European Journal of Epidemiology

, Volume 13, Issue 4, pp 403–415 | Cite as

The validity of hospital discharge register data on coronary heart disease in Finland

  • Markku Mähönen
  • Veikko Salomaa
  • Mats Brommels
  • Anu Molarius
  • Heikki Miettinen
  • Kalevi Pyörälä
  • Jaakko Tuomilehto
  • Matti Arstila
  • Esko Kaarsalo
  • Matti Ketonen
  • Kari Kuulasmaa
  • Seppo Lehto
  • Harri Mustaniemi
  • Matti Niemelä
  • Pertti Palomäki
  • Jorma Torppa
  • Tapio Vuorenmaa
Article

Abstract

We studied the validity of the Finnish hospital discharge register data on coronary heart disease (CHD) for the purposes of epidemiologic studies and health services research. The Finnish nationwide hospital discharge register (HDR) was linked with the FINMONICA acute myocardial infarction (AMI) register for the years 1983–1990. The frequency of errors in the HDR was assessed separately. Between 8% and 13% of hospitalized AMI events registered in the AMI Register were not found in the HDR with an ICD code for CHD. Problems with the register linkage and the use of some ICD code other than one of the codes for CHD explained these missing events. The frequency of errors in the personal identification number was about 5% in the early 1980s. After 1986 errors were found only occasionally. The diagnosis recorded in the HDR was the same as that in the discharge sheet in about 95% of hospitalizations. The positive predictive value of the ICD code 410 (AMI), compared with the FINMONICA definite+possible AMI category, was very high and stable, about 90% in all areas and all hospitals, but it sensitivity varied from 50% at local hospitals to 80% at central hospitals. In summary, data on CHD obtained from the Finnish hospital discharge register give, on average, a correct picture on changes in the occurrence of AMI in Finland and can, with necessary caution, be used in epidemiological studies and health services research. However, the classification of individual cases is not standardized in the HDR, but varies over time, between geographical areas and the levels of care. Therefore, these data should not be used without confirmation in studies where correct classification of individual outcomes is of crucial importance, such as follow-up studies and case-control studies.

Coronary heart disease Epidemiologic studies Health services research Routine morbidity statistics 

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References

  1. 1.
    Tuomilehto J, Arstila M, Kaarsalo E, Kankaanpää J, Ketonen M, Kuulasmaa K, Lehto S, Miettinen H, Mustaniemi H, Palomäki P, Puska P, Pyörälä K, Salomaa V, Torppa J, Vuorenmaa T. Acute myocardial infarction (AMI) in Finland: Baseline data from the FINMONICA AMI Register in 1983–1985. Eur Heart J 1992; 13: 577–587.Google Scholar
  2. 2.
    Jackson R, Graham P, Beaglehole R, de Boer G. Validation of coronary heart disease death certificate diagnoses. NZ Med J 1988; 101: 658–660.Google Scholar
  3. 3.
    Martin CA, Hobbs MST, Armstrong BK. Estimation of myocardial infarction mortality from routinely collected data in western Australia. J Chron Dis 1987; 40: 661–669.Google Scholar
  4. 4.
    WHO MONICA Project, prepared by Tunstall-Pedoe H, Kuulasmaa K, Amouyel P, Arveiler D, Rajakangas A-M, Pajak A. Myocardial infarction and coronary deaths in the World Health organization MONICA Project. Registration procedures, event rates, and case-fatality rates in 38 populations from 21 countries in four continents. Circulation 1994; 90: 583–612.Google Scholar
  5. 5.
    Hammar N, Ahlbom A. Recent trends in mortality from and incidence of myocardial infarction in Stockholm. Br Med J 1987; 294: 609–610.Google Scholar
  6. 6.
    Koskenvuo M, Kaprio J, Langinvainio H, Romo M, Pulkkinen P. Changes in incidence and prognosis of ischemic heart disease in Finland: A record linkage study of data on death certificates and hospital records for 1972 and 1981. Br Med J 1985; 290: 1773–1775.Google Scholar
  7. 7.
    Näyhä S. Improved survival after acute myocardial infarction in Finland, 1974–1985. Int J Epidemiol 1992; 21: 30–35.Google Scholar
  8. 8.
    Reznik RB, Goldstein GB, Ring I, Berry G. The determination of the incidence of acute myocardial infarction from hospital morbidity records. J Chron Dis 1984; 37: 733–742.Google Scholar
  9. 9.
    Romo M, Koskenvuo M, Kaprio J, Langinvainio H, Pulkkinen P. Incidence and prognosis of ischemic heart disease with respect to geographical area. Acta Med Scand 1982; 212: 355–360.Google Scholar
  10. 10.
    Demlo LK, Campbell PM. Improving hospital discharge data: Lessons from the National Hospital Discharge Survey. Med Care 1981; 19: 1030–1040.Google Scholar
  11. 11.
    Iezzoni LI, Burnside S, Sickles L, Moskowitz MA, Sawitz E, Levine PA. Coding for acute myocardial infarction and policy implications. Ann Intern Med 1988; 109: 745–751.Google Scholar
  12. 12.
    Kennedy GT, Stern MP, Crawford MH. Miscoding of hospital discharges as acute myocardial infarction: Implications for surveillance programs aimed at elucidating trends in coronary artery disease. Am J Cardiol 1984; 53: 1000–1002.Google Scholar
  13. 13.
    Lloyd SS, Rissing P. Physician and coding errors in patient records. JAMA 1985; 254: 1330–1336.Google Scholar
  14. 14.
    Pears J, Alexander GF, Waugh NR. Audit of the quality of hospital discharge data. Health Bulletin 1992; 50: 356–361.Google Scholar
  15. 15.
    Aro S, Koskinen R, Keskimäki I. Sairaalastapoistorekisterin diagnoosi-, toimenpide-ja tapaturmatietojen luotettavuus. Duodecim 1990; 106: 1443–1450 (in Finnish).Google Scholar
  16. 16.
    Salmela R, Koistinen V. Is the discharge register in general hospitals complete and reliable? Sairaala 1987; 49: 480–482 (in Finnish).Google Scholar
  17. 17.
    Lockwood E. Accuracy of Scottish hospital morbidity data. Brit J Prev Soc Med 1971; 25: 76–83.Google Scholar
  18. 18.
    Martini CJM, Hughes AO, Patton VA. A study of the validity of the hospital activity analysis information. Brit J Prev Soc Med 1976; 30: 180–186.Google Scholar
  19. 19.
    WHO Regional Office for Europe. Myocardial Infarction Community Registers. Public Health in Europe 5. Copenhagen: Regional Office for Europe, World Health Organisation, 1977.Google Scholar
  20. 20.
    WHO MONICA project principal investigators (prepared by Tunstall-Pedoe H.). The World Health Organization MONICA project (monitoring trends and determinants in cardiovascular disease): A major international collaboration. J Clin Epidemiol 1988; 41: 105–114.Google Scholar
  21. 21.
    WHO MONICA project (prepared by Tuomilehto J and KuulasmaaK). Assessing CHD mortality and morbidity. Int J Epidemiol 1989; 18: S38–S45.Google Scholar
  22. 22.
    Palomäki P, Miettinen H, Mustaniemi H, Lehto S, Pyörälä K, Mähönen M, Tuomilehto J. Diagnosis of acute myocardial infarction by MONICA and FINMONICA diagnostic criteria in comparison with hospital discharge diagnosis. J Clin Epidemiol 1994; 47: 659–666Google Scholar
  23. 23.
    Nikiforov O. General hospital care in Finland in the 1960s and 1970s (in Finnish with an English summary). Health Services Research by the National Board of Health in Finland 1984, 32 pp.Google Scholar
  24. 24.
    Heliövaara M, Reunanen A, Aromaa A, Knekt P, Aho K, Suhonen O. Validity of hospital discharge data in a prospective epidemiological study on stroke and myocardial infarction. Acta Med Scand 1984; 216: 309–315.Google Scholar
  25. 25.
    Mähönen M, Miettinen H, Pyörälä K, Molarius A, Arstila M, Kaarsalo E, Ketonen M, Kuulasmaa K, Lehto S, Mustaniemi H, Niemelä M, Palomäki P, Salomaa V, Torppa J, Tuomilehto J, Vuorenmaa T. Hospital discharge register data in the assessment of trends in acute myocardial infarction. Comparison with the FINMONICA AMI register. Ann Med 1995; 27: 547–554.Google Scholar
  26. 26.
    Smith MW. Hospital discharge diagnoses: How accurate are they and their international classification of diseases (ICD) codes? NZ Med J 1989: 102: 507–508.Google Scholar
  27. 27.
    Beaglehole R, Stewart AW, Walker P. Validation of coronary heart disease hospital discharge data. Aust NZ J Med 1987; 17: 43–46.Google Scholar
  28. 28.
    Hammar N, Laresen FE, de Faire U. Are geographical differences and time trends in myocardial infarction in Sweden real? Validity of hospital discharge diagnoses. J Clin Epidemiol 1994; 47: 685–693.Google Scholar
  29. 29.
    van Walraven C, Wang B, Ugnat A-M, Naylor CD. False-positive coding for acute myocardial infarction on hospital discharge records: Chart audit results from a tertiary care. Can J Cardiol 1990; 6: 383–386.Google Scholar
  30. 30.
    Assaf AL, Lapane KL, McKenney JL, Carleton RA. Possible influence of the prospective payment system on the assignment of discharge diagnoses for coronary heart disease. N Engl J Med 1993; 329: 931–935.Google Scholar
  31. 31.
    The Nova-Scotian-Saskatchewan Cardiovascular disease epidemiology study group. Estimation of the incidence of acute myocardial infarction using record linkage: A feasibility study in Nova Scotia and Saskatchewan. Can J Publ Health 1989; 80: 412–417.Google Scholar

Copyright information

© Kluwer Academic Publishers 1997

Authors and Affiliations

  • Markku Mähönen
    • 1
  • Veikko Salomaa
    • 1
  • Mats Brommels
    • 2
  • Anu Molarius
    • 1
  • Heikki Miettinen
    • 3
  • Kalevi Pyörälä
    • 3
  • Jaakko Tuomilehto
    • 1
  • Matti Arstila
    • 4
  • Esko Kaarsalo
    • 5
  • Matti Ketonen
    • 6
  • Kari Kuulasmaa
    • 1
  • Seppo Lehto
    • 3
  • Harri Mustaniemi
    • 6
  • Matti Niemelä
    • 5
  • Pertti Palomäki
    • 3
  • Jorma Torppa
    • 1
  • Tapio Vuorenmaa
    • 4
  1. 1.Department of Epidemiology and Health PromotionNational Public Health InstituteHelsinkiFinland
  2. 2.Department of Public HealthHelsinki University, Faculty of MedicineFinland
  3. 3.Department of MedicineKuopio University HospitalKuopioFinland
  4. 4.Turku University HospitalTurkuFinland
  5. 5.Loimaa District HospitalLoimaaFinland
  6. 6.North Karelia Central HospitalJoensuuFinland

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