Article Figures & Data
Figures
- Figure 1.
Network Plots Showing Correlations of Diagnoses by Age Group
Note: See Table 1 footnotes for code definitions.
- Figure 2.
Relative Region (Powiat) Probabilities of Receiving a Particular Diagnosis From Ambiguous Pairs
Note: See Table 1 footnotes for code definitions.
- Figure 3.
Relative Region (Powiat) Probabilities of Receiving a Particular Diagnosis for the Pair of J00 and J06 Among Children
J00 = acute nasopharyngitis [common cold]; J06 = acute upper respiratory infections of multiple and unspecified sites; Loess = locally weighted scatterplot smoothing.
Tables
- Table 1.
Distribution of ARls by ICD-10 Diagnosis Codes for Polish Regions During 2010-2019
Diagnosis Codea Share of ARIs, mean (range) [SD], % of total Children (0-17 y) Middle-aged adults (18-64 y) Older adults (≥65 y) J00 31.9 (11.2-47.2) [6.8] 17.9 (9.4-28.8) [3.5] 14.9 (7.3-26.5) [3.1] J01 2.8 (0.6-8.3) [1.2] 8.5 (3.0-16.1) [1.9] 4.1 (1.3-10.7) [1.3] J02 13.9 (6.9-29.8) [3.8] 15.7 (9.7-26.0) [2.8] 10.6 (5.2-21.9) [2.5] J03 7.8 (3.4-21.0) [2.2] 9.1 (4.2-15.9) [1.9] 3.5 (1.1-9.7) [1.3] J04 5.3 (1.2-17.7) [2.1] 6.2 (0.8-14.5) [2.4] 5.2 (0.4-15.1) [2.6] J05 0.5 (0.0-5.0) [0.4] 0.1 (0.0-3.2) [0.2] 0.1 (0.0-1.1) [0.1] J06 22.7 (6.2-50.7) [6.4] 26.2 (10.7-42.8) [5.1] 25.3 (11.2-40.9) [4.5] J10 0.1 (0.0-0.7) [0.1] 0.2 (0.0-1.8) [0.2] 0.4 (0.0-4.0) [0.4] J11 0.6 (0.0-2.8) [0.4] 1.5 (0.2-5.0) [0.8] 0.9 (0.1-4.2) [0.5] J12 0.1 (0.0-1.5) [0.2] 0.0 (0.0-0.3) [0.0] 0.1 (0.0-1.1) [0.1] J13 0.0 (0.0-0.6) [0.0] 0.0 (0.0-0.3) [0.0] 0.1 (0.0-6.3) [0.3] J14 0.0 (0.0-0.1) [0.0] 0.0 (0.0-0.1) [0.0] 0.0 (0.0-0.5) [0.1] J15 0.3 (0.0-2.1) [0.3] 0.3 (0.0-1.8) [0.2] 1.4 (0.1-9.9) [1.4] J16 0.1 (0.0-1.2) [0.2] 0.1 (0.0-1.2) [0.1] 0.5 (0.0-4.0) [0.5] J17 0.0 (0.0-0.2) [0.0] 0.0 (0.0-0.5) [0.0] 0.1 (0.0-1.9) [0.1] J18 2.3 (0.5-8.4) [1.2] 2.6 (0.8-7.7) [0.9] 9.2 (2.8-21.1) [2.9] J20 10.8 (3.9-22.3) [2.7] 10.2 (5.8-19.9) [2.1] 20.8 (13.1-33.2) [3.2] J21 0.1 (0.0-1.3) [0.1] 0.1 (0.0-1.0) [0.1] 0.2 (0.0-2.1) [0.3] J22 0.8 (0.0-8.8) [0.9] 1.3 (0.0-7.4) [1.0] 2.7 (0.1-13.8) [1.9] Total 100.0 100.0 100.0 ARI = acute respiratory infection; ICD-10 = International Classification of Diseases,10th Revision.
Note: Cells for which the mean value exceeds 5% within the age group are in bold.
↵a J00: acute nasopharyngitis [common cold]. J01: acute sinusitis. J02: acute pharyngitis. J03: acute tonsillitis. J04: acute laryngitis and tracheitis. J05: acute obstructive laryngitis [croup] and epiglottitis. J06: acute upper respiratory infections of multiple and unspecified sites. J10: influenza due to other identified influenza virus. J11: influenza due to unidentified influenza virus. J12: viral pneumonia, not elsewhere classified. J13: pneumonia due to Streptococcus pneumoniae. J14: pneumonia due to Hemophilus influenzae. J15: bacterial pneumonia, not elsewhere classified. J16: pneumonia due to other infectious organisms, not elsewhere classified. J17: pneumonia in diseases classified elsewhere. J18: pneumonia, unspecified organism. J20: acute bronchitis. J21: acute bronchiolitis. J22: unspecified acute lower respiratory infection.
SUPPLEMENTAL MATERIALS IN PDF FILE BELOW
Supplemental Appendix
Supplemental Figure 1. Share of J00 in Pair J00 and J20 Among Children by Powiat (County) in Years 2010-2019
Supplemental Figure 2. Share of J03 in Pair J03 and J06 Among Working Age Population by Powiat (County) in Years 2010-2019
Supplemental Figure 3. Share of J04 in Pair J04 and J06 Among Working Age Population by Powiat (County) in YEars 2010-2019
Supplemental Figure 4. Share of J04 in Pair J04 and J06 Among Elders by Powiat (County) in Years 2010-2019
Supplemental Figure 5. Share of J00 in Pair J00 and J18 Among Elders by Powiat (County) in Years 2010-2019- Walkowiak_Supp_App_Supp_Figs_1-5.pdf -
PDF file
- Walkowiak_Supp_App_Supp_Figs_1-5.pdf -
VISUAL ABSTRACT IN PDF FILE BELOW
- Walkowiak_visual_abstract.pdf -
PDF file
- Walkowiak_visual_abstract.pdf -
PLAIN-LANGUAGE SUMMARY
Original Research
Background and Goal: The International Classification of Diseases (ICD) system is designed to standardize diagnostic codes globally, enabling accurate comparisons of health data. However, variability in how ICD codes are applied can hinder their effectiveness. This study investigated regional differences in respiratory infection diagnoses in Poland to identify potential ambiguities in ICD coding and their implications for data comparability.
Study Approach:Researchers analyzed over 292 million primary care visits for acute respiratory infections in Poland between 2010 and 2019, using ICD-10 codes (J00–J22). Diagnosis data were grouped by age (children, working-age adults, elders) and analyzed at the county level. Statistical methods and visualizations were used to uncover regional differences in how ICD codes were applied. These inconsistencies were further analyzed to determine whether they reflected genuine differences in diagnoses or systemic issues with code usage.
Main Results:
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The most problematic code appeared to be "acute upper respiratory infections of multiple and unspecified sites" (J06) which was frequently used interchangeably with other codes, especially "common cold" (J00) and "bronchitis" (J20)
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Significant differences were observed in how respiratory conditions were coded across counties, with no consistent regional patterns to explain these variations. Larger counties showed less variability, likely due to random factors canceling out.
Why It Matters:Variation in physician coding practices requires particular attention during analyses to avoid conclusions about differences that may simply be coding variation. The study findings highlight the need for clearer guidelines and better training to reduce variability in ICD code application.
Breaking ICD Codes: Identifying Ambiguous Respiratory Infection Codes via Regional Diagnosis Heterogeneity
Marcin Piotr Walkowiak, PhD, et al
Department of Preventive Medicine, Poznan University of Medical Sciences, Poznań, Poland
Visual Abstract:
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