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Performance of diagnostic coding and laboratory testing results to measure COVID-19 during pregnancy and associations with pregnancy outcomes.
Regan, Annette K; Arah, Onyebuchi A; Sullivan, Sheena G.
  • Regan AK; School of Nursing and Health Professions, University of San Francisco, Orange, California, USA.
  • Arah OA; Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles (UCLA), Los Angeles, California, USA.
  • Sullivan SG; OptumLabs Visiting Fellow, OptumLabs, Eden Prairie, MN, USA.
Paediatr Perinat Epidemiol ; 36(4): 508-517, 2022 07.
Article in English | MEDLINE | ID: covidwho-1650172
ABSTRACT

BACKGROUND:

Large-scale evaluation of COVID-19 is likely to rely on the quality of ICD coding. However, little is known about the validity of ICD-coded COVID-19 diagnoses.

OBJECTIVES:

To evaluate the performance of diagnostic codes in detecting COVID-19 during pregnancy.

METHODS:

We used data from a national cohort of 78,283 individuals with a pregnancy ending between 11 March 2020 and 31 January 2021 in the OptumLabs® Data Warehouse (OLDW). OLDW is a longitudinal, real-world data asset with de-identified administrative claims and electronic health record data. We identified all services with an ICD-10-CM diagnostic code of U07.1 and all laboratory claims records for COVID-19 diagnostic testing. We compared ICD-coded diagnoses to testing results to estimate positive and negative predictive values (PPV and NPV). To evaluate impact on risk estimation, we estimated risk of adverse pregnancy outcomes by source of exposure information.

RESULTS:

Of 78,283 pregnancies, 5644 had a laboratory test result for COVID-19. Testing was most common among older individuals, Hispanic individuals, those with higher socioeconomic status and those with a diagnosed medical condition or pregnancy complication; 52% of COVID-19 cases was identified through ICD-coded diagnosis alone, 19% from laboratory test results alone and 29% from both sources. Agreement between ICD-coded diagnosis and laboratory testing records was high 91% (95% confidence interval [CI] 90, 92). However, the PPV of ICD-code diagnosis was low (36%; 95% CI 33, 39). We observed up to a 50% difference in risk estimates of adverse pregnancy outcomes when exposure was based on laboratory testing results or diagnostic coding alone.

CONCLUSIONS:

More than one-in-five COVID-19 cases would be missed by using ICD-coded diagnoses alone to identify COVID-19 during pregnancy. Epidemiological studies exclusively relying on diagnostic coding or laboratory testing results are likely to be affected by exposure misclassification. Research and surveillance should draw upon multiple sources of COVID-19 diagnostic information.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 Type of study: Cohort study / Diagnostic study / Experimental Studies / Observational study / Prognostic study Limits: Female / Humans / Pregnancy Language: English Journal: Paediatr Perinat Epidemiol Journal subject: Epidemiology / Pediatrics / Perinatology Year: 2022 Document Type: Article Affiliation country: Ppe.12863

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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 Type of study: Cohort study / Diagnostic study / Experimental Studies / Observational study / Prognostic study Limits: Female / Humans / Pregnancy Language: English Journal: Paediatr Perinat Epidemiol Journal subject: Epidemiology / Pediatrics / Perinatology Year: 2022 Document Type: Article Affiliation country: Ppe.12863