Most estimates of rheumatoid arthritis (RA) prevalence, including all official figures in Australia and many other countries, are based on self-report. Self-report has been shown to overestimate RA, but the ‘gold standard’ of reviewing individual medical records is costly, time-consuming and impractical for large-scale research and population monitoring. This study provides an algorithm to estimate RA cases using administrative data that can be adjusted for use in multiple contexts to provide the first approximate RA cohort in Australia that does not rely on self-report. Survey data on self-reported RA and medications from 25 467 respondents of the Australian Longitudinal Study on Women’s Health (ALSWH) were linked with data from the national medication reimbursement database, hospital and emergency department (ED) episodes, and Medicare Benefits codes. RA prevalence was calculated for self-reported RA, self-reported RA medications, dispensed RA medications, and hospital/ED RA presentations. Linked data were used to exclude individuals with confounding autoimmune conditions. Of 25 467 survey respondents, 1367 (5·4%) women self-reported disease. Of the 26 840 women with hospital or ED presentations, 292 (1·1%) received ICD-10 codes for RA. There were 1038 (2·8%) cases by the medication database definition, and 294 cases (1·5%) by the self-reported medication definition. After excluding individuals with other rheumatic conditions, prevalence was 3·9% for self-reported RA, 1·9% based on the medication database definition and 0·5% by self-reported medication definition. This confirms the overestimation of RA based on self-reporting. We provide an algorithm for identifying individuals with RA, which could be used for population studies and monitoring RA in Australia and, with adjustments, internationally. Its balance of accuracy and practicality will be useful for health service planning using relatively easily accessible input data.

中文翻译：

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使用医院和药物数据库监测类风湿性关节炎患病率的新方法


大多数类风湿性关节炎（RA）患病率的估计，包括澳大利亚和许多其他国家的所有官方数据，都是基于自我报告。自我报告已被证明会高估 RA，但审查个人病历的“黄金标准”对于大规模研究和人群监测而言成本高昂、耗时且不切实际。本研究提供了一种使用管理数据来估计 RA 病例的算法，该数据可以调整以在多种情况下使用，以提供澳大利亚第一个不依赖于自我报告的近似 RA 队列。澳大利亚妇女健康纵向研究 (ALSWH) 25 467 名受访者的自我报告 RA 和药物调查数据与国家药物报销数据库、医院和急诊科 (ED) 事件以及医疗保险福利代码的数据相关联。 RA 患病率是根据自我报告的 RA、自我报告的 RA 药物、配发的 RA 药物和医院/急诊室 RA 表现来计算的。关联数据用于排除患有混杂自身免疫性疾病的个体。在 25 467 名调查受访者中，1367 名 (5·4%) 女性自我报告了疾病。在 26 840 名住院或急诊室就诊的女性中，292 名 (1·1%) 收到了 RA 的 ICD-10 代码。根据药物数据库定义，有 1038 例 (2·8%) 病例，根据自我报告药物定义，有 294 例 (1·5%)。排除患有其他风湿性疾病的个体后，自我报告的 RA 患病率为 3·9%，根据药物数据库定义为 1·9%，根据自我报告药物定义为 0·5%。这证实了基于自我报告的 RA 高估。 我们提供了一种识别 RA 个体的算法，该算法可用于澳大利亚以及国际上的人口研究和 RA 监测（经过调整）。其准确性和实用性的平衡将有助于使用相对容易获取的输入数据进行卫生服务规划。