Institut de veille sanitaire, Départements des maladies chroniques et des traumatismes, Saint-Maurice, France.
Cancer Epidemiol. 2013 Apr;37(2):99-114. doi: 10.1016/j.canep.2012.10.010. Epub 2012 Nov 30.
District-level cancer incidence estimation is an important issue in countries without a national cancer registry. This study aims to both evaluate the validity of district-level estimations in France for 24 cancer sites, using health insurance data (ALD demands--Affection de Longue Durée) and to provide estimations when considered valid. Incidence is estimated at a district-level by applying the ratio between the number of first ALD demands and incident cases (ALD/I ratio), observed in those districts with cancer registries, to the number of first ALD demands available in all districts. These district-level estimations are valid if the ratio does not vary greatly across the districts or if variations remain moderate compared with variations in incidence rates.
Validation was performed in the districts covered by cancer registries over the period 2000-2005. The district variability of the ALD/I ratio was studied, adjusted for age (mixed-effects Poisson model), and compared with the district variability in incidence rate. The epidemiological context is also considered in addition to statistical analyses.
District-level estimation using the ALD/I ratio was considered valid for eight cancer sites out of the 24 studied (lip-oral cavity-pharynx, oesophagus, stomach, colon-rectum, lung, breast, ovary and testis) and incidence maps were provided for these cancer sites.
Estimating cancer incidence at a sub-national level remains a difficult task without a national registry and there are few studies on this topic. Our validation approach may be applied in other countries, using health insurance or hospital discharge data as correlate of incidence.
在没有国家癌症登记处的国家，对地区癌症发病率进行估计是一个重要问题。本研究旨在评估使用医疗保险数据（ALD 需求——长期影响）对法国 24 个癌症部位进行地区水平估计的有效性，并在有效时提供估计。通过将在有癌症登记处的地区观察到的首次 ALD 需求与新发病例（ALD/I 比）数量与所有地区可获得的首次 ALD 需求数量进行比较，在地区水平上估计发病率。如果比率在不同地区之间变化不大，或者与发病率变化相比变化保持适度，则该地区水平估计是有效的。
在 2000-2005 年期间有癌症登记处覆盖的地区进行了验证。研究了 ALD/I 比的地区变异性，同时考虑了年龄因素（混合效应泊松模型），并与发病率的地区变异性进行了比较。除了统计分析外，还考虑了流行病学背景。
使用 ALD/I 比进行的地区水平估计在 24 个研究部位中的 8 个部位被认为是有效的（唇-口腔-咽、食管、胃、结肠-直肠、肺、乳房、卵巢和睾丸），并为这些癌症部位提供了发病率地图。
在没有国家登记处的情况下，在国家以下水平估计癌症发病率仍然是一项艰巨的任务，关于这个主题的研究很少。我们的验证方法可以应用于其他国家，使用医疗保险或住院数据作为发病率的相关指标。
