TY  - JOUR
AU  - Tatem, Kathleen S.
AU  - Romo, Matthew L.
AU  - McVeigh, Katharine H.
AU  - Chan, Pui Ying
AU  - Lurie-Moroni, Elizabeth
AU  - Thorpe, Lorna E.
AU  - Perlman, Sharon E.
PY  - 2017
TI  - Comparing Prevalence Estimates From Population-Based Surveys to Inform Surveillance Using Electronic Health Records
T2  - Preventing Chronic Disease
JO  - Prev Chronic Dis
SP  - E44
VL  - 14
CY  - Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
N2  - INTRODUCTION  Electronic health record (EHR) systems provide an opportunity to use a novel data source for population health surveillance. Validation studies that compare prevalence estimates from EHRs and surveys most often use difference testing, which can, because of large sample sizes, lead to detection of significant differences that are not meaningful. We explored a novel application of the two one-sided t test (TOST) to assess the equivalence of prevalence estimates in 2 population-based surveys to inform margin selection for validating EHR-based surveillance prevalence estimates derived from large samples. METHODS  We compared prevalence estimates of health indicators in the 2013 Community Health Survey (CHS) and the 2013-2014 New York City Health and Nutrition Examination Survey (NYC HANES) by using TOST, a 2-tailed t test, and other goodness-of-fit measures. RESULTS  A +/-5 percentage-point equivalence margin for a TOST performed well for most health indicators. For health indicators with a prevalence estimate of less than 10% (extreme obesity [CHS, 3.5%; NYC HANES, 5.1%] and serious psychological distress [CHS, 5.2%; NYC HANES, 4.8%]), a +/-2.5 percentage-point margin was more consistent with other goodness-of-fit measures than the larger percentage-point margins. CONCLUSION  A TOST with a +/-5 percentage-point margin was useful in establishing equivalence, but a +/-2.5 percentage-point margin may be appropriate for health indicators with a prevalence estimate of less than 10%. Equivalence testing can guide future efforts to validate EHR data.
SN  - 1545-1151
UR  - https://doi.org/10.5888/pcd14.160516
DO  - 10.5888/pcd14.160516
ER  - 
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