Claims-Based Definition of Death in Japanese Claims Database: Validity and ImplicationsReport as inadecuate




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Background

For the pending National Claims Database in Japan, researchers will not have access to death information in the enrollment files. We developed and evaluated a claims-based definition of death.

Methodology-Principal Findings

We used healthcare claims and enrollment data between January 2005 and August 2009 for 195,193 beneficiaries aged 20 to 74 in 3 private health insurance unions. We developed claims-based definitions of death using discharge or disease status and Charlson comorbidity index CCI. We calculated sensitivity, specificity and positive predictive values PPVs using the enrollment data as a gold standard in the overall population and subgroups divided by demographic and other factors. We also assessed bias and precision in two example studies where an outcome was death. The definition based on the combination of discharge-disease status and CCI provided moderate sensitivity around 60% and high specificity 99.99% and high PPVs 94.8%. In most subgroups, sensitivity of the preferred definition was also around 60% but varied from 28 to 91%. In an example study comparing death rates between two anticancer drug classes, the claims-based definition provided valid and precise hazard ratios HRs. In another example study comparing two classes of anti-depressants, the HR with the claims-based definition was biased and had lower precision than that with the gold standard definition.

Conclusions-Significance

The claims-based definitions of death developed in this study had high specificity and PPVs while sensitivity was around 60%. The definitions will be useful in future studies when used with attention to the possible fluctuation of sensitivity in some subpopulations.



Author: Nobuhiro Ooba, Soko Setoguchi, Takashi Ando, Tsugumichi Sato, Takuhiro Yamaguchi, Mayumi Mochizuki, Kiyoshi Kubota

Source: http://plos.srce.hr/



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