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外文期刊>Pharmacoepidemiology and drug safety
>Validation of algorithms to estimate gestational age at birth in the Medicaid Analytic extract—Quantifying the misclassification of maternal drug exposure during pregnancy
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Validation of algorithms to estimate gestational age at birth in the Medicaid Analytic extract—Quantifying the misclassification of maternal drug exposure during pregnancy
Purpose: Accurate ascertainment of gestational age (GA) has been a challenge in perinatal epidemiologic research. To date, no study has validated GA algorithms in Medicaid Analytic extract (MAX). Methods: We linked livebirths of mothers enrolled in Medicaid >30 days after delivery in 1999-2010 MAX to state birth certificates. We used clinical/obstetric estimate of gestation on the birth certificates as gold standard to validate claims-based GA algorithms. We calculated the proportions of deliveries with algorithm-estimated GA within 1-/2-weeks of the gold standard, the sensitivity, specificity, and positive/negative predictive value (PPV/NPV) of exposure to select medications during specific gestation windows, and quantified the impact of exposure misclassification on hypothetical relative risk (RR) estimates. Results: We linked 1 336 495 eligible deliveries. Within 1-week agreement was 77-80 overall and 47-56 for preterm deliveries. The trimester-specific drug exposure status had high sensitivities and PPVs (88.5-98.5), and specificities and NPVs (>99.0). Assuming a hypothetical RR of 2.0, bias associated with exposure misclassification during first trimester ranged from 10 to 40 under non-differential/differential misclassification assumptions. Conclusions: Claims-based GA algorithms had good agreement with the gold standard overall, but lower agreement among preterm deliveries, potentially resulting in biased risk estimated for pregnancy exposure evaluations.
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机译:目的:准确确定胎龄(GA)一直是围产期流行病学研究的一大挑战。迄今为止,尚无研究验证 Medicaid Analytic 提取物 (MAX) 中的 GA 算法。方法:我们将 1999-2010 MAX 分娩后 30 天参加医疗补助的母亲的活产>与州出生证明联系起来。我们使用出生证明上妊娠的临床/产科估计作为验证基于声明的GA算法的金标准。我们计算了在金标准后 1/2 周内使用算法估计的 GA 分娩的比例、在特定妊娠窗口期间暴露于特定药物的敏感性、特异性和阳性/阴性预测值 (PPV/NPV),并量化了暴露错误分类对假设相对风险 (RR) 估计的影响。结果:我们关联了 1 336 495 个符合条件的投放。1周内总体协议率为77%-80%,早产协议率为47%-56%。妊娠期特异性药物暴露状态具有较高的敏感性和PPV(88.5%-98.5%),特异性和NPVs(>99.0%)。假设RR为2.0,在非差分/差分误分类假设下,与妊娠早期暴露错误分类相关的偏差范围为10%至40%。结论:基于声明的GA算法总体上与金标准有很好的一致性,但早产的一致性较低,可能导致妊娠暴露评估的偏倚风险估计。
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