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International Epidemiology Databases to Evaluate AIDS

Home >> Publications >> Cancer Incidence in HIV-Infected Versus Uninfected Veterans: Comparison of Cancer Registry and ICD-9 Code Diagnoses.

Publication

Author(s):

Park LS, Tate JP, Rodriguez-Barradas MC, Rimland D, Goetz MB, Gibert C, Brown ST, Kelley MJ, Justice AC, Dubrow R.

Pub Title:

Cancer Incidence in HIV-Infected Versus Uninfected Veterans: Comparison of Cancer Registry and ICD-9 Code Diagnoses.

Pub Date:

Jul 31 2014

Journal:

Title: 
Journal of AIDS & Clinical Research
Link: 
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4285627/

PubMed: 25580366
Pub PDF: PDF icon 25580366.pdf

Abstract
BACKGROUND:
Given the growing interest in the cancer burden in persons living with HIV/AIDS, we examined the validity of data sources for cancer diagnoses (cancer registry versus International Classification of Diseases, Ninth Revision [ICD-9 codes]) and compared the association between HIV status and cancer risk using each data source in the Veterans Aging Cohort Study (VACS), a prospective cohort of HIV-infected and uninfected veterans from 1996 to 2008.

METHODS: We reviewed charts to confirm potential incident cancers at four VACS sites. In the entire cohort, we calculated cancer-type-specific age-, sex-, race/ethnicity-, and calendar-period-standardized incidence rates and incidence rate ratios (IRR) (HIV-infected versus uninfected). We calculated standardized incidence ratios (SIR) to compare VACS and Surveillance, Epidemiology, and End Results rates.

RESULTS: Compared to chart review, both Veterans Affairs Central Cancer Registry (VACCR) and ICD-9 diagnoses had approximately 90% sensitivity; however, VACCR had higher positive predictive value (96% versus 63%). There were 6,010 VACCR and 13,386 ICD-9 incident cancers among 116,072 veterans. Although ICD-9 rates tended to be double VACCR rates, most IRRs were in the same direction and of similar magnitude, regardless of data source. Using either source, all cancers combined, most viral-infection-related cancers, lung cancer, melanoma, and leukemia had significantly elevated IRRs. Using ICD-9, eight additional IRRs were significantly elevated, most likely due to false positive diagnoses. Most ICD-9 SIRs were significantly elevated and all were higher than the corresponding VACCR SIR.

CONCLUSIONS: ICD-9 may be used with caution for estimating IRRs, but should be avoided when estimating incidence or SIRs. Elevated cancer risk based on VACCR diagnoses among HIV-infected veterans was consistent with other studies.

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Citation:

Park LS, Tate JP, Rodriguez-Barradas MC, Rimland D, Goetz MB, Gibert C, Brown ST, Kelley MJ, Justice AC, Dubrow R. Cancer Incidence in HIV-Infected Versus Uninfected Veterans: Comparison of Cancer Registry and ICD-9 Code Diagnoses. J AIDS Clin Res. 2014 Jul;5(7):1000318. PubMed PMID: 25580366; PubMed Central PMCID: PMC4285627.