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Predict and diabetes

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  • 1. Validity of Diabetes Prevalence from Health Data Simon Thornley, Craig Wright, Roger Marshall, Gary Jackson, Paul L Drury, Susan Wells, James Smith, Wing Cheuk Chan, Romana Pylypchuk, Rod Jackson. NZSSD Conference Apr 2010 Simon Thornley, Wing Cheuk Chan, Paul Drury, Rod Jackson
  • 2. Outline  Diabetes prevalence  Routine data  Accuracy  Compare to primary care database  Capture-Recapture  Diagnosed vs undiagnosed
  • 3. Diabetes Prevalence  Rapid increase last 30 years  Time trends  Health Planning  Primary Prevention efficacy
  • 4. Surveys  e.g. 2005 NZHS  Not frequent  Limited by selection bias (e.g. 70% response) Simon Thornley, Wing Cheuk Chan, Paul Drury, Rod Jackson
  • 5. Health data Linked by NHI Dispensing, Diagnoses, Labs, Mortality, GP. Improved quality since 2006, >90% NHI linkage Similar overall prevalence to survey results (Smith 2010) Simon Thornley, Wing Cheuk Chan, Paul Drury, Rod Jackson
  • 6. Algorithm  Record review  Diabetes if:  5+ HbA last two years 1c  Hospital ICD(1998-2008)  Diabetes clinic ('04-'08)  Dispensing ('01-'08) Simon Thornley, Wing −insulin/oral hypo Cheuk Chan, Paul Drury, Rod Jackson
  • 7. Aim  Assess validity of derived diabetes prevalence  Compare to Primary care cohort (PREDICT) Wing Simon Thornley, Cheuk Chan, Paul Drury, Rod Jackson
  • 8. “Gold Standard”  PREDICT TM CVD RISK  GP entered diagnosis.  >100,000('00-'10)  54,000 enter '07-'08  Upper North Island Simon Thornley, Wing Cheuk Chan, Paul Drury, Rod Jackson
  • 9. Agreement?  PREDICT vs. Algorithm?  Sensitivity, Specificity, Kappa  Capture-Recapture Simon Thornley, Wing Cheuk Chan, Paul Drury, Rod Jackson
  • 10.  Recording of diabetes status? Simon Thornley, Wing Cheuk Chan, Paul Drury, Rod Jackson
  • 11. Results  PREDICT: 53,911  20% Pac, 16% Maori  Diabetes prevalence  20.1% Algorithm  20.9% PREDICT  23.7% Capture-recap Simon Thornley, Wing Cheuk Chan, Paul Drury, Rod Jackson
  • 12. Results  Good agreement  Sens~86% P(A+|P+)  Spec~96% P(A-|P-)  Kappa~85%  Capture-Recapture  ~15% undercount in Algorithm  ~10% undercount in PREDICT Simon Thornley, Wing Cheuk Chan, Paul Drury, Rod Jackson
  • 13. Agreement Diagram Total Algorithm PREDICT Simon Thornley, Wing Cheuk Chan, Paul Drury, Rod Jackson
  • 14. Summary  Algorithm is accurate  High level agreement  Cheap, cost- effective method Simon Thornley, Wing Cheuk Chan, Paul Drury, Rod Jackson
  • 15. Thank You Dr Simon Thornley, Lecturer, University of Auckland Section of Epidemiology and Biostatistics s.thornley@auckland.ac.nz www.slideshare.net/sithor Simon Thornley, Wing Cheuk Chan, Paul Drury, Rod Jackson