Malignant mesothelioma among US Medicare beneficiaries: incidence, prevalence and therapy, 2016-2019

Our plain-English summary of Malignant mesothelioma among US Medicare beneficiaries: incidence, prevalence and therapy, 2016-2019, by L. Kurth, J.M. Mazurek, D.J. Blackley (Occupational and Environmental Medicine, 2023).

The study

• Authors: L. Kurth, J.M. Mazurek, D.J. Blackley
• Journal: Occupational and Environmental Medicine
• Published: 2023;80(2):86-92
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Objectives: Mesothelioma is a rare, aggressive cancer caused by exposure to asbestos fibres. Mesothelioma patients who receive trimodal therapy (chemotherapy, surgical resection and radiation) survive longer than those who receive two or fewer therapy modalities. This study analyses the 2016-2019 Medicare claims data to estimate the burden of malignant mesothelioma and describe therapy patterns (when available) among continuously enrolled fee-for-service (FFS; Medicare parts A and B) beneficiaries.

Methods: We analysed claims and enrolment information from 42 529 117 FFS Medicare beneficiaries using three mesothelioma case definitions (broad, intermediate and narrow) with varying levels of diagnostic requirements. Results are presented as ranges of values for the three definitions.

Results: Among FFS beneficiaries, 8213-19 036 beneficiaries with mesothelioma were identified depending on the case definition. The annual prevalence per 100 000 beneficiaries ranged from 8.8 in 2016 (narrow) to 31.3 in 2019 (broad) and annual incidence per 100 000 beneficiaries ranged from 4.5 in 2019 (narrow) to 12.6 in 2017 (broad). Depending on the mesothelioma case definition, 41.8%-81.5% had available therapy claim information indicating that 7.6%-11.3% received chemotherapy alone, 1.3%-1.5% received radiation alone, and 14.3%-27.0% underwent surgery only, with 4.6%-10.5% receiving all three therapy modalities.

Conclusions: Mesothelioma was a prevalent disease among FFS Medicare beneficiaries during 2016-2019, and a limited proportion of beneficiaries received all three therapy modalities. Medicare data build on findings from cancer registry data to enhance our understanding of the mesothelioma burden and therapy patterns.

© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.

In plain English

This study used Medicare claims from 2016 to 2019 to estimate how common malignant mesothelioma was among 42,529,117 people with continuous fee-for-service Medicare coverage in the USA, and what treatment they received. It did not measure asbestos exposure. The diagnoses came only from claims, so the authors used three case definitions of increasing strictness: broad, intermediate and narrow. Depending on the definition, 8,213 to 19,036 beneficiaries had mesothelioma, a four-year prevalence of 19.3 to 44.8 per 100,000. Annual incidence ranged from 4.5 per 100,000 (2019, narrow) to 12.6 (2017, broad). Under the intermediate definition, 56.0% had treatment information on their claims. Of all 13,642 intermediate cases, 9.1% had chemotherapy alone, 1.5% radiation alone, 19.3% surgery only, and 6.4% all three. People with mesothelioma were more likely than other beneficiaries to be 75 or older, male and white. The authors concluded that mesothelioma was a prevalent disease in this group and that a limited proportion received all three therapies. They noted that early-year estimates may understate prevalence and incidence, though early incidence could also be inflated, and that therapy use was likely underestimated.

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: Retrospective analysis of Medicare administrative claims data (population-based, claims-based case definitions)
• Who was studied: 42,529,117 US Medicare beneficiaries with continuous fee-for-service (parts A and B) coverage, 2016–2019
• Exposure: Asbestos exposure was not studied. Mesothelioma was identified from the ICD-10-CM diagnosis code C45 on Medicare claims, with stricter definitions requiring more claims or a diagnostic procedure code.
• Main results:
  • Beneficiaries with mesothelioma, 2016–2019: 19,036 under the broad definition (four-year prevalence 44.8 per 100,000), 13,642 under the intermediate definition (32.1) and 8,213 under the narrow definition (19.3)
  • Annual prevalence ranged from 8.8 per 100,000 (2016, narrow definition) to 31.3 per 100,000 (2019, broad definition)
  • Annual incidence ranged from 4.5 per 100,000 in 2019 (narrow definition) to 12.6 per 100,000 in 2017 (broad definition)
  • Under the intermediate definition, annual incidence was 8.8 per 100,000 in 2017 and 6.8 per 100,000 in 2019
  • Of the 13,642 beneficiaries meeting the intermediate definition, 56.0% (n=7638) had therapy information on their claims
  • Among the 13,642 intermediate-definition beneficiaries, 9.1% received chemotherapy alone, 1.5% radiation alone, 19.3% surgery only, and 6.4% all three therapies
  • Compared with the whole fee-for-service population, beneficiaries with mesothelioma were more likely to be aged 75 or older, male, white, and originally enrolled because of age 65 or over (p less than 0.05), under all three definitions
  • Only 46.6% of beneficiaries meeting the broad definition had any claim mentioning mesothelioma of the pleura (C45.0)
  • The authors judged that the intermediate definition appeared to better represent the true number of cases in the Medicare population
• The authors' conclusion: The authors concluded that mesothelioma was a prevalent disease among fee-for-service Medicare beneficiaries during 2016–2019, and that a limited proportion received all three therapy modalities
• Limitations the authors state:
  • Annual figures for 2016 and 2017 are likely incomplete and may underestimate incidence and prevalence
  • Methodological factors could artificially inflate incidence at the beginning of the study period, because people whose disease began earlier are counted as incident cases
  • Patients whose disease began before 2016 may have been wrongly counted as new cases despite the 1-year clean enrolment period
  • Receipt of therapy is likely underestimated
  • Case definitions were based only on claims, unlike cancer registry statistics, which use more rigorous diagnostic criteria
  • Results may not be representative of the Medicare population because people ever enrolled in managed care plans were excluded
  • Results of diagnostic procedures are not available in Medicare claims

Topics

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

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma, Mesothelioma, Chemotherapy, Surgical Resection, Cancer Registry.

Related studies

• Treatment patterns and outcomes in older patients with advanced malignant pleural mesothelioma: Analyses of Surveillance, Epidemiology, and End Results-Medicare data — M.D. Danese, M. Daumont, et al. (2022)
• Modelling prevalence and incidence of fibrosis and pleural plaques in asbestos-exposed populations for screening and follow-up: a cross-sectional study — C. Paris, A. Martin, et al. (2008)
• Prevalence and Incidence of Multiple Sclerosis in the City of Biancavilla — F. Patti, C. Caserta, et al. (2019)
• Pleural mesothelioma in Poland: Spatial analysis of malignant mesothelioma prevalence in the period 1999-2013 — M. Krówczyńska, E. Wilk, et al. (2018)
• Prevalence and features of advanced asbestosis (ILO profusion scores above 2/2). International Labour Office — K.H. Kilburn (2000)
• Mesothelioma in the United States: a Surveillance, Epidemiology, and End Results (SEER)-Medicare investigation of treatment patterns and overall survival — J.L. Beebe-Dimmer, J.P. Fryzek, et al. (2016)

Browse more research in Occupational and Environmental Medicine, or return to medical research.