Cancer Incidence in HIV-Infected Versus Uninfected Veterans: Comparison of Cancer Registry and ICD-9 Code Diagnoses
Year: 2014
Type: article
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.
Author: Lesley S Park Janet P Tate
Institution: Yale University
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Funders: U.S. Department of Veterans Affairs, National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism, National Institute of Mental Health, National Institute on Drug Abuse, National Cancer Institute, National Institute of Allergy and Infectious Diseases, National Center for Advancing Translational Sciences
Awards: G1158786059, Johns Hopkins HIV Clinical Cohort, Liver cancer risk and prevention among persons living with HIV/AIDS, 2/6 COMpAAAS U01: Observation Study, G3673658808, 5/6 COMpAAAS U24: Resource in Informatics and Biostatistics (RIB), Alcohol Associated Outcomes Among HIV+/- Aging Veterans, 1/6 COMpAAAS U24: Coordinating Center, Yale University Clinical and Translational Science Award Program, Interdisciplinary HIV Prevention Training Program, North American AIDS Cohorts on Collaboration and Design (NAACCORD), Center for Interdisciplinary Research on AIDS
OpenAlex ID: W2121669790