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ICD Code: 493. Asthma

ICD Code: 493. Article Review
Title: Miller JE; "Predictors of Asthma in Young Children: Does Reporting Source Affect Our Conclusions?" American Journal of Epidemiology; V.154; No.3; 2001; p245
      STUDY DESIGN: The authors compared predictors of asthma using two different criteria to identify cases: maternal reports and medical records. The authors made use of a unique data set that collected information from birth certificates, medical records, and mothers of a nationally representative, population-based cohort, which allowed them to compare across two different reporting sources for the same sample of young children. Data were extracted from the 1988 National Maternal and Infant Health Survey (NMIHS) and its companion 1991 Longitudinal Follow-up (LF).
      MOTHER VERSUS DOCTOR REPORTING: Overall, the mother, the medical provider, or both identified 1094 cases of asthma. 36% of the cases were mentioned by both the mother and the medical provider, 36% by the mother only, and the remaining 27% by the medical provider only. Mothers were more likely to recall and report serious cases of asthma, such as those that resulted in a hospitalization. However, there is surprisingly poor concurrence between maternal reports and medical records, even for relatively severe cases. For only 79% of the 190 children with medical records that indicated hospitalization for asthma did their mother report that the child had ever been diagnosed with asthma. Inclusion of children hospitalized for other serious respiratory conditions in the comparison (241 subjects) resulted in only slightly higher agreement (80%).
      Estimates of asthma prevalence differ substantially depending on which reporting source is used. Weighted to national levels, the prevalence estimates for asthma in the sample were 7.7% based on medical records or 10.0% based on maternal reports. Restricting the definition of "cases" to those for whom both the mother and medical provider mention asthma yields a prevalence of 4.1%; broadening the definition to include any child for whom either the mother or medical provider reported the condition yields a prevalence of 13.6%.
      Asthma cases reported by both the mother and the doctor had a higher average number of medical visits since birth than those for whom either one or the other source reported asthma. Mother-only cases were considerably more common among children for whom some providers did not respond to the survey (47.6% compared with 28.6% and 26.5% of mother-and-doctor to doctor-only cases), raising the possibility that the child had been diagnosed with asthma by a doctor, but that the pertinent medical records were not included in the database.
      DISCUSSION: When considering the implications of the observed discordance between maternal reports and medical records on asthma or other health conditions, one should note that neither reporting source can be considered to be the definitive "gold standard" against which the other should be judged. Medical records are completed at the time of each visit by trained medical providers who are familiar with diagnostic criteria. Hence, medical records are less likely to suffer from either recall bias or misdiagnosis than are the retrospective maternal reports. However, if children are not taken to a physician for a particular health problem, that problem will be overlooked in the medical records.
      These findings suggest that analyses based on medical charts or discharge records are likely to understate the deleterious effects of socioeconomic disadvantages on the risk of asthma or other health conditions.

Search Criteria: Text - American Journal of Epidemiology; V.154; No.3; 2001; p245