Reproducibility, reliability and validity of population-based administrative health data for the assessment of cancer non-related comorbidities

Abstract

Background: Patients with comorbidities do not receive optimal treatment for their cancer, leading to lower cancer survival. Information on individual comorbidities is not straightforward to derive from population-based administrative health datasets. We described the development of a reproducible algorithm to extract the individual Charlson index comorbidities from such data. We illustrated the algorithm with 1,789 laryngeal cancer patients diagnosed in England in 2013. We aimed to clearly set out and advocate the time-related assumptions specified in the algorithm by providing empirical evidence for them.

Methods: Comorbidities were assessed from hospital records in the ten years preceding cancer diagnosis and internal reliability of the hospital records was checked. Data were right-truncated 6 or 12 months prior to cancer diagnosis to avoid inclusion of potentially cancer-related comorbidities. We tested for collider bias using Cox regression.

Results: Our administrative data showed weak to moderate internal reliability to identify comorbidities (ICC ranging between 0.1 and 0.6) but a notably high external validity (86.3%). We showed a reverse protective effect of non-cancer related Chronic Obstructive Pulmonary Disease (COPD) when the effect is split into cancer and non-cancer related COPD (Age-adjusted HR: 0.95, 95% CI:0.7-1.28 for non-cancer related comorbidities). Furthermore, we showed that a window of 6 years before diagnosis is an optimal period for the assessment of comorbidities.

Conclusion: To formulate a robust approach for assessing common comorbidities, it is important that assumptions made are explicitly stated and empirically proven. We provide a transparent and consistent approach useful to researchers looking to assess comorbidities for cancer patients using administrative health data.

Fig 1. Graphical representation of data management and time-related assumptions.

Fig 2. Proportions of individual comorbidities recorded for laryngeal cancer patients diagnosed in 2013 for increasing time periods pre-diagnosis, N = 1,789.

1: Myocardial infarction; 2: Congestive heart failure; 3: Peripheral vascular disease; 4: Cerebrovascular disease; 5: Dementia; 6: COPD; 7: Rheumatic disease; 8: Peptic ulcer disease; 9: Mild liver disease; 10: Diabetes without chronic complications; 11: Diabetes with chronic complications; 12: Hemiplegia or paraplegia; 13: Renal disease; 14: Moderate or severe liver disease; 15: AIDS/HIV; 16: Any malignancy; 17: Metastatic solid tumours; 18: Obesity.