Defining Cannabis Use Disorder in Administrative Health Data: A Systematic Review of Case Definitions and Validation...

Area of Science:

• Epidemiology
• Health Services Research
• Public Health Policy

Background:

• Reliable case definitions (CDs) for cannabis use disorder (CUD) are vital for surveillance and research.
• Increasing reliance on administrative health data necessitates robust CUD definitions.
• Current diagnostic coding practices and limited validation may compromise CUD estimate accuracy.

Purpose of the Study:

• To systematically identify, describe, and appraise CUD operationalization in administrative health data.
• To examine coding strategies and validation practices for CUD within these data sources.
• To assess the reliability of existing CUD definitions for research and policy.

Main Methods:

• Systematic literature search following PRISMA guidelines across major databases.
• Inclusion of studies using International Classification of Diseases (ICD) codes for CUD in administrative data.
• Independent data extraction and methodological quality assessment using the Newcastle-Ottawa Scale.

Main Results:

• 56 studies met inclusion criteria, primarily using ICD-9/ICD-10 codes for CUD identification.
• Operational details of CUD definitions varied significantly by jurisdiction and coding framework.
• No studies reported explicit internal or external validation of their CUD case definitions.
• Reported CUD prevalence estimates showed extreme variability (0.06% to 76.9%).

Conclusions:

• Existing CUD case definitions in administrative data are highly variable and lack empirical validation.
• This variability and lack of validation limit the reliability of CUD estimates for surveillance and comparative research.
• Standardized and validated CUD definitions are essential for advancing cannabis epidemiology and ensuring reproducible research.