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. 2014 Sep;24(9):666-72, 672.e1-2.
doi: 10.1016/j.annepidem.2014.06.099. Epub 2014 Jul 3.

Limited validity of diagnosis codes in Medicare claims for identifying cancer metastases and inferring stage

Neetu Chawla  1 , K Robin Yabroff  2 , Angela Mariotto  3 , Timothy S McNeel  4 , Deborah Schrag  5 , Joan L Warren  2
Affiliations

Limited validity of diagnosis codes in Medicare claims for identifying cancer metastases and inferring stage

Neetu Chawla et al. Ann Epidemiol. 2014 Sep.

Abstract

Purpose: Researchers are using diagnosis codes from health claims to identify metastatic disease in cancer patients. The validity of this approach has not been established.

Methods: We used the linked 2005-2007 Surveillance, Epidemiology and End Results (SEER)-Medicare data to assess the validity of metastasis codes at diagnosis from claims compared with stage reported by SEER cancer registries. The cohort included 80,052 incident breast, lung, and colorectal cancer patients aged 65 years and older. Using gold-standard SEER data, we evaluated sensitivity, specificity, positive predictive value, and negative predictive value of claims-based stage, survival by stage classification, and patient factors associated with stage misclassification using multivariable regression.

Results: For patients with a registry report of distant metastatic cancer, the sensitivity, specificity, and positive predictive value of claims never simultaneously exceeded 80% for any cancer: lung (42.7%, 94.8%, and 88.1%), breast (51.0%, 98.3%, and 65.8%), and colorectal (72.8%, 93.8%, and 68.5%). Misclassification of stage from Medicare claims was significantly associated with inaccurate estimates of stage-specific survival (P < .001). In adjusted analysis, patients who were older, black, or living in low-income areas were more likely to have their stage misclassified in claims.

Conclusions: Diagnosis codes in Medicare claims have limited validity for inferring cancer stage and metastatic disease.

Keywords: Cancer; Medicare claims; Metastasis; Registry; SEER; Stage at diagnosis.

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Figures

Figure 1
Figure 1
Figure 1A. Aggregate Distributions of Breast Cancer Stage at Diagnosis from SEER Data and Inferred from Medicare Claims Figure 1B. Aggregate Distributions of Colorectal Cancer Stage at Diagnosis from SEER Data and Inferred from Medicare Claims Figure 1C. Aggregate Distributions of Lung Cancer Stage at Diagnosis from SEER Data and Inferred from Medicare Claims
Figure 1
Figure 1
Figure 1A. Aggregate Distributions of Breast Cancer Stage at Diagnosis from SEER Data and Inferred from Medicare Claims Figure 1B. Aggregate Distributions of Colorectal Cancer Stage at Diagnosis from SEER Data and Inferred from Medicare Claims Figure 1C. Aggregate Distributions of Lung Cancer Stage at Diagnosis from SEER Data and Inferred from Medicare Claims
Figure 1
Figure 1
Figure 1A. Aggregate Distributions of Breast Cancer Stage at Diagnosis from SEER Data and Inferred from Medicare Claims Figure 1B. Aggregate Distributions of Colorectal Cancer Stage at Diagnosis from SEER Data and Inferred from Medicare Claims Figure 1C. Aggregate Distributions of Lung Cancer Stage at Diagnosis from SEER Data and Inferred from Medicare Claims
Figure 2
Figure 2
Figure 2A, Panel 1. Comparison of Overall Survival for Men with Local Lung Cancer by Stage at Diagnosis Inferred from Medicare Claims to SEER Data Figure 2B, Panel 1. Comparison of Overall Survival for Women with Local Breast Cancer by Stage at Diagnosis Inferred from Medicare Claims to SEER Data Figure 2A, Panel 2. Comparison of Overall Survival for Men with Distant Lung Cancer by Stage at Diagnosis Inferred from Medicare Claims to SEER Data Figure 2B, Panel 2. Comparison of Overall Survival for Women with Distant Breast Cancer by Stage at Diagnosis Inferred from Medicare Claims to SEER Data
Figure 2
Figure 2
Figure 2A, Panel 1. Comparison of Overall Survival for Men with Local Lung Cancer by Stage at Diagnosis Inferred from Medicare Claims to SEER Data Figure 2B, Panel 1. Comparison of Overall Survival for Women with Local Breast Cancer by Stage at Diagnosis Inferred from Medicare Claims to SEER Data Figure 2A, Panel 2. Comparison of Overall Survival for Men with Distant Lung Cancer by Stage at Diagnosis Inferred from Medicare Claims to SEER Data Figure 2B, Panel 2. Comparison of Overall Survival for Women with Distant Breast Cancer by Stage at Diagnosis Inferred from Medicare Claims to SEER Data
Figure 2
Figure 2
Figure 2A, Panel 1. Comparison of Overall Survival for Men with Local Lung Cancer by Stage at Diagnosis Inferred from Medicare Claims to SEER Data Figure 2B, Panel 1. Comparison of Overall Survival for Women with Local Breast Cancer by Stage at Diagnosis Inferred from Medicare Claims to SEER Data Figure 2A, Panel 2. Comparison of Overall Survival for Men with Distant Lung Cancer by Stage at Diagnosis Inferred from Medicare Claims to SEER Data Figure 2B, Panel 2. Comparison of Overall Survival for Women with Distant Breast Cancer by Stage at Diagnosis Inferred from Medicare Claims to SEER Data
Figure 2
Figure 2
Figure 2A, Panel 1. Comparison of Overall Survival for Men with Local Lung Cancer by Stage at Diagnosis Inferred from Medicare Claims to SEER Data Figure 2B, Panel 1. Comparison of Overall Survival for Women with Local Breast Cancer by Stage at Diagnosis Inferred from Medicare Claims to SEER Data Figure 2A, Panel 2. Comparison of Overall Survival for Men with Distant Lung Cancer by Stage at Diagnosis Inferred from Medicare Claims to SEER Data Figure 2B, Panel 2. Comparison of Overall Survival for Women with Distant Breast Cancer by Stage at Diagnosis Inferred from Medicare Claims to SEER Data
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