Dataset Information

CKD Prevalence in the Military Health System: Coded Versus Uncoded CKD.

ABSTRACT:

Rationale & objective

Chronic kidney disease (CKD) is common but often goes unrecorded.

Study design

Cross-sectional.

Setting & participants

Military Health System (MHS) beneficiaries aged 18 to 64 years who received care during fiscal years 2016 to 2018.

Predictors

Age, sex, active duty status, race, diabetes, hypertension, and numbers of kidney test results.

Outcomes

We defined CKD by International Classification of Diseases, Tenth Revision (ICD-10) code and/or a positive result on a validated electronic phenotype that uses estimated glomerular filtration rate and measures of proteinuria with evidence of chronicity. We defined coded CKD by the presence of an ICD-10 code. We defined uncoded CKD by a positive e-phenotype result without an ICD-10 code.

Analytical approach

We compared coded and uncoded populations using 2-tailed t tests (continuous variables) and Pearson χ² test for independence (categorical variables).

Results

The MHS population included 3,330,893 beneficiaries. Prevalence of CKD was 3.2%, based on ICD code and/or positive e-phenotype result. Of those identified with CKD, 63% were uncoded. Compared with beneficiaries with coded CKD, those with uncoded CKD were younger (aged 45 ± 13 vs 52 ± 11 years), more often women (54.4% vs 37.6%) and active duty (20.2% vs 12.5%), and less often of Black race (18.5% vs 31.5%) or with diabetes (23.5% vs 43.5%) or hypertension (46.6% vs 77.1%; P < 0.001). Beneficiaries with coded (vs uncoded) CKD had greater numbers of kidney test results (P < 0.001).

Limitations

Use of cross-sectional administrative data prevents inferences about causality. The CKD e-phenotype may fail to capture CKD in individuals without laboratory data and may underestimate CKD.

Conclusions

The prevalence of CKD in the MHS is ~3.2%. Beneficiaries with well-known CKD risk factors, such as older age, male sex, Black race, diabetes, and hypertension, were more likely to be coded, suggesting that clinicians may be missing CKD in groups traditionally considered lower risk, potentially resulting in suboptimal care.

SUBMITTER: Norton JM

PROVIDER: S-EPMC8350811 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Rationale & objectiveThe US Military Health System (MHS) is a global health care network with a diverse population that is more representative of the US population than other study cohorts and with fewer disparities in health care access. We aimed to examine the prevalence of chronic kidney disease (CKD) in the MHS and within demographic subpopulations.Study designMultiple cross-sectional analyses of demographic and claims-based data extracted from the MHS Data Repository, 1 for each fiscal year from 2006-2015.Setting & populationMulticenter health care network including active-duty military, retirees, and dependents. The average yearly sample size was 3,285,348 individuals.ExposuresAge, sex, race, active-duty status, and active-duty rank (a surrogate for socioeconomic status).OutcomeCKD, defined as the presence of matching International Classification of Diseases, Ninth Revision, codes on either 1 or more inpatient or 2 or more outpatient encounters.Analytical approacht test for continuous variables and χ2 test for categorical variables; multivariable logistic regression for odds ratios.ResultsFor 2015, the mean (standard deviation) age was 38 (16). Crude CKD prevalence was 2.9%. Age-adjusted prevalence was 4.9% overall-1.9% active-duty and 5.4% non-active-duty individuals. ORs for CKD were calculated with multiple imputations to account for missing data on race. After adjustment, the ORs for CKD (all P < 0.001) were 1.63 (95% CI, 1.62-1.64) for an age greater than 40 years, 1.16 (95% CI, 1.15-1.17) for Black race, 1.15 (95% CI, 1.14-1.16) for senior enlisted rank, 0.94 (95% CI, 0.93-0.95) for women, and 0.50 (95% CI, 0.49-0.51) for active-duty status.LimitationsRetrospective study based on International Classification of Diseases, Ninth Revision, coding.ConclusionsWithin the MHS, older age, Black race, and senior enlisted rank were associated with a higher risk of CKD, whereas female sex and active-duty status were associated with a lower risk.

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