Estimation of the incidence of pleural mesothelioma according to death certificates in France

Our plain-English summary of Estimation of the incidence of pleural mesothelioma according to death certificates in France, by Y. Iwatsubo, M. Matrat, E. Michel, et al (American Journal of Industrial Medicine, 2002).

The study

• Authors: Y. Iwatsubo, M. Matrat, E. Michel, C. Boutin, F. Galateau-Salle, E. Jougla, J. Bignon, J.C. Pairon, P. Brochard
• Journal: American Journal of Industrial Medicine
• Published: 2002;42(3):188-99
• Cited by: 18 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: The number of cases of pleural mesothelioma in France has varied substantially according to methods of assessment.

Materials And Methods: We collected information from certifying physicians about 316 subjects who died between 1 July 1992 and 30 June 1993 in three regions of France with a cause of death coded as ICD-9 category 163. The ICD codes selected as the cause of death for 178 deaths between 1 January 1987 and 31 December 1992 histologically confirmed and diagnosed as pleural mesothelioma by an expert committee were examined. Finally, we used this information to estimate the number of deaths from pleural mesothelioma in France in 1992.

Results: In Part I, 45% (men: 54%; women: 28%) of the cases coded as ICD-9 section 163 were definitely or probably mesothelioma; 18% (men: 16%; women: 21%) possibly mesothelioma; and 37% (men: 30%; women: 51%) other tumors, primarily adenocarcinoma metastases. In Part II, 74% of the confirmed pleural mesotheliomas were coded in category 163 (men: 75%; women: 70%). Extrapolation nationwide indicated that 902 deaths were coded as ICD-9 163 in 1992: 521 cases involved definite or probable mesothelioma and 724 definite, probable, and possible cases.

Conclusions: The analysis of this sample suggests that estimating the number of mesothelioma cases from the cause-of-death statistics may overestimate their incidence, but that death certificates appeared to report the diagnosis of histologically confirmed mesothelioma accurately.

Copyright 2002 Wiley-Liss, Inc.

In plain English

This French study checked how accurately death certificates identify deaths from pleural mesothelioma. In the first part, the authors identified 316 deaths between 1 July 1992 and 30 June 1993 in the Paris area, Provence-Alpes-Côte d'Azur and Corsica that were coded as ICD-9 category 163 (cancer of the pleura), and sent questionnaires to the certifying physicians for 285 of them. Among 168 usable replies, 45.2% were definite or probable mesothelioma (54% of men, 28% of women), and 63.1% when possible cases were added. Thirty-seven percent were other tumors, mostly cancers that had spread to the pleura. In the second part, 74% of 178 deaths among people with histologically confirmed pleural mesothelioma had been coded 163, and 15% were coded as lung cancer. Combining both parts, the authors estimated 521 to 724 pleural mesothelioma deaths in France in 1992. The authors concluded that correction factors should be applied to deaths coded 163. They noted that the study covered only three regions and that only 59% of the questionnaires sent could be analyzed.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Two-part pilot validation study of death-certificate data. Part I was a physician questionnaire survey on deaths coded ICD-9 163. Part II checked the death codes of confirmed mesothelioma cases from an earlier case-control study. The two parts were then used to extrapolate a national estimate.
• Who was studied: Part I: 316 people whose deaths, between 1 July 1992 and 30 June 1993 in the Paris region, PACA and Corsica, were coded as ICD-9 category 163. Questionnaires were sent for 285 of them, and replies on 168 (111 men, 57 women) were analyzed. Part II: 178 deaths (1987 to 1992) of people with histologically confirmed pleural mesothelioma from a case-control study in the same three regions.
• Exposure: Not studied. The article examines the accuracy of death-certificate diagnoses and ICD-9 coding, not asbestos exposure.
• Main results:
  • Of the 316 deaths, 6 certificates were unavailable, 20 were judged erroneously coded, and 5 signing physicians could not be located. That left 285 questionnaires sent, of which 211 were returned: 115 with histological proof, 53 without, and 43 not interpretable.
  • Low estimate (definite or probable mesothelioma) among deaths coded 163: 54% of men's deaths and 28% of women's deaths.
  • High estimate including possible cases: 70% for men and 49% for women.
  • Overall confirmation rate among the 168 analyzed deaths: 45.2% definite or probable, and 63.1% including possible cases.
  • 37% of analyzed deaths coded 163 were other tumors: 3 other intrathoracic primary tumors and 59 pleural metastases. The certificates for the secondary tumors most often listed 'adenocarcinoma of the pleura'.
  • The confirmation rate was lower for people 65 or older and higher for men. It did not differ by place of residence.
  • Among the 178 histologically confirmed pleural mesothelioma deaths, 74% were coded as category 163 (75% of men, 70% of women).
  • The most frequent miscoding of confirmed cases was as lung cancer (category 162.9), at 15%.
  • Starting from 902 deaths coded 163 in France in 1992 (630 men, 272 women), the estimated number of pleural mesothelioma deaths in France in 1992 ranged from 521 to 724.
  • Estimated 1992 mortality rates in France were 14.9 to 19.4 per million for men and 3.5 to 6.2 per million for women.
• The authors' conclusion: The authors concluded that correction factors should be applied to the number of deaths coded as ICD-9 category 163 when using them to count pleural mesothelioma. Their abstract adds that cause-of-death statistics may overestimate incidence, while death certificates appeared to report histologically confirmed mesothelioma accurately.
• Limitations the authors state:
  • Only three regions were studied, although they hold about one quarter of France's population. If confirmation rates differ by place of residence, the national estimate could be wrong.
  • Only 59% of the questionnaires sent to physicians could be analyzed.
  • Part II cases came from a case-control study with specialist pathology review, so detection may be lower in the general population.
  • The estimates cannot include mesothelioma cases never diagnosed during the patient's lifetime.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Death Certificate, Mesothelioma, Adenocarcinoma.

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