Cargando…

CKD Prevalence in the Military Health System: Coded Versus Uncoded CKD

RATIONALE & OBJECTIVE: Chronic kidney disease (CKD) is common but often goes unrecorded. STUDY DESIGN: Cross-sectional. SETTING & PARTICIPANTS: Military Health System (MHS) beneficiaries aged 18 to 64 years who received care during fiscal years 2016 to 2018. PREDICTORS: Age, sex, active duty...

Descripción completa

Detalles Bibliográficos
Autores principales: Norton, Jenna M., Grunwald, Lindsay, Banaag, Amanda, Olsen, Cara, Narva, Andrew S., Marks, Eric, Koehlmoos, Tracey P.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8350811/
https://www.ncbi.nlm.nih.gov/pubmed/34401726
http://dx.doi.org/10.1016/j.xkme.2021.03.015
_version_ 1783735850509533184
author Norton, Jenna M.
Grunwald, Lindsay
Banaag, Amanda
Olsen, Cara
Narva, Andrew S.
Marks, Eric
Koehlmoos, Tracey P.
author_facet Norton, Jenna M.
Grunwald, Lindsay
Banaag, Amanda
Olsen, Cara
Narva, Andrew S.
Marks, Eric
Koehlmoos, Tracey P.
author_sort Norton, Jenna M.
collection PubMed
description RATIONALE & OBJECTIVE: Chronic kidney disease (CKD) is common but often goes unrecorded. STUDY DESIGN: Cross-sectional. SETTING & PARTICIPANTS: Military Health System (MHS) beneficiaries aged 18 to 64 years who received care during fiscal years 2016 to 2018. PREDICTORS: Age, sex, active duty status, race, diabetes, hypertension, and numbers of kidney test results. OUTCOMES: We defined CKD by International Classification of Diseases, Tenth Revision (ICD-10) code and/or a positive result on a validated electronic phenotype that uses estimated glomerular filtration rate and measures of proteinuria with evidence of chronicity. We defined coded CKD by the presence of an ICD-10 code. We defined uncoded CKD by a positive e-phenotype result without an ICD-10 code. ANALYTICAL APPROACH: We compared coded and uncoded populations using 2-tailed t tests (continuous variables) and Pearson χ(2) test for independence (categorical variables). RESULTS: The MHS population included 3,330,893 beneficiaries. Prevalence of CKD was 3.2%, based on ICD code and/or positive e-phenotype result. Of those identified with CKD, 63% were uncoded. Compared with beneficiaries with coded CKD, those with uncoded CKD were younger (aged 45 ± 13 vs 52 ± 11 years), more often women (54.4% vs 37.6%) and active duty (20.2% vs 12.5%), and less often of Black race (18.5% vs 31.5%) or with diabetes (23.5% vs 43.5%) or hypertension (46.6% vs 77.1%; P < 0.001). Beneficiaries with coded (vs uncoded) CKD had greater numbers of kidney test results (P < 0.001). LIMITATIONS: Use of cross-sectional administrative data prevents inferences about causality. The CKD e-phenotype may fail to capture CKD in individuals without laboratory data and may underestimate CKD. CONCLUSIONS: The prevalence of CKD in the MHS is ~3.2%. Beneficiaries with well-known CKD risk factors, such as older age, male sex, Black race, diabetes, and hypertension, were more likely to be coded, suggesting that clinicians may be missing CKD in groups traditionally considered lower risk, potentially resulting in suboptimal care.
format Online
Article
Text
id pubmed-8350811
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher Elsevier
record_format MEDLINE/PubMed
spelling pubmed-83508112021-08-15 CKD Prevalence in the Military Health System: Coded Versus Uncoded CKD Norton, Jenna M. Grunwald, Lindsay Banaag, Amanda Olsen, Cara Narva, Andrew S. Marks, Eric Koehlmoos, Tracey P. Kidney Med Original Research RATIONALE & OBJECTIVE: Chronic kidney disease (CKD) is common but often goes unrecorded. STUDY DESIGN: Cross-sectional. SETTING & PARTICIPANTS: Military Health System (MHS) beneficiaries aged 18 to 64 years who received care during fiscal years 2016 to 2018. PREDICTORS: Age, sex, active duty status, race, diabetes, hypertension, and numbers of kidney test results. OUTCOMES: We defined CKD by International Classification of Diseases, Tenth Revision (ICD-10) code and/or a positive result on a validated electronic phenotype that uses estimated glomerular filtration rate and measures of proteinuria with evidence of chronicity. We defined coded CKD by the presence of an ICD-10 code. We defined uncoded CKD by a positive e-phenotype result without an ICD-10 code. ANALYTICAL APPROACH: We compared coded and uncoded populations using 2-tailed t tests (continuous variables) and Pearson χ(2) test for independence (categorical variables). RESULTS: The MHS population included 3,330,893 beneficiaries. Prevalence of CKD was 3.2%, based on ICD code and/or positive e-phenotype result. Of those identified with CKD, 63% were uncoded. Compared with beneficiaries with coded CKD, those with uncoded CKD were younger (aged 45 ± 13 vs 52 ± 11 years), more often women (54.4% vs 37.6%) and active duty (20.2% vs 12.5%), and less often of Black race (18.5% vs 31.5%) or with diabetes (23.5% vs 43.5%) or hypertension (46.6% vs 77.1%; P < 0.001). Beneficiaries with coded (vs uncoded) CKD had greater numbers of kidney test results (P < 0.001). LIMITATIONS: Use of cross-sectional administrative data prevents inferences about causality. The CKD e-phenotype may fail to capture CKD in individuals without laboratory data and may underestimate CKD. CONCLUSIONS: The prevalence of CKD in the MHS is ~3.2%. Beneficiaries with well-known CKD risk factors, such as older age, male sex, Black race, diabetes, and hypertension, were more likely to be coded, suggesting that clinicians may be missing CKD in groups traditionally considered lower risk, potentially resulting in suboptimal care. Elsevier 2021-06-02 /pmc/articles/PMC8350811/ /pubmed/34401726 http://dx.doi.org/10.1016/j.xkme.2021.03.015 Text en https://creativecommons.org/licenses/by/4.0/This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Original Research
Norton, Jenna M.
Grunwald, Lindsay
Banaag, Amanda
Olsen, Cara
Narva, Andrew S.
Marks, Eric
Koehlmoos, Tracey P.
CKD Prevalence in the Military Health System: Coded Versus Uncoded CKD
title CKD Prevalence in the Military Health System: Coded Versus Uncoded CKD
title_full CKD Prevalence in the Military Health System: Coded Versus Uncoded CKD
title_fullStr CKD Prevalence in the Military Health System: Coded Versus Uncoded CKD
title_full_unstemmed CKD Prevalence in the Military Health System: Coded Versus Uncoded CKD
title_short CKD Prevalence in the Military Health System: Coded Versus Uncoded CKD
title_sort ckd prevalence in the military health system: coded versus uncoded ckd
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8350811/
https://www.ncbi.nlm.nih.gov/pubmed/34401726
http://dx.doi.org/10.1016/j.xkme.2021.03.015
work_keys_str_mv AT nortonjennam ckdprevalenceinthemilitaryhealthsystemcodedversusuncodedckd
AT grunwaldlindsay ckdprevalenceinthemilitaryhealthsystemcodedversusuncodedckd
AT banaagamanda ckdprevalenceinthemilitaryhealthsystemcodedversusuncodedckd
AT olsencara ckdprevalenceinthemilitaryhealthsystemcodedversusuncodedckd
AT narvaandrews ckdprevalenceinthemilitaryhealthsystemcodedversusuncodedckd
AT markseric ckdprevalenceinthemilitaryhealthsystemcodedversusuncodedckd
AT koehlmoostraceyp ckdprevalenceinthemilitaryhealthsystemcodedversusuncodedckd