Lehnert M, Baumgardt-Elms C, Stegmaier C, Liese A, Krieg V, Mattauch V, Hense H W
Institut für Epidemiologie und Sozialmedizin, Universität Münster.
Gesundheitswesen. 1999 Apr;61(4):161-7.
A German Federal law enacted in 1995 aims at nation-wide cancer registration, the details of realization based on local regulations being left to the individual Federal states. The impact of different approaches and regulations on the results of registration was investigated at three well-established records in the Saarland, Hamburg and North-Rhine Westphalia, taking the group of lymphoma and leukaemia (ICD 200-208) taken as an example.
Incidence and mortality rates calculated by the record files for the period from 1987 to 1994 were compared. The resulting mortality/incidence ratios were compared as well as the percentage of cases in each register with death certificates (DCO) as the only information source.
There was a distinct increase of incidence rates visible in Hamburg and Münster. As far as the male patients was concerned, both records attained the level of Saarland at the end of the period. However, the leukaemia and lymphoma mortality figures for males and females was about 10% lower for Saarland than in the comparative regions. The male mortality incidence ratio was 0.55 for Saarland versus 0.60 average in Hamburg and Münster at the end of the period. In Saarland and Hamburg there was a decrease of DCO-cases from 14% to less than 6% in 1994. More constant values around 11% could be observed in the Münster registry. The distribution of diagnosis within the group as well as age-specific incidence rates for the selected diagnosis "lymphatic leukaemia" (ICD 204) and "Hodgkin's disease" (ICD 201) yielded only slight differences.
The increase of incidence rates in Münster and Hamburg indicates more complete reporting. Assuming that the survival rates are the same in the three regions, the lower mortality in Saarland points to lower morbidity. Hence in spite of a definite approximation the cancer registries in Hamburg and Münster do not reach the level of completeness of the Saarland cancer registry. This may be due to the informed patient consent required by regional law for reports to the registry. To achieve completeness a special reporting procedure for pathological and haematological Institutes is mandatory. Simple indicators should be available in each registry for continuous estimation of completeness. Standardised case definitions and rules for the coding of diagnosis in cancer registries will improve national and international comparability and feasibility of data exchange.
1995年颁布的一项德国联邦法律旨在进行全国范围的癌症登记，具体实施细节则依据地方法规由各个联邦州自行决定。以淋巴瘤和白血病组（国际疾病分类代码200 - 208）为例，在萨尔州、汉堡市和北莱茵 - 威斯特法伦州的三个成熟的登记处，对不同方法和法规对登记结果的影响进行了调查。
比较了各登记处档案在1987年至1994年期间计算得出的发病率和死亡率。还比较了由此得出的死亡率/发病率比率以及每个登记处中仅以死亡证明（DCO）作为唯一信息来源的病例百分比。
在汉堡市和明斯特市可见发病率有明显上升。就男性患者而言，在该时期末，这两个登记处的发病率均达到了萨尔州的水平。然而，萨尔州男性和女性的白血病和淋巴瘤死亡率比对照地区低约10%。在该时期末，萨尔州男性死亡率与发病率之比为0.55，而汉堡市和明斯特市的平均比率为0.60。在萨尔州和汉堡市，1994年仅依据死亡证明的病例从14%降至不到6%。在明斯特登记处可观察到更稳定的约11%的值。所选诊断“淋巴性白血病”（国际疾病分类代码204）和“霍奇金病”（国际疾病分类代码201）在组内的诊断分布以及特定年龄发病率仅存在细微差异。
明斯特市和汉堡市发病率的上升表明报告更加完整。假设三个地区的生存率相同，萨尔州较低的死亡率表明发病率较低。因此，尽管汉堡市和明斯特市的癌症登记处有了明显的接近，但仍未达到萨尔州癌症登记处的完整程度。这可能是由于地方法规要求向登记处报告需患者知情同意。为实现完整性，病理和血液学研究所必须采用特殊的报告程序。每个登记处都应具备简单指标以便持续评估完整性。癌症登记处标准化的病例定义和诊断编码规则将提高数据交换在国家和国际层面的可比性及可行性。
