Soppe Sarah E, Peacock Hinton Sharon, Halula Jamie C, Lund Jennifer L, Baggett Chris D, Pruitt Sandi L, Mullins Megan A, Dillon Ellis C, Barclay Matthew E, Thompson Matthew, Pettit Nicholas, Lyratzopoulos Georgios, Thompson Caroline A
Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Division of Cancer Epidemiology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Cancer Causes Control. 2025 May;36(5):539-550. doi: 10.1007/s10552-024-01953-6. Epub 2025 Jan 9.
Studies of healthcare encounters leading to cancer diagnosis have increased over recent years. While some studies examine healthcare utilization before the cancer registry date of diagnosis, relevant pre-diagnosis interactions are not always immediately prior to this date due to date abstraction guidelines. We evaluated agreement of a registry date with a claims-based index and examined Emergency Department (ED) involvement in cancer diagnosis as an example of possible pre-diagnostic healthcare misclassification that could arise from improper date choice.
We implemented an algorithm to define a claims-based index as the date of the earliest International Classification of Diseases code for the cancer in Medicare and estimated agreement with the date of diagnosis from a North Carolina registry for patients diagnosed aged 66 or older with 16 cancer types from 2008 to 2017 (n = 92,056). We then classified whether each cancer was initially diagnosed through care originating in the ED using each date.
The index date was identical to the cancer registry date for 47% of patients and preceded the registry date for 28%, with extent of agreement varying by cancer- and patient-specific characteristics. Agreement in ED-involved diagnosis classification using each date varied by cancer site, with sensitivity of classifications using the registry date relative to the index having a minimum of 86% for prostate and kidney cancer.
Studies assessing healthcare utilization proximal to cancer diagnosis should carefully consider the relevant assessment window and be aware that the use of cancer registry versus claims-based dates may impact variable classification.
近年来，对导致癌症诊断的医疗接触的研究有所增加。虽然一些研究在癌症诊断登记日期之前检查医疗服务的利用情况，但由于日期提取指南，相关的诊断前互动并不总是恰好在该日期之前。我们评估了登记日期与基于索赔的索引的一致性，并以急诊科（ED）参与癌症诊断为例，研究了由于日期选择不当可能导致的诊断前医疗错误分类。
我们实施了一种算法，将基于索赔的索引定义为医疗保险中癌症最早国际疾病分类代码的日期，并估计与2008年至2017年诊断为16种癌症类型的66岁及以上患者的北卡罗来纳州登记处诊断日期的一致性（n = 92,056）。然后，我们使用每个日期对每种癌症是否最初通过急诊科的护理进行诊断进行分类。
47%的患者索引日期与癌症登记日期相同，28%的患者索引日期早于登记日期，一致性程度因癌症和患者特定特征而异。使用每个日期进行的急诊科参与诊断分类的一致性因癌症部位而异，使用登记日期相对于索引进行分类的敏感性对于前列腺癌和肾癌至少为86%。
评估癌症诊断附近医疗服务利用情况的研究应仔细考虑相关评估窗口，并意识到使用癌症登记日期与基于索赔的日期可能会影响变量分类。
