How accurate are diagnoses for rheumatoid arthritis and juvenile idiopathic arthritis in the general practice research database?


Thomas, SL; Edwards, CJ; Smeeth, L; Cooper, C; Hall, AJ; (2008) How accurate are diagnoses for rheumatoid arthritis and juvenile idiopathic arthritis in the general practice research database? Arthritis and rheumatism, 59 (9). pp. 1314-21. ISSN 0004-3591 DOI: 10.1002/art.24015

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Abstract

OBJECTIVE: To identify characteristics that predict a valid rheumatoid arthritis (RA) or juvenile idiopathic arthritis (JIA) diagnosis among RA- and JIA-coded individuals in the General Practice Research Database (GPRD), and to assess limitations of this type of diagnostic validation. METHODS: Four RA and 2 JIA diagnostic groups were created with differing strengths of evidence of RA/JIA (Group 1 = strongest evidence), based on RA/JIA medical codes. Individuals were sampled from each group and clinical and prescription data were extracted from anonymized hospital/practice correspondence and electronic records. American College of Rheumatology and International League of Associations for Rheumatology diagnostic criteria were used to validate diagnoses. A data-derived diagnostic algorithm that maximized sensitivity and specificity was identified using logistic regression. RESULTS: Among 223 RA-coded individuals, the diagnostic algorithm classified individuals as having RA if they had an appropriate GPRD disease-modifying antirheumatic drug prescription or 3 other GPRD characteristics: >1 RA code during followup, RA diagnostic Group 1 or 2, and no later alternative diagnostic code. This algorithm had >80% sensitivity and specificity when applied to a test data set. Among 101 JIA-coded individuals, the strongest predictor of a valid diagnosis was a Group 1 diagnostic code (>90% sensitivity and specificity). CONCLUSION: Validity of an RA diagnosis among RA-coded GPRD individuals appears high for patients with specific characteristics. The findings are important for both interpreting results of published GPRD studies and identifying RA/JIA patients for future GPRD-based research. However, several limitations were identified, and further debate is needed on how best to validate chronic disease diagnoses in the GPRD.

Item Type: Article
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology
Faculty of Epidemiology and Population Health > Dept of Non-Communicable Disease Epidemiology
Research Centre: Centre for Global Non-Communicable Diseases (NCDs)
PubMed ID: 18759262
Web of Science ID: 259669700014
URI: http://researchonline.lshtm.ac.uk/id/eprint/7168

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