The influence of patient case mix on public health area statistics for cancer stage at diagnosis: a cross-sectional study.
Greenberg, David C
European journal of public health
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Barclay, M., Abel, G. A., Elliss-Brookes, L., Greenberg, D. C., & Lyratzopoulos, G. (2019). The influence of patient case mix on public health area statistics for cancer stage at diagnosis: a cross-sectional study.. European journal of public health, 29 (6), 1103-1107. https://doi.org/10.1093/eurpub/ckz024
Introduction Summary statistics comparing the stage at diagnosis of geographically-defined populations of cancer patients are increasingly used in public reporting to monitor geographical inequalities but may be confounded by patient case-mix. We explore the impact of case-mix adjustment on a publicly-reported measure of early stage at diagnosis in England. Methods We analysed data used for publicly reported statistics about the stage of patients diagnosed with one of 11 solid tumours in 2015 in England, including information on cancer site (bladder, breast, colon, rectum, kidney, lung, melanoma, non-Hodgkin lymphoma, ovarian, prostate, endometrial), age, gender, income deprivation and population-based commissioning organisation. We investigated how cancer site and other patient characteristics influence organisational comparisons and attainment of early stage targets (60% of all cases diagnosed in TNM stages I-II). Results Adjusting for patient case-mix reduced between-organisation variance by more than 50%, resulting in appreciable discordance in organisational ranks (Kendall’s tau=0.53), with 18% (37/207) of organisations being reclassified as meeting/failing the early stage target due to case-mix. Conclusion Summary statistics on stage of cancer diagnosis for geographical populations currently used as public health surveillance tools to monitor organisational inequalities need to account for patient sociodemographic characteristics and cancer site case-mix.
External DOI: https://doi.org/10.1093/eurpub/ckz024
This record's URL: https://www.repository.cam.ac.uk/handle/1810/289304