Brackley Moyra E, Penning Margaret J, Lesperance Mary L
Centre on Aging and Department of Anthropology, University of Victoria, PO Box 1700, STN CSC, Victoria, BC V8W 2Y2, Canada.
Int J Equity Health. 2006 Oct 6;5:12. doi: 10.1186/1475-9276-5-12.
Within the health literature, a major goal is to understand distribution of service utilisation by social location. Given equivalent access, differential incidence leads to an expectation of differential service utilisation. Cancer incidence is differentially distributed with respect to socioeconomic status. However, not all jurisdictions have incidence registries, and not all registries allow linkage with utilisation records. The British Columbia Linked Health Data resource allows such linkage. Consequently, we examine whether, in the absence of registry data, first hospitalisation can act as a proxy measure for incidence, and therefore as a measure of need for service.
Data are drawn from the British Columbia Linked Health Data resource, and represent 100% of Vancouver Island Health Authority cancer registry and hospital records, 1990-1999. Hospital separations (discharges) with principal diagnosis ICD-9 codes 140-208 are included, as are registry records with ICDO-2 codes C00-C97. Non-melanoma skin cancer (173/C44) is excluded. Lung, colorectal, female breast, and prostate cancers are examined separately. We compare registry and hospital annual counts and age-sex distributions, and whether the same individuals are represented in both datasets. Sensitivity, specificity and predictive values are calculated, as is the kappa statistic for agreement. The registry is designated the gold standard.
For all cancers combined, first hospitalisation counts consistently overestimate registry incidence counts. From 1995-1999, there is no significant difference between registry and hospital counts for lung and colorectal cancer (p = 0.42 and p = 0.56, respectively). Age-sex distribution does not differ for colorectal cancer. Ten-year period sensitivity ranges from 73.0% for prostate cancer to 84.2% for colorectal cancer; ten-year positive predictive values range from 89.5% for female breast cancer to 79.35% for prostate cancer. Kappa values are consistently high.
Claims and registry databases overlap with an appreciable proportion of the same individuals. First hospital separation may be considered a proxy for incidence with reference to colorectal cancer since 1995. However, to examine equity across cancer health services utilisation, it is optimal to have access to both hospital and registry files.
在健康文献领域，一个主要目标是了解社会位置对服务利用情况的分布影响。在同等可及性条件下，发病率差异会导致人们预期服务利用情况也存在差异。癌症发病率在社会经济地位方面存在差异分布。然而，并非所有辖区都有发病率登记处，而且并非所有登记处都允许与利用记录相链接。不列颠哥伦比亚省的关联健康数据资源则允许这种链接。因此，我们研究在没有登记处数据的情况下，首次住院是否可作为发病率的替代指标，进而作为服务需求的衡量指标。
数据取自不列颠哥伦比亚省关联健康数据资源，涵盖1990 - 1999年温哥华岛卫生局癌症登记处和医院记录的100%。包括主要诊断ICD - 9编码为140 - 208的医院出院记录，以及ICDO - 2编码为C00 - C97的登记处记录。非黑色素瘤皮肤癌（173/C44）被排除。分别对肺癌、结直肠癌、女性乳腺癌和前列腺癌进行研究。我们比较登记处和医院的年度计数以及年龄 - 性别分布，以及两个数据集中是否为相同个体。计算敏感性、特异性和预测值，以及一致性的kappa统计量。将登记处数据指定为金标准。
对于所有癌症综合来看，首次住院计数一直高估登记处的发病率计数。1995 - 1999年期间，肺癌和结直肠癌的登记处计数与医院计数之间无显著差异（分别为p = 0.42和p = 0.56）。结直肠癌的年龄 - 性别分布无差异。十年期敏感性从前列腺癌的73.0%到结直肠癌的84.2%不等；十年期阳性预测值从女性乳腺癌的89.5%到前列腺癌的79.35%不等。kappa值一直很高。
索赔数据库和登记处数据库在相当比例的相同个体上存在重叠。自1995年以来，对于结直肠癌，首次住院可被视为发病率的替代指标。然而，要研究癌症健康服务利用的公平性，最好同时获取医院和登记处文件。
