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Accuracy of Japanese claims data in identifying diabetes-related complications

Kazuya Fujihara1, Mayuko Yamada-Harada1, Yasuhiro Matsubayashi1

  • 1Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan.

Pharmacoepidemiology and Drug Safety
|February 25, 2021
PubMed

Insights

Claims-based definitions using Diagnosis Procedure Combination (DPC) and procedure codes accurately identify diabetes complications like coronary artery disease (CAD) and heart failure. These methods offer higher accuracy than International Classification of Diseases, Tenth Revision (ICD-10) codes alone for reliable patient data extraction.

Area of Science:

  • Medical Informatics
  • Health Services Research
  • Epidemiology

Background:

  • Accurate identification of diabetes-related complications is crucial for patient care and research.
  • Claims databases are valuable resources, but their accuracy for specific conditions needs validation.

Purpose of the Study:

  • To assess the accuracy of various claims-based definitions for identifying diabetes-related complications.
  • To compare the performance of Diagnosis Procedure Combination (DPC), International Classification of Diseases, Tenth Revision (ICD-10), procedure, and medication codes.

Main Methods:

  • A retrospective study of 1379 inpatients at Niigata University Medical & Dental Hospital.
  • Manual chart reviews served as the gold standard for identifying diabetes-related complications.
  • Calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for different claims-based definitions.

Main Results:

  • DPC-based definitions demonstrated high accuracy (sensitivity, specificity, PPV) for coronary artery disease (CAD) and cerebrovascular disease.
  • Procedure codes were highly accurate for CAD and dialysis.
  • Combined DPC or ICD-10 with medication codes improved accuracy for heart failure compared to ICD-10 alone.
  • ICD-10 codes alone yielded low PPVs (<60%) for most complications.

Conclusions:

  • DPC-based definitions and procedure codes are effective for identifying CAD and cerebrovascular disease in claims data.
  • Specific coding combinations (DPC/ICD-10 + medication) accurately capture heart failure.
  • These validated claims-based definitions enhance the utility of healthcare databases for diabetes complication research.
Abstract

Keywords:
claims-based diagnosiscomplicationsdiabetespharmacoepidemiologyvalidity

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