Copyright © 2004 by the Johns Hopkins Bloomberg School of Public Health
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Trends in the Sensitivity, Positive Predictive Value, False-Positive Rate, and Comparability Ratio of Hospital Discharge Diagnosis Codes for Acute Myocardial Infarction in Four US Communities, 1987–2000
1 Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill, NC.
2 Collaborative Studies Coordinating Center, Department of Biostatistics, School of Public Health, University of North Carolina, Chapel Hill, NC.
3 Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, Bethesda, MD.
4 Department of Epidemiology, School of Public Health, State University of New York, Albany, NY.
5 Department of Epidemiology and Health Services Evaluation, Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheva, Israel.
6 Department of Pediatrics, School of Medicine, University of Mississippi, Jackson, MS.
7 Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, MN.
Variations in the validity of hospital discharge diagnoses can complicate the assessment of trends in incidence of acute myocardial infarction (AMI). To clarify trends in the validity of discharge codes, the authors compared event classification based on published Atherosclerosis Risk in Communities (ARIC) Study criteria with the presence or absence of an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) hospital discharge code for AMI (code 410). Between 1987 and 2000, 154,836 coronary heart disease events involving hospitalization in the four ARIC communities had ICD-9-CM codes screened for AMI. The sensitivity of ICD-9-CM code 410 for classifying AMI in men (sensitivity = 0.65, 95% confidence interval (CI): 0.63, 0.66) was statistically significantly greater than that found for women (sensitivity = 0.60, 95% CI: 0.58, 0.62) and was greater in Whites (sensitivity = 0.67, 95% CI: 0.65, 0.68) than in Blacks (sensitivity = 0.50, 95% CI: 0.47, 0.53). The ethnic difference was related to a greater frequency of hypertensive heart disease and congestive heart failure codes encompassing AMI among Blacks as compared with Whites. The authors found that although the validity of ICD-9-CM code 410 to identify AMI was generally stable from 1987 through 2000, differences between Blacks and Whites and across geographic locations support investment in validation efforts in ongoing surveillance studies.
coronary disease; diagnosis; hospital records; myocardial infarction; population surveillance; validation studies [publication type]
Abbreviations: Abbreviations: AMI, acute myocardial infarction; ARIC, Atherosclerosis Risk in Communities; CI, confidence interval; ICD-9-CM, International Classification of Diseases, Ninth Revision, Clinical Modification.
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