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ICD-10 codes predict gestational diabetes burden
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ICD-10 codes could be used to accurately estimate the population-level burden of gestational diabetes, according to researchers in Canada.
“ICD codes in administrative health databases are often used to estimate the prevalence of gestational diabetes at the population level,” Samantha L. Bowker, BA, MSc, PhD, of the school of public health at the University of Alberta, Edmonton, and colleagues wrote. “However, to our knowledge, there have been no previous reports in the literature on the validity of ICD-10 codes for gestational diabetes relative to glucose thresholds from laboratory data.”
Researchers analyzed data from 58,338 singleton deliveries among women aged 12 to 54 years between Oct. 1, 2008, and March 31, 2010, in the province of Alberta. Bowker and colleagues used laboratory diagnoses of gestational diabetes to determine the sensitivity, specificity, positive predictive value, false positives and false negatives of a gestational diabetes code in outpatients, inpatients and combined inpatients and outpatients, as well as the Alberta Perinatal Health Program (APHP) databases.
Mean maternal age was 29.5 years, and 18.1% of patients were aged at least 35 years at delivery. Most (81.4%) were non-Chinese, non-South Asian and non-aboriginal. Prevalence of gestational diabetes was 5.2% in the outpatient-only group, 4.8% in the inpatient-only group, 5.8% in the combined group and 4.8% in the APHP database group, Bowker and colleagues reported. Overall prevalence of gestational diabetes was 3.6% in laboratory data, and another 1,502 (2.6%) pregnancies were considered to have impaired glucose tolerance. Combining the inpatient and outpatient databases produced the highest sensitivity (92%) and specificity (97%), the researchers wrote. Positive predictive value was 57% to 62% across groups, which Bowker and colleagues attributed to a high number of false positives. The researchers noted, however, that 81% of false positives in the outpatient-only group, along with 84.8% in the inpatient-only group, 77.9% in the combined group and 85.3% in the APHP databases qualified as impaired glucose tolerance.
The results, the researchers wrote, suggest impaired glucose tolerance was often coded as gestational diabetes in databases.
“In summary, ICD-10 codes for gestational diabetes in administrative databases, especially when outpatient and inpatient databases are combined, are highly sensitive and specific and can be used to estimate the burden of the disease reliably at the population level,” Bowker and colleagues wrote. “As impaired glucose tolerance in pregnancy and gestational diabetes are often managed and treated similarly in clinical practice, impaired glucose tolerance in pregnancy is often coded as gestational diabetes in administrative and perinatal databases.” – by Andy Polhamus
Disclosure: The researchers report no relevant financial disclosures.
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