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
. 2015 Nov 4;10(11):e0140165.
doi: 10.1371/journal.pone.0140165. eCollection 2015.

Differences in the Prevalence of Obesity, Smoking and Alcohol in the United States Nationwide Inpatient Sample and the Behavioral Risk Factor Surveillance System

Elie S Al Kazzi  1 , Brandyn Lau  2   3   4 , Tianjing Li  5 , Eric B Schneider  2 , Martin A Makary  2   6 , Susan Hutfless  1   5
Affiliations

Differences in the Prevalence of Obesity, Smoking and Alcohol in the United States Nationwide Inpatient Sample and the Behavioral Risk Factor Surveillance System

Elie S Al Kazzi et al. PLoS One. .

Abstract

Background: The lack of adequate and standardized recording of leading risk factors for morbidity and mortality in medical records have downstream effects on research based on administrative databases. The measurement of healthcare is increasingly based on risk-adjusted outcomes derived from coded comorbidities in these databases. However inaccurate or haphazard assessment of risk factors for morbidity and mortality in medical record codes can have tremendous implications for quality improvement and healthcare reform.

Objective: We aimed to compare the prevalence of obesity, overweight, tobacco use and alcohol abuse of a large administrative database with a direct data collection survey.

Materials and methods: We used the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for four leading risk factors in the United States Nationwide Inpatient Sample (NIS) to compare them with a direct survey in the Behavioral Risk Factor Surveillance System (BRFSS) in 2011. After confirming normality of the risk factors, we calculated the national and state estimates and Pearson's correlation coefficient for obesity, overweight, tobacco use and alcohol abuse between NIS and BRFSS.

Results: Compared with direct participant questioning in BRFSS, NIS reported substantially lower prevalence of obesity (p<0.01), overweight (p<0.01), and alcohol abuse (p<0.01), but not tobacco use (p = 0.18). The correlation between NIS and BRFSS was 0.27 for obesity (p = 0.06), 0.09 for overweight (p = 0.55), 0.62 for tobacco use (p<0.01) and 0.40 for alcohol abuse (p<0.01).

Conclusions: The prevalence of obesity, overweight, tobacco smoking and alcohol abuse based on codes is not consistent with prevalence based on direct questioning. The accuracy of these important measures of health and morbidity in databases is critical for healthcare reform policies.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. State-level comparisons between BRFSS and NIS in 2011.
Dashed lines represent the national prevalence.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Danaei G, Ding EL, Mozaffarian D, Taylor B, Rehm J, Murray CJ, et al. The preventable causes of death in the United States: comparative risk assessment of dietary, lifestyle, and metabolic risk factors. PLoS Med. 2009;6: e1000058 10.1371/journal.pmed.1000058 - DOI - PMC - PubMed
    1. Rajaram R, Barnard C, Bilimoria KY. Concerns about using the patient safety indicator-90 composite in pay-for-performance programs. JAMA. 2015;313: 897–898. 10.1001/jama.2015.52 - DOI - PubMed
    1. Courtney PK. Data liquidity in health information systems. Cancer J. 2011;17: 219–221. 10.1097/PPO.0b013e3182270c83 - DOI - PMC - PubMed
    1. Centers for Medicare & Medicaid Services (CMS), HHS. CMS announces entrepreneurs and innovators to access Medicare data. 2015.
    1. O'Malley KJ, Cook KF, Price MD, Wildes KR, Hurdle JF, Ashton CM. Measuring diagnoses: ICD code accuracy. Health Serv Res. 2005;40: 1620–1639. - PMC - PubMed