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Cancer Incidence in HIV-Infected Versus Uninfected Veterans: Comparison of Cancer Registry and ICD-9 Code Diagnoses | OMICS International | Abstract
ISSN 2155-6113

Journal of AIDS & Clinical Research
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Research Article

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

Lesley S Park1,2*, Janet P Tate3,4, Maria C Rodriguez-Barradas5,6, David Rimland7,8, Matthew Bidwell Goetz9,10, Cynthia Gibert11,12, Sheldon T Brown13,14, Michael J Kelley15,16,17, Amy C Justice3,4 and Robert Dubrow1,2
1Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
2Department of Epidemiology and Public Health, Yale School of Medicine, New Haven, CT, USA
3Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
4Department of General Internal Medicine, Veterans Affairs Healthcare System, West Haven, CT, USA
5Infectious Diseases Section, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
6Department of Medicine, Baylor College of Medicine, Houston, TX, USA
7Medical Specialty Care Service Line, Atlanta Veterans Affairs Medical Center, Atlanta, GA, USA
8Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
9Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
10Department of Medicine, David Geffen School of Medicine, University of California los Angeles, Los Angeles, CA, USA
11Section of Infectious Diseases, Washington DC Veterans Affairs Medical Center, Washington, DC, USA
12Department of Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
13Department of Medicine, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
14Department of Medicine, Icahn School of Medicine, Mt. Sinai, New York, NY, USA
15Office of Patient Care Services, Department of Veterans Affairs, Washington, DC, USA
16Hematology-Oncology Service, Durham Veterans Affairs Medical Center, Durham, NC, USA
17Division of Medical Oncology, Duke University Medical Center, Durham, NC, USA
*Corresponding Author: Lesley S Park, Department of Chronic Disease Epidemiology, Yale School of Public Health, P.O. Box 208034, New Haven, CT 06520- 8034, USA, Tel: (703) 835-1987, Fax: (203) 785-6980, Email: [email protected]

Received Date: Apr 04, 2014 / Accepted Date: Jun 23, 2014 / Published Date: Jun 30, 2014

Citation: Park LS, Tate JP, Rodriguez-Barradas MC, Rimland D, Goetz MB, et al. (2014) Cancer Incidence in HIV-Infected Versus Uninfected Veterans: Comparison of Cancer Registry and ICD-9 Code Diagnoses. J AIDS Clin Res 5:318.DOI: 10.4172/2155-6113.1000318

Copyright: © 2014 Park LS, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.



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 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.


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