Use of administrative data for national surveillance of osteoporosis and related fractures in Canada: results from a feasibility study.

UNLABELLED: Using administrative data healthcare databases from five Canadian provinces, we compared prevalence estimates of diagnosed osteoporosis and incidence rates for related fractures in Canada. The algorithms adopted showed consistent age and sex patterns across all provinces and will be suitable for national surveillance and monitoring.
PURPOSE: This study aims to evaluate the feasibility of using provincial population-based administrative data to develop a national surveillance system of diagnosed osteoporosis and related fractures (forearm, humerus, vertebra, pelvis, and hip) in Canada.
METHODS: Linked healthcare databases from five provinces representing approximately 85 % of the Canadian population were used. Multiple algorithms combining hospitalizations, physician visits, and osteoporosis prescription drug dispensations were evaluated in each province. The adopted algorithms for diagnosed osteoporosis and incident fractures combined hospitalizations and physician visits based on 3 years and 1 year of data, respectively. Sex-specific age-standardized osteoporosis prevalence and fracture incidence rates were estimated for each province from 1995/1996 to 2007/2008.
RESULTS: Age-standardized prevalence of diagnosed osteoporosis in those ≥50 years increased over the study period but stabilized in the most recent years. Using the adopted algorithm produced provincial estimates ranging from 5.6 to 10.5 % for 2007/2008, with consistent age and sex patterns across provinces. The use of osteoporosis drug data resulted in higher osteoporosis estimates compared with estimates without drug data. Age-standardized incidence of fractures in those ≥40 years showed similar age and sex patterns across all provinces. The highest level of agreement among provinces was for hip and humerus fracture rates, with wider provincial variation for forearm, vertebra, and pelvis fractures.
CONCLUSIONS: Our results are consistent with previous validation works and confirm that the algorithms adopted will be suitable for the national monitoring of diagnosed osteoporosis and related fractures. A similar approach may be applicable to other countries with high-quality administrative data.