Validity of asthma diagnoses in the Danish National Registry of Patients, including an assessment of impact of misclassification on risk estimates in an actual dataset

Annette Østergaard Jensen¹, Gunnar Lauge Nielsen², Vera Ehrenstein¹

¹Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; ²Department of Medicine, Himmerland Hospital, Farsø, Denmark

Objective: Asthma diagnoses recorded in the Danish National Registry of Patients (DNRP) are a misclassified measure of the actual asthma status. We quantified this misclassification and examined its impact on the results of an epidemiologic study on asthma.

Study design and setting: We validated the DNRP asthma diagnoses against records of asthma diagnosed at medical examinations conducted during mandatory conscription evaluation. We had data on 22,177 male conscripts who were born from January 1st, 1977 to December 31st, 1983, in a conscription district in northern Denmark. We obtained asthma diagnoses recorded among the conscripts in the DNRP from January 1st, 1977 through December 31st, 2003. We estimated sensitivity, specificity, and positive predictive value (PPV) of the DNRP asthma diagnoses. We then conducted sensitivity analysis to quantify the impact of nondifferential misclassification on the rate ratios measuring the association between asthma and risks of different skin cancers.

Results: The sensitivity of the DNRP for detecting an asthma diagnosis was 0.44 (95% confidence interval [CI]: 0.42–0.47), the specificity was 0.98 (95% CI: 0.98–0.99) and the PPV was 0.65 (95% CI: 0.62–0.68). Both direct and inverse associations between asthma and the different types of skin cancers became more pronounced after correcting for the misclassification.

Conclusion: The DNRP registered asthma diagnosis may be used to measure asthma status in epidemiologic studies seeking to estimate relative effects of asthma. Even at low values of DNRP sensitivity of asthma diagnoses were not sufficient to nullify observed relative associations in an actual dataset. The specificity of DNRP asthma diagnosis is high.

Keywords: asthma, validity, registry data, epidemiology