Validating claims-based algorithms for a systemic lupus erythematosus diagnosis in Medicare data for informed use of the Lupus Index: a tool for geospatial research

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Abstract

Objective

This study aimed to validate claims-based algorithms for identifying SLE and lupus nephritis (LN) in Medicare data, enhancing the use of the Lupus Index for geospatial research on SLE prevalence and outcomes.

Methods

We retrospectively evaluated the performance of rule-based algorithms using the International Classification of Diseases, 10th Revision (ICD-10) codes to identify SLE and LN in a well-defined prospective longitudinal cohort of patients with and without SLE from a South Carolina registry and rheumatology outpatient clinics. The analysis included comparison of algorithms based on Medicare fee-for-service claims data to these rigorously phenotyped populations. The primary classification for SLE cases was based on the American College of Rheumatology and Systemic Lupus Erythematosus International Collaborating Clinics criteria for SLE and LN. Algorithms were based on the number of ICD-10 codes with and without a 30-day separation in the observation period, including all of 2016–2018.

Results

The algorithm using two ICD-10 codes for SLE, with or without a 30-day separation, showed the best overall performance. For LN, specific ICD-10 codes outperformed combinations of SLE and renal/proteinuria codes that were found in ICD-9.

Conclusions

The findings of this study highlight the performance of specific ICD-10 code algorithms in identifying SLE and LN cases within Medicare data, providing a valuable tool for informing use of the Lupus Index. This index allows for improved geographical targeting of clinical resources, health disparity studies and clinical trial site selection. The study underscores the importance of algorithm selection based on research objectives, recommending more specific algorithms for precise tasks like clinical trial site identification and less specific ones for broader applications such as health disparities research.

Related collections

Most cited references 19

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Updating the American college of rheumatology revised criteria for the classification of systemic lupus erythematosus

Marc C Hochberg (1997)

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The 1982 revised criteria for the classification of systemic lupus erythematosus.

E M Tan, A Cohen, J F Fries … (1982)

The 1971 preliminary criteria for the classification of systemic lupus erythematosus (SLE) were revised and updated to incorporate new immunologic knowledge and improve disease classification. The 1982 revised criteria include fluorescence antinuclear antibody and antibody to native DNA and Sm antigen. Some criteria involving the same organ systems were aggregated into single criteria. Raynaud's phenomenon and alopecia were not included in the 1982 revised criteria because of low sensitivity and specificity. The new criteria were 96% sensitive and 96% specific when tested with SLE and control patient data gathered from 18 participating clinics. When compared with the 1971 criteria, the 1982 revised criteria showed gains in sensitivity and specificity.

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The classification of glomerulonephritis in systemic lupus erythematosus revisited.

Jan J Weening, Vivette D D'Agati, Melvin M Schwartz … (2004)

The currently used classification reflects our understanding of the pathogenesis of the various forms of lupus nephritis, but clinicopathologic studies have revealed the need for improved categorization and terminology. Based on the 1982 classification published under the auspices of the World Health Organization (WHO) and subsequent clinicopathologic data, we propose that class I and II be used for purely mesangial involvement (I, mesangial immune deposits without mesangial hypercellularity; II, mesangial immune deposits with mesangial hypercellularity); class III for focal glomerulonephritis (involving or = 50% of total number of glomeruli) either with segmental (class IV-S) or global (class IV-G) involvement, and also with subdivisions for active and sclerotic lesions; class V for membranous lupus nephritis; and class VI for advanced sclerosing lesions]. Combinations of membranous and proliferative glomerulonephritis (i.e., class III and V or class IV and V) should be reported individually in the diagnostic line. The diagnosis should also include entries for any concomitant vascular or tubulointerstitial lesions. One of the main advantages of the current revised classification is that it provides a clear and unequivocal description of the various lesions and classes of lupus nephritis, allowing a better standardization and lending a basis for further clinicopathologic studies. We hope that this revision, which evolved under the auspices of the International Society of Nephrology and the Renal Pathology Society, will contribute to further advancement of the WHO classification.

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All references

Author and article information

Contributors

Candace Feldman

Jeffrey R Curtis

Jim C Oates:

ORCID: http://orcid.org/0000-0002-5426-1359

Jinoos Yazdany:

ORCID: http://orcid.org/0000-0002-3508-4094

Peter Izmirly:

ORCID: http://orcid.org/0000-0001-5445-2182

Journal

Journal ID (nlm-ta): Lupus Sci Med

Journal ID (iso-abbrev): Lupus Sci Med

Journal ID (hwp): lupusscimed

Journal ID (publisher-id): lupus

Title: Lupus Science & Medicine

Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )

ISSN (Electronic): 2053-8790

Publication date Collection: 2024

Publication date (Electronic): 14 October 2024

Volume: 11

Issue: 2

Electronic Location Identifier: e001329

Affiliations

[1 ]departmentDivision of Rheumatology , Brigham and Women's Hospital , Boston, Massachusetts, USA

[2 ]departmentDivision of Clinical Immunology and Rheumatology , The University of Alabama at Birmingham Heersink School of Medicine , Birmingham, Alabama, USA

[3 ]departmentMedicine , Medical University of South Carolina College of Medicine , Charleston, South Carolina, USA

[4 ]departmentMedical Service , Ralph H Johnson VA Medical Center , Charleston, South Carolina, USA

[5 ]departmentDivision of Rheumatology , University of California San Francisco School of Medicine , San Francisco, California, USA

[6 ]departmentMedicine-Rheumatology , New York University Grossman School of Medicine , New York City, New York, USA

Author notes

Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

Additional supplemental material is published online only. To view, please visit the journal online ( https://doi.org/10.1136/lupus-2024-001329).

None declared.

Dr; oatesjc@ 123456musc.edu

Author information

Jim C Oates http://orcid.org/0000-0002-5426-1359

Jinoos Yazdany http://orcid.org/0000-0002-3508-4094

Peter Izmirly http://orcid.org/0000-0001-5445-2182

Article

Publisher ID: lupus-2024-001329

DOI: 10.1136/lupus-2024-001329

PMC ID: 11474710

PubMed ID: 39401954

SO-VID: c1c45421-8b6d-416b-bab0-8dec5dda6b2e

License:

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

History

Date received : 25 July 2024

Date accepted : 18 September 2024

Funding

Funded by: Medical University of South Carolina (MUSC);

Funded by: Core Center for Clinical Research, Improving Minority Health;

Funded by: NIH;

Award ID: P30 AR072582

Award ID: P30 AR072583

Award ID: UL1 TR000062

Funded by: BMS, EMD Serono, GSK, Janssen, Lupus Research Alliance;