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Open Access Highly Accessed Open Badges Research article

Verifying a questionnaire diagnosis of asthma in children using health claims data

Connie L Yang1, Teresa To2, Richard G Foty2, David M Stieb3 and Sharon D Dell12*

Author Affiliations

1 Division of Respiratory Medicine, Hospital for Sick Children, Toronto, Canada

2 Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Canada

3 Health Canada, Ottawa, Ontario, Canada

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BMC Pulmonary Medicine 2011, 11:52  doi:10.1186/1471-2466-11-52

Published: 22 November 2011



Childhood asthma prevalence is widely measured by parental proxy report of physician-diagnosed asthma in questionnaires. Our objective was to validate this measure in a North American population.


The 2884 study participants were a subsample of 5619 school children aged 5 to 9 years from 231 schools participating in the Toronto Child Health Evaluation Questionnaire study in 2006. We compared agreement between "questionnaire diagnosis" and a previously validated "health claims data diagnosis". Sensitivity, specificity and kappa were calculated for the questionnaire diagnosis using the health claims diagnosis as the reference standard.


Prevalence of asthma was 15.7% by questionnaire and 21.4% by health claims data. Questionnaire diagnosis was insensitive (59.0%) but specific (95.9%) for asthma. When children with asthma-related symptoms were excluded, the sensitivity increased (83.6%), and specificity remained high (93.6%).


Our results show that parental report of asthma by questionnaire has low sensitivity but high specificity as an asthma prevalence measure. In addition, children with "asthma-related symptoms" may represent a large fraction of under-diagnosed asthma and they should be excluded from the inception cohort for risk factor studies.