Chen-Hardee Shari, Chrischilles Elizabeth A, Voelker Margaret D, Brooks John M, Scott Shane, Link Brian K, Delgado David
Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, IA, USA.
Cancer Causes Control. 2006 Jun;17(5):647-54. doi: 10.1007/s10552-005-0502-4.
To study neutropenia hospitalization (NH) incidence and risk factors in a population-based sample of older adults with non-Hodgkin's lymphoma (NHL) and evaluate the validity of inferences from Surveillance, Epidemiology and End Results (SEER)-Medicare linked databases.
NHL cases receiving first-course chemotherapy were identified from Iowa SEER-Medicare. Survival methods evaluated NH risk factors. Medical record and Medicare claims data on chemotherapy and NH were compared.
Of 761 subjects, 165 (21.7%, 95% CI: 18.8, 24.6) were hospitalized for neutropenia. Of those hospitalized, 41% were hospitalized in cycle 1 and 22% in cycle 2. Significant multivariable risk factors for NH were diffuse large cell histology, renal disease, Charlson comorbidity index, and anthracycline chemotherapy but not patient age. Medicare and medical records agreed on month of chemotherapy initiation 95% of the time and chemotherapy type 95% of the time. ICD-9 code 288.0 sensitivity for NH was 80%.
Neutropenia hospitalizations were common in the first 2 chemotherapy cycles, especially among older adults with comorbidity. Findings conflict with a prior medical records study in which age was a risk factor for NH and dose intensity a negative confounder. Valid inferences about age effects on chemotherapy toxicity require more clinical detail than is available in administrative data.
在以人群为基础的非霍奇金淋巴瘤（NHL）老年患者样本中研究中性粒细胞减少症住院（NH）发生率及危险因素，并评估来自监测、流行病学和最终结果（SEER）-医疗保险关联数据库推断的有效性。
从爱荷华州SEER-医疗保险中识别出接受首次化疗的NHL病例。采用生存分析方法评估NH的危险因素。比较化疗及NH的病历和医疗保险理赔数据。
761名受试者中，165名（21.7%，95%可信区间：18.8，24.6）因中性粒细胞减少症住院。在这些住院患者中，41%在第1周期住院，22%在第2周期住院。NH的显著多变量危险因素为弥漫大细胞组织学类型、肾脏疾病、Charlson合并症指数及蒽环类化疗，但不包括患者年龄。医疗保险和病历在化疗开始月份上95%的时间一致，在化疗类型上95%的时间一致。NH的国际疾病分类第九版（ICD-9）编码288.0的敏感性为80%。
中性粒细胞减少症住院在最初2个化疗周期中很常见，尤其是在有合并症的老年人中。研究结果与之前的一项病历研究相矛盾，在该研究中年龄是NH的危险因素，而剂量强度是一个负混杂因素。关于年龄对化疗毒性影响的有效推断需要比行政数据中更多的临床细节。
