Validity of diagnostic codes and prevalence of physician-diagnosed psoriasis and psoriatic arthritis in southern Sweden--a population-based register study

PLoS One. 2014 May 29;9(5):e98024. doi: 10.1371/journal.pone.0098024. eCollection 2014.


Objective: To validate diagnostic codes for psoriasis and psoriatic arthritis (PsA) and estimate physician-diagnosed prevalence of psoriasis and PsA in the Skåne region, Sweden.

Methods: In the Skåne Healthcare Register (SHR), all healthcare consultations are continuously collected for all inhabitants in the Skåne region (population 1.2 million). During 2005-2010 we identified individuals with ≥1 physician-consultations consistent with psoriasis (ICD-10). Within this group we also identified those diagnosed with PsA. We performed a validation by reviewing medical records in 100 randomly selected cases for psoriasis and psoriasis with PsA, respectively. Further, we estimated the pre- and post-validation point prevalence by December 31, 2010.

Results: We identified 16 171 individuals (psoriasis alone: n = 13 185, psoriasis with PsA n = 2 986). The proportion of ICD-10 codes that could be confirmed by review of medical records was 81% for psoriasis and 63% for psoriasis with PsA with highest percentage of confirmed codes for cases diagnosed ≥2 occasions in specialized care. For 19% and 29% of the cases respectively it was not possible to determine diagnosis due to insufficient information. Thus, the positive predicted value (PPV) of one ICD-10 code for psoriasis and psoriasis with PsA ranged between 81-100% and 63-92%, respectively. Assuming the most conservative PPV, the post-validation prevalence was 1.23% (95% CI: 1.21-1.25) for psoriasis (with or without PsA), 1.02% (95% CI: 1.00-1.03) for psoriasis alone and 0.21% (95% CI: 0.20-0.22) for psoriasis with PsA. The post-validation prevalence of PsA in the psoriasis cohort was 17.3% (95% CI: 16.65-17.96).

Conclusions: The proportion of diagnostic codes in SHR that could be verified varied with frequency of diagnostic codes and level of care highlighting the importance of sensitivity analyses using different case ascertainment criteria. The prevalence of physician-diagnosed psoriasis and PsA confirm other population-based studies, also after adjustment due to misclassification of disease.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Arthritis, Psoriatic / diagnosis*
  • Arthritis, Psoriatic / epidemiology*
  • Female
  • Humans
  • International Classification of Diseases*
  • Male
  • Middle Aged
  • Physicians
  • Population Surveillance
  • Prevalence
  • Psoriasis / diagnosis*
  • Psoriasis / epidemiology*
  • Registries
  • Reproducibility of Results
  • Sweden / epidemiology

Grant support

This study was supported by grants from the Region Skåne, the Swedish Social Insurance Agency, the Swedish Research Council, Faculty of Medicine, Lund University, the Österlund and Kock Foundations, King Gustav V 80 Year Fund and the Swedish Rheumatism Associa-tion. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.