Table 3.
Diabetes from Electronic Medical Record Data Compared with Chart Adjudication in the VACS Biomarker Cohort, by HIV Status
| n | Sensitivity | Specificity | PPV | NPV | Kappa | ||
|---|---|---|---|---|---|---|---|
| Prevalence | |||||||
| HBA1c ≥6.5% at least once | All | 2,389 | 88 (85–91) | 99 (98–99) | 95 (93–97) | 97 (96–98) | 0.89 |
| PWH | 1,546 | 85 (80–89) | 99 (98–99) | 94 (90–96) | 97 (96–98) | 0.87 | |
| HIV-negative | 843 | 92 (89–95) | 99 (98–100) | 97 (94–99) | 97 (95–98) | 0.92 | |
| HBA1c ≥6.5% two or more times | All | 2,389 | 76 (72–79) | 100 (100–100) | 100 (98–100) | 94 (92–95) | 0.83 |
| PWH | 1,546 | 70 (64–75) | 100 (100–100) | 100 (97–100) | 94 (92–95) | 0.79 | |
| HIV-negative | 843 | 82 (77–87) | 100 (99–100) | 100 (97–100) | 93 (91–95) | 0.86 | |
| HbA1c ≥6.5% two or more times within a year | All | 2,389 | 59 (54–63) | 100 (100–100) | 99 (98–100) | 90 (88–91) | 0.69 |
| PWH | 1,546 | 53 (47–59) | 100 (100–100) | 99 (96–100) | 91 (90–92) | 0.65 | |
| HIV-negative | 843 | 65 (59–71) | 100 (99–100) | 99 (97–100) | 87 (85–90) | 0.72 | |
| EMR Composite Definition | All | 2,389 | 92 (89–94) | 98 (98–99) | 93 (91–95) | 98 (97–98) | 0.90 |
| PWH | 1,546 | 91 (87–94) | 99 (98–99) | 93 (89–96) | 98 (97–99) | 0.90 | |
| HIV-negative | 843 | 92 (88–95) | 98 (96–99) | 94 (90–97) | 97 (95–98) | 0.90 | |
| ICD-9 code only | All | 2,389 | 90 (87–93) | 91 (89–92) | 73 (70–77) | 97 (96–98) | 0.75 |
| PWH | 1,546 | 88 (83–91) | 92 (91–94) | 72 (67–76) | 97 (96–98) | 0.74 | |
| HIV-negative | 843 | 93 (89–96) | 87 (84–90) | 75 (70–80) | 97 (95–98) | 0.75 | |
| Incidence | |||||||
| HBA1c ≥6.5% at least once | All | 1,824 | 85 (80–89) | 95 (94–96) | 70 (67–78) | 98 (97–98) | 0.73 |
| PWH | 1,245 | 81 (73–88) | 96 (94–97) | 69 (61–76) | 98 (97–99) | 0.71 | |
| HIV-negative | 579 | 89 (82–94) | 92 (89–94) | 72 (64–79) | 97 (95–99) | 0.74 | |
| HBA1c ≥6.5% two or more times | All | 1,868 | 72 (65–77) | 99 (99–100) | 93 (88–96) | 96 (95–97) | 0.79 |
| PWH | 1,271 | 68 (59–76) | 99 (99–100) | 93 (85–97) | 97 (95–98) | 0.76 | |
| HIV-negative | 597 | 76 (67–84) | 99 (97–100) | 93 (86–98) | 95 (93–97) | 0.81 | |
| HbA1c ≥6.5% two or more times within a year | All | 1,868 | 48 (41–54) | 99 (99–100) | 93 (86–97) | 93 (92–94) | 0.59 |
| PWH | 1,271 | 47 (38–56) | 100 (99–100) | 92 (83–97) | 94 (93–96) | 0.59 | |
| HIV-negative | 597 | 49 (39–58) | 99 (98–100) | 93 (83–98) | 90 (87–92) | 0.59 | |
| EMR Composite Definition | All | 1,871 | 95 (92–98) | 94 (93–95) | 70 (65–75) | 99 (99–100) | 0.78 |
| PWH | 1,272 | 95 (89–98) | 95 (94–96) | 68 (61–75) | 99 (99–100) | 0.76 | |
| HIV-negative | 599 | 96(91–99) | 92 (89–94) | 72 (64–80) | 99 (98–100) | 0.78 | |
| ICD-9 code only | All | 1,871 | 83 (78–88) | 90 (89–91) | 55 (49–60) | 97 (96–98) | 0.60 |
| PWH | 1,272 | 81 (73–88) | 92 (91–94) | 54 (47–61) | 98 (97–99) | 0.60 | |
| HIV-negative | 599 | 85 (77–91) | 85 (81–88) | 55 (48–63) | 96 (94–98) | 0.58 | |
| Presence of Diabetes** | |||||||
| ICD-10 code | All | 1,753 | 84 (80–87) | 93 (92–95) | 85 (82–88) | 93 (91–94) | 0.77 |
| PWH | 1,118 | 81 (76–86) | 95 (93–96) | 85 (80–89) | 93 (92–95) | 0.77 | |
| HIV-negative | 635 | 87 (82–90) | 90 (87–93) | 86 (81–90) | 91 (87–93) | 0.76 | |
*
Prevalence and incidence are calculated at time of VACS blood draw date (2005 to 2007)
**
Presence is based on chart review with a last date of October 2017 and ICD-10 codes from October 2015 to February 2018; limited to those alive as of October 2016 (n=1,118 PWH and 635 HIV-negative)
Abbreviations: VACS, Veterans Aging Cohort Study; HIV, human immunodeficiency virus; HbA1c, hemoglobin A1c; PWH, persons with human immunodeficiency virus; EMR, electronic medical record; ICD-9, International Classification of Diseases, Ninth Revision; ICD-10, International Classification of Diseases, Tenth Revision