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Lung cancer
Original Article
Investigation of the international comparability of population-based routine hospital data set derived comorbidity scores for patients with lung cancer
  1. Margreet Lüchtenborg1,2,
  2. Eva J A Morris3,
  3. Daniela Tataru1,
  4. Victoria H Coupland1,
  5. Andrew Smith1,
  6. Roger L Milne4,
  7. Luc te Marvelde4,
  8. Deborah Baker5,
  9. Jane Young6,
  10. Donna Turner7,
  11. Diane Nishri8,
  12. Craig Earle9,
  13. Lorraine Shack10,
  14. Anna Gavin11,
  15. Deirdre Fitzpatrick11,
  16. Conan Donnelly11,
  17. Yulan Lin12,
  18. Bjørn Møller13,
  19. David H Brewster14,
  20. Andrew Deas14,
  21. Dyfed W Huws15,
  22. Ceri White15,
  23. Janet Warlow15,
  24. Jem Rashbass1,
  25. Michael D Peake1,16
  1. 1 National Cancer Registration and Analysis Service, Skipton House, Public Health England, London, UK
  2. 2 Department of Cancer Epidemiology, Population and Global Health, Division of Cancer Studies, Faculty of Life Sciences & Medicine, King’s College London, London, UK
  3. 3 Cancer Epidemiology Group, Leeds Institute of Data Analytics, University of Leeds, LS2 9JT, Leeds, UK
  4. 4 Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Victoria, Australia
  5. 5 Cancer Institute New South Wales, Sydney, New South Wales, Australia
  6. 6 University of Sydney, Sydney, New South Wales, Australia
  7. 7 Cancer Care Manitoba, Winnipeg, Manitoba, Canada
  8. 8 Cancer Care Ontario, Toronto, Ontario, Canada
  9. 9 Ontario Institute for Cancer Research, Toronto, Ontario, Canada
  10. 10 Cancer Control Alberta, Alberta Health Services, Calgary, Alberta, Canada
  11. 11 Northern Ireland Cancer Registry, Centre for Public Health Medicine, Queen’s University Belfast, Belfast, UK
  12. 12 Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
  13. 13 Cancer Registry of Norway, Oslo, Norway
  14. 14 Scottish Cancer Registry, Public Health & Intelligence Unit of NHS National Services Scotland, Edinburgh, UK
  15. 15 Welsh Cancer Intelligence and Surveillance Unit, Public Health Wales, Cardiff, UK
  16. 16 Institute for Lung Health, University of Leicester, Leicester, UK
  1. Correspondence to Eva J A Morris, Institute of Data Analytics, Level 11 Worsley Building, University of Leeds, Leeds LS2 9JT, UK; e.morris{at}leeds.ac.uk

Abstract

Introduction The International Cancer Benchmarking Partnership (ICBP) identified significant international differences in lung cancer survival. Differing levels of comorbid disease across ICBP countries has been suggested as a potential explanation of this variation but, to date, no studies have quantified its impact. This study investigated whether comparable, robust comorbidity scores can be derived from the different routine population-based cancer data sets available in the ICBP jurisdictions and, if so, use them to quantify international variation in comorbidity and determine its influence on outcome.

Methods Linked population-based lung cancer registry and hospital discharge data sets were acquired from nine ICBP jurisdictions in Australia, Canada, Norway and the UK providing a study population of 233 981 individuals. For each person in this cohort Charlson, Elixhauser and inpatient bed day Comorbidity Scores were derived relating to the 4–36 months prior to their lung cancer diagnosis. The scores were then compared to assess their validity and feasibility of use in international survival comparisons.

Results It was feasible to generate the three comorbidity scores for each jurisdiction, which were found to have good content, face and concurrent validity. Predictive validity was limited and there was evidence that the reliability was questionable.

Conclusion The results presented here indicate that interjurisdictional comparability of recorded comorbidity was limited due to probable differences in coding and hospital admission practices in each area. Before the contribution of comorbidity on international differences in cancer survival can be investigated an internationally harmonised comorbidity index is required.

  • Lung cancer
  • Clinical epidemiology

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/thoraxjnl-2017-210362

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    Footnotes

    • Contributors All authors have contributed to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work. All authors have been involved in drafting the work or revising it critically for important intellectual content, and have approved of the final version to be published. Finally, all authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

    • Funding This study was supported primarily by NHS England, with additional contributions from Cancer Control Alberta, Cancer Institute NSW, Norwegian Directorate of Health, Cancer Care Ontario, Scottish Government, Cancer Council Victoria, Public Health Wales, Tenovus Cancer Care, Northern Ireland Cancer Registry, the Public Health Agency for Northern Ireland and the Danish Cancer Society.

    • Competing interests None declared.

    • Ethics approval The study protocol and the project’s secure data management system were approved by the North West Liverpool Central Research Ethics Committee (14/NW/1372). In addition, each participating registry also obtained the necessary ethical approvals required for participation and data sharing in their jurisdiction via their relevant Research Ethics and Information Governance bodies. Details of these approvals are available on request.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Correction notice This article has been corrected since it was published Online First. A number of issues were corrected: 1) Authors' Luc te Marvelde and Bjørn Møller names were amended; 2) Figure 3 has been replaced it now has the missing legend included; 3) Data within Table 4 has been corrected; 4) Errors within the references list has been corrected.