Validating Type 2 Diabetes Diagnoses Across the Madrid Hospital Network: Evidence for Secondary Use of the CMBD in the European Health Data Space
8 affiliations
- 1Servicio de Admisión y Documentación Clínica, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
- 2Department of Public Health and Maternal & Child Health, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
- 3Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, 3584 CS Utrecht, The Netherlands
- 4Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Carlos III Health Institute, 28029 Madrid, Spain
- 5Research Network on Health Services and Chronic Diseases (REDISSEC), Carlos III Health Institute, 28029 Madrid, Spain
- 6Frailty, Multimorbidity Patterns and Mortality in the Elderly Population Residing in the Community Group—Hospital La Paz Institute for Health Research IdiPAZ, 28046 Madrid, Spain
- 7Community and Home Care Unit, Faculty of Biomedical and Health Sciences, Alfonso X El Sabio University, Villanueva de la Cañada, 28691 Madrid, Spain
- 8Servicio de Medicina Preventiva, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
Abstract
Background/Objectives: Hospital discharge data are increasingly reused for research and within health data spaces, but their value depends on accurate diagnostic coding. The validity of type 2 diabetes mellitus (T2DM) coding in the Spanish hospital discharge database (CMBD) had not been assessed across a whole regional network. We aimed to quantify the precision and completeness of E11 coding across the public hospital network of the Region of Madrid. Methods: We conducted a retrospective validation study in the public hospitals of the Region of Madrid (2016–2025). In each of four hospital complexity groups, we selected admissions with and without an ICD-10-ES E11 code, matched by age and sex (787 and 781 analysed). The reference standard was the American Diabetes Association criteria, checked in health records. Predictive values were estimated directly; sensitivity, specificity and prevalence were reconstructed for the whole population, adjusting for sex and age. Results: Of 4,707,924 discharges, 918,797 (19.5%) had a T2DM code. The positive predictive value was 94.2% (95% CI: 92.1–96.0), the negative predictive value 94.0% (91.3–96.3), specificity 98.5% (98.0–99.0) and sensitivity 79.3% (72.4–86.2), a lower bound. The estimated prevalence of T2DM among discharges was 23.2%, against 19.5% coded; about 226,000 admissions with T2DM had no code. Only the positive predictive value differed between hospital groups (p = 0.006). Conclusions: The E11 code is highly precise but incomplete: it is reliable for building cohorts, whereas counts based on it underestimate the number of cases by about one in five.
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BibTeX
@article{gomezcoronadomartin2026validating,
title = {{Validating Type 2 Diabetes Diagnoses Across the Madrid Hospital Network: Evidence for Secondary Use of the CMBD in the European Health Data Space}},
author = {Rafael Gómez-Coronado-Martín and Ana Chacón-García and Ana López-de-Andrés and Miguel A. Salinero-Fort and Daniala L. Weir and Carmen de Burgos-Lunar},
journal = {Journal of clinical medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15197717},
url = {https://europepmc.org/article/PMC/PMC13666438},
note = {CC BY},
}
RIS
TY - JOUR
TI - Validating Type 2 Diabetes Diagnoses Across the Madrid Hospital Network: Evidence for Secondary Use of the CMBD in the European Health Data Space
AU - Rafael Gómez-Coronado-Martín
AU - Ana Chacón-García
AU - Ana López-de-Andrés
AU - Miguel A. Salinero-Fort
AU - Daniala L. Weir
AU - Carmen de Burgos-Lunar
PY - 2026
DA - 2026/10/01
JO - Journal of clinical medicine
DO - 10.3390/jcm15197717
UR - https://europepmc.org/article/PMC/PMC13666438
AB - Background/Objectives: Hospital discharge data are increasingly reused for research and within health data spaces, but their value depends on accurate diagnostic coding. The validity of type 2 diabetes mellitus (T2DM) coding in the Spanish hospital discharge database (CMBD) had not been assessed across a whole regional network. We aimed to quantify the precision and completeness of E11 coding across the public hospital network of the Region of Madrid. Methods: We conducted a retrospective validation study in the public hospitals of the Region of Madrid (2016–2025). In each of four hospital complexity groups, we selected admissions with and without an ICD-10-ES E11 code, matched by age and sex (787 and 781 analysed). The reference standard was the American Diabetes Association criteria, checked in health records. Predictive values were estimated directly; sensitivity, specificity and prevalence were reconstructed for the whole population, adjusting for sex and age. Results: Of 4,707,924 discharges, 918,797 (19.5%) had a T2DM code. The positive predictive value was 94.2% (95% CI: 92.1–96.0), the negative predictive value 94.0% (91.3–96.3), specificity 98.5% (98.0–99.0) and sensitivity 79.3% (72.4–86.2), a lower bound. The estimated prevalence of T2DM among discharges was 23.2%, against 19.5% coded; about 226,000 admissions with T2DM had no code. Only the positive predictive value differed between hospital groups (p = 0.006). Conclusions: The E11 code is highly precise but incomplete: it is reliable for building cohorts, whereas counts based on it underestimate the number of cases by about one in five.
SN - 2077-0383
ER -