Proportion of Death Certificate Only Cases and Its Related Factors, Kwangju Cancer Registry (KCR)

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1 Ca nce r Research a nd Treatme nt 2001;33(6): Proportion of Death Certificate Only Cases and Its Related Factors, Kwangju Cancer Registry (KCR) S u Jin Lee, R.N. 1, Min Ho S hin, M.D. 1, Sang Young Kim, M.D. 1, Kye ong S oo Park, M.D. 1, Young Jin Kim, M.D. 2, Tai Ju Hwang, M.D. 3 and Jin S u Choi, M.D. 1 Kwangju Cancer Registry, Gwangju, Departments of 1 Preventive Medicine, 2 General Surgery and 3 Pediatrics, Chonnam National University Medical School, Gwangju, Korea Purpose: To asce rtain the factors as soc iated with the pro po rtio n of death ce rtificate only (DCO) cas es contained in the Kwangju Cance r Reg is try (KCR) that are not as yet in the good range. Materials and Methods : The dis tributio n of DCO cas es was analyzed by sex, age, cance r s ite, his to log ical verification (HV) as well as the physician's death certificate s tatus. Results : All cases (n=4,243) in Kwangju diag nos ed as having cance r betwee n 1997 and 1998 were regis tered with the KCR. Death ce rtificates (n=2,390) re porting cance r as the caus es of death we re collected from the National Statistics Office and reviewed with hospital data linkage and a total of 590 cas es we re reg is te red as DCO. DCOs acco unted for 12.2% (male 12.8%, female 11.5%) of all regis tratio ns in Kwangju, The proportion of DCO cases was high in s ubjects under15 (male 13.5%,female 9.4%) as well as those 75 and over (male 20.3%, fe male 27.2%). For cancer s ites, the pro portion of DCO cas es was hig h (over 10%) fo r live r, bronc hus -lung, es o phag us and panc reas and low (under 3%) fo r s kin, bladde r, ute ri ce rvix and breas t. The propo rtio n of DCO cas es was invers e ly ass oc iated with HV%. Whe n the death ce rtificate was is s ued by phys ic ian, the pos s ibility of DCO dec reas ed. Conclusion: The pro portion of DCO is pos itive ly as s ociated with increas ing age and negative ly as s oc iated with HV% and the is s uance of a phys ic ian's death ce rtificate. Thes e findings s ugges t that furthe r s oc ioc ultural efforts are required to reduce the DCO propo rtio n. (Cancer Research and Treatment 2001;33: ) Key Words : Cance r regis try, Death certificate, Kwangju, Ko rea (1).. (24), (5). Correspondence: Su Jin Lee, Department of Preventive Medicine, Chonnam National University Medical School, 5 Hak 1(il)-dong, Dong-gu, Gwangju , Korea. (Tel) , (Fax) , ( ) sujin95@netian.com Received July 30, 2001, Accepted November 22, 2001 (5).,,, ( ) (2,46). (death certificate only, DCO) (1,69), (death certificate notification, DCN). (5). DCO (Kwangju Cancer Registry, KCR),., KCR 512

2 S u Jin Lee, et a lproportion of DCO Cases and Its Related Factors, KCR 513,. DCO (1012). DCO,,. DCO (9,13). DCO. DCO,. (8,13,14). DCO (10,11,15), DCO (5,13,16,17). ( ) DCO,. 1) 1,326,478(18,19) ,243 ( 2,360, 1,883) (Central Cancer Registry; CCR) ,279(20,21), (ICD-10; C00-C97) 2,390( 1,554, 836). 2) KCRDCO ,390, KCR. KCR 1,583(66.2%),. 807(33.8%) 2 Fig. 1. Detection procedure for the death certificate only (DCO) in Kwangju Cancer Registry (KCR). * NC denotes for Not Confirmed, which dose not mean the case is not cancer, but means the case could not be confirmed as cancer.

3 514 Cancer Resea rch and Treatme nt 2001;33(6). 164 KCR, 53 KCR. 590 DCO. (Fig. 1). 3) DCO ICD-10, KCR International Classification of Diseases for Oncology Second Edition(22) ICD-O. DCO%. DCO% Number of true DCOs during two years DCO% = = 100 Total number of cancer cases during two years Table 1. General characteristics of death certificate only (DCO) Variables No. % Sex Male Female Year at death Age group (years) Under and over Place of death Home Hospital Others Issuer of Physician death certificate Herb doctor No Occupation Unemployed Farmer & fisher Engineer Service worker Others No Education Elementary school Middle school High school College & university No and uneducated Cancer site Liver Stomach Lung Colo-rectum Pancreas Haematopoietic system Unknown primary site Esophagus Gall bladder, etc Uterus, nos

4 S u Jin Lee, et a lproportion of DCO Cases and Its Related Factors, KCR 515 DCO%,. (histological verification; HV%) DCO%, HV%DCO%. DCO DCO% , 1529, 3044, 4559, 60 74, % %, % 69.5%. 64.2%, 28.8%, 57.5%.,, 62.2% (Table 1). 2),, DCO % (1) : , DCO 12.2% 1) DCO 590 DCO58.5%345, Table 2. Proportion of death certificate only (DCO) by sex Sex KCR* Death DCO DCO% (A) Certificate (B) (B/(A B)) Male 2,360 1, Female 1, All 4,243 2, *Kwangju Cancer Registry Fig. 2. Proportion of death certificate only (DCO) by sex and age at diagnosis. Table 3. Proportion of death certificate only (DCO) by selected cancer sites Male Female Cancer site DCO% Cancer site DCO% Over 14% Liver 20.0 Liver 27.4 Bronchus, lung 18.2 Pancreas 26.2 Haematopoietic system 18.2 Esophagus 25.0 Esophagus 14.9 Bronchus, lung 17.3 Stomach % Pancreas 11.4 Haematopoietic system 13.0 Stomach 10.6 Gall bladder, etc. 9.9 Larynx 7.8 Ovary 8.3 Gall bladder, etc. 7.3 Bladder 7.4 Prostate 7.0 Colo-rectum 7.3 Colo-rectum 5.1 Under 5% Skin 2.9 Breast 4.9 Bladder 2.5 Skin 3.8 Uterine cervix 2.1 Thyroid 0.5

5 516 Cancer Resea rch and Treatme nt 2001;33(6), 12.8%, 11.5% (Table 2). (2) : DCO%, DCO% 75 DCO% (Fig. 2). (3) : DCO%,, -,,,, (10% ),, (3% ) (Table 3). 3) HV %DCO% (1) : 1529, 3044 DCO% 8.5%, 4.4% HV%86.2%, 92.8%., 75 DCO%20.3%, 27.2%, HV%61.9%, 52.9%. HV%DCO% (Fig. 3). (2) :,, -,, DCO%10%, HV%75%.,, DCO%5% HV% 85% (Table 4). 4) DCO%,, (21.0%) Fig. 3. Proportion of histological verification (HV) and death certificate only (DCO) by age group at diagnosis in male and female. Table 4. Proportion of histological verification (HV) and death certificate only (DCO) by selected cancer sites in male and female Male Female Cancer site DCO% HV% Cancer site DCO% HV% Liver Liver Bronchus, lung Pancreas Brain Esophagus Esophagus Brain Kidney Bronchus, lung Pancreas Stomach Stomach Bladder Prostate Colo-rectum Colo-rectum Kidney Bladder Breast Uterine cervix

6 S u Jin Lee, et a lproportion of DCO Cases and Its Related Factors, KCR 517 Fig. 4. Relation between age at diagnosis and proportion of death certificate only (DCO) by attachment of physician s death certificate in only deceased cases, in male and female. (32.7%),,. DCO% DCO% 42.9%, 15.0%, %, 28.6% %, 17.8%, %, 37.9% (Fig. 4)., (5,6,8). DCO% /(mortality/incidence ratio, M/I ratio),, capture-recapture. (validity) DCO%, HV%, (primary site unknown, PSU%), (age unknown, Age UNK%). DCO. DCO%,, (5,6,9). DCO%, DCO%., DCN.,. DCO% (57). DCO%, IARC (International Agency for Research on Cancer)5 DCO 10% A(A=good), 1119%B(B=acceptable), 20% C(C=not acceptable) (23). KCR 12.2%B, acceptable 10%. IARC Parkin(6) DCO%24%, JensenStorm 1% 15%, SEER (Surveillance, Epidemiology, and End Results), 1.5% (24). 23%, 5% (25),,,

7 518 Cancer Resea rch and Treatme nt 2001;33(6) 12%(5). DCO% 12.2% 16.2% ( ), 18.9% ( ), 15.7% (1997), SEER ( , 0.93%), ( , 1.6% 13.8%), ( , 2.0%) (10,11,16,24) , DCO %, 12.8%, 11.5%., DCO%. 15 DCO%, 69, DCO,,. (5),. KCR,,. DCO%, 75 DCO%. Pollock Vickers(13) 40, 4064, 6574, 754,, DCO%75 (34.8%)DCO% (32.4%). DCO%,,, -,, 10%,, 3%., ( ),, 5%, -,, 35%,, 1%. ( ), 6%,, -,, 24%,,,,, 1% (16). ( ),, 33%,,,, 1719%,, 10% (13). DCO, 1998 DCO%.,,, - 20%,,, 1520%.,, 3% (15). DCO%,,, -,,,,., KCR. DCO%. HV%,,,,,, - DCO% (5,10,11)., DCO% DCO%.., % 74.7% %, % DCO.

8 S u Jin Lee, et a lproportion of DCO Cases and Its Related Factors, KCR 519,...,. DCO,,., KCR. 5, KCR4., DCN, DCO 2.,, , DCO 12.2%. DCO%,,,. KCRDCO%. 1. Jensen OM, Parkin DM, MacLennan R, Muir CS, Skeet RG. Cancer Registration: Principles and Methods, Lyon; IARC Scientific Publications No. 95, Kim IS. Epidemiological usefulness of registered death information in Korea. Korean J Epidemiol 1989;11: Meng KH. Problems and improvement of mortality data in Korea. Korean J Epidemiol 1989;11: Percy C, Stanek E 3d, Gloeckler L. Accuracy of cancer death certificates and its effect on cancer mortality statistics. Am J Public Health 1981;71: Parkin DM, Chen VW, Ferlay J, Galceran J, Storm HH, Whelan SL. Comparability and quality control in cancer registration. Lyon; IARC Technical Report No: 19, Parkin DM, Whelan SL, Ferlay J, Raymond L, Young J. Cancer Incidence in Five Continents. Vol VII. Lyon; IARC Scientific Publications No. 143, Brenner H. Limitations of the death certificate only index as a measure of incompleteness of cancer registration. Br J Cancer 1995;72: Bullard J, Coleman MP, Robinson D, Lutz JM, Peto J. Completeness of cancer registration: A new method for routine use. Br J Cancer 2000;82: Menck H, Smart C. Central cancer registries; design, management, and use. Harwood Academic Published GmbH Ahn DH. Population-based Cancer Registry in Five Cities of Korea Ahn DH. Population-based Cancer Registry in Five Cities of Korea Choi JS, Sohn SJ, Na BJ, Sun BH, Park KS, Kweon SS, Im JS, Kim YJ, Hwang TJ. A feasibility study for the implementation of Kwangju Cancer Registry (KCR). J Korean Cancer Assoc 1999;31(4): Pollock AM, Vickers N. Why are a quarter of all cancer deaths in south-east England registered by death certificate only? Factors related to death certificate only registrations in the Thames Cancer Registry between 1987 and Br J Cancer 1995;71: Vercelli M, Capocaccia R, Quaglia A, Casella C, Puppo A, Coebergh JWW, EUROCARE Working Group. Relative survival in elderly European cancer patients: Evidence for health care inequalities. Crit Rev Oncol Hematol 2000;35: Shin HR, Lee DH. Busan Cancer Registry. Ministry of Health and Welfare Chen VW, Wu XC, Andrews PA. Cancer in North America, Volume One: Incidence, North American Association of Central Cancer Registries, Pollock AM, Vickers N. Reducing DCO registrations through electronic matching of cancer registry data and routine hospital data. Br J Cancer 2000;82: Kwangju Metropolitan City The Statistics of Registered Population Kwangju Metropolitan City The Statistics of Registered Population Korean National Statistical Office Annual Report on the Cause of Death Statistics Korean National Statistical Office Annual Report on the Cause of Death Statistics Percy C, Van Holten V, Muir C. International Classification of Disease for Oncology. 2nd ed., Geneva; World Health Organization, Esteban D, Whelan S, Laudico A, Parkin DM. Manual for Cancer Registry Personnel, Lyon; IARC Technical Report No. 10, Seiffert JE. Standards for Cancer Registries Volume, Standards for Completeness, Quality, Analysis, and Management of Data. American Association of Central Cancer Registries, Gaudette L. Personal Communication. Letter to editor January 7, 1994.