Using hospital discharge files to enhance cancer surveillance

Use of the traditional mechanism for cancer surveillance, hospital-based registries, may limit ascertainment of incident cases. In this study, the authors evaluated the ability of a statewide hospital discharge file (HDF) to enhance central cancer registry reporting. Incident cancers from a Virginia cancer registry were linked with an HDF for 1995. Medical record abstractions for over 2,000 cancers verified HDF and registry data. There were 19,740 unique cases ascertained from the two combined data sources. The registry captured approximately 83% of cases, while the HDF captured 62%. Although the HDF missed a substantial number of registry cases, the HDF positive predictive value for identifying the correct cancer site was 94%. Logistic regression was used to identify significant characteristics of cases likely to be captured only by the HDF; these characteristics included hospital cancer program certification, the position of the cancer diagnosis on the claim, and cancer surgery. This study represents the evaluation of a novel approach to enhancing registry completeness and accuracy using statewide HDFs. The results strongly suggest that neither a central cancer registry nor an HDF is a sufficient source for complete capture of cases. Using HDFs to supplement a central cancer registry may be a valuable and efficient method for improving registry completeness of reporting.     

Validity of coronary heart diseases and heart failure based on hospital discharge and mortality data in the Netherlands using the cardiovascular registry Maastricht cohort study

Incidence rates of cardiovascular diseases are often estimated by linkage to hospital discharge and mortality registries. The validity depends on the quality of the registries and the linkage. Therefore, we validated incidence rates of coronary heart disease (CHD), acute myocardial infarction, unstable angina pectoris, and heart failure, estimated by this method, against the disease registry of the cardiovascular registry Maastricht cohort study. The cohort consists of 21,148 persons, born between 1927 and 1977, who were randomly sampled from Maastricht and surrounding communities in 1987–1997. Incident cases were identified by linkage to the Netherlands causes of death registry and either the hospital discharge registry (HDR) or the cardiology information system (CIS) of the University Hospital Maastricht. Sensitivities and positive predictive values were calculated using the CIS-based registry as gold standard. Relatively high sensitivities and positive predictive values were found for CHD (72 and 91%, respectively) and acute myocardial infarction (84 and 97%, respectively). These values were considerably lower for unstable angina pectoris (53 and 78%, respectively) and heart failure (43 and 80%, respectively). A substantial number of cases (14–47%) were found only in the CIS-based registry, because they were missed or miscoded in the HDR-based registry. As a consequence, the incidence rates in the HDR-based registry were considerably lower than in the CIS-based registry, especially for unstable angina pectoris and heart failure. Incidence rates based on hospital discharge and mortality data may underestimate the true incidence rates, especially for unstable angina pectoris and heart failure.     

Role of hospital claims databases from care units for estimating thyroid cancer incidence in the Rhône-Alpes region of France

BACKGROUND: Incidence measures are essentially based on the data collected by cancer registries. Hospital claims databases from care units (PMSI) can be used as a source of information for registries because they contain standard records of most cancer patients. Regarding thyroid cancer, we have evaluated the PMSI as a source of information for the Rh?ne-Alpes thyroid cancer registry and usefulness of PMSI as a tool for surveillance of thyroid cancer incidence. METHODS: Patients with incident thyroid cancer in 2002 were identified in the claims data of the Rh?ne-Alpes region using an algorithm based on DRG codes of thyroidectomy and on diagnosis codes of thyroid cancer in a principal or secondary position. The patients identified were compared to those in thyroid cancer registry of the Rh?ne-Alpes region regarding sex, age, ZIP code of residence, month of discharge and length of stay versus the diagnosis date. When the percentage of cases of claims data identified in the cancer registry and the percentage of cases of the cancer registry identified in claims data were obtained, the capture-recapture method was applied to estimate the number of missing cases and the total number of incident thyroid cancers in the region. RESULTS: 667 patients were identified in claims data while the cancer registry included 677 patients. 95.2% of patients identified in claims data were in the cancer registry and 82.3% of patients in the cancer registry were identified in claims data. Cases lacking in claims data mostly corresponded to micro-cancers which represented 41% of cases in the cancer registry. Regarding cancer above 1 cm, 92% of the cancer registry cases were identified in claims data. Sensitivity of combining information from cancer registry and claims data was 99.2%. Cases lacking in cancer registry, present in claims data base and considered as true cases after obtaining pathological confirmation represented 2% of the whole thyroid cancer population. CONCLUSION: Claims data obtained from anonymous regional or national bases can be helpful for checking the completeness of thyroid cancer registries and to provide a small amount of unknown cases. They can be considered an acceptable tool for surveillance of thyroid cancer incidence. The significance of the variations in incidence that could be observed from claims data remains to be evaluated in comparison with comparable data obtained from registries.     

Estimations départementales de l’incidence du cancer colorectal en France à partir des données hospitalières, 1999–2003

BackgroundCancer incidence in France is monitored by district-level cancer registries, which cover only 15% of the population. Incidence at the national and regional level are estimated from mortality data by extrapolating the ratio between incidence and mortality observed in the districts covered by a cancer registry. Using the incidence/mortality ratio might not be relevant at the district-level (département). This study aims to produce district-level estimations of colorectal cancer incidence, using the ratio between incident cases from cancer registries and surgery admissions for colorectal cancer identified in the national hospital discharge database.MethodsThis ratio was studied for the period 1999–2003 in the 13 districts covered by a cancer registry. For each sex separately, the number of incident cases was analyzed according to the number of surgery admissions for resection of colorectal cancer using a Poisson model. Age was introduced in the model as a fixed effect and district as a random effect. The model's ability to predict incidence was tested through cross-validation. The model was then extrapolated in order to estimate incidence of colorectal cancer in all French districts.ResultsIn the districts covered by a cancer registry, cross-validation showed the model had a good predictive ability, except in men for one district where the difference between predicted and observed incidence reached 10%. Estimated incidence rates, age-standardized on the world population, ranged broadly from 29 to 44 per 100,000 in men and from 17 to 27 per 100,000 in women. Incidence did not show any clear geographical pattern.ConclusionAmong districts covered by a cancer registry, cross-validation showed overall good accuracy of predicted incidence. Inclusion of several admissions per patient was certainly a minor source of error in these estimations. Indeed, our selection only included 2% of multiple admissions, without geographical variations, in 2002 and 2003, years for which patient identifiers were available in the hospital discharge database. Estimated incidence rates presented moderate geographical variations and their prediction intervals should be taken into account.     

Is it possible to estimate the incidence of breast cancer from medico-administrative databases?

One approach to estimate cancer incidence in the French Départements is to quantify the relationship between data in cancer registries and data obtained from the PMSI (Programme de Médicalisation des Systèmes d’Information Médicale). This relationship may then be used in Départements without registries to infer the incidence from local PMSI data. We present here some methodological solutions to apply this approach. Data on invasive breast cancer for 2002 were obtained from 12 Départemental registries. The number of hospital stays was obtained from the National PMSI using two different algorithms based on the main diagnosis only (Algorithm 1) or on that diagnosis associated to a mention of “resection” (Algorithm 2). Considering registry data as gold standard, a calibration approach was used to model the ratio of the number of hospital stays to the number of incident cases. In Départements with registries, validation of the predictions was done through cross-validation. In Départements without registries, validation was done through a study of homogeneity of the mean number of hospital stays per patient. Cross-validation showed that the estimates predicted by the model were true with data extracted by Algorithm 1 but not by Algorithm 2. However, with Algorithm 1, there was an important heterogeneity between French Départements as to the mean number of hospital stays per patient, which had an important impact on the estimations. In the near future, the method will allow using medico-administrative data (after calibration with registry data) to estimate Départemental incidence of selected cancers.     

An application of capture-recapture methods to the estimation of completeness of cancer registration

Completeness of cancer registration has not been consistently ascertained across different registries. This report describes how capture-recapture methods have been used to estimate completeness at the Ontario Cancer Registry. The method was applied in two fashions; first, using three data sources in a modeling approach: and second, using two data sources and standard, simple capture-recapture methods. The modeling approach is more flexible, since several variables that influence cancer registration can be considered and can be used to identify reporting patterns of different data sources. In the present analysis, estimates of completeness of the registry as a whole were remarkably similar using either two or three data sources, and site-specific comparisons differed by at most 7%. Because of the advantages of capture-recapture methods-estimation of level of completeness, possible comparability of estimates across different registries, and versatility to consider other determinants of cancer registration-a plea for greater use of these methods in cancer registration is made.     

Predictive value and sensibility of hospital discharge system (PMSI) compared to cancer registries for thyroïd cancer (1999-2000)

BACKGROUND: Cancer registries have a complete recording of new cancer cases occurring among residents of a specific geographic area. In France, they cover only 13% of the population. For thyroid cancer, where incidence rate is highly variable according to the district conversely to mortality, national incidence estimates are not accurate. A nationwide database, such as hospital discharge system, could improve this estimate but its positive predictive value and sensibility should be evaluated. METHODS: The positive predictive value and the sensitivity for thyroid cancer case ascertainment (ICD-10) of the national hospital discharge system in 1999 and 2000 were estimated using the cancer registries database of 10 French districts as gold standard. The linkage of the two databases required transmission of nominative information from the health facilities of the study. From the registries database, a logistic regression analysis was carried out to identify factors related to being missed by the hospital discharge system. RESULTS: Among the 973 standardized discharge charts selected from the hospital discharge system, 866 were considered as true positive cases, and 107 as false positive. Forty five of the latter group were prevalent cases. The predictive positive value was 89% (95% confidence interval (CI): 87-91%) and did not differ according to the district (p=0,80). According to the cancer registries, 322 thyroid cancer cases diagnosed in 1999 or 2000 were missed by the hospital discharge system. Thus, the sensitivity of this latter system was 73% (70-76%) and varied significantly from 62% to 85% across districts (p<0.001) and according to the type of health facility (p<0.01). CONCLUSION: Predictive positive value of the French hospital discharge system for ascertainment of thyroid cancer cases is high and stable across districts. Sensitivity is lower and varies significantly according to the type of health facility and across districts, which limits the interest of this database for a national estimate of thyroid cancer incidence rate.     

Completeness of a newly implemented general cancer registry in northern France: Application of a three-source capture-recapture method

BackgroundCompleteness, timeliness and accuracy are important qualities for registries. The objective was to estimate the completeness of the first two years of full registration (2008/2009) of a new population-based general cancer registry, at the time of national data centralisation.MethodsRecords followed international standards. Numbers of cases missed were estimated from a three-source (pathology labs, healthcare centres, health insurance services) capture-recapture method, using log-linear models for each gender. Age and place of residence were considered as potential variables of heterogeneous catchability.ResultsWhen data were centralized (2011/2012), 4446 cases in men and 3642 in women were recorded for 2008/2009 in the Registry. Overall completeness was estimated at 95.7% (95% CI: 94.3–97.2) for cases in men and 94.8% (95% CI: 92.6–97.0) in women. Completeness appeared higher for younger than for older subjects, with a significant difference of 4.1% (95% CI: 1.4–6.7) for men younger than 65 compared with their older counterparts. Estimates were collated with the number of cases registered in 2014 for the years 2008/2009 (4566 cases for men/3755 for women), when additional structures had notified cases retrospectively to the Registry. These numbers were consistent with the stratified capture-recapture estimates.ConclusionThis method appeared useful to estimate the completeness quantitatively. Despite a rather good completeness for the new Registry, the search for cases among older subjects must be improved.     

应用捕获-再捕获法估计5岁以下儿童死亡人数

目的 应用捕获-再捕获方法 估计林州市2004—2005年5岁以下儿童死亡人数,评价全死因登记报告中5岁以下儿童死亡数据的完整性。方法 通过林州市居民全死因登记处、全国第3次死因调查的村访谈资料和公安部门3个来源收集林州市2004—2005年5岁以下儿童死亡资料。不同来源数据间的匹配采用姓名、年龄、性别、死亡时间、死因和居住地址等变量。考虑到样本间的相依性和异质性,在年龄、性别分层中使用对数线性模型估计三样本中都没有出现的5岁以下儿童死亡理论数,加上已知观察数,得到估计死亡总数。结果 林州市2004—2005年3个来源资料合并共报告5岁以下儿童死亡人数为359例,死亡率为2.16%。其中,居民全死因登记处报告的儿童死亡人数为291人,死亡率为1.75%;用捕获-再捕获方法 估计的儿童死亡人数为398人,死亡率为2.39%。登记处的漏报率为26.9%,合并样本的漏报率为9.8%;女童组更易被漏报,同时在低年龄儿童组死亡漏报率较高。结论 仅使用居民全死因登记处或合并样本资料会低估5岁以下儿童死亡人数。在公安部门、死因调查的村访谈资料、居民全死因登记处等部门的现有资料基础上使用捕获-再捕获方法 ,可以校正低估的5岁以下儿童死亡人数。     

Estimating infra-national and national thyroid cancer incidence in France from cancer registries data and national hospital discharge database

Objective As in many countries, cancer registries cover only part of the population in France. Incidence/mortality ratio observed in registries is usually extrapolated to produce national estimates of cancer incidence. District-level estimates are not currently available. For cancer sites such as thyroid, the incidence/mortality ratio widely varies between districts, and alternative indicators must be explored. This study aims to produce national and district-level estimations of thyroid cancer incidence in France, using the ratio between incidence and hospital-based incidence. Methods Analyses concerned population living in France and aged over 20, for the period 1998–2000. For each sex, number of incident cases were analysed according to number of surgery admissions for thyroid cancer (Poisson model) in the districts covered by a registry. Age was included in the model as fixed effect and district as random effect. The model’s ability to predict incidence was tested through cross-validation. The model was then extrapolated to produce national incidence estimations, and for women, district-level estimations. Results The national estimations of incidence rate age-standardised on the world population were 3.1 [95% prediction interval: 2.8–3.4] for men and 10.6 [9.8–11.4] for women, corresponding respectively to 1,148 [1,042–1,264] and 4,104 [3,817–4,413] annual new cases. For women, district-level incidence rates presented wide geographical variations, ranging broadly from 5 to 20 per 100,000. These estimations were quite imprecise, but their imprecision was smaller than the extent of geographical disparities. Conclusion National incidence estimations obtained are relatively precise. District-level estimations in women are imprecise and should be treated carefully. They are informative though regarding the extent of geographical disparities. The approach can be useful to improve national incidence estimates and to produce district-level estimates for cancer sites presenting a high variability of the incidence/mortality ratio.     

Patterns of surgical care for prostate cancer in NSW, 1993-2002: rural/urban and socio-economic variation

Objectives: Prostate cancer is the most commonly registered cancer in Australian men, yet there is a lack of information about its management. We described the patterns and trends in the surgical treatment of men with prostate cancer in New South Wales (NSW). Method: We used probabilistic record linkage to link cancer registry data with hospital admissions. All NSW men diagnosed with prostate cancer between 1993 and 2002 were eligible for the study. Rates of radical prostatectomy, bilateral orchidectomy and transurethral resection of the prostate were calculated. Factors affecting the probability of undergoing these procedures were examined using log‐binomial regression. Results: Between January 1993 and December 2002, 38,712 men were diagnosed with prostate cancer in NSW. Of these, 33,200 (85.8%) cancer registry records were linked to at least one hospital admission record. Men resident in rural areas at diagnosis (RR = 0.69, 95% Cl 0.65‐0.73) and men resident in more socio‐economically disadvantaged areas (RR =0.83, 95% Cl 0.78‐0.89 for most disadvantaged) were significantly less likely to undergo a radical prostatectomy after adjusting for age and disease stage. While orchidectomy rates fell significantly during the period, rates were significantly higher in rural and lower socio‐economic areas after adjusting for age and stage. Conclusion and implications: Further investigation is needed to understand the reasons for the variation in the surgical patterns of care for prostate cancer so that interventions can be implemented to ensure appropriate access for all men.     

Chronic obstructive pulmonary disease and mortality following hip fracture: a population-based cohort study

Introduction: Mortality rates after hip fracture have not declined in 20 years. We assessed the impact of chronic obstructive pulmonary disease (COPD) on mortality after hip fracture, and compared mortality in this cohort to persons without hip fracture in a population-based prospective cohort study. Methods: Using Danish health care registries, we identified persons ≥40 years old with first-time hospitalization for hip fracture between 1/1/1998 and 1/31/2003. Hospitalization for COPD was assessed from hospital discharge registries. Using Cox regression, we computed relative risks (RR) and 95% confidence intervals (CI) for mortality endpoints among persons with COPD compared to persons without COPD. Mortality following hip fracture was also compared to age and gender matched controls without hip fracture. Results: We identified 11, 985 persons with first-time hospitalization for hip fracture; 771 (6.4%) had a diagnosis of COPD. Average follow up was 22 months. Compared to persons without COPD, mortality following hip fracture in persons with COPD was RR = 1.58 (95% CI 1.30–1.90) at 30 days, RR = 1.52 (95% CI 1.30–1.77) at 90–days, RR = 1.58 (95% CI 1.40–1.78) at 1 year, and RR = 1.71 (95% CI 1.55–1.88) overall. The 1-year mortality in persons with hip fracture and COPD was approximately 3–5 times greater than in controls without hip fracture. Conclusions: In this cohort, persons with COPD have a 60–70% higher risk of death following hip fracture than those without COPD. In addition, hip fracture and COPD increased 1-year mortality 3–5 times that of persons without hip fracture. Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

Estimating the cumulative number of human immunodeficiency virus diagnoses by cross-linking from four different sources

BACKGROUND: We estimated the cumulative number of people diagnosed with human immunodeficiency virus (HIV) infection in a region of Italy by cross-linking data from four surveillance systems and applying capture-recapture methods. METHODS: The study was conducted using data referring to residents of the Veneto Region (population 4.4 million). We cross-linked data from the AIDS Registry (data 1983-2000), the HIV Registry (1988-2000), the Death Registry (1992-1999), and the Hospital-Discharge Registry (1997-2000), using a code based on name, birth date, and sex. A specific software for capture-recapture models (CARE-1) was used to estimate the size of the target population with two different statistical approaches (sample coverage and log-linear models). RESULTS: A total of 2801 people were reported to the AIDS Registry, 6415 to the HIV Registry, 1598 to the Death Registry as HIV/AIDS-related deaths, and 3330 to the Hospital-Discharge Registry with a diagnosis of HIV infection. Overall, 8723 people were present in at least one registry: 4896 people were present in only one registry, 2387 in two registries, 1286 in three registries, and 154 in all four registries. Using the sample coverage approach, we estimated that, since the beginning of the epidemic in Veneto, an estimated 11 281 people (95% CI: 10 981, 11 621) should have been reported to at least one registry; thus the estimated coverage of the four registries was 77.3% (i.e. 8723/11 281). Results obtained applying the log-linear approach were similar, although the fitting of this model was not adequate. CONCLUSIONS: Cross-linking data from four different sources and applying the capture-recapture method can improve the accuracy of the estimates of the dimensions of the HIV epidemic.     

Estimating cancer incidence in Indigenous Australians

Objective: To assess data quality of cancer registrations for Indigenous Australians and produce reliable national Indigenous cancer incidence statistics. Methods: Completeness of Indigenous identification was assessed for the eight Australian cancer registries using an innovative indirect assessment method based on registry‐specific registration rates for smoking‐related cancers. National age‐standardised incidence rates and rate ratios (Indigenous:non‐Indigenous) were calculated for all cancers combined and 26 individual cancer sites. Multivariate regression analysis was used to investigate trends in Indigenous cancer incidence by time or remoteness of residence, and whether the incidence rate ratio (Indigenous:non‐Indigenous) was different in younger than older age‐groups. Results: Four registries covering 84% of the Indigenous population had sufficiently complete Indigenous identification to be included in analysis. Compared to other Australians, Indigenous Australians had much higher incidence of lung and other smoking‐related cancers, cervix, uterus and liver cancer, but much lower incidence of breast, prostate, testis, colorectal and brain cancer, melanoma of skin, lymphoma and leukaemia. Incidence was higher in remote areas for some cancers (including several smoking‐related cancers) but lower for others. The incidence rate ratios (IRRs) for smoking‐related cancers were higher in younger than older people. Conclusions: Indigenous Australians have a different pattern of incidence of specific cancers than other Australians and large geographical variations for several cancers. Implications: All cancer registries need to further improve Indigenous identification, but national Indigenous cancer incidence statistics can, and should, be regularly reported. Tobacco control is a critical cancer‐control issue for Indigenous Australians.     

The accuracy of discharge diagnosis coding for Amyotrophic Lateral Sclerosis in a large teaching hospital

To evaluate the accuracy of hospital discharge data as a source of Amyotrophic Lateral Sclerosis (ALS) cases for epidemiological studies or disease registries, a validation study was performed. All records of patients discharged in 2005 and 2006 with principal or secondary International Classification of Diseases, 9th rev., Clinical Modification (ICD 9 CM) diagnosis code of ALS (335.20), other anterior horn cell disease (335), spinal cord disease (336), hereditary and idiopathic peripheral neuropathy (356), inflammatory and toxic neuropathy (357), myoneural disorders (358), muscular dystrophies and myopathies (359), were selected from the electronic archive of discharge data of the University Hospital of Udine, Friuli Venezia Giulia Region, North East Italy. Corresponding clinical documentation was reviewed to ascertain the presence of El Escorial criteria, the gold standard. Sensitivity of the ICD 9 CM discharge code 335.20 was 93% (95%CI: 82–99%) and decreased to 91% (95%CI: 77–98%) when suspect ALS was excluded. Specificity was 99% (95%CI: 97–99%). The ICD 9 CM discharge code 335.20 can identify a high percentage of hospitalizations of patients truly affected by ALS and of patients with no ALS, among selected neurological diagnostic codes. To ensure complete ALS case ascertainment, prospective population-based registries or epidemiologic studies require active prospective surveillance and use of multiple sources, among them hospital discharge archives can provide accurate information.     

Predictors of Medicare costs in elderly beneficiaries with breast, colorectal, lung, or prostate cancer

Background: Determining the apportionment of costs of cancer care and identifying factors that predict costs are important for planning ethical resource allocation for cancer care, especially in markets where managed care has grown. Design: This study linked tumor registry data with Medicare administrative claims to determine the costs of care for breast, colorectal, lung and prostate cancers during the initial year subsequent to diagnosis, and to develop models to identify factors predicting costs. Subjects: Patients with a diagnosis of breast (n=1,952), colorectal (n=2,563), lung (n=3,331) or prostate cancer (n=3,179) diagnosed from 1985 through 1988. Results: The average costs during the initial treatment period were $12,141 (s.d.=$10,434) for breast cancer, $24,910 (s.d.=$14,870) for colorectal cancer, $21,351 (s.d.=$14,813) for lung cancer, and $14,361 (s.d.=$11,216) for prostate cancer. Using least squares regression analysis, factors significantly associated with cost included comorbidity, hospital length of stay, type of therapy, and ZIP level income for all four cancer sites. Access to health care resources was variably associated with costs of care. Total R ² ranged from 38% (prostate) to 49% (breast). The prediction error for the regression models ranged from <1% to 4%, by cancer site. Conclusions: Linking administrative claims with state tumor registry data can accurately predict costs of cancer care during the first year subsequent to diagnosis for cancer patients. Regression models using both data sources may be useful to health plans and providers and in determining appropriate prospective reimbursement for cancer, particularly with increasing HMO penetration and decreased ability to capture complete and accurate utilization and cost data on this population. This revised version was published online in July 2006 with corrections to the Cover Date.     

Post Partum Discharge Against Medical Advice: Who Leaves and Does it Matter?

Objective: To examine risk factors and sequela for post partum discharge against medical advice. Methods: We conducted cross-sectional analyses of hospital discharge data linked to American Hospital Association data for women discharged following a live birth for California, Florida, and New York in the years 1998–2000. We examined rates, risk factors, hospital readmission rate and mortality (California only), associated with discharge against medical advice after controlling for patient and hospital characteristics. Results: Post partum discharge against medical advice averaged 0.10%. Rates were lowest among women following uncomplicated cesarean and vaginal births (0.07%), intermediate following complicated vaginal birth (0.21%) and highest following complicated cesarean birth (0.29%). African American race, lower income, public health insurance, no health insurance, or greater comorbidity, particularly drug abuse or psychotic illness, discharge from a hospital in California or New York (compared to Florida), and location in medium or large metropolitan areas, were associated with significantly higher rates of discharge against advice. Asian or Hispanic race or ethnicity and delivery at an obstetrical specialized hospital were associated with lower risk. Patients discharged against medical advice in California were significantly more likely to be re-admitted within 30 days (adjusted odds ratio 2.7; 95% confidence interval [CI] 1.8–3.9), though none died during the period. Conclusions: Discharge against medical advice among post partum patients is uncommon, but occurs primarily among vulnerable women with psychosocial and medical risk factors. Thus, discharge against medical advice may help identify women who may benefit from additional maternal and/or child services.     

Risk Factors Correlated with Post-operative Mortality for Hip Fracture Surgery in the Elderly: A Population-based Approach

Objectives: To estimate the effect of waiting time for surgery and volume of surgical activity on mortality in patients with hip fracture and to compare risk-adjusted outcomes between hospitals providing surgery for such patients. Design: Retrospective cohort study. Setting: Friuli Venezia Giulia, Italy. Participants: A total of 6,629 elderly people who underwent surgery for hip fracture between 1st January 1996 and 31th December 2000. Main outcome measures: In-hospital, 6-month and 1-year mortality rate Results: In-hospital mortality rate was 5.4%. At six months, the mortality rate was 20.0%, and at 1 year 25.3%. Age, male sex, and comorbidity were significant predictors of mortality. Logistic regression analysis indicated that, after controlling for main patients risk factors and taking into account the hospital level variability, there was no significant association between increase in mortality rate and more than 1 day of waiting time for surgery (OR 0.90; 95% CI 0.58–1.40 for in-hospital mortality). One hospital had a significantly higher mortality rate than the others; high hospital volume for hip fracture surgery was associated with worse outcomes (OR 1.57; 95% CI 1.38–1.78 for in-hospital mortality). Mortality after hip fracture decreased significantly from 1996 to 2000 (OR 0.85; 95% CI 0.80–0.90). Conclusions: Longer waiting time for surgery was not associated with mortality after adjusting for patient risk factors, and taking into account hospital level variability. Hospital level variability was statistically significant, and was partially explained by the total volume of hospital surgical activity. The decrease in mortality between 1996 and 2000 was confirmed by multivariate models.     

Estimating completeness of cancer registration: an empirical evaluation of the two source capture-recapture approach in Germany.

STUDY OBJECTIVE--In recent years, capture-recapture methods have become increasingly popular in estimating completeness of disease registries. This study aimed to assess the performance of the two source capture-recapture method in estimating the completeness of cancer registration. DESIGN--The study was conducted in the population based cancer registry of Saarland, Germany, for which there are three main sources of notifications: reports by clinicians and pathologists, and death certificates. For groups of cases notified by one of the three sources, known completeness of registration by the other two sources was compared with the corresponding two source capture-recapture estimates. PATIENTS--A total of 16,020 patients notified to the cancer registry in 1970, 1975, 1980, and 1985 were included in the analysis. MAIN RESULTS--There was a tendency towards underestimation of completeness of notifications from pathologists and death certificates for patients notified by clinicians which was essentially confined to the older age groups. In contrast, capture-recapture methods tended to overestimate completeness of notifications from clinicians and death certificates for patients notified by pathologists. This overestimation was observed consistently in all age groups and for all of the most common cancer sites. Nevertheless, deviations of estimated completeness from known completeness were generally small or moderate. Agreement between estimated and known completeness was closest for patients notified by death certificates, although completeness was somewhat underestimated in patients above age 75. The observed patterns are in agreement with knowledge on clinical aspects and clinical management of cancer patients and with the circumstances of cancer registration in Saarland. CONCLUSIONS--Careful application of capture-recapture methods may provide an alternative to traditional approaches for estimating completeness of cancer registration.     

A Geographic Correlation Study of the Incidence of Pancreatic and other Cancers in Whites

Ecologic analyses of cancer incidence rates may be helpful to formulate hypotheses on risk factors and mechanisms of poorly known neoplasms, such as pancreatic cancer. We calculated sex-specific pair-wise and partial (after adjustment for lung cancer incidence) correlations between the incidence of pancreatic cancer and that of 23 other cancers in two international sets of cancer incidence data: the recorded or estimated incidence for 2000 in 38 European countries and the recorded incidence in Whites for 1993–1997 in 35 cancer registries from North America and Oceania. In both sexes and datasets, a strong, highly significant correlation was present between the incidence of pancreatic cancer and that of lung and kidney cancer. For the latter, correlation coefficients in the European data were 0.71 in men and 0.74 in women (both p<0.0001); in the cancer registry data they were 0.57 (p=0.0004) in men and 0.45 (p=0.007) in women. The results on kidney cancer were not modified by adjustment for the correlation with lung cancer, were confirmed by the application of spatial regression models and, with the exception of men in the cancer registry data, were confirmed in sensitivity analyses restricted to the populations with data of best quality. Weaker, less consistent correlations were found for colorectal, endometrial, ovarian and bladder cancers. Tobacco smoking is a plausible explanation of the association between pancreatic and lung cancer; the association with kidney cancer likely reflects additional common etiologic and pathogenetic factors of the two neoplasms.