利用健康保险索赔数据评估前列腺癌队列的长期疾病进展情况。

Using health insurance claims data to assess long-term disease progression in a prostate cancer cohort.

机构信息

Department of Surgery, Division of Public Health Sciences, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA.

Epidemiology Program, College of Health Sciences, University of Delaware, Newark, Delaware, USA.

出版信息

Prostate. 2022 Nov;82(15):1447-1455. doi: 10.1002/pros.24418. Epub 2022 Jul 26.

DOI:10.1002/pros.24418

PMID:35880605

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9492636/

Abstract

BACKGROUND

Long-term population-based cohort studies of men diagnosed with prostate cancer are limited. However, adverse outcomes can occur many years after treatment. Herein, we aim to assess the utility of using claims data to identify prostate cancer progression 10-15 years after diagnosis.

METHODS

The study population was derived from the North Carolina-Louisiana Prostate Cancer Project (PCaP). PCaP-North Carolina (NC) included 1031 men diagnosed with prostate cancer from 2004 to 2009. An initial follow-up with a survey and manual medical record abstraction occurred from 2008 to 2011 (Follow-up 1). Herein, we extended this follow-up with linkage to healthcare claims data from North Carolina (2011-2017) and a second, supplementary 10-year follow-up survey (2018-2020) (Follow-up 2). Vital statistics data also were utilized. Long-term oncological progression was determined using these data sources in combination with expert clinical input.

RESULTS

Among the 1031 baseline PCaP-NC participants, 652 were linked to medical claims. Forty-two percent of the men had insurance coverage for the entire 72 months of follow-up. In addition, 275 baseline participants completed the supplementary 10-year follow-up survey. Using all sources of follow-up data, we identified a progression event in 259 of 1031 (25%) men with more than 10 years of follow-up data after diagnosis.

CONCLUSIONS

Understanding long-term clinical outcomes is essential for improving the lives of prostate cancer survivors. However, access and utility of long-term clinical outcomes with claims alone remain a challenge due to individualized agreements required with each insurer for data access, lack of detailed clinical information, and gaps in insurance coverage. We were able to utilize claims data to determine long-term progression due to several unique advantages that included the availability of detailed baseline clinical characteristics and treatments, detailed manually abstracted clinical data at 5 years of follow-up, vital statistics data, and a supplementary 10-year follow-up survey.

摘要

背景

长期的基于人群的前列腺癌男性队列研究有限。然而，治疗后多年可能会出现不良后果。在此，我们旨在评估使用索赔数据来识别诊断后 10-15 年前列腺癌进展的效用。

方法

研究人群来自北卡罗来纳州-路易斯安那州前列腺癌项目 (PCaP)。PCaP-NC 包括 2004 年至 2009 年期间诊断出的 1031 名前列腺癌患者。从 2008 年至 2011 年进行了首次随访，包括调查和手动病历摘录（随访 1）。在此基础上，我们通过与北卡罗来纳州的医疗保健索赔数据（2011-2017 年）进行链接，并进行了第二次、补充的 10 年随访调查（2018-2020 年）（随访 2）来扩展了这项随访。还利用了人口统计数据。通过这些数据源结合专家临床意见来确定长期肿瘤进展情况。

结果

在 1031 名基线 PCaP-NC 参与者中，有 652 名与医疗索赔相关联。42%的男性有医疗保险，覆盖了整个 72 个月的随访期。此外，275 名基线参与者完成了补充的 10 年随访调查。使用所有随访数据来源，我们在诊断后有 10 年以上随访数据的 1031 名男性中确定了 259 名进展事件。

结论

了解长期临床结局对于改善前列腺癌幸存者的生活至关重要。然而，由于需要与每家保险公司就数据访问达成个性化协议、缺乏详细的临床信息以及保险覆盖范围存在差距，仅使用索赔数据来获取长期临床结局的方法仍然具有挑战性。我们能够利用索赔数据来确定长期进展，这得益于几个独特的优势，包括详细的基线临床特征和治疗方法、5 年随访时详细的手动摘录临床数据、人口统计数据以及补充的 10 年随访调查。