{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T18:00:48Z","timestamp":1789149648405,"version":"build-2803163510"},"reference-count":21,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2025,9,17]],"date-time":"2025-09-17T00:00:00Z","timestamp":1758067200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"The research was carried out at the NIHR Manchester Biomedical Research Centre","award":["NIHR203308"],"award-info":[{"award-number":["NIHR203308"]}]},{"name":"National Institute for Health and Care Research (NIHR) Advanced Fellowship","award":["NIHR301413"],"award-info":[{"award-number":["NIHR301413"]}]},{"name":"Nuffield Foundation\u2019s Oliver Bird Fund and Versus Arthritis"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,12,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Prevalence estimates using primary care data health identify cases via code lists. Validation studies can discover and exclude false positives, but it is often difficult or impossible to find false negatives. This study aimed, using the example of psoriatic arthritis (PsA), to examine the extent of and adjust for misclassification by linking primary care records with text-mined outpatient letters from a Northwest regional hospital (2014-2019). Two hundred forty-five cases of PsA were identified among 188\u2009286 adults registered with primary care, giving an observed prevalence of 0.13% [95% CI, 0.11%-0.15%]. Among a subgroup of 7532 primary care patients attending the hospital rheumatology clinic, 202 had a primary care PsA code: 188 were confirmed as true PsA, while 14 were false positives. Primary care codes failed to identify 196 hospital-diagnosed PsA cases, leading to a more than 2-fold underestimation. The adjusted prevalence, accounting for misclassification, was 0.25% [95% CI, 0.21%-0.28%]. Linking primary care with hospital records identified false positives and negatives, enabling correction of prevalence estimates. This highlights the value of text-mining hospital letters to replace the national absence of coded secondary care diagnosis data from outpatient departments, and the importance of considering the impact of false negatives.<\/jats:p>","DOI":"10.1093\/aje\/kwaf206","type":"journal-article","created":{"date-parts":[[2025,9,17]],"date-time":"2025-09-17T12:18:04Z","timestamp":1758111484000},"page":"3640-3645","source":"Crossref","is-referenced-by-count":3,"title":["Improving disease misclassification and prevalence estimates by linking primary and secondary care electronic health records: an illustration from arthritis research"],"prefix":"10.1093","volume":"194","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8621-6539","authenticated-orcid":false,"given":"Belay Birlie","family":"Yimer","sequence":"first","affiliation":[{"name":"Faculty of Biology Medicine and Health, Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, The University of Manchester , Manchester ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2188-922X","authenticated-orcid":false,"given":"Fangyuan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Faculty of Biology Medicine and Health, Division of Informatics, Imaging and Data Science, The University of Manchester , Manchester ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2497-4080","authenticated-orcid":false,"given":"Jenny","family":"Humphreys","sequence":"additional","affiliation":[{"name":"Faculty of Biology Medicine and Health, Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, The University of Manchester , Manchester ,","place":["United Kingdom"]},{"name":"NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre , Manchester ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2391-5575","authenticated-orcid":false,"given":"Mark","family":"Lunt","sequence":"additional","affiliation":[{"name":"Faculty of Biology Medicine and Health, Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, The University of Manchester , Manchester ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1487-277X","authenticated-orcid":false,"given":"Meghna","family":"Jani","sequence":"additional","affiliation":[{"name":"Faculty of Biology Medicine and Health, Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, The University of Manchester , Manchester ,","place":["United Kingdom"]},{"name":"NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre , Manchester ,","place":["United Kingdom"]},{"name":"Department of Rheumatology, Salford Royal Hospital, Northern Care Alliance , Salford ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7047-2183","authenticated-orcid":false,"given":"John","family":"McBeth","sequence":"additional","affiliation":[{"name":"Faculty of Biology Medicine and Health, Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, The University of Manchester , Manchester ,","place":["United Kingdom"]},{"name":"NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre , Manchester ,","place":["United Kingdom"]},{"name":"Faculty of Medicine, The University of Southampton , Southampton ,","place":["United Kingdom"]},{"name":"Faculty of Engineering and Physical Science, The University of Southampton , Southampton ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5881-4857","authenticated-orcid":false,"given":"William G","family":"Dixon","sequence":"additional","affiliation":[{"name":"Faculty of Biology Medicine and Health, Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, The University of Manchester , Manchester ,","place":["United Kingdom"]},{"name":"Faculty of Biology Medicine and Health, Division of Informatics, Imaging and Data Science, The University of Manchester , Manchester ,","place":["United Kingdom"]},{"name":"NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre , Manchester ,","place":["United Kingdom"]},{"name":"Department of Rheumatology, Salford Royal Hospital, Northern Care Alliance , Salford ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,9,17]]},"reference":[{"issue":"6","key":"2025120218125936600_ref1","doi-asserted-by":"publisher","first-page":"547","DOI":"10.1111\/joim.12119","article-title":"Electronic health records: new opportunities for clinical research","volume":"274","author":"Coorevits","year":"2013","journal-title":"J Intern Med."},{"issue":"10","key":"2025120218125936600_ref2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.0040297","article-title":"Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration","volume":"4","author":"Vandenbroucke","year":"2007","journal-title":"PLoS Med."},{"issue":"10","key":"2025120218125936600_ref3","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001885","article-title":"The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) statement","volume":"12","author":"Benchimol","year":"2015","journal-title":"PLoS Med."},{"key":"2025120218125936600_ref4","doi-asserted-by":"publisher","first-page":"49","DOI":"10.2147\/CLEP.S104448","article-title":"Helping everyone do better: a call for validation studies of routinely recorded health data","volume":"8","author":"Ehrenstein","year":"2016","journal-title":"Clin Epidemiol."},{"key":"2025120218125936600_ref5","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.f2350","article-title":"Completeness and diagnostic validity of recording acute myocardial infarction events in primary care, hospital care, disease registry, and national mortality records: cohort study","volume":"346","author":"Herrett","year":"2013","journal-title":"BMJ."},{"issue":"1","key":"2025120218125936600_ref6","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1111\/j.1365-2125.2009.03537.x","article-title":"Validation and validity of diagnoses in the general practice research database: a systematic review","volume":"69","author":"Herrett","year":"2010","journal-title":"Br J Clin Pharmacol."},{"issue":"1","key":"2025120218125936600_ref7","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1183\/20734735.0344-2018","article-title":"How to validate a diagnosis recorded in electronic health records","volume":"15","author":"Nissen","year":"2019","journal-title":"Breathe (Sheff)."},{"issue":"6","key":"2025120218125936600_ref8","doi-asserted-by":"publisher","first-page":"161","DOI":"10.14745\/ccdr.v46i06a02","article-title":"Challenges and opportunities for public health made possible by advances in natural language processing","volume":"46","author":"Baclic","year":"2020","journal-title":"Can Commun Dis Rep."},{"issue":"12","key":"2025120218125936600_ref9","doi-asserted-by":"publisher","first-page":"3346","DOI":"10.1093\/rheumatology\/kead586","article-title":"The epidemiology of psoriatic arthritis in the UK: a health intelligence analysis of UK primary care electronic health records 1991-2020","volume":"63","author":"Druce","year":"2024","journal-title":"Rheumatology (Oxford)."},{"issue":"8","key":"2025120218125936600_ref10","doi-asserted-by":"publisher","first-page":"1082","DOI":"10.1136\/ard-2024-225544","article-title":"Development and evaluation of a text analytics algorithm for automated application of national COVID-19 shielding criteria in rheumatology patients","volume":"83","author":"Jani","year":"2024","journal-title":"Ann Rheum Dis."},{"key":"2025120218125936600_ref11","doi-asserted-by":"publisher","DOI":"10.1016\/j.artmed.2021.102083","article-title":"Multi-domain clinical natural language processing with MedCAT: the Medical Concept Annotation Toolkit","volume":"117","author":"Kraljevic","year":"2021","journal-title":"Artif Intell Med."},{"issue":"6943","key":"2025120218125936600_ref12","doi-asserted-by":"publisher","first-page":"1552","DOI":"10.1136\/bmj.308.6943.1552","article-title":"Diagnostic tests. 1: sensitivity and specificity","volume":"308","author":"Altman","year":"1994","journal-title":"BMJ."},{"key":"2025120218125936600_ref13","doi-asserted-by":"publisher","DOI":"10.1016\/j.lanepe.2022.100519","article-title":"Rheumatoid arthritis, psoriatic arthritis, and axial spondyloarthritis epidemiology in England from 2004 to 2020: an observational study using primary care electronic health record data","volume":"23","author":"Scott","year":"2022","journal-title":"Lancet Reg Health Eur."},{"issue":"9","key":"2025120218125936600_ref14","doi-asserted-by":"publisher","first-page":"1314","DOI":"10.1002\/art.24015","article-title":"How accurate are diagnoses for rheumatoid arthritis and juvenile idiopathic arthritis in the general practice research database?","volume":"59","author":"Thomas","year":"2008","journal-title":"Arthritis Rheum."},{"issue":"5","key":"2025120218125936600_ref15","doi-asserted-by":"publisher","first-page":"1269","DOI":"10.1111\/rssc.12435","article-title":"Bayesian analysis of tests with unknown specificity and sensitivity","volume":"69","author":"Gelman","year":"2020","journal-title":"J R Stat Soc Ser C Appl Stat."},{"key":"2025120218125936600_ref16","volume-title":"Confidentiality Advisory Group (CAG)","author":"NHS","year":"2024"},{"key":"2025120218125936600_ref17","volume-title":"What is Five Safes Framework?","author":"UKDataService","year":"2024"},{"key":"2025120218125936600_ref18","volume-title":"Uniting the UK\u2019s Health Data: A Huge Opportunity for Society","author":"Sudlow","year":"2024"},{"key":"2025120218125936600_ref19","volume-title":"Prime Minister Turbocharges Medical Research","author":"Department of Health and Social Care","year":"2025"},{"key":"2025120218125936600_ref20","doi-asserted-by":"publisher","DOI":"10.1136\/bmj-2023-076365","article-title":"Quantifying possible bias in clinical and epidemiological studies with quantitative bias analysis: common approaches and limitations","volume":"385","author":"Brown","year":"2024","journal-title":"BMJ."},{"key":"2025120218125936600_ref21","volume-title":"Investing in the Future of Health Research: Secure, Accessible, and Life-Saving","author":"Bloomfield","year":"2023"}],"container-title":["American Journal of Epidemiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/aje\/advance-article-pdf\/doi\/10.1093\/aje\/kwaf206\/64302640\/kwaf206.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/aje\/article-pdf\/194\/12\/3640\/64302640\/kwaf206.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/aje\/article-pdf\/194\/12\/3640\/64302640\/kwaf206.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T23:13:04Z","timestamp":1764717184000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/aje\/article\/194\/12\/3640\/8256745"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,17]]},"references-count":21,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,9,17]]},"published-print":{"date-parts":[[2025,12,2]]}},"URL":"https:\/\/doi.org\/10.1093\/aje\/kwaf206","relation":{},"ISSN":["0002-9262","1476-6256"],"issn-type":[{"value":"0002-9262","type":"print"},{"value":"1476-6256","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,12]]},"published":{"date-parts":[[2025,9,17]]}}}