Administrative coding for non-alcoholic fatty liver disease is accurate in Swedish patients

Background and Aims: Epidemiological studies of non-alcoholic fatty liver disease (NAFLD) frequently use the International Classification of Disease (ICD) codes to identify patients. The validity of such ICD codes in a Swedish setting is unknown. Here, we aimed to validate the administrative code for NAFLD in Sweden.Methods: In total, 150 patients with an ICD-10 code for NAFLD (K76.0) from the Karolinska University Hospital between 1 January 2015 and 3 November 2021 were randomly selected. Patients were classified as true or false positives for NAFLD by medical chart review and the positive predictive value (PPV) for the ICD-10 code corresponding to NAFLD was calculated.Results: The PPV of the ICD-10 code for NAFLD was 0.82 (95% confidence interval [CI] = 0.76-0.89). After exclusion of patients with diagnostic coding for other liver diseases or alcohol abuse disorder (n = 14), the PPV was improved to 0.91 (95% CI 0.87-0.96). The PPV was higher in patients with coding for NAFLD in combination with obesity (0.95, 95%CI = 0.87-1.00) or type 2 diabetes (0.96, 95%CI = 0.89-1.00). However, in false-positive cases, a high alcohol consumption was common and such patients had somewhat higher Fibrosis-4 scores than true-positive patients (1.9 vs 1.3, p = 0.16)Conclusions: The ICD-10 code for NAFLD had a high PPV, that was further improved after exclusion of patients with coding for other liver diseases than NAFLD. This approach should be preferred when performing register-based studies to identify patients with NAFLD in Sweden. Still, residual alcohol-related liver disease might risk confound some findings seen in epidemiological studies which needs to be considered.