Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Feb 22, 2023
Date Accepted: Sep 26, 2023
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Optimal look-back period to identify true incident cases of diabetes for the Chinese population in insurance data
ABSTRACT
Background:
Accurate estimate of incidence and prevalence is vital to preventing and controlling diabetes. Administrative data, like Insurance data, disease register data, can be used to estimate the incidence of diabetes. A look-back period (LP) is used to remove cases with preceding records to avoid overestimation of incidence. Researchers are in a dilemma when confirming the length of LP. A short LP will cause the overestimation of the incidence, whereas a long LP will limit the use of a database. Therefore, it is necessary to determine the optimal length of LP when identify the incident cases in administrative data.
Objective:
This study aims to first identify the optimal LP of diabetes for the Chinese population by using medical insurance data with different methods.
Methods:
The insurance database from Weifang city of China between January 2016 and December 2020 was used. To identify the incident cases in 2020, we removed prevalent patients with preceding records of diabetes between 2016 and 2019 (four-year LP). Using this four-year LP as a reference, consistency examination indexes (CEIs), including positive predictive values, Kappa coefficient, and overestimation rate were calculated and combined with the result of the retrograde survival model to determine the optimal LP for Chinese diabetes patients.
Results:
The Kappa agreement is excellent (0.925), with a high PPVs (92.2%), and a low overestimation rate (8.4%) after a two-year LP. As for the retrograde survival function, Survival probability dropped rapidly during the first one-year LP (from 1.00 to 0.11). At around 400 days of LP, the hazard function approximately reaches zero (), while the frequency of increases dramatically and remains at 0.10 stably, showing that a two-year LP is optimal for Chinese diabetes patients.
Conclusions:
The retrograde survival method and CEIs are both effective. Two-year LP should be considered when identifying the incident cases of diabetes using the insurance data for the Chinese.
Citation
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