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Open Access Research article

Coding of obesity in administrative hospital discharge abstract data: accuracy and impact for future research studies

Billie-Jean Martin1*, Guanmin Chen1, Michelle Graham2 and Hude Quan1

Author Affiliations

1 Department of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, Room C849, 8th Floor Cardiology, 1403 29th Street NW, Calgary, AB T2N 2 T9, Canada

2 Department of Medicine, University of Alberta, Edmonton, AB Canada

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BMC Health Services Research 2014, 14:70  doi:10.1186/1472-6963-14-70

Published: 13 February 2014

Abstract

Background

Obesity is a pervasive problem and a popular subject of academic assessment. The ability to take advantage of existing data, such as administrative databases, to study obesity is appealing. The objective of our study was to assess the validity of obesity coding in an administrative database and compare the association between obesity and outcomes in an administrative database versus registry.

Methods

This study was conducted using a coronary catheterization registry and an administrative database (Discharge Abstract Database (DAD)). A Body Mass Index (BMI) ≥30 kg/m2 within the registry defined obesity. In the DAD obesity was defined by diagnosis codes E65 – E68 (ICD-10). The sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) of an obesity diagnosis in the DAD was determined using obesity diagnosis in the registry as the referent. The association between obesity and outcomes was assessed.

Results

The study population of 17380 subjects was largely male (68.8%) with a mean BMI of 27.0 kg/m2. Obesity prevalence was lower in the DAD than registry (2.4% vs. 20.3%). A diagnosis of obesity in the DAD had a sensitivity 7.75%, specificity 98.98%, NPV 80.84% and PPV 65.94%. Obesity was associated with decreased risk of death or re-hospitalization, though non-significantly within the DAD. Obesity was significantly associated with an increased risk of cardiac procedure in both databases.

Conclusions

Overall, obesity was poorly coded in the DAD. However, when coded, it was coded accurately. Administrative databases are not an optimal datasource for obesity prevalence and incidence surveillance but could be used to define obese cohorts for follow-up.

Keywords:
Obesity; Coding; Administrative data; Clinical databases; ICD-10