Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Aug 1;81(8):875-881.
doi: 10.1001/jamaneurol.2024.2044.

Derivation and Validation of ICD-10 Codes for Identifying Incident Stroke

Jesse A Columbo  1   2 , Natalie Daya  3 , Lisandro D Colantonio  4 , Zhixin Wang  4 , Kathryn Foti  4 , Hyacinth I Hyacinth  5 , Michelle C Johansen  6 , Rebecca Gottesman  7 , Phillip P Goodney  1   2 , Virginia J Howard  4 , Paul Muntner  4 , Andrea L C Schneider  8   9 , Elizabeth Selvin  3 , Caitlin W Hicks  3   10
Affiliations

Derivation and Validation of ICD-10 Codes for Identifying Incident Stroke

Jesse A Columbo et al. JAMA Neurol. .

Abstract

Importance: Claims data with International Statistical Classification of Diseases, Tenth Revision (ICD-10) codes are routinely used in clinical research. However, the use of ICD-10 codes to define incident stroke has not been validated against expert-adjudicated outcomes in the US population.

Objective: To develop and validate the accuracy of an ICD-10 code list to detect incident stroke events using Medicare inpatient fee-for-service claims data.

Design, setting, and participants: This cohort study used data from 2 prospective population-based cohort studies, the Atherosclerosis Risk in Communities (ARIC) study and the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, and included participants aged 65 years or older without prior stroke who had linked Medicare claims data. Stroke events in the ARIC and REGARDS studies were identified via active surveillance and adjudicated by expert review. Medicare-linked ARIC data (2016-2018) were used to develop a list of ICD-10 codes for incident stroke detection. The list was validated using Medicare-linked REGARDS data (2016-2019). Data were analyzed from September 1, 2022, through September 30, 2023.

Exposures: Stroke events detected in Medicare claims vs expert-adjudicated stroke events in the ARIC and REGARDS studies.

Main outcomes and measures: The main outcomes were sensitivity and specificity of incident stroke detection using ICD-10 codes.

Results: In the ARIC study, there were 110 adjudicated incident stroke events among 5194 participants (mean [SD] age, 80.1 [5.3] years) over a median follow-up of 3.0 (range, 0.003-3.0) years. Most ARIC participants were women (3160 [60.8%]); 993 (19.1%) were Black and 4180 (80.5%) were White. Using the primary diagnosis code on a Medicare billing claim, the ICD-10 code list had a sensitivity of 81.8% (95% CI, 73.3%-88.5%) and a specificity of 99.1% (95% CI, 98.8%-99.3%) to detect incident stroke. Using any diagnosis code on a Medicare billing claim, the sensitivity was 94.5% (95% CI, 88.5%-98.0%) and the specificity was 98.4% (95% CI, 98.0%-98.8%). In the REGARDS study, there were 140 adjudicated incident strokes among 6359 participants (mean [SD] age, 75.8 [7.0] years) over a median follow-up of 4.0 (range, 0-4.0) years. More than half of the REGARDS participants were women (3351 [52.7%]); 1774 (27.9%) were Black and 4585 (72.1%) were White. For the primary diagnosis code, the ICD-10 code list had a sensitivity of 70.7% (95% CI, 63.2%-78.3%) and a specificity of 99.1% (95% CI, 98.9%-99.4%). For any diagnosis code, the ICD-10 code list had a sensitivity of 77.9% (95% CI, 71.0%-84.7%) and a specificity of 98.9% (95% CI, 98.6%-99.2%).

Conclusions and relevance: These findings suggest that ICD-10 codes could be used to identify incident stroke events in Medicare claims with moderate sensitivity and high specificity.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Columbo reported receiving grants from the National Institutes of Health (NIH) during the conduct of the study. Dr Colantonio reported receiving grants from Amgen outside the submitted work. Dr Howard reported grants from the National Institute of Neurological Disorders and Stroke (NINDS) and the National Institute on Aging (NIA) during the conduct of the study. Dr Schneider reported receiving grants from the NIH and the US Department of Defense (DOD) and serving as the associate editor of Neurology (American Academy of Neurology) outside the submitted work. Dr Selvin reported receiving grants from the NIH during the conduct of the study and outside the submitted work. Dr Hicks reported receiving personal fees from Silk Road Medical during the conduct of the study and from W.L. Gore and Cook Medical outside the submitted work. In addition, Dr Hicks reported receiving grants from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), the American College of Surgeons, and the Society for Vascular Surgery outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. Incident Stroke Among Participants in the Atherosclerosis Risk in Communities (ARIC) Study
A and B, Cumulative incidence of incident stroke among ARIC participants comparing prospectively adjudicated strokes vs strokes identified in Medicare claims when considering the primary diagnosis (A) and any diagnosis (B) on a billing claim.
See this image and copyright information in PMC

References

    1. Wright JD, Folsom AR, Coresh J, et al. The ARIC (Atherosclerosis Risk in Communities) study: JACC Focus Seminar 3/8. J Am Coll Cardiol. 2021;77(23):2939-2959. doi: 10.1016/j.jacc.2021.04.035 - DOI - PMC - PubMed
    1. Howard VJ, Cushman M, Pulley L, et al. The Reasons for Geographic and Racial Differences in Stroke study: objectives and design. Neuroepidemiology. 2005;25(3):135-143. doi: 10.1159/000086678 - DOI - PubMed
    1. Howard G, Howard VJ. Design and implementation of observational studies to measure disease burden with a focus on stroke. Int J Stroke. 2018;13(2):157-165. doi: 10.1177/1747493017743800 - DOI - PubMed
    1. Roger VL, Sidney S, Fairchild AL, et al. ; American Heart Association Advocacy Coordinating Committee . Recommendations for cardiovascular health and disease surveillance for 2030 and beyond: a policy statement from the American Heart Association. Circulation. 2020;141(9):e104-e119. doi: 10.1161/CIR.0000000000000756 - DOI - PubMed
    1. Sidney S, Rosamond WD, Howard VJ, Luepker RV; National Forum for Heart Disease and Stroke Prevention . The “heart disease and stroke statistics—2013 update” and the need for a national cardiovascular surveillance system. Circulation. 2013;127(1):21-23. doi: 10.1161/CIRCULATIONAHA.112.155911 - DOI - PubMed

Publication types