ICF International Inc., Bethesda, MD 20814, USA.
Cancer Epidemiol. 2012 Feb;36(1):22-8. doi: 10.1016/j.canep.2011.07.004. Epub 2011 Sep 8.
Cancer mortality statistics, an important indicator for monitoring cancer burden, are traditionally restricted to instances when cancer is determined to be the underlying cause of death (UCD) based on information recorded on standard certificates of death. This study's objective was to determine the impact of using multiple causes of death codes to compute site-specific cancer mortality statistics.
The state cancer registries of California, Colorado and Idaho provided linked cancer registry and death certificate data for individuals who died between 2002 and 2004, had at least one cancer listed on their death certificate and were diagnosed with cancer between 1993 and 2004. These linked data were used to calculate the site-specific proportion of cancers not selected as the UCD (non-UCD) among all cancer-related deaths (any mention on the death certificate). In addition, the retrospective concordance between the death certificate and the population-based cancer registry, measured as confirmations rates, was calculated for deaths with cancer as the UCD, as a non-UCD, and for any mention.
Overall, non-UCD deaths comprised 9.5 percent of total deaths; 11 of the 79 cancer sites had proportions greater than 3 standard deviations from 9.5 percent. The confirmation rates for UCD and for any mention did not differ significantly for any of the cancer sites.
The site-specific variation in proportions and rates suggests that for a few cancer sites, death rates might be computed for both UCD and any mention of the cancer site on the death certificate. Nevertheless, this study provides evidence that, in general, restricting to UCD deaths will not under report cancer mortality statistics.
癌症死亡率统计数据是监测癌症负担的一个重要指标，传统上仅限于根据死亡证明上记录的信息确定癌症是根本死因（UCD）的情况。本研究旨在确定使用多个死因代码计算特定部位癌症死亡率统计数据的影响。
加利福尼亚州、科罗拉多州和爱达荷州的州癌症登记处提供了 2002 年至 2004 年间死亡、至少有一种癌症在死亡证明上列出且在 1993 年至 2004 年间被诊断患有癌症的个体的癌症登记处和死亡证明的链接数据。这些链接数据用于计算所有与癌症相关的死亡（死亡证明上的任何提及）中未被选为 UCD（非 UCD）的特定部位癌症的比例。此外，还计算了作为 UCD、非 UCD 和任何提及的癌症死亡的死亡证明与基于人群的癌症登记处之间的回顾性一致性，以确认率表示。
总体而言，非 UCD 死亡占总死亡人数的 9.5%；79 个癌症部位中有 11 个部位的比例超过 9.5%的 3 个标准差。UCD 和任何提及的确认率在任何癌症部位均无显著差异。
特定部位的比例和速率变化表明，对于少数癌症部位，可能会根据死亡证明上 UCD 和癌症部位的任何提及来计算死亡率。然而，本研究提供的证据表明，一般来说，将 UCD 死亡限制在范围内不会少报癌症死亡率统计数据。
