Sex-stratified assessment of the concordance between self-reported diagnoses and the administrative health databases across eight cardiovascular and neurological traits

While sex-based differences are well-documented in health-related research, it remains unclear whether sex influences agreement between self-reported and administrative health data (AHD) diagnoses. Neurological and cardiovascular diseases pose substantial burdens, and present sex differences in terms of prevalence, progression and treatment response. We assessed whether AHD and self-reported data concordance differs by sex.

Self-reported data was obtained from CARTaGENE, a population-based cohort in Québec, Canada, and linked with health insurance records. Agreement between self-reported and administrative data was assessed for eight neurological or cardiovascular diseases using Cohen’s Kappa. Additionally, through sex-stratified analyses, we evaluated the correlation between disease prevalence and published polygenic risk scores.

Kappa estimates had non-overlapping 95% confidence intervals between the sex-stratified analyses for myocardial infarction (0.67 [0.63–0.70] in males vs. 0.48 [0.39–0.57] in females) and stroke (0.53 [0.47–0.59] in males vs. 0.38 [0.29–0.46] in females), indicating higher agreement among males. Our analysis of comparing published polygenic risk scores to this cohort in a sex-stratified manner based on either administrative health data diagnoses or responses to self-report survey questions suggested differences between female and male prevalence by score decile for myocardial infarction, hypertension, depression and multiple sclerosis. Knowledge on agreement between self-reported and health administrative data by sex helps clarify, for a given disease and sex, whether diagnoses from different sources of data can be reliably compared or integrated.

This research has been conducted using data from CARTaGENE (https://cartagene.qc.ca/en). This work has been made possible through financial support from Genome Québec (Ministère de l’Économie, de l’Innovation et de l’Énergie), the Canadian Partnership Against Cancer and Health Canada. The authors thank all the CARTaGENE participants as well as the Régie de l’assurance maladie du Québec (RAMQ) and the Commission d’accès à l’information (CAI) for obtaining the administrative health data for the study.

This research was enabled in part by support provided by Calcul Quebec (https://www.calculquebec.ca) and the Digital Research Alliance of Canada (alliancecan.ca). We thank Ken Sin Lo at the Montreal Heart Institute Research Centre for preparing the CARTaGENE genetic data. S.A.G.T. is funded by a Junior 2 award (https://doi.org/10.69777/347366) from the Fonds de Recherche du Québec - Santé (https://frq.gouv.qc.ca); S.A.G.T. acknowledges funding through the Alzheimer Society Research Program by the Alzheimer Society of Canada and co-funding by the Canadian Institutes of Health Research (CIHR)– Institute of Aging (Funding Reference Number 189919).

JB was supported by a CIHR Canada Graduate Scholarship– Master’s (CSG M) award. Jordan Boulais-Richard and Daphnée Duong contributed equally to this work. Department of Biochemistry and Molecular Medicine, Faculty of Medicine, Université de Montréal, Montréal, Québec, H3C 3J7, Canada Jordan Boulais-Richard & Justin Bellavance Research Centre, Montreal Heart Institute, Montréal, Québec, H1T 1C8, Canada Jordan Boulais-Richard, Daphnée Duong, Justin Bellavance, Guillaume Lettre, Rafik Tadros & Sarah A.