Recovering missing mesothelioma deaths in death certificates using hospital records

Our plain-English summary of Recovering missing mesothelioma deaths in death certificates using hospital records, by V.S. Santana, E. Algranti, F. Campos, et al (American Journal of Industrial Medicine, 2018).

The study

• Authors: V.S. Santana, E. Algranti, F. Campos, F. Cavalcante, L. Salvi, S.A. Santos, R.N. Inamine, W. Souza, D. Consonni
• Journal: American Journal of Industrial Medicine
• Published: 2018;61(7):547-555
• Cited by: 7 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: In Brazil, underreporting of mesothelioma and cancer of the pleura (MCP) is suspected to be high. Records from death certificates (SIM) and hospital registers (SIH-SUS) can be combined to recover missing data but only anonymous databases are available. This study shows how common data can be used for linkage and as an assessment of accuracy.

Methods: Mesothelioma (all sites, ICD-10 codes C45.0-C45.9) and cancer of the pleura (C38.4) were retrieved from both information systems and combined using a linkage algorithm. Accuracy was examined with non-anonymous databases, limited to the state of São Paulo.

Results: We found 775 cases in death certificates and 283 in hospital registers. The linkage matched 57 cases, all accurately paired. Three cases, 0.4% in SIM and 1.3% in SIH-SUS, could not be matched because of data inconsistencies.

Conclusions: A computer linkage can recover MCP cases from hospital records not found in death certificates in Brazil.

© 2018 Wiley Periodicals, Inc.

In plain English

This Brazilian study tested whether hospital records could identify mesothelioma or cancer of the pleura (MCP) diagnoses that death certificates did not record. Because the national databases are anonymous, the authors linked death certificates (SIM) with public hospital records (SIH-SUS) by sex, date of birth, municipality and year of death. They included adults aged 30 or older who died in 2002 to 2012 with any MCP code among their recorded diagnoses. Accuracy was checked in São Paulo state using named records. There, 775 MCP deaths were in death certificates and 283 usable cases were in hospital records. Of these, 57 were matched, and all matched pairs were correct. Three cases failed to match because of inconsistencies in sex and date of birth. Of 226 cases found only in hospital records, 219 appeared on death certificates with other causes, mostly other cancers (196 of 219), especially unspecified lung cancer (120 of 219). Nationally, 1059 cases appeared only in hospital records. Asbestos exposure was not studied. The authors concluded that computer linkage can recover MCP cases missing from death certificates. They cautioned that underreporting could not be fully estimated and some records may be false positives.

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: Record-linkage study combining anonymous national death certificate data (SIM) and public hospital data (SIH-SUS), with linkage accuracy checked against non-anonymous records in the state of São Paulo
• Who was studied: Deaths among adults aged 30 or older in Brazil, 2002-2012, recorded with mesothelioma (any site) or cancer of the pleura codes. A case was any death with at least one such code among the recorded diagnoses. Accuracy was tested in São Paulo state, which represents 36.3% of all SIM registered cases. Hospital records were limited to patients who died under hospital care in publicly funded hospitals.
• Exposure: No asbestos exposure was measured. The study concerned how deaths coded as mesothelioma (ICD-10 C45.0-C45.9, all sites) or cancer of the pleura (C38.4) were recorded in two information systems.
• Main results:
  • São Paulo state: 775 MCP deaths were found in death certificates (SIM) and 321 in hospital records (SIH-SUS). Of the hospital records, 38 were excluded for missing data, leaving 283 for analysis.
  • São Paulo state: after linkage there were 1001 single cases. Of these, 718 (71.7%) were only in SIM, 226 (22.6%) only in SIH-SUS, and 57 (5.7%) in both.
  • São Paulo state: all 57 matched cases were correctly paired, as checked against the full names of the deceased and their mothers.
  • São Paulo state: inconsistencies in sex and date of birth caused the linkage to miss three cases, 0.4% in SIM (3/718) and 1.3% in SIH-SUS (3/226).
  • São Paulo state: cases found only in hospital records were found in SIM with other ICD codes, except for four lost cases (4/226; 1.8%).
  • São Paulo state: among these cases recorded in SIM under other diagnoses, most were other cancers (196/219; 89.5%), particularly unspecified cancer of the bronchus or lung (C34.9) (120/219; 54.8%). Twenty-three (10.5%) had non-malignant diseases.
  • Brazil as a whole, 2002-2012: 2133 MCP deaths were found in SIM and 1193 in SIH-SUS. After linkage, 1999 records were only in SIM, 1059 only in SIH-SUS, and 134 were paired.
  • The authors reported that applying the linkage to the entire country gave a 32.2% increase in the number of MCP records found in death certificates.
• The authors' conclusion: The authors concluded that computer linkage can recover MCP cases from hospital records that are not found in death certificates in Brazil.
• Limitations the authors state:
  • The extent of underreporting in both SIM and SIH-SUS could not be ruled out or fully estimated.
  • Cases recorded only in SIM or only in SIH-SUS may be false positives that need further investigation.
  • Linkage performance depends on data quality, which could be poor in earlier years or in remote regions.
  • The simple algorithm suited a rare disease like MCP, and its use for common diseases could be limited.
  • The study counted all cases ever diagnosed as MCP, not only those whose underlying cause of death was MCP.
  • Hospital data come only from public hospitals, which have limited coverage of workers with private health plans.

Topics

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

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

Related studies

• Mortality from pleural mesothelioma in Rio de Janeiro, Brazil, 1979-2000: estimation from death certificates, hospital records, and histopathologic assessments — G.A. Pinheiro, V.C. Antão, et al. (2003)
• Hospital records as a data source for occupational disease surveillance: a feasibility study — J. Balmes, D. Rempel, et al. (1992)
• Influence of age at death on accuracy of death certificate disease diagnosis: findings in 475 consecutive deaths of mesothelioma among asbestos insulation workers and asbestos factory workers — I.J. Selikoff (1992)
• Hospital records: an underutilized source of information regarding occupational diseases and exposures — G.M. Liss, R.A. Kusiak, et al. (1997)
• Death certificates in epidemiological studies, including occupational hazards: inaccuracies in occupational categories — I.J. Selikoff (1992)
• Use of death certificates in epidemiological studies, including occupational hazards: variations in discordance of different asbestos-associated diseases on best evidence ascertainment — I.J. Selikoff, H. Seidman (1992)

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