Performance of administrative case definitions for comorbidity in multiple sclerosis in Manitoba and Nova Scotia.

INTRODUCTION: As the population ages and the prevalence of comorbid conditions increases, the need for feasible, validated methods of comorbidity surveillance in chronic diseases such as multiple sclerosis (MS) increases. METHODS: Using kappa (k) statistics, we evaluated the performance of administrative case definitions for comorbidities commonly observed in MS by comparing agreement between Manitoba (MB) administrative data and self-report (n = 606) and Nova Scotia (NS) administrative data and self-report (n = 1923). RESULTS: Agreement between the administrative definitions and self-report was substantial for hypertension (k = 0.69 [NS], 0.76 [MB]) and diabetes (k = 0.70 [NS], 0.66 [MB]); moderate for hyperlipidemia (k = 0.53 [NS], 0.51 [MB]) and heart disease (k = 0.42 [NS], 0.51 [MB]) and fair for anxiety (k = 0.27 [NS], 0.26 [MB]). In NS, agreement was substantial for inflammatory bowel disease (k = 0.71) and moderate for epilepsy (k = 0.48). CONCLUSION: Administrative definitions for commonly observed comorbidities in MS performed well in 2 distinct jurisdictions. This suggests that they could be used more broadly across Canada and in national studies.

TITRE: Performance des définitions administratives de cas pour les affections concomitantes de la sclérose en plaques au Manitoba et en Nouvelle-Écosse. INTRODUCTION: Au fur et à mesure du vieillissement de la population et de l'augmentation de la prévalence d'affections concomitantes, le recours à des méthodes fiables et efficaces de surveillance des affections concomitantes de maladies chroniques telles que la sclérose en plaques (SP) s'avère de plus en plus nécessaire. MÉTHODOLOGIE: Nous avons évalué, au moyen de la statistique kappa (k), la performance des définitions administratives de cas pour les affections concomitantes fréquemment observées en lien avec la SP en comparant les concordances entre les données administratives et les données provenant d'autodéclarations au Manitoba (MB) (n = 606) et en Nouvelle-Écosse (NS) (n = 1 923). RÉSULTATS: Les concordances entre les définitions administratives et les autodéclarations étaient bonnes pour l'hypertension (k = 0,69 [NS] et 0,76 [MB]) et le diabète (k = 0,70 [NS] et 0,66 [MB]), modérées pour l'hyperlipidémie (k = 0,53 [NS] et 0,51 [MB]) et la cardiopathie (k = 0,42 [NS] et 0,51 [MB]) et médiocres pour l'anxiété (k = 0,27 [NS] et 0,26 [MB]). La concordance était bonne en Nouvelle-Écosse pour la maladie inflammatoire chronique de l'intestin (k = 0,71) et modérée pour l'épilepsie (k = 0,48). CONCLUSION: Les définitions administratives étaient performantes dans les deux provinces pour plusieurs affections concomitantes fréquemment observées en lien avec la SP. À la lumière de ces résultats, il semble que ces définitions puissent être utilisées plus largement au Canada et dans les études nationales.

The incidence of fracture among patients with inflammatory bowel disease. A population-based cohort study.

BACKGROUND: The clinical significance of the high prevalence of osteopenia in inflammatory bowel disease is unclear. OBJECTIVE: To determine whether persons with inflammatory bowel disease have increased incidence of fracture. DESIGN: Population-based matched cohort study. SETTING: Manitoba, Canada. PATIENTS: Patients with inflammatory bowel disease in the University of Manitoba IBD Database (n = 6027) were matched to 10 randomly selected persons in the general population without inflammatory bowel disease (n = 60 270) by year, age, sex, and postal area of residence. MEASUREMENTS: The incidence of hospitalization for hip fracture was determined on the basis of hospital discharge abstracts. Outpatient medical billing records and hospital discharge abstracts were used to calculate the incidence of spine, rib, and forearm fractures. Rates were calculated on the basis of person-years of follow-up for 1984 to 1997. RESULTS: Persons with inflammatory bowel disease had significantly increased incidence of fractures at the spine (incidence rate ratio [IRR], 1.74 [95% CI, 1.34 to 2.24]; P < 0.001), hip (IRR, 1.59 [CI, 1.27 to 2.00]; P < 0.001), wrist/forearm (IRR, 1.33 [CI, 1.11 to 1.58]; P = 0.001), and rib (IRR, 1.25 [CI, 1.02 to 1.52]; P = 0.03) and of any of these fractures (IRR, 1.41 [CI, 1.27 to 1.56]; P < 0.001). CONCLUSION: The incidence of fracture among persons with inflammatory bowel disease is 40% greater than that in the general population.