Validation of medical claims data for obstructive lung disease diagnosis with medical records from an occupational clinic.
Gulati-M; Slade-M; Sircar-K; Taiwo-O; Cantley-L; Vesgo-S; Fiellin-M; Cullen-M
Proc Am Thorac Soc 2006 Apr; 3(Abstracts):A654
Medical claims (MC) may be a valuable tool in occupational studies of obstructive lung disease (OLD); MC data can identify OLD and be linked to exposure and other datasets.Few occupational studies have validated MC usage. In a case control study,we compared the OLD MC diagnosis in aluminum workers with medical records from an onsite occupational clinic.Of 1293 workers with any MC between the 2 years 2001-2002,64 had at least 1 OLD MC for asthma, chronic bronchitis, emphysema or chronic airflow obstruction.We reviewed records of 53 of 64 cases and 60 matched controls.We recorded chart OLD diagnosis, smoking status and spirometry.We used 2 MC diagnostic strategies:in the first,the presence of at least 1 OLD MC defined a case.In the second stricter strategy,we required at least 2 MC or any MC for a hospitalization.We calculated kappa statistics (k) for MC and chart agreeement. All workers were predominantly Caucasian male and had a mean age and employment duration of over 40 yo and 15 yrs.46% of cases v 33% of controls ever smoked (p=0.17).There were 181 claims for 81 service dates;4 of 10 workers with MC for non-asthma OLD also had an asthma MC.30 of 53 (56%) with 1+ OLD MC had a chart diagnosis compared to 16 of 19 (84%) with 2+ MC or any MC for a hospitalization.The when using the 1 + MC criteria was 0.47 (95% CI: 0.32-0.63) and 0.46 (95% CI: 0.29-0.64) when using the stricter criteria.Airflow obstruction (FEV1/FVC<70%) was similar between cases and controls (18% vs. 20%, p=0.74);7 workers with obstruction had no OLD MC or chart record. Medical claims can identify OLD cases in occupational studies.Also, despite evidence of obstruction during spirometry surveillance, providers may not diagnose OLD.
Lung-disease; Diseases; Medical-screening; Medical-examinations; Occupational-health-services; Health-care-facilities; Occupational-health; Occupational-diseases; Occupational-exposure; Case-studies; Bronchial-asthma; Air-flow; Airway-obstruction; Spirometry; Pulmonary-system-disorders; Respiratory-system-disorders; Workers; Worker-health; Demographic-characteristics; Age-factors; Sex-factors; Surveillance-programs
Issue of Publication
Proceedings of the American Thoracic Society