Defining incident cases of epilepsy in administrative data

Abstract

Purpose: To determine the minimum enrollment duration for identifying incident cases of epilepsy in administrative data.

Methods: We performed a retrospective dynamic cohort study using Ohio Medicaid data from 1992 to 2006 to identify a total of 5037 incident epilepsy cases who had at least 1 year of follow-up prior to epilepsy diagnosis (epilepsy-free interval). The incidence for epilepsy-free intervals from 1 to 8 years, overall and stratified by pre-existing disability status, was examined. The graphical approach between the slopes of incidence estimates and the epilepsy-free intervals was used to identify the minimum epilepsy-free interval that minimized misclassification of prevalent as incident epilepsy cases.

Results: As the length of epilepsy-free interval increased, the incidence rates decreased. A graphical plot showed that the decline in incidence of epilepsy became nearly flat beyond the third epilepsy-free interval.

Conclusion: The minimum of 3-year epilepsy-free interval is needed to differentiate incident from prevalent cases in administrative data. Shorter or longer epilepsy-free intervals could result in over- or under-estimation of epilepsy incidence.

Keywords: Administrative data; Epilepsy; Incidence.

Figure 1

Changes of the incidence of epilepsy by different length of epilepsy-free intervals. An absolute value of the slope for each epilepsy-free interval was calculated by dividing the difference of the incidence estimates between the adjacent epilepsy-free intervals with the difference of the epilepsy-free intervals.