Validity of type 2 diabetes diagnosis in a population-based electronic health record database.
BACKGROUND
The increasing burden of type 2 diabetes mellitus makes the continuous surveillance of its prevalence and incidence advisable. Electronic health records (EHRs) have great potential for research and surveillance purposes; however the quality of their data must first be evaluated for fitness for use. The aim of this study was to assess the validity of type 2 diabetes diagnosis in a primary care EHR database covering more than half a million inhabitants, 97% of the population in Navarra, Spain.


METHODS
In the Navarra EPIC-InterAct study, the validity of the T90 code from the International Classification of Primary Care, Second Edition was studied in a primary care EHR database to identify incident cases of type 2 diabetes, using a multi-source approach as the gold standard. The sensitivity, specificity, positive predictive value, negative predictive value and the kappa index were calculated. Additionally, type 2 diabetes prevalence from the EHR database was compared with estimations from a health survey.


RESULTS
The sensitivity, specificity, positive predictive value and negative predictive value of incident type 2 diabetes recorded in the EHRs were 98.2, 99.3, 92.2 and 99.8%, respectively, and the kappa index was 0.946. Overall prevalence of type 2 diabetes diagnosed in the EHRs among adults (35-84 years of age) was 7.2% (95% confidence interval [CI] 7.2-7.3) in men and 5.9% (95% CI 5.8-5.9) in women, which was similar to the prevalence estimated from the health survey: 8.5% (95% CI 7.1-9.8) and 5.5% (95% CI 4.4-6.6) in men and women, respectively.


CONCLUSIONS
The high sensitivity and specificity of type 2 diabetes diagnosis found in the primary care EHRs make this database a good source for population-based surveillance of incident and prevalent type 2 diabetes, as well as for monitoring quality of care and health outcomes in diabetic patients.
['Moreno-Iribas|Conchi|C|', 'Sayon-Orea|Carmen|C|', 'Delfrade|Josu|J|', 'Ardanaz|Eva|E|', 'Gorricho|Javier|J|', 'Burgui|Rosana|R|', 'Nuin|Marian|M|', 'Guevara|Marcela|M|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D016208:Databases, Factual D003924:Diabetes Mellitus, Type 2 D057286:Electronic Health Records D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D011320:Primary Health Care D015203:Reproducibility of Results D012680:Sensitivity and Specificity D013030:Spain
Validity Electronic health records Type 2 diabetes mellitus Incidence Primary care