence of CC and comparison of clinical characteristics between specialist-diagnosed and event-diagnosed CC subgroups.
Results:
A total of 50,163 patients with CC of more than 8 weeks were identified. Of these, 11,290 (22.5%) were specialist diagnosed, and 38,873 (77.5%) were event diagnosed. The CC cohort was 57.4 ± 16.5 years of age; 67.6% were female. The overall prevalence was 1.04% (95% confidence interval = 1.03-1.06) in 2016. Prevalence in 2016 was higher in female patients (1.21%) than in male patients (0.81%), higher in patients aged 65 to 85 years (2.2%) than in patients aged 18 to 44 years (0.43%), and higher in Blacks (1.38%) than in Whites (1.21%). Compared with patients with event-diagnosed CC, patients with specialist-diagnosed CC exhibited significantly higher frequencies of laboratory tests and respiratory and nonrespiratory comorbidities and dispensed medication and lower frequency of pneumonia, all-cause and respiratory-cause emergency department visits and hospitalizations, and dispensed antitussives.
Conclusions:
We identified a CC cohort using electronic data in a managed care organization. Prevalences varied by sex, age, and ethnicity. Clinical characteristics varied between specialist-diagnosed and event-diagnosed CC.
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