Format

Send to

Choose Destination
J AIDS Clin Res. 2014 Jul;5(7):1000318.

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

Author information

1
Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA ; Department of Epidemiology and Public Health, Yale School of Medicine, New Haven, CT, USA.
2
Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA ; Department of General Internal Medicine, Veterans Affairs Healthcare System, West Haven, CT, USA.
3
Infectious Diseases Section, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA ; Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
4
Medical Specialty Care Service Line, Atlanta Veterans Affairs Medical Center, Atlanta, GA, USA ; Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
5
Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA ; Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
6
Section of Infectious Diseases, Washington DC Veterans Affairs Medical Center, Washington, DC, USA ; Department of Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
7
Department of Medicine, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA ; Department of Medicine, Icahn School of Medicine, Mt. Sinai, New York, NY, USA.
8
Office of Patient Care Services, Department of Veterans Affairs, Washington, DC, USA ; Hematology-Oncology Service, Durham Veterans Affairs Medical Center, Durham, NC, USA ; Division of Medical Oncology, Duke University Medical Center, Durham, NC, USA.

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.

KEYWORDS:

HIV Infections; International Classification of Diseases; Neoplasms; Registries

Supplemental Content

Full text links

Icon for PubMed Central
Loading ...
Support Center