中华人民共和国全国医疗保险系统报道的慢性阻塞性肺疾病诊断的有效性
2016/05/31
摘要
背景：慢性阻塞性肺病（COPD）是全世界第四大死亡疾病，尤其在中国死亡率更高，甚至在不吸烟者中也是如此。大的人群为基础的队列研究应该可以对疾病的决定因素进行可靠的评估，这个可靠的评估依赖于疾病诊断的质量。我们通过电子健康记录信息在中国收集慢性阻塞性肺病诊断，并对其有效性进行评估。
方法：2004-2008年间，中国慢性病前瞻性研究从中国十个不同的地区招募了50万名年龄30-79岁之间成年人。在7年的随访中，11800例慢性阻塞性肺病患者通过死亡登记和国家健康保险系统的联动被识别。我们随机选择约10%的COPD患者，并对1069例患者检索到的医院病历进行了独立的裁断。
结果：总的来说，这1069例患者累计超过9年时间（2004-2013年）涉及10个地区153家医院。即使肺功能测试并没有广泛地在医院的常规治疗中使用（14%），诊断证实了911例COPD病患（85%），对应的阳性预测值为85%（95%可信区间[CI]：83% - 87%）。当患者从死亡登记和医疗保险系统（97%，95%可信区间：94% - 100%）同时被记录时，COPD的阳性预测价值在医院排名和时间上变化并不显着，但男性高于女性（89% VS 79%），70岁以上的老年人高于年轻人（88%，95%可信区间：85% - 91%）。其余病例中，87例（8.1%）有其他呼吸系统疾病（主要是肺炎和哮喘；n=85），71例（6.6%）没有发现任何呼吸道疾病的临床记录的。
结论：在中国，从电子健康记录中获得的COPD诊断有很好的质量，适合用于基于大群体的研究，不保证所有报告病例的系统性裁决。
（杨冬审校）
Int J Chron Obstruct Pulmon Dis. 2016 Mar 1;11:419-30. doi: 10.2147/COPD.S100736. eCollection 2016.
Validity of COPD diagnoses reported through nationwide health insurance systems in the People's Republic of China.
Kurmi OP1, Vaucher J1, Xiao D2, Holmes MV1, Guo Y3, Davis KJ4, Wang C5, Qin H6, Turnbull I1, Peng P7, Bian Z3, Clarke R1, Li L8, Chen Y1, Chen Z1.
Author information
Abstract
BACKGROUND:COPD is the fourth leading cause of death worldwide, with particularly high rates in the People's Republic of China, even among never smokers. Large population-based cohort studies should allow for reliable assessment of the determinants of diseases, which is dependent on the quality of disease diagnoses. We assessed the validity of COPD diagnoses collected through electronic health records in the People's Republic of China.
METHODS:The CKB study recruited 0.5 million adults aged 30-79 years from ten diverse regions in the People's Republic of China during the period 2004-2008. During 7 years of follow-up, 11,800 COPD cases were identified by linkage with mortality registries and the national health insurance system. We randomly selected ~10% of the reported COPD cases and then undertook an independent adjudication of retrieved hospital medical records in 1,069 cases.
RESULTS:Overall, these 1,069 cases were accrued over a 9-year period (2004-2013) involving 153 hospitals across ten regions. A diagnosis of COPD was confirmed in 911 (85%) cases, corresponding to a positive predictive value of 85% (95% confidence interval [CI]: 83%-87%), even though spirometry testing was not widely used (14%) in routine hospital care. The positive predictive value for COPD did not vary significantly by hospital ranking or calendar period, but was higher in men than women (89% vs 79%), at age ≥70 years than in younger people (88%, 95% CI: 85%-91%), and when the cases were reported from both death registry and health insurance systems (97%, 95% CI: 94%-100%). Among the remaining cases, 87 (8.1%) had other respiratory diseases (chiefly pneumonia and asthma; n=85) and 71 (6.6%) cases showed no evidence of any respiratory disease on their clinical records.
CONCLUSION:In the People's Republic of China, COPD diagnoses obtained from electronic health records are of good quality and suitable for large population-based studies and do not warrant systematic adjudication of all the reported cases.
Int J Chron Obstruct Pulmon Dis. 2016 Mar 1;11:419-30. doi: 10.2147/COPD.S100736. eCollection 2016.
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哮喘与COPD中甲壳质酶蛋白40 (YKL-40) 和壳三糖酶水平升高
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病毒感染对门诊中哮喘急性发作的影响：一项前瞻性研究
