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Abstract Details
Misclassification Error-Adjusted Prevalence of Injection Drug Use Among Infective Endocarditis Hospitalizations in the United States: A Serial Cross-Sectional Analysis of the 2007-2016 National Inpatient Sample
Am J Epidemiol. 2020 Sep 30;kwaa207. doi: 10.1093/aje/kwaa207. Online ahead of print.
Kaitlin M McGrew1, Tabitha Garwe1, S Reza Jafarzadeh2, Douglas A Drevets34, Yan Daniel Zhao1, Mary B Williams15, Hélène Carabin1678
Author information
1Department of Biostatistics & Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
2Department of Medicine, Boston University School of Medicine, Boston, Massachusetts.
3Department of Internal Medicine- Infectious Diseases, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
4Medical Services, Department of Veterans Affairs Medical Center, Oklahoma City, Oklahoma.
5Department of Family and Community Medicine, OU-TU School of Community Medicine, Tulsa, Oklahoma.
6Département de pathologie et de microbiologie, Faculté de Médecine vétérinaire, Université de Montréal, Saint-Hyacinthe, Québec, Canada.
7Département de médecine sociale et préventive, École de Santé Publique, Université de Montréal, Montréal, Québec, Canada.
8Centre de Recherche en Santé Publique (CReSP), Université de Montréal et CIUSSS du Centre sud de l'île de Montréal, Montréal, Québec, Canada.
Abstract
Administrative health databases have been used to monitor trends in infective endocarditis hospitalization related to non-prescription injection drug use (IDU) using International Classification of Diseases (ICD) code algorithms. Because no ICD code for IDU exists, drug dependence and Hepatitis C Virus (HCV) have been used as surrogate measures for IDU making misclassification error a threat to the accuracy of existing estimates. This serial cross-sectional analysis compared the unadjusted and misclassification error-adjusted prevalences of IDU among 70,899 unweighted endocarditis hospitalizations in the 2007-2016 United States National Inpatient Sample. The unadjusted IDU prevalence was estimated with a drug algorithm, HCV algorithm, and combination algorithm (drug and HCV). Bayesian latent class models estimated the median IDU prevalence and 95% Bayesian credible intervals (BCI) and ICD algorithm sensitivity and specificity. Sex- and age group-stratified IDU prevalences were also estimated. Compared to the misclassification-adjusted prevalence, unadjusted estimates were lower using the drug algorithm and higher using the combination algorithm. The median misclassification error-adjusted IDU prevalence increased from 9.7% (95% BCI: 6.3%, 14.8%) in 2008 to 32.5% (95% BCI: 26.5, 38.2%) in 2016. IDU prevalence was higher in females than males among those aged 18-34 years. Misclassification error-adjustment in ICD-based studies of injection-related endocarditis is recommended.