Identification and Validation of Osteoporotic Hip Fracture Using the National Health Insurance Database

Chanmi Park; Sunmee Jang; Suhyun Jang; Yong-Chan Ha; Young-Kyun Lee; Hyun-Koo Yoon; Chan Soo Shin; Deog-Yoon Kim; Seong-su Lee; Hyung Jin Choi; Bom-Taeck Kim; Ji-Yeob Choi

doi:10.5371/jkhs.2010.22.4.305

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Park, Jang, Jang, Ha, Lee, Yoon, Shin, Kim, Lee, Choi, Kim, and Choi: Identification and Validation of Osteoporotic Hip Fracture Using the National Health Insurance Database

Original Article

The Journal of the Korean Hip Society

The Journal of the Korean Hip Society 2010; 22(4): 305-311.

Published online: 31 December 2010

DOI: https://doi.org/10.5371/jkhs.2010.22.4.305

Identification and Validation of Osteoporotic Hip Fracture Using the National Health Insurance Database

Chanmi Park, PhD, Sunmee Jang, PhD, Suhyun Jang, Ms, Yong-Chan Ha, MD^*,^†, Young-Kyun Lee, MD^*,^‡, Hyun-Koo Yoon, MD^*,^§, Chan Soo Shin, MD^*,^∥, Deog-Yoon Kim, MD^*,^¶, Seong-su Lee, MD^*, Hyung Jin Choi, MD^*,^∥, Bom-Taeck Kim, MD^*,^**, Ji-Yeob Choi, PhD^*,^††

Health Insurance Review & Assessment Service, Seoul, Korea.

^*The Korean Society of Bone Metabolism, Epidemiology Committee, Seoul, Korea.

^†Department of Orthopaedic Surgery, College of Medicine, Chung-Ang University, Seoul, Korea.

^‡Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Sungnam, Korea.

^§Department of Internal Medicine, Cheil General Hospital and Women's Healthcare Center, School of Medicine, Kwandong University, Seoul, Korea.

^∥Department of Internal Medicine, College of Medicine, Seoul National University, Seoul, Korea.

^¶Department of Nuclear Medicine, Kyung Hee University Medical Center, Seoul, Korea.

^**Department of Family Practice & Community Health, School of Medicine, Ajou University, Suwon, Korea.

^††PharmacoGenomics Research Center, College of Medicine, Inje University, Busan, Korea.

Address reprint request to Sunmee Jang, PhD. Health Insurance Review & Assessment Service, 168 Hyoryeongro, Seocho-gu, Seoul 137-706, Korea. TEL: +82-2-2182-2561, FAX: +82-2-6710-5836, sunmeejang@hiramail.net

Received 14 September 2010 Revised 27 October 2010 Accepted 27 October 2010

Abstract

Purpose

The aim of this study was to develop and validate identification criteria for the cases of osteoporotic hip fracture using the National Health Insurance Database, and we calculated the incidence rate of osteoporotic hip fracture in the Korean population using these criteria.

Materials and Methods

The criteria to identify osteoporotic hip fracture using a diagnosis code, a procedure code, the type and number of medical service usages and the patients' ages were developed via discussions among experts. These criteria were validated by using a hip fracture cohort in which all the genuine osteoporotic hip fracture patients in the Jeju area were identified by reviewing the registered medical records and radiographs. By applying the identification criteria to the National Health Insurance Database that was accumulated until June 2009, we calculated the incidence rate of osteoporotic hip fracture in patients between 50 and 100 years of age in 2008.

Results

The identification criteria had a sensitivity of 93.1% and a positive predictive value of 77.4%. A total of 20,432 osteoporotic hip fracture cases were identified in 2008, and the incidence rate was 15.7 cases per 10,000 persons. The osteoporotic hip fracture incidence rate for females was 20.7 (per 10,000persons), and this was 2.1 times higher than that for the males (9.8case per 10,000persons), and the rates were increased with age.

Conclusion

The incidence of osteoporotic hip fracture that occurred on a nationwide scale can be more precisely estimated by using the National Health Insurance Database with its comprehensive information on the overall details of treatment as well as the diagnosis codes, and so the incidence of osteoporotic hip fracture can be reliably calculated for each year. The results from this research could be used as evidence in a hip fracture management plan for establishing Korean Health policy.

Keywords: Osteoporotic hip fracture, Incidence rate, National Health Insurance Database

Figures and Tables

Fig. 1

Age-specific Incidence of Osteoporotic Hip Fracture in Both Genders

Table 1

Identification Criteria of Osteoporotic Hip Fracture

^* National Health Insurance Database

Table 2

Positive Predicted Value and Sensitivity of Identification Method

^* Positive Predicted Value, ^†Sensitivity

Table 3

Incidence of Osteoporotic Hip Fracture for Korean 50+ Years in 2008

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