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J Clin Epidemiol. 2014 Oct;67(10):1139-49. doi: 10.1016/j.jclinepi.2014.05.012. Epub 2014 Jul 14.

Administrative data on diagnosis and mineralocorticoid receptor antagonist prescription identified patients with primary aldosteronism in Taiwan.

Author information

  • 1Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan.
  • 2Division of Endocrinology, Taipei Tzu Chi General Hospital, 289 Jianguo Road, Xindian, Taiwan.
  • 3Division of Nephrology, Taipei Tzu Chi General Hospital, 289 Jianguo Road, Xindian, Taiwan.
  • 4Division of Nephrology, Department of Internal Medicine, Taipei Medical University Hospital, 250 Wu-Hsing Street, Taipei, Taiwan.
  • 5Department of Internal Medicine and Medical Research Center, Cardinal Tien Hospital, 362 Zhongzheng Road, Xindian, Taiwan.
  • 6Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, 25 Jingguo Road, Hsinchu, Taiwan.
  • 7Department of Internal Medicine, Taipei City Hospital, Zhongxing Branch, 145 Zhengzhou Road, Taipei, Taiwan.
  • 8Department of Internal Medicine, Postal Hospital, 14 Fu-Chuo Street, Taipei, Taiwan.
  • 9Department of Urology, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan. Electronic address:
  • 10Institute of Population Health Sciences, National Health Research Institutes, 35 Keyan Road, Zhunan, Taiwan. Electronic address:



To develop algorithms of locating patients with primary aldosteronism (PA) using insurance reimbursement data and to validate the algorithms using medical charts.


We extracted National Health Insurance (NHI) reimbursement data and medical charts in seven enrolled hospitals and analyzed diagnosis-related information for 1999-2010. The NHI codes PA as 255.1x, using the International Classification of Diseases, Ninth Revision, Clinical Modification. Confirmation of PA was based on suppression tests.


We reviewed medical charts for 1,094 cases with at least one PA diagnosis. PA was confirmed for 563 cases. Compared with patients with essential hypertension, PA patients had higher systolic blood pressure, higher aldosterone, lower renin activity, and lower potassium level (all P-values <0.05). An algorithm based on PA diagnosis reported in at least one hospital stay or three outpatient visits had modest performance (sensitivity = 0.94 and specificity = 0.20). The best additional condition for the algorithm was use of mineralocorticoid receptor antagonist (MRA; sensitivity = 0.89 and specificity = 0.88).


Using information on PA diagnosis and MRA prescription reported in insurance claims data can precisely locate PA patients in high-risk groups. This algorithm can construct a reliable PA sample for conducting research in various fields, including epidemiology and clinical practice.

Copyright © 2014 Elsevier Inc. All rights reserved.


Adjudication; Administrative data; Medical chart review; Mineralocorticoid receptor antagonist; Primary aldosteronism; Validation

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